Campaigns that ` counter-moralize ' obesity ( i.e. that refute moralising messages ) are more productive , although they should be tailored to those who see themselves as being overweight .


Whether initial treatment for Parkinson 's disease should consist of levodopa , dopamine agonists , or monoamine oxidase type B inhibitors ( MAOBI ) is uncertain .


We aimed to establish which of these three classes of drug , as initial treatment , provides the most effective long-term control of symptoms and best quality of life for people with early Parkinson 's disease .


In this pragmatic , open-label randomised trial , patients newly diagnosed with Parkinson 's disease were randomly assigned ( by telephone call to a central office ; @:@:@ ) between levodopa-sparing therapy ( dopamine agonists or MAOBI ) and levodopa alone .


Patients and investigators were not masked to group assignment .


Primary outcomes were the mobility dimension on the @-item patient-rated Parkinson 's disease questionnaire ( PDQ-@ ) quality-of-life scale ( range @-@ with six points defined as the minimally important difference ) and cost-effectiveness .


Analysis was intention to treat .


This trial is registered , number ISRCTN@ .


Between Nov @ , @ , and Dec @ , @ , @ patients were assigned to study groups ( @ to levodopa , @ to dopamine agonist , @ to MAOBI ) .


With @-year median follow-up , PDQ-@ mobility scores averaged @ points ( @ % CI @-@ , p = @ ) better in patients randomly assigned to levodopa than those assigned to levodopa-sparing therapy , with no increase or attrition of benefit during @ years ' observation .


PDQ-@ mobility scores were @ points ( @ % CI @-@ , p = @ ) better in patients allocated MAOBI than in those allocated dopamine agonists .


EQ-@D utility scores averaged @ ( @ % CI @-@ ; p = @ ) better with levodopa than with levodopa-sparing therapy ; rates of dementia ( hazard ratio -LSB- HR -RSB- @ , @ % CI @-@ , p = @ ) , admissions to institutions ( @ , @-@ ; p = @ ) , and death ( @ , @-@ , p = @ ) were not significantly different , but the upper CIs precluded any substantial increase with levodopa compared with levodopa-sparing therapy .


@ ( @ % ) of @ patients allocated dopamine agonists and @ ( @ % ) of @ patients allocated MAOBI discontinued allocated treatment because of side-effects compared with @ ( @ % ) of @ patients allocated levodopa ( p < @ ) .


Very small but persistent benefits are shown for patient-rated mobility scores when treatment is initiated with levodopa compared with levodopa-sparing therapy .


MAOBI as initial levodopa-sparing therapy was at least as effective as dopamine agonists .


Observational studies suggest that moderate intakes of retinol and increased circulating retinol levels may increase fracture risk .


Easy access to supplements , combined with an aging population , makes this a potentially important association .


The aim of this study was to investigate plasma retinol and total carotene concentrations in relation to fracture risk after long-term supplementation with retinol and/or beta-carotene in @ adults between @ and @ .


Participants were @ men and @ women in a cancer prevention program who were initially randomized to a retinol ( @ mg RE/d ) or beta-carotene ( @ mg/d ) supplement between @ and @ .


After @ , all participants received the retinol supplement only .


Plasma retinol and total carotene , medication use and various lifestyle factors were measured at annual clinic visits .


Fractures were identified by self-report in @ .


The risk for any fracture or osteoporotic fracture was modeled using Cox proportional hazard models .


Over a median follow-up of @ y , @ participants with plasma samples reported an incident fracture .


Although plasma retinol concentrations were markedly higher than those reported in observational studies , no association was observed between plasma retinol and risk for any fracture ( hazard ratio -LSB- HR -RSB- , @ mol/L ; @ % confidence interval -LSB- CI -RSB- , @-@ @ ) or osteoporotic fracture ( HR , @ mol/L ; @ % CI , @-@ @ ) .


A lower risk for any fracture was suggested with increasing plasma total carotenes ( HR , @ mol/L ; @ % CI , @-@ @ ) .


This study does not support earlier reports of an increased fracture risk associated with increased plasma retinol concentration .


The potential for carotenes to prevent fractures deserves further investigation .


To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device ( ` LNG-IUS ' ) and usual medical treatment for women with menorrhagia in primary care ; and compare the cost-effectiveness findings using two alternative measures of quality of life .


@ women with menorrhagia from @ UK centres were randomised between February @ and July @ .


Women were randomised to having a LNG-IUS fitted , or usual medical treatment , after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment .


The treatment was specified prior to randomisation .


For the economic evaluation we developed a state transition ( Markov ) model with a @ month follow-up .


The model structure was informed by the trial women 's pathway and clinical experts .


The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year ( QALY ) estimated using both EQ-@D and SF-@D .


Using EQ-@D , LNG-IUS was the most cost-effective treatment for menorrhagia .


LNG-IUS costs @ more than usual medical treatment but generated @ more QALYs .


The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was @ per additional QALY .


Using SF-@D , usual medical treatment was the most cost-effective treatment .


Usual medical treatment was both less costly ( @ ) and generated @ more QALYs .


Impact on quality of life is the primary indicator of treatment success in menorrhagia .


However , the most cost-effective treatment differs depending on the quality of life measure used to estimate the QALY .


Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia .


This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial .


Hyperuricemia is a recognized risk factor for cardiovascular diseases .


Soy foods contain a moderate amount of purine and may predispose to raised serum uric acid ( UA ) .


However , no study has examined the long-term effect of soy intake on UA levels .


We examined whether consumption of soy foods and isoflavone extracts for @ months altered serum UA .


The analysis included two randomized controlled trials ( soy protein trial and whole soy trial ) among total @ postmenopausal women with either prehypertension or prediabetes .


We conducted a pooled analysis by combining participants from both the soy flour and soy protein groups ( combined soy foods group ) , participants from both the isoflavone and daidzein groups ( combined isoflavone group ) and participants from both milk placebo groups .


Fasting venous samples were obtained at baseline and the end of the trial for serum UA analysis .


In the pooled data , @ subjects completed the study according to protocol .


The baseline serum UA levels were comparable among the three combined groups .


There was a lower decrease in UA levels among women in the combined soy foods group compared with women in the other two groups ( p = @ and @ ) .


The net decrease and % decrease in UA were @ mol/L ( @ % CI @-@ @ , p = @ ) or @ % ( @ % CI @-@ @ % , p = @ ) between the combined soy foods group and placebo group .


Among Chinese postmenopausal women with either prehypertension or prediabetes , soy intake did not increase urate levels .


Surgical site infections are the most common hospital-acquired infections among surgical patients .


The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections .


The optimal timing of this procedure is still a matter of debate .


While most studies suggest that it should be given as close to the incision time as possible , others conclude that this may be too late for optimal prevention of surgical site infections .


A large observational study suggests that surgical antimicrobial prophylaxis should be administered @ to @minutes before surgery .


The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis .


In this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland , we plan to include @,@ patients undergoing general , oncologic , vascular and orthopedic trauma procedures .


Patients are randomized in a @:@ ratio into two groups : one receiving surgical antimicrobial prophylaxis in the anesthesia room ( @ to @minutes before incision ) and the other receiving surgical antimicrobial prophylaxis in the operating room ( less than @minutes before incision ) .


We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than @minutes before the scheduled incision .


The primary outcome is the occurrence of surgical site infections during a @-day follow-up period ( one year with an implant in place ) .


When assuming a @ % surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room , the planned sample size has an @ % power to detect a relative risk reduction for surgical site infections of @ % when administering surgical antimicrobial prophylaxis in the anesthesia room ( with a two-sided type I error of @ % ) .


We expect the study to be completed within three years .


The results of this randomized controlled trial will have an important impact on current international guidelines for infection control strategies in the hospital .


Moreover , the results of this randomized controlled trial are of significant interest for patient safety and healthcare economics .


Depression and anxiety are prevalent in patients with chronic pain and adversely affect pain , quality of life , and treatment response .


The purpose of this psychometric study was to determine the reliability and validity of the four-item Patient Reported Outcomes Measurement Information System ( PROMIS ) depression and anxiety scales in patients with chronic pain .


Secondary analysis of data from the Stepped Care to Optimize Pain care Effectiveness study , a randomized clinical trial of optimized analgesic therapy .


Five primary care clinics at the Roudebush VA Medical Center ( RVAMC ) in Indianapolis , Indiana .


Two hundred forty-four primary care patients with chronic musculoskeletal pain .


All patients completed the four-item depression and anxiety scales from the PROMIS @-item profile , as well as several other validated psychological measures .


The minimally important difference ( MID ) using the standard error of measurement ( SEM ) was calculated for each scale , and convergent validity was assessed by interscale correlations at baseline and @ months .


Operating characteristics of the PROMIS measures for detecting patients who had probable major depression or were anxiety-disorder screen-positive were calculated .


The PROMIS scales had good internal reliability , and the MID ( as represented by two SEMs ) was @ points for the depression scale and @ points for the anxiety scale .


Convergent validity was supported by strong interscale correlations .


The optimal screening cutpoint on the @ - to @-point PROMIS scales appeared to be @ for both the depression and anxiety scales .


The PROMIS four-item depression and anxiety scales are reasonable options as ultra-brief measures for screening in patients with chronic pain .


To investigate the association of radiographic progression defined by Prostate Cancer Working Group ( PCWG ) -@ guidelines and overall survival ( OS ) in men with metastatic castration-resistant prostate cancer ( mCRPC ) .


Two trials that used PCWG-@ guidelines to define progression were analysed : a randomized phase II trial ( n = @ ) comparing first-line docetaxel-prednisone plus AT-@ or placebo , and a phase III trial ( n = @ ) comparing prednisone plus sunitinib or placebo after docetaxel-based chemotherapy .


Cox proportional hazards regression models were used to estimate the association of radiographic progression with OS .


Landmark analyses compared progressing patients with those who had not progressed .


Sub-analyses compared patients removed from trial for progression vs other reasons .


An increased risk of death was seen for radiographic progression at landmark times from @ to @ months with docetaxel-based therapy ( hazard ratio -LSB- HR -RSB- > @ at all time-points ) .


An increased risk of death was also seen with post-docetaxel prednisone alone or with sunitinib for progression at landmark times from @ to @ months ( HR > @ at all time-points ) .


Kendall 's was @ ( P < @ ) in the setting of docetaxel-based therapy and @ ( P < @ ) in the post-docetaxel setting for association between radiographic progression and death amongst patients with both events .


Removal from study due to radiographic progression was associated with a significantly lower OS compared with removal for other reasons in both trials .


Limitations of a retrospective analysis apply and there was no central radiology review .


Radiographic progression by PCWG-@ criteria was significantly associated with OS in patients with mCRPC receiving first-line docetaxel-based chemotherapy or post-docetaxel therapy .


With external validation as a surrogate endpoint in trials showing survival benefits , the use of radiographic progression-free survival may expedite drug development in mCRPC , which has been hampered by the lack of intermediate endpoints .


This study aimed to develop a system for predicting work-related musculoskeletal disorders ( WMSD ) among dental students .


The system comprised @ accelerometer sensors to register neck and upper back postures and movements , and software developed to collect and process the data .


Hidden Markov models ( HMMs ) were used to predict the likelihood of WMSD in dental students by comparing their neck and upper back movement patterns with WMSD and non-WMSD HMMs learned from previous data .


To evaluate the performance of the system , @ participants were randomly assigned into a @ @ crossover trial scheduled for each sequence of working : receiving feedback or no-feedback from the system .


The primary outcome measure was the extension of the neck and upper back , before ( pre-test ) and after ( posttest ) receiving feedback or no-feedback from the system .


The secondary outcome measure was the log likelihood of classifying the movements as WMSD .


The results showed that in the group that received feedback , the extension of the neck in the y axis and of the upper back in the y axis decreased significantly ( t test , p < @ ) on the post-test .


The system for predicting and preventing WMSD aids the correction of the extension of the neck and upper back in the y axis .


This exploratory study investigated whether integration of the Client Self-Care Commitment Model ( CSCCM ) Instructional Module in a dental hygiene curriculum , as an additional educational experience , would further enhance students ' client-centred knowledge , values and actions .


Subjects ( n = @ ) were second-year students enrolled in a BS entry-level dental hygiene programme with random assignments to two groups .


The experimental group participated in a @-h didactic session , an @-h preclinical session , an @-h clinical session and a @-h question and answer period .


An online pretest-post-test survey administered at three time intervals ( baseline , @ and @ weeks ) was used to measure differences between the groups on three subscales ( knowledge , values and actions ) .


Cronbach 's for each subscale across time was above @ .


A repeated-measures anova determined that there were no statistically significant interactions between Time and Group ( experimental or control group ) for the knowledge and values variables ; however , there was a significant interaction between Time ( P = @ ) and Group ( P = @ ) for the actions variable .


A content analysis of participants ' responses to three open-ended questions reflected both positive and negative comments and revealed that students ' primary barrier to implementing the model in client care was lack of time .


Significant differences in the actions variable between the groups suggested that implementation of the CSCCM Instructional Module enhanced students ' client-centred actions during client care .


To evaluate health related quality of life ( HRQOL ) in TEACH , a phase III randomized placebo controlled trial of @ months of adjuvant lapatinib in HER@ positive ( HER@ + ) early breast cancer which demonstrated marginal benefit in disease-free survival .


Women on TEACH completed the Short Form @-item health survey ( version@ ; SF-@v@ ) at the baseline , six and @ months after therapy initiation and six monthly thereafter .


Mean changes were compared between treatment groups for two summary measures ( Physical and Mental Component Summary scores ; PCS and MCS ) and eight domain measures ( physical functioning , role physical , bodily pain , general health , vitality , social functioning , role emotional and mental health ) , and in patients discontinuing therapy .


A five-point change was deemed a Minimally Clinically Important Difference ( MCID ) .


Response analysis compared the proportion of patients demonstrating a MCID in HRQOL , and a regression analysis identified predictors of worsening HRQOL .


@ ( @ % ) subjects completed baseline SF-@v@ .


During the initial @ months , summary SF-@v@ scores decreased in both arms but did not reach Minimally Clinically Important Difference ( MCID ) despite significant incidences of diarrhoea and rash in lapatinib treated patients .


At six months , women receiving lapatinib had more significant reductions ( p < @ versus placebo ) in social functioning .


Early treatment discontinuations were more frequent on lapatinib ( @ % versus @ % ) , and were associated with more substantial decrements of HRQOL in both arms .


For those discontinuing primarily due to adverse events , decrements in HRQOL reached MCID in Mental Summary scores ( MCS ) only .


Lower baseline HRQOL was a significant predictor of worsening HRQOL ( p < @ ) .


Despite frequent but usually mild toxicities , adjuvant lapatinib is not associated with clinically significant decreases in overall HRQOL .


These placebo-controlled results may also help to inform physicians and patients using lapatinib in metastatic HER@ positive breast cancer .


Cerebrovascular anomalies resulting from the persistence of unfused embryonic twig-like vessels are associated with intracranial aneurysms .


All records of patients with ruptured intracranial aneurysms who were treated at our institution were retrospectively reviewed for the presence of aneurysm-associated , unfused , twig-like vessels in the middle cerebral artery ( MCA ) .


Such vessels were recorded as twig-like MCA ( T-MCA ) or twig-like networks of an anomalous collateral artery ( T-NACA ) .


Additionally , we sought to characterize vulnerable intracranial aneurysms associated with those vascular anomalies .


A total of @ ruptured aneurysms were treated from June @ to November @ ; of these , @ ruptured aneurysms exhibited the presence of ipsilateral , unfused , twig-like vessels .


Computed tomography ( CT ) scans , three-dimensional CT angiography , and digital subtraction angiography ( DSA ) were performed immediately after the initial ictus .


Data analysis included age , sex , Hunt and Hess grade ( HHG ) , Fisher grade ( FG ) , medical risk factors , angiographic architecture , operative methods and findings , radiologic outcomes , and Glasgow outcome scale ( GOS ) .


The average follow-up period was @ months .


Patient ages ranged from @ to @ years with a mean age of @ ; there were two females and two males .


All four patients showed FG IV , and three patients had unfavorable HHG ( IV in @ and V in one ) at admission .


An M@ segmental occlusion and an adjacent small aneurysmal pouch were detected with three-dimensional CT angiography in three patients .


Hypertension was recorded in all patients .


The initial DSA revealed T-MCA in one patient and T-NACA in three patients .


Six aneurysms in all , including two unruptured aneurysms , were found ; three ruptured aneurysms existed inside of the twigs .


All but one patient required diverse treatment modalities , and four of the five aneurysms were completely occluded after treatment .


The remaining aneurysm , treated only with gluing , disappeared during follow-up .


In two of the three patients with T-NACA , atresia of the M@ segment was confirmed intraoperatively .


The GOS during follow-up was recorded as favorable ( good recovery ) in two patients and unfavorable ( severe disability and permanent vegetative state ) in two patients .


These unique vascular anomalies , T-MCA and T-NACA , which are caused by heterogeneous maldevelopment of the primitive cerebral vessels , are not benign because of their frequent association with flow-related aneurysms , which are vulnerable to rupture .


Microsurgical or endovascular treatments for this type of flow-related aneurysm associated with twigs are mandatory to prevent fatal rebleeding , and more attention has to be given when physicians encounter steno-occlusive MCA lesions in patients with subarachnoid hemorrhage to detect any vulnerable aneurysms associated with twig-like vessels .


To evaluate the efficacy of memantine on metabolite levels in different areas of the brain and to determine whether changes in metabolite levels correlate with clinical variables in Fibromyalgia ( FM ) patients .


Doubled-blind parallel randomized controlled trial .


Twenty-five patients diagnosed with FM were enrolled in the study .


Patients were administered questionnaires on pain , anxiety , depression , quality of life , and cognitive impairment , and single-voxel MRS of the brain was performed .


All assessments were performed at baseline and after @months of treatment with memantine or placebo .


Patients treated with memantine exhibited a significant increase in the glutamate ( P = @ ) , glutamate/creatine ratio ( P = @ ) , combined glutamate + glutamine ( P = @ ) and total N-acetyl-aspartate ( NAA+NAAG ) ( P = @ ) in the posterior cingulate cortex compared with those on placebo .


Furthermore , the memantine group exhibited increases in creatine ( P = @ ) and choline ( Cho ) ( P = @ ) in the right posterior insula and also a correlation between choline and the Fibromyalgia Impact Questionnaire ( FIQ ) in the posterior insula ( P = @ ) was observed .


Memantine treatment resulted in an increase in cerebral metabolism in FM patients , suggesting its utility for the treatment of the illness .


The objective of this study was to evaluate the effect of vaginal packing following pelvic floor surgery with regard to post-operative pain , bleeding and infection .


This was a double-blind randomised study of women undergoing vaginal hysterectomy and/or pelvic floor repair at a tertiary urogynaecology unit .


The primary outcome of day @ post-operative pain was assessed using the short-form McGill Pain score .


Secondary outcomes were haematological and infective morbidity , evaluated using changes in full blood count , and cultures of midstream urine and high vaginal swabs .


A transvaginal ultrasound scan to exclude pelvic haematoma was performed at @ weeks in all women who underwent vaginal hysterectomy with or without a pelvic floor repair .


In total , @ women were recruited : mean age @ years ( @-@ years ) , mean body mass index @ kg/m ( @ ) and median parity @ .


Women were randomised into the ` pack ' ( n = @ ) and ` no pack ' ( n = @ ) arms with no demographic differences between the groups .


No statistically significant differences in the post-operative pain scores or secondary outcome measures were demonstrated .


Incidence of haematoma formation ( @ % no pack , @ % pack , p = @ ) was not statistically significant .


There were three clinically significant complications in the no pack group and none in the pack group .


This is the first study to examine pain in association with post-operative vaginal packing .


There is no evidence to suggest that packing increases pain scores or post-operative morbidity .


A trend towards increased haematoma and significant complications was seen in the no pack group .


As vaginal packing does no harm and may be of some benefit it may be argued that packing should be recommended as routine clinical practice .


Cognitive remediation ( CR ) aims primarily to improve cognition and functional outcomes .


However , a limited number of studies reported a positive effect on symptoms .


This limited effect may be because the symptom clusters considered are too broad and heterogeneous .


This study explores , for the first time , the effect of CR on five empirically defined symptom dimensions of schizophrenia .


Participants were patients with schizophrenia taking part in a randomised controlled trial comparing CR plus treatment as usual ( CR , N = @ ) to treatment as usual ( TAU , N = @ ) .


All participants were assessed at baseline and @-weeks ( i.e. at the conclusion of treatment for the CR group ) with the Positive and Negative Symptoms Scale ( PANSS ) .


Five symptom dimensions were derived from the PANSS scores : Positive ( POS ) , Negative ( NEG ) , Disorganised ( DIS ) , Excited ( EXC ) and Emotional Distressed ( EMD ) .


After CR , the therapy group had a significant reduction in DIS and NEG symptom dimensions compared to the TAU group .


The traditional PANSS factors showed no effect of CR on symptoms .


CR can have not only a positive effect on disorganisation but also on negative symptoms .


Using detailed symptom dimensions can characterise more accurately the effect of CR on symptom of schizophrenia .


To increase access to early second-trimester surgical abortion by determining noninferiority of same-day synthetic osmotic dilators compared with overnight Laminaria for cervical preparation before early second-trimester dilation and evacuation .


We enrolled women between @ and @ weeks of gestation and randomized them to same-day synthetic osmotic dilators or overnight Laminaria .


Study participants and clinicians were blinded to group assignment .


The primary outcome was procedure duration .


The trial was powered to assess noninferiority of synthetic osmotic dilators to exclude a mean difference of @ minutes or longer .


We enrolled @ patients : @ were randomized to same-day synthetic osmotic dilators and @ to overnight Laminaria .


Mean procedure duration was @ and @ minutes , respectively , with a mean difference of @ minutes ( @ % confidence interval -@ to @ ) .


Same-day synthetic osmotic dilators resulted in less initial cervical dilation than overnight Laminaria ( mean circumference @ compared with @ mm Pratt , P < @ ) and required more mechanical dilation ( @ % compared with @ % , P = @ ) .


There was no difference in complications , all of which were minor , or in the median procedural difficulty score rated by physicians .


Most patients in both groups would choose a same-day procedure if necessary in the future .


Despite less initial cervical dilation and a greater need for mechanical dilation , same-day synthetic osmotic dilators are not inferior to overnight Laminaria with respect to procedure duration .


Same-day osmotic dilation is preferred by patients and may be a reasonable alternative to overnight Laminaria for cervical preparation before early second-trimester dilation and evacuation .


Obstructive sleep apnea ( OSA ) , common in Parkinson disease ( PD ) , contributes to sleep disturbances and daytime sleepiness .


We assessed the effect of continuous positive airway pressure ( CPAP ) on OSA , sleep , and daytime sleepiness in patients with PD .


This was a randomized placebo-controlled , crossover design .


Patients with PD and OSA were randomized into @ w of therapeutic treatment or @ w of placebo followed by @ w of therapeutic treatment .


Patients were evaluated by polysomnography ( PSG ) and multiple sleep latency test ( MSLT ) pretreatment ( baseline ) , after @ w , and after @ w of CPAP treatment .


Analyses included mixed models , paired analysis , and within-group analyses comparing @ w to @ w of treatment .


Sleep laboratory .


Thirty-eight patients with PD ( mean age = @ @ y ; @ females ) .


Continuous positive airway pressure .


PSG OUTCOME MEASURES : sleep efficiency , % sleep stages ( N@ , N@ , N@ , R ) , arousal index , apnea-hypopnea index ( AHI ) , and % time oxygen saturation < @ % ( % time SaO@ < @ % ) .


MSLT outcome measures : mean sleep-onset latency ( MSL ) .


There were significant group-by-time interactions for AHI ( P < @ ) , % time SaO@ < @ % ( P = @ ) , % N@ ( P = @ ) and % N@ ( P = @ ) .


Subjects receiving therapeutic CPAP showed significant decrease in AHI , % time SaO@ < @ % , % N@ , and significant increase in % N@ indicating effectiveness of CPAP in the treatment of OSA , improvement in nighttime oxygenation , and in deepening sleep .


The paired sample analyses revealed that @ w of therapeutic treatment resulted in significant decreases in arousal index ( t = @ , P = @ ) .


All improvements after @ w were maintained at @ w. Finally , @ w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness ( P = @ ) .


Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events , improving oxygen saturation , and deepening sleep in patients with Parkinson disease and obstructive sleep apnea .


Additionally , arousal index was reduced and effects were maintained at @ weeks .


Finally , @ weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test .


These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease .


Simple aeration of food matrices with gas has previously been shown to generate immediate suppression of appetite , though duration of effects has not been shown .


This research tested whether liquids aerated with nitrous oxide ( N@ O ) to achieve high in-body stability could produce enhanced and sustained effects on eating motivations .


In two randomized cross-over studies , appetite ratings were collected for @ min .


In Study @ , @ volunteers consumed a full portion liquid ( @ ml , @ kcal ) or aerated ( @,@ ml , @ kcal ) drink at @ min , or half portions of liquid ( @ ml , @ kcal ) or aerated ( @ ml , @ kcal ) drink at @ and @ min .


In Study @ , assessing the effect of N@ O itself , @ volunteers consumed water saturated with N@ O or with CO@ @ min after a mini-drink ( @ kcal ) .


Appetite was quantified by area-under-the curve ( AUC ) and time-to-return-to-baseline ( TTRTB ) .


Full - and half-size aerated drinks decreased hunger AUC over @ h by @ and @ % ( P < @ ) versus the respective liquid versions .


Effects were also sustained significantly longer ( TTRTB from @ to @ and from @ to @ min , respectively ) .


In Study @ , N@ O and CO@ had similar effects on appetite ratings .


Aeration of foods using appropriate microstructural design has a powerful effect on eating motivations .


Hypo-fractionated external beam radiotherapy with narrow CTV-PTV margins is increasingly applied for prostate cancer .


This demands a precise target definition and knowledge on target location and extension during treatment .


It is unclear how increase in fraction size affects changes in prostate volume during treatment .


Our aim was to study prostate volume changes during extreme hypo-fractionation ( @ @ Gy ) by using sequential MRIs .


Twenty patients treated with extreme hypo-fractionation were recruited from an on-going prospective randomized phase III trial .


An MRI scan was done before start of treatment , at mid treatment and at the end of radiotherapy .


The prostate was delineated at each MRI and the volume and maximum extension in left-right , anterior-posterior and cranial-caudal directions were measured .


There was a significant increase in mean prostate volume ( @ % ) at mid treatment as compared to baseline .


The prostate volume remained enlarged ( @ % ) at the end of radiotherapy .


Prostate swelling was most pronounced in the anterior-posterior and cranial-caudal directions .


Extreme hypo-fractionation induced a significant prostate swelling during treatment that was still present at the time of last treatment fraction .


Our results indicate that prostate swelling is an important factor to take into account when applying treatment margins during short extreme hypo-fractionation , and that tight margins should be applied with caution .


This is a randomized , double-blind , placebo-controlled study aimed to evaluate the clinical and biologic effects of letrozole plus lapatinib or placebo as neoadjuvant therapy in hormone receptor ( HR ) - positive/human epidermal growth factor receptor @ ( HER@ ) - negative operable breast cancer .


Ninety-two postmenopausal women with stage II to IIIA primary breast cancer were randomly assigned to preoperative therapy consisting of @ months of letrozole @ mg orally daily plus lapatinib @,@ mg orally daily or placebo .


Surgery was performed within @ weeks from the last study medication .


Clinical response was assessed by ultrasonography .


Pre - and post-treatment samples were evaluated for selected biomarkers .


Fresh-frozen tissue samples were collected for genomic analyses .


Numerically similar clinical response rates ( partial + complete response ) were observed ( @ % for letrozole-lapatinib and @ % for letrozole-placebo ) .


Toxicities were generally mild and manageable .


A significant decrease in Ki-@ and pAKT expression from baseline to surgery was observed in both arms .


Overall , @ patients ( @ % ) had a mutation in PIK@CA exon @ or @ .


In the letrozole-lapatinib arm , the probability of achieving a clinical response was significantly higher in the presence of PIK@CA mutation ( objective response rate , @ % v @ % in PIK@CA wild type ; P = @ ) .


The combination of letrozole-lapatinib in early breast cancer was feasible , with expected and manageable toxicities .


In unselected estrogen receptor-positive/HER@-negative patients , letrozole-lapatinib and letrozole-placebo resulted in a similar overall clinical response rate and similar effect on Ki-@ and pAKT .


Our secondary end point findings of a significant correlation between PIK@CA mutation and response to letrozole-lapatinib in HR-positive/HER@-negative early breast cancer must now be independently confirmed .


To study the effects of low tidal volume with positive end-expiratory pressure ( PEEP ) on arterial blood gases of patients undergoing laparoscopic urologic surgeries .


Eighty-six laparoscopic urologic patients were enrolled in this study .


Patients were randomized into two groups according to the ventilatory settings .


In the conventional group ( Group C ) ( n = @ ) , the tidal volume was @mL/kg , and the PEEP was set at @cm of H@O .


In the low tidal volume with PEEP group ( Group LP ) , the tidal volume was @mL/kg , with PEEP of @cm of H@O .


In both groups total minute volume was @ L/kg .


Peak and plateau airway pressure ( PPEAK and PPLAT , respectively ) and arterial blood gases were recorded before pneumoperitoneum ( PNP ) ( T@ ) and the first and third hour ( T@ ) after PNP induction and also after extubation in the intensive care unit .


Additionally , heart rate , mean arterial pressure , and peripheral O@ saturation of hemoglobin were recorded .


Heart rate , PPEAK , and PPLAT values were similar in both groups .


Partial arterial O@ pressure values measured postoperatively were significantly higher in Group LP , whereas those measured before PNP induction were similar ( P = @ and P = @ , respectively ) .


Compared with the baseline , partial arterial CO@ pressure values measured at T@ and at T@ after PNP induction were significantly higher in Group C than in Group LP ( P < @ ) .


The pH values of Group C at T@ and at T@ postoperatively were significantly lower than the values of Group LP ( P < @ ) .


Extubation times were significantly lower in Group LP .


The results of the present study suggest that low tidal volume with PEEP application may be a good alternative for preventing high CO@ levels and yielding better oxygenation and lower extubation times in patients undergoing prolonged laparoscopic urology .


Masitinib is a highly selective tyrosine kinase inhibitor with activity against the main oncogenic drivers of gastrointestinal stromal tumor ( GIST ) .


Masitinib was evaluated in patients with advanced GIST after imatinib failure or intolerance .


Prospective , multicenter , randomized , open-label trial .


Patients with inoperable , advanced imatinib-resistant GIST were randomized ( @ : @ ) to receive masitinib ( @ mg/kg/day ) or sunitinib ( @ mg/day @-weeks-on/@-weeks-off ) until progression , intolerance , or refusal .


Primary efficacy analysis was noncomparative , testing whether masitinib attained a median progression-free survival ( PFS ) ( blind centrally reviewed RECIST ) threshold of > @ months according to the lower bound of the @ % unilateral confidence interval ( CI ) .


Secondary analyses on overall survival ( OS ) and PFS were comparative with results presented according to a two-sided @ % CI .


Forty-four patients were randomized to receive masitinib ( n = @ ) or sunitinib ( n = @ ) .


Median follow-up was @ months .


Patients receiving masitinib experienced less toxicity than those receiving sunitinib , with significantly lower occurrence of severe adverse events ( @ % versus @ % , respectively , P = @ ) .


Median PFS ( central RECIST ) for the noncomparative primary analysis in the masitinib treatment arm was @ months ( @ % CI @ ) .


Secondary analyses showed that median OS was significantly longer for patients receiving masitinib followed by post-progression addition of sunitinib when compared against patients treated directly with sunitinib in second-line -LSB- hazard ratio ( HR ) = @ , @ % CI @-@ @ , P = @ -RSB- .


This improvement was sustainable as evidenced by @-month follow-up OS data ( HR = @ , @ % CI @-@ @ , P = @ ) ; an additional @ months survival advantage being reported for the masitinib treatment arm .


Risk of progression while under treatment with masitinib was in the same range as for sunitinib ( HR = @ , @ % CI @-@ @ , P = @ ) .


Primary efficacy analysis ensured the masitinib treatment arm could satisfy a prespecified PFS threshold .


Secondary efficacy analysis showed that masitinib followed by the standard of care generated a statistically significant survival benefit over standard of care .


Encouraging median OS and safety data from this well-controlled and appropriately designed randomized trial indicate a positive benefit-risk ratio .


Further development of masitinib in imatinib-resistant/intolerant patients with advanced GIST is warranted .


We evaluated the efficacy and safety of a once monthly oxybutynin vaginal ring in women with overactive bladder .


This randomized , multicenter , double-blind , @-week phase @ study compared oxybutynin vaginal ring ( @ or @ mg daily ) to a placebo vaginal ring in women with well-defined overactive bladder symptoms .


The primary efficacy variable was the change from baseline to week @ in the total weekly number of incontinence episodes ( stress and urge ) .


Safety was measured in terms of treatment emergent adverse events , laboratory , physical , gynecologic examinations , electrocardiogram and vital signs .


After a @-week post-randomization placebo run-in phase ( sample size @ ) @ women entered the treatment phase ( safety population ) .


Of these women @ met all @ overactive bladder specific baseline characteristics of @ or more urinary urge incontinence episodes weekly , urinary frequency @ or more voids per @ hours and voided volume @ L or less per @ hours ) ( analysis population ) .


Women treated with @ and @ mg daily oxybutynin vaginal ring had significantly fewer incontinence episodes weekly ( p = @ and p = @ , respectively ) , lower daily urinary frequency ( p = @ , p = @ ) and a higher proportion had no incontinence episodes at week @ ( p = @ , p = @ ) compared with placebo .


The change in severity of urgency and voided volume was similar for all groups ( p > @ ) .


Except for a higher incidence of dry mouth and urinary tract infections that were not always culture confirmed , the oxybutynin vaginal ring was well tolerated and had a safety profile similar to that of the placebo vaginal ring .


The oxybutynin vaginal ring appears to be an effective and safe once monthly treatment option for women with overactive bladder characterized primarily by urinary urge incontinence that merits further evaluation in a phase @ study .


The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs , acid suppressive therapy , and antiplatelets .


However , their effectiveness in changing actual practice is unknown .


The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies .


A cost-benefit analysis will also be conducted .


We will carry out a parallel , open , superiority , randomized trial directed to primary care physicians .


Physicians will be recruited and allocated at a cluster-level ( primary care unit ) by minimization .


Data will be analyzed at the physician level .


Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate .


Physicians in intervention units will be offered individual educational outreach visits ( one for each guideline ) at their workplace during a six-month period .


Physicians in the control group will be offered a single unrelated group training session .


Primary outcomes will be the proportion of cyclooxygenase-@ inhibitors prescribed in the anti-inflammatory class , and the proportion of omeprazole in the proton pump inhibitors class at @ months post-intervention .


Prescription data will be collected from the regional pharmacy claims database .


We estimated a sample size of @ physicians in each group , corresponding to @ clusters with a mean size of @ physicians .


Outcome collection and data analysis will be blinded to allocation , but due to the nature of the intervention , physicians and detailers can not be blinded .


This trial will attempt to address unresolved issues in the literature , namely , long term persistence of effect , the importance of sequential visits in an outreach program , and cost issues .


If successful , this trial may be the cornerstone for deploying large scale educational outreach programs within the Portuguese National Health Service .


Few studies have compared the effect of Web-based eLearning versus small-group learning on medical student outcomes .


Palliative and end-of-life ( PEOL ) education is ideal for this comparison , given uneven access to PEOL experts and content nationally .


In @ , the authors enrolled all third-year medical students at the University of California , Davis School of Medicine into a quasi-randomized controlled trial of Web-based interactive education ( eDoctoring ) compared with small-group education ( Doctoring ) on PEOL clinical content over two months .


Students participated in three @-hour PEOL sessions with similar content .


Outcomes included a @-item PEOL-specific self-efficacy scale with three domains ( diagnosis/treatment -LSB- Cronbach alpha = @ ; CI : @-@ @ -RSB- , communication/prognosis -LSB- alpha = @ ; CI : @-@ @ -RSB- , and social impact/self-care -LSB- alpha = @ ; CI : @-@ @ -RSB- ) ; @ knowledge items ; @ curricular advantage/disadvantages ; and curricular satisfaction ( both students and faculty ) .


Students were randomly assigned to Web-based eDoctoring ( n = @ ) or small-group Doctoring ( n = @ ) curricula .


Self-efficacy and knowledge improved equivalently between groups ( e.g. , prognosis self-efficacy , @ % ; knowledge , @ % -@ % ) .


Student and faculty ratings of the Web-based eDoctoring curriculum and the small-group Doctoring curriculum were equivalent for most goals , and overall satisfaction was equivalent for each , with a trend toward decreased eDoctoring student satisfaction .


Findings showed equivalent gains in self-efficacy and knowledge between students participating in a Web-based PEOL curriculum in comparison with students learning similar content in a small-group format .


Web-based curricula can standardize content presentation when local teaching expertise is limited , but it may lead to decreased user satisfaction .


We hypothesized that novices would be able to use the McGrath MAC ( Aircraft Medical Ltd , Edinburgh , UK ) equally as well as the GlideScope Ranger ( Verathon , Inc , Bothell , WA ) for intubation in regular simulated airways .


We performed a prospective , randomized crossover study of @ medical students using the McGrath MAC , GlideScope Ranger , and Macintosh in a manikin with @ normal airways .


The primary outcome was the intubation time .


Secondary outcomes included the success rates and the overall glottic view of the @ laryngoscopes .


The mean intubation times for each attempt with the McGrath MAC were @ @ seconds or less and did not differ significantly from those obtained with the GlideScope Ranger or the Macintosh in both airway scenarios ( P = @ ; P = @ ) .


The mean success rates at each attempt with the McGrath MAC were @ % @ % or more , equal to the Macintosh and the GlideScope Ranger in both scenarios ( P = @ ; P = @ ) except during the first intubation attempt in a normal airway ( P = @ ) .


The median grades of the glottic view visible at each intubation attempt with the McGrath Mac were Cormack-Lehane grade @ ( scenario @ : interquartile range , @-@ ; scenario @ : interquartile range , @-@ ) , which was significantly better than the Macintosh laryngoscope in both scenarios .


However , the McGrath Mac did not produce a better glottic view than the GlideScope Ranger with either scenario .


The intubation performance of novices using the McGrath MAC was equal to their performance using the GlideScope Ranger in regular simulated airways .


Complications are a common and accepted risk of surgery .


Failure to optimize the management of patients who suffer postoperative morbidity may result in poorer surgical outcomes .


This study aimed to evaluate a checklist-based tool to improve and standardize care of postoperative complications .


Surgical trainees conducted baseline ward rounds of three patients with common postoperative complications in a high-fidelity simulated ward environment .


Subjects were randomized to intervention or control groups , and final ward rounds were conducted with or without the aid of checklists for management of postoperative complications .


Adherence to critical care processes was assessed , in addition to technical ( Surgical Ward-care Assessment Tool , SWAT ) and non-technical ( Ward NOn-TECHnical Skills ( W-NOTECHS ) scale ) performance .


Subjects completed a feedback questionnaire regarding their perception of the checklists .


Twenty trainees completed @ patient assessments .


All intervention group subjects opted to use the checklists , resulting in significantly fewer critical errors compared with controls ( median ( i.q.r. ) @ ( @-@ ) versus @ ( @-@ ) per cent ; P < @ ) .


The intervention group demonstrated improved patient management ( SWAT-M ) ( P < @ ) and non-technical skills ( P = @ ) between baseline and final ward rounds , whereas controls did not ( P = @ and P = @ respectively ) .


A small learning effect was seen with improvement in patient assessment ( SWAT-A ) in both groups ( P < @ ) .


Intervention group subjects found checklists easy and effective to use , and would want them used for their own care if they were to experience postoperative complications .


Checklist use resulted in significantly improved standardization , evidence-based management of postoperative complications , and quality of ward rounds .


Simulation-based piloting aided appropriate use of checklists and staff engagement .


Checklists represent a low-cost intervention to reduce rates of failure to rescue and to improve patient care .


We sought to improve lumbar spine bone mineral density ( LS-BMD ) in long-term survivors of childhood acute lymphoblastic leukemia ( ALL ) using calcium and cholecalciferol supplementation .


This double-blind , placebo-controlled trial randomized @ participants ( median age , @ -LSB- @-@ @ -RSB- years ) with age - and gender-specific LS-BMD Z-scores < @ to receive nutritional counseling with supplementation of @,@ mg/day calcium and @ International Unit cholecalciferol or placebo for @ years .


The primary outcome was change in LS-BMD assessed by quantitative computerized tomography ( QCT ) at @ months .


Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes .


Pre-randomization LS-BMD below the mean was associated with male gender ( P = @ ) , White race ( P = @ ) , lower body mass index ( P < @ ) , and cumulative glucocorticoid doses of @,@ mg ( P = @ ) .


One hundred eighty-eight ( @ % ) participants completed the study ; @ % adhered to the intervention .


Mean LS-BMD change did not differ between survivors randomized to supplements ( @ @ ) or placebo ( @ @ ) .


Participants aged @-@ years and those @-@ years had the greatest mean increases in LS-BMD ( @ @ and @ @ , respectively ) .


Vitamin D insufficiency ( serum @ -LSB- OH -RSB- D < @ ng/ml ) found in @ ( @ % ) , was not associated with LS-BMD outcomes ( P = @ ) .


Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL ( @ % of whom had LS-BMD Z-scores above the mean at study entry ) .


Strategies for oxygen therapy for preterm infants , such as the Vermont-Oxford 's ` Breathsavers ' guidelines , seek to strike a balance between the potential risks of the extremes of hyperoxia and hypoxia in preterm infants .


Using an algorithm based on those guidelines , we aimed to compare the proportion of time spent within the SpO@ target range during algorithm-based management of oxygen delivery compared with routine nursing care .


In a randomised crossover trial , maintenance of SpO@ over a @-hour period during routine care was compared with algorithm-based control ( administered by a dedicated research nurse ) .


SpO@ target ( @-@ % ) and alarm limits ( @-@ % ) were identical in both arms .


Infants < @ weeks ' gestation were eligible if having > @ desaturations episodes to < @ % / @ h while receiving continuous positive airway pressure/synchronised intermittent mandatory ventilation .


Data was recorded via the Powerlab system from Masimo oximeters and Babylog @ + ventilators .


@ infants with a gestation of @ @ weeks ( mean SD ) and birth weight @ @ g were studied at a postmenstrual age of @ @ weeks .


The percentage of time spent within target range was @ @ % during routine care versus @ @ % during algorithm-based care ( p = @ ) .


Compliance with alarm limits was @ @ % during routine versus @ @ % for algorithm-based care ( p = @ ) .


The frequency of desaturations , episode severity or number of FiO@ adjustments did not differ between the two care strategies .


The observation that algorithm-based control did not improve time spent within the SpO@ target and alarm limits suggests nursing care has reached an optimum in the unit studied .


Our finding indicates that significant modifications to the algorithm are likely to be necessary to improve target range compliance .


After a hip fracture , a catabolic state develops , with increased bone loss during the first year .


The aim of this study was to evaluate the effects of postoperative treatment with calcium , vitamin D , and bisphosphonates ( alone or together ) with nutritional supplementation on total hip and total body bone mineral density ( BMD ) .


Seventy-nine patients ( @ women ) , with a mean age of @ years ( range , @-@ years ) and with a recent hip fracture , who were ambulatory before fracture and without severe cognitive impairment , were included .


Patients were randomized to treatment with bisphosphonates ( risedronate @ mg weekly ) for @ months ( B ; n = @ ) , treatment with bisphosphonates along with nutritional supplementation ( @ g protein , @ kcal daily ) for the first @ months ( BN ; n = @ ) , or to controls ( C ; n = @ ) .


All participants received calcium ( @,@ mg ) and vitamin D@ ( @ IU ) daily .


Total hip and total body BMD were assessed with dual-energy X-ray absorptiometry at baseline , @ , and @ months .


Marker of bone resorption C-terminal telopeptide of collagen I and @-hydroxy vitamin D were analyzed in serum .


Analysis of complete cases ( @/@ at @ months and @/@ at @ months ) showed an increase in total hip BMD of @ % in the BN group , whereas the B and C groups lost @ % and @ % of BMD , respectively , between baseline and @ months ( P = @ , between groups ) .


There was no change in total body BMD between baseline and @ months in the BN group , whereas the B group and C group both lost BMD , with C losing more than B ( P = @ ) .


Intention-to-treat analysis was in concordance with the complete cases analyses .


Protein-and energy-rich supplementation in addition to calcium , vitamin D , and bisphosphonate therapy had additive effects on total body BMD and total hip BMD among elderly hip fracture patients .


Ten percent of the time , peripheral intravenous access ( PIV ) is not obtained in @ attempts in the emergency department .


Typically , a tourniquet is used to dilate the target vein ; but recent research showed that a blood pressure ( BP ) cuff improves dilation , which may translate to increased PIV success .


We sought to determine if there is improved success in obtaining ultrasound-guided PIV using a BP cuff vs a tourniquet in `` difficult stick '' patients .


This is a prospective , randomized , single-blinded trial .


Adult patients requiring PIV with at least @ prior failed attempts were enrolled .


Patients were assigned to tourniquet or BP cuff for target vein dilation randomly .


Nurses prepared the patient for PIV attempt by either placing a BP cuff inflated to @ mm Hg or placing a tourniquet on the chosen extremity .


The extremity was draped to blind the physician to assignment .


Physicians then attempted ultrasound-guided PIV .


Failures were defined as IVs requiring greater than @ ultrasound-guided attempts or @ minutes , or patient intolerance .


If failure occurred , the physician was unblinded ; and the patient could be crossed over and reattempted .


Thirty-eight patients were enrolled .


The success rate for the tourniquet group ( n = @ ) and BP cuff group ( n = @ ) was @ % and @ % , respectively ( P = @ ) .


There were no differences between groups for vessel depth , diameter , or procedure time .


Six in the BP cuff group were crossed over and had successful PIV obtained with tourniquet .


Tourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV .


To compare the efficacy and safety of dulaglutide , a once-weekly GLP-@ receptor agonist , with placebo and exenatide in type @ diabetic patients .


The primary objective was to determine superiority of dulaglutide @ mg versus placebo in HbA@c change at @ weeks .


This @-week , multicenter , parallel-arm study ( primary end point : @ weeks ) randomized patients ( @:@:@:@ ) to dulaglutide @ mg , dulaglutide @ mg , exenatide @ g , or placebo ( placebo-controlled period : @ weeks ) .


Patients were treated with metformin ( @,@-@ ,@ mg ) and pioglitazone ( @-@ mg ) .


Mean baseline HbA@c was @ % ( @ mmol/mol ) .


Least squares mean SE HbA@c change from baseline to the primary end point was -@ @ % ( -@ @ mmol/mol ) for dulaglutide @ mg , -@ @ % ( -@ @ mmol/mol ) for dulaglutide @ mg , -@ @ % ( -@ @ mmol/mol ) for exenatide , and -@ @ % ( -@ @ mmol/mol ) for placebo .


Both dulaglutide doses were superior to placebo at @ weeks ( both adjusted one-sided P < @ ) and exenatide at @ and @ weeks ( both adjusted one-sided P < @ ) .


Greater percentages of patients reached HbA@c targets with dulaglutide @ mg and @ mg than with placebo and exenatide ( all P < @ ) .


At @ and @ weeks , total hypoglycemia incidence was lower in patients receiving dulaglutide @ mg than in those receiving exenatide ; no dulaglutide-treated patients reported severe hypoglycemia .


The most common gastrointestinal adverse events for dulaglutide were nausea , vomiting , and diarrhea .


Events were mostly mild to moderate and transient .


Both once-weekly dulaglutide doses demonstrated superior glycemic control versus placebo and exenatide with an acceptable tolerability and safety profile .


Alcohol accelerates the course of hepatitis C ( HCV ) infection and liver damage .


Little is known about recency of alcohol use among patients with HCV .


Alcohol consumption recency was compared among HCV patients with and without alcohol use disorders and current and lifetime alcohol use histories .


Patients considering antiviral treatment for HCV ( n = @ ) recruited from university-affiliated and VA liver and infectious disease clinics were assessed for lifetime and current-year psychiatric disorders and alcohol-use patterns .


Full diagnostic interviews , self-report surveys , medical record review , and urine screening for recent alcohol and drug use were conducted .


@ % used alcohol in the last year .


Besides alcohol history , those who stopped using alcohol in the past year differed from those with no lifetime use only in gender ( @ % vs. @ % ) ; however , patients no longer using alcohol in the last year were less likely than those still using to have a current drug use disorder ( @ % vs. @ % ) or last-month drug use ( @ % vs. @ % ) , and had fewer current risky behaviors ( @ vs. @ ) .


Among patients with last-year alcohol use , those with past alcohol use disorders differed from those without only by higher prevalence of drug use disorder ( @ % vs. @ % ) and drug use after HCV diagnosis ( @ % vs. @ % ) .


Patients who had stopped using alcohol for at least a year were much like those who never used alcohol in regard to other drug use , psychiatric history , smoking , and risky behaviors .


These findings indicate that HCV patients with at least a year of abstinence from alcohol , including those with a history of alcohol use disorder , should be considered HCV treatment candidates .


Telephone triage is increasingly used to manage workload in primary care ; however , supporting evidence for this approach is scarce .


We aimed to assess the effectiveness and cost consequences of general practitioner - ( GP ) - led and nurse-led telephone triage compared with usual care for patients seeking same-day consultations in primary care .


We did a pragmatic , cluster-randomised controlled trial and economic evaluation between March @ , @ , and March @ , @ , at @ practices in four centres in the UK .


Practices were randomly assigned ( @:@:@ ) , via a computer-generated randomisation sequence minimised for geographical location , practice deprivation , and practice list size , to either GP-led triage , nurse-led computer-supported triage , or usual care .


We included patients who telephoned the practice seeking a same-day face-to-face consultation with a GP .


Allocations were concealed from practices until after they had agreed to participate and a stochastic element was included within the minimisation algorithm to maintain concealment .


Patients , clinicians , and researchers were not masked to allocation , but practice assignment was concealed from the trial statistician .


The primary outcome was primary care workload ( patient contacts , including those attending accident and emergency departments ) in the @ days after the first same-day request .


Analyses were by intention to treat and per protocol .


This trial was registered with the ISRCTN register , number ISRCTN@ .


We randomly assigned @ practices to GP triage ( n = @ ) , nurse triage ( n = @ ) , or usual care ( n = @ ) , and @,@ patients ( n = @ vs @ vs @ ) were randomly assigned , of whom @,@ ( @ % ) patients provided primary outcome data ( n = @ vs @ vs @ ) .


GP triage was associated with a @ % increase in the mean number of contacts per person over @ days compared with usual care ( @ -LSB- SD @ -RSB- vs @ -LSB- @ -RSB- ; rate ratio -LSB- RR -RSB- @ , @ % CI @-@ ) , and nurse triage with a @ % increase ( @ -LSB- SD @ -RSB- ; RR @ , @ % CI @-@ ) .


Eight patients died within @ days of the index request : five in the GP-triage group , two in the nurse-triage group , and one in the usual-care group ; however , these deaths were not associated with the trial group or procedures .


Although triage interventions were associated with increased contacts , estimated costs over @ days were similar between all three groups ( roughly @ per patient ) .


Introduction of telephone triage delivered by a GP or nurse was associated with an increase in the number of primary care contacts in the @ days after a patient 's request for a same-day GP consultation , with similar costs to those of usual care .


Telephone triage might be useful in aiding the delivery of primary care .


The whole-system implications should be assessed when introduction of such a system is considered .


To explore the effectiveness and participant experience of web-based physiotherapy for people moderately affected with Multiple Sclerosis ( MS ) and to provide data to establish the sample size required for a fully powered , definitive randomized controlled study .


A randomized controlled pilot study .


Rehabilitation centre and participants ' homes .


Thirty community dwelling adults moderately affected by MS ( Expanded Disability Status Scale @-@ @ ) .


Twelve weeks of individualised web-based physiotherapy completed twice per week or usual care ( control ) .


Online exercise diaries were monitored ; participants were telephoned weekly by the physiotherapist and exercise programmes altered remotely by the physiotherapist as required .


The following outcomes were completed at baseline and after @ weeks ; @ Foot Walk , Berg Balance Scale , Timed Up and Go , Multiple Sclerosis Impact Scale , Leeds MS Quality of Life Scale , MS-Related Symptom Checklist and Hospital Anxiety and Depression Scale .


The intervention group also completed a website evaluation questionnaire and interviews .


Participants reported that website was easy to use , convenient , and motivating and would be happy to use in the future .


There was no statistically significant difference in the primary outcome measure , the timed @ft walk in the intervention group ( P = @ ) , or other secondary outcome measures , except the Multiple Sclerosis Impact Scale ( P = @ ) .


Effect sizes were generally small to moderate .


People with MS were very positive about web-based physiotherapy .


The results suggested that @ participants , @ in each group , would be sufficient for a fully powered , definitive randomized controlled trial .


Botulinum toxin injections are used to treat spasticity in stroke .


Although this treatment is effective on muscle tone , its effect on functional gait-related activities remains uncertain .


The aim of this randomized controlled trial was to determine the effect of a self-rehabilitation programme as an adjunct to botulinum toxin injections on gait-related activities in patients with chronic hemiparesis .


Thirty-five outpatients were included .


Each patient was randomized to @ of @ groups : botulinum toxin + standardized self-rehabilitation programme ( R group , n = @ ) or botulinum toxin alone ( C group , n = @ ) .


Each patient was evaluated with the following tests before botulinum toxin injections and one month afterwards : @-m timed walk , Timed Up and Go , distance covered in @ min over an ecological circuit , and the stair test .


There were significant improvements in the R group compared with the C group : maximal gait speed improved by @ % ( p = @ ) ; distance covered in @ min over an ecological circuit increased by @ % ( p = @ ) ; and time to ascend and to descend a flight of stairs decreased by @ % ( p = @ ) and @ % ( p = @ ) , respectively .


The self-rehabilitation programme was well tolerated and safe .


These results strongly suggest that a standardized self-rehabilitation programme constitutes a useful adjunct to botulinum toxin injections in order to improve gait-related activities .


Headache is a common health problem in adolescents .


There are a number of risk factors for headache in adolescents that are amenable to intervention .


The aim of the study was to assess the effectiveness of a low-level headache prevention programme in the classroom setting to prevent these risk factors .


In all , @ students in @th-@th grade at @ grammar schools in greater Munich , Germany , were cluster randomized into intervention and control groups .


A standardized @-min prevention lesson focusing on preventable risk factors for headache ( physical inactivity , coffee consumption , alcohol consumption and smoking ) and providing instructions on stress management and neck and shoulder muscle relaxation exercises was given in a classroom setting .


Seven months later , students were reassessed .


The main outcome parameter was headache cessation .


Logistic regression models with random effects for cluster and adjustment for baseline risk factors were calculated .


Nine hundred students ( intervention group N = @ , control group N = @ ) with headache at baseline and complete data for headache and confounders were included in the analysis .


Headache cessation was observed in @ % of the control group compared with @ % in the intervention group ( number needed to treat = @ ) .


Accounting for cluster effects and confounders , the probability of headache cessation in the intervention group was @ ( @ % confidence interval = -LSB- @ ; @ -RSB- ) higher than in the control group .


The effect was most pronounced in adolescents with tension-type headache : odds ratio = @ ( @ % confidence interval = -LSB- @ ; @ -RSB- ) .


Our study demonstrates the effectiveness of a one-time , classroom-based headache prevention programme .


To investigate the associations of NOS@AP rs@ polymorphism with the risk of type @ diabetes mellitus ( T@DM ) and repaglinide therapeutic efficacy in Chinese patients with T@DM .


Prospective case-control study .


Academic medical center .


A total of @ patients with T@DM and @ healthy volunteers were enrolled to identify NOS@AP rs@ genotypes using the polymerase chain reaction-restriction fragment length polymorphism assay .


Eighty-four patients with various genotypes were randomly selected to receive oral repaglinide as a single-agent therapy ( @mg/day ) for @weeks .


Anthropometric measurements and fasting plasma glucose ( FPG ) , postprandial plasma glucose , hemoglobin A@c , fasting serum insulin ( FINS ) , postprandial serum insulin , homeostasis model assessment for insulin resistance ( HOMA-IR ) , triglyceride , total cholesterol , low-density lipoprotein-cholesterol , and high-density lipoprotein-cholesterol tests were obtained before and after repaglinide treatment .


The risk C allelic frequency of NOS@AP rs@ was higher in patients with T@DM than in healthy volunteers ( p < @ ) .


Patients with T@DM and genotypes AA and AC at NOS@AP rs@ had a significant reduction in FPG ( mmol/l ) compared with those with genotype CC ( p < @ ) .


Patients with CC homozygotes and AC heterozygotes had a greater increase in FINS ( mU/l ) than those with wild-type AA ( p < @ ) .


In addition , the carriers of genotype CC at NOS@AP rs@ had higher differential values of HOMA-IR compared with genotypes AC and AA carriers ( p < @ ) .


The effects of repaglinide treatment on FPG ( p < @ ) , FINS ( p < @ ) and HOMA-IR ( p < @ ) were reduced in patients with T@DM carrying the NOS@AP rs@ risk C allele compared with the AA genotype carriers .


The NOS@AP rs@ polymorphism is associated with therapeutic efficacy of repaglinide in Chinese T@DM patients .


Lactoferrin ( LF ) , a non-haem iron binding glycoprotein , shares antimicrobial properties with innate immune system components influencing proinflammatory release of cytokines involved in psoriatic plaque development .


The objective of the study was to verify if LF could provide a therapeutic application in psoriasis .


An open-label , two arms , @-week trial was designed on @ subjects affected by mild to moderate plaque psoriasis .


All patients received oral bovine LF @ mg .


Fifteen patients ( group A ) were topically treated with @ % LF ointment , @ patients ( group B ) with @ % LF ointment .


All patients applied only ointment vehicle on contra lateral target lesion as intra-patient side to side control .


Efficacy was assessed by Target Lesion Score .


Twenty-two patients completed the study .


Improvement in elevation , redness and scaling was observed on LF treated psoriatic target lesions comparing to the controlateral controls ( P < @ ) .


There was no additional efficacy for @ % versus @ % topical applications .


Oral drug alone did not exert any improvement on the control plaques receiving topical placebo .


Our clinical results suggest that LF could be included as a possible safe topical therapeutic option in the treatment of psoriatic plaque .


The negative impact of rising progesterone levels on pregnancy rates is well known , but data on mature oocyte yield are conflicting .


We examined whether delaying the oocyte maturation trigger in IVF/ICSI affected the number of mature oocytes and investigated the potential influence of serum progesterone levels in this process .


Between January @ , @ , and December @ , @ , @ consecutive patients were monitored using ultrasound plus hormonal evaluation .


Those with > = @ follicles with a mean diameter of > = @ mm were divided into @ groups depending on their serum progesterone levels .


In cases with a progesterone level < = @ ng/ml , which was observed in @ patients , @-@ % of their total number of follicles ( only counting those larger than @ mm ) were at least @ mm in diameter .


These patients were randomised into @ groups : in one group , final oocyte maturation was triggered the same day ; for the other , maturation was triggered @ hours later .


Seventy-two patients with progesterone levels > @ ng/ml were randomised in the same manner , irrespective of the percentage of larger follicles ( > = @ mm ) .


The number of metaphase II oocytes was our primary outcome variable .


Because some patients were included more than once , correction for duplicate patients was performed .


In the study arm with low progesterone ( < = @ ng/ml ) , the mean number of metaphase II oocytes ( + / - SD ) was @ ( + / -@ ) in the group with delayed administration of the oocyte maturation trigger versus @ ( + / -@ ) in the control group .


After adjusting for age , the mean difference was @ ( @ % CI : @-@ @ ; p = @ ) .


In the study arm with elevated progesterone ( > @ ng/ml ) , the mean numbers of metaphase II oocytes ( + / - SD ) were @ ( + / -@ ) and @ ( + / -@ ) for the delayed and control groups , respectively .


After adjusting for PCOS ( polycystic ovary syndrome ) and female pathology , the mean difference was -@ ( @ % CI : -@ -@ ; p = @ ) .


Delaying oocyte maturation in patients with low progesterone levels yields greater numbers of mature oocytes .


Calcium dobesilate is an antioxidant drug and this study is aimed to investigate the effects of calcium dobesilate on gentamicin-induced nephrotoxicity .


This experimental study was conducted on @ male Sprague-Dawley rats .


The rats were randomly divided into the following @ groups : control , sham , gentamicin ( @ mg/kg/d , intraperitoneal ) , gentamicin and calcium dobesilate ( @ mg/kg body weight ) , gentamicin and calcium dobesilate ( @ mg/kg body weight ) .


Treatment was provided once a day in a @-day period .


At the end of the @th day , plasma and urine samples were taken and the concentrations of creatinine , urea nitrogen , sodium , potassium , and osmolarity were measured in both samples .


The level of oxidative stress in the left kidney tissue samples was also assessed by measuring malondialdehyde and ferric reducing antioxidant power .


Calcium dobesilate intake with both doses led to a significant decrease in the elevated concentration of creatinine , urea nitrogen , and fractional excretion of sodium by gentamicin , and an increase in creatinine clearance and absolute excretion of potassium as compared to the gentamicin group .


Furthermore , calcium dobesilate decreased tissue malondialdehyde and increased tissue ferric reducing antioxidant power at both doses , in comparison to those in the gentamicin group .


Calcium dobesilate is capable of protecting rats against gentamicin-induced nephrotoxicity .


This protective effect of calcium dobesilate is probably dependent on its antioxidant properties .


To compare postoperative pain following laser-assisted subepithelial keratectomy ( LASEK ) and transepithelial photorefractive keratectomy ( T-PRK , two-step surgery ) and alleviate postoperative subjective pain .


Thirty patients ( @ eyes ) with myopia or myopic astigmatism were consecutively recruited into this prospective , randomized paired study .


Patients underwent LASEK in one eye , and T-PRK in the other .


The degree of pain was rated on a scale of @-@ on postoperative days @ , @ and @ .


Uncorrected visual acuity ( UCVA ) and subepithelial corneal haze were assessed at postoperative @ and @ months .


The pain was relieved on the @th postoperative day in all patients , healing of corneal epithelium was observed at @-@ days after surgery and contact lenses were removed promptly .


At postoperative @ day , the mean subjective pain score in the LASEK group was @ @ and @ @ in T-PRK group ( P = @ ) .


No significant difference was found between two groups on postoperative @ and @ days .


At postoperative @ months , the percentage of UCVA @ in the LASEK group was @ % and @ % in the T-PRK group ( P = @ ) , @ % of patients in the LASEK with UCVA @ and @ % in the T-PRK group ( P = @ ) .


In the LASEK group , the value of corneal haze was @ @ and @ @ in the T-PRK group ( P = @ ) .


Good visual acuity was obtained in both groups at postoperative @ months .


Compared with those in the T-PRK group , patients undergoing had less discomfort in the LASEK group , which may be associated with corneal epithelial activity .


The changing curve of subjective pain in the T-PRK group was relatively flat and stable at postoperative @ days .


Obesity affects @ % of the UK adult population but modest weight loss can reduce the incidence of obesity-related chronic disease .


Some effective weight loss treatments exist but there is no nationally available National Health Service ( NHS ) treatment service , and general practitioners ( GPs ) rarely discuss weight management with patients or support behavior change .


Evidence shows that commercial weight management services , that most primary care trusts have ` on prescription ' , are more effective than primary care treatment .


We propose a controlled trial where patients will be randomized to receive either the offer of help by referral to a weight management service and follow-up to assess progress , or advice to lose weight on medical grounds .


The primary outcome will be weight change at @-months .


Other questions are : what actions do people take to manage their weight in response to the two GP intervention types ?


How do obese patients feel about GPs opportunistically discussing weight management and how does this vary by intervention type ?


How do GPs feel about raising the issue opportunistically and giving the two types of brief intervention ?


What is the cost per kg/m@ lost for each intervention ?


Research assistants visiting GP practices in England ( n = @ ) would objectively measure weight and height prior to GP consultations and randomize willing patients ( body mass index @ + , excess body fat , @ + years ) using sealed envelopes .


Full recruitment ( n = @ ) is feasible in @weeks , requiring six sessions of advice-giving per GP .


Participants will be contacted at @months ( postintervention ) via telephone to identify actions they have taken to manage their weight .


We will book appointments for participants to be seen at their GP practice for a @-month follow-up .


Trial results could make the case for brief interventions for obese people consulting their GP and introduce widespread simple treatments akin to the NHS Stop Smoking Service .


Likewise , the intervention could be introduced in the Quality and Outcomes Framework and influence practice worldwide .


Anorexia nervosa is a serious illness with significant morbidity .


The evidence base for existing psychological and pharmacological interventions to manage anorexia nervosa is not strong , and use of new adjunctive therapies that improve the effectiveness of existing treatments , and lead to improved mental health outcomes for this patient group is highly desirable .


This study investigates the views of patients with anorexia nervosa receiving an acupuncture or acupressure intervention .


A randomised controlled trial was conducted in Sydney , Australia .


Twenty-six inpatients with a diagnosis of anorexia nervosa were randomised to a six week intervention of acupuncture or acupressure with light massage .


Treatment was administered twice weekly for three weeks , then weekly for three weeks .


A post treatment questionnaire was administered to explore participant views , of the study consultation .


Questions examined important aspects of the clinical encounter including the , patient 's perception of the practitioners ' relational empathy ( CARE ) , treatment perceptions and the , therapeutic relationship .


Participants in both groups scored highly on the CARE scale assessing empathy and the , therapeutic relationship .


There was no difference in the mean CARE scores for the acupuncture group ( @ ( SD @ ) ) and the acupressure group ( @ ( SD @ ) ) .


Participants highly valued the therapeutic , encounter and in particular the characteristics of empathy , positive regard , acceptance , non , judgmental responses and trust .


Having someone to talk to , being less stressed/relaxed and contact , with the study staff were also perceived to be important .


Study participants perceive the therapeutic relationship and empathy as important qualities of the acupuncture or acupressure intervention as an adjunct therapy for the treatment of anorexia nervosa .


Delcasertib is a selective inhibitor of delta-protein kinase C ( delta-PKC ) , which reduced infarct size during ischaemia/reperfusion in animal models and diminished myocardial necrosis and improved reperfusion in a pilot study during primary percutaneous coronary intervention ( PCI ) for ST elevation myocardial infarction ( STEMI ) .


A multicentre , double-blind trial was performed in patients presenting within @ h and undergoing primary PCI for anterior ( the primary analysis cohort , n = @ patients ) or inferior ( an exploratory cohort , capped at @ patients ) STEMI .


Patients with anterior STEMI were randomized to placebo or one of three doses of delcasertib ( @ , @ , or @ mg/h ) by intravenous infusion initiated before PCI and continued for @ h.


There were no differences between treatment groups in the primary efficacy endpoint of infarct size measured by creatine kinase MB fraction area under the curve ( AUC ) ( median @ , @ , @ , and @ ng h/mL in the placebo , delcasertib @ , @ , and @ mg/mL groups , respectively ) in the anterior STEMI cohort .


No treatment-related differences were seen in secondary endpoints of infarct size , electrocardiographic ST-segment recovery AUC or time to stable ST recovery , or left ventricular ejection fraction at @ months .


No differences in rates of adjudicated clinical endpoints ( death , heart failure , or serious ventricular arrhythmias ) were observed .


Selective inhibition of delta-PKC with intravenous infusion of delcasertib during PCI for acute STEMI in a population of patients treated according to contemporary standard of care did not reduce biomarkers of myocardial injury .


The aim of this study was to compare lung deposition and assess the bioequivalence of two formulations containing budesonide and formoterol and being delivered via Elpenhaler and Turbuhaler , respectively .


A pharmacokinetic ( PK ) study was conducted .


An open , randomized , two-sequence , two-period , crossover , single-dose study in @ asthmatic patients under fasting conditions was performed .


Wash out period was @ days .


Equivalence in lung deposition was assessed after a single inhalation of each treatment with concomitant oral administration of activated charcoal ( @g ) to prevent gastrointestinal absorption of the drugs .


Several PK parameters were estimated , the area under the drug concentration in plasma versus time curve ( AUC@-t ) and the maximum drug concentration in plasma ( Cmax ) being the primary response variables .


Equivalent lung deposition was concluded if the @ % confidence interval ( CI ) for the Elpenhaler/Turbuhaler geometric mean ratio of AUC@-t and Cmax , for both drug substances fell within the regulatory limits ( @-@ @ ) .


Acceptance criteria were met .


Equivalent lung deposition can be concluded .


No statistically significant differences between treatments in the incidence of adverse events were found .


The formulations are bioequivalent regarding both rate and extent of absorption .


The treatments were also well tolerated by the participating subjects .


To evaluate the effect of Dexmedetomidine and Midazolam on respiratory and circulation in patients experiencing open heart surgery under acupuncture-assisted general anesthesia .


Sixty patients undergoing open heart surgery ( cardiac valve replacement surgery and aortic valve replacement surgery ) were randomly and equally divided into Dexmedetomidine ( D ) and Midazolam ( M ) groups .


Electroacupuncture ( EA ) was applied to bilateral Yunmen ( LU @ ) , Zhongfu ( LU@ ) , Lieque ( LU@ ) and Neiguan ( PC@ ) .


For patients of group D , Dexmedetomidine ( i.v. , loading dose : @ microg/kg , and succedent dose : @-@ microg x kg ( -@ ) x h ( -@ ) ) was given .


For patients of group M , Midazolam ( i.v. , loading dose : @ mg/kg , succedent dose : @-@ @ mg x kg ( -@ ) x h ( -@ ) ) was given .


Arterial oxygen pressure ( PaO@ ) , arterial carbondioxide tension ( PaCO@ ) , O@ saturation ( SPO@ ) , mean arterial pressure ( MAP ) , heart rate ( HR ) , anesthetic effect , time of spontaneous breathing recovery , and time of resuscitation were recorded before operation ( T@ ) , immediately after skin incision ( T@ ) , immediately after sternotomy ( T@ ) , before suspension of cardiopulmonary bypass ( CPB , T@ ) , immediately after cardiac re-beating ( T@ ) , immediately after CPB cessation ( T@ ) , and at the end of surgery ( T@ ) .


Before operation , no significant differences were found between the group D and M in the levels of PaO@ , PaCO@ and SPO@ ( P > @ ) .


The PaO@ and SPO@ levels after skin incision , sternotomy , before suspension of CPB and at the end of surgery were significantly lower in group M than in group D ( P < @ ) , while the le - vels of PaCO@ after skin incision , sternotomy , before suspension of CPB and at the end of surgery , and HR after skin incision , sternotomy , before suspension of CPB , after heart re-beating , after CPB cessation and at the end of surgery in group M were considerably higher than those in group D ( P < @ ) .


In addition , the time of spontaneous breathing recovery of group M was significantly later than that of group D ( P < @ ) .


No significant differences were found between the two groups in MAP levels at the @ time-points during surgery , in the PaO@ , PaCO@ and SPO@ levels at the time-points of post-cardiac re-beating , and after CPB cessation ( P > @ ) .


It suggested that the respiration and circulation states in group D were more smoothly than those in group M.


There was no significant difference between the two groups in the time of resuscitation ( P > @ ) .


Dexmedetomidine is superior to Midazolam in analgesia , and improving respiration and circulation functions for open heart surgery patients under acupuncture-assisted general anesthesia .


We aimed to assess the safety and efficacy of thrombectomy for the treatment of stroke in a trial embedded within a population-based stroke reperfusion registry .


During a @-year period at four centers in Catalonia , Spain , we randomly assigned @ patients who could be treated within @ hours after the onset of symptoms of acute ischemic stroke to receive either medical therapy ( including intravenous alteplase when eligible ) and endovascular therapy with the Solitaire stent retriever ( thrombectomy group ) or medical therapy alone ( control group ) .


All patients had confirmed proximal anterior circulation occlusion and the absence of a large infarct on neuroimaging .


In all study patients , the use of alteplase either did not achieve revascularization or was contraindicated .


The primary outcome was the severity of global disability at @ days , as measured on the modified Rankin scale ( ranging from @ -LSB- no symptoms -RSB- to @ -LSB- death -RSB- ) .


Although the maximum planned sample size was @ , enrollment was halted early because of loss of equipoise after positive results for thrombectomy were reported from other similar trials .


Thrombectomy reduced the severity of disability over the range of the modified Rankin scale ( adjusted odds ratio for improvement of @ point , @ ; @ % confidence interval -LSB- CI -RSB- , @ to @ ) and led to higher rates of functional independence ( a score of @ to @ ) at @ days ( @ % vs. @ % ; adjusted odds ratio , @ ; @ % CI , @ to @ ) .


At @ days , the rates of symptomatic intracranial hemorrhage were @ % in both the thrombectomy group and the control group ( P = @ ) , and rates of death were @ % and @ % , respectively ( P = @ ) .


Registry data indicated that only eight patients who met the eligibility criteria were treated outside the trial at participating hospitals .


Among patients with anterior circulation stroke who could be treated within @ hours after symptom onset , stent retriever thrombectomy reduced the severity of post-stroke disability and increased the rate of functional independence .


( Funded by Fundaci Ictus Malaltia Vascular through an unrestricted grant from Covidien and others ; REVASCAT ClinicalTrials.gov number , NCT@ . )


Pain is the most encountered complication following third molar surgery .


Although nonsteroidal anti-inflammatory drugs are often used for pain control , the effect of preemptive lornoxicam has not been detailed .


We compare the analgesic efficacy of preemptive lornoxicam versus postoperative lornoxicam .


Forty-three participants aged @ to @ years who had bilateral , symmetrical third molars were included in this double-blind , randomized , placebo-controlled study .


All participants took part in each of the @ groups for a @-month interval ( crossover design ) .


Group Pre received lornoxicam @ mg intravenously @ minutes before surgery and @ mL serum saline postoperatively .


Group Post was given the opposite protocol .


Pain was evaluated by visual analog scale in the first @ hours .


We observed statistically significant differences in the reduction of the pain level in group Pre ( P < @ ) .


These participants felt less pain in the first @ postoperative hours and needed fewer analgesics in the first @ postoperative hours .


Preemptive lornoxicam is effective for postoperative pain control .


The objective of this study was to test the effect of sugar-free chewing gum sweetened with xylitol or maltitol compared to the use of a gum base or no gum on gingivitis and plaque scores under both brushing and non-brushing circumstances .


The design of the study was a four-group , double-blinded , randomized controlled study with a @-week duration .


In each group , the participants did not brush the teeth in the lower jaw designated to develop experimental gingivitis , while maintaining normal oral hygiene procedures in the upper jaw .


After professional dental prophylaxis , the participants were allocated into one of four groups ( xylitol , maltitol , gum base or no gum ) .


Chewing gum was used five times a day for @ min .


@ participants completed the study and provided evaluable data .


The increase in bleeding on marginal probing ( BOMP ) and plaque scores ( PS ) in the non-brushed ( lower ) jaw with experimental gingivitis was significant in all groups ( P < @ ) .


As compared to the gum base , the increase in BOMP in the xylitol and maltitol group was significantly lower .


In the brushed upper jaw , no significant changes for BOMP were observed from the baseline to the end point of the study , and there were no significant differences in BOMP and PS between the groups .


In circumstances where regular brushing is performed , no effect of chewing gum was observed on bleeding and plaque scores .


In the absence of brushing , chewing xylitol or maltitol gum provided a significant inhibitory effect on gingivitis scores compared to chewing gum base .


The difference when compared to the group not using gum was not significant .


Due to structural differences , bioavailability of krill oil , a phospholipid based oil , could be higher than fish oil , a triglyceride-based oil , conferring properties that render it more effective than fish oil in increasing omega-@ index and thereby , reducing cardiovascular disease ( CVD ) risk .


The objective was to assess the effects of krill oil compared with fish oil or a placebo control on plasma and red blood cell ( RBC ) fatty acid profile in healthy volunteers .


Twenty four healthy volunteers were recruited for a double blinded , randomized , placebo-controlled , crossover trial .


The study consisted of three treatment phases including krill or fish oil each providing @ mg of n-@ polyunsaturated fatty acids ( PUFA ) or placebo control , corn oil in capsule form .


Each treatment lasted @ wk and was separated by @ wk washout phases .


Krill oil consumption increased plasma ( p = @ ) and RBC ( p = @ ) n-@ PUFA concentrations , including EPA and DHA , and reduced n-@ : n-@ PUFA ratios ( plasma : p = @ , RBC : p = @ ) compared with fish oil consumption .


Sum of EPA and DHA concentrations in RBC , the omega-@ index , was increased following krill oil supplementation compared with fish oil ( p = @ ) and control ( p < @ ) .


Serum triglycerides and HDL cholesterol concentrations did not change with any of the treatments .


However , total and LDL cholesterol concentrations were increased following krill ( TC : p = @ , LDL : p = @ ) and fish oil supplementation ( TC : p = @ , LDL : p = @ ) compared with control .


Consumption of krill oil was well tolerated with no adverse events .


Results indicate that krill oil could be more effective than fish oil in increasing n-@ PUFA , reducing n-@ : n-@ PUFA ratio , and improving the omega-@ index .


R-CHOP ( rituximab plus cyclophosphamide , doxorubicin , vincristine , and prednisone ) is standard care for aggressive B-cell lymphoma .


A prospective trial was conducted to investigate the role of additive radiotherapy ( RT ) to bulky and extralymphatic disease .


The best arm of the RICOVER-@ trial ( @R-CHOP-@ +@ R -LSB- R-CHOP administered once every @ weeks plus two additional applications of rituximab -RSB- plus involved-field RT -LSB- @ Gy -RSB- to sites of initial bulky -LSB- @ cm -RSB- disease and extralymphatic involvement ) was compared with a cohort receiving the same immunochemotherapy but without RT in an amendment to the RICOVER-@ trial ( RICOVER-noRTh ) in a prospective fashion .


After a median observation time of @ months , @ of @ RICOVER-noRTh patients were evaluable .


In a multivariable analysis of the intention-to-treat population adjusting for International Prognostic Index risk factors and age ( > @ years ) , event-free survival ( EFS ) of patients with bulky disease was inferior without additive RT ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ; P = @ ) , with trends for inferior progression-free ( PFS ; HR , @ ; @ % CI , @ to @ ; P = @ ) and overall survival ( OS ; HR , @ ; @ % CI , @ to @ ; P = @ ) .


In a per-protocol analysis with @ patients in RICOVER-noRTh excluded for receiving unplanned RT , multivariable analysis revealed HRs of @ ( @ % CI , @ to @ ; P = @ ) for EFS , @ ( @ % CI , @ to @ ; P = @ ) for PFS , and @ ( @ % CI , @ to @ ; P = @ ) for OS for patients not receiving RT to bulky disease .


Additive RT to bulky sites abrogates bulky disease as a risk factor and improves outcome of elderly patients with aggressive B-cell lymphoma .


Whether RT can be spared in patients with ( metabolic ) complete remission after immunochemotherapy must be addressed in appropriately designed prospective trials .


The purpose of this study was to investigate the role of ( hyperopic or myopic ) spectacle correction in reading speed of @ - to @-year-old children .


Subjects were recruited at their schools .


Initial selection was based on reduced distance acuity and/or a positive blur test .


Final inclusion depended on cycloplegic refraction .


Forty-three myopes were prescribed glasses .


Sixty-five hyperopes were randomized to three groups : ( @ ) no glasses , ( @ ) +@ DS for both eyes , and ( @ ) full correction .


Before and @ to @ months after prescription of glasses , reading speed was tested : One-Minute Test ( reading speed of genuine words ) and the Klepel ( reading speed of nonwords ) .


Data for this second reading test were obtained in @ myopes and @ hyperopes .


At baseline , myopes had about @ % higher One-Minute scores ( p = @ ) and about @ % higher Klepel scores ( p = @ ) than hyperopes .


At follow-up , the hyperopia-full correction group improved its One-Minute score by about @ % more than both the no-glasses group ( p = @ ) and +@ DS group ( p = @ ) .


Spectacles did not , or only slightly , improve reading scores of myopes ( One-Minute scores , p = @ ; Klepel scores , p = @ ) .


Correction of hyperopia may increase speed of reading ( as reflected by the One-Minute score ) .


The fact that reading speed of nonwords does not increase after correction suggests that hyperopia affects speed of recognition but not decoding per se .


Attention-deficit/hyperactivity disorder ( ADHD ) is associated with difficulties in learning , behaviour and psychosocial adjustment that persist into adulthood .


Decreased omega-@ fatty acids and increased inflammation or oxidative stress may contribute to neuro-developmental and psychiatric disorders such as ADHD .


The aim of this study was to determine the effect of n-@ supplementation on hyperactivity , oxidative stress and inflammatory mediators in children with ADHD .


In this double blind study , @ children ( @-@ years ) with ADHD receiving maintenance therapy were assigned randomly into two groups .


The n-@ group received n-@ fatty acids ( @ mg eicosapentaenoic acid ( EPA ) , @ mg docosahexaenoic acid ( DHA ) ) , and the placebo group received olive oil capsules which were visually similar to the n-@ capsules .


The duration of supplementation was @ weeks .


Plasma C-reactive protein ( CRP ) , interleukin-@ ( IL-@ ) and the activity of glutathione reductase ( GR ) , catalase ( CAT ) and superoxide dismutase ( SOD ) were determined before and after the intervention .


Likewise the Conners ' Abbreviated Questionnaires ( ASQ-P ) was applied .


After @-week intervention , a significant reduction was observed in the levels of CRP ( P < @ , @ % CI = @-@ @ ) and IL-@ ( P < @ , @ % CI = @-@ @ ) in the n-@ group .


There was also a significant increase in activity of SOD and GR ( P < @ ) .


A significant improvement was seen in the ASQ-P scores in the n-@ group ( P < @ ) .


Eight weeks of EPA and DHA supplementation decreased plasma inflammatory mediators and oxidative stress in the children with ADHD .


These results suggest that n-@ fatty acid supplementation may offer a safe and efficacious treatment for children with ADHD .


To compare the fitting time requirements and the efficiency in achieving improvements in speech perception during the first @ months after initial stimulation of computer-assisted fitting with the Fitting to Outcome eXpert ' ( FOX ) and a standard clinical fitting procedure .


Twenty-seven post-lingually deafened adults , newly implanted recipients of the Advanced Bionics HiRes @K cochlear implant from Germany , the UK , and France took part in a controlled , randomized , clinical study .


Speech perception was measured for all participants and fitting times were compared across groups programmed using FOX and conventional programming methods .


The fitting time for FOX was significantly reduced at @ days ( P < @ ) but equivalent over the @-month period .


The groups were not well matched for duration of deafness ; therefore , speech perception could not be compared across groups .


Despite including more objective measures of performance than a standard fitting approach and the adjustment of a greater range of parameters during initial fitting , FOX did not add to the overall fitting time when compared to the conventional approach .


FOX significantly reduced the fitting time in the first @ weeks and by providing a standard fitting protocol , reduced variability across centres .


FOX computer-assisted fitting can be successfully used at switch on , in different clinical environments , reducing fitting time in the first @ weeks and is efficient at providing a usable program .


Glomerular filtration rate ( GFR ) declines during long-term dialysis treatment .


In peritoneal dialysis , blockade of the renin-angiotensin-aldosterone system reduces GFR decline .


Observational studies suggest that similar treatment may preserve kidney function in hemodialysis ( HD ) .


A multicenter , randomized , placebo-controlled , double-blinded trial , with @-year follow-up .


Adult HD patients with urine output > @mL/@h , HD vintage less than @ year , and cardiac ejection fraction > @ % .