A multiple regression analysis clearly showed ( r ( @ ) = @ , P < @ , SEE @ m ) that P max , Fv IMB and lower limb extension range ( h PO ) explained a significant part of the interindividual differences in CMJ performance ( P < @ ) with positive regression coefficients for P max and h PO and a negative one for Fv IMB .


Compared to SJ , F-v relationships were shifted to the right in CMJ , with higher P max , maximal theoretical force and velocity ( +@ , @ and @ % , respectively ) .


As in SJ , CMJ performance depends on Fv IMB , independently from the effect of P max , with the existence of an individual optimal F-v profile ( Fv IMB having an even larger influence in CMJ ) .


To investigate whether retesting with the oral glucose tolerance test ( OGTT ) is useful and necessary for all women with polycystic ovary syndrome ( PCOS ) .


Follow-up study .


Tertiary medical center .


Eighty-four women with PCOS and @ healthy controls .


Peripheral venous blood sampling .


We performed a @-g @-hour OGTT in women with normal glucose tolerance ( NGT ) and impaired glucose tolerance ( IGT ) at the time of the first test with and without PCOS .


The average follow-up period for women with PCOS was @ years ( range , @-@ @ years ) .


Seventy-eight of these women had NGT at baseline , @ % converted to IGT , with an annualized incidence rate of @ % .


Of those women with IGT at baseline ( n = @ ) , @ % converted to type @ diabetes mellitus , with an annualized incidence rate of @ % .


In the healthy subjects , the average follow-up period was @ years ( range , @-@ @ years ) .


Forty-two of these women had NGT at baseline , @ % converted to IGT , giving a progression of @ % per year .


Among the three women with IGT at baseline , @ % reverted to NGT , and @ % had persistent IGT .


Conversion rates from NGT to IGT or type @ diabetes mellitus were accelerated in women with PCOS compared with healthy subjects .


Women with PCOS should be tested regularly for early detection of abnormal glucose tolerance .


In addition , the interval for periodic rescreening should be determined by further studies involving more women with PCOS .


To verify the nutritive and non-nutritive stimuli efficacy in the newborn 's response to pain during venipuncture .


The main sample was composed of @ newborns that were randomly divided into three groups .


The first group ( n = @ ) received nutritive sucking stimulus that was performed through maternal breastfeeding .


The second group ( n = @ ) received non-nutritive sucking stimulus that was performed through the introduction of the researcher little finger in the newborn 's oral cavity .


The third group or control group ( n = @ ) did not receive any analgesia stimulus .


The newborns were evaluated using the Neonatal Infant Pain Scale , and the responses to painful stimuli were compared .


The nutritive as well as non-nutritive suction methods provided a comforting effect , resulting in lower pain response scores ( p < @ ) .


There was no difference between the analgesia provided by both methods ( p > @ ) .


The nutritive and the non-nutritive sucking stimuli proved to be efficacious tools in relieving pain among newborns .


At northern latitudes , vitamin D is not synthesized endogenously during winter , causing low plasma @-hydroxyvitamin D ( @ ( OH ) D ) concentrations .


Therefore , we evaluated the effects of a healthy Nordic diet based on Nordic nutrition recommendations ( NNR ) on plasma @ ( OH ) D and explored its dietary predictors .


In a Nordic multi-centre trial , subjects ( n = @ ) with metabolic syndrome were randomized to a control or a healthy Nordic diet favouring fish ( @g/week , including @g/week fatty fish ) , whole-grain products , berries , fruits , vegetables , rapeseed oil and low-fat dairy products .


Plasma @ ( OH ) D and parathyroid hormone were analysed before and after @ - to @-week intervention .


At baseline , @ % had vitamin D inadequacy ( < @nmol/l ) , whereas @ % had deficiency ( < @nmol/l ) .


Dietary vitamin D intake was increased by the healthy Nordic diet ( P < @ ) .


The healthy Nordic and the control diet reduced the prevalence of vitamin D inadequacy by @ % ( P < @ ) and @ % ( P = @ ) , respectively , without between-group difference ( P = @ ) .


Compared with control , plasma @ ( OH ) D ( P = @ ) and parathyroid hormone ( P = @ ) were not altered by the healthy Nordic diet .


Predictors for @ ( OH ) D were intake of vitamin D , eicosapentaenoic acids ( EPA ) , docosahexaenoic acids ( DHA ) , vitamin D supplement , plasma EPA and plasma DHA .


Nevertheless , only vitamin D intake and season predicted the @ ( OH ) D changes .


Consuming a healthy Nordic diet based on NNR increased vitamin D intake but not plasma @ ( OH ) D concentration .


The reason why fish consumption did not improve vitamin D status might be that many fish are farmed and might contain little vitamin D or that frying fish may result in vitamin D extraction .


Additional ways to improve vitamin D status in Nordic countries may be needed .


To evaluate the effects of intravenous ( IV ) or intramuscular ( IM ) hyoscine premedication on physiologic variables following IV administration of medetomidine in horses .


Randomized , crossover experimental study .


Eight healthy crossbred horses weighing @ @ kg and aged @ @ years .


Baseline measurements of heart rate ( HR ) , cardiac index ( CI ) , respiratory rate , systemic vascular resistance ( SVR ) , percentage of patients with second degree atrioventricular ( @ ( o ) AV ) block , mean arterial pressure ( MAP ) , pH , and arterial partial pressures of carbon dioxide ( PaCO@ ) and oxygen ( PaO@ ) were obtained @ minutes before administration of IV hyoscine ( @ mg kg ( -@ ) ; group HIV ) , IM hyoscine ( @ mg kg ( -@ ) ; group HIM ) , or an equal volume of physiologic saline IV ( group C ) .


Five minutes later , medetomidine ( @ g kg ( -@ ) ) was administered IV and measurements were recorded at various time points for @ minutes .


Medetomidine induced bradycardia , @ ( o ) AV blocks and increased SVR immediately after administration , without significant changes in CI or MAP in C. Hyoscine administration induced tachycardia and hypertension , and decreased the percentage of @ ( o ) AV blocks induced by medetomidine .


Peak HR and MAP were higher in HIV than HIM at @ @ beats minute ( -@ ) and @ @ mmHg versus @ @ beats minute ( -@ ) and @ @ mmHg , respectively .


CI was increased significantly in HIV ( p @ ) .


Respiratory rate decreased significantly in all groups during the recording period .


pH , PaCO@ and PaO@ were not significantly changed by administration of medetomidine with or without hyoscine .


Hyoscine administered IV or IM before medetomidine in horses resulted in tachycardia and hypertension under the conditions of this study .


The significance of these changes , and responses to other dose rates , requires further investigation .


Bone damage around the joints is one of the major pathophysiological mechanisms that leads to rheumatoid arthritis ( RA ) chronic disability .


Serum tartrate-resistant acid phosphatase @b ( TRACP-@b ) is secreted by osteoclasts , its activity can be used as a clinically relevant bone resorption marker .


The aim of this study was to test whether the measurement of serum levels of TRACP-@b in patients with RA would correlate with measures of disease activity and with responses to therapy .


Fifty-six patients were randomly assigned to receive recombinant human cytotoxic tlymphocyte-associated antigen-@ immunoglobulin ( RhCTLA@-Ig ) , infliximab or methotrexate ( MTX ) .


The clinical and serologic indicators of RA activity were evaluated at baseline and at @ weeks .


Serum TRACP-@b was measured by Enzyme-linked Immunosorbent Assay ( ELISA ) at @ , @ and @ weeks .


Hand X-rays were obtained at baseline .


At baseline , the levels of TRACP-@b correlated with the severity of X-ray damage , disease duration ( r = @ , P = @ ) , and tender joint count ( r = @ , P = @ ) .


The @ weeks values of TRACP-@b for RhCTLA@-Ig group and infliximab group differed significantly from the baseline values in each group ( P < @ ; P < @ ) , whereas only the value for RhCTLA@-Ig group differed significantly from the @ weeks value for the MTX group ( P < @ ) .


Considering the two biologics-treated groups together , the TRACP-@b levels at @ weeks differed significantly from the baseline values only in those patients who reached an ACR@ level ( P < @ ) .


Measurement of serum TRACP-@b in RA patients reflects clinical and radiological measures of disease activity , treatment with certain biologics , and degree of response to therapy .


TRACP-@b should be investigated further as a potential biomarker to predict response to therapy , including slowing of radiographic progression .


Different anesthetic techniques have been used for fast tracking in cardiac anesthesia .


Remifentanil , with its unique pharmacokinetic profile , could be an ideal drug for fast tracking .


Possible limitations of remifentanil are rapid onset of postoperative pain after discontinuation of the drug infusion , which may increase the risk of an ischemic event .


We conducted this randomized study to compare the efficacy of remifentanil versus low doses of fentanyl in fast-track cardiac anesthesia .


It has been hypothesized that remifentanil would provide a safe anesthesia with no impact on myocardial function and with positive effects on extubation time and mobilization .


We compared the postoperative course of patients , the remifentanil group ( RG ) and the low-dose fentanyl group ( LDFG ) , in whom remifentanil and low-dose fentanyl , respectively , were used for fast-track cardiac anesthesia .


The study was designed as a prospective randomized study .


The primary outcomes were changes in the cardiac index and creatine kinase MB fraction ( CKMB ) , extubation times , mobilization times , and lengths of stay in the intensive care unit ( ICU ) and the hospital .


Frequency of myocardial infarction ( MI ) , reoperations due to excessive bleeding , renal impairment , and cerebral complications were registered as well .


Seventy-one patients were enrolled in the study , and @ were excluded due to difficult airway , bleeding , and technical difficulties .


The RG comprised @ patients and the LDFG comprised of @ patients .


There were no differences between the groups in terms of age , Euroscore , types of surgery , extracorporeal circulation , and aortic cross-clamp time .


We did not find significant difference in cardiac index , CKMB , extubation times , mobilization times , length of stay in the ICU and in the hospital between the groups .


Postoperative complications such as MI , rates of reoperations , renal and cerebral complications and incidence of atrial fibrillation did not show any significant differences .


Remifentanil fast-track anesthesia for cardiac patients has no negative impact on myocardial function .


Both remifentanil and low-dose fentanyl are equally effective and safe for fast-track cardiac anesthesia .


The study did not highlight any statistical superiority of remifentanil anesthesia over low-dose fentanyl anesthesia .


Rheumatoid arthritis ( RA ) patients are at an increased risk of developing comorbid conditions .


A close monitoring of the disease targeting a status of low disease activity is associated with a better outcome .


The aim of this trial was to evaluate the impact of a nurse-led programme on comorbidities and the impact of patient self-assessment of disease activity on the management of RA .


We enrolled @ patients ( mean age @years , @ % women ) in a prospective , randomised , controlled , open-label , @-month trial .


In the comorbidity group ( n = @ ) , the nurse checked comorbidities and sent the programme results to the attending physicians .


In the self-assessment group ( n = @ ) , the nurse taught the patient how to calculate his/her Disease Activity Score which had to be reported on a booklet to be shared with the treating rheumatologist .


The number of measures taken for comorbidities and the percentage of patients recording a change ( initiation , switch or increased dose ) in disease-modifying antirheumatic drugs ( DMARDs ) in the @months follow-up period of the study defined the outcomes of the trial .


The number of measures taken per patient was statistically higher in the comorbidity group : @ versus @ ( p < @ ) ; incidence rate ratio : @ ( @-@ @ ) and DMARD therapy was changed more frequently in the self-assessment group : @ % versus @ % ( OR = @ ( @ ; @ ) , p = @ ) .


This study demonstrates the short-term benefit of a nurse-led programme on RA comorbidity management and the impact of patient self-assessment of disease activity on RA treatment intensification .


The aim of the present study is to determine the long-term effects of a ten-week exercise training program in adult patients with a systemic right ventricle .


All patients who participated in a @ randomized controlled trial were approached .


At approximately three years of follow-up from initial baseline , patients underwent cardiopulmonary exercise testing , filled out two quality of life questionnaires , and NT proBNP levels were measured .


All examinations were performed according to the protocols of the @ trial .


In addition , patients were asked about their current sports habits .


Of the @ patients who were randomized in the @-trial @ participated in the current re-evaluation ( male @ % , ccTGA @ % , age @ @ years , intervention group n = @ , control group n = @ ) .


After three years , no persistent effect of exercise training on V'Opeak training remained ( -@ % of predicted , @ % CI -@ % to @ % ; p = @ ) .


However , patients who already participated in regular sports or exercise at baseline ( n = @/@ ( @ % ) ) showed higher V'Opeak of @ % of predicted ( @ % CI @ % to @ % ; p > @ ) and a decrease of @ % in plasma NT-proBNP ( @ % CI -@ % to -@ % ; p > @ ) during follow-up , when compared to patients who did not .


Moreover , sports were associated with a lower incidence of clinical events ( p = @ ) .


Short-term beneficial effects of exercise training did not persist over a three-year follow-up period .


However , sports participation at baseline was associated with better exercise capacity , lower neurohormone levels , and increased event-free survival .


The objective of this study is to evaluate the impact of therapeutic HIV vaccination on the HIV reservoir and assess the relationship of the viral reservoir with HIV-specific immune status and viral rebound kinetics .


A retrospective analysis of ACTG A@ , a randomized , placebo-controlled trial of a therapeutic rAd@ HIV-@ gag vaccine .


Participants received vaccine/placebo at weeks @ , @ and @ prior to a @-week analytic treatment interruption ( ATI ) at week @ .


Cell-associated HIV-@ RNA and DNA ( CA-RNA and CA-DNA ) and HIV-@ residual viremia were quantified at weeks @ , @ and @ .


HIV-specific CD@ ( + ) / CD@ ( + ) activity was assessed by an intracellular cytokine staining assay .


At study entry , CA-RNA and CA-DNA levels were correlated inversely with the numbers of HIV-specific CD@ ( + ) interferon - producing cells ( CA-RNA : r = -@ , P = @ and CA-DNA : r = -@ , P < @ , N = @ ) .


Therapeutic HIV vaccination induced HIV-specific CD@ ( + ) activity , but did not significantly affect levels of CA-RNA or CA-DNA .


Vaccine recipients with undetectable residual viremia at week @ had higher frequencies of HIV-specific CD@ ( + ) and CD@ ( + ) interferon - producing cells ( undetectable versus detectable residual viremia : @ versus @ CD@ ( + ) cells/@ ( @ ) lymphocytes , P = @ and @ versus @ CD@ ( + ) cells/@ lymphocytes , P = @ ) .


Pre-ATI CA-RNA and CA-DNA were associated with post-ATI plasma HIV set point ( CA-RNA : r = @ , P < @ and CA-DNA : r = @ , P < @ ) .


Vaccine-induced T-cell responses were associated with a modest transient effect on residual viremia , but more potent immune responses and/or combination treatment with latency-reversing agents are needed to reduce the HIV reservoir .


HIV reservoir measures may act as biomarkers of post-ATI viral rebound kinetics .


To evaluate the ability of the Sonomat to diagnose obstructive sleep apnea ( OSA ) .


Prospective and randomized .


Sleep laboratory and home .


@ subjects ; @ with a clinical history of OSA and @ normal control subjects .


N/A .


Simultaneous PSG and Sonomat recordings were made in @ subjects ; @ were excluded due to a poor nasal flow recording in PSG .


There were positive correlations between the two devices for measures of sleep time , respiratory events , and the AHI ( all correlations > @ ) .


Bland-Altman analysis of the AHI showed positive agreement between devices , particularly at levels around common diagnostic thresholds .


The mean difference in AHI values was @ events per hour , and at a diagnostic threshold of @ events per hour , sensitivity and specificity were @ % and @ % .


More than @ % of PSG defined respiratory events were identified by the Sonomat and the absence of respiratory events was correctly identified in @ % of occasions .


Gender , obesity , and body position did not influence the accuracy of the Sonomat .


PSG snore sensors differed in how much snoring was detected when compared to the Sonomat .


These data indicate that the Sonomat was reliable and accurate for the diagnosis of OSA .


The provision of audible breath sound/snoring replay permits more accurate quantification of snoring .


It requires no patient attachment and can be performed in the home with minimal training .


Long-term outcomes after lung transplantation are limited due to chronic lung allograft dysfunction ( CLAD ) .


Bronchiolitis obliterans syndrome ( BOS ) is the most common form of obstructive CLAD and its definition derives from spirometric measurements .


Given the importance of this diagnosis , both the accuracy and reliability of the definition of CLAD are crucial in understanding the pathophysiology of this disease to develop therapeutic options and influence outcome after lung transplantation .


A web-based survey was designed and distributed to members of the Pulmonary Council of the International Society for Heart and Lung Transplantation ( ISHLT ) to better understand the accuracy and reliability of pulmonary function criteria in diagnosing BOS .


Spirometric data from five patient scenarios that were discordant among reviewers regarding BOS determination from the Assessment of Immunosuppressive Regimen in Suppressing Acute and Chronic Rejection ( AIRSAC ) trial were randomly selected and summarized in this survey .


Survey questions included the respondent 's general understanding of the BOS definition , the determination of BOS , and difficulties with the current BOS definition .


Eighty-seven respondents from the Pulmonary Council of the ISHLT responded to this survey .


There was an overall @ % interobserver agreement regarding the presence or absence of BOS .


Among those who agreed upon the presence of BOS , there was a @ % interobserver agreement regarding its time of onset .


Despite this variability , the majority of respondents were not only familiar and agreed with the BOS criteria , they also felt confident in applying these criteria .


Our survey identified potential limitations with the current criteria for diagnosing BOS .


With recognition of the various CLAD phenotypes , further refinements of these diagnostic criteria will allow for an improved ability to identify and characterize patients who develop or are at risk for BOS , prognosticate outcomes , and , most importantly , marshal in future strategies directed at treating and preventing chronic lung dysfunction after lung transplantation .


Intravenous morphine has been used as a common method of pain control in emergency care .


Nebulized fentanyl is also an effective temporary substitute .


This study was designed to compare the effectiveness of nebulized fentanyl with intravenous ( IV ) morphine on management of acute limb pain .


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


Ninety emergency department patients with moderate to severe pain aged @ to @ years were blocked randomized and enrolled in this study .


Forty-seven patients in the experimental group received nebulized fentanyl ( @ g/kg ) and IV normal saline as placebo , and the remaining @ patients in the control group received IV morphine ( @ mg/kg ) and nebulized normal saline as placebo .


All participants ' pain scores were assessed by Numerical Rating Scale before and after intervention at @ - , @ - , @ - , @ - , @ - , and @-minute intervals .


Patients ' vital sign and possible adverse effects were recorded respectively .


Finally , all participants were assessed for their satisfaction .


The mean initial pain score in the experimental group was @ and @ in the control group ( P = @ ) .


Pain relief in both groups after @ and @ minutes were similar ( P = @ ) .


Although the pain relief was significantly greater with fentanyl at @ minutes , this difference is not clinically significant .


Pain management in both groups was successful and was more than @ scores reduction in Numerical Rating Scale .


Patient satisfaction in both groups was similar .


No adverse effects were reported in the experimental group .


This study suggests that nebulized fentanyl is a rapid , safe , and effective method for temporary control of acute limb pain in emergency department patients .


This prospective double-blinded , randomized controlled trial compared adductor canal block ( ACB ) with femoral nerve block ( FNB ) in patients undergoing total knee arthroplasty .


The authors hypothesized that ACB , compared with FNB , would exhibit less quadriceps weakness and demonstrate noninferior pain score and opioid consumption at @ to @ h postanesthesia .


Patients received an ACB or FNB as a component of a multimodal analgesic .


Quadriceps strength , pain score , and opioid consumption were assessed on both legs preoperatively and at @ to @ , @ , and @ h postanesthesia administration .


In a joint hypothesis test , noninferiority was first evaluated on the primary outcomes of strength , pain score , and opioid consumption at @ to @ h ; superiority on each outcome at @ to @ h was then assessed only if noninferiority was established .


Forty-six patients received ACB ; @ patients received FNB .


At @ to @ h postanesthesia , ACB patients had significantly higher median dynamometer readings versus FNB patients ( median -LSB- interquartile range -RSB- , @ kgf -LSB- @ , @ -RSB- ( ACB ) vs. @ kgf -LSB- @ , @ -RSB- ( FNB ) ; P < @ ) , but was not inferior to FNB with regard to Numeric Rating Scale pain scores ( @ -LSB- @ , @ -RSB- ACB vs. @ -LSB- @ , @ -RSB- FNB ; P = @ ) , or to opioid consumption ( @ -LSB- @ , @ -RSB- ACB vs. @ -LSB- @ , @ -RSB- ; P = @ ) .


At @ and @ h postanesthesia , there was no significant statistical difference in dynamometer results , pain scores , or opioid use between the two groups .


At @ to @ h postanesthesia , the ACB , compared with the FNB , exhibited early relative sparing of quadriceps strength and was not inferior in both providing analgesia or opioid intake .


Continuous subcutaneous insulin infusion ( CSII ) treatment among children with type @ diabetes is increasing in Sweden .


However , studies evaluating glycaemic control in children using CSII show inconsistent results .


The distribution of responsibility for diabetes self-management between children and parents is often unclear and needs clarification .


There is much published support for continued parental involvement and shared diabetes management during adolescence .


Guided Self-Determination ( GSD ) is an empowerment-based , person-centred , reflection and problem solving method intended to guide the patient to become self-sufficient and develop life skills for managing difficulties in diabetes self-management .


This method has been adapted for adolescents and parents as Guided Self-Determination-Young ( GSD-Y ) .


This study aims to evaluate the effect of an intervention with GSD-Y in groups of adolescents starting on insulin pumps and their parents on diabetes-related family conflicts , perceived health and quality of life ( QoL ) , and metabolic control .


Here , we describe the protocol and plans for study enrollment .


This study is designed as a randomized , controlled , prospective , multicentre study .


Eighty patients between @-@ years of age who are planning to start CSII will be included .


All adolescents and their parents will receive standard insulin pump training .


The education intervention will be conducted when CSII is to be started and at four appointments in the first @ months after starting CSII .


The primary outcome is haemoglobin A@c levels .


Secondary outcomes are perceived health and QoL , frequency of blood glucose self-monitoring and bolus doses , and usage of carbohydrate counting .


The following instruments will be used : Disabkids , ` Check your health ' , the Diabetes Family Conflict Scale and the Swedish Diabetes Empowerment Scale .


Outcomes will be evaluated within and between groups by comparing data at baseline , and at @ and @ months after starting treatment .


In this study , we will assess the effect of starting an CSII together with the model of GSD to determine whether this approach leads to retention of improved glycaemic control , QoL , responsibility distribution and reduced diabetes-related conflicts in the family .


Nutrition in childhood has an influence on the cardiovascular function later on in life .


European Childhood Obesity Project is a multicenter , randomized clinical intervention trial examining the effect of early protein intake on later health outcomes , particularly adiposity and related disorders .


The aim of the study was to examine the effect of nutritional intervention -- different protein intake in infancy on carotid intima-media thickness ( cIMT ) at @ years .


The association of cardiovascular risk factors with cIMT was also assessed .


Healthy term formula-fed infants in five European countries were enrolled either to the higher ( HP ) or to the lower ( LP ) protein group .


Observational group consisted of breastfed infants .


Plasma insulin , glucose , lipid profile , IGF-@ , apolipoprotein A@ and B were measured as well as anthropometric parameters of parents and a child , blood pressure and physical activity .


No difference in cIMT between HP and LP group was observed .


Insulin , HOMA-IR index and total IGF-@ were positively associated with cIMT but after adjustment for confounders only an inverse association between ApoA@ and positive between ApoB/ApoA@ and cIMT were significant .


High versus low protein intake in infancy does not influence cIMT at @ years .


cIMT in healthy children at @ years is associated with their apolipoprotein profile .


Compare the efficacy and safety of monotherapy with dulaglutide , a once-weekly GLP-@ receptor agonist , to metformin-treated patients with type @ diabetes .


The primary objective compared dulaglutide @ mg and metformin on change from baseline glycosylated hemoglobin A@c ( HbA@c ) at @ weeks .


This @-week double-blind study randomized patients to subcutaneous dulaglutide @ mg , dulaglutide @ mg , or metformin .


Patients ( N = @ ) had HbA@c @ % ( @ mmol/mol ) and @ % ( @ mmol/mol ) with diet and exercise alone or low-dose oral antihyperglycemic medication ( OAM ) monotherapy ; OAMs were discontinued at beginning of lead-in period .


At @ weeks , changes from baseline HbA@c ( least squares -LSB- LS -RSB- mean SE ) were : dulaglutide @ mg , -@ @ % ( -@ @ mmol/mol ) ; dulaglutide @ mg , -@ @ % ( -@ @ mmol/mol ) ; and metformin , -@ @ % ( -@ @ mmol/mol ) .


Dulaglutide @ and @ mg were superior to metformin ( LS mean difference ) : -@ % ( -@ mmol/mol ) and -@ % ( -@ mmol/mol ) ( one-sided P < @ , both comparisons ) , respectively .


Greater percentages reached HbA@c targets < @ % ( < @ mmol/mol ) and @ % ( @ mmol/mol ) with dulaglutide @ and @ mg compared with metformin ( P < @ , all comparisons ) .


No severe hypoglycemia was reported .


Compared with metformin , decrease in weight was similar with dulaglutide @ mg and smaller with dulaglutide @ mg .


Over @ weeks , nausea , diarrhea , and vomiting were the most common adverse events ; incidences were similar between dulaglutide and metformin .


Dulaglutide improves glycemic control and is well tolerated as monotherapy in patients with early stage type @ diabetes .


Ischemia monitoring can not always be performed by @-lead ECG .


Hence , the individual performance of the ECG leads is crucial .


No experimental data on the ECG 's specificity for transient ischemia exist .


In @ patients a @-lead ECG was registered during a @-minute balloon occlusion of a coronary artery ( left anterior descending artery -LSB- LAD -RSB- , right coronary artery -LSB- RCA -RSB- or left circumflex artery -LSB- LCX -RSB- ) .


ST-segment shifts and sensitivity/specificity of the leads were measured .


During LAD occlusion , V@ showed maximal ST-segment elevation ( @ mV -LSB- IQR @-@ @ mV -RSB- , p = @ ) and sensitivity/specificity ( @ % and @ % ) .


During RCA occlusion , III showed maximal ST-elevation ( @ mV -LSB- IQR @-@ @ mV -RSB- , p = @ ) , aVF had the best sensitivity/specificity ( @ % and @ % ) .


During LCX occlusion , V@ showed maximal ST-segment elevation ( @ mV -LSB- IQR @-@ @ mV -RSB- , p = @ ) , and sensitivity/specificity was ( @ % / @ % ) but could be improved ( @ % / @ % ) using an optimized cut-off for ischemia .


V@ , aVF and V@ show the best performance to detect transient ischemia .


Subclinical depression is one of the most frequent mental comorbidities in patients with diabetes and is associated with a poorer long-term prognosis .


Since there is a lack of specific intervention concepts for this patient group , a self-management-oriented group program ( DIAMOS -LSB- Diabetes Motivation Strengthening -RSB- ) was newly developed and evaluated in a randomized trial .


DIAMOS is composed of cognitive behavioral interventions aiming at the reduction of diabetes distress .


The active control group ( CG ) received diabetes education .


The primary outcome was depressive symptoms .


Secondary outcomes were diabetes distress , well-being , self-care behavior , diabetes acceptance , diabetes treatment satisfaction , HbA@c , and subclinical inflammation .


Two hundred fourteen participants ( mean age @ @ years , female sex @ % , type @ diabetes @ % , mean diabetes duration @ @ years , HbA@c @ @ % , BMI @ @ kg/m ( @ ) ) were randomized .


The @-month follow-up revealed a significantly stronger reduction of depressive symptoms ( Center for Epidemiologic Studies Depression Scale score ) in the DIAMOS group compared with the CG ( @ -LSB- @ % CI @-@ @ -RSB- , P = @ ) .


Of the secondary variables , the Patient Health Questionnaire-@ ( @ -LSB- @ % CI @-@ @ -RSB- , P = @ ) , Problem Areas in Diabetes scale ( @ -LSB- @ % CI @-@ @ -RSB- , P = @ ) , and Diabetes Distress Scale scores ( @ -LSB- @ % CI @-@ @ -RSB- , P = @ ) displayed significant treatment effects .


Moreover , the risk of incident major depression in the DIAMOS group was significantly reduced ( odds ratio @ -LSB- @ % CI @-@ @ -RSB- , P = @ ) .


Inflammatory variables were not substantially affected .


DIAMOS is more effective in lowering depressive symptoms and diabetes-related distress in diabetic patients with subclinical depression .


DIAMOS also has a preventive effect with respect to the incidence of major depression .


We compared post-breakfast closed-loop glucose control either matched with a carbohydrate-matching bolus or a weight-dependent bolus .


Twelve adults with type @ diabetes consumed a @ g CHO breakfast on two occasions .


In random order , the breakfast was accompanied by a full carbohydrate-matching insulin bolus ( @ U -LSB- @ U-@ @ U -RSB- ) or a partial weight-dependent insulin bolus ( @ U/kg ; @ U -LSB- @ U-@ @ U -RSB- ) .


Postprandial glucose was regulated by sensor-responsive insulin and glucagon delivery .


Glucose control after the weight-dependent bolus was safe and feasible ( glucose values returned to pre-prandial levels after @ h ) .


However , @-hr incremental area under the curve and percentage of time above @ mmol/L were lower after the full bolus compared to the partial bolus ( IAUC , @ -LSB- @-@ @ -RSB- mmol/L/hr vs @ -LSB- @-@ @ -RSB- mmol/L/hr ; time in hyperglycaemia , @ % -LSB- @ % -@ % -RSB- vs @ % -LSB- @ % -@ % -RSB- ; P < @ ) .


Post-breakfast closed-loop glucose control without carbohydrate counting , but based on weight-dependent bolus is feasible but a carbohydrate-matching bolus provides better glucose control .


The nephrotoxicity of cyclosporine A ( CsA ) accounts for dysfunction of kidney allografts in the clinic .


Short-term intensified dosing using enteric-coated mycophenolate sodium ( EC-MPS ) may facilitate CsA sparing after kidney transplantation without compromising safety .


In a @-month , single-centre open-label prospective trial , @ de novo live-donor kidney transplant recipients at low-immunological risk were randomised to a low-dose cyclosporine group which received a low dose of cyclosporine , short-term intensified EC-MPS dosing ( @mg/day to week @ , @mg/day thereafter ) and corticosteroids or a standard-dose cyclosporine group which received a standard dose of cyclosporine , standard EC-MPS dosing ( @mg/day ) and corticosteroids .


The primary end-point -LSB- treatment failure including biopsy-proven acute rejection ( BPAR ) , graft loss , death -RSB- , secondary end-point and adverse events were monitored .


The primary end-point ( treatment failure ) occurred in @ % ( @/@ ) of the low-dose cyclosporine group and @ % ( @/@ ) of the standard-dose cyclosporine group ( p = @ ) ( difference -@ % , @ % confidence interval -@ % to @ % , based on a noninferiority margin of @ % ) .


BPAR occurred in @ % and @ % of patients in the low-dose cyclosporine group and standard-dose cyclosporine group , respectively ( p = @ ) .


The estimated glomerular filtration rate , as calculated by the Cockcroft-Gault formula , was similar at @months after transplantation ( low-dose cyclosporine group @ml/min/@ @ m ( @ ) and standard-dose cyclosporine group @ml/min/@ @ m ( @ ) ; p = @ ) .


The levels of serum creatinine and occurrence of adverse events between the two groups were not statistically different .


A regimen of early intensified EC-MPS dosing permits low-dose cyclosporine in live-donor kidney transplant patients at low-immunological risk without compromising efficacy at @months ' follow-up .


This study aimed to examine compensatory changes in nonexercise energy expenditure ( NEEx ) and nonexercise physical activity ( NEPA ) in response to an aerobic exercise training program .


Ninety-two overweight/obese ( body mass index , @-@ @ kgm ) sedentary young adults ( @-@ yr ) completed a @-month randomized clinical efficacy trial of aerobic exercise @ dwk at either @ kcal per session ( n = @ ) , @ kcal per session ( n = @ ) , or control ( n = @ ) .


Total daily energy expenditure ( TDEE ) and resting metabolic rate ( RMR ) were measured at months @ and @ .


NEPA was measured by an accelerometer at months @ , @ , @ , and @ .


NEEx was calculated by the following formula : -LSB- ( total daily energy expenditure @ ) - RMR -RSB- - net EEEx ( EEEx-RMR ) .


Mixed modeling was used to examine differences between groups ( group effect ) , within groups ( time effect ) , and group-time interaction for NEEx and NEPA .


Within the exercise groups , there were no significant effects ( all P > @ ) of group , time , or group-time interaction for NEPA .


In addition , there were no significant within - or between-group differences for change in NEEx .


However , activity counts per minute were significantly higher ( P < @ ) in the @-kcal-per-session group ( @ @ mind ) versus controls ( @ @ mind ) at month @ and significantly higher ( P < @ ) in both the @-kcal-per-session ( @ @ mind ) and @-kcal-per-session groups ( @ @ mind ) versus controls ( @ @ mind ) at @ months .


A @-month aerobic exercise training program in previously sedentary , overweight and obese young adults was not associated with compensatory decreases in NEEx or NEPA .


Results suggest that overweight and obese individuals do not become less physically active or spend more time in sedentary pursuits in response to exercise .


In adult patients who are critically ill and mechanically ventilated , daily interruption of sedation ( DSI ) is an effective method of improving sedation management , resulting in a decrease of the duration of mechanical ventilation , the length of stay in the intensive care unit ( ICU ) and the length of stay in the hospital .


It is a safe and effective approach and is common practice in adult ICUs .


For critically ill children it is unknown if DSI is effective and feasible .


The aim of this multicenter randomized controlled trial is to evaluate the safety and efficacy of daily sedation interruption in critically ill children .


Children between @ and @ years of age who require mechanical ventilation , with an expected duration of at least @ h and need for sedative infusion , will be included .


After enrollment patients will be randomly assigned to DSI in combination with protocolized sedation ( intervention group ) or protocolized continuous sedation ( control group ) .


A sedation protocol that contains an algorithm for increasing and weaning of sedatives and analgesics will be used .


The sedative infusion will be restarted if the patient becomes uncomfortable or agitated according to the sedation protocol .


The primary endpoint is the number of ventilator-free days at @ days .


Despite the brevity of the procedure , bilateral myringotomy and tympanostomy tube placement ( BMT ) can result in significant postoperative pain and discomfort .


As the procedure is frequently performed without intravenous access , non-parenteral routes of administration are frequently used for analgesia .


The current study prospectively compares the efficacy of intranasal ( IN ) dexmedetomidine with IN fentanyl for children undergoing BMT .


This prospective , double-blinded , randomized clinical trial included pediatric patients undergoing BMT .


The patients were randomized to receive either IN dexmedetomidine ( @ g/kg ) or fentanyl ( @ g/kg ) after the induction of general anesthesia with sevoflurane .


All patients received rectal acetaminophen ( @ mg/kg ) and the first @ patients also received premedication with oral midazolam .


Postoperative pain and recovery were assessed using pediatric pain and recovery scales , and any adverse effects were monitored for .


The study cohort included @ patients who ranged in age from @ to @ years and in weight from @ to @ kg .


They were divided into @ groups with @ patients in each group : ( @ ) midazolam premedication + IN dexmedetomidine ; ( @ ) midazolam premedication + IN fentanyl ; ( @ ) no premedication + IN dexmedetomidine ; and ( @ ) no premedication + IN fentanyl .


Pain scores were comparable when comparing groups @ , @ and @ , but were higher in group @ ( midazolam premedication with IN dexmedetomidine ) .


There was no difference in total time in the post-anesthesia care unit ( PACU ) or time from arrival in the PACU until hospital discharge between the @ groups .


The heart rate ( HR ) was significantly lower in group @ when compared to the other groups at several different times after arrival to the PACU .


No clinically significant difference was noted in blood pressure .


Following BMT , when no premedication is administered , there was no clinical advantage when comparing IN dexmedetomidine ( @ g/kg ) to IN fentanyl ( @ g/kg ) .


The addition of oral midazolam as a premedication worsened the outcome measures particularly for children receiving IN dexmedetomidine .


The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women , Infants , and Children ( WIC ) .


As of @ , @ % of WIC clients received services from local WIC agencies that offered peer counseling .


Little is known about the effectiveness of these peer counseling programs .


Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration , but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally .


We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation , duration , and exclusivity .


We randomly assigned @ WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to @ study arms : no peer counseling , @ telephone contacts , or @ telephone contacts .


We combined @ treatment arms because there was no difference in the distribution of peer contacts .


Nonexclusive breastfeeding duration was greater at @ months postpartum for all women in the treatment group ( adjusted relative risk : @ ; @ % confidence interval -LSB- CI -RSB- : @-@ @ ) but greater at @ months for Spanish-speaking clients only ( adjusted relative risk : @ ; @ % CI : @-@ @ ) .


The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients ( adjusted odds ratio : @ ; @ % CI : @-@ @ ) .


A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish - speaking women .


How does the successful cryopreservation of semen affect the odds of post-treatment fatherhood among Hodgkin lymphoma ( HL ) survivors ?


Among @ survivors who wanted to have children , the availability of cryopreserved semen doubled the odds of post-treatment fatherhood .


Cryopreservation of semen is the easiest , safest and most accessible way to safeguard fertility in male patients facing cancer treatment .


Little is known about what proportion of patients achieve successful semen cryopreservation .


To our knowledge , neither the factors which influence the occurrence of semen cryopreservation nor the rates of fatherhood after semen has been cryopreserved have been analysed before .


This is a cohort study with nested case-control analyses of consecutive Hodgkin survivors treated between @ and @ in multi-centre randomized controlled trials .


A written questionnaire was developed and sent to @ male survivors .


Nine hundred and two survivors provided analysable answers .


The median age at treatment was @ years .


The median follow-up after cryopreservation was @ years ( range @-@ ) .


Three hundred and sixty-three out of @ men ( @ % ) cryopreserved semen before the start of potentially gonadotoxic treatment .


The likelihood of semen cryopreservation was influenced by age , treatment period , disease stage , treatment modality and education level .


Seventy eight of @ men ( @ % ) used their cryopreserved semen .


Men treated between @ and @ had significantly lower odds of cryopreserved semen use compared with those treated earlier , whereas alkylating or second-line ( chemo ) therapy significantly increased the odds of use ; no other influencing factors were identified .


We found an adjusted odds ratio of @ ( @ % confidence interval @-@ @ , P = @ ) for post-treatment fatherhood if semen cryopreservation was performed .


Forty-eight out of @ men ( @ % ) who had children after HL treatment became a father using cryopreserved semen .


Data came from questionnaires and so this study potentially suffers from response bias .


We could not perform an analysis with correction for duration of follow-up or provide an actuarial use rate due to lack of dates of semen utilization .


We do not have detailed information on either the techniques used in cryopreserved semen utilization or the number of cycles needed .


Our hypothesis was that patients treated with hinged external fixators as an adjunct to multiple-ligament reconstruction would have fewer reconstruction failures than patients treated without external fixation .


In this prospective randomized study , patients with a knee dislocation either underwent ligament reconstruction with placement of an external hinged knee brace following surgery ( Group A ) or underwent ligament reconstruction with placement of a hinged external fixator ( Compass Knee Hinge ) for six weeks instead of the brace ( Group B ) .


The patients were followed clinically and were evaluated with physical examination , Lysholm and International Knee Documentation Committee knee scores , visual analog scale pain scores , and status regarding return to work and activities .


One hundred patients with @ knee dislocations were enrolled .


Seventy-seven patients with seventy-nine dislocations ( thirty-two in Group A and forty-seven in Group B ) , with a minimum follow-up interval of twelve months , were available for evaluation .


The mean duration of follow-up was thirty-nine months ( range , twelve to eighty-six months ) .


Nine patients ( @ % ) in Group A had failed reconstructions compared with seven ( @ % ) in Group B ( p = @ ) .


Group-A patients had twenty-two ( @ % ) of @ reconstructed individual ligaments fail compared with eleven ( @ % ) of @ reconstructed ligaments in Group B.


The difference in ligament failure was significant ( p < @ ; power > @ ) , with more favorable results for the patients managed with the external fixation .


Hinged external fixation as a supplement to reconstruction following knee dislocation was associated with fewer failed ligament reconstructions compared with external bracing .


Patients presenting with highly unstable knee dislocations should be considered for hinged external fixation to supplement initial reconstructive procedures .


To compare dosimetric parameters , seed migration rates , operation times , and acute toxicities of intraoperatively built custom-linked ( IBCL ) seeds with those of loose seeds for prostate brachytherapy .


Participants were @ patients with low or intermediate prostate cancer prospectively allocated to an IBCL seed group ( n = @ ) or a loose seed group ( n = @ ) , using quasirandomization ( allocated by week of the month ) .


All patients underwent prostate brachytherapy using an interactive plan technique .


Computed tomography and plain radiography were performed the next day and @ month after brachytherapy .


The primary endpoint was detection of a @ % difference in dose to @ % of prostate volume on postimplant computed tomography @ month after treatment .


Seed migration was defined as a seed position > @ cm from the cluster of other seeds on radiography .


A seed dropped into the seminal vesicle was also defined as a migrated seed .


Dosimetric parameters including the primary endpoint did not differ significantly between groups , but seed migration rate was significantly lower in the IBCL seed group ( @ % ) than in the loose seed group ( @ % ; P < @ ) .


Mean operation time was slightly but significantly longer in the IBCL seed group ( @ min ) than in the loose seed group ( @ min ; P < @ ) .


No significant differences in acute toxicities were seen between groups ( median follow-up , @ months ) .


This prospective quasirandomized control trial showed no dosimetric differences between IBCL seed and loose seed groups .


However , a strong trend toward decreased postimplant seed migration was shown in the IBCL seed group .


Weight monitoring is an important element of HF self-care , yet the most clinically meaningful way to evaluate weight monitoring adherence is uncertain .


We conducted this study to evaluate the association of ( @ ) self-reported recall and ( @ ) daily diary-recorded weight monitoring adherence with heart failure-related ( HF-related ) hospitalization .


We conducted a prospective cohort study among @ patients within a randomized trial of HF self-care training .


All patients had an initial self-care training session followed by @ calls ( median ) to reinforce educational material ; patients were also given digital scales , instructed to weigh daily , record weights in a diary , and mail diaries back monthly .


Weight monitoring adherence was assessed with a self-reported recall question administered at @ months and dichotomized into at least daily versus less frequent weighing .


Diary-recorded weight monitoring was evaluated over @ months and dichotomized into @ % and < @ % adherence .


HF-related hospitalizations were ascertained through patient report and confirmed through record review .


Over @ months in @ patients , we identified @ HF-related hospitalizations .


Patients self-reporting daily or more frequent weight monitoring had an incidence rate ratio of @ ( @ % CI @-@ @ ) for HF-related hospitalizations compared to those reporting less frequent weight monitoring .


Patients who completed @ % of weight diaries had an IRR of @ ( @ % CI @-@ @ ) for HF-related hospitalizations compared to patients who completed < @ % of weight diaries .


Self-reported recall of weight monitoring adherence was not associated with fewer HF hospitalizations .


In contrast , diary-recorded adherence @ % of days was associated with fewer HF-related hospitalizations .


Incorporating diary-based measures of weight monitoring adherence into HF self-care training programs may help to identify patients at risk for HF-related hospitalizations .


Some smokers may benefit from a therapy that combines different nicotine replacement therapies ( NRT ) or drugs with different mechanisms of action.The aim of this study was to determine the efficacy of the combined therapy of varenicline and nicotine patches versus varenicline monotherapy .


Three hundred forty-one smokers who smoked @ or more cigarettes per day were recruited from a smoking cessation clinic between February @ and June @ .


The participants were randomized to receive a varenicline plus nicotine patch of @ mg every @ hours ( @ ) or varenicline plus a placebo patch ( @ ) .


All of the smokers received a standard @-week course of varenicline and an @-week course of either the placebo patch or the active patch after the target quit day .


Both groups received behavioral support .


The primary outcome was continuous abstinence for weeks @ through @ confirmed by exhaled levels of carbon monoxide .


Post hoc subgroup analyses were performed to evaluate the treatment effects for a specific endpoint in subgroups of smokers .


The combination of the nicotine patch with varenicline was not associated with higher rates of continuous abstinence at @ weeks ( @ % versus @ % ; odds ratio ( OR ) @ ; @ % confidence interval ( CI ) @ to @ ) and @ weeks ( @ % versus @ % ; OR @ ; @ % CI @ to @ ) .


When participants were analyzed by subgroups according to cigarette consumption , the abstinence rates among smokers who smoked more than @ cigarettes per day at @ weeks ( OR @ ; @ % CI @ to @ ) and @ weeks ( OR @ ; @ % CI @ to @ ) were significantly higher in the combination group .


Other post hoc analyses based on level of dependence and previous quit attempts did not show subgroup differences .


No differences between the groups for the reported adverse events were observed ( @ value @ ; P @ ) .


The combination of varenicline with the nicotine patch does not improve abstinence rates at @ and @ weeks compared with varenicline used as monotherapy when all smokers were analyzed as a whole , independent of consumption level .


Metabolic syndrome ( MetS ) and depression have become two prevalent diseases worldwide , whose interaction needs further investigation .


Dietary treatment for weight loss in patients with MetS may improve depressive manifestations , however , the precise interactive pathways remain uncertain .


Therefore , the aim of this study was to examine the effects of a hypocaloric diet designed to reduce MetS features on self-perceived depression and the possible underlying factors .


Sixty subjects ( Age : @ @ y ; BMI : @ @ kg/m ( @ ) ) with MetS were selected from the RESMENA study ( control and intervention ) after they completed the @-months hypocaloric treatment and rated for depressive symptoms using the Beck Depression Inventory ( BDI ) .


Anthropometric and biochemical measurements including leptin , C-reactive protein ( CRP ) and insulin levels were evaluated .


Depressive symptoms decreased during the weight loss intervention , with no differences between both dietary groups ( control group -@ @ vs RESMENA group -@ @ , P = @ ) .


The number of criteria of the MetS was higher among subjects with more somatic-related depressive symptoms at baseline ( B = @ , P-trend = @ ) .


After six months of dietary treatment , body weight decreased in all subjects ( -@ % ; confidence interval ( @ % CI ) = @-@ @ ) and also self-perceived depression ( -@ % ; @ % CI = @-@ @ ) , as well as circulating leptin ( -@ % ; @ % CI = @-@ @ ) , CRP ( -@ % ; @ % CI = @-@ @ ) and insulin ( -@ % ; @ % CI = @-@ @ ) concentrations .


The decrease in BDI was significantly associated with declines in body fat mass ( B = @ , @ % CI = @-@ @ ) and also with the decrease in leptin ( B = @ , @ % CI = @-@ @ ) and CRP ( B = @ , @ % CI = @-@ @ ) concentrations .


The decrease in depressive manifestations after a weight loss intervention was related with adiposity , CRP and leptin in subjects with MetS .


Brain scans are essential to exclude haemorrhage in patients with suspected acute ischaemic stroke before treatment with alteplase .


However , patients with early ischaemic signs could be at increased risk of haemorrhage after alteplase treatment , and little information is available about whether pre-existing structural signs , which are common in older patients , affect response to alteplase .


We aimed to investigate the association between imaging signs on brain CT and outcomes after alteplase .


IST-@ was a multicentre , randomised controlled trial of intravenous alteplase ( @ mg/kg ) versus control within @ h of acute ischaemic stroke .


The primary outcome was independence at @ months ( defined as an Oxford Handicap Scale -LSB- OHS -RSB- score of @-@ ) .


@ patients were enrolled to IST-@ and underwent prerandomisation brain CT. .


Experts who were unaware of the random allocation assessed scans for early signs of ischaemia ( tissue hypoattenuation , infarct extent , swelling , and hyperattenuated artery ) and pre-existing signs ( old infarct , leukoaraiosis , and atrophy ) .


In this prespecified analysis , we assessed interactions between these imaging signs , symptomatic intracranial haemorrhage ( a secondary outcome in IST-@ ) and independence at @ months , and alteplase , adjusting for age , National Institutes of Health Stroke Scale ( NIHSS ) score , and time to randomisation .


This trial is registered at ISRCTN.com , number ISRCTN@ .


@ patients were assessed in this analysis , of whom @ were allocated alteplase and @ were assigned control .


A reduction in independence was predicted by tissue hypoattenuation ( odds ratio @ , @ % CI @-@ ) , large lesion ( @ , @-@ ) , swelling ( @ , @-@ ) , hyperattenuated artery ( @ , @-@ ) , atrophy ( @ , @-@ ) , and leukoaraiosis ( @ , @-@ ) .


Symptomatic intracranial haemorrhage was predicted by old infarct ( odds ratio @ , @ % CI @-@ ) , tissue hypoattenuation ( @ , @-@ ) , and hyperattenuated artery ( @ , @-@ ) .


Some combinations of signs increased the absolute risk of symptomatic intracranial haemorrhage ( eg , both old infarct and hyperattenuated artery , excess with alteplase @ % , @ % CI @-@ ; both signs absent , excess @ % , @-@ ) .


However , no imaging findings-individually or combined-modified the effect of alteplase on independence or symptomatic intracranial haemorrhage .


Some early ischaemic and pre-existing signs were associated with reduced independence at @ months and increased symptomatic intracranial haemorrhage .


Although no interaction was noted between brain imaging signs and effects of alteplase on these outcomes , some combinations of signs increased some absolute risks .


Pre-existing signs should be considered , in addition to early ischaemic signs , during the assessment of patients with acute ischaemic stroke .


Chronic pain impacts one-third of the U.S. population , and its effects are debilitating for individuals and costly to the medical system .


Although opioids are commonly prescribed to address chronic pain , they confer risk for misuse and addiction in some patients and may not fully restore life function-particularly with regard to psychosocial factors .


Because of the multiplicity of impacts that chronic pain may have on daily functioning , broad-spectrum behavioral interventions are needed .


The purpose of this study was to conduct follow-up analyses from a pilot randomized controlled trial of Mindfulness-Oriented Recovery Enhancement ( MORE ) to assess specific effects of MORE on various biopsychosocial aspects of pain-related impairment .


Chronic pain patients ( N = @ ; mean age , @years ; @ % female ) were randomly assigned to either eight weeks of MORE or a support group .


Domains of pain-related functional interference were measured with the Brief Pain Inventory at pre - and post-treatment and at a three-month follow-up .


Treatment effects were analyzed with multivariate intention-to-treat models .


MORE participants reported significantly greater reductions in functional interference than support group participants at post-treatment across all domains , including general activity , mood , walking ability , normal work , relationships , sleep , and enjoyment of life .


These effects were largely maintained by the three-month follow-up ; however , general activity level and walking ability were no longer significant , indicating differential long-term effects between physiological and psychological functioning .


Findings demonstrate preliminary efficacy of MORE as a treatment for pain-related functional impairments and suggest that effects may be more pronounced and durable for aspects of psychological function .


To compare efficacy , safety , and tolerability of the preservative-free fixed combination ( FC ) and non-fixed combination ( NFC ) of tafluprost @ % and timolol @ % in patients with open-angle glaucoma or ocular hypertension .


This @-month , prospective , randomized , double-masked , active-controlled , parallel group , multicenter phase III study was performed in patients with ocular hypertension and open-angle glaucoma with untreated intraocular pressure ( IOP ) @ and @mmHg at baseline .


Four hundred patients washed out from IOP-lowering medication were randomized , @ received the FC , and @ received the NFC .


Mean time-wise IOP decreases from baseline ranged from -@ to -@ mmHg ( @ % -@ % ) in the FC and from -@ to -@ mmHg ( @ % -@ % ) in the NFC arm -LSB- per-protocol ( PP ) dataset , P < @ compared with baseline for both groups -RSB- .


At month @ , the estimated overall treatment difference ( FC-NFC ) was @ mmHg ( PP dataset , @ % confidence interval from -@ to @ mmHg ) .


An IOP decrease @ % was achieved in @ % and @ % of the patients in the FC and NFC groups , respectively ( PP dataset ; P = @ ) ; an IOP decrease @ % was achieved in @ % and @ % of patients in the FC and NFC groups , respectively ( PP dataset ; P = @ ) .


Patients with ocular adverse events were evenly distributed in both groups .


The most common side effect , conjunctival/ocular hyperemia was found in @ % and @ % of patients in the FC and NFC arms , respectively .


All measures of IOP reduction for FC of preservative-free tafluprost/timolol were statistically and clinically significant and non-inferior to those of the NFC , throughout the @-month study period .


Cross-match-compatible platelets are used for the management of thrombocytopenic patients who are refractory to transfusions of randomly selected platelets .


Data supporting the effectiveness of platelets that are compatible according to cross-matching with a modified antigen capture enzyme-linked immunosorbent assay ( MAC-ELISA or MACE ) are limited .


This study aimed to determine the effectiveness of cross-match-compatible platelets in an unselected group of refractory patients .


One hundred ABO compatible single donor platelet transfusions given to @ refractory patients were studied .


Patients were defined to be refractory if their @-hour corrected count increment ( CCI ) was < @ ( @ ) / L following two consecutive platelet transfusions .


Platelets were cross-matched by MACE and the CCI was determined to monitor the effectiveness of platelet transfusions .


The clinical sensitivity , specificity , positive predictive value and negative predictive value of the MACE-cross-matched platelets for post-transfusion CCI were @ % , @ % , @ % and @ % , respectively .


The difference between adequate and inadequate post-transfusion @-hour CCI for MACE cross-matched-compatible vs incompatible single donor platelet transfusions was statistically significant ( p = @ ) .


The @-hour CCI ( meanSD ) was significantly higher for cross-match-compatible platelets ( @,@ ) than for incompatible ones ( @,@,@ ) ( p < @ ) .


Most of the incompatible cross-matches ( @ % ) were due to anti-HLA antibodies , alone ( @ % of cases ) or together with anti-platelet glycoprotein antibodies ( @ % ) .


The clinical sensitivity and negative predictive value of platelet cross-matching by MACE were high in this study and such tests may , therefore , be used to select compatible platelets for refractory patients .


A high negative predictive value demonstrates the greater chance of an adequate response with cross-matched-compatible platelets .


Training efforts in disaster education need to provide updated knowledge , skills and expertise to nurses through evidence-based interventions .


The purpose of the study was the development , implementation and evaluation of an educational programme for nurses regarding the provision of health care during disasters .


A randomized controlled trial using Switching Replications design was conducted for the evaluation of the programme .


@ hospital-based nurses were randomly assigned into intervention ( n = @ ) and original control ( n = @ ) groups .


Changes between groups and over time were measured by questionnaire and used as the outcome measure to demonstrate effectiveness of the training intervention .


The intervention improved nurses ' knowledge and self-confidence levels while no significant changes were detected in behavioral intentions .


A significant increase in the mean knowledge score was observed in both groups in times @ and @ compared to time @ -LSB- pre-test : @ ( @ ) ; post-test : @ ( @ ) ; follow-up test : @ ( @ ) -RSB- , ( P < @ ) .


Changes in knowledge between intervention and control group were significantly different ( P < @ ) with a large effect size ( eta-squared = @ ) .


The training programme was feasible and effective in improving nurses ' knowledge concerning disaster response .


To examine the influence of the glycemic index ( GI ) of foods consumed after evening exercise on postprandial glycemia , metabolic and inflammatory markers , and nocturnal glycemic control in type @ diabetes .


On two evenings ( @ h ) , @ male patients ( @ @ years of age , HbA@c @ @ % -LSB- @ @ mmol/mol -RSB- ) were administered a @ % rapid-acting insulin dose with a carbohydrate bolus @ min before @ min of treadmill running .


At @ min postexercise , patients were administered a @ % rapid-acting insulin dose with one of two isoenergetic meals ( @ g carbohdyrate/kg body mass -LSB- BM -RSB- ) matched for macronutrient content but of either low GI ( LGI ) or high GI ( HGI ) .


At @ min postmeal , the LGI group ingested an LGI snack and the HGI group an HGI snack ( @ g carbohdyrate/kg BM ) before returning home ( @ h ) .


Interval samples were analyzed for blood glucose and lactate ; plasma glucagon , epinephrine , interleukin-@ ( IL-@ ) , and tumor necrosis factor - ( TNF - ) ; and serum insulin , cortisol , nonesterified fatty acid , and - hydroxybutyrate concentrations .


Interstitial glucose was recorded for @ h postlaboratory attendance through continuous glucose monitoring .


Following the postexercise meal , an HGI snack induced hyperglycemia in all patients ( mean SD glucose @ @ mmol/L ) and marked increases in TNF - and IL-@ , whereas relative euglycemia was maintained with an LGI snack ( @ @ mmol/L , P < @ ) without inflammatory cytokine elevation .


Both meal types protected all patients from early hypoglycemia .


Overnight glycemia was comparable , with a similar incidence of nocturnal hypoglycemia ( n = @ for both HGI and LGI ) .


Consuming LGI food with a reduced rapid-acting insulin dose following evening exercise prevents postprandial hyperglycemia and inflammation and provides hypoglycemia protection for @ h postexercise ; however , the risk of late nocturnal hypoglycemia remains .


The study goal was to determine whether clonidine treatment of neonatal abstinence syndrome ( NAS ) would result in a better neurobehavioral performance compared with morphine .


This pilot study prospectively enrolled infants @ weeks ' gestational age admitted for treatment of NAS .


After informed consent was obtained , infants were randomized to receive morphine ( @ mg/kg per day ) or clonidine ( @ g/kg per day ) divided into @ doses .


A @ % dose escalation every @ hours was possible per protocol ( maximum of @ mg/kg per day for morphine and @ g/kg per day for clonidine ) .


After control of symptoms , the dose was tapered by @ % every other day .


Clinical staff monitored infants by using Finnegan scoring .


Masked research staff administered the NICU Network Neurobehavioral Scale ( NNNS ) at @ week and at @ to @ weeks after initiation of treatment and the Bayley Scales III , and Preschool Language Scale IV , at @-year adjusted age .


Analyses included descriptive statistics , repeated measures analysis of variance , and Wilcoxon tests .


Infants treated with morphine ( n = @ ) versus clonidine ( n = @ ) did not differ in birth weight or age at treatment .


Treatment duration was significantly longer for morphine ( median @ days ) than for clonidine ( median @ days ; P = @ ) .


NNNS summary scores improved significantly with clonidine but not with morphine .


On subsequent assessment , those receiving clonidine had lower height of arousal and excitability ( P < @ ) .


One-year motor , cognitive , and language scores did not differ between groups .


Clonidine may be a favorable alternative to morphine as a single-drug therapy for NAS .


A multicenter randomized trial is warranted .


The study examined the rate of remission in individuals experiencing a first episode of schizophrenia ( FES ) in China and explored predictors of remission in the acute phase of the illness .


Fifty-five FES patients were randomly treated with risperidone , olanzapine , or aripiprazole at therapeutic doses for @ weeks , and their clinical profiles and cognition were assessed using standardized assessment instruments at entry and the end of the study .


Of the @ patients , @ ( @ % ) remitted by the end of the @-week study .


In univariate analyses , shorter duration of untreated psychosis , higher scores on both the time-based prospective memory ( TBPM ) and event-based prospective memory tasks and the Hopkins Verbal Learning Test-revised , and less severe negative symptoms were significantly associated with remission .


In stepwise multiple logistic regression analyses , only higher scores on the TBPM significantly predicted remission .


Individuals having higher scores reflecting better TBPM at baseline were more likely to achieve remission after @ weeks of optimized antipsychotic treatment .


TPBM may be useful in helping clinicians identify those FES patients most likely to achieve a favorable treatment response .


Danoprevir is a hepatitis C virus ( HCV ) protease inhibitor with activity against genotypes ( G ) @/G@ , which is maintained at lower doses by ritonavir-boosting .


We report results of a large , randomized , active-controlled phase IIb study of ritonavir-boosted danoprevir ( danoprevir/r ) plus peginterferon alpha-@a / ribavirin ( P/R ) in treatment-naive patients with HCV G@/@ infection .


Treatment-naive patients with HCV G@/@ infection were randomized to twice-daily danoprevir/r @/@ mg ( A , n = @ ) ; @/@ mg ( B , n = @ ) ; or @/@ mg ( C , n = @ ) plus P/R for @ weeks ; twice-daily danoprevir/r @/@ mg ( D , n = @ ) plus P/R for @ or @ weeks ; or P/R alone ( E , n = @ ) for @ weeks .


Patients in the response-guided therapy arm ( D ) with an extended rapid virological response ( eRVR@ : HCV RNA < @ IU/ml during Weeks @-@ ) stopped all therapy at Week @ ; non-eRVR@ patients continued all treatment to Week @ .


The primary efficacy endpoint was sustained the virological response ( SVR@ : HCV RNA < @ IU/ml after @ weeks of untreated follow-up ) .


SVR@ rates in Arms A , B , C , D and E were @ % , @ % , @ % , @ % and @ % , respectively , in the overall population ; @ % , @ % , @ % , @ % and @ % in G@a-infected patients , @ % , @ % , @ % , @ % and @ % in G@b-infected patients and @ % , @ % , @ % , @ % and @ % in G@-infected patients .


Danoprevir/r plus P/R was generally well tolerated compared with P/R alone .


There was a higher incidence of serious adverse events in danoprevir-treatment arms , but most were associated with P/R .


The combination of danoprevir/r plus P/R is efficacious in treatment-nave patients with HCV genotype @ or @ infection .


There is debate on renal graft stenting during ureteroneocystostomy , patients with ureteral stents may encounter several complications such as encrustation , stent crustation which can lead to loss of kidney , and complications related to stent extraction : pain and UTI increasing related to cystoscopy for stent extraction accompanying excess expenses .


This study designed to reduce complications related to stent extraction .


@ patients prepared for renal transplantation during @ year randomly classified to groups , study group : patients with attached stent to Foley catheter , control group : patients with conventional technique ( stent separated from Foley ) then in their follow up ; UTI , stent crustation , luts severity compared to each other .


Second week and fourth week UTI reported @ % , @ % in study group versus @ % , @ % in control group ( P.value :@ and @ ) .


Urinary leakage was @ % overall , that all of them occurred in separate stent group , @ % vs. @ % in the linked stent group .


Stent crustation in separate stent was @ % compared with @ % in the linked stent .


Low complications rate in linked stent group , despite the lack of significant statistical differences , but indicate the effectiveness and success of the new technique .


Wound edge eversion has been hypothesized to improve aesthetic outcomes after cutaneous wound closure .


Data supporting this assertion are sparse .


We sought to determine if wound eversion , achieved with interrupted subcuticular sutures , improves aesthetic outcome compared with planar closures .


We undertook a prospective , randomized , split-scar intervention in patients who underwent cutaneous surgery .


Half of the wound was randomized to an everted or planar repair ; the other side received the opposite one .


At @ - and @-month follow-up , both the patient and @ blinded observers evaluated the wound using the Patient Observer Self-Assessment Scale ( POSAS ) .


The total observer POSAS score for the everted ( @ , @ ) and planar ( @ , @ ) sides did not differ significantly at @ or @ months , respectively .


Similarly , there was not a significant difference in patient assessment between the everted ( @ , @ ) and planar ( @ , @ ) sides at @ or @ months , respectively .


Finally , there was no significant difference between the @ closure methods in terms of scar height or width at follow-up .


This was a single-center trial , which used a validated but still subjective scar assessment instrument .


Wound eversion was not significantly associated with improved overall scar assessments byblinded observers or patient assessment .


Anal incontinence is a frequent complaint that profoundly affects quality of life .


Our aim was to determine whether perineal retraining gives additional benefits to standard medical treatment .


Patients with anal incontinence and a Wexner score > @ were randomly assigned to standard conservative treatment ( control ) or perineal retraining , including biofeedback , in addition to standard treatments ( biofeedback ) .


Diaries , self-administered questionnaires and satisfaction scores quantified the benefits .


Self-evaluated improvement was the primary outcome measure .


A score @ ( in an improvement scale from -@ to +@ ) defined success .


Overall , @ patients were included ; @ in the control group ( @ % females , mean age @ @ years ) and @ in the biofeedback group ( @ % females , mean age @ @ years ) .


After a @-month follow-up , the success rate was significantly higher in the biofeedback group ( @ % versus @ % ; p < @ ) .


In the biofeedback group , daily stool frequency , leakage , and faecal urgency significantly decreased , and daily non-urgent perception of stool increased .


Conversely , symptomatic scores and quality of life scales did not significantly differ between groups .


In a multivariate model , the adjusted odds ratio showed that perineal retraining was significantly associated with a higher chance of self-rated improvement ( adjusted Odd Ratio -LSB- @ % CI -RSB- : @ -LSB- @-@ @ -RSB- ; p = @ ) .


Perineal retraining offers a moderate but significant benefit for patients suffering from anal incontinence .


Workplace stress in Australia and other western countries has been steadily increasing over the past decade .


It can be observed not only in terms of increased compensation claims but also costs due to absenteeism , loss of productivity at work and reduced psychological and physiological health and well-being .


Given the cost and pervasive effects of stress in the modern workforce , time efficient and cost-effective interventions capable of reducing occupational stress ( or strain ) and burnout are urgently required for the improved well-being of stressed employees .


One intervention gaining scientific traction is supplementation with nutritional interventions , particularly the B group vitamins .


This study was developed to examine the effects of B group vitamins on workplace stress and mood variables with a sample of full-time employed older adults who subjectively report feeling stressed .


The study is a randomized , double-blind , placebo-controlled , parallel-groups clinical trial where @ ( N = @/group ) participants will be randomized to receive Blackmores Executive B Stress Formula or placebo daily for a period of @months .


Participants will be tested at baseline and @months post-randomization on workplace stress , cognitive , personality and mood measures , cardiovascular ( brachial and aortic systolic and diastolic blood pressures as well as arterial stiffness ) , biochemical ( assays to measure inflammation and safety ) as well as genetic assessments ( to assess stress processing ) and neuroimaging measures ( to investigate in vivo mechanisms of action of B vitamins ) .


In addition to this pre - and post - supplementation testing , participants will also complete a battery of self-report questionnaires online to assess their stress and mood once a month for the duration of the study .


The primary aim of the study is to investigate the effects of B vitamin supplementation on work related stress .


The secondary aims are to explore the mechanisms underpinning any changes in mood or workplace stress due to the B vitamin intervention by examining relationships between cognitive , biological , neuroimaging and cardiovascular variables over @months .


A subset of @ participants ( N = @/group ) will undergo neuroimaging at baseline and at @months using functional magnetic resonance imaging ( fMRI ) and magnetic resonance spectroscopy ( MRS ) in order to further explore in vivo mechanisms of action of B vitamins .


The purpose of this work was to evaluate the potential of a novel custom-designed rigid gas permeable ( RGP ) contact lens to modify the relative peripheral refractive error in a sample of myopic patients .


Fifty-two right eyes of @ myopic patients ( mean -LSB- SD -RSB- age , @ -LSB- @ -RSB- years ) with spherical refractive errors ranging from -@ to -@ diopters ( D ) and refractive astigmatism of @ D or less were fitted with a novel experimental RGP ( ExpRGP ) lens designed to create myopic defocus in the peripheral retina .


A standard RGP ( StdRGP ) lens was used as a control in the same eye .


The relative peripheral refractive error was measured without the lens and with each of two lenses ( StdRGP and ExpRGP ) using an open-field autorefractometer from @ degrees nasal to @ degrees temporal , in @-degree steps .


The effectiveness of the lens design was evaluated as the amount of relative peripheral refractive error difference induced by the ExpRGP compared with no lens and with StdRGP conditions at @ degrees in the nasal and temporal ( averaged ) peripheral visual fields .


Experimental RGP lens induced a significant change in relative peripheral refractive error compared with the no-lens condition ( baseline ) , beyond the @ degrees of eccentricity to the nasal and temporal side of the visual field ( p < @ ) .


The maximum effect was achieved at @ degrees .


Wearing the ExpRGP lens , @ % of the eyes had peripheral myopia exceeding -@ D , whereas none of the eyes presented with this feature at baseline .


There was no significant correlation ( r = @ ; p = @ ) between the degree of myopia induced at @ degrees of eccentricity of the visual field with the ExpRGP lens and the baseline refractive error .


Custom-designed RGP contact lenses can generate a significant degree of relative peripheral myopia in myopic patients regardless of their baseline spherical equivalent refractive error .


Since the introduction of breast-conserving treatment , various radiation doses after lumpectomy have been used .


In a phase @ randomised controlled trial , we investigated the effect of a radiation boost of @ Gy on overall survival , local control , and fibrosis for patients with stage I and II breast cancer who underwent breast-conserving treatment compared with patients who received no boost .


Here , we present the @-year follow-up results .


Patients with microscopically complete excision for invasive disease followed by whole-breast irradiation of @ Gy in @ weeks were centrally randomised ( @:@ ) with a minimisation algorithm to receive @ Gy boost or no boost , with minimisation for age , menopausal status , presence of extensive ductal carcinoma in situ , clinical tumour size , nodal status , and institution .


Neither patients nor investigators were masked to treatment allocation .


The primary endpoint was overall survival in the intention-to-treat population .


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


Between May @ , @ , and June @ , @ , @ patients were randomly assigned to receive no radiation boost and @ patients randomly assigned to receive a radiation boost .


Median follow-up was @ years ( IQR @-@ @ ) .


@-year overall survival was @ % ( @ % CI @-@ @ ) in the boost group versus @ % ( @-@ @ ) in the no boost group , hazard ratio ( HR ) @ ( @ % CI @-@ @ , p = @ ) .


Ipsilateral breast tumour recurrence was the first treatment failure for @ patients ( @ % ) in the no boost group versus @ patients ( @ % ) in the boost group , HR @ ( @ % CI @-@ @ , p < @ ) .


The @-year cumulative incidence of ipsilatelal breast tumour recurrence was @ % ( @ % CI @-@ @ ) in the no boost group versus @ % ( @-@ @ ) in the boost group .


Mastectomies as first salvage treatment for ipsilateral breast tumour recurrence occurred in @ ( @ % ) of @ patients in the no boost group versus @ ( @ % ) of @ in the boost group .


The cumulative incidence of severe fibrosis at @ years was @ % ( @ % CI @-@ @ ) in the no boost group versus @ % ( @ % CI @-@ @ ) in the boost group ( p < @ ) .


A radiation boost after whole-breast irradiation has no effect on long-term overall survival , but can improve local control , with the largest absolute benefit in young patients , although it increases the risk of moderate to severe fibrosis .


The extra radiation dose can be avoided in most patients older than age @ years .


To record the fate of transfused platelet doses in the North of England , and thereby assist with demand-planning and help target teaching on appropriate use .


Platelet use has risen recently to the extent that donation practice has changed to meet demand .


Two national comparative audits have shown inappropriate use and the @ audit concluded that current U.K. guidelines for platelet usage should be completely implemented at a local level .


It is necessary to know how platelets are used and by whom in order to facilitate guideline concordance .


All hospital trusts in the North East and Cumbria recorded data on all platelet doses transfused in two separate @-week periods in @ .


Data were entered onto an electronic survey tool .


One thousand and five hundred and seventy-four reports were received , documenting @ transfused doses -- @ % of total issues for the study periods .


One thousand and forty-five platelet doses ( @ % ) were given for haematological indications .


The second commonest indication was cardiac surgery ( @ doses , @ % of the total ) followed by non-haematological oncology ( @ doses , @ % ) , critical care ( @ doses , @ % ) and liver disease ( @ doses , @ % ) .


The commonest haematological indication was acute myeloid leukaemia , @ doses , ( @ % of all platelet use ) , followed by stem cell transplantation , @ doses ( @ % ) .


Seventy-two percent of platelet doses were given prophylactically , the majority without any planned procedure .


The commonest indication for platelet use , where reinforcement of guidelines will be productive , is prophylaxis in haematological disease .


Use of platelets in cardiac surgery is also worthy of close scrutiny .


The aim of this study was to evaluate the safety and efficacy of thyroidectomy using the Harmonic ACE scalpel ( HS ) or the LigaSure Precise ( LS ) instrument in conventional thyroidectomy .


A prospective , randomized controlled trial was performed .


Between August @ and June @ , @ patients who required thyroidectomy for papillary thyroid cancer were randomized into groups treated with either the HS or the LS instrument .


Operative time and surgical morbidities were analyzed .


A total of @ patients ( HS group , N = @ ; LS instrument group , N = @ ) were randomized for analysis according to the intention-to-treat principle .


There were no statistically significant differences in the operative times ( HS group versus LS instrument group : @ versus @ ; P = @ ) , postoperative transient hypoparathyroidism ( @ % versus @ % ; P = @ ) , and permanent recurrent laryngeal nerve injuries between the two groups .


In this study , both hemostatic devices were safe and effective in terms of postoperative results and complications without any differences .


Mortality in people in Africa with HIV infection starting antiretroviral therapy ( ART ) is high , particularly in those with advanced disease .


We assessed the effect of a short period of community support to supplement clinic-based services combined with serum cryptococcal antigen screening .


We did an open-label , randomised controlled trial in six urban clinics in Dar es Salaam , Tanzania , and Lusaka , Zambia .


From February , @ , we enrolled eligible individuals with HIV infection ( age @ years , CD@ count of < @ cells per L , ART naive ) and randomly assigned them to either the standard clinic-based care supplemented with community support or standard clinic-based care alone , stratified by country and clinic , in permuted block sizes of ten .


Clinic plus community support consisted of screening for serum cryptococcal antigen combined with antifungal therapy for patients testing antigen positive , weekly home visits for the first @ weeks on ART by lay workers to provide support , and in Tanzania alone , re-screening for tuberculosis at @-@ weeks after ART initiation .


The primary endpoint was all-cause mortality at @ months , analysed by intention to treat .


This trial is registered with the International Standard Randomised Controlled Trial Number registry , number ISCRTN @ .


Between Feb @ , @ , and Sept @ , @ , @ patients were randomly assigned to clinic plus community support and @ to standard care .


@ ( @ % ) of @ participants in the clinic plus community support group did not receive their assigned intervention , and @ ( @ % ) of @ participants in the standard care group received a home visit or a cryptococcal antigen screen rather than only standard care .


At @ months , @ ( @ % ) of @ participants in the clinic plus community support group and @ ( @ % ) of @ participants in the standard care group had been lost to follow-up , and were censored at their last visit for the primary analysis .


At @ months , @ ( @ % ) of @ participants in the clinic plus community support group had died compared with @ ( @ % ) of @ in the standard care group .


Mortality was @ % ( @ % CI @-@ ) lower in the clinic plus community support group than in standard care group ( p = @ ) .


Screening and pre-emptive treatment for cryptococcal infection combined with a short initial period of adherence support after initiation of ART could substantially reduce mortality in HIV programmes in Africa .


To compare standard coil embolization versus the use of an antireflux microcatheter ( ARM ) in patients undergoing planning angiography before selective internal radiation therapy ( SIRT ) .


A prospective , single-center trial was performed in which @ patients were randomly assigned to undergo SIRT with coil embolization or the use of an ARM .


The coil group underwent detachable coil embolization of nontarget vessels , and the ARM group underwent infusion of macroaggregated albumin with use of an ARM system , without coil embolization .


Single-photon emission computed tomography ( CT ) / CT was then performed to assess for nontarget distribution .


The primary endpoint was fluoroscopy time during planning angiography .


Secondary endpoints included deployment time , total procedure time , radiation dose-area product , contrast agent used , and adverse events .


Endpoints were evaluated during planning angiography and SIRT .


Over a @-month period , @ consecutive patients were randomized at a @:@ ratio between coil embolization and ARM groups .


Technical success rates were @ % in both groups .


Mean fluoroscopy time was significantly reduced in the ARM group versus the coil embolization group ( @ min -LSB- range , @-@ @ min -RSB- vs @ min -LSB- range , @-@ @ min -RSB- ; P = @ ) .


The planning procedure time ( P < @ ) , deployment time ( P < @ ) , dose-area product ( P = @ ) , and amount of contrast agent used ( P < @ ) were also significantly less in the ARM group than in the coil embolization group .


No nontarget distribution was detected in either group .


There was no difference between groups in dose delivered on the day of SIRT ( P = @ ) .


There were no major or minor adverse events at @ days .


The use of an ARM during planning angiography can significantly reduce fluoroscopy time , procedure time , and radiation dose .


Diffuse isolated liver metastases are the dominant mode of tumor progression in a number of cancers and present a major treatment challenge for oncologists .


An experimental treatment , percutaneous hepatic perfusion ( PHP ) , utilizes partial venovenous cardiopulmonary bypass to allow administration of high-dose chemotherapy directly and solely to the liver with filtration of chemotherapeutic agents from the blood prior to its return to the systemic circulation , thereby minimizing toxic systemic effects .


The following case series describes the management of @ patients with metastatic melanoma undergoing serial PHPs .


A single-center experience from a national multi-center random-assignment trial comparing PHP to best alternative care ( BAC ) in patients with diffuse melanoma liver metastases .


A tertiary care hospital .


Five patients with metastatic melanoma to the liver .


Five patients underwent a total of fifteen PHPs using a venovenous bypass circuit with hemofiltration , receiving hepatic intra-arterial melphalan , @ mg/kg of ideal body weight , for @ minutes with a total of @ minutes of hemofiltration .


Five patients tolerated the procedure well with transient hemodynamic and metabolic changes .


In patients with diffuse isolated liver metastases , PHP is a safe and well-tolerated procedure that can be performed more than once and is associated with marked anti-tumor activity in some patients .


Neonatal circumcision is one of the oldest and most frequently performed surgical procedures on males .


Newborns demonstrate strong endogenous reaction to pain and therefore modalities are being explored for optimum pain relief during circumcision .


Pediatric nurses have a vital role for the use of these modalities and minimising the pain response during the neonatal minor procedures .


The aim of this study was to assess the effectiveness of eutectic mixture of local anaesthetic ( EMLA ) cream compared with oral sucrose and both in alleviating pain in neonatal circumcision .


This study was conducted in the Day Care Surgery Department of Maternity and Children Hospital , Dammam City , KSA .


@ full-term newborn males who underwent circumcision were divided randomly into three groups ( @ each ) .


Each group was assigned to receive a different type of analgesics such as EMLA cream ( Group A ) , oral sucrose ( Group B ) or combination of EMLA cream and oral sucrose ( Group C ) .


Neonatal pain agitation and sedation scale ( N-PASS ) was used @ min before , during and @ min after the circumcision procedure to assess the neonatal response to pain .


N-PASS scores were significantly lower in Group C ( median Group C = @ , Group A = @ , Group B = @ ; P < @ ) .


The endogenous response to pain in terms of escalation of heart rate and reduction in O @ saturation were minimal among Group C ( P < @ ) .


Duration of crying was comparable among all the groups .


The combination of sucrose and EMLA cream revealed a higher analgesic effect and minimal adverse response to pain than either EMLA cream or sucrose alone during neonatal circumcision .


Colonoscopy is one of the most reliable methods for the detection of colorectal neoplasms .


However , colonic peristalsis during colonoscopy results in some neoplastic lesions being hidden from view and commonly requires an intravenous or intramuscular injection of antispasmodic agents , which may sometimes causes unexpected adverse reactions .


The aim of this study was to evaluate the efficacy of L-menthol spray as an antiperistaltic agent and its effect on adenoma detection .


This was a prospective , randomized , single-blind placebo-controlled trial .


A total of @ patients who were scheduled to undergo colonoscopy were randomly assigned to receive either @mL of @ % L-menthol ( n = @ ) or placebo ( n = @ ) .


Both treatments were sprayed locally onto the colonic mucosa via an endoscope .


The adenoma detection rate ( ADR ) and the proportion of patients with no peristalsis were the primary and secondary outcomes , respectively .


The ADR was significantly higher in the L-menthol group than in the placebo group ( @ % vs. @ % ; P = @ ) .


The proportion of patients with no peristalsis after treatment with L-menthol was significantly higher than in the placebo group ( @ % vs. @ % ; P < @ ) .


There were no adverse effects in either group .


The results suggest that the suppression of colonic peristalsis by L-menthol sprayed directly onto the colonic mucosa improves the ADR .


Limited information is available regarding sedation and motor function following repeat dosing of antihistamines .


This study examined how promethazine and loratadine affect day-time drowsiness , the commencement of voluntary movement , and involuntary movement when administered on consecutive days .


Ten healthy young subjects ( @years ) were recruited into a double-blind , placebo-controlled , three-way crossover study .


Subjects ingested either promethazine , loratadine or a placebo , and ingested the same drug @h later .


Measures of drowsiness , simple reaction time ( SRT ) , choice reaction time ( CRT ) , and postural tremor were obtained pre-ingestion , @h post-ingestion and @h post-ingestion on each day .


Consecutive daily doses of promethazine and loratadine affected SRT and CRT , respectively , whereby reaction time deficits were less pronounced following the repeat dose .


A reduced tremor response was also observed following consecutive daily dosing of promethazine , in contrast to loratadine which caused an increase in tremor amplitude with the consecutive daily dose .


Reaction time and tremor responses differed following the single dose compared to consecutive doses .


Sufferers of allergic rhinitis often require antihistamine dosing regimens that continue over multiple days .


Future studies will benefit from examining drowsiness and movement responses following single doses as well as consecutive dosing .


Stress-relieving effects of balneotherapy compared to progressive muscle relaxation ( PMR ) and to resting were investigated by measuring subjective relaxation and salivary cortisol .


It was also examined whether participants with a high versus low stress level would have a different relaxation response .


A sample of healthy volunteers was randomized to balneotherapy , PMR , or a resting control group , each intervention lasting for @ min .


Pre - and post-intervention salivary cortisol samples were collected , and participants rated their status of relaxation on a quantitative scale .


In addition , @ questionnaires were applied to detect participants ' stress level and bodily complaints .


@ healthy participants were recruited ( @ % female ) .


In a pre-post comparison , salivary cortisol decreased ( F = @ , p < @ ) and subjective relaxation ratings increased ( F = @ , p < @ ) in all @ groups .


Study participants in the balneotherapy group rated themselves as more relaxed after the intervention as compared to the other groups ( F = @ , p < @ ) .


Participants with a high versus low stress level differed in somatic symptoms and in morning cortisol levels , but showed a similar relaxation response .


Findings suggest that compared to PMR and resting , balneotherapy seems to be more beneficial with regard to subjective relaxation effects and similarly beneficial with regard to a decrease in salivary cortisol .


To characterize visual field ( VF ) loss at the baseline visit and to evaluate VF quality control ( QC ) procedures in the Idiopathic Intracranial Hypertension Treatment Trial ( IIHTT ) .


The Visual Field Reading Center ( VFRC ) evaluated @ baseline VFs ( @ hemifields ) from @ enrolled patients .


Three readers independently classified each superior and inferior hemifield and identified any abnormalities .


A subset ( @ % ) of the hemifields was reread to evaluate within - and between-reader agreements .


The QC system addressed test parameters , patient data , and shipment errors .


The majority ( @ % ) of the baseline hemifields consisted of localized nerve fiber bundle-type VF loss .


Approximately one-third ( @ % ) of all the classifications consisted of partial arcuate defects combined with an enlarged blind spot , making this the most common type of hemifield classification .


Inferior hemifield loss was greater than superior loss for both study and nonstudy eyes .


Reader agreements were > @ % for both inferior and superior hemifields for two out of three readers .


Test-retest reliability agreement for individual readers was @ % for both hemifields .


There were few QC errors with only @ error points per @-point VF .


The most common type of IIHTT baseline hemifield abnormality was a localized nerve fiber bundle-like defect .


Localized inferior hemifield loss was more common than superior hemifield loss .


Quality control and within - and between-reader agreement were excellent for the IIHTT ( ClinicalTrials.gov number , NCT@ ) .


Analgesia after caesarean section is important because postpartum women with pain have difficulty in mobility , which undermines breastfeeding .


Intrathecal morphine provides adequate and prolonged analgesia after cesarean .


The aim of this study was to compare the quality of analgesia provided by two doses of intrathecal morphine and its side effects in patients undergoing cesarean section .


The study included @ pregnant women with gestational age over @ weeks and scheduled for cesarean section .


The women were randomly allocated into two groups to receive either @ or @ g of intrathecal morphine ( Group @/Group @ ) .


All patients were intrathecally anesthetized with @ mg of @ % hyperbaric bupivacaine .


Patients were assessed between the @ ( th ) and @ ( th ) hour and the @ ( nd ) and @ ( th ) hour after blockade for quality of analgesia , analgesic consumption , side effects , and main cause of discomfort in the first @ hours after surgery .


There was similarity between groups regarding anthropometric data and obstetric history .


There was no statistical difference in pain intensity between groups .


In both groups , pain was more intense in the first @ hours after anesthesia ( p < @ ) .


Tramadol hydrochloride consumption and time to first dose were similar in both groups .


Pruritus was the most common side effect , with statistically higher incidence in Group @ ( p = @ ) .


Intrathecal morphine @ g provides the same quality of analgesia as @ g , with a lower incidence of side effects .


Unwanted submental fat ( SMF ) may result in an unattractive chin profile and dissatisfaction with appearance .


An approved and rigorously tested non-surgical method for SMF reduction is lacking .


To evaluate the efficacy and safety of ATX-@ for the pharmacological reduction of unwanted SMF in a phase III randomized , double-blind , placebo-controlled study .


Patients ( n = @ ) with moderate or severe SMF were randomized to receive ATX-@ @ or @ mg/cm ( @ ) or placebo injected into their SMF for up to four treatments ~ @ days apart , with a @-week follow-up .