Patients were asked to respond on whether they had taken their medication , whether the text reminded them to do so if they had forgotten , and if they had not taken their medication to determine if there was a reason for not doing so .


At @ months , use of medication was assessed .


Two patients were lost to follow-up , providing data on @ for analysis .


In the No text group @/@ ( @ % ) took less than @ % of the prescribed regimen ( ie .


stopped medication completely or took it on fewer than @ of the last @ days of follow-up ) compared to @/@ patients ( @ % ) in the Text group - an improvement in adherence affecting @ per @ patients ( @ % CI @ to @ ) , p < @ .


The texts reminded @/@ patients ( @ % ) to take medication on at least one occasion and lead to @/@ ( @ % ) who stopped taking medication because of concern over efficacy or side-effects , resuming treatment .


In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular disease , text messaging improved medication adherence compared with no text messaging .


A novel , fully bacterially produced recombinant virus-like particle ( VLP ) based influenza vaccine ( gH@-Qbeta ) against A/California/@ / @ ( H@N@ ) was tested in a double-blind , randomized phase I clinical trial at two clinical sites in Singapore .


The trial evaluated the immunogenicity and safety of gH@-Qbeta in the presence or absence of alhydrogel adjuvant .


Healthy adult volunteers with no or low pre-existing immunity against A/California/@ / @ ( H@N@ ) were randomized to receive two intramuscular injections @ days apart , with @g vaccine , containing @g hemagglutinin antigen .


Antibody responses were measured before and @ days after each immunization by hemagglutination inhibition ( HAI ) assays .


The primary endpoint was seroconversion on Day @ , defined as percentage of subjects which reach a HAI titer @ or achieve an at least @-fold rise in HAI titer ( with pre-existing immunity ) .


The co-secondary endpoints were safety and seroconversion on Day @ .


A total of @ Asian volunteers were enrolled in this study and randomized to receive the adjuvanted ( n = @ ) or the non-adjuvanted ( n = @ ) vaccine .


Of those , @ and @ respectively ( @ % ) completed the study .


There were no deaths or serious adverse events reported during this trial .


A total of @ adverse events occurred during treatment with @ % local solicited symptoms , of mostly ( @ % ) mild severity .


The most common treatment-related systemic symptom was fatigue .


The non-adjuvanted vaccine met all primary and secondary endpoints and showed seroconversion in @ % and @ % of participants respectively on Day @ and Day @ .


While the adjuvanted vaccine showed an increased seroconversion from @ % ( Day @ ) to @ % ( Day @ ) , it did not meet the immunogenicity endpoint .


In summary , non-adjuvanted gH@-Qbeta showed similar antibody mediated immunogenicity and a comparable safety profile in healthy humans to commercially available vaccines .


These results warrant the consideration of this VLP vaccine platform for the vaccination against influenza infection ( HSA CTC@ ) .


Two percent chlorhexidine gluconate ( CHG ) is used in preparing the skin of surgical patients .


In practice , it often is diluted with saline prior to use .


Whether this affects efficacy is unknown , as the manufacturer does not address dilution but does recommend scrubbing twice .


We attempted to determine whether diluting CHG affects its antiseptic potency and if one scrub is as effective as two .


To test effects of CHG dilution , @ healthy subjects were recruited and randomized into a dilution group ( @ % , @ % , @ % , @ % , or @ % CHG ) or a control group ( saline ) .


One area of one foot of each subject was prepared , and colony-forming units ( CFU ) were counted at baseline and at @min after preparation .


In a second study , @ subjects were again recruited .


Based on the previous study , a @ % dilution was applied as the scrub .


Colony-forming units were calculated at baseline and after each CHG application .


Baseline CFU did not differ among the dilution groups ( p = @ ) .


Subjects in all dilution groups exhibited nearly a @ % decrease in CFU , whereas the control group exhibited an @ % decrease .


These results were statistically significant ( p < @ ) .


In the second study , the CFU values after two scrubs ( mean @ ; range @-@ ) were significantly lower than after one scrub ( mean @ , range @-@ ) ( p = @ ) .


Diluting CHG to a concentration as low as @ % does not affect antiseptic efficacy .


The manufacturer-recommended two scrubs is superior to one scrub at reducing skin bacterial colony counts .


Although uncomplicated cystitis is often self-limiting , most such patients will be prescribed antibiotic treatment .


We are investigating whether treatment of cystitis with an NSAID is as effective as an antibiotic in achieving symptomatic resolution .


This is a randomized , controlled , double blind trial following the principles of Good Clinical Practice .


Women between the ages of @ to @ presenting with symptoms of uncomplicated cystitis are screened for eligibility .


@ women from four sites in Norway , Sweden and Denmark are allocated to treatment with @ mg ibuprofen three times a day or @ mg mecillinam three times a day for three days .


Allocation is conducted using block randomization .


The primary outcome is the number of patients who feel cured by day four as recorded in a diary .


Adverse events will be handled and reported in accordance with Good Clinical Practice .


If treatment of uncomplicated cystitis with ibuprofen is as effective as mecillinam for symptom relief , we can potentially reduce the use of antibiotics on a global scale .


Intravenous loop diuretics are a cornerstone of therapy in acutely decompensated heart failure ( ADHF ) .


We sought to determine if there are any differences in clinical outcomes between intravenous bolus and continuous infusion of loop diuretics .


Subjects with ADHF within @ hours of hospital admission were randomly assigned to continuous infusion or twice daily bolus therapy with furosemide .


There were three co-primary endpoints assessed from admission to discharge : the mean paired changes in serum creatinine , estimated glomerular filtration rate ( eGFR ) , and reduction in B-type natriuretic peptide ( BNP ) .


Secondary endpoints included the rate of acute kidney injury ( AKI ) , change in body weight and six months follow-up evaluation after discharge .


A total of @ received a continuous infusion and @ were assigned to bolus treatment .


At discharge , the mean change in serum creatinine was higher ( +@ @ versus -@ @ mg/dl P < @ ) , and eGFR was lower ( -@ @ versus +@ @ ml/min/@ @ m ( @ ) P < @ ) in the continuous arm .


There was no significant difference in the degree of weight loss ( -@ @ versus -@ @ kg P = @ ) .


The continuous infusion arm had a greater reduction in BNP over the hospital course , ( -@ @ versus -@ @ pg/ml P = @ ) .


The rates of AKI were comparable ( @ % and @ % P = @ ) between the two groups .


There was more frequent use of hypertonic saline solutions for hyponatremia ( @ % versus @ % P < @ ) , intravenous dopamine infusions ( @ % versus @ % P = @ ) , and the hospital length of stay was longer in the continuous infusion group ( @ @ versus @ @ days , P < @ ) .


At @ months there were higher rates of re-admission or death in the continuous infusion group , @ % versus @ % , ( P = @ ) and this mode of treatment independently associated with this outcome after adjusting for baseline and intermediate variables ( adjusted hazard ratio = @ , @ % confidence interval , @ to @ P = @ ) .


In the setting of ADHF , continuous infusion of loop diuretics resulted in greater reductions in BNP from admission to discharge .


However , this appeared to occur at the consequence of worsened renal filtration function , use of additional treatment , and higher rates of rehospitalization or death at six months .


Prolonged exposure ( PE ) therapy for post-traumatic stress disorder ( PTSD ) in military veterans has established efficacy , but is ineffective for a substantial number of patients .


PE is also associated with high dropout rates .


We hypothesized that hydrocortisone augmentation would enhance symptom improvement and reduce drop-out rates by diminishing the distressing effects of traumatic memories retrieved during imaginal exposure .


We also hypothesized that in responders , hydrocortisone augmentation would be more effective in reversing glucocorticoid indices associated with PTSD than placebo augmentation .


Twenty-four veterans were randomized to receive either @ mg oral hydrocortisone or placebo prior to PE sessions @-@ in a double-blind protocol .


Glucocorticoid receptor sensitivity was assessed in cultured peripheral blood mononuclear cells ( PBMC ) using the in vitro lysozyme inhibition test and was determined before and after treatment .


Intent-to-treat analysis was performed using latent growth curve modeling of treatment effects on change in PTSD severity over time .


Veterans who no longer met diagnostic criteria for PTSD at post-treatment were designated as responders .


Veterans randomized to hydrocortisone or placebo augmentation did not differ significantly in clinical severity or glucocorticoid sensitivity at pre-treatment .


Hydrocortisone augmentation was associated with greater reduction in total PTSD symptoms compared to placebo , a finding that was explained by significantly greater patient retention in the hydrocortisone augmentation condition .


A significant treatment condition by responder status interaction for glucocorticoid sensitivity indicated that responders to hydrocortisone augmentation had the highest pre-treatment glucocorticoid sensitivity ( lowest lysozyme IC@-DEX ) that diminished over the course of treatment .


There was a significant association between decline in glucocorticoid responsiveness and improvement in PTSD symptoms among hydrocortisone recipients .


The results of this pilot study suggest that hydrocortisone augmentation of PE may result in greater retention in treatment and thereby promote PTSD symptom improvement .


Further , the results suggest that particularly elevated glucocorticoid responsiveness at pre-treatment may identify veterans likely to respond to PE combined with an intervention that targets glucocorticoid sensitivity .


Confirmation of these findings will suggest that pharmacologic interventions that target PTSD-associated glucocorticoid dysregulation may be particularly helpful in promoting a positive clinical response to PTSD psychotherapy .


Hypertension develops early in patients with autosomal dominant polycystic kidney disease ( ADPKD ) and is associated with disease progression .


The renin-angiotensin-aldosterone system ( RAAS ) is implicated in the pathogenesis of hypertension in patients with ADPKD .


Dual blockade of the RAAS may circumvent compensatory mechanisms that limit the efficacy of monotherapy with an angiotensin-converting-enzyme ( ACE ) inhibitor or angiotensin II-receptor blocker ( ARB ) .


In this double-blind , placebo-controlled trial , we randomly assigned @ patients , @ to @ years of age , with ADPKD ( estimated glomerular filtration rate -LSB- GFR -RSB- , @ to @ ml per minute per @ m ( @ ) of body-surface area ) to receive an ACE inhibitor ( lisinopril ) and placebo or lisinopril and an ARB ( telmisartan ) , with the doses adjusted to achieve a blood pressure of @/@ to @/@ mm Hg .


The composite primary outcome was the time to death , end-stage renal disease , or a @ % reduction from the baseline estimated GFR .


Secondary outcomes included the rates of change in urinary aldosterone and albumin excretion , frequency of hospitalizations for any cause and for cardiovascular causes , incidence of pain , frequency of ADPKD-related symptoms , quality of life , and adverse study-medication effects .


Patients were followed for @ to @ years .


There was no significant difference between the study groups in the incidence of the composite primary outcome ( hazard ratio with lisinopril-telmisartan , @ ; @ % confidence interval , @ to @ ) .


The two treatments controlled blood pressure and lowered urinary aldosterone excretion similarly .


The rates of decline in the estimated GFR , urinary albumin excretion , and other secondary outcomes and adverse events , including hyperkalemia and acute kidney injury , were also similar in the two groups .


Monotherapy with an ACE inhibitor was associated with blood-pressure control in most patients with ADPKD and stage @ chronic kidney disease .


The addition of an ARB did not alter the decline in the estimated GFR .


( Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others ; HALT-PKD -LSB- Study B -RSB- ClinicalTrials.gov number , NCT@ . )


Surgical extraction of lower third molars is followed by mild or severe postoperative pain which peaks at maximal intensity in the first @ hours and has a significant impact on a patient 's postoperative quality of life .


The use of long-acting local anaesthetics is a promising strategy to improve postoperative analgesia .


The aim of the present study was to investigate analgesic parameters and patient satisfaction after using @ % levobupivacaine ( Lbup ) , @ % bupivacaine ( Bup ) and @ % lidocaine with epinephrine @:@,@ ( Lid + Epi ) for an inferior alveolar nerve block following lower third molar surgery .


A total of @ patients ( ASA I ) were divided into three groups , each of which received either @ mL of Lbup , Bup or Lid + Epi .


The intensity of postoperative analgesia was measured using a verbal rating scale ( VRS ) .


The total amounts of rescue analgesics were recorded on the first and during seven postoperative days .


Patients satisfaction was noted using a modified verbal scales .


A significantly higher level of postoperative pain was recorded in Lid + Epi group compared to Bup and Lbup groups .


No significant differences were seen between Bup and Lbup , but a significant reduction in the need for rescue analgesics was seen postoperatively in both Lbup and Bup ( @ % ) in comparison with Lid + Epi ( @ % ) in the first @ hours .


The same significant trend in rescue analgesic consumption was recorded for seven postoperative days .


Patients ' overall satisfaction was significantly lower for Lid + Epi ( @ % ) than for Lbup ( @ % ) and Bup ( @ % ) .


The use of a new and long-acting local anaesthetic @ % levobupivacaine is clinically relevant and effective for an inferior alveolar nerve block and postoperative pain control after third molar surgery .


In our study Lbup and Bup controled postoperative pain more efficiently after lower third molar surgery compared to Lid + Epi .


Awake fiberoptic intubation is the gold standard for management of predicted difficult intubation .


The purpose of this study was to test whether Glide Scope video laryngoscopy ( GVL ) will provide significant advantages over fiberoptic bronchoscopy ( FOB ) for awake intubation in morbidly obese patients with predicted difficult intubation .


We therefore tested the hypothesis that intubation using GVL is faster than intubation with FOB .


@ morbidly obese patients with predicted difficult intubation undergoing laparoscopic bariatric surgery were enrolled in this study .


Patients were randomly assigned to receive awake oral intubation by either GVL or FOB .


After airway topical anesthesia and sedation using target controlled remifentanil infusion to a Ramsay sedation scale of @ , wee compared the two devices for time to intubate , successful intubation on first attempt , glottic view using Cormack and Lehane score system , response of the patient to scope , patients satisfaction and incidence of postoperative sore throat and hoarseness .


Intubation time was @ + / - @ seconds and @ + / - @ seconds for FOB and GVL respectively .


@ % of patients were successfully intubated on the first attempt with FOB compared to @ % with GVL .


Grade I/II glottic view was reported with GVL in @ % of patients compared to @ % with FOB .


The highest target concentration of remifentanil to maintain patients sedated during intubation was @ + / - @ ng/ml and @ + / - @ ng/ml in FOB and GVL respectively .


No significant differences regarding maximum patient response to intubation , adverse effects or patient satisfaction were recorded between groups .


GVL can be used as a useful alternative to FOB in morbidly obese patients with predicted difficult intubation .


Bevacizumab , a recombinant humanized monoclonal antibody against vascular endothelial growth factor , was approved by the US Food and Drug Administration for the treatment of advanced non-small-cell lung cancer ( NSCLC ) in combination with carboplatin and paclitaxel .


ARIES ( Avastin Regimens : Investigation of Effectiveness and Safety ) , a prospective observational cohort study , evaluated outcomes in a large , community-based population of patients with first-line NSCLC .


From @ to @ , ARIES enrolled patients with locally advanced or metastatic NSCLC who were eligible for bevacizumab , excluding those with predominantly squamous histology .


Patients were required to provide informed consent and to have initiated bevacizumab with chemotherapy within @ months before enrollment .


There were no protocol-defined treatments or assessments .


The dosing of bevacizumab and chemotherapy , and the choice of chemotherapy regimen , was at the discretion of the treating physician .


ARIES enrolled @ patients with first-line NSCLC .


At study closure , median follow-up was @ months ( range , @-@ @ ) .


Median age was @ years ( range , @-@ ) , and @ patients ( @ % ) identified as never smokers .


Median progression-free survival was @ months ( @ % confidence interval , @-@ @ ) , and median overall survival was @ months ( @ % confidence interval , @-@ @ ) with first-line bevacizumab plus chemotherapy .


Incidences of bevacizumab-associated adverse events ( @ % overall ) were consistent with those in randomized controlled trials of bevacizumab in NSCLC .


Results from ARIES demonstrate similar outcomes to randomized controlled trials of bevacizumab when added to standard chemotherapy in a real-world patient population with advanced NSCLC .


To evaluate effects of maropitant , acepromazine , and electroacupuncture on morphine-related signs of nausea and vomiting in dogs and assess sedative effects of the treatments .


Randomized controlled clinical trial .


@ dogs .


Dogs received @ of @ treatments : injection of saline ( @ % NaCl ) solution , maropitant citrate , or acepromazine maleate or electroacupuncture treatment at @ acupoint , @ acupoints , or a sham acupoint .


Morphine was administered after @ minutes of electroacupuncture treatment or @ minutes after injectable treatment .


Vomiting and retching events and signs of nausea and sedation were recorded .


Incidence of vomiting and retching was significantly lower in the maropitant ( @/@ -LSB- @ % -RSB- ) group than in the saline solution ( @/@ -LSB- @ % -RSB- ) and sham-acupoint electroacupuncture ( @/@ -LSB- @ % -RSB- ) groups .


The number of vomiting and retching events in the maropitant ( @ ) , acepromazine ( @ ) , @-acupoint ( @ ) , and @-acupoint ( @ ) groups was significantly lower than in the saline solution ( @ ) and sham-acupoint electroacupuncture ( @ ) groups .


Incidence of signs of nausea was significantly lower in the acepromazine group ( @/@ -LSB- @ % -RSB- ) than in the sham-acupoint group ( @/@ -LSB- @ % -RSB- ) .


Mean nausea scores for the saline solution , maropitant , and sham-acupoint electroacupuncture groups increased significantly after morphine administration , whereas those for the acepromazine , @-acupoint electroacupuncture , and @-acupoint electroacupuncture groups did not .


Mean sedation scores after morphine administration were significantly higher in dogs that received acepromazine than in dogs that received saline solution , maropitant , and sham-acupoint electroacupuncture treatment .


Maropitant treatment was associated with a lower incidence of vomiting and retching , compared with control treatments , and acepromazine and electroacupuncture appeared to prevent an increase in severity of nausea following morphine administration in dogs .


Over-diagnosis of malaria among African children results in mismanagement of non-malaria infections .


Limited laboratory capacity makes it difficult to implement policies that recommend pre-treatment confirmation of infections so a new approach with a package for on-the-spot management of fevers was evaluated .


Febrile children presenting to outpatient clinic were randomized to receive either a ` test-treat ' package ( history with clinical examination ; point-of-care tests ; choice of artesunate-amodiaquine , co-amoxiclav and/or paracetamol ) or routine outpatient care in a secondary health care facility in Kumasi , Ghana .


A diagnosis of malaria , bacterial , viral or mixed malarial and bacterial infections was made using pre-defined criteria .


Outcome was resolution of all symptoms including fever on day @ .


The median age of the patients was @ months ( IQR : @ to @ months ) , with @ % being males .


Compared to routine care the test-treat package resulted in less diagnoses of malaria , ( @ % vs @ % , p = @ ) and mixed malaria and bacterial infections ( @ % vs @ % , p < @ ) but more diagnoses of viral ( @ % vs @ % , p < @ ) and bacterial infections only ( @ % vs @ % , p < @ ) .


Less anti-malarials ( @ % vs @ % , p < @ ) and antibiotics ( @ % vs @ % , p < @ ) , were prescribed in the test-treat group on completion of study , more test-treat package patients were clinically well ( @ % vs @ % , p < @ ) and febrile ( @ % vs @ % , p = @ ) and less were admitted for inpatient care ( @ % vs @ % p = @ ) compared to the routine care group .


Test-treat package improves the effectiveness of outpatient diagnosis and treatment of children with fever and reduces inappropriate prescribing of anti-malarials and antibiotics .


The package provides clinicians with the option for immediate diagnosis and treatment of non-malaria fevers .


The test-treat package now needs to be evaluated in other settings including primary health care facilities .


The @ American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation .


Recent work has shown that residents and anesthesiologists do not apply these guidelines when tested .


This research hypothesized that a decision support tool would improve adherence to this consensus guideline .


Anesthesiology residents at four training programs participated in an unblinded , prospective , randomized , cross-over trial in which they completed two tests covering clinical scenarios .


One quiz was completed from memory and one with the aid of an electronic decision support tool .


Performance was evaluated by overall score ( % correct ) , number of incorrect answers with possibly increased cost or risk of care , and the amount of time required to complete the quizzes both with and without the cognitive aid .


The primary outcome was the proportion of correct responses attributable to the use of the decision support tool .


All anesthesiology residents at four institutions were recruited and @ residents participated .


Use of the decision support tool resulted in a @ % improvement in adherence to guidelines compared with memory alone ( P < @ ) , and participants made @ % fewer incorrect responses that would have resulted in increased costs .


Use of the tool was associated with a @-min increase in time to complete the test ( P < @ ) .


Use of an electronic decision support tool significantly improved adherence to the guidelines as compared with memory alone .


The decision support tool also prevented inappropriate management steps possibly associated with increased healthcare costs .


To examine the relationships between stressful life events and physiological measures , adherence to prescribed oral medication regimens , depressive symptoms , and impaired quality of life ( QoL ) in adolescents with recent-onset type @ diabetes ( T@D ) .


Data were collected from @ ethnically diverse participants ( @ % female ) in the final year of the Treatment Options for Type @ Diabetes in Adolescents and Youth multicenter clinical trial .


Exposure to @ possible events over the previous year and rating of subsequent distress were collected by self-report and summarized as a major stressors score .


This score was analyzed for relationship to glycemic control ( hemoglobin A@c and treatment failure ) , body mass index , diagnosis of hypertension or triglyceride dyslipidemia , adherence to a prescribed oral medication regimen , presence of depressive symptoms , and impaired QoL .


The total number of major stressful life events in the adolescents with T@D was calculated , with @ % reporting none , @ % reporting @ , @ % reporting @ , @ % reporting @ , and @ % reporting @ .


There were no associations between the major stressors score and physiological measures or diagnosis of comorbidities .


The odds of medication nonadherence increased significantly from those reporting @ major stressor ( OR , @ ; P = @ ) to those reporting @ major stressors ( OR , @ ; P = @ ) .


Significant odds of elevated depressive symptoms and impaired QoL were also found with increased reporting of major stressors .


Exposure to major stressful life events is associated with lower adherence to prescribed oral medication regimens and impaired psychosocial functioning in adolescents with T@D .


Low back pain ( LBP ) is responsible for more than @ million visits to US emergency departments ( EDs ) annually .


These patients are usually treated with nonsteroidal anti-inflammatory drugs , acetaminophen , opioids , or skeletal muscle relaxants , often in combination .


To compare functional outcomes and pain at @ week and @ months after an ED visit for acute LBP among patients randomized to a @-day course of ( @ ) naproxen + placebo ; ( @ ) naproxen + cyclobenzaprine ; or ( @ ) naproxen + oxycodone/acetaminophen .


This randomized , double-blind , @-group study was conducted at one urban ED in the Bronx , New York City .


Patients who presented with nontraumatic , nonradicular LBP of @ weeks ' duration or less were eligible for enrollment upon ED discharge if they had a score greater than @ on the Roland-Morris Disability Questionnaire ( RMDQ ) .


The RMDQ is a @-item questionnaire commonly used to measure LBP and related functional impairment on which @ indicates no functional impairment and @ indicates maximum impairment .


Beginning in April @ , a total of @ patients were approached for enrollment .


Of the @ deemed eligible for participation , @ were randomized to receive placebo and @ each to cyclobenzaprine and to oxycodone/acetaminophen .


Follow-up was completed in December @ .


All participants were given @ tablets of naproxen , @ mg , to be taken twice a day .


They were randomized to receive either @ tablets of placebo ; cyclobenzaprine , @ mg ; or oxycodone , @ mg/acetaminophen , @ mg .


Participants were instructed to take @ or @ of these tablets every @ hours , as needed for LBP .


They also received a standardized @-minute LBP educational session prior to discharge .


The primary outcome was improvement in RMDQ between ED discharge and @ week later .


Demographic characteristics were comparable among the @ groups .


At baseline , median RMDQ score in the placebo group was @ ( interquartile range -LSB- IQR -RSB- ,@ -@ ) , in the cyclobenzaprine group @ ( IQR,@-@ ) , and in the oxycodone/acetaminophen group @ ( IQR,@-@ ) .


At @-week follow-up , the mean RMDQ improvement was @ in the placebo group , @ in the cyclobenzaprine group , and @ in the oxycodone/acetaminophen group .


Between-group difference in mean RMDQ improvement for cyclobenzaprine vs placebo was @ ( @ % CI , -@ to @ ; P = @ ) , for oxycodone/acetaminophen vs placebo , @ ( @ % CI , -@ to @ ; P = @ ) , and for oxycodone/acetaminophen vs cyclobenzaprine , @ ( @ % CI , -@ to @ ; P = @ ) .


Among patients with acute , nontraumatic , nonradicular LBP presenting to the ED , adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at @-week follow-up .


These findings do not support use of these additional medications in this setting .


To improve survival rates in children with acute myeloid leukemia ( AML ) , we evaluated gemtuzumab-ozogamicin ( GO ) , a humanized immunoconjugate targeted against CD@ , as an alternative to further chemotherapy dose escalation .


Our primary objective was to determine whether adding GO to standard chemotherapy improved event-free survival ( EFS ) and overall survival ( OS ) in children with newly diagnosed AML .


Our secondary objectives examined outcomes by risk group and method of intensification .


Children , adolescents , and young adults ages @ to @ years with newly diagnosed AML were enrolled onto Childrens Oncology Group trial AAML@ and then were randomly assigned to either standard five-course chemotherapy alone or to the same chemotherapy with two doses of GO ( @ mg/m@/dose ) administered once in induction course @ and once in intensification course @ ( two of three ) .


There were @,@ evaluable patients enrolled .


GO significantly improved EFS ( @ years : @ % v. @ % ; hazard ratio -LSB- HzR -RSB- , @ ; @ % CI , @ to @ ; P. @ ) but not OS ( @ years : @ % v. @ % ; HzR , @ ; @ % CI , @ to @ ; P = @ ) .


Although remission was not improved ( @ % v. @ % ; P = @ ) , posthoc analyses found relapse risk ( RR ) was significantly reduced among GO recipients overall ( @ years : @ % v. @ % ; HzR , @ ; @ % CI , @ to @ ; P = @ ) .


Despite an increased postremission toxic mortality ( @ years : @ % v. @ % ; HzR , @ ; @ % CI , @ to @ ; P = @ ) , disease-free survival was better among GO recipients ( @ years : @ % v. @ % ; HzR , @ ; @ % CI , @ to @ ; P = @ ) .


GO added to chemotherapy improved EFS through a reduction in RR for children and adolescents with AML .


Fatigue is one of many unintended consequences of shift work in the nursing profession .


Natural health products ( NHPs ) for fatigue are becoming an increasingly popular topic of clinical study ; one such NHP is Rhodiola rosea .


A well-designed , rigorously conducted randomized controlled trial is required before therapeutic claims for this product can be made .


To compare the efficacy of R. rosea with placebo for reducing fatigue in nursing students on shift work .


A parallel-group randomized , double-blinded , placebo-controlled trial of @-@ year old students from the Faculty of Nursing from the University of Alberta , participating in clinical rotations between January @ and September @ .


Participants were randomized to take @ mg of either R. rosea or identical placebo at the start of their wakeful period and up to one additional capsule within the following four hours on a daily basis over a @-day period .


The primary outcome was reduction in fatigue over the @-day trial period measured using the Vitality-subscale of the RAND-@ , cross-validated by the visual analogue scale for fatigue ( VAS-F ) .


Secondary outcomes included health-related quality of life , individualized outcomes assessment , and adverse events .


A total of @ participants were randomized to R. rosea ( n = @ ) or placebo ( n = @ ) .


The mean change in scores on the Vitality-subscale was significantly different between the study groups at day @ in favor of placebo ( -@ ( @ % CI -@ , -@ ) , p = @ ) , The mean change in scores on the VAS-F was also significantly difference between study groups at day @ in favour of placebo ( @ ( @ % CI @ , @ ) , p = @ ) .


Total number of adverse events did not differ between R. rosea and placebo groups .


This study indicates that among nursing students on shift work , a @-day course of R. Rosea compared with placebo worsened fatigue ; however , the results should be interpreted with caution .


Stroke is one of the most common causes of cognitive impairment .


Up to @ % of stroke survivors may be considered to have cognitive impairment , which severely limit individual autonomy for successful reintegration into family , work and social life .


The clinical efficacy of acupuncture with Baihui ( DU@ ) and Shenting ( DU@ ) in stroke and post-stroke cognitive impairment has been previously demonstrated .


Computer-assisted cognitive training is part of conventional cognitive rehabilitation and has also shown to be effective in improvement of cognitive function of affected patients .


However , the cognitive impairment after stroke is so complexity that one single treatment can not resolve effectively .


Besides , the effects of acupuncture and RehaCom cognitive training have not been systematically compared , nor has the possibility of a synergistic effect of combination of the two therapeutic modalities been evaluated .


Our primary aim of this trial is to evaluate the synergistic effect of acupuncture and RehaCom cognitive training on cognitive dysfunction after stroke .


A randomized controlled trial of @ @ factorial design will be conducted in the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine .


A total of @ patients with cognitive dysfunction after stroke who meet the eligibility criteria will be recruited and randomized into RehaCom training group , acupuncture group , a combination of both or control group in a @:@:@:@ ratio .


All patients will receive conventional treatment .


The interventions will last for @ weeks ( @ min per day , Monday to Friday every week ) .


Evaluations will be conducted by blinded assessors at baseline and again at @ , @ and @ weeks .


Outcome measurements include mini-mental state examination ( MMSE ) , Montreal cognitive assessments ( MoCA ) , functional independence measure scale ( FIM ) and adverse events .


The results of this trial are expected to clarify the synergistic effect of acupuncture and RehaCom cognitive training on cognitive dysfunction after stroke .


Furthermore , to confirm whether combined or alone of acupuncture and RehaCom cognitive training , is more effective than conventional treatment in the management of post-stroke cognitive dysfunction .


Anastomotic leakage of pancreaticojejunostomy ( PJ ) remains the single most important source of morbidity after pancreaticoduodenectomy ( PD ) .


The primary aim of this randomized clinical trial comparing PG with PJ after PD was to test the hypothesis that invaginated PG would result in a lower rate and severity of pancreatic fistula .


Patients undergoing PD were randomized to receive either a duct-to-duct PJ or a double-layer invaginated PG .


The primary endpoint was the rate of pancreatic fistula , using the definition of the International Study Group on Pancreatic Fistula .


Secondary endpoints were the evaluation of severe abdominal complications ( Clavien-Dindo grade IIIa or above ) , endocrine and exocrine function .


Of @ patients randomized , @ underwent PJ and @ had PG .


The incidence of pancreatic fistula was significantly higher following PJ than for PG ( @ of @ versus @ of @ respectively ; P = @ ) , as was the severity of pancreatic fistula ( grade A : @ versus @ per cent ; grade B-C : @ versus @ per cent ; P = @ ) .


The hospital readmission rate for complications was significantly lower after PG ( @ versus @ per cent ; P = @ ) , weight loss was lower ( P = @ ) and exocrine function better ( P = @ ) .


The rate and severity of pancreatic fistula was significantly lower with this PG technique compared with that following PJ .


Predictors of outcome after aneurysmal subarachnoid hemorrhage have been determined previously through hypothesis-driven methods that often exclude putative covariates and require a priori knowledge of potential confounders .


Here , we apply a data-driven approach , principal component analysis , to identify baseline patient phenotypes that may predict neurological outcomes .


Principal component analysis was performed on @ subjects enrolled in a prospective randomized trial of clazosentan for the prevention of angiographic vasospasm .


Correlation matrices were created using a combination of Pearson , polyserial , and polychoric regressions among @ variables .


Scores of significant components ( with eigenvalues > @ ) were included in multivariate logistic regression models with incidence of severe angiographic vasospasm , delayed ischemic neurological deficit , and long-term outcome as outcomes of interest .


Sixteen significant principal components accounting for @ % of the variance were identified .


A single component dominated by the patients ' initial hemodynamic status , World Federation of Neurosurgical Societies score , neurological injury , and initial neutrophil/leukocyte counts was significantly associated with poor outcome .


Two additional components were associated with angiographic vasospasm , of which one was also associated with delayed ischemic neurological deficit .


The first was dominated by the aneurysm-securing procedure , subarachnoid clot clearance , and intracerebral hemorrhage , whereas the second had high contributions from markers of anemia and albumin levels .


Principal component analysis , a data-driven approach , identified patient phenotypes that are associated with worse neurological outcomes .


Such data reduction methods may provide a better approximation of unique patient phenotypes and may inform clinical care as well as patient recruitment into clinical trials .


To evaluate the effects of an Al ( @ + ) - and Mg ( @ + ) - containing antacid , ferrous sulfate , and calcium carbonate on the absorption of nemonoxacin in healthy humans .


Two single-dose , open-label , randomized , crossover studies were conducted in @ healthy male Chinese volunteers ( @ per study ) .


In Study @ , the subjects orally received nemonoxacin ( @ mg ) alone , or an antacid ( containing @ mg of Al ( @ + ) and @ mg of Mg ( @ + ) ) plus nemonoxacin administered @ h before , concomitantly or @ h after the antacid .


In Study @ , the subjects orally received nemonoxacin ( @ mg ) alone , or nemonoxacin concomitantly with ferrous sulfate ( containing @ mg of Fe ( @ + ) ) or calcium carbonate ( containing @ mg of Ca ( @ + ) ) .


Concomitant administration of nemonoxacin with the antacid significantly decreased the area under the concentration-time curve from time @ to infinity ( AUC@ - ) for nemonoxacin by @ % , the maximum concentration ( Cmax ) by @ % , and urine recovery ( Ae ) by @ % .


Administration of nemonoxacin @ h after the antacid decreased the AUC@ - for nemonoxacin by @ % , Cmax by @ % , and Ae by @ % .


Administration of nemonoxacin @ h before the antacid did not affect the absorption of nemonoxacin .


Administration of nemonoxacin concomitantly with ferrous sulfate markedly decreased AUC@ - by @ % , Cmax by @ % , and Ae by @ % , while concomitant administration of nemonoxacin with calcium carbonate mildly decreased AUC@ - by @ % , Cmax by @ % , and Ae by @ % .


Metal ions , Al ( @ + ) , Mg ( @ + ) , and Fe ( @ + ) markedly decreased the absorption of nemonoxacin in healthy Chinese males , whereas Ca ( @ + ) had much weaker effects .


To avoid the effects of Al ( @ + ) and Mg ( @ + ) - containing drugs , nemonoxacin should be administered @ h before them .


This study was conducted to compare the effectiveness of PETTLEP-based imagery , and traditional imagery interventions , on performance of passing skill in volleyball .


@ beginners male volleyball players ( Mage = @ years , SD = @ years ) with @-@ months practice experience were randomly assigned to one of three groups : physical practice + PETTLEP imagery ( PP+PI ) ( N. = @ ) , physical practice + traditional imagery ( N. = @ ) , and physical practice only ( PP ; N. = @ ) .


Subjects in the PP+PI group applied the seven components of PETTLEP imagery training ; whereas subjects in the PP+TI engaged in a relaxation session before imagery and used response laden motor imagery scripts .


The two groups completed @ minutes of imagery training followed immediately by @ minutes of `` passing '' practice three times per week .


The PP group completed only @ minutes of `` passing '' practice three times per week .


Each group performed its respective tasks for @ weeks .


A pre-test took place during the first practice session in which `` passing '' was assessed .


After the @-week practice program , a post-test took place followed by a retention test , one `` no-practice '' week later .


All groups improved significantly ( P < @ ) from pre - to post-test and retention test .


However , as hypothesised the PP+PI group improved more ( P < @ ) than the PP+TI and PP groups .


The findings , therefore , support the effectiveness of PETTLEP imagery in enhancing performance of passing skill in volleyball when combined with physical practice .


This multicenter , randomized , open-labeled , clinical trial evaluated the efficacy and safety of cisplatin/@-fluorouracil ( @-FU ) hepatic arterial infusion chemotherapy ( CF-HAIC ) versus adriamycin adding to CF-HAIC ( ACF-HAIC ) in advanced HCC patients .


Fifty-six patients with advanced HCC were randomized to two treatment groups : ( @ ) CF-HAIC group -LSB- n = @ , @-FU , @ mg/m ( @ ) on days @-@ , and cisplatin , @ mg/m ( @ ) on day @ -RSB- and ( @ ) ACF-HAIC group -LSB- n = @ , adriamycin , @ mg/m ( @ ) on day @ , @-FU , @ mg/m ( @ ) on days @-@ , and cisplatin , @ mg/m ( @ ) on day @ -RSB- every @ weeks via an implantable port system .


Primary efficacy endpoint was overall survival ( OS ) .


Treatment response and time to progression were secondary endpoints .


Treatment response rates did not differ significantly between the two treatment groups .


Time to progression ( @ vs. @ months , P = @ ) and OS ( @ vs. @ months , P = @ ) were not significantly different .


When the factors affecting patient OS were analyzed , disease control rate -LSB- P < @ , HR @ ( @ % CI @-@ @ ) -RSB- was independently associated with OS .


Age ( @ years ) and serum AFP level ( @ ng/dL ) also were significant factors for OS -LSB- P = @ , HR @ ( @ % CI @-@ @ ) , P = @ , HR @ ( @ % CI @-@ @ ) , respectively -RSB- .


Grade @ treatment-related toxicity and mortality was not observed in both groups .


Although both HAIC regimens are safe and effective in patients with advanced HCC , HAIC adding adriamycin did not show delayed tumor progression and survival benefit compared to CF-HAIC in advanced HCC .


To assess the effectiveness and safety on post-stroke dysphagia in chronic stage treated with magnetic-ball sticking therapy at the auricular points .


Ninety cases of post-apoplexy dysphagia in chronic stage were randomized into an auricular points group and an acupuncture group .


In the auricular points group , the magnetic-ball sticking therapy was applied to subcortex ( pizhixia , AT@ ) , brainstem ( naogan , AT ( @,@ i ) ) , mouth ( kou , CO@ ) , cheek ( mianjia , LO ( @,@ i ) ) , tongue ( she , LO@ ) and throat ( yanhou , TG@ ) on one ear each time , and were changed on the other ear once every @ days .


In the acupucnture group , acupuncture was applied to Feng-chi ( GB @ ) , Yifeng ( TE @ ) , Shanglianquan ( Extra ) , Jinjin ( EX-HN @ ) , Yuye ( EX-HN @ ) , Shuigou ( GV @ ) and Tongli ( TH @ ) , etc. .


The needles were retained for @ min in each treatment .


The treatment was gi-yen once a day in the two groups and the treatment of @ days made one session .


There was @ day at an interval among the sessions .


Totally , @ sessions of treatment were required .


The video fluoroscopic swallowing study ( VFSS ) was performed for @ kinds of food with different properties and shapes in each patient .


The main indices were Rosenbek penetration-aspiration score , oral-retaining score and throat-retaining score .


The efficacy , and the incidences of aspiration pneumonia and malnutrition were compared between the two groups .


The nutrition indices were compared before and after treatment between the two groups , such as the skinfold thickness of triceps brachii muscle , serum albumin and peralbumin .


In @ days of treatment , in the auricular points group , the @ mL liquid loversol Rosenbek penetration-aspiration score ( @ + / - @ ) , oral-retaining score ( @ + / - @ ) and throat-retaining score ( @ + / - @ ) were all lower than those ( @ + / - @ , @ + / - @ , @ + / - @ ) in the acupuncture group separately .


The @ mL liquid loversol Rosenbek penetration-aspiration score ( @ + / - @ ) , oral-retaining score ( @ + / - @ ) and throat-retaining score ( @ + / - @ ) were all lower than those ( @ + / - @ , @ + / - @ , @ + / - @ ) in the acupuncture group separately .


The @ mL paste loversol Rosenbek penetration-aspiration score ( @ + / - @ ) , oral-retaining score ( @ + / - @ ) and throat-retaining score ( @ + / - @ ) were all lower than those ( @ + / - @ , @ + / - @ , @ + / - @ ) in the acupuncture group separately .


The @/@ cake-form loversol Rosenbek penetration-aspiration score ( @ + / - @ ) , oral-retaining score ( @ + / - @ ) and throat-retaining score ( @ + / - @ ) were all lower than those ( @ + / - @ , @ + / - @ , @ + / - @ ) in the acupuncture group separately .


The incidence of aspiration pneumonia was @ % ( @/@ ) in the auricular points group , which was lower than @ % ( @/@ ) in the acupuncture group ( P < @ ) .


The incidence of malnutrition was @ % ( @/@ ) in the auricular points group , which was lower than @ % ( @/@ ) in the acupuncture group ( P < @ ) .


In @ days of treatment , the results of the skinfold thickness of triceps brachii muscle and serum albumin in the auricular points group were better than those in the acupuncture group ( both P < @ ) .


The magnetic-ball sticking therapy at auricular points achieves the definite efficacy on post-stoke dysphagia in chronic stage and decreases the incidences of aspiration pneumonia and malnutrition .


The efficacy of this therapy is better than acupuncture .


Several characteristics of bone-targeted agents are considered when making treatment decisions .


This study evaluated physicians ' therapy preferences for preventing skeletal-related events ( SREs ) in patients with bone metastases secondary to solid tumors .


A Web-enabled , discrete-choice experiment online survey was conducted among physicians who treated patients with bone metastases and solid tumors in the United States .


Respondents chose between pairs of hypothetical medications defined by combinations of six attributes at varying levels for two hypothetical patients .


Preference weights for attribute levels were estimated using a random-parameters logit model .


In total , @ physicians completed the survey .


Their mean age was @ years , @ % were in practice for more than @ years , @ % were oncologists , and @ % treated @ or fewer patients with bone metastases weekly .


Out-of-pocket cost to patients was the most important attribute overall .


Among clinical outcomes , time to first SRE and risk of renal impairment were the most important attributes .


Statistically significant preferences were observed for all attribute levels for time to first SRE , risk of renal impairment , and mode of administration .


Predicted choice probability analysis showed that physicians preferred a hypothetical medication with attributes similar to those of denosumab over one with attributes similar to those of zoledronic acid .


Physicians indicated that clinical attributes are important when considering bone-targeting therapy for bone metastases , but consistent with the current health care landscape , patient out-of-pocket cost was the most important .


With health care costs being increasingly shifted to patients , physicians require accurate information about co-pays and assistance programs to avoid patients receiving less costly , yet potentially inferior , treatment .


Despite their positive motivation to quit , many smokers do not attempt to quit or relapse soon after their quit attempt .


This study investigated the predictors of successful and unsuccessful quit attempts among smokers motivated to quit smoking .


We conducted secondary data analysis among respondents motivated to quit within @ months , randomized to the control group ( N = @ ) of a Web-based smoking cessation intervention study .


Using chi-square tests and ANOVA with Tukey post hoc comparisons , we investigated baseline differences by smoking status ( successful quitter/relapse/persistent smoker ) assessed after @ weeks ( N = @ ) .


To identify independent predictors of smoking status , multivariate multinomial logistic regression analyses were conducted .


Successful quitters at @-week follow-up ( @ % ) had reported significantly higher baseline levels of self-efficacy than relapsers ( @ % ) and persistent smokers ( @ % ) .


Furthermore , both successful quitters and relapsers had reported a significantly higher baseline intention to quit than persistent smokers and successful quitters had reported significantly more preparatory planning at baseline than persistent smokers .


Results from regression analyses showed that smokers ' baseline intention to quit positively predicted quit attempts reported after @ weeks , while self-efficacy positively predicted quit attempt success .


Different factors appear to play a role in predicting quit attempts and their success .


Whereas intention to quit only appeared to play a role in predicting quit attempts , self-efficacy was the main factor predicting quit attempt success .


More research is needed to determine the role of preparatory planning and plan enactment and to investigate whether these findings can be replicated on the long term .


AirSeal is a novel class of valve-free insufflation system that enables a stable pneumoperitoneum with continuous smoke evacuation and carbon dioxide ( CO ) recirculation during laparoscopic surgery .


Comparison data to standard CO pressure pneumoperitoneum insufflators is scarce .


The aim of this study is to evaluate the potential advantages of AirSeal compared to a standard CO insufflator .


This is a single center randomized controlled trial comparing elective laparoscopic cholecystectomy , colorectal surgery and hernia repair with AirSeal ( group A ) versus a standard CO pressure insufflator ( group S ) .


Patients are randomized using a web-based central randomization and registration system .


Primary outcome measures will be operative time and level of postoperative shoulder pain by using the visual analog score ( VAS ) .


Secondary outcomes include the evaluation of immunological values through blood tests , anesthesiological parameters , surgical side effects and length of hospital stay .


Taking into account an expected dropout rate of @ % , the total number of patients is @ ( n = @ per group ) .


All tests will be two-sided with a confidence level of @ % ( P < @ ) .


The duration of an operation is an important factor in reducing the patient 's exposure to CO pneumoperitoneum and its adverse consequences .


This trial will help to evaluate if the announced advantages of AirSeal , such as clear sight of the operative site and an exceptionally stable working environment , will facilitate the course of selected procedures and influence operation time and patients clinical outcome .


To compare the difference in the clinical efficacy on perennial allergic rhinitis between three nasal points acupuncture therapy and the oral administration of loratadine so as to provide the better acupuncture program in clinical treatment .


Sixty cases were randomized into an acupuncture group ( @ cases ) and a medication group ( @ cases ) .


In the acupuncture group , acupuncture was applied to three nasal points -LSB- Yingxiang ( LI @ ) , Yintang ( EX-HN @ ) , Bitong ( Extra ) -RSB- and acupoints selected by syndrome differentiation .


Acupuncture was given once every two days , three times a week , for @ weeks totally .


In the medication group , loratadine was prescribed for oral administration , @ mg every day , for @ weeks .


The symptom and physical sign scores before and after treatment , as well the short-term and long-term efficacy were compared between the two groups .


The total effective rate was @ % ( @/@ ) in the acupuncture group and was @ % ( @/@ ) in the medication group after treatment .


The efficacy was similar between the two groups ( P > @ ) .


In follow-up , the total effective rate was @ % ( @/@ ) in the acupuncture group , which was better than @ % ( @/@ , P < @ ) in the medication group .


The scores of symptoms and physical signs after treatment and in follow-up were all reduced apparently as compared with those before treatment in the patients of the two groups ( all P < @ ) .


The scores of symptoms and physical signs were reduced more apparently in the acupuncture group as compared with those in the medication group in follow-up ( all P < @ ) .


The acupuncture at three nasal points and the acupoints selected by syndrome differentiation achieves the similar short-term efficacy on perennial allergic rhinitis as compared with the oral administration of loratadine .


The acupuncture therapy presents the obvious advantages on long-term efficacy .


Comparing the overall and differential effects of psychodynamic psychotherapy ( PDT ) versus cognitive behavior therapy ( CBT ) for social anxiety disorder ( SAD ) .


Patients with a primary SAD ( N = @ ) were randomly assigned to PDT ( N = @ ) or CBT ( N = @ ) .


Both PDT and CBT consisted of up to @ sessions ( average PDT @ and CBT @ sessions ) .


Assessments took place at waitlist : pretest , after @ and @ weeks for those who received longer treatment : posttest , @-month and @-year follow-up .


Changes in the main outcome measure self-reported social anxiety composite , as well as in other psychopathology , social skills , negative social beliefs , public self-consciousness , defense mechanisms , personal goals , independent rater 's judgments of SAD and general improvement , and approach behavior during an objective test , were analyzed using multilevel analysis .


No improvement occurred during waitlist .


Treatments were highly efficacious , with large within-subject effect sizes for social anxiety , but no differences between PDT and CBT on general and treatment-specific measures occurred .


Remission rates were over @ % and similar for PDT and CBT .


Personality disorders did not influence the effects of PDT or CBT .


PDT and CBT are both effective approaches for SAD .


Further research is needed on the cost-effectiveness of PDT versus CBT , on different lengths PDT , and on patient preferences and their relationship to outcome of PDT versus CBT .


To examine how prenatal drug exposure ( PDE ) to heroin/cocaine and behavioral problems relate to adolescent drug experimentation .


The sample included African-American adolescents ( mean age = @ years , SD = @ ) with PDE ( n = @ ) and a nonexposed community comparison ( n = @ ) .


PDE status was determined at delivery through toxicology analysis and maternal report .


Internalizing/externalizing problems were assessed during adolescence with the Behavior Assessment System for Children , Second Edition .


Drug experimentation was assessed by adolescent report and urine analysis .


Logistic regression evaluated the likelihood of drug experimentation related to PDE and behavioral problems , adjusting for age , gender , PDE , perceived peer drug use , and caregiver drug use .


Interaction terms examined gender modification .


Sixty-seven subjects ( @ % ) used drugs : @ ( @ % ) used tobacco/alcohol only and @ ( @ % ) used marijuana/illegal drugs .


Ninety-four subjects ( @ % ) perceived peer drug use .


PDE significantly increased the risk of tobacco/alcohol experimentation ( odds ratio = @ , @ % confidence interval -LSB- CI -RSB- @-@ @ , p = @ ) but not after covariate adjustment ( adjusted odds ratio -LSB- aOR -RSB- = @ , @ % CI @ -@ , p > @ ) .


PDE was not related to the overall or marijuana/illegal drug experimentation .


The likelihood of overall drug experimentation was doubled per SD increase in externalizing problems ( aOR = @ , @ % CI @-@ @ , p = @ ) and , among girls , @ times greater ( aOR = @ , @ % CI @-@ @ , p = @ ) per SD increase in internalizing problems .


Age and perceived peer drug use were significant covariates .


Drug experimentation was relatively common ( @ % ) , especially in the context of externalizing problems , internalizing problems ( girls only ) , older age , and perceived peer drug use .


Findings support the Problem Behavior Theory and suggest that adolescent drug prevention addresses behavioral problems and promotes prosocial peer groups .


Intra-articular triamcinolone in combination with DMARDs may be able to achieve faster and tighter control of disease activity in early rheumatoid arthritis that may be the key to preventing or minimizing later deformities .


To compare the efficacy of a combination of Disease Modifying Anti-Rheumatoid Drugs ( DMARDs ) with Intra-articular Glucocorticoids versus only DMARDs in a group of patients with early Rheumatoid Arthritis ( RA ) .


Fifty patients diagnosed as Rheumatoid Arthritis ( RA ) by American Rheumatology Association ( ARA ) criteria ( @ ) with disease duration less than two years were randomized into two groups .


The Control group received a combination of Methotrexate @ mg daily with Sulfasalazine @ gm daily for @ months and the Study group received the above combination along with Intra-articular injections of Triamcinolone acetate ( @ mg per ml ) in each of the swollen joints at the start of the study .


Outcome was assessed in terms of Disease Activity Score ( DAS-@ ) , American College of Rheumatology ( ACR ) @/@/@ criteria and number of rescue medications used at the end of @ months .


The study group had significant reductions in DAS @ scores ( @ versus @ in control group ) and significantly more subjects achieved the ACR @/@/@ criteria at the end of @ months ( @/@/@ % versus @/@/@ % ) Secondary end-points like tender and swollen joint count , ESR , early morning stiffness , health assessment questionnaire ( HAQ ) scores and general health status were significantly reduced in the study group .


Also , significantly lesser rescue medications were needed in the study group .


Combination of DMARDs with Intra-articular corticosteroids is significantly better than DMARDs alone in early RA .


The Ipswich Touch Test is a novel method to detect subjects with diabetes with loss of foot sensation and is simple , safe , quick , and easy to perform and teach .


This study determines whether it can be used by relatives and/or carers to detect reduced foot sensation in the setting of the patient 's home .


The test involves lightly and briefly ( @-@ s ) touching the tips of the first , third and fifth toes of both feet with the index finger .


Reduced foot sensation was defined as @ insensate areas .


Patients due to attend clinic over a @-week period were invited by post .


The invitation contained detailed instructions and a sheet for recording the results .


The findings were compared with those obtained in clinic using the @-g monofilament at the same six sites .


Of @ patients ( @ males ) , @ % ( n = @ ) had @ insensate areas to @-g monofilament testing .


Compared with this , the Ipswich Touch Test at home had a sensitivity of @ % and a specificity of @ % .


The predictive values of detecting ` at-risk ' feet were positive at @ % and negative at @ % .


The likelihood ratios were positive at @ and negative at @ .


With clearly written instructions , this simple test can be used by non-professionals to accurately assess for loss of protective sensation .


We believe that the Ipswich Touch Test may also be a useful educational adjunct to improve awareness of diabetes foot disease in patients and relatives alike and empower them to seek appropriate care if sensation was found to be abnormal .


The cellular immunity has a profound impact on the status of hepatitis C virus ( HCV ) infection .


However , the response of cellular immunity on the virological response in patients with antiviral treatment remains largely unclear .


We aimed to clarify the response of peripheral T cells and monocytes in chronic hepatitis C patients with antiviral treatment .


Patients with chronic hepatitis C were treated either with interferon alpha-@b plus ribavirin ( n = @ ) or with pegylated interferon alpha-@a plus ribavirin ( n = @ ) for up to @ weeks .


Frequencies of peripheral regulatory T-cells ( Tregs ) , programmed death-@ ( PD-@ ) expressing CD@ + T-cells or CD@ + T-cells and toll-like receptor ( TLR ) @ expressing CD@ + monocytes were evaluated by flow cytometry in patients at baseline , @ and @ weeks following treatment and in @ healthy controls .


Frequencies of Tregs , PD-@ and TLR@ expressing cells were higher in patients than those in control subjects ( P < @ ) .


Patients with complete early virological response ( cEVR ) showed lower Tregs , PD-@ expressing CD@ + or CD@ + T-cells than those without cEVR at @ weeks ( P < @ ) .


Patients with low TLR@ expressing CD@ + monocytes at baseline had a high rate of cEVR ( P < @ ) .


Low peripheral TLR@ expressing CD@ + monocytes at baseline could serve as a predictor for cEVR of antiviral therapy in chronic HCV-infected patients .


The cEVR rates were significantly increased in the patients with reduced circulating Tregs , PD-@ expressing CD@ + or CD@ + T-cells .


Few randomized trials have compared the results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy and excisional open hemorrhoidectomy .


Few studies have reported long-term results .


The aim of this study is to evaluate the results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy compared with excisional open hemorrhoidectomy in patients with grade III hemorrhoids .


This is a prospective randomized study registered at clinicaltrials.gov ( NCT@ ) .


A power analysis assessed the study 's sample size .


Patients were randomly assigned to undergo either hemorrhoidectomy or Doppler-guided hemorrhoid dearterialization plus mucopexy .


The test , Mann-Whitney U test , Student t test , and a regression model were used , as appropriate .


This study was conducted at the Department of Surgery , San Raffaele Scientific Institute , Milan , Italy .


Fifty consecutive patients were treated for grade III hemorrhoids from July to November @ .


The primary outcome was postoperative pain .


The secondary outcomes included postoperative morbidity , the resumption of social and/or working activity , patient satisfaction , and the relapse of symptoms at @ and @ months .


No major complications occurred in either group .


The median visual analog scale scores for pain in the hemorrhoidectomy and Doppler-guided dearterialization plus mucopexy groups on days @ , @ , @ , and @ were @ vs @ , @ vs @ , @ vs @ , and @ vs @ ( p > @ ) .


The median work resumption day was the @nd in the hemorrhoidectomy group and the @th in the Doppler-guided dearterialization plus mucopexy group ( p = @ ) .


Patient satisfaction at @ and @ postoperative months , with the use of a @-point scale , was @ vs @ and @ vs @ ( p > @ ) .


During the follow-up , @ patients in the dearterialization group required ambulatory treatment , and @ patient in each group required further surgery for symptom relapse .


Nonvalidated questionnaires were used in the follow-up .


Cost analysis was not performed .


Compared with hemorrhoidectomy , dearterialization with mucopexy resulted in similar postoperative pain and morbidity , and a similar long-term cure rate .


Management of antihistamine refractory chronic idiopathic urticaria ( CIU ) has poorly defined therapeutic options .


To evaluate the efficacy of dapsone ( @,@ ' - diaminodiphenylsulfone ) in antihistamine refractory CIU compared with placebo .


Twenty-two patients with antihistamine refractory CIU were randomly assigned to @ mg of dapsone daily or placebo for @ weeks in a @-week double-blind , placebo-controlled crossover trial .


End points were measured from a daily diary that reflected the weekly hive score , the weekly itch score , and a visual analog scale ( VAS ) score .


Secondary to a carryover effect , the first period results were analyzed as a parallel design that compared placebo with dapsone directly by using repeated-measures analysis .


After @ weeks , the patients in the dapsone arm showed mean improvement over baseline in VAS ( @ -LSB- @ % CI , @-@ @ -RSB- , P = @ ) , urticaria score ( -@ -LSB- @ % CI , -@ to -@ -RSB- , P = @ ) , and itch score ( -@ -LSB- @ % CI , -@ to -@ -RSB- , P = @ ) , whereas the placebo arm showed no improvement over baseline for VAS , urticaria , or itch scores .


Dapsone showed greater improvement compared with placebo for itch ( P = @ ) and VAS ( P = @ ) .


Of the @ patients , @ showed complete resolution of hives and itch with dapsone , whereas @ % and @ % had @ % resolution of hives and itch , respectively .


No serious adverse effects were observed with dapsone .


To our knowledge , this is the first double-blind , placebo controlled study of dapsone in CIU and indicates that dapsone has efficacy in patients with antihistamine refractory CIU .


In alcohol-dependent patients , alcohol cues evoke increased activation in mesolimbic brain areas , such as the nucleus accumbens and the amygdala .


Moreover , patients show an alcohol approach bias , a tendency to more quickly approach than avoid alcohol cues .


Cognitive bias modification training , which aims to retrain approach biases , has been shown to reduce alcohol craving and relapse rates .


The authors investigated effects of this training on cue reactivity in alcohol-dependent patients .


In a double-blind randomized design , @ abstinent alcohol-dependent patients received either bias modification training or sham training .


Both trainings consisted of six sessions of the joystick approach-avoidance task ; the bias modification training entailed pushing away @ % of alcohol cues and @ % of soft drink cues , whereas this ratio was @/@ in the sham training .


Alcohol cue reactivity was measured with functional MRI before and after training .


Before training , alcohol cue-evoked activation was observed in the amygdala bilaterally , as well as in the right nucleus accumbens , although here it fell short of significance .


Activation in the amygdala correlated with craving and arousal ratings of alcohol stimuli ; correlations in the nucleus accumbens again fell short of significance .


After training , the bias modification group showed greater reductions in cue-evoked activation in the amygdala bilaterally and in behavioral arousal ratings of alcohol pictures , compared with the sham training group .


Decreases in right amygdala activity correlated with decreases in craving in the bias modification but not the sham training group .


These findings provide evidence that cognitive bias modification affects alcohol cue-induced mesolimbic brain activity .


Reductions in neural reactivity may be a key underlying mechanism of the therapeutic effectiveness of this training .


To compare the effectiveness of misoprostol sublingual and oral routes before manual vacuum aspiration ( MVA ) in first trimester termination of pregnancy .


A double-blinded randomized controlled trial was conducted infirst trimester termination ofpregnancy cases .


Eighty cases were recruited and divided into sublingual and oral groups .


Both groups were randomized to receive @ microg misoprostol two hours prior to MVA .


Main outcomes were cervical dilatation , operative time , complications , side effects , pain scores , and patient satisfactions .


Sublingual group had significantly more cervical dilatation and shorter operative time than oral group ( @ + / - @ vs. @ + / - @ mm , p < @ and @ + / - @ vs. @ + / - @ min , p = @ , respectively ) .


However there were similar side effects , pain scores , and patient satisfactions in two groups .


The present study had no uterine perforation , cervical tear hemorrhage , or re-evacuation .


Sublingual misoprostol route was more effective for cervical priming prior to MVA in first trimester therapeutic abortion than oral route .


To compare the safety and efficacy of laser debulking ( LD ) and drug-eluting balloon ( DEB ) angioplasty to treatment with DEB angioplasty alone in patients affected by critical limb ischemia ( CLI ) and superficial femoral artery ( SFA ) chronic stent occlusion in a prospective , randomized study .


Among @ CLI patients treated from December @ to March @ , @ patients ( @ men ; mean age @ years ) with chronic SFA in-stent occlusion were randomly assigned to treatment using LD+DEB ( n = @ ) or DEB angioplasty alone ( n = @ ) .


Patency at @ months was the primary outcome measure ; secondary outcomes were target lesion revascularization ( TLR ) and clinical success at @ months .


In the LD+DEB group , the patency rates at @ and @ months ( @ % and @ % , respectively ) were significantly higher ( p = @ ) than in the DEB only patients ( @ % and @ % , respectively ) .


TLR at @ months was @ % in the LD+DEB group and @ % in the DEB only group ( p = @ ) .


Two ( @ % ) patients needed major amputations in the LD+DEB group vs. @ ( @ % ) in the DEB only group at @ months ( p = @ ) .


In this small initial experience , combined treatment with LD and DEB angioplasty is correlated with better outcomes in CLI patients with occluded SFA stents .


Hypertension is one of the most common co-existing conditions in patients with chronic pain , and the potential effects of an analgesic on heart rate and blood pressure are of particular concern for patients with hypertension .


The purpose of this analysis was to evaluate changes in blood pressure and heart rate with tapentadol extended release ( ER ) treatment in patients with hypertension .


We performed a post hoc analysis of data pooled from three randomized , placebo - and active-controlled , phase III studies of tapentadol ER for managing chronic osteoarthritis knee ( NCT@ , NCT@ ) or low back ( NCT@ ) pain ( @-week , double-blind treatment period ) .


Data were independently analyzed for patients with a listed medical history of hypertension at baseline and patients with at least one listed concomitant antihypertensive medication at baseline .


Heart rate , systolic blood pressure ( SBP ) , and diastolic blood pressure ( DBP ) were measured at each visit .


In patients with a listed medical history of hypertension ( n = @,@ ) , least-squares mean ( LSM -LSB- standard error ( SE ) -RSB- ) changes from baseline to endpoint with placebo , tapentadol ER , and oxycodone HCl controlled release ( CR ) , respectively , were -@ ( @ ) , @ ( @ ) , and -@ ( @ ) beats per minute ( bpm ) for heart rate ; -@ ( @ ) , -@ ( @ ) , and -@ ( @ ) mmHg for SBP ; and -@ ( @ ) , -@ ( @ ) , and -@ ( @ ) mmHg for DBP ; in patients with at least one listed concomitant antihypertensive medication ( n = @,@ ) , the LSM ( SE ) changes from baseline to endpoint were -@ ( @ ) , @ ( @ ) , and -@ ( @ ) bpm for heart rate ; -@ ( @ ) , -@ ( @ ) , and -@ ( @ ) mmHg for SBP ; and -@ ( @ ) , -@ ( @ ) , and -@ ( @ ) mmHg for DBP .


No clinically meaningful mean changes in heart rate or blood pressure were observed for the evaluated cohorts of patients with hypertension who were treated with tapentadol ER ( @-@ mg twice daily ) .


To assess the relative bioavailability of a new subcutaneous ( SC ) diclofenac hydroxypropyl b-cyclodextrin ( HPbCD ) formulation administered to three body sites : quadriceps , gluteus , and abdomen .


This was a pilot , single-dose , randomized , three-way crossover relative bioavailability study .


A total of @ healthy subjects received a single SC injection of diclofenac HPbCD @ mg/@ mL in the quadriceps , gluteus , or abdomen .


The AUC was comparable after SC diclofenac HPbCD in the quadriceps , gluteus , and abdomen .


The Cmax was comparable after SC administration in the quadriceps or abdomen , and ~ @ % higher in the gluteus .


The absorption was rapid ( @ minutes ) after administration of the treatment at any site .


The treatment was well tolerated .


The relative bioavailability of SC diclofenac HPbCD was comparable when administered to the quadriceps , gluteus , and abdomen .


The new diclofenac formulation can therefore be administered subcutaneously to any of these sites without clinically significant differences .


A further adequately powered study would be necessary to reveal any differences among injection sites in terms of peak plasma concentration .


To evaluate the correlation between the dosage frequency of sildenafil and its treatment outcomes in men with erectile dysfunction ( ED ) .


Data were from a @-week , multicenter , observational study of men ( @ ) , between @ and @ years of age , with a clinical diagnosis of ED defined as the Sexual Health Inventory for Men ( SHIM ) score @ .


The erectile function and quality of sexual life were evaluated at the baseline and the endpoint of sildenafil treatment ( after @ weeks ) by using SHIM , Self-Esteem and Relationship Questionnaire , @-Item Short Form Health Survey , Erection Hardness Score , and the global efficacy question .


Nine hundred thirty-five patients were enrolled in the @ weekly , @ in the @-@ weekly , and @ in the @-@ weekly dosage frequency cohorts .


After @ weeks of treatment , a higher dosage frequency of sildenafil was associated with a better SHIM , Self-Esteem and Relationship Questionnaire , and @-Item Short Form Health Survey score improvement ( all P < @ ) .


Hyperlipidemia is a poor prognostic factor ( odds ratio , @ ; P = @ ) , whereas hypertension ( odds ratio , @ ; P < @ ) and coronary heart disease ( odds ratio , @ ; P = @ ) are sensitive to sildenafil treatment .


Higher dosage frequency of sildenafil is associated with a better improvement of sexual function and quality of life of men with ED , and the concomitant treatment of hyperlipidemia is recommended .


LigaSure , a bipolar electronic vessel sealing system , has become popular in abdominal surgery but few clinical studies have been conducted to evaluate its effectiveness in radical gastrectomy for gastric cancer .


In this multicenter , prospective , randomized controlled trial , patients with curative gastric cancer were randomly assigned to undergo gastrectomy either with LigaSure or a conventional technique .


Of the @ patients enrolled , @ were randomized to the LigaSure group and @ to the conventional group .


Patient characteristics were well balanced in the two groups .


There were no significant differences between the LigaSure and conventional groups in blood loss ( @ vs. @ml , respectively ; P = @ ) or operative time ( @ and @min , respectively ; P = @ ) ; nor in the incidence of surgical complications or duration of postoperative hospital stay .


In a subgroup analysis of patients who underwent gastrectomy that preserved the distal part of the greater omentum , the use of LigaSure significantly reduced blood loss ( @ vs. @ml ; P = @ ) , and the duration of the operation ( @ vs. @min ; P = @ ) .


LigaSure did not contribute to reducing intraoperative blood loss , operative time , or other adverse surgical outcomes .


The usefulness of the device may be limited to a specific part of the surgical procedure in open gastrectomy .


Cerebral microbleeds have been observed in normal-appearing brain tissue of patients with glioma years after receiving radiation therapy .


The contrast of these paramagnetic lesions varies with field strength due to differences in the effects of susceptibility .


The purpose of this study was to compare @T and @T MRI as platforms for detecting cerebral microbleeds in patients treated with radiotherapy using susceptibility-weighted imaging ( SWI ) .


SWI was performed with both @T and @T MR scanners on ten patients with glioma who had received prior radiotherapy .


Imaging sequences were optimized to obtain data within a clinically acceptable scan time .


Both T@ * - weighted magnitude images and SWI data were reconstructed , minimum intensity projection was implemented , and microbleeds were manually identified .


The number of microbleeds was counted and compared among datasets .


Significantly more microbleeds were identified on SWI than magnitude images at both @T ( p = @ ) and @T ( p = @ ) .


Seven-tesla SWI detected significantly more microbleeds than @T SWI for seven out of ten patients who had tumors located remote from deep brain regions ( p = @ ) , but when the additional three patients with more inferior tumors were included , the difference was not significant .


SWI is more sensitive for detecting microbleeds than magnitude images at both @T and @T .


For areas without heightened susceptibility artifacts , @T SWI is more sensitive to detecting radiation therapy-induced microbleeds than @T SWI .


Tumor location should be considered in conjunction with field strength when selecting the most appropriate strategy for imaging microbleeds .


To assess the microflora of root canals in primary molars following use of rotary NiTi files and conventional hand NiTi and stainless steel files .


This randomized clinical trial consisted of a total of @ first and second primary molars requiring root canal treatment , who were selected from children aged @-@ years .


Based on type of root canal instrumentation , the teeth were randomly assigned to three groups of twenty teeth each ; Group A : Rotary NiTi files , Group B : Hand NiTi files and Group C : Hand stainless steel files .


Following administration of local anesthesia , isolation with rubber dam was carried out .


For the purpose of instrumentation and sampling , the palatal canal of maxillary molars and the distal canal of mandibular molars were selected .


Prior to sampling , the orifices of other canals in these teeth were sealed , so as to prevent any contamination .


Instrumentation was carried out in each group using respective instruments along with intermittent saline irrigation .


Root canal samples were obtained both before and after instrumentation , using sterile absorbent paper points and transferred to a sterile vial with transport fluid .


Serial dilutions were prepared and cultured on suitable agar media .


Both aerobic and anaerobic microbial counts were made .


Data obtained was subjected to statistical analysis using Wilcoxon signed rank test and one-way Analysis of variance .


In all three groups , there was a significant reduction in both aerobic and anaerobic mean microbial count following root canal instrumentation .


( p < @ ) .


Rotary NiTi files were as efficient as conventional hand instruments in significantly reducing the root canal microflora .


Disruptive behavior is common in children with autism spectrum disorder .


Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials .


To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior .


This @-week randomized trial compared parent training ( n = @ ) to parent education ( n = @ ) at @ centers ( Emory University , Indiana University , Ohio State University , University of Pittsburgh , University of Rochester , Yale University ) .


We screened @ children ; @ children ( aged @-@ years ) with autism spectrum disorder and disruptive behaviors were randomly assigned ( @ % white , @ % male ) between September @ and February @ .


Parent training ( @ core , @ optional sessions ; @ telephone boosters ; @ home visits ) provided specific strategies to manage disruptive behavior .


Parent education ( @ core sessions , @ home visit ) provided information about autism but no behavior management strategies .


Parents rated disruptive behavior and noncompliance on co-primary outcomes : the Aberrant Behavior Checklist-Irritability subscale ( range , @-@ ) and the Home Situations Questionnaire-Autism Spectrum Disorder ( range , @-@ ) .


On both measures , higher scores indicate greater severity and a @ % reduction indicates clinical improvement .


A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression ( range , @-@ ) , a secondary outcome , with a positive response less than @ .


At week @ , the Aberrant Behavior Checklist-Irritability subscale declined @ % in parent training ( from @ to @ ) compared with @ % for parent education ( @ to @ ) ( treatment effect , -@ ; @ % CI , -@ to -@ ; P < @ , standardized effect size = @ ) .


The Home Situations Questionnaire-Autism Spectrum Disorder declined @ % ( from @ to @ ) compared with @ % in parent education ( @ to @ ) ( treatment effect , -@ ; @ % CI , -@ to -@ ; P < @ , standardized effect size = @ ) .


Neither measure met the prespecified minimal clinically important difference .


The proportions with a positive response on the Clinical Global Impression-Improvement scale were @ % for parent training vs @ % for parent education ( P < @ ) .


For children with autism spectrum disorder , a @-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes , although the clinical significance of the improvement is unclear .


The rate of positive response judged by a blinded clinician was greater for parent training vs parent education .


As relapse after completed cognitive behavior therapy ( CBT ) for obsessive-compulsive disorder ( OCD ) is common , many treatment protocols include booster programs to improve the long-term effects .


However , the effects of booster programs are not well studied .


In this study , we investigated the long-term efficacy of Internet-based CBT ( ICBT ) with therapist support for OCD with or without an Internet-based booster program .


A total of @ participants were included in the long-term follow-up analysis of ICBT .


Of these , @ were randomized to a booster program or no booster program .


Outcome assessments were collected at @ , @ , @ and @ months after receiving ICBT .


The entire sample had sustained long-term effects from pre-treatment to all follow-up assessments , with large within-group effect sizes ( Cohen 's d = @-@ @ ) .


The booster group had a significant mean reduction in OCD symptoms compared to the control condition from booster baseline ( @ months ) to @ months , but not at @ or @ months .


Participants in the booster group improved significantly in terms of general functioning at @ , @ and @ months , and had fewer relapses .


Kaplan-Meier analysis also indicated a significantly slower relapse rate in the booster group .


The results suggest that ICBT has sustained long-term effects and that adding an Internet-based booster program can further improve long-term outcome and prevent relapse for some OCD patients .


Data from an open label randomised controlled trial have suggested possible advantages on both motor and non-motor measures in patients with Parkinson 's disease following @ months exposure to exenatide .


Continued follow up of these same patients was performed to investigate whether these possible advantages persisted in the prolonged absence of this medication .


All participants from an open label , randomised controlled trial of exenatide as a treatment for Parkinson 's disease , were invited for a further follow up assessment at the UCL Institute of Neurology .


This visit included all @ individuals who had previously completed twelve months exposure to exenatide @ug bd and the @ individuals who had acted as randomised controls .


Motor severity of PD was compared after overnight withdrawal of conventional PD medication using blinded video assessment of the MDS-UPDRS , together with several non-motor tests .


This assessment was thus @ months after their original baseline visit , i.e. @ months after cessation of exenatide .


Compared to the control group of patients , patients previously exposed to exenatide had an advantage of @ points ( @ % CI , @-@ @ ; p = @ ) using blinded video rating of the MDS-UPDRS part @ motor subscale .


There was also a difference of @ points ; ( @ % CI , @-@ @ ; p = @ ) between the @ groups on the Mattis Dementia Rating scale .


While these data must still not be interpreted as evidence of neuroprotection , they nevertheless provide strong encouragement for the further study of this drug as a potential disease modifying agent in Parkinson 's disease .


The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation ( MANTRA-PAF ) trial assessed the long-term efficacy of an initial strategy of radiofrequency ablation ( RFA ) vs. antiarrhythmic drug therapy ( AAD ) as first-line treatment for patients with PAF .


In this substudy , we evaluated the effect of these treatment modalities on the Health-Related Quality of Life ( HRQoL ) and symptom burden of patients at @ and @ months .


During the study period , @ patients were enrolled in the MANTRA-PAF trial and randomized to receive AAD ( N = @ ) or RFA ( N = @ ) .


Two generic questionnaires were used to assess the HRQoL -LSB- Short Form-@ ( SF-@ ) and EuroQol-five dimensions ( EQ-@D ) -RSB- , and the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia ( ASTA ) was used to evaluate the symptoms appearing during the trial .


All comparisons were made on an intention-to-treat basis .


Both randomization groups showed significant improvements in assessments with both SF-@ and EQ-@D , at @ months .


Patients randomized to RFA showed significantly greater improvement in four physically related scales of the SF-@ .


The three most frequently reported symptoms were breathlessness during activity , pronounced tiredness , and worry/anxiety .


In both groups , there was a significant reduction in ASTA symptom index and in the severity of seven of the eight symptoms over time .


Both AAD and RFA as first-line treatment resulted in substantial improvement of HRQoL and symptom burden in patients with PAF .


Patients randomized to RFA showed greater improvement in physical scales ( SF-@ ) and the EQ-visual analogue scale .


To establish the efficiency of bowel ligatures in colon cancer surgery , focusing on the extent to which exfoliated cancer cells are shed in the colonic lumen during sigmoidectomy .


Twenty consecutive patients who underwent sigmoidectomy for sigmoid colon cancer were prospectively randomized into two groups : the `` ligatures group '' , in which bowel ligatures were placed , @ , @ , @ cm from the tumor proximally and distally before dissection ; and the `` no ligatures group '' , in which the corresponding sites were ligated only immediately before taking the specimen out .


Each colonic segment ligated was irrigated with saline and samples were sent for blind cytological examination .


Cancer cells were found in the colonic segment where the tumor was located , in @ of @ samples .


The frequency of free cancer cells decreased from @ to @ % ( p < @ ) in the distal @-@ cm colonic segment and from @ to @ % ( p < @ ) in the proximal colonic segment after performing bowel ligatures .


Free cancer cells were confirmed in @ of @ samples at both colonic segments @-@ cm from the tumor , even after bowel ligatures .


Intraluminal exfoliated cancer cells could be eliminated by placing bowel ligatures during sigmoidectomy .


Measures should be considered to eliminate exfoliated cancer cells during colectomy , even after placing bowel ligatures .


To compare postoperative visual symptoms and spectacle freedom after bilateral implantation of the AT LISA @M ( Carl Zeiss Meditec , Jena , Germany ) versus the AcrySof ReSTOR SN@AD@ ( Alcon Laboratories , Irvine , CA ) multifocal intraocular lens ( IOL ) .


Double-masked , prospective , randomized , controlled clinical trial .


A total of @ patients undergoing bilateral sequential cataract surgery or bilateral refractive lens exchange .


Patients were preoperatively randomized ( allocation ratio @:@ ) to bilateral implantation with the AT LISA @M IOL or ReSTOR SN@AD@ IOL .


Postoperative outcomes were assessed @ to @ months after second eye surgery .


The primary outcome was visual symptoms evaluated with the Quality of Vision ( QoV ) questionnaire .


Secondary outcomes included other questionnaire data ( CatQuest-@SF , spectacle independence , vision satisfaction , and dysphotopsia ) and visual function measures ( near , intermediate , and distance visual acuity , binocular reading speed -LSB- International Reading Speed Texts -RSB- , contrast sensitivity , and forward light scatter ) .


Adverse events , including intraoperative and postoperative complications , also were evaluated .


There was no significant difference between IOL groups in Rasch-adjusted QoV scores for frequency ( P = @ ) , severity ( P = @ ) , and bothersomeness ( P = @ ) of visual symptoms ; median ( interquartile ) scores for these QoV subscales were @ ( @-@ ) , @ ( @-@ ) , and @ ( @-@ ) for the AT LISA @M IOL group , respectively , and @ ( @-@ ) , @ ( @-@ ) , and @ ( @-@ ) for the ReSTOR SN@AD@ IOL group , respectively .


Halo was the most prominent dysphotopsia symptom , with @ % in both IOL groups reporting halo symptoms as very bothersome .


Complete spectacle independence was achieved in @ of @ ( @ % ) AT LISA @M recipients and @ of @ ( @ % ) ReSTOR SN@AD@ recipients ( P = @ ) .


Preferred reading distance was slightly nearer for the AT LISA @M IOL .


There were no statistically significant differences in any of the other secondary outcome measures .


Visual symptoms were similar after bilateral implantation of the AT LISA @M and ReSTOR SN@AD@ IOLs .


Both these diffractive bifocal IOLs produce high levels of spectacle independence and patient satisfaction .


However , a small but clinically significant minority of patients remained symptomatic and dissatisfied with visual results @ to @ months after surgery .


Little is known about how colorectal cancer screening test preferences operate together with test access and navigation to influence screening adherence in primary care .


We analyzed data from a randomized trial of @ primary care patients to assess the independent effects of screening test preference for fecal immunochemical test ( FIT ) or colonoscopy , mailed access to FIT and colonoscopy , and telephone navigation for FIT and colonoscopy , on screening .


Preference was not associated with overall screening , but individuals who preferred FIT were more likely to complete FIT screening ( P = @ ) , whereas those who preferred colonoscopy were more likely to perform colonoscopy screening ( P = @ ) .


Mailed access to FIT and colonoscopy was associated with increased overall screening ( OR = @ , P = @ ) , due to a @-fold increase in FIT use .


Telephone navigation was also associated with increased overall screening ( OR = @ , P = @ ) , mainly due to a @-fold increase in colonoscopy performance .


We estimated that providing access and navigation for both screening tests may substantially increase screening compared with a preference-tailored approach , mainly due to increased performance of nonpreferred tests .


Preference influences the type of screening tests completed .


Test access increases FIT and navigation mainly increases colonoscopy .


Screening strategies providing access and navigation to both tests may be more effective than preference-tailored approaches .


Preference tailoring in colorectal cancer screening strategies should be avoided if the objective is to maximize screening rates , although other factors ( e.g. , costs , necessary follow-up ) should also be considered .


Appropriate sedation benefits patients by reducing the stress response , but it requires an appropriate method of assessment to adjust the dosage of sedatives .


The aim of this study was to compare the difference in the sedation of mechanically ventilated patients undergoing flexible bronchoscopy ( FB ) monitored by auditory-evoked potentials ( AEPs ) or the Ramsay sedation scale ( RSS ) .


In a prospective , randomized , controlled study , all patients who underwent FB with propofol sedation were monitored and their sedation adjusted .


During FB , one group was monitored by AEP and another group was monitored by RSS .


The propofol dosage was adjusted by the nursing staff during examination to maintain the Alaris AEP index ( AAI ) value between @ and @ in the AEP group and the RSS at @ or @ in the RSS group .


Before FB and during FB , the AAI , heart rate ( HR ) , and mean arterial pressure ( MAP ) were recorded every @ min .


The percentages of time at the sedation target and the propofol dosages were calculated .


Nineteen patients received AEP monitoring and @ patients received RSS monitoring .


The percentage of time at the sedation target during FB was significantly higher in the AEP monitoring group ( @ % ; interquartile range -LSB- IQR -RSB- , @-@ @ % ) than in the RSS group ( @ % ; IQR , @-@ @ % ) , ( P < @ ) .


During FB , the RSS group had a significantly higher AAI ( P = @ ) , HR ( P < @ ) , and MAP ( P < @ ) than the AEP group .


In mechanically ventilated patients undergoing FB , AEP monitoring resulted in less variation in AAI , HR , and MAP , and a higher percentage of time at the sedation target than RSS monitoring .


Given increasing rates of resistance to existing therapy , new options for treatment and prophylaxis of malaria are needed .


Two randomised , comparative , non-inferiority studies were conducted in Africa , one double-blinded and one open-label .


Adults with fever , a positive peripheral blood smear , and a positive rapid diagnostic test for Plasmodium falciparum were randomised in both studies to either azithromycin ( AZ ) @,@ mg plus chloroquine ( CQ ) @-mg base ( AZCQ @,@ mg ) once daily for three days or mefloquine hydrochloride ( MQ ) @,@ mg ( split dose ) .


In the first study , an additional regimen of AZ @ mg plus CQ @-mg base ( AZCQ @ mg ) once daily for three days was included .


All study participants were hospitalised until three consecutive daily blood smears were negative for asexual P. falciparum parasitaemia .


Study participants were evaluated weekly for @ days , with Day @ polymerase chain reaction ( PCR ) - corrected parasitological clearance rate as primary endpoint .


A total of @ subjects were randomised in the two studies .


At @ days ' follow-up , PCR-corrected parasitological clearance rates in the per protocol population in the first study were @/@ ( @ % ) with AZCQ @,@ mg compared with @/@ ( @ % ) with MQ ( @ % confidence interval -LSB- CI -RSB- : -@ , @ ) .


The AZCQ @-mg regimen was stopped during an interim study review ( six -LSB- @ % -RSB- clearance of seven evaluable ; two lost to follow-up ) .


In the second study , clearance rates were similar : AZCQ @,@ mg @/@ ( @ % ) vs MQ @/@ ( @ % ; @ % CI : -@ , @ ) .


Among the participating countries , in vitro CQ resistance based on pfcrt mutation frequency in the baseline isolates across both studies ranged from @ % ( Zambia ) to @ % ( Uganda ) .


Serious adverse events ( AEs ; all causality ) were observed more frequently with MQ compared with AZCQ ( four vs one , respectively ) , though discontinuations for AEs were similar ( four vs three , respectively ) .


Common AEs in the AZ-containing arms included pruritus , vomiting , dizziness , and headache .


Among adults with symptomatic uncomplicated falciparum malaria in Africa , the combination of AZ @,@ mg and CQ @-mg base once daily for three days resulted in Day @ PCR-corrected parasitological clearance rates of @ % and was non-inferior to treatment with MQ .


AZCQ was well tolerated .


The phase @ LUME-Lung @ study assessed the efficacy and safety of docetaxel plus nintedanib as second-line therapy for non-small-cell lung cancer ( NSCLC ) .


Patients from @ centres in @ countries with stage IIIB/IV recurrent NSCLC progressing after first-line chemotherapy , stratified by ECOG performance status , previous bevacizumab treatment , histology , and presence of brain metastases , were allocated ( by computer-generated sequence through an interactive third-party system , in @:@ ratio ) , to receive docetaxel @ mg/m ( @ ) by intravenous infusion on day @ plus either nintedanib @ mg orally twice daily or matching placebo on days @-@ , every @ weeks until unacceptable adverse events or disease progression .


Investigators and patients were masked to assignment .


The primary endpoint was progression-free survival ( PFS ) by independent central review , analysed by intention to treat after @ events in all patients .


The key secondary endpoint was overall survival , analysed by intention to treat after @ events had occurred , in a prespecified stepwise order : first in patients with adenocarcinoma who progressed within @ months after start of first-line therapy , then in all patients with adenocarcinoma , then in all patients .


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


Between Dec @ , @ , and Feb @ , @ , @ patients were randomly assigned to receive docetaxel plus nintedanib and @ to receive docetaxel plus placebo .


The primary analysis was done after a median follow-up of @ months ( IQR @-@ ) .


PFS was significantly improved in the docetaxel plus nintedanib group compared with the docetaxel plus placebo group ( median @ months -LSB- @ % CI @-@ -RSB- vs @ months -LSB- @-@ -RSB- ; hazard ratio -LSB- HR -RSB- @ -LSB- @ % CI @-@ -RSB- , p = @ ) .


After a median follow-up of @ months ( IQR @-@ ) , overall survival was significantly improved for patients with adenocarcinoma histology who progressed within @ months after start of first-line treatment in the docetaxel plus nintedanib group ( @ patients ) compared with those in the docetaxel plus placebo group ( @ patients ; median @ months -LSB- @ % CI @-@ -RSB- vs @ months -LSB- @-@ -RSB- ; HR @ -LSB- @ % CI @-@ -RSB- , p = @ ) .


Similar results were noted for all patients with adenocarcinoma histology ( @ patients in the docetaxel plus nintedanib group and @ in the docetaxel plus placebo group ; median overall survival @ months -LSB- @ % CI @-@ -RSB- vs @ months -LSB- @ % CI @-@ -RSB- ; HR @ -LSB- @ % CI @-@ -RSB- , p = @ ) , but not in the total study population ( median @ months -LSB- @ % CI @-@ -RSB- vs @ months -LSB- @-@ -RSB- ; HR @ , @ % CI @-@ , p = @ ) .


Grade @ or worse adverse events that were more common in the docetaxel plus nintedanib group than in the docetaxel plus placebo group were diarrhoea ( @ -LSB- @ % -RSB- of @ vs @ -LSB- @ % -RSB- of @ ) , reversible increases in alanine aminotransferase ( @ -LSB- @ % -RSB- vs six -LSB- @ % -RSB- ) , and reversible increases in aspartate aminotransferase ( @ -LSB- @ % -RSB- vs three -LSB- @ % -RSB- ) .