Barriers to such care include health insurance , cost , knowledge , attitudes , health literacy , and cultural norms and practices .


Among the most promising approaches to increase screening in these groups are patient navigators that can link women to sources of appropriate care .


Another recent promising approach is using human papilloma virus ( HPV ) self-sampling .


In this manuscript , we describe our National Cancer Institute-sponsored study testing such approaches among immigrant minority women .


The South Florida Center for the Reduction of Cancer Health Disparities ( SUCCESS ) is conducting a three-arm randomized trial among Hispanic , Haitian , and African American women in Miami-Dade County .


Community health workers ( CHW ) based in each of three communities are recruiting @ women at each site ( @ total ) .


Eligibility criteria include women aged @-@ years who have not had a Pap smear test in the last @years .


Prior to randomization , all women undergo a standardized structured interview .


Women randomized to public health outreach , Group @ , receive culturally tailored educational materials .


Women in Group @ receive an individualized comprehensive cervical cancer CHW-led education session followed by patient navigation to obtain the Pap smear test at community-based facilities .


Women in Group @ have the option of navigation to a Pap smear test or performing HPV self-sampling .


The primary outcome is self-report of completed screening through a Pap smear test or HPV self-sampling within @months after enrollment .


SUCCESS is one of the first trials testing HPV self-sampling as a screening strategy among underserved minority women .


If successful , HPV self-sampling may be an important option in community outreach programs aimed at reducing disparities in cervical cancer .


To compare postoperative pain scores and assess efficacy between an adjustable single-incision sling and a standard transobturator sling for stress urinary incontinence ( SUI ) .


This single-blinded randomized controlled trial involved @ women with clinically proven SUI .


Women were allocated to receive either an adjustable single-incision or a transobturator sling .


The primary outcome was postoperative pain score on a visual analog scale .


Secondary outcomes were objective and subjective cure rates at @ months , symptom bother scores , quality of life , and complications .


The mean pain score in the first week postoperatively was significantly lower at all time points in the adjustable single-incision sling group compared with the transobturator sling group .


Maximum difference in pain score was reported on the evening of the day of surgery ; median pain score was @ ( interquartile range @ ) in the adjustable sling group and @ ( interquartile range @ ) in the transobturator sling group ( Mann Whitney U test P < @ ) .


There was no statistical difference in analgesic use .


The objective cure rates in the adjustable single-incision sling and in the transobturator sling group were @ % and @ % ( P = @ ) , and the subjective cure rates were @ % and @ % ( P = @ ) , respectively .


No difference in the complication rate was found .


An adjustable single-incision sling for the treatment of SUI is associated with lower early postoperative pain scores but shows comparable cure rates with a transobturator at @ months of follow-up .


To investigate the preventive effect of behavioral therapy plus flunarizine in children with migraine .


Ninety pediatric patients with migraine between January @and January @ were randomly divided into treatment group ( @ cases ) and control group ( @ cases ) .


The treatment group received behavioral therapy in addition to oral flunarizine , while the control group received oral flunarizine alone .


All patients were followed up for @ months to evaluate the therapeutic effect by the Pediatric Migraine Disability Assessment Score ( PedMIDAS ) and improved Bussone headache index .


There were no significant differences in PedMIDAS ( P > @ ) and improved Bussone headache index ( P > @ ) between the control and treatment groups before treatment .


Significant differences were observed in PedMIDAS ( @ vs @ ; P < @ ) and improved Bussone headache index ( @ vs @ ; P < @ ) between the two groups after @ months of treatment .


Preventive treatment of behavioral therapy plus oral flunarizine shows a better clinical efficacy than oral flunarizine alone in children with migraine and holds promise for clinical application .


Uncontrolled asthma during pregnancy is associated with maternal and perinatal hazards .


A pharmacist-led intervention directed at improving maternal asthma control , involving multidisciplinary care , education , and regular monitoring to help reduce these risks , was developed and evaluated .


A randomized controlled trial was carried out in the antenatal clinics of two major Australian maternity hospitals .


Sixty pregnant women < @ weeks gestation who had used asthma medications in the previous year were recruited .


Participants were randomized to either an intervention or a usual care group and followed prospectively throughout pregnancy .


The primary outcome was Asthma Control Questionnaire ( ACQ ) score .


Mean changes in ACQ scores from baseline were compared between groups at @ and @ months to evaluate intervention efficacy .


The ACQ score in the intervention group ( n = @ ) decreased by a mean SD of @ @ at @ months and @ @ at @ months .


The control group ( n = @ ) had a mean decrease of @ @ at @ months and @ @ at @ months .


The difference between groups , adjusting for baseline , was -@ ( @ % CI , -@ to @ ) at @ months and -@ ( @ % CI , -@ to -@ ) at @ months .


The difference at @ months was statistically significant ( P < @ ) and clinically significant ( > @ ) .


No asthma-related oral corticosteroid use , hospital admissions , emergency visits , or days off from work were reported during the trial .


A multidisciplinary model of care for asthma management involving education and regular monitoring could potentially improve maternal asthma outcomes and be widely implemented in clinical practice .


Anxiety disorders are among the most prevalent mental disorders and are usually treated with medication and/or psychotherapy .


When anxiety disorders are accompanied with comorbid depression , this further complicates the treatment process .


Medication compliance is a common problem due to adverse side effects and new and effective treatments that have minimal side effects are needed for the treatment of anxiety and depression .


This study used a randomized , double-blind , sham controlled design to examine the effectiveness of CES as a treatment for anxiety disorders and comorbid depression in a primary care setting .


The study was registered at clinicaltrials.gov , NCT@ .


One hundred and fifteen participants , age @ years and over , with a primary diagnosis of an anxiety disorder were enrolled from February @ to December @ The Hamilton Rating Scale for Anxiety ( HAM-A ) and the Hamilton Depression Rating Scale@ ( HAM-D@ ) were used for baseline and outcome measures at weeks one , three , and five .


Response to treatment was defined as a reduction of @ % or more on these measures .


Analysis of covariance revealed a significant difference between the active CES group and the sham CES group on anxiety ( p = @ , d = @ ) and on depression ( p = @ , d = @ ) from baseline to endpoint of study in favor of the active CES group .


CES significantly decreases anxiety and comorbid depression .


Subjects reported no adverse events during the study .


Obstructive sleep apnea ( OSA ) has been associated with hypertension , which is one of the intermediary mechanisms leading to increased cardiovascular morbidity .


This study aimed at evaluating the effects of a combination of continuous positive airway pressure ( CPAP ) and telemedicine support on blood pressure ( BP ) reduction in high cardiovascular risk OSA patients .


A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention .


Sleep clinics in France .


@ adult ( @-@ years old ) OSA patients ( AHI > @ events/h ) with a high cardiovascular risk ( cardiovascular SCORE > @ % or secondary prevention ) .


Patients were randomized to either standard care CPAP ( n = @ ) or CPAP and telemedicine ( n = @ ) .


Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements , CPAP adherence , sleepiness , and quality of life data ; in return , they received pictograms containing health-related messages .


The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution , objective physical activity , CPAP adherence , sleepiness and quality of life .


Self-measured BP did not improve in either group ( telemedicine or standard care ) .


Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention .


CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients .


This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients .


To provide patient-centred holistic care , doctors must possess good interpersonal and empathic skills .


Medical schools traditionally adopt a skills-based approach to such training but creative engagement with the arts has also been effective .


A novel arts-based approach may help medical students develop empathic understanding of patients and thus contribute to medical students ' transformative process into compassionate doctors .


This study aimed to evaluate the impact of an arts-making workshop on medical student empathy .


This was a mixed-method quantitative-qualitative study .


In the @-@ academic year , all @ third year medical students at the University of Hong Kong were randomly allocated into either an arts-making workshop or a problem-solving workshop during the Family Medicine clerkship according to a centrally-set timetable .


Students in the arts-making workshop wrote a poem , created artwork and completed a reflective essay while students in the conventional workshop problem-solved clinical cases and wrote a case commentary .


All students who agreed to participate in the study completed a measure of empathy for medical students , the Jefferson Scale of Empathy ( JSE ) ( student version ) , at the start and end of the clerkship .


Quantitative data analysis : Paired t-test and repeated measures ANOVA was used to compare the change within and between groups respectively .


Qualitative data analysis : Two researchers independently chose representational narratives based on criteria adapted from art therapy .


The final @ works were agreed upon by consensus and thematically analysed using a grounded theory approach .


The level of empathy declined in both groups over time , but with no statistically significant differences between groups .


For JSE items relating to emotional influence on medical decision making , participants in the arts-making workshop changed more than those in the problem-solving workshop .


From the qualitative data , students perceived benefits in arts-making , and gained understanding in relation to self , patients , pain and suffering , and the role of the doctor .


Though quantitative findings showed little difference in empathy between groups , arts-making workshop participants gained empathic understanding in four different thematic areas .


This workshop also seemed to promote greater self-awareness which may help medical students recognize the potential for emotions to sway judgment .


Future art workshops should focus on emotional awareness and regulation .


Resistant hypertension ( res-HTN ) is a challenging problem , but little is known of res-HTN in patients with coronary artery disease ( CAD ) .


In this post-hoc INternational VErapamil SR-Trandolapril STudy ( INVEST ) analysis , we assessed prevalence , predictors , and impact on outcomes of res-HTN in CAD patients with hypertension .


Participants ( n = @ ) were divided into three groups according to achieved blood pressure ( BP ) : controlled ( BP < @/@ mmHg on three or fewer drugs ) ; uncontrolled ( BP @/@ mmHg on two or fewer drugs ) ; or resistant ( BP @/@ mmHg on three drugs or any patient on at least four drugs ) .


The prevalence of res-HTN was @ % : significant predictors of res-HTN included heart failure -LSB- odds ratio ( OR ) @ -RSB- , diabetes ( OR @ ) , Black race ( OR @ ) , and US residence ( OR @ ) .


Compared with controlled HTN , res-HTN had multivariate-adjusted association with higher risk of adverse outcomes -LCB- first occurrence of all-cause death , nonfatal myocardial infarction , or nonfatal stroke -LSB- hazard ratio @ , @ % confidence interval ( CI ) @-@ @ -RSB- , and individual outcomes of all-cause death ( hazard ratio @ , @ % CI @-@ @ ) , cardiovascular mortality ( hazard ratio @ , @ % CI @-@ @ ) , and nonfatal stroke ( hazard ratio @ , @ % CI @-@ @ ) , but not nonfatal myocardial infarction ( hazard ratio @ , @ % CI @-@ @ ) -RCB- .


Adverse outcomes , except nonfatal stroke , did not differ in patients with res-HTN compared to uncontrolled HTN .


Res-HTN is common in patients with CAD and hypertension , associated with poor prognosis , and linked with a number of conditions .


Emphasis should be placed on recognizing those at risk for res-HTN and future studies should examine whether more aggressive treatment of res-HTN improves outcomes .


There has been no study on the efficacy of lafutidine for patients with reflux esophagitis in Korea .


To evaluate the efficacy of a new-generation histamine-@ receptor antagonist , lafutidine , in comparison with famotidine in patients with reflux esophagitis .


This was a randomized , double-blind , non-inferiority trial enrolling patients with erosive esophagitis .


The efficacy and safety of @ mg lafutidine ( treatment group ) were compared with those of @ mg famotidine ( control group ) and @ mg omeprazole ( reference group ) .


The primary endpoint was the complete healing rates of reflux esophagitis on endoscopy after @ weeks of treatment .


The non-inferiority margin was assumed to be -@ % .


The healing rates of reflux esophagitis on endoscopy after @ weeks of treatment were @ % ( @/@ ) in the lafutidine , @ % ( @/@ ) in the famotidine , and @ % ( @/@ ) in the omeprazole group .


The difference in healing rates between the lafutidine and famotidine groups was @ % ( @ % confidence interval = -LSB- -@ to @ -RSB- ) .


In addition , lafutidine was superior to famotidine in clinical improvement ( @ % vs. @ % , P = @ ) .


Lafutidine was non-inferior to famotidine in healing of reflux esophagitis .


Lafutidine , however , was superior to famotidine in terms of symptom relief of reflux esophagitis .


Upper limb ( UL ) impairment is the most common disabling deficit following a stroke .


Previous studies have suggested that transcranial direct current stimulation ( tDCS ) enhances the effect of conventional therapies .


This pilot double-blind randomized control trial aimed to determine whether or not tDCS , combined with Wii virtual reality therapy ( VRT ) , would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals .


Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS , or a control group that received VRT and sham tDCS .


The therapy was delivered over @ sessions with @ minutes of active or sham anodal tDCS , and one hour of virtual reality therapy .


The outcomes included were determined using the Fugl-Meyer scale , the Wolf motor function test , the modified Ashworth scale ( MAS ) , grip strength , and the stroke specific quality of life scale ( SSQOL ) .


Minimal clinically important differences ( MCID ) were observed when assessing outcome data .


Both groups demonstrated gains in all evaluated areas , except for the SSQOL-UL domain .


Differences between groups were only observed in wrist spasticity levels in the experimental group , where more than @ % of the participants achieved the MCID .


These findings support that tDCS , combined with VRT therapy , should be investigated and clarified further .


Insulin resistance and secretion depend on calcium homeostasis .


Cross-sectional studies have associated elevated serum calcium levels with markers of impaired glucose metabolism .


However , only one prospective cohort study has demonstrated an increased risk of diabetes in individuals with increased serum calcium concentrations .


The aim of the current study was to prospectively investigate the association between albumin-adjusted serum calcium concentrations and type @ diabetes in subjects at high cardiovascular risk .


Prospective assessment of participants from two Spanish PREDIMED study centers where serum calcium levels were measured at baseline and yearly during follow-up .


Multivariate-adjusted Cox regression models were fitted to assess associations between baseline and changes during follow-up in serum calcium levels and relative risk of diabetes incidence .


After a median follow-up of @ years , @ new cases of type @ diabetes occurred .


An increase in serum calcium levels during follow-up was related to an increased risk of diabetes .


In comparison with individuals in the lowest tertile ( -@ @ mg/dL ) , the hazard ratio ( HR ) and @ % CI for diabetes incidence in individuals in the higher tertile of change ( @ @ mg/dL ) during follow-up was @ ( @ % CI @-@ @ ; P for trend = @ ) .


When albumin-adjusted serum calcium was analyzed as a continuous variable , per @ mg/dL increase , the HR of diabetes incidence was @ ( @ % CI @-@ @ ; P value = @ ) .


These associations remained significant after individuals taking calcium supplements or having calcium levels out of normal range had been excluded .


An increase in serum calcium concentrations is associated with an increased risk of type @ diabetes in individuals at high cardiovascular risk .


To assess effectiveness and feasibility of public-private collaboration in delivering influenza immunization to children .


Four pediatric and four family medicine ( FM ) practices in Colorado with a common public health department ( PHD ) were randomized at the beginning of baseline year ( @/@ ) to Intervention ( joint community clinics and PHD nurses aiding in delivery at practices ) ; or control involving usual care without PHD .


Generalized estimating equations compared changes in rates over baseline between intervention and control practices at end of @nd intervention year ( Y@ = @/@ ) .


Barriers to collaboration were examined using qualitative methods .


Overall , rates increased from baseline to Y@ by @ % in intervention and @ % in control ( p < @ ) , with significant increases in both pediatric and FM practices .


The largest increases were seen among school-aged and adolescent children ( p < @ for both ) , with differences for @-month-old to @-year-old children and for children with high-risk conditions not reaching significance .


Barriers to collaboration included uncertainty regarding the delivery of vaccine supplies , concerns about using up all purchased vaccine by practices , and concerns about documentation of vaccination if collaboration occurred .


In spite of barriers , public-private collaboration resulted in significantly higher influenza immunization rates , particularly for older , healthy children who visit providers less frequently .


The minimum alveolar concentration ( MAC ) of sevoflurane in neonates is @ % , but this value has not been verified in Chinese neonates and the effect of different doses of fentanyl on MAC in neonates has not been investigated .


This study was designed to determine the ED and ED values of sevoflurane in Chinese neonates with and without fentanyl .


Ninety-three neonates were randomly assigned to receive sevoflurane alone ( control group , n = @ ) , @ g/kg sevoflurane ( group fent@ , n = @ ) , or @ g/kg fentanyl ( group fent@ , n = @ ) .


Following inhalational induction and tracheal intubation , the end-tidal concentration of sevoflurane was adjusted to achieve the designated concentration , which was determined using the modified Dixon 's up-and-down method starting with @ % in each group , with a @ % step size .


Success was defined as no motor response within @ s of skin incision .


The MAC ( standard deviation ) values of sevoflurane were @ % ( @ ) in the control group , @ % ( @ ) in the fent@ group , and @ % ( @ ) in the fent@ group according to Dixon 's up-and-down method .


Logistic probit regression analysis revealed that the ED and ED ( @ % CI ) of sevoflurane in neonates were @ % ( @-@ @ ) and @ % ( @-@ @ ) , respectively , in the control group ; @ % ( @-@ @ ) and @ % ( @-@ @ ) , respectively , in the fent@ group ; and @ % ( @-@ @ ) and @ % ( @-@ @ ) , respectively , in the fent@ group .


The MAC value of sevoflurane in Chinese neonates was lower than previously reported and was reduced by the addition of fentanyl .


To compare intrauterine device ( IUD ) use at @ months postpartum among women who underwent intracesarean delivery ( during cesarean delivery ) IUD placement compared with women who planned for interval IUD placement @ or more weeks postpartum .


In this nonblinded randomized trial , women who were undergoing a cesarean delivery and desired an IUD were randomized to intracesarean delivery or interval IUD placement .


The primary outcome was IUD use at @ months postpartum .


A sample size of @ ( @ in each group ) was planned to detect a @ % difference in IUD use at @ months postpartum between groups .


From March @ to June @ , @ women were screened and @ women were randomized into the trial .


Baseline characteristics were similar between groups .


Data regarding IUD use at @ months postpartum were available for @ women , @ and @ women in the intracesarean delivery and interval groups , respectively .


A larger proportion of the women in the intracesarean delivery group were using an IUD at @ months postpartum ( @/@ -LSB- @ % -RSB- ) compared with those in the interval group ( @/@ -LSB- @ % -RSB- , relative risk @ , @ % confidence interval @-@ @ ) .


Among the @ women randomized to interval IUD insertion , @ ( @ % ) of them never received an IUD ; @ ( @ % ) never returned for IUD placement , five ( @ % ) women declined an IUD , and three ( @ % ) had a failed IUD placement .


Intrauterine device placement at the time of cesarean delivery leads to a higher proportion of IUD use at @ months postpartum when compared with interval IUD placement .


Hemicraniectomy and Durotomy Upon Deterioration From Infarction-Related Swelling Trial ( HeADDFIRST ) was a randomized pilot study to obtain information necessary to design a Phase III trial to evaluate the benefit of surgical decompression for brain swelling from large supratentorial cerebral hemispheric infarction .


All patients with stroke were screened for eligibility ( age @-@ years , National Institutes of Health Stroke Scale@ with Item @a < @ -LSB- responsive to minor stimulation -RSB- , and CT demonstrating unilateral , complete middle cerebral artery territory infarction by specific imaging criteria ) .


All enrolled patients were treated using a standardized medical treatment protocol .


Those with both@ mm of pineal shift and deterioration in level of arousal or @ mm of anteroseptal shift within @ hours of stroke onset were randomized to continued medical treatment only or medical treatment plus surgery .


Death at @ days was the primary outcome measure .


Among @ screened patients , only @ ( @ % ) patients were eligible for HeADDFIRST .


Forty patients were enrolled , and @ patients developed the requisite brain swelling for randomization .


All who failed to meet randomization criteria were alive at @ days .


Mortality at @ and @ days was @ % ( @/@ ) in the medical treatment only and @ % ( @/@ ) and @ % ( @/@ ) in the medical treatment plus surgery arms , respectively .


HeADDFIRST randomization criteria effectively distinguished low from high risk of death from large supratentorial cerebral hemispheric infarction .


Lower mortality in the medical treatment only group than in other published trials suggests a possible benefit to standardizing medical management .


These results can inform the interpretation of recently completed European trials concerning patient selection and medical management .


To compare clinical outcome and callus biomechanical properties of a novel angle stable interlocking nail ( AS-ILN ) and a @ mm bolted standard ILN ( ILN@b ) in a canine tibial fracture model .


Experimental in vivo study .


Purpose-bred hounds ( n = @ ) .


A @ mm mid-diaphyseal tibial ostectomy was stabilized with an AS-ILN ( n = @ ) or an ILN@b ( n = @ ) .


Orthopedic examinations and radiographs were performed every other week until clinical union ( @ weeks ) .


Paired tibiae were tested in torsion until failure .


Callus torsional strength and toughness were statistically compared and failure mode described .


Total and cortical callus volumes were computed and statistically compared from CT slices of the original ostectomy gap .


Statistical significance was set at P < @ RESULTS : From @ to @ weeks , lameness was less pronounced in AS-ILN than ILN@b dogs ( P < @ ) .


Clinical union was reached in all AS-ILN dogs by @ weeks and in @/@ ILN@b dogs at @ weeks .


Callus mechanical properties were significantly greater in AS-ILN than ILN@b specimens by @ % ( failure torque ) and @ % ( toughness ) .


Failure occurred by acute spiral ( control and AS-ILN ) or progressive transverse fractures ( ILN@b ) .


Cortical callus volume was @ % greater in AS-ILN than ILN@b specimens ( P < @ ) .


Earlier functional recovery , callus strength and remodeling suggest that the AS-ILN provides a postoperative biomechanical environment more conducive to bone healing than a comparable standard ILN .


Guidelines recommendations regarding anticoagulant therapy after percutaneous coronary intervention ( PCI ) among patients with atrial fibrillation ( AF ) rely on retrospective , nonrandomized observational data .


Currently , patients are treated with triple-therapy ( dual antiplatelet therapy -LSB- DAPT -RSB- + oral anticoagulation therapy ) , but neither the duration of DAPT nor the level of anticoagulation has been studied in a randomized fashion .


Recent studies also suggest dual pathway therapy with clopidogrel plus oral anticoagulation therapy may be superior , and other studies suggest that novel oral anticoagulants such as rivaroxaban may further improve patient outcomes .


PIONEER AF-PCI ( ClinicalTrials.gov NCT@ ) is an exploratory , open-label , randomized , multicenter clinical study assessing the safety of @ rivaroxaban treatment strategies and @ vitamin K antagonist ( VKA ) treatment strategy in subjects who have paroxysmal , persistent , or permanent nonvalvular AF and have undergone PCI with stent placement .


Approximately @,@ subjects will be randomized in a @:@:@ ratio to receive either rivaroxaban @ mg once daily plus clopidogrel @ mg daily for @ months ( a WOEST trial-like strategy ) , or rivaroxaban @ mg twice daily ( with stratification to a prespecified duration of DAPT @ , @ , or @ months , an ATLAS trial-like strategy ) , or dose-adjusted VKA once daily ( with stratification to a prespecified duration of DAPT @ , @ , or @ months , traditional triple therapy ) .


All patients will be followed up for @ months for the primary composite end point of Thrombolysis in Myocardial Infarction major bleeding , bleeding requiring medical attention , and minor bleeding ( collectively , clinically significant bleeding ) .


The PIONEER AF-PCI study is the first randomized comparison of VKA vs novel oral anticoagulant therapy in patients with NVAF receiving antiplatelet therapy after PCI to assess the relative risks of bleeding complications .


Roux-en-Y gastric bypass ( RYGB ) surgery causes profound weight loss and improves insulin sensitivity ( S ( I ) ) in obese patients .


Regular exercise can also improve S ( I ) in obese individuals ; however , it is unknown whether exercise and RYGB surgery-induced weight loss would additively improve S ( I ) and other cardiometabolic factors .


We conducted a single-blind , prospective , randomized trial with @ men and women who recently underwent RYGB surgery ( within @-@ months ) .


Participants were randomized to either a @-month semi-supervised moderate exercise protocol ( EX , n = @ ) or a health education control ( CON ; n = @ ) intervention .


Main outcomes measured included S ( I ) and glucose effectiveness ( S ( G ) ) , which were determined from an intravenous glucose tolerance test and minimal modeling .


Secondary outcomes measured were cardiorespiratory fitness ( VO@ peak ) and body composition .


Data were analyzed using an intention-to-treat ( ITT ) and per-protocol ( PP ) approach to assess the efficacy of the exercise intervention ( > @ min of exercise/week ) .


@ ( @ % ) participants completed the interventions , @ % for CON and @ % for EX .


There was a significant decrease in body weight and fat mass for both groups ( P < @ for time effect ) .


S ( I ) improved in both groups following the intervention ( ITT : CON vs. EX ; +@ vs. +@ min/U/ml , P = @ for , P < @ for time effect ) .


A PP analysis revealed that exercise produced an additive S ( I ) improvement ( PP : CON vs. EX ; +@ vs. +@ min/U/ml , P = @ ) above that of surgery .


Exercise also improved S ( G ) ( ITT : CON vs. EX ; +@ vs. +@ min , P = @ ) compared with the CON group .


Exercise improved cardiorespiratory fitness ( VO@ peak ) compared with the CON group .


Moderate exercise following RYGB surgery provides additional improvements in S ( I ) , S ( G ) , and cardiorespiratory fitness compared with a sedentary lifestyle during similar weight loss .


Breast cancer is the most common female malignancy in the world .


Beta glucan can be a hematopoietic and an immune modulator agent in cancer patients .


The aim of this trial was to determine the effect of beta glucan on white blood cell counts and serum levels of IL-@ and IL-@ in women with breast cancer undergoing chemotherapy .


This randomized double-blind placebo-controlled clinical trial was conducted on @ women with breast carcinoma aged @-@ years .


The eligible participants were randomly assigned to intervention ( n = @ ) or placebo ( n = @ ) groups using a block randomization procedure with matching based on age , course of chemotherapy and menopause status .


Patients in the intervention group received two @-mg capsules of soluble @-@ , @-@ , D-beta glucan daily and the control group receiving placebo during @ days , the interval between two courses of chemotherapy .


White blood cells , neuthrophil , lymphocyte and monocyte counts as well as serum levels of IL-@ and IL-@ were measured at baseline and at the end of the study as primary outcomes of the study .


In both groups white blood cell counts decreased after @ days of the intervention , however in the beta glucan group , WBC was less decreased non significantly than the placebo group .


At the end of the study , the change in the serum level of IL-@ in the beta glucan group in comparison with the placebo group was statistically significant ( p = @ ) .


The serum level of IL-@ in the beta glucan group statistically increased ( p = @ ) and comparison between two groups at the end of the study was significant after adjusting for baseline values and covariates ( p = @ ) .


The findings suggest that beta glucan can be useful as a complementary or adjuvant therapy and immunomodulary agent in breast cancer patients in combination with cancer therapies , but further studies are needed for confirmation .


Ropivacaine-induced vasoconstriction may affect the early absorption speed of ropivacaine ; however , the effects of dose on pharmacokinetics following transversus abdominis plane ( TAP ) block have not been studied .


In this study , we have examined plasma ropivacaine concentrations following TAP block with various ropivacaine concentrations ( @ , @ , and @ % ) .


With the approval of our University ethics committee and informed consent , @ adult patients undergoing open retropubic prostatectomy were enrolled .


Patients were randomly assigned to three groups ( n = @ each ) receiving TAP block with @ ml ( @ ml each side ) of different concentrations of ropivacaine .


To determine plasma concentrations , blood samples were drawn before and @ , @ , @ , @ , @ , @ , and @ min after completion of bilateral TAP blocks .


Plasma ropivacaine concentrations were analyzed by gas chromatography with mass spectrometry .


We found that the peak plasma concentrations ( C ( max ) ) increased dose dependently ( @ @ , @ @ , and @ @ g/ml ) , but the times to C ( max ) ( @ @ , @ @ , and @ @ min ) were not different between @ , @ , and @ % ropivacaine doses , respectively .


Terminal elimination half-life ( t ( @/@ ) ) , total body clearance ( CL ) , and distribution volume ( V ( d ) ) were also not different among the three groups .


Ropivacaine concentration did not alter pharmacokinetic profile following TAP blocks .


There are a high number of adolescents who are at risk of developing an eating disorder .


There is , therefore , a strong need to implement prevention programs aimed at reducing the incidence of eating disorders at this critical age .


Among other factors , successful prevention programs have been shown to be interactive , carried out by professionals , focused on educational as well as psychosocial elements and have taken risk factors as well as resources into account .


The objective of this study protocol is to present the design of a new prevention program for eating disorders in schools .


The gender-adapted prevention program extends over six school hours .


It contains interactive and educational elements about eating disorders and their treatment .


Participants pass through different exercises and reflect on the influences of the media , self-esteem , body perception and individual resources .


A cluster-randomized controlled trial is chosen to evaluate the program .


Based on an estimated effect size of d = @ a total of @ participants are enrolled in the study .


Eating disorder risk , internalization of Western beauty ideals , body dissatisfaction , self-concept as well as anxiety and symptoms of depression are measured before and immediately after the intervention as well as at a six-month follow-up .


In addition , the intervention group evaluates the different components of the program .


The study intends to test the practicability and efficacy of an interactive , gender-adapted ED prevention program in schools .


Moreover , it will provide valuable information about the occurrence of eating disorder risk factors in school-aged children .


In chronic human immunodeficiency virus ( HIV ) infection , plasma cystatin C may be influenced by factors other than glomerular filtration rate such as inflammation .


Statins may improve cystatin C by improving glomerular function or by decreasing inflammation .


The Stopping Atherosclerosis and Treating Unhealthy Bone With Rosuvastatin in HIV ( SATURN-HIV ) trial randomized @ patients on stable antiretroviral therapy ( ART ) with low-density lipoprotein cholesterol @ mg/dL to blinded @ mg daily rosuvastatin or placebo .


We analyzed relationships of baseline and @ - to @-week changes in plasma cystatin C concentration with measures of vascular disease , inflammation , and immune activation .


Median age was @ ( interquartile range , @-@ ) years ; @ % were male , @ % African American .


Tenofovir and protease inhibitors were used in @ % and @ % of subjects , respectively .


Baseline cystatin C was associated with higher carotid intima-media thickness and epicardial adipose tissue independent of age , sex , and race .


Biomarkers of endothelial activation and inflammation were associated with cystatin C in a multivariable model independent of creatinine-based estimated glomerular filtration rate ( eGFRcr ) .


After @ weeks , statin use slowed mean eGFRcr decline ( @ vs -@ mL/minute/@ @ m ( @ ) for statin vs placebo ; P = @ ) and decreased mean cystatin C ( -@ mg/L vs @ mg/L ; P = @ ) .


Within the statin group , changes in cystatin C correlated with changes in endothelial activation , inflammation , and T-cell activation .


Rosuvastatin @ mg daily reduces plasma cystatin C and slows kidney function decline in HIV-infected patients on ART .


Reductions in cystatin C with statin therapy correlate with reductions in inflammatory biomarkers .


Relationships between cystatin C , kidney function , and cardiovascular risk in HIV may be mediated in part by inflammation .


Clinical Trials Registration .


NCT@ .


The steady-state pharmacokinetics of two doses of a transdermal testosterone cream ( TTC ) was investigated after daily application for @ days .


This was a two-way cross-over study conducted for @ weeks .


Seven healthy postmenopausal women ( mean age , @ y ) were randomly allocated to @ or @ mg of TTC applied daily to the upper arm .


Serum total testosterone ( TT ) , free testosterone ( fT ) , sex hormone-binding globulin , and metabolite concentrations were measured .


Baseline-corrected and uncorrected serum TT and fT pharmacokinetic parameters ( AUC@-@ , C avg , Cmax , and Tmax ) were calculated using a standard model-independent approach .


After the single-dose application of @ mg of TTC on day @ , the median uncorrected TT C avg was found to be @ ng/mL ( range , @-@ @ ) , and the median uncorrected fT C avg was found to be @ pg/mL ( range , @-@ @ ) .


Doubling of the dose only resulted in a @ % increase in baseline-corrected TT C avg ( @ vs @ ng/mL for @ and @ mg , respectively ) and a @ % increase in baseline-corrected fT C avg ( @ vs @ pg/mL for @ and @ mg , respectively ) .


Neither dose resulted in any meaningful variation in dihydrotestosterone , estrone , estradiol , or sex hormone-binding globulin across the postdose sampling period .


The @-mg TTC dose restores TT and fT levels to levels above and within the reference range , respectively , for premenopausal women .


Transbronchial lung biopsy ( TBLB ) is required for evaluation in selected patients with interstitial lung disease ( ILD ) .


The diagnostic yield of histopathologic assessment is variable and is influenced by factors such as the size of samples and the presence of crush artefacts left by conventional biopsy forceps .


We compared the diagnostic yield and safety of TBLB with cryoprobe sampling versus conventional forceps sampling .


This randomized clinical trial analysed data for @ patients undergoing TBLB for evaluation of ILD ; patients were assigned to either a conventional-forceps group or a cryoprobe group .


Two pathologists assessed the tissue samples and agreed on histopathologic diagnoses .


We also compared the duration of procedures , complications and sample-quality variables .


The most frequent diagnosis observed in the cryoprobe group was non-specific interstitial pneumonia .


Histopathologic diagnoses were identified in more cases in the cryoprobe group ( @ % ) than in the conventional-forceps group ( @ % ) ( P < @ ) , and the diagnostic yield was higher in the cryoprobe group ( @ % vs @ % in the conventional forceps group ; P = @ ) .


A larger mean area of tissue was harvested by cryoprobe ( @ @ mm ( @ ) ) than by conventional forceps ( @ @ mm ( @ ) ) ( P < @ ) .


More grade @ bleeding ( not statistically significant ) occurred in the cryoprobe group ( @ % ) than in the conventional-forceps group ( @ % ) .


No differences in other complications were observed .


TBLB by cryoprobe is safe and potentially useful in the diagnosis of ILD .


Larger multisite randomized trials are required to confirm the potential benefits of this procedure .


Clinical trial registration at ClinicalTrials.gov : NCT@ .


Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents .


We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder , depression , and anxiety ( treatment aim ) ; and improving a sense of hope and functioning ( preventive aim ) .


We conducted a cluster randomized trial with @ children in war-affected Burundi ( aged @ to @ ( mean @ years , standard deviation @ ) ; @ % girls ) .


One group of children ( n = @ ) participated in a @-session school-based intervention implemented by para-professionals , and the remaining @ children formed a waitlist control condition .


Outcomes were measured before , one week after , and three months after the intervention .


No main effects of the intervention were identified .


However , longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators .


Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment , and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms .


The groups of children in the waitlist condition showed increases in depressive symptoms .


In addition , younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope .


Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment , whereas children in the intervention condition showed deterioration on these outcomes .


Given inconsistent effects across studies , findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children .


The intervention appears to have more consistent preventive benefits , but these effects are contingent upon individual ( for example , age , gender ) and contextual ( for example , family functioning , state of conflict , displacement ) variables .


Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings .


Although fresh frozen plasma ( FFP ) is one of the most commonly used hemostatic agents in clinical specialties today , there is little evidence available supporting its administration .


Our present study observed the effects of a priming strategy without FFP during cardiopulmonary bypass ( CPB ) on postoperative coagulation and clinical recovery in pediatric patients , aiming to supply new evidence for evidence-based use of FFP .


Eighty pediatric patients with congenital heart disease undergoing cardiac surgery with CPB were randomized to receive either @-@ ml/kg @ % succinylated gelatin ( Gelofusine , GEL group , n = @ ) or @-@ units FFP ( FFP group , n = @ ) in the pump prime .


Rapid-thromboelastography ( r-TEG ) and functional fibrinogen level were measured before skin incision and @ minutes after heparin reversal .


We recorded the volume of chest tube drainage , transfusion requirements and the dosage of pharmacological agents .


The ventilation time , ICU length of stay and hospitalization time after surgery were also collected .


After heparin neutralization , there were significantly elevated levels of fibrinogen in the FFP group , which were manifested by r-TEG parameters MAf and FLEV .


No significant differences were observed between the two groups in postoperative bleeding , transfusion requirements and the usage of pharmacological agents .


Recovery time was also comparable between the two groups .


In conclusion , prophylactic use of FFP in the priming solution does not provide clinical benefits as presumed .


Artificial colloids , such as Gelofusine , can be used safely and effectively as a substitute for FFP in the pump prime .


TEG is an effective assessment tool to evaluate postoperative coagulation function in pediatric patients .


The prevalence of heart failure ( HF ) is rising in industrialized and developing countries .


Though invasive coronary angiography ( ICA ) remains the gold standard for anatomical assessment of coronary artery disease in HF patients , alternatives are being sought .


Computed tomographic coronary angiography ( CTA ) has emerged as an accurate non-invasive diagnostic tool for coronary artery disease ( CAD ) and has been demonstrated to have prognostic value .


Whether or not CTA can be used in HF patients is unknown .


Acknowledging the aging population , the growing prevalence of HF and the increasing financial burden of healthcare , we need to identify non-invasive diagnostic tests that are available , safe , accurate and cost-effective .


The proposed study aims to provide insight into the efficacy of CTA in HF patients .


A multicenter randomized controlled trial will enroll @ HF patients requiring coronary anatomical definition .


Enrolled patients will be randomized to either CTA or ICA ( n = @ per group ) as the first test to define coronary anatomy .


The primary outcomes will be collected to determine downstream resource utilization .


Secondary outcomes will include the composite clinical events and major adverse cardiac events .


In addition , the accuracy of CTA for detecting coronary anatomy and obstruction will be assessed in patients who subsequently undergo both CTA and ICA .


It is expected that CTA will be a more cost-effective strategy for diagnosis : yielding similar outcomes with fewer procedural risks and improved resource utilization .


People with multiple and persistent mental and physical health problems have high rates of transition failures when transferring from a hospital level of care to home .


The transitional care model ( TCM ) is evidence-based and demonstrated to improve posthospital outcomes for elderly with physical health conditions , but it has not been studied in the population with serious mental illness .


Using a randomized controlled design , @ inpatients from two general hospital psychiatric units were recruited and randomly assigned to an intervention group ( n = @ ) that received the TCM intervention that was delivered by a psychiatric nurse practitioner for @ days posthospitalization , or a control group ( n = @ ) that received usual care .


Outcomes were as follows : service utilization , health-related quality of life , and continuity of care .


The intervention group showed higher medical and psychiatric rehospitalization than the control group ( p = @ ) .


Emergency room use was lower for intervention group but not statistically significant .


Continuity of care with primary care appointments were significantly higher for the intervention group ( p = @ ) .


The intervention group 's general health improved but was not statistically significant compared with controls .


A transitional care intervention is recommended ; however , the model needs to be modified from a single nurse to a multidisciplinary team with expertise from a psychiatric nurse practitioner , a social worker , and a peer support specialist .


A team approach can best manage the complex physical/mental health conditions and complicated social needs of the population with serious mental illness .


To compare the operative data and early postoperative outcomes of total laparoscopic hysterectomy ( TLH ) , laparoscopically assisted vaginal hysterectomy ( LAVH ) and vaginal hysterectomy ( VH ) .


One hundred and eight women requiring hysterectomy for enlarged myomatous uterus were randomly allocated into three treatment arms : TLH ( n = @ ) ; LAVH ( n = @ ) ; VH ( n = @ ) .


Randomization procedure was based on a computer-generated list .


The primary outcome was the discharge time comparison .


The secondary outcomes were operating time , blood loss , paralytic ileus time , intraoperative complications , postoperative pain , and early postoperative complications .


The mean discharge time was shorter after VH than after LAVH and TLH ( P = @ ) .


Operating time significantly influenced the discharge time , considered as a dependent variable in general linear model analysis ( P = @ ) .


In contrast , blood loss did not influence the discharge time ( P = @ ) .


The mean operating time was significantly shorter in VH than in TLH and LAVH groups ( P = @ ) .


The intraoperative blood loss was greater during LAVH than during TLH and VH ( P = @ ) .


Paralytic ileus time was shorter after VH than after TLH and LAVH ( P = @ ) .


No intraoperative complications or conversion to laparotomy occurred .


VH was the faster operative technique with smaller blood loss and shorter discharge time compared with the others two techniques .


So , VH should be considered the preferred approach in patients with enlarged myomatous uteri .


When VH is not feasible or salpingo-oophorectomy is required , LAVH or TLH should be considered as valid alternatives .


It is necessary to continue prospective comparative studies between the various surgical options to identify the best approach for hysterectomy in each single woman .


Hirsutism has negative impact on adolescent psychosocial development for both cosmetic and endocrine reasons .


This study evaluated the effectiveness of a new intermittent , low-dose finasteride regimen consisting of @ mg of drug given every @ days ( @ day of treatment , @ days of drug withdrawal ) for @ months in girls with hirsutism by polycystic ovarian syndrome ( PCOS ) or idiopathic hirsutism ( IH ) .


Twenty-eight girls ( @-@ y old ) with hirsutism were randomly assigned to @ treatment groups and treated for @ months .


Fourteen patients ( @ with IH , @ with PCOS ) received finasteride ; fourteen patients ( @ with IH , @ with PCOS ) received placebo .


Hirsutism score ( HS ) , clinical , and hormonal effects were compared between the @ groups .


In patients treated with finasteride , the HS value at @ months was @ % lower than that observed at baseline in girls with IH , and @ % lower in girls with PCOS ( P < @ for both ) .


Similarly , the @-@ - androstenediol glucuronide serum levels were decreased by @ % in patients with IH , and by @ % in patients with PCOS ( P < @ , respectively ) .


Finasteride treatment was well tolerated and did not alter values of BMI , serum levels of sexual hormones , metabolic parameters related to liver and kidney function as well as glycemic and lipidic asset .


A low-dose of finasteride , given every @ days , reduces the HS in young patients affected by PCOS or IH .


Compared with conventional continuous finasteride administration , the intermittent low-dose regimen has similar efficacy with the advantage to be safer and less expensive .


Relevant clinical data are needed given the increasing national interest in charged particle radiation therapy ( CPT ) programs .


Here we report long-term outcomes from the only randomized , stratified trial comparing CPT with iodine-@ plaque therapy for choroidal and ciliary body melanoma .


From @ to @ , @ patients met eligibility criteria and were randomized to receive particle ( @ patients ) or plaque therapy ( @ patients ) .


Patients were stratified by tumor diameter , thickness , distance to disc/fovea , anterior extension , and visual acuity .


Tumors close to the optic disc were included .


Local tumor control , as well as eye preservation , metastases due to melanoma , and survival were evaluated .


Median follow-up times for particle and plaque arm patients were @ years and @ years , respectively ( P = @ ) , and for those alive at last follow-up , @ and @ years , respectively ( P = @ ) .


Local control ( LC ) for particle versus plaque treatment was @ % versus @ % at @ years , and @ % versus @ % at @ years , respectively ( log rank : P = @ ) .


If patients with tumors close to the disc ( < @ mm ) were excluded , CPT still resulted in significantly improved LC : @ % versus @ % at @ years and @ % versus @ % at @ years , respectively ( log rank : P = @ ) .


Enucleation rate was lower after CPT : @ % versus @ % at @ years and @ % versus @ % at @ years , respectively ( log rank : P = @ ) .


Using Cox regression model , likelihood ratio test , treatment was the most important predictor of LC ( P = @ ) and eye preservation ( P = @ ) .


CPT was a significant predictor of prolonged disease-free survival ( log rank : P = @ ) .


Particle therapy resulted in significantly improved local control , eye preservation , and disease-free survival as confirmed by long-term outcomes from the only randomized study available to date comparing radiation modalities in choroidal and ciliary body melanoma .


There is a need for controlled trials to guide the perioperative management of patients undergoing endoscopic sinus surgery ( ESS ) .


The authors performed a pilot multicenter trial to compare two types of saline delivery devices in this population .


Patients were randomized to high volume saline irrigation with a squeeze bottle and low volume saline spray after ESS in patients with chronic rhinosinusitis ( CRS ) .


Surgeons were blinded to treatment , and one-month postoperative scores for sinonasal outcomes -LSB- Sinonasal Outcome Test-@ ( SNOT-@ ) -RSB- scale , nasal and sinus symptom score ( NSS ) , and perioperative sinus endoscopy ( POSE ) scale were compared with preoperative scores .


Nine centers provided data for @ patients .


All three outcomes measures improved significantly for both groups .


Saline spray : SNOT-@ @ versus .


@ , treatment effect @ ( @ % confidence interval -LSB- CI -RSB- , @-@ @ ) , POSE @ versus .


@ , treatment effect @ ( @ % CI , @-@ @ ) , and NSS @ versus @ , treatment effect @ ( @ % CI , @-@ @ ) pre - and postoperatively , respectively ( all p < @ ) .


Squeeze bottle : SNOT-@ @ versus @ , treatment effect @ ( @ % CI , @-@ @ ) , POSE @ versus @ , treatment effect @ , ( @ % CI @-@ @ ) , and NSS @ versus @ , treatment effect @ ( @ % CI , @-@ @ ) pre - and postoperatively , respectively ( all p < @ ) .


Analysis of variance did not identify a difference between the two treatment groups .


Subgroup analysis based on preoperative disease severity did not change the nonassociation of saline bottle with outcome measures .


Post hoc sample size calculation determined that @ patients is required to detect an @-point difference in SNOT-@ scores .


In this pilot multicenter trial examining patients with chronic rhinosinusitis undergoing ESS , both squeeze bottle and saline spray showed significant improvement in SNOT-@ , POSE , and NSS scores at one-month postoperatively .


Because the study was nonpowered , we can not rule out a potential difference between the two treatment groups .


Intentional weight loss in obese older adults is a risk factor for muscle loss and sarcopenia .


The objective was to examine the effect of a high whey protein - , leucine - , and vitamin D-enriched supplement on muscle mass preservation during intentional weight loss in obese older adults .


We included @ obese older adults in a double-blind randomized controlled trial .


During a @-wk weight loss program , all subjects followed a hypocaloric diet ( -@ kcal/d ) and performed resistance training @/wk .


Subjects were randomly allocated to a high whey protein - , leucine - , and vitamin D-enriched supplement including a mix of other macro - and micronutrients ( @ kcal , @ g protein ; @/wk , intervention group ) or an isocaloric control .


The primary outcome was change in appendicular muscle mass .


The secondary outcomes were body composition , handgrip strength , and physical performance .


Data were analyzed by using ANCOVA and mixed linear models with sex and baseline value as covariates .


At baseline , mean SD age was @ @ y , and body mass index ( in kg/m ( @ ) ) was @ @ .


During the trial , protein intake was @ @ g kg body weight ( -@ ) d ( -@ ) in the intervention group compared with @ @ g kg body weight ( -@ ) d ( -@ ) in the control group ( P < @ ) .


Both intervention and control groups decreased in body weight ( -@ @ kg and -@ @ kg ; both P < @ ) and fat mass ( -@ @ kg and -@ @ kg ; both P < @ ) , with no differences between groups .


The @-wk change in appendicular muscle mass , however , was different in the intervention and control groups -LSB- +@ @ kg and -@ @ kg , respectively ; = @ kg ( @ % CI : @ , @ ) ; P = @ -RSB- .


Muscle strength and function improved over time without significant differences between groups .


A high whey protein - , leucine - , and vitamin D-enriched supplement compared with isocaloric control preserves appendicular muscle mass in obese older adults during a hypocaloric diet and resistance exercise program and might therefore reduce the risk of sarcopenia .


This trial was registered at the Dutch Trial Register ( http://www.trialregister.nl ) as NTR@ .


Treatments for drug addiction and smoking in severely mentally ill ( SMI ) adults are needed .


To investigate the effect of a contingency management ( CM ) intervention targeting psycho-stimulant on cigarette smoking .


@ stimulant dependent SMI smokers were assigned to CM or a non-contingent control condition .


Rates of smoking-negative ( < @ ppm ) carbon monoxide breath-samples were compared .


Individuals who received CM targeting psycho-stimulants were @ % more likely to submit a smoking-negative breath-sample relative to controls .


This study provides initial evidence that a behavioral treatment for drug use results in reductions in cigarette smoking in SMI adults .


Although dipeptidyl-peptidase-@ inhibitors exert their major action via an incretin mechanism , a favorable effect of vildagliptin on lipid metabolism remains unexplained .


The objective was to examine hepatic triglyceride levels and insulin sensitivity on vildagliptin .


This was a @-month , randomized , double-blind , placebo-controlled trial .


This was an outpatient study at a university clinical research center .


Individuals with type @ diabetes ( n = @ ) and glycated hemoglobin @ % on stable metformin therapy were included .


Intervention was vildagliptin @ mg twice a day or placebo over @ months .


Main outcome measures were hepatic triglyceride levels and insulin sensitivity .


Mean fasting liver triglyceride content decreased by @ % with vildagliptin , from @ @ % ( baseline ) to @ @ % ( endpoint ) .


There was no change in the placebo group .


The between-group difference in change from baseline was significant ( P = @ ) .


Mean fasting plasma glucose concentration decreased over the study period with vildagliptin vs placebo by -@ mmol/L ( P = @ ) , and there was a positive correlation between these decrements and liver triglyceride in the vildagliptin group at @ months ( r = @ ; P = @ ) and @ months ( r = @ ; P = @ ) .


Plasma alanine aminotransferase fell from @ @ to @ @ IU/L in the vildagliptin group ( P = @ ) , and there was a correlation between the decrements in alanine aminotransferase and liver triglyceride ( r = @ ; P < @ ) .


Insulin sensitivity during the euglycemic clamp was similar in each group at baseline ( @ @ vs @ @ mg/kg/min ) and did not change ( adjusted mean change of @ @ vs @ @ mg/kg/min ; P = @ ) .


Mean body weight decreased by @ @ vs @ @ kg in the vildagliptin and placebo groups , respectively ( P = @ ) .


This study demonstrates that the dipeptidyl-peptidase-@ inhibitor vildagliptin brings about a clinically significant decrease in hepatic triglyceride levels during @ months of therapy unrelated to change in body weight .


There was no change in peripheral insulin sensitivity .


To investigate the genomic response induced by ischaemic preconditioning ( IPC ) in muscle biopsies taken from the operative leg of total knee arthroplasty patients .


The gene expression profile GSE@ was extracted from Gene Expression Omnibus ( GEO ) database .


Patients undergoing primary knee arthroplasty were randomized to control and treatment ( IPC ) groups .


Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery ( T@ ) and at @ hour into surgery ( T@ ) .


Limma package of R language was used to identify the differentially expressed genes ( DEGs ) between control and treatment group .


To find out specific genes , DEGs at T@ were compared with DEGs at T@ .


Scansite was used to find out the binding domain for specific DEGs .


Functional enrichment analysis was done by DAVID .


Of the genes queried on the Affymetrix Human Genome U@ Plus @ microarray , we identified @ ( T@ ) and @ ( T@ ) DEGs compared to the control group .


Down-regulation of DEGs related with regulation neuron apoptosis was observed at T@ .


The most significant function of DEGs at T@ was related with neurological system process .


The most specific DEG was FAM@B at T@ and T@ time points .


Its common binding domain was SH@ .


The protective effect of IPC was associated with altered expression of genes involved in neurological system process and regulation of neuron apoptosis .


The dynamic expression of FAM@B can be a supervised marker during the surgery .


IPC may be of potential benefit in this and other musculoskeletal conditions .


Stigma associated with HIV has been documented as a barrier for accessing quality health-related services .


When the stigma manifests in the health care setting , people living with HIV receive substandard services or even be denied care altogether .


Although the consequences of HIV stigma have been documented extensively , efforts to reduce these negative attitudes have been scarce .


Interventions to reduce HIV stigma should be implemented as part of the formal training of future health care professionals .


The interventions that have been tested with health care professionals and published have several limitations that must be surpassed ( i.e. lack of comparison groups in research designs and longitudinal follow-up data ) .


Furthermore , Latino health care professionals have been absent from these intervention efforts even though the epidemic has affected this population disproportionately .


In this article , we describe an intervention developed to reduce HIV stigma among medical students in Puerto Rico .


A total of @ medical students were randomly introduced into our intervention and control conditions .


The results show statistically significant differences between the intervention and control groups ; intervention group participants had lower HIV stigma levels than control participants after the intervention .


In addition , differences in HIV stigma levels between the groups were sustained for a @-month period .


The results of our study demonstrate the efficacy of the modes of intervention developed by us and serve as a new training tool for future health care professionals with regard to stigma reduction .


Treatment with pegylated interferon ( peg-IFN ) alfa-@a ( @KD ) results in hepatitis B `` e '' antigen ( HBeAg ) seroconversion @ months after treatment in up to @ % of HBeAg-positive chronic hepatitis B patients .


This study explored the efficacy of a novel combination of peg-IFN alfa-@a and entecavir ( ETV ) , a potent nucleoside analogue .


In total , @ treatment-naive Chinese HBeAg-positive patients were randomized to peg-IFN alfa-@a ( @ g/week ) for @ weeks , either as monotherapy ( n = @ ) , or with @ weeks of ETV ( @ mg/daily ) added at week @ ( ETV add-on , n = @ ) , or pretreatment with a @-week course of ETV , starting peg-IFN alfa-@a at week @ ( ETV pretreatment , n = @ ) .


The primary endpoint was reduction in quantitative HBeAg from baseline to @ weeks posttreatment .


Significant reductions in HBeAg from baseline were achieved in all treatment groups @ weeks posttreatment ; reductions were comparable across treatment arms ( shown as log@ Paul Ehrlich international units -LSB- PEIU -RSB- / mL ) : monotherapy : -@ ( SD , @ ) ; ETV add-on : -@ ( SD , @ ) ; ETV pretreatment : -@ ( SD , @ ) .


Rates of HBeAg seroconversion were similar across treatment groups posttreatment ( monotherapy : @ -LSB- @ % -RSB- ; ETV add-on : @ -LSB- @ % -RSB- ; ETV pretreatment : @ -LSB- @ % -RSB- ) .


Significantly greater reductions of hepatitis B virus DNA were achieved with ETV add-on while on treatment , but were not sustained posttreatment .


Safety profiles were comparable between treatment groups ; adverse events were experienced by @ ( @ % ) monotherapy , @ ( @ % ) ETV add-on , and @ ( @ % ) ETV pretreatment patients .


Neither ETV add-on nor ETV pretreatment demonstrated superiority compared with @ weeks of peg-IFN alfa-@a monotherapy .


The optimal treatment strategy using nucleos ( t ) ide analogues and peg-IFN alfa-@a remains to be determined .


Clinical Trials Registration.NCT@ .


To observe the clinical efficacy differences among warming-promotion acupuncture , regular acupuncture and psychological care for post-earthquake depression .


Ninety cases of post-earthquake depression in Gansu province were randomly divided into a warming-promotion acupuncture group , a regular acupuncture group and a care group , @ cases in each one .


The psychological treatment was applied in the care group ; the regular acupuncture at Baihui ( GV @ ) , Sishencong ( EX-HN @ ) ) , Fengchi ( GB @ ) , Shenmen ( HT @ ) , Yang-lingquan ( GB @ ) , Taichong ( LR @ ) and Sanyinjiao ( SP @ ) was used in the regular acupuncture group ; based on the treatment of regular acupuncture group , the warming-promotion acupuncture was applied in the warming-promotion acupuncture group , once a day .


Ten days were taken as one course with an interval of two days between two courses .


Totally @ treatment courses were completed .


The Hamilton depression ( HAMD ) scale before and after treatment in each group was observed while the efficacy was analyzed .


All three treatments were effective for depression .


The total cured rate was @ % ( @/@ ) in the warming-promotion acupuncture group , which was obviously superior to @ % ( @/@ ) in the regular acupuncture group ( P < @ ) and @ % ( @/@ ) in the care group ( P < @ ) .


After the treatment , the score of HAMD was all reduced in three groups , in which the effect in warming-promotion acupuncture group was superior to that in the regular acupuncture group and care group ( @ + / - @ vs @ + / - @ and @ + / - @ , P < @ , P < @ ) .


The warming-promotion acupuncture has positive effect on post-earthquake depression , which has special effect and is worthy of clinical generalization and application .


Previous open-label studies have suggested that quetiapine could be a valuable alternative for treating fibromyalgia .


This study aims to compare the efficacy and tolerability of extended-release quetiapine with amitriptyline for treating fibromyalgia .


This study was a randomized , open-label , flexible-dose , non-inferiority trial .


Patients with fibromyalgia were randomized to receive quetiapine extended-release ( XR ) ( N = @ ) ( @ to @ mg daily ) or amitriptyline ( N = @ ) ( @ to @ mg daily ) for @ weeks .


The primary endpoint was the change from baseline to endpoint in the Fibromyalgia Impact Questionnaire ( FIQ ) total score ; the non-inferiority threshold was established at @ points .


The secondary outcomes included sleep quality , anxiety , depression , and quality of life .


Twenty-two ( @ % ) patients in the quetiapine group and @ ( @ % ) patients in the amitriptyline group completed the study .


We found a reduction of @ points in the total FIQ score at the endpoint for the quetiapine-treated patients compared to @ points for the amitriptyline-treated patients , for a difference of @ points ( @ % confidence interval ( CI ) -@ to @ ) .


No significant differences were found between the quetiapine XR and amitriptyline groups for any of the secondary outcomes .


The proportion of patients discontinuing treatment due to adverse events was higher in the quetiapine group ( n = @ , @ % ) than the amitriptyline group ( n = @ , @ % ) .


Our results appear to indicate that quetiapine XR does not provide similar efficacy to amitriptyline for treating patients with fibromyalgia .


Quetiapine XR had a worse tolerability than amitriptyline in this population , possibly due to a relatively high starting dose .


Elderly people do not mount strong immune responses to vaccines .


We compared @-valent capsular polysaccharide ( @vPPV ) alone versus @-valent conjugate ( PCV@ ) vaccine followed by @vPPV @ months later in hospitalized elderly .


Participants were randomized to receive @vPPV or PCV@-@vPPV .


Antibodies against serotypes @ , @ , @A , @B , @V , @ , @C , @A , @F , @F were measured by enzyme-linked immunosorbent ( ELISA ) and opsonophagocytic ( OPA ) assays at baseline , @ months and @ months .


Of @ recruited , between @ % and @ % of subjects had undetectable OPA titres at baseline .


After one dose , PCV@ recipients had significantly higher responses to serotypes @V ( both assays ) and @F ( OPA only ) , and @vPPV recipients had significantly higher responses to serotype @ ( ELISA ) , @F and @A ( OPA only ) .


In subjects with undetectable OPA titres at baseline , a proportionately greater rise in OPA titre ( P < @ ) was seen for all serotypes after both vaccines .


The GMT ratio of OPA was significantly higher at @ months in the PCV@-@vPPV group for serotypes @A , @V , @C and @F .


OPA titre levels for these serotypes increased moderately after @ months , whereas immunity waned in the @vPPV only arm .


We did not show overwhelming benefit of one vaccine over the other .


Low baseline immunity does not preclude a robust immune response , reiterating the importance of vaccinating the frail elderly .


A schedule of PCV@-@vPPV prevents waning of antibody , suggesting that both vaccines could be useful in the elderly .


Follow up studies are needed to determine persistence of immunity .


The best criteria for surfactant treatment in the perinatal period are unknown and this makes it of interest to consider the possible economic implications of lessening the use of more restrictive criteria .


The objective of this study is the evaluation of the costs of respiratory care for preterm infants with Respiratory Distress Syndrome ( RDS ) treated with `` early rescue '' surfactant compared to a `` late rescue '' strategy .


The study was carried out applying the costs of materials used , of staff and pharmacological therapy calculated in the Neonatal Intensive Care Unit ( NICU ) of an Italian hospital to the Verder et al. study ( Pediatrics @ ) clinical data .


The cost for patients treated with early strategy was slightly lower than for patients treated with late strategy ( Euro @,@ vs. Euro @,@ ) .


The cost of treatment with surfactant was greater in the early group ( Euro @ vs. Euro @ ) , but this was compensated by the greater cost of treatment with Mechanical Ventilation ( MV ) in the late group ( respectively Euro @ vs. Euro @ ) .


The cost-effectiveness analysis performed in this study shows how early treatment with surfactant in preterm infants with RDS , as well as being clinically more effective , is associated with a slightly lower cost .


To evaluate the efficacy and safety of Arbidol ( umifenovir ) in adult patients with influenza .


The analysis of the preliminary results of the multicenter double-blind randomized placebo-controlled post-marketing study ARBITR was performed .


A total of @ adults aged @ to @ years with influenza or acute respiratory tract infection of no more than @ hours ' duration were enrolled in the study .


Individuals were randomized into @ treatment groups : oral umifenovir @ mg four times daily for @ days or placebo four times daily for @ days .


The efficacy endpoints were time to resolution of all symptoms , severity of symptoms and illness , durations of virus shedding .


The efficacy of umifenovir was evaluated in the group of @ ( @ % ) patients with influenza : @ patients with laboratory-confirmed influenza and @ patients whom diagnosis of influenza was made based on clinical and epidemiological data .


Umifenovir had influence on the time to resolution of all symptoms .


All symptoms were resolved within the first @ hours after therapy initiation in @ % patients with laboratory-confirmed influenza in the umifenovir group and it was @ times greater compared to placebo group ( @ % ) ( p < @ ) .


Severity of illness , catarrhal symptoms and intoxication was reduced with umifenovir compared to placebo , reducing of severity was most evidently observed within the first @-@ days following the therapy initiation .


Umifenovir had a significant effect on viral shedding .


The proportion of patients still shedding influenza virus on day @ was significantly reduced in the umifenovir group compared to placebo ( @ vs @ % , respectively ; p < @ ) .


It was found that the effect of umifenovir in the treatment of influenza in adults is most pronounced in the acute stage of the disease and appears in the reduction of time to resolution of all symptoms of the disease , reducing the severity of symptoms of the disease and durations of virus shedding .


Median OS after surgery in curative intent for non-metastasized pancreas cancer ranges under study conditions from @ months to @ months .


Tumor recurrence occurs locally , at distant sites ( liver , peritoneum , lungs ) , or both .


Observational and autopsy series report local recurrence rates of up to @ % even after potentially `` curative '' R@ resection .


To achieve better local control , neoadjuvant CRT has been suggested for preoperative tumour downsizing , to elevate the likelihood of curative , margin-negative R@ resection and to increase the OS rate .


However , controlled , randomized trials addressing the impact of neoadjuvant CRT survival do not exist .


The underlying hypothesis of this randomized , two-armed , open-label , multicenter , phase III trial is that neoadjuvant CRT increases the three-year overall survival by @ % compared to patients undergoing upfront surgery for resectable pancreatic cancer .


A rigorous , standardized technique of histopathologically handling Whipple specimens will be applied at all participating centers .


Overall , @ patients ( n = @ in each study arm ) will be enrolled in the trial , taking into regard an expected drop out rate of @ % and allocated either to receive neoadjuvant CRT prior to surgery or to undergo surgery alone .


Circumferential resection margin status , i.e. R@ and R@ rates , respectively , surgical resectability rate , local and distant disease-free and global survival , and first site of tumor recurrence constitute further essential endpoints of the trial .


For the first time , the NEOPA study investigates the impact of neoadjuvant CRT on survival of resectable pancreas head cancer in a prospectively randomized manner .


The results of the study have the potential to change substantially the treatment regimen of pancreas cancer .


Assess the safety , tolerability , and pharmacokinetic ( PK ) profiles of daclatasvir ( DCV ) and asunaprevir ( ASV ) in healthy male Japanese subjects .


AI@-@ and AI@-@ were phase I , double-blind , placebo-controlled , sequential , single-ascending dose ( SAD ) , and multiple-ascending dose ( MAD ) studies assessing DCV or ASV , respectively .


Eight subjects per panel were randomized to study drug or placebo ( @ : @ ) .


In the SAD part of each study , subjects received single oral dose DCV @/@/@ / @/@ mg or ASV @/@/@ / @/@ ,@ mg .


In MAD , subjects received @-day oral multiple dose DCV @/@/@ mg once-daily or ASV @/@/@ mg every @ hours .


Serial PK blood sampling occurred from predose to @-hours postdose or post-last-dose .


Safety and tolerability was assessed throughout .


@ ( SAD , n = @ ; MAD , n = @ ) and @ ( SAD , n = @ ; MAD , n = @ ) subjects were enrolled in AI@-@ and AI@-@ , respectively .


DCV and ASV were generally well tolerated , with no serious adverse events or clinicallyrelevant changes in vital signs or ECG parameters .


Baseline demographic characteristics were comparable across treatment groups in both studies .


DCV was readily absorbed , with median tmax of ~ @ - @ hours postdose and concentrations declining in a multi-phasic manner .


Exposure generally increased dose-proportionally within dose-range studied .


Steady-state was achieved between days @ and @ of multiple dosing .


ASV was readily absorbed , with median tmax of ~ @ - @ hours postdose and concentrations declining in a biphasic manner .


Steady-state appeared to be achieved between days @ - @ of multiple dosing .


Results suggest no clinically significant short-term safety signals with DCV and ASV at single or multiple doses in this population .


The use of animals to augment traditional medical therapies was reported as early as the @th century but to our knowledge has not been studied in an orthopaedic patient population .


The purpose of this study was to evaluate the role of animal-assisted therapy using therapy dogs in the postoperative recovery of patients after THA and TKA .


We asked : ( @ ) Do therapy dogs have an effect on patients ' perception of pain after total joint arthroplasty as measured by the VAS ?


( @ ) Do therapy dogs have an effect on patients ' satisfaction with their hospital stay after total joint arthroplasty as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems ( HCAHPS ) ?


A randomized controlled trial of @ patients undergoing primary unilateral THA or TKA was conducted .


Patients were randomized to a @-minute visitation with a therapy dog before physical therapy or standard postoperative physical therapy regimens .


Both groups had similar demographic characteristics .


Reduction in pain was assessed using the VAS after each physical therapy session , beginning on postoperative Day @ and continuing for three consecutive sessions .


To ascertain patient satisfaction , the proportion of patients selecting top-category ratings in each subsection of the HCAHPS was compared .


Patients in the treatment group had lower VAS scores after each physical therapy session with a final VAS score difference of @ units ( animal-assisted therapy VAS , @ ; SD , @ -LSB- @ % CI , @-@ @ -RSB- versus control VAS , @ ; SD , @ -LSB- @ % CI , @-@ @ -RSB- , p < @ ) after the third physical therapy session .


Patients in the treatment group had a higher proportion of top-box HCAHPS scores in the following fields : nursing communication ( @ of @ , @ % -LSB- @ % CI , @ % -@ % -RSB- versus @ % , @ of @ -LSB- @ % CI , @ % -@ % -RSB- , p = @ ; risk ratio , @ -LSB- @ % CI of risk ratio , @-@ @ -RSB- ; risk difference , @ % -LSB- @ % CI of risk difference , @ % -@ % -RSB- ) , pain management ( @ of @ , @ % -LSB- @ % CI , @ % -@ % -RSB- , versus @ of @ , @ % -LSB- @ % CI , @ % -@ % -RSB- , p = @ ; risk ratio , @ -LSB- @ % CI of risk ratio , @-@ @ -RSB- ; risk difference , @ % -LSB- @ % CI of risk difference , @ % -@ % -RSB- ) .


The overall hospital rating also was greater in the treatment group ( @-@ scale ) ( @ ; SD , @ -LSB- @ % CI , @-@ @ -RSB- versus @ , SD , @ -LSB- @ % CI , @-@ @ -RSB- , p < @ ) .


The use of therapy dogs has a positive effect on patients ' pain level and satisfaction with hospital stay after total joint replacement .


Surgeons are encouraged to inquire about the status of volunteer-based animal-assisted therapy programs in their hospital as this may provide a means to improve the immediate postoperative recovery for a select group of patients having total joint arthroplasty .


Level II , randomized controlled study .


See Instructions for Authors for a complete description of levels of evidence .


The efficacy and safety of canagliflozin , a sodium glucose co-transporter @ inhibitor , was evaluated in patients with type @ diabetes mellitus ( T@DM ) inadequately controlled with metformin and pioglitazone .


In this randomized , double-blind , phase @ study , patients ( N = @ ) received canagliflozin @ or @mg during a @-week , placebo-controlled , core period and a @-week , active-controlled extension in which placebo-treated patients were switched to sitagliptin @mg .


Efficacy comparisons for canagliflozin versus placebo at week @ are reported , with no comparisons versus sitagliptin at week @ ( sitagliptin used to maintain double-blind and control for safety ) .


Safety data are reported for canagliflozin and placebo/sitagliptin .


Canagliflozin @ and @mg significantly lowered haemoglobin A@c ( HbA@c ) compared with placebo at week @ ( -@ % , -@ % and -@ % ; p < @ ) ; reductions with canagliflozin @ and @mg were maintained at week @ ( -@ % and -@ % ) .


Relative to placebo , both canagliflozin doses significantly reduced body weight ( -@ and -@ kg ) , fasting plasma glucose and systolic blood pressure ( BP ) at week @ ( p < @ for all ) , with reductions maintained at week @ .


Overall adverse event ( AE ) incidence over @ weeks was @ , @ and @ % with canagliflozin @ and @mg and placebo/sitagliptin ; AE-related discontinuation and serious AE rates were low .


Incidences of genital mycotic infections and AEs related to osmotic diuresis and volume depletion were higher with canagliflozin than placebo/sitagliptin .


Canagliflozin improved glycaemic control , reduced body weight and systolic BP , and was generally well tolerated in patients with T@DM on metformin and pioglitazone over @ weeks .


Delivery of a pharmacologically effective drug dosage to a target tissue is critical .


Barrett 's epithelia are a unique challenge for drug delivery of orally administered zinc due to rapid transit down the esophageal lumen , incomplete absorptive differentiation of these epithelia , and the use of proton-pump inhibitor drugs abrogating intestinal uptake of supplemental zinc .


Barrett 's esophagus patients were administered oral zinc gluconate ( @ mg zinc twice daily ) for @ days prior to biopsy procurement .


Barrett 's biopsies were analyzed for total zinc content by atomic absorption spectroscopy and by western immunoblot for cellular proteins known to be regulated by zinc .


Cellular levels of both the Znt-@ transport protein and the alpha isoform of PKC were over @ % lower in the zinc treatment group .


Oral zinc administration can result in effective delivery of zinc to Barrett 's epithelia with resulting effects on intracellular signal transduction .


Ribavirin ( RBV ) remains part of several interferon-free treatment strategies even though its mechanisms of action are still not fully understood .


One hypothesis is that RBV increases responsiveness to type I interferons .


Pegylated Interferon alpha ( PEG-IFNa ) has recently been shown to alter natural killer ( NK ) cell function possibly contributing to control of hepatitis C virus ( HCV ) infection .


However , the effects of ribavirin alone or in combination with IFNa on NK cells are unknown .


Extensive ex vivo phenotyping and functional analysis of NK cells from hepatitis C patients was performed during antiviral therapy .


Patients were treated for @ weeks with RBV monotherapy ( n = @ ) , placebo ( n = @ ) or PEG-IFNa-@a alone ( n = @ ) followed by PEG-IFNa/RBV combination therapy .


The effects of RBV and PEG-IFNa-@a on NK cells were also studied in vitro after co-culture with K@ or Huh@ @ cells .


Ribavirin monotherapy had no obvious effects on NK cell phenotype or function , neither ex vivo in patients nor in vitro .


In contrast , PEG-IFNa-@a therapy was associated with an increase of CD@bright cells and distinct changes in expression profiles leading to an activated NK cell phenotype , increased functionality and decline of terminally differentiated NK cells .


Ribavirin combination therapy reduced some of the IFN effects .


An activated NK cell phenotype during therapy was inversely correlated with HCV viral load .


PEG-IFNa activates NK cells possibly contributing to virological responses independently of RBV .


The role of NK cells during future IFN-free combination therapies including RBV remains to be determined .


Hyperoxemic management during cardiopulmonary bypass ( CPB ) is still common , and there is no consensus about physiologic oxygen tension strategy ( normoxemic management ) during pediatric CPB .


In this study , we compared the postoperative conditions and measures of inflammatory response among patients with acyanotic congenital heart disease subjected to either hyperoxemic or normoxemic management strategy during CPB .


We studied @ patients with a ventricular septal defect and pulmonary artery hypertension .


The patients were divided into two groups .


Group I ( n = @ ) received normoxemic management ( PaO@ = @-@ mm Hg ) and group II ( n = @ ) received hyperoxemic management ( PaO@ = @-@ mm Hg ) during CPB .


There was no difference between groups with regard to age , body weight , duration of CPB , and aorta clamping time or preoperative pulmonary hypertension ( pulmonary pressure/systemic pressure -LSB- Pp/Ps -RSB- ) .


In each group , the blood samples to measure the cytokine levels were collected before and after the CPB .


Although we observed no statistically significant differences in postoperative intubation time , alveolar-arterial oxygen difference , creatine kinase MB level , and pulmonary hypertension ( Pp/Ps ) between group I ( @ hours , @ mm Hg , @ IU/L , @ % @ % , respectively ) and group II ( @ hours , @ mm Hg , @ IU/L , @ % @ % , respectively ) , levels of median interleukin @ and tumor necrosis factor were lower in group I ( @ and @ pg/mL , respectively ) than that in group II ( @ and @ pg/mL , respectively ) .


During the CPB in acyanotic pediatric patients , normoxemic management can minimize the systemic inflammatory response syndrome associated with CPB .


We can apply this physiologic oxygen tension strategy to surgical advantage during heart surgeries in acyanotic pediatric patients .


Worsening heart failure ( WHF ) in the first @ days after an admission for acute HF ( AHF ) has been proposed as a therapeutic target in several recent AHF studies and was a co-primary endpoint of the VERITAS studies .


Patients were randomized within @h of admission for AHF .


WHF was defined as worsening or persistent signs and symptoms of HF requiring additional intravenous or mechanical therapy for HF or death within @ days of randomization .


Multivariable models were developed to predict the time to WHF through day @ .


Unadjusted and multivariable-adjusted associations of WHF with the length of stay ( LOS ) of the index hospitalization , and @ - and @-day outcomes were estimated .


WHF occurred by day @ in @ % of the @ patients enrolled .


Age , co-morbidities , and markers of HF severity were moderately predictive of WHF ; the C-index for a multivariable model for WHF was @ .


After multivariable adjustment for baseline characteristics , WHF was associated with an increase in LOS of @ days -LSB- @ % confidence interval ( CI ) @-@ @ days -RSB- , a hazard ratio ( HR ) for @-day HF readmission or death of @ ( @ % CI @-@ @ ) , and a HR for @-day mortality of @ ( @ % CI @-@ @ ) , all with P < @ .


The associations of WHF with these outcomes remained largely unchanged after adjustment for both baseline characteristics and changes in markers of renal and hepatic dysfunction during the first day of admission .


In patients admitted for AHF , WHF is a significant clinical event that is associated with delays in discharge and higher rates for readmission and death .


Persons with mild dementia experience multiple losses and manifest depressive symptoms .


This research study aimed to evaluate the effectiveness of a support group led by a social worker for Chinese persons with mild dementia .


Participants were randomly assigned to either a ten-session support group or a control group .


Standardized assessment tools were used for data collection at pretreatment and post-treatment periods by a research assistant who was kept blind to the group assignment of the participants .


Upon completion of the study , @ treatment group participants and @ control group participants completed all assessments .


At baseline , the treatment and control groups did not show any significant difference on all demographic variables , as well as on all baseline measures ; over one-half ( @ % ) of all the participants reported having depression , as assessed by a Chinese Geriatric Depression Scale score @ .


After completing the support group , the depressive mood of the treatment group participants reduced from @ ( standard deviation = @ ) to @ ( standard deviation = @ ) , which was significant ( Wilcoxon signed-rank test ; P = @ , P < @ ) , while the control group 's participants did not show any significant change .


This present study supports the efficacy and effectiveness of the support group for persons with mild dementia in Chinese society .


In particular , this present study shows that a support group can reduce depressive symptoms for participants .


Green tea ( GT ) extract may play a role in body weight regulation .


Suggested mechanisms are decreased fat absorption and increased energy expenditure .


We examined whether GT supplementation for @ wk has beneficial effects on weight control via a reduction in dietary lipid absorption as well as an increase in resting energy expenditure ( REE ) .


Sixty Caucasian men and women -LSB- BMI ( in kg/m ) : @-@ or > @ ; age : @-@ y -RSB- were included in a randomized placebo-controlled study in which fecal energy content ( FEC ) , fecal fat content ( FFC ) , resting energy expenditure , respiratory quotient ( RQ ) , body composition , and physical activity were measured twice ( baseline vs. week @ ) .


For @ wk , subjects consumed either GT ( > @ g/d epigallocatechin gallate + @-@ @ g/d caffeine ) or placebo capsules .


Before the measurements , subjects recorded energy intake for @ consecutive days and collected feces for @ consecutive days .


No significant differences between groups and no significant changes over time were observed for the measured variables .


Overall means SDs were @ @ g/d , @ @ MJ/d , @ @ kg , and @ @ % for FFC , REE , body weight , and body fat percentage , respectively .


GT supplementation for @ wk in @ men and women did not have a significant effect on FEC , FFC , REE , RQ , and body composition .


The optimum size of endotracheal tube ( ETT ) for general anesthesia remains unresolved .


Choice of ETT size may be of particular relevance to thyroid surgery because of the increased risk of laryngeal trauma and concerns regarding postoperative vocal outcomes .


To test our hypothesis that intubation with a smaller ETT would lead to reduced postoperative vocal impairment and associated reduced laryngoscopic evidence of laryngeal trauma compared with intubation with a standard-size ETT .


This double-blind randomized clinical trial studied patients @ years and older undergoing elective thyroidectomy at an academic teaching hospital from October @ , @ , through June @ , @ .


Patients were randomized to group @ ( standard-size ETT , @ mm for men and @ mm for women ; n = @ ) or group @ ( small ETT , @ mm for men and @ mm for women ; n = @ ) .


Patients were assessed preoperatively and at @ hours and @ weeks postoperatively .


Fiberoptic videolaryngoscopy with modified scoring system , voice assessment using the GRBAS ( grade , roughness , breathiness , asthenia , strain ) rating scale , vocal self-assessment using the @-item Voice Handicap Index , and subjective pain score .


At @ hours , no significant differences were found between patients in groups @ and @ in change in GRBAS scores , change in laryngoscopic score ( @ vs @ , P = @ ) , or postoperative pain score ( @ vs @ , P = @ ) .


At @ weeks , no significant differences were found in changes in the @-item Voice Handicap Index score ( -@ vs -@ , P = @ ) , GRBAS scores , or laryngoscopic score ( @ vs @ , P = @ ) .


We did not find evidence that smaller ETT size for thyroidectomy has any significant effect on postoperative vocal outcomes , incidence of laryngeal trauma as assessed by laryngoscopy , or pain scores .


However , because of the small sample size , our study may have been underpowered to detect small differences .


Recent developments of open irrigated catheters have sought to create uniform cooling of the entire ablating electrode .


The aim of this randomized study was to assess whether the diffuse irrigation of the Coolflex ( ) ( CF ) catheter results in improved short-term procedural benefits in patients undergoing ablation of right atrial typical flutter .


Sixty consecutive patients ( age @ @ ) with typical atrial flutter were prospectively randomized to ablation of the cavotricuspid isthmus ( CTI ) using either a standard @ mm tip ablation catheter with six distal irrigation channels ( @C ) ( @ patients ) or a @ mm tip fully irrigated ablation catheter ( CF ) ( @ patients ) .


There were no significant differences seen between procedures performed with the diffusely irrigated CF catheter and the standard six-channel irrigated-tip catheter .


This concerned the total procedural duration RF duration , fluoroscopic duration , the total amount of irrigation fluid , and the occurrence of steam pop .


The use of a diffuse irrigation at the ablation catheter tip does neither facilitate lesion formation nor reduce the amount of irrigation during RF ablation for typical right atrial flutter using recommended flow and power settings .


To assess the association of the vitreomacular interface with outcomes of eyes treated with anti-vascular endothelial growth factor drugs for neovascular age-related macular degeneration ( AMD ) .


Prospective cohort study within a multicenter , randomized clinical trial .


Patients enrolled in the Comparison of AMD Treatments Trials ( CATT ) .


Treatment was assigned randomly as either ranibizumab or bevacizumab and as @ different regimens for dosing over a @-year period .


Masked readers at a reading center assessed optical coherence tomography ( OCT ) scans at baseline and follow-up for vitreomacular traction ( VMT ) and vitreomacular adhesion ( VMA ) , fluid , and central thickness .


Visual acuity ( VA ) was measured by masked , certified examiners .


Anatomic features and VA at baseline and @ and @ years and number of treatments .


At baseline , @ patient eyes ( @ % ) had VMT or VMA .


Compared with those with neither ( n = @ ) , patients with VMT or VMA were younger ( mean standard error , @ @ vs. @ @ years ; P < @ ) and more likely to be male ( @ % vs. @ % ; P = @ ) , to be cigarette smokers ( @ % vs. @ % ; P = @ ) , and to have subretinal fluid on OCT ( @ % vs. @ % ; P = @ ) .


Vitreomacular interface status was not associated with VA at baseline or follow-up .


Among eyes treated as needed ( n = @ ) and followed up for @ years ( n = @ ) , the mean number of injections was @ @ for eyes having VMT at baseline or during follow-up ( n = @ ) , @ @ for eyes with VMA at baseline or follow-up ( n = @ ) , and @ @ ( P = @ ) for eyes without VMT or VMA ( n = @ ) .


In addition , the mean number of injections in eyes treated as needed increased from @ @ when VMT was not observed to @ @ when observed once and to @ @ when observed more than once during follow-up .


At @ years , geographic atrophy developed in a lower percentage of eyes with VMT or VMA at baseline ( @ % ) than with neither condition ( @ % ; P = @ ) .


In eyes in the CATT , VMT and VMA were infrequent .


At baseline and follow-up , VMT or VMA were not associated with VA. .


Eyes with VMT or VMA treated as needed required on average @ more injections over @ years .


To evaluate the efficacy of resiniferatoxin in the treatment of patients with lifelong premature ejaculation .


A total of @ outpatients ( mean age @ years ) with premature ejaculation completed the present study .


They were randomly separated into the resiniferatoxin group and the placebo group .


The resiniferatoxin group included @ patients with redundant prepuce and @ patients without redundant prepuce , whereas the placebo group contained @ patients with redundant prepuce and @ patients without .


For the treatment , the glans were respectively soaked in @mL of resiniferatoxin with a concentration of @nmol/L or @ % alcohol solution for @min before sexual intercourse .


Clinical efficacy was assessed by using the Chinese Index of Sexual Function for Premature Ejaculation-@ and the intravaginal ejaculation latency time before or @ weeks after the treatment .


The side-effects were also evaluated .


In the resiniferatoxin group , the effective rate of patients with redundant prepuce was @ % , and both the intravaginal ejaculation latency time and Chinese Index of Sexual Function for Premature Ejaculation-@ significantly increased ( P < @ ) .


However , the effective rate of patients without redundant prepuce was @ % , and there were no significant changes of their intravaginal ejaculation latency time and Chinese Index of Sexual Function for Premature Ejaculation-@ before and after the resiniferatoxin treatment ( P > @ ) .


The total effective rate of patients treated with resiniferatoxin was @ % .


In the placebo group , the effective rate of patients with or without redundant prepuce was @ % and @ % , respectively .


The total effective rate of patients treated with placebo was @ % , and there were no significant changes of their intravaginal ejaculation latency time and Chinese Index of Sexual Function for Premature Ejaculation-@ before and after the placebo treatment ( P > @ ) .


The side-effects included a slight burning sensation for the glans penis and dysuria .


These preliminary results show that resiniferatoxin might be suitable for treating patients with lifelong premature ejaculation and particularly those with redundant prepuce .


Circumferential excisional hemorrhoidectomy ( CEH ) enables the surgeon to remove the encircling hemorrhoids completely .


The purpose of this study is to compare the efficacy of CEH with that of Ferguson hemorrhoidectomy ( FH ) for end-stage hemorrhoids .


Between February @ and December @ , a prospective randomized trial was conducted with @ patients who presented with end-stage hemorrhoids and underwent FH or CEH at our center .


The patient demographics , mean operative times , lengths of hospital stay , and cumulative rates of postoperative complications were similar in the study groups .


Significant differences were revealed in the incidence of postoperative hemorrhage ( @ vs. @ patients in the FH and CEH groups , respectively ; p = @ ) and in the tendency to form anal stricture ( @ vs. @ patients in the FH and CEH groups , respectively ; p = @ ) .


However , all cases of anal strictures were easily managed by digital dilatations .


At a mean follow-up of @ ( range , @-@ ) years , accessible patients from the CEH group remained symptom free , whereas @ of @ patients in the FH group indicated that they had recurrent hemorrhoidal symptoms .