Without increasing postoperative complications , CEH demonstrates an advantage compared with FH , with regard to reducing the rate of recurrence to @ through complete hemorrhoid removal .


In developing countries , accessibility to specialists , and physician to patient contact time is limited .


In Thailand , A unique community health service is provided by subdistrict health care officers and Village Health Volunteers ( VHVs ) .


If the personnel were trained on proper chronic kidney disease ( CKD ) care , CKD progression would be delayed .


We conducted a community-based , cluster randomized controlled trial at Kamphaeng Phet Province , located about @ kilometers north of Bangkok .


Two out of eleven districts of the province were randomly selected .


Approximatly @ stage @-@ CKD patients from @ districts were enrolled .


Patients in both groups will be treated with standard guidelines .


The patients in intervention group were provided the additional treatments by multidisciplinary team in conjunction with community CKD care network ( subdistrict health care officers and VHVs ) which will provide group counseling during each hospital visit and quarterly home visits to monitor dietary protein and sodium intake , blood pressure measurement and drug compliance .


Duration of the study is @years .


The primary outcome is the difference of rate of eGFR decline .


The secondary outcomes are laboratory parameters and incidence of clinical endpoints such as mortality rate and cardiovascular events , end-stage renal disease ( ESRD ) , etc. .


Insights of this study may set forth a new standard of community-based CKD care .


Patients with evidence of vascular disease are at increased risk for subsequent vascular events despite effective use of statins to lower the low-density lipoprotein ( LDL ) cholesterol level .


Niacin lowers the LDL cholesterol level and raises the high-density lipoprotein ( HDL ) cholesterol level , but its clinical efficacy and safety are uncertain .


After a prerandomization run-in phase to standardize the background statin-based LDL cholesterol-lowering therapy and to establish participants ' ability to take extended-release niacin without clinically significant adverse effects , we randomly assigned @,@ adults with vascular disease to receive @ g of extended-release niacin and @ mg of laropiprant or a matching placebo daily .


The primary outcome was the first major vascular event ( nonfatal myocardial infarction , death from coronary causes , stroke , or arterial revascularization ) .


During a median follow-up period of @ years , participants who were assigned to extended-release niacin-laropiprant had an LDL cholesterol level that was an average of @ mg per deciliter ( @ mmol per liter as measured in the central laboratory ) lower and an HDL cholesterol level that was an average of @ mg per deciliter ( @ mmol per liter ) higher than the levels in those assigned to placebo .


Assignment to niacin-laropiprant , as compared with assignment to placebo , had no significant effect on the incidence of major vascular events ( @ % and @ % of participants with an event , respectively ; rate ratio , @ ; @ % confidence interval -LSB- CI -RSB- , @ to @ ; P = @ ) .


Niacin-laropiprant was associated with an increased incidence of disturbances in diabetes control that were considered to be serious ( absolute excess as compared with placebo , @ percentage points ; P < @ ) and with an increased incidence of diabetes diagnoses ( absolute excess , @ percentage points ; P < @ ) , as well as increases in serious adverse events associated with the gastrointestinal system ( absolute excess , @ percentage point ; P < @ ) , musculoskeletal system ( absolute excess , @ percentage points ; P < @ ) , skin ( absolute excess , @ percentage points ; P = @ ) , and unexpectedly , infection ( absolute excess , @ percentage points ; P < @ ) and bleeding ( absolute excess , @ percentage points ; P < @ ) .


Among participants with atherosclerotic vascular disease , the addition of extended-release niacin-laropiprant to statin-based LDL cholesterol-lowering therapy did not significantly reduce the risk of major vascular events but did increase the risk of serious adverse events .


( Funded by Merck and others ; HPS@-THRIVE ClinicalTrials.gov number , NCT@ . )


This study sought to assess the effect of the addition of coronary artery bypass grafting ( CABG ) to medical therapy on mode of death in heart failure .


Although CABG therapy is widely used in ischemic cardiomyopathy patients , there are no prospective clinical trial data on mode of death .


The STICH ( Surgical Treatment for Ischemic Heart Failure ) trial compared the strategy of CABG plus medical therapy to medical therapy alone in @,@ ischemic cardiomyopathy patients with reduced ejection fraction .


A clinical events committee adjudicated deaths using pre-specified definitions for mode of death .


In the STICH trial , there were @ deaths over a median follow-up of @ months .


The addition of CABG therapy tended to reduce cardiovascular deaths ( hazard ratio -LSB- HR -RSB- : @ ; @ % confidence interval -LSB- CI -RSB- : @ to @ ; p = @ ) and significantly reduced the most common modes of death : sudden death ( HR : @ ; @ % CI : @ to @ ; p = @ ) and fatal pump failure events ( HR : @ ; @ % CI : @ to @ ; p = @ ) .


Time-dependent estimates indicate that the protective effect of CABG principally occurred after @ months in both categories .


Deaths post-cardiovascular procedures were increased in CABG patients ( HR : @ ; @ % CI : @ to @ ) , but fatal myocardial infarction deaths were lower ( HR : @ ; @ % CI : @ to @ ) .


Noncardiovascular deaths were infrequent and did not differ between groups .


In the STICH trial , the addition of CABG to medical therapy reduced the most common modes of death : sudden death and fatal pump failure events .


The beneficial effects were principally seen after @ years .


Post-procedure deaths were increased in patients randomized to CABG , whereas myocardial infarction deaths were decreased .


To evaluate the effect of Chen 's needling therapy on facial neuritis .


Eighty-four patients of facial neuritis were randomized into a Chen 's needling therapy group and a conventional needling group , @ cases in each one .


In the Chen 's needling therapy group , the few acupoints were selected ( @ acupoints ) .


Chen 's flying insertion of needle and the reinforcing and reducing techniques were applied .


In the conventional needling group , the acupoint selection and needling method were used routinely .


The treatment of @ month was @ session in the two groups .


According to the symptom and physical sign quantification scale , the effect was assessed at multiple time points respectively ( in @ weeks of treatment , @ session of treatment and @ month after @ session of treatment ) .


Simultaneously , House-Brackmann scale and EMG were adopted to determine the function of facial nerve .


After treatment , the results of symptoms and physical sign quantification scale and facial nerve EMG were different significantly as compared with those before treatment in the patients of the two groups ( all P < @ ) .


But the differences were not significant between the two groups ( all P > @ ) .


Chen 's needling therapy achieves the same effect on facial neuritis as compared with the conventional acupuncture therapy , and additionally it is specialized at flying insertion of needle technique and selection of few acupoints .


In the Effects of Postconditioning on Myocardial Reperfusion in Patients with ST-segment Elevation Myocardial Infarction ( POST ) trial , ischemic postconditioning failed to improve myocardial reperfusion .


However , long-term effects of ischemic postconditioning on clinical outcomes are not known in patients with ST-segment elevation myocardial infarction .


A total of @ patients undergoing primary percutaneous coronary intervention ( PCI ) were randomly assigned to the postconditioning group or the conventional primary PCI group in a @:@ ratio .


Postconditioning was performed immediately after restoration of coronary flow by balloon occlusion @ times for @ minute .


Complete follow-up data for major clinical events at @ year were available in @ patients ( @ % ) , and analyses were done by the intention to treat principle .


The primary outcome was a composite of death , myocardial infarction , severe heart failure , or stent thrombosis at @ year .


At @ year , a composite of death , myocardial infarction , severe heart failure , or stent thrombosis occurred in @ patients ( @ % ) in the postconditioning group and @ patients ( @ % ) in the conventional PCI group ( hazard ratio -LSB- HR -RSB- @ , @ % CI @-@ @ , P = @ ) .


The risk of death ( @ % vs @ % , HR @ , @ % CI @-@ @ , P = @ ) , heart failure ( @ % vs @ % , HR @ , @ % CI @-@ @ , P = @ ) , and stent thrombosis ( @ % vs @ % , HR @ , @ % CI @-@ @ , P = @ ) did not differ significantly between the @ groups .


Ischemic postconditioning does not seem to improve the @-year clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary PCI .


To investigate the effectiveness of a worksite social and physical environment intervention on need for recovery ( i.e. , early symptoms of work-related mental and physical fatigue ) , physical activity and relaxation .


Also , the effectiveness of the separate interventions was investigated .


In this @ @ factorial design study , @ office employees from a financial service provider participated .


Participants were allocated to the combined social and physical intervention , to the social intervention only , to the physical intervention only or to the control group .


The primary outcome measure was need for recovery .


Secondary outcomes were work-related stress ( i.e. , exhaustion , detachment and relaxation ) , small breaks , physical activity ( i.e. , stair climbing , active commuting , sport activities , light/moderate/vigorous physical activity ) and sedentary behavior .


Outcomes were measured by questionnaires at baseline , @ and @ months follow-up .


Multilevel analyses were performed to investigate the effects of the three interventions .


In all intervention groups , a non-significant reduction was found in need for recovery .


In the combined intervention ( n = @ ) , exhaustion and vigorous physical activities decreased significantly , and small breaks at work and active commuting increased significantly compared to the control group .


The social intervention ( n = @ ) showed a significant reduction in exhaustion , sedentary behavior at work and a significant increase in small breaks at work and leisure activities .


In the physical intervention ( n = @ ) , stair climbing at work and active commuting significantly increased , and sedentary behavior at work decreased significantly compared to the control group .


None of the interventions was effective in improving the need for recovery .


It is recommended to implement the social and physical intervention among a population with higher baseline values of need for recovery .


Furthermore , the intervention itself could be improved by increasing the intensity of the intervention ( for example weekly GMI-sessions ) , providing physical activity opportunities and exercise schemes , and by more drastic environment interventions ( restructuring entire department floor ) .


To observe the clinical effect on treatment of premature ovarian failure ( POF ) patients by Bushen Tiaojing Recipe ( BTR ) and hormone replacement therapy ( HRT ) .


Totally @ POF patients were randomly assigned to three groups by random digit table , i.e. , the Chinese medicine group , the Western medicine group , and the integrative medicine group , @ in each group .


Those in the Chinese medicine group took BTR .


Those in the Western medicine group were treated by HRT .


Those in the integrative medicine group were treated by BTR + HRT .


All were treated for three courses and followed-up for @ months after treatment .


The clinical efficacy , integrals of clinical symptoms , and serum sex hormones levels -LSB- follicular stimulating hormone ( FSH ) , estradiol ( E@ ) , luteinizing hormone ( LH ) -RSB- were compared among the three groups before treatment , at the end of treatment , and @ months after withdrawal .


( @ ) The total effective rate was better in the integrative medicine group than in the Chinese medicine group and the Western medicine group ( P < @ ) .


( @ ) At the end of treatment , the integrals of clinical symptoms decreased in the @ groups when compared with before treatment in the same group ( P < @ , P < @ ) .


The integrals of clinical symptoms were higher at @ months after withdrawal than at the end of treatment in the Western medicine group ( P < @ ) .


But there was no statistical difference in changes of integrals between the Chinese medicine group and the integrative medicine group ( P > @ ) .


( @ ) By the end of treatment serum E@ increased ( P < @ ) , FSH and LH decreased ( P < @ ) in the three groups , more significantly in the integrative medicine group and the Western medicine group ( P < @ , P < @ ) .


At @ months after withdrawal serum E@ decreased , FSH and LH increased in the Western medicine group , showing statistical difference when compared with the other two groups ( P < @ , P < @ ) .


There was no statistical difference in changes of serum E@ , FSH , or LH between the Chinese medicine group and the integrative medicine group ( P > @ ) .


BTR combined HRT had significant effect on treatment of POF , could significantly improve patients ' clinical symptoms , menstrual states , and serum sex hormones levels .


It had lower recurrence rate .


Patients suffered from less adverse reactions .


Benzodiazepines are considered first-line therapy for pediatric status epilepticus .


Some studies suggest that lorazepam may be more effective or safer than diazepam , but lorazepam is not Food and Drug Administration approved for this indication .


To test the hypothesis that lorazepam has better efficacy and safety than diazepam for treating pediatric status epilepticus .


This double-blind , randomized clinical trial was conducted from March @ , @ , to March @ , @ .


Patients aged @ months to younger than @ years with convulsive status epilepticus presenting to @ of @ US academic pediatric emergency departments were eligible .


There were @ patients ; @ randomized to diazepam and @ to lorazepam .


Patients received either @ mg/kg of diazepam or @ mg/kg of lorazepam intravenously , with half this dose repeated at @ minutes if necessary .


If status epilepticus continued at @ minutes , fosphenytoin was administered .


The primary efficacy outcome was cessation of status epilepticus by @ minutes without recurrence within @ minutes .


The primary safety outcome was the performance of assisted ventilation .


Secondary outcomes included rates of seizure recurrence and sedation and times to cessation of status epilepticus and return to baseline mental status .


Outcomes were measured @ hours after study medication administration .


Cessation of status epilepticus for @ minutes without recurrence within @ minutes occurred in @ of @ ( @ % ) in the diazepam group and @ of @ ( @ % ) in the lorazepam group , with an absolute efficacy difference of @ % ( @ % CI , -@ % to @ % ) .


Twenty-six patients in each group required assisted ventilation ( @ % given diazepam and @ % given lorazepam ; absolute risk difference , @ % ; @ % CI , -@ % to @ % ) .


There were no statistically significant differences in secondary outcomes except that lorazepam patients were more likely to be sedated ( @ % vs @ % , respectively ; absolute risk difference , @ % ; @ % CI , @ % to @ % ) .


Among pediatric patients with convulsive status epilepticus , treatment with lorazepam did not result in improved efficacy or safety compared with diazepam .


These findings do not support the preferential use of lorazepam for this condition .


Acetylcysteine has been suggested as a beneficial treatment for idiopathic pulmonary fibrosis , although data from placebo-controlled studies are lacking .


In our initial double-blind , placebo-controlled trial , we randomly assigned patients who had idiopathic pulmonary fibrosis with mild-to-moderate impairment in pulmonary function to receive a three-drug regimen of prednisone , azathioprine , and acetylcysteine ; acetylcysteine alone ; or placebo .


The study was interrupted owing to safety concerns associated with the three-drug regimen .


The trial continued as a two-group study ( acetylcysteine vs. placebo ) without other changes ; @ and @ patients were enrolled in the acetylcysteine and placebo groups , respectively .


The primary outcome was the change in forced vital capacity ( FVC ) over a @-week period .


At @ weeks , there was no significant difference in the change in FVC between the acetylcysteine group and the placebo group ( -@ liters and -@ liters , respectively ; P = @ ) .


In addition , there were no significant differences between the acetylcysteine group and the placebo group in the rates of death ( @ % vs. @ % , P = @ by the log-rank test ) or acute exacerbation ( @ % in each group , P > @ ) .


As compared with placebo , acetylcysteine offered no significant benefit with respect to the preservation of FVC in patients with idiopathic pulmonary fibrosis with mild-to-moderate impairment in lung function .


( Funded by the National Heart , Lung , and Blood Institute and others ; ClinicalTrials.gov number , NCT@ . )


The aim of this study was to evaluate marginal bone levels , with cone beam computed tomography , on the buccal and lingual aspects of implants placed with the implant-abutment interface ( IAI ) at different positions in relation to the alveolar crest .


Thirty patients in need of single-tooth rehabilitation were randomly assigned to three groups based on the position of the IAI in relation to the buccal aspect of the alveolar crest at the time of implant placement .


Patients in groups @ , @ , and @ had their implants placed level with the buccal crest or @ or @ mm apical to the buccal aspect of the alveolar crest , respectively .


The implants were restored with screw-retained single crowns after @ months .


Marginal bone levels on the buccal and lingual aspects of the implants were evaluated at @ months after implant placement .


All groups of implants demonstrated significantly different crestal positions .


Group @ implants maintained the greatest subcrestal position ( @ @ mm ) compared to the implants of group @ ( -@ @ mm ) and group @ ( @ @ mm ) .


There were no differences between groups in the level of the first bone-to-implant contact relative to the implant platform .


Implants of group @ exhibited less buccal bone remodeling ( -@ @ mm ) compared to group @ ( -@ @ mm ) and group @ ( -@ @ mm ) implants .


For groups @ and @ implants , there was a significant negative correlation between buccal wall thickness following the osteotomy and the amount of buccal bone remodeling .


In this study , different responses were seen in the buccal and lingual peri-implant bone for implants with platform-switched Morse taper connections placed with the IAI at different locations in relation to the alveolar crest .


Evaluate antinociception , anesthesia , and recovery in llamas given tiletamine-zolazepam ( TZ ) with either morphine , xylazine , morphine and xylazine , or saline .


Randomized crossover experimental study .


Six healthy , adult intact male llamas .


Llamas were given each of four treatments intramuscularly with a @-week washout : TZ ( @ mg kg ( -@ ) ) combined with either morphine ( @ mg kg ( -@ ) ; M ) , xylazine ( @ mg kg ( -@ ) ; X ) , morphine ( @ mg kg ( -@ ) ) and xylazine ( @ mg kg ( -@ ) ) ( MX ) , or saline ( C ) .


Llamas breathed room air during the experiment .


Characteristics of anesthesia , recovery , and selected cardiopulmonary variables were recorded .


Antinociception was assessed by clamping a claw at @-minute intervals .


Data were analyzed using a mixed-model anova and Tukey-Kramer test , and are expressed as least squares mean SEM .


Significance was set at p < @ .


No llama in the control group demonstrated antinociception .


Antinociception was longest with treatment MX , followed by treatments X and M , respectively .


Heart rates in llamas given treatments X and MX were significantly lower than with other treatments .


The respiratory rate in llamas given treatment C was greater ( p < @ ) than for all other treatments , however , the respiratory rate was not significantly different among treatments X , M and MX .


The PaO@ for llamas given MX remained < @ mmHg throughout the @ minute period of blood gas analysis .


Mean arterial blood pressure in llamas in treatment MX was less than for treatments M or C.


The combination of morphine ( @ mg kg ( -@ ) ) and xylazine ( @ mg kg ( -@ ) ) increased the duration of antinociception compared with xylazine alone , in TZ-anesthetized llamas .


Treatments X , M and MX were associated with hypoxemia ( PaO@ < @ mmHg ) .


Current oral rotavirus vaccines perform suboptimally in resource-poor settings .


We investigated the effect of an additional dose and later schedule on the immunogenicity of monovalent rotavirus vaccine ( RV@ ) in a developing country .


Infants received RV@ at @ and @ , @ and @ , or @ , @ , and @ weeks of age .


The primary objective was to compare antirotavirus immunoglobulin A ( IgA ) seroconversion at @ weeks in the @/@/@ arm to the cumulative seroconversion ( highest result at @ or @ weeks ) in the @/@ arm .


Overall , @ ( @ % ) of @ randomized infants completed the trial per protocol .


Seroconversion in the @/@/@ arm was @ % ( @ % CI , @ , @ ) compared to @ % ( CI , @ , @ ) in the @/@ arm , ( P = @ ) ; the result from the @/@ arm was @ % ( CI , @ , @ ) .


Seroconversion in the @/@ arm at @ weeks ( post hoc ) was lower at @ % ( CI , @ , @ ) .


In Pakistani infants , the immunogenicity of RV@ did not increase significantly with @ doses at @ , @ , and @ weeks compared to @ doses at @ and @ weeks .


Additional strategies should be evaluated for improving rotavirus vaccine immunogenicity in high burden countries .


The cholesterol absorption inhibitor ezetimibe has been shown to ameliorate non-alcoholic fatty liver disease ( NAFLD ) pathology in a single-armed clinical study and in experimental animal models .


In this study , we investigated the efficacy of ezetimibe on NAFLD pathology in an open-label randomised controlled clinical trial .


We had planned to enrol @ patients in the trial , as we had estimated that , with this sample size , the study would have @ % power .


The study intervention and enrolment were discontinued because of the higher proportion of adverse events ( significant elevation in HbA ( @c ) ) in the ezetimibe group than in the control group .


Thirty-two patients with NAFLD were enrolled and randomised ( allocation by computer program ) .


Ezetimibe ( @ mg/day ) was given to @ patients with NAFLD for @ months .


The primary endpoint was change in serum aminotransferase level .


Secondary outcomes were change in liver histology ( @ control and @ ezetimibe patients ) , insulin sensitivity including a hyperinsulinaemic-euglycaemic clamp study ( ten control and @ ezetimibe patients ) and hepatic fatty acid composition ( six control and nine ezetimibe patients ) .


Hepatic gene expression profiling was completed in @ patients using an Affymetrix gene chip .


Patients and the physician in charge knew to which group the patient had been allocated , but people carrying out measurements or examinations were blinded to group .


Serum total cholesterol was significantly decreased in the ezetimibe group .


The fibrosis stage and ballooning score were also significantly improved with ezetimibe treatment .


However , ezetimibe treatment significantly increased HbA@c and was associated with a significant increase in hepatic long-chain fatty acids .


Hepatic gene expression analysis showed coordinate downregulation of genes involved in skeletal muscle development and cell adhesion molecules in the ezetimibe treatment group , suggesting a suppression of stellate cell development into myofibroblasts .


Genes involved in the L-carnitine pathway were coordinately downregulated by ezetimibe treatment and those in the steroid metabolism pathway upregulated , suggestive of impaired oxidation of long-chain fatty acids .


Ezetimibe improved hepatic fibrosis but increased hepatic long-chain fatty acids and HbA@c in patients with NAFLD .


These findings shed light on previously unrecognised actions of ezetimibe that should be examined further in future studies .


To investigate whether the long term use of two dentifrices containing arginine , an insoluble calcium compound , and fluoride : ( @ ) @ % arginine and @ ppm F as sodium monofluorophosphate ( NaMFP ) in a dicalcium phosphate dihydrate ( dical ) base , and ( @ ) @ % arginine and @ ppm F as NaMFP in a calcium carbonate base , results in an increase in oral malodor potentially associated with increased ammonia production from breakdown of arginine , as compared to a commercially available fluoride dentifrice without arginine ( @ ppm F as NaMFP in a dical base ) , after @ months of product use .


A @-month clinical study , with @ subjects , was conducted in Chengdu , China , using a double blind , randomized , parallel , three-treatment design .


A panel of four expert judges used a nine-point hedonic scale to evaluate breath odor using a protocol designed in concordance with the ADA Acceptance Program Guidelines for Product Used in the Management of Oral Malodor .


After a baseline evaluation , study subjects who scored above the threshold value for unpleasant breath odor were stratified by score and randomized into one of three treatment groups .


Subjects were provided with a soft-bristled manual toothbrush ( Colgate Classic Clean Toothbrush ) and brushed their teeth thoroughly in their regular and customary manner for @ minute with their assigned dentifrice , twice daily .


Before breath-odor evaluations , the subjects refrained from eating odorigenic foods and did not use dental hygiene procedures , breath mints , or mouth rinses for @ hours and @ hours , respectively .


There was no statistically significant difference in oral malodor levels among subjects using the three dentifrices after @ , @ and @ months of product use .


Recurrence rates of actinic keratosis ( AK ) lesions after cryosurgery are high , and this treatment does not address field cancerization .


We investigated the efficacy and safety of field treatment of AKs with ingenol mebutate gel following cryosurgery .


In this phase @ , randomized , double-blind , vehicle-controlled study ( NCT@ ) , patients @ years with four to eight clinically typical , visible , discrete AKs within a contiguous @-cm@ treatment area on the face or scalp underwent cryosurgery followed @ weeks later by once-daily ingenol mebutate @ % or vehicle gel for @ consecutive days .


Endpoints included complete clearance at week @ and safety and efficacy over @ months .


In @ randomized patients , complete clearance rates were greater with ingenol mebutate than vehicle ( week @ : @ % vs @ % ; P = @ ; month @ : @ % vs @ % ; P = @ ) .


Fewer patients experienced the emergence of new lesions with ingenol mebutate than with vehicle ( @ % vs @ % ; P = @ ) .


At month @ , mean percentage reduction of AKs was higher with ingenol mebutate than with vehicle ( @ % vs @ % ; P = @ ) .


The probability of remaining free of lesions was sustained longer with ingenol mebutate compared with vehicle gel : @ % vs @ % at @ months ; @ % vs @ % at @ months ; @ % vs @ % at month @ , respectively .


Ingenol mebutate @ % gel was well tolerated and no unexpected adverse events occurred ; all adverse events resolved within @ weeks of starting treatment .


Field treatment with ingenol mebutate @ % gel following cryosurgery significantly enhanced clearance of baseline lesions , and was well tolerated .


Furthermore , ingenol mebutate @ % gel following cryosurgery reduced development of new lesions in the treated field .


Lecturing has been traditionally used as the core teaching strategy in university education in all disciplines .


However , new research in education suggests that other formats such as game teaching could be more effective .


To compare students ' performance , satisfaction and retention of knowledge between a Jeopardy! - style game format and a didactic lecture format in teaching the subject of models for organising patient care to fourth-year nursing students .


A parallel-group randomised controlled trial was conducted .


Participants were fourth-year nursing students who registered in the second semester of @-@ and enrolled in the Nursing Management and Ethics in Nursing Course in the Community Health Department .


@ students completed the study ( @ in the quiz game group and @ in the lecture group ) .


Pre-test results showed no significant difference between the two groups in their achievement scores .


However , in the immediate achievement post-test and the retention test the students in the quiz group scored significantly better than those in the lecture group .


A satisfaction questionnaire showed that the game format was well liked and accepted by students as a more satisfying teaching method .


This study is the first of its kind in Jordan to explore the effectiveness of this particular game format versus the lecture format .


RESULTS suggest that the game format was well liked and accepted by students as a more satisfying teaching method .


Additionally , it appeared to be a better method of education as it promoted greater information retention .


Obesity and stress are among the most common lifestyle-related health problems .


Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most .


Therefore , novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management .


This randomized controlled trial examines the effectiveness , applicability , and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress .


The offered interventions are based on cognitive behavioral approaches , and are designed for enhancing general well-being and supporting personalized lifestyle changes .


@ obese individuals reporting stress symptoms were recruited and randomized to either ( @ ) a minimal contact web-guided Cognitive Behavioral Therapy-based ( CBT ) intervention including an approach of health assessment and coaching methods , ( @ ) a mobile-guided intervention comprising of mindfulness , acceptance and value-based exercises , ( @ ) a face-to-face group intervention using mindfulness , acceptance and value-based approach , or ( @ ) a control group .


The participants were measured three times during the study ( pre = week @ , post = week @ , and follow-up = week @ ) .


Psychological well-being , lifestyles and habits , eating behaviors , and user experiences were measured using online surveys .


Laboratory measurements for physical well-being and general health were performed including e.g. liver function , thyroid glands , kidney function , blood lipids and glucose levels and body composition analysis .


In addition , a @-day ambulatory heart rate and @-day movement data were collected for analyzing stress , recovery , physical activity , and sleep patterns .


Food intake data were collected with a @ - hour diet recall interview via telephone .


Differences in the effects of the interventions would be examined using multiple-group modeling techniques , and effect-size calculations .


This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms .


The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value-based brief group intervention .


Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions .


Understanding the intracellular mechanisms induced by remote ischemic preconditioning ( RIPC ) in the human left ventricle opens new possibilities for development of pharmacological cardioprotection against ischemia and reperfusion injury .


In this study we investigated the effects of RIPC on mitochondrial function , activation of pro-survival protein kinase Akt and microRNA expression in left ventricular biopsies from patients undergoing coronary artery bypass surgery ( CABG ) .


Sixty patients were randomized to control ( n = @ ) or RIPC ( n = @ ) .


A blood pressure cuff was applied to the arm of all patients preoperatively .


The cuff remained deflated in control group , whereas RIPC was performed by @ cycles of cuff inflation to @ mm Hg for @ min , separated by @ min deflation intervals .


Left ventricular biopsies were obtained before and @ min after aortic declamping .


The primary outcome was mitochondrial respiration measured in situ .


Secondary outcomes were activation of protein kinase Akt , assessed by western immunoblotting , and expression of microRNAs assessed by array and real-time polymerase chain reaction .


Mitochondrial respiration was preserved during surgery in patients receiving RIPC ( +@ mol O@/min/g , p = @ ) , and reduced by @ % in controls ( -@ mol O@/min/g , p = @ ) .


Furthermore , RIPC activated protein kinase Akt before aortic clamping ( difference from control +@ % , p = @ ) , followed by increased phosphorylation of Akt substrates at reperfusion ( +@ % , p < @ ) .


No differences were observed in microRNA expression .


RIPC preserves mitochondrial function and activates pro-survival protein kinase Akt in left ventricle of patients undergoing CABG .


Modulation of mitochondrial function and Akt activation should be further explored as cardioprotective drug targets .


In the management of attention-deficit hyperactivity disorder ( ADHD ) in adults it is important to recognize that individual patients respond to a wide range of methylphenidate doses .


Studies with methylphenidate modified release long acting ( MPH-LA ) in children have reported the need for treatment optimization for improved outcomes .


We report the results from a post hoc analysis of a @-week dose optimization phase from a large randomized , placebo-controlled , multicenter @-week study ( @-week double-blind dose confirmation phase , @-week open-label dose optimization phase , and @-week double-blind maintenance of effect phase ) .


Patients entering the open-label dose optimization phase initiated treatment with MPH-LA @ mg/day ; up/down titrated to their optimal dose ( at which there was balance between control of symptoms and side effects ) of @ , @ , or @ mg/day in increments of @ mg/week by week @ or @ .


Safety was assessed by monitoring the adverse events ( AEs ) and serious AEs .


Efficacy was assessed by the Diagnostic and Statistical Manual of Mental Disorders , fourth edition , Attention-Deficit Hyperactivity Disorder Rating Scale ( DSM-IV ADHD RS ) and Sheehan Disability Scale ( SDS ) total scores .


At the end of the dose confirmation phase , similar numbers of patients were treated optimally with each of the @ , @ , and @ mg/day doses ( @ , @ , and @ , respectively ) for MPH-LA .


Mean improvement from baseline in the dose confirmation phase in total scores of DSM-IV ADHD RS and SDS were @ @ and @ @ , respectively .


Dose optimization with MPH-LA ( @ , @ , or @ mg/day ) improved treatment outcomes and was well-tolerated in adult ADHD patients .


The aim of this study was to compare the efficacy of combined intracervical Foley catheter and low-dose vaginal misoprostol with low-dose vaginal misoprostol alone for induction of labor .


This prospective non-blinded randomized controlled trial was conducted over a @-year period in @ pregnant women planned for induction of labor at a tertiary care centre .


Women at @ gestational weeks with a singleton fetus in cephalic presentation , intact membranes and a Bishop score of @ were randomized for labor induction with either a combination of Foley catheter and misoprostol or only misoprostol .


The primary outcome variable was the induction-to-delivery interval between the two groups .


The secondary outcome variables included rate of vaginal deliveries , uterine hyperstimulation , cesarean section rate , Apgar scores at @ and @ min , neonatal intensive care unit admissions and chorioamnionitis .


The mean induction-to-delivery interval and rate of vaginal deliveries were not significantly different between the groups ( @ h in the combination group and @ h in the misoprostol group , P = @ ; @ % and @ % , respectively , P = @ ) .


Uterine hyperstimulation and meconium-stained liquor were significantly more prevalent in the misoprostol group ( P = @ ) .


Neonatal outcomes did not differ significantly between the groups .


The addition of Foley catheter to misoprostol did not cause any statistically significant benefit in reducing the induction-to-delivery time .


However , it reduced the incidence of uterine hyperstimulation and meconium-stained liquor .


The aim of this study was to investigate clinical efficacy and safety of Remifemin on peri-menopausal symptoms in endometriosis patients with a post-operative GnRH-a therapy .


We treated @ women who had endometriosis with either Remifemin ( n = @ ) @ mg bid po or Tibolone ( n = @ ) @ mg qd po for @ weeks after GnRH-a injection .


The efficacy was evaluated by Kupperman menopausal index ( KMI ) , and hot flash/sweating scores .


The safety parameters such as liver and renal functions , lipid profile , endometrial thickness , and serum sex hormone level , as well as the incidence of adverse events were recorded .


( @ ) After GnRH-a therapy , KMI and hot flash/sweating scores in both groups increased significantly ( P < @ ) but we found no significant difference for KMI ( @ for Remifemin and @ for Tibolone ) and hot flash/sweating scores ( @ for Remifemin and @ for Tibolone ) between the @ groups ( P > @ ) .


( @ ) No statistical change was observed in liver or renal functions and lipid profile in both groups before and after the treatment ( P > @ ) .


The post-therapeutic serum FSH , LH , and E@ level and endometrial thickness decreased remarkably in both groups ( P < @ ) .


E@ level in the Remifemin group was obviously lower than that in the Tibolone group ( P < @ ) , and FSH and LH levels were strongly higher ( P < @ ) .


No significant difference in thickness were found in either group ( P > @ ) .


The Remifemin group had far fewer adverse events than the Tibolone group ( P < @ ) .


Compared with Tibolone , Remifemin had a similar clinical efficacy and was safer for the peri-menopausal symptoms induced by GnRH-a in endometriosis patients .


To assess the dose proportionality of azacitidine pharmacokinetics ( PK ) after single subcutaneous ( SC ) doses of @-@ mg/m@ , and determine the effect of renal impairment on PK after single and multiple @ mg/m@ SC azacitidine doses .


Multicenter , phase I , open-label , parallel group study .


Community clinics and major academic centers .


Twenty-seven patients with solid or hematologic malignancies .


Part @ evaluated azacitidine dose proportionality in patients with normal renal function randomized to single @ , @ , @ , or @ mg/m@ SC doses .


The @ mg/m@ dosing group received @ additional days of SC azacitidine .


In Part @ , patients with severe renal impairment ( creatinine clearance < @ ml/min/@ @ m@ Cockcroft-Gault adjusted ) received azacitidine @ mg/m@ for @ consecutive days .


PK parameters were determined using noncompartmental methods .


In patients with normal renal function ( n = @ ) , azacitidine area under the plasma-time curve ( AUC@ - ) and maximum observed plasma concentration ( Cmax ) were dose proportional within the @-@ mg/m@ range .


Concentration versus time profiles after single and multiple azacitidine @ mg/m@ doses were similar in shape for patients with normal ( n = @ ) or impaired renal function ( n = @ ) , with higher mean concentrations in the latter group .


Higher mean exposures ( AUC@ - and Cmax ) in renally impaired patients were observed ; however , individual exposure values were , with few exceptions , within the same range in both groups .


No drug accumulation after multiple doses was observed in either group .


Terminal half-life and time to maximum plasma concentration were comparable between groups .


Azacitidine tolerability was similar in patients with normal or impaired renal function .


Azacitidine is dose proportional over the @-@ mg/m@ dosing range .


Overall , renal impairment had no important effect on azacitidine PK .


Therefore , no initial azacitidine dose adjustment in patients with renal impairment is required .


The purpose of this study was to determine ( a ) whether among sober ( blood alcohol concentration -LSB- BAC -RSB- = @ % ) drivers , being drug positive increases the drivers ' risk of being killed in a fatal crash ; ( b ) whether among drinking ( BAC > @ % ) drivers , being drug positive increases the drivers ' risk of being killed in a fatal crash ; and ( c ) whether alcohol and other drugs interact in increasing crash risk .


We compared BACs for the @ , @ , and @ crash cases drawn from the U.S. Fatality Analysis Reporting System ( FARS ) with control drug and blood alcohol data from participants in the @ U.S. National Roadside Survey .


Only FARS drivers from states with drug information on @ % or more of the drivers who also participated in the @ National Roadside Survey were selected .


For both sober and drinking drivers , being positive for a drug was found to increase the risk of being fatally injured .


When the drug-positive variable was separated into marijuana and other drugs , only the latter was found to contribute significantly to crash risk .


In all cases , the contribution of drugs other than alcohol to crash risk was significantly lower than that produced by alcohol .


Although overall , drugs contribute to crash risk regardless of the presence of alcohol , such a contribution is much lower than that by alcohol .


The lower contribution of drugs other than alcohol to crash risk relative to that of alcohol suggests caution in focusing too much on drugged driving , potentially diverting scarce resources from curbing drunk driving .


Patients with head and neck cancer undergoing surgery have a high occurrence of postoperative complications .


The aim of our study was to investigate whether postoperative nutrition of head and neck cancer patients , using an enhanced enteral formula with three different doses of arginine could improve nutritional variables as well as clinical outcome , depending of arginine dose .


A population of @ patients with oral and laryngeal cancer was enrolled .


At surgery patients were randomly assigned to three different treatment groups , each one containing at less @ patients .


Group I ( @ patients ) received an enteral diet supplements with a low physiological dose of arginine ( @ g per day ) , group II ( @ patients ) received an isocaloric , isonitrogenous enteral formula with a medium dose of arginine ( @ g per day ) and group III ( @ patients ) received an isocaloric , isonitrogenous enteral formula with a high dose of arginine ( @ g per day ) .


The length of postoperative stay had a trend to be better with high dose of arginine received ( @ @ days in group I vs @ @ days in group II vs @ @ days in group III : p = @ ) .


No differences were detected in postoperative infections complications and diarrhea .


Fistula was less frequent in groups II and III than I ( @ % group I vs @ % group II vs @ % group III : p = @ ) , The length of postoperative stay had a trend to be better with high dose of arginine received ( @ @ days in group I vs @ @ days in group II vs @ @ days in group III : p = @ ) .


Our results suggest that these patients could benefit from a high dose of arginine enhanced enteral formula to decrease length of hospital stay and fistula wound complications .


Changes in adolescent interpersonal behavior before and after an acute course of psychotherapy were investigated as outcomes and mediators of remission status in a previously described treatment study of depressed adolescents .


Maternal depressive symptoms were examined as moderators of the association between psychotherapy condition and changes in adolescents ' interpersonal behavior .


Adolescents ( n = @ , mean age = @ years , @ % female , @ % White ) engaged in videotaped interactions with their mothers before randomization to cognitive behavior therapy ( CBT ) , systemic behavior family therapy ( SBFT ) , or nondirective supportive therapy ( NST ) and after @-@ weeks of treatment .


Adolescent involvement , problem solving , and dyadic conflict were examined .


Improvements in adolescent problem solving were significantly associated with CBT and SBFT .


Maternal depressive symptoms moderated the effect of CBT , but not SBFT , on adolescents ' problem solving ; adolescents experienced increases in problem solving only when their mothers had low or moderate levels of depressive symptoms .


Improvements in adolescents ' problem solving were associated with higher rates of remission across treatment conditions , but there were no significant indirect effects of SBFT on remission status through problem solving .


Exploratory analyses revealed a significant indirect effect of CBT on remission status through changes in adolescent problem solving , but only when maternal depressive symptoms at study entry were low .


Findings provide preliminary support for problem solving as an active treatment component of structured psychotherapies for depressed adolescents and suggest one pathway by which maternal depression may disrupt treatment efficacy for depressed adolescents treated with CBT .


A high prevalence of low back pain has persisted over the years despite extensive primary prevention initiatives among nurses ' aides .


Many single-faceted interventions addressing just one aspect of low back pain have been carried out at workplaces , but with low success rate .


This may be due to the multi-factorial origin of low back pain .


Participatory ergonomics , cognitive behavioral training and physical training have previously shown promising effects on prevention and rehabilitation of low back pain .


Therefore , the main aim of this study is to examine whether a multi-faceted workplace intervention consisting of participatory ergonomics , physical training and cognitive behavioral training can prevent low back pain and its consequences among nurses ' aides .


External resources for the participating workplace and a strong commitment from the management and the organization support the intervention .


To overcome implementation barriers within usual randomized controlled trial designed workplace interventions , this study uses a stepped-wedge cluster-randomized controlled trial design with @ groups .


The intervention is delivered to the groups at random along four successive time periods three months apart .


The intervention lasts three months and integrates participatory ergonomics , physical training and cognitive behavioral training tailored to the target group .


Local physiotherapists and occupational therapists conduct the intervention after having received standardized training .


Primary outcomes are low back pain and its consequences measured monthly by text messages up to three months after initiation of the intervention .


Intervention effectiveness trials for preventing low back pain and its consequences in workplaces with physically demanding work are few , primarily single-faceted , with strict adherence to a traditional randomized controlled trial design that may hamper implementation and compliance , and have mostly been unsuccessful .


By using a stepped wedge design , and obtain high management commitment and support we intend to improve implementation and aim to establish the effectiveness of a multi-faceted intervention to prevent low back pain .


This study will potentially provide knowledge of prevention of low back pain and its consequences among nurses ' aides .


Results are expected to be published in @-@ .


Evidence is accumulating that , similar to other ventral hernias , umbilical and epigastric hernias must be mesh repaired .


The difficulties involved in mesh placement and in mesh-related complications could be the reason many small abdominal hernias are still primary closed .


In laparoscopic repair , a mesh is placed intraperitoneally , while the most common procedure is open surgery is pre-peritoneal mesh placement .


A recently developed alternative method is the so-called patch repair , in this approach a mesh can be placed intraperitoneally through open surgery .


In theory , such patches are particularly suitable for small hernias due to a reduction in the required dissection .


This simple procedure is described in several studies .


It is still unclear whether this new approach is associated with an equal risk of recurrence and complications compared with pre-peritoneal meshes .


The material of the patch is in direct contact with intra-abdominal organs , it is unknown if this leads to more complications .


On the other hand , the smaller dissection in the pre-peritoneal plane may lead to a reduction in wound complications .


@ patients suffering from an umbilical or epigastric hernia will be included in a multi-centre patient-blinded trial , comparing mesh repair with patch repair .


Randomisation will take place for the two operation techniques .


The two devices investigated are a flat pre-peritoneal mesh and a Proceed Ventral Patch .


Stratification will occur per centre .


Post-operative evaluation will take place after @ , @ , @ and @ months .


The number of complications requiring treatment is the primary endpoint .


Secondary endpoints are Verbal Descriptor Scale ( VDS ) pain score and VDS cosmetic score , operation duration , recurrence and costs .


An intention to treat analysis will be performed .


This trial is one of the first in its kind , to compare different mesh devices in a randomized controlled setting .


The results will help to evaluate mesh repair for epigastric an umbilical hernia , and find a surgical method that minimizes the complication rate .


The aim of this study was to map the sensitivity of the marginal and other conjunctival regions and to investigate changes in the sensitivity of these regions when determined in the morning and evening .


Thirty-five healthy , noncontact lens wearers ( @ female , @ male ; age @ @ years ) were enrolled .


Mechanical sensitivity was measured at @ locations on the ocular surface and adnexa ( cornea , marginal , bulbar , and tarsal conjunctiva ) using a Cochet-Bonnet esthesiometer ( @-mm diameter filament ) .


A subgroup of @ subjects ( @ female , @ male ; age @ @ years ) returned after @ hours when this protocol was repeated .


The cornea was found to be the most sensitive region ( all P < @ ) .


The marginal conjunctiva showed greater sensitivity than did the bulbar and tarsal conjunctiva ( all P < @ ) .


The temporal marginal conjunctiva was more sensitive than the central marginal conjunctiva ( all P < @ ) .


No difference in marginal conjunctival sensitivity was found between upper and lower eyelids ( all P > @ ) .


The upper tarsal conjunctiva was more sensitive than the lower tarsal conjunctiva ( P = @ ) .


There was no significant difference in the sensitivity determined in the morning and the evening for any of the locations investigated ( Bonferroni adjusted , P > @ ) .


This work has demonstrated that the marginal conjunctiva was the most sensitive of all the conjunctival regions and that this does not alter over the course of the day .


To compare @ weeks of supervised physical rehabilitation with or without progressive strength training ( PST ) commenced early after fast-track total knee arthroplasty ( TKA ) on functional performance .


In total , @ patients with a unilateral primary TKA were randomized to @ different interventions : @ weeks of supervised physical rehabilitation with PST ( PST group ) and without PST ( CON group ) commenced early after fast-track TKA .


The primary outcome was the maximal distance walked in @ minutes ( @-minute walk test ) .


Secondary outcomes were lower extremity strength and power , knee joint effusion and range of motion , knee pain , and self-reported disability and quality of life .


All outcome measures were assessed before TKA ( baseline ) and @ , @ , and @ weeks after TKA .


There was no statistically significant difference between the PST and CON groups in the change score from baseline to the @-week postoperative assessment ( primary end point ) for the @-minute walk test with unadjusted baseline scores ( mean difference between groups : -@ meters -LSB- @ % confidence interval -@ , @ -RSB- ; analysis of variance P = @ ) .


There were no statistically significant or clinically meaningful differences between groups in change scores from baseline to any other time point for all secondary outcomes .


The secondary outcome knee extension strength did not reach the level recorded before surgery in both groups .


Seven weeks of supervised physical rehabilitation with PST was not superior to @ weeks of supervised physical rehabilitation without PST in improving functional performance , measured as the maximal walking distance in @ minutes , at the primary end point @ weeks after fast-track TKA .


Effective interventions to improve medication adherence are usually complex and expensive .


To assess the impact of a low-cost intervention designed to improve medication adherence and clinical outcomes in post-discharge patients with CVD .


A pilot RCT was conducted at a teaching hospital .


Intervention was based on the four-item Morisky Medication Adherence Scale ( MMAS-@ ) .


The primary outcome measure was medication adherence assessed using the eight-item MMAS at baseline , at @ month post hospital discharge and re-assessed @ year after hospital discharge .


Other outcomes included readmission and mortality rates .


@ patients were randomized to intervention ( n = @ ) and control ( n = @ ) groups .


The mean age of the patients was @ years ( SD @ ) , @ % were males , and @ % were married or living with a partner .


Mean number of prescribed medications per patient was @ ( SD @ ) .


Medication adherence was correlated to intervention ( p = @ ) and after @ month , @ % of patients in the control group and @ % in the intervention group were considered adherent .


However , this difference decreased after @ year , when adherence was @ % and @ % , respectively .


Readmission and mortality rates were related to low adherence in both groups .


The intervention based on a validated patient self-report instrument for assessing adherence is a potentially effective method to improve adherent behavior and can be successfully used as a tool to guide adherence counseling in the clinical visit .


However , a larger study is required to assess the real impact of intervention on these outcomes .


This study investigated the clinical efficacy of electroacupuncture ( EA ) in inhibiting upper-extremity spasticity in chronic stroke patients , and also in mapping a unique preliminary acupoint-selection protocol .


Fifteen patients were divided into two groups : patients in the control group ( n = @ ) received minimal acupuncture ( MA ) , and those in the experimental group ( n = @ ) received EA .


Four acupoints , which include Neiguan ( PC@ ) , Shaohai ( HT@ ) , Zeqian ( Ex-UE , A@ ) , and Shounizhu ( EX-UE ) , were treated near the motor points of the muscles for elbow flexion , forearm pronation , and finger flexion .


Both groups were treated for twelve sessions , @ minutes per session , for @ weeks ( two sessions per week ) .


The outcome measures in this study included angle of muscle reaction ( R@ ) , passive range of motion ( R@ ) , and dynamic component ( R@-R@ ) .


In the experimental group , the R@-R@ of the elbow joint was significantly decreased at @ ( P = @ ) , @ ( P = @ ) , and @ weeks ( P = @ ) after treatment compared with pretreatment levels ( P < @ ) .


The between-group difference in the R@-R@ of the elbow joint after the @-week treatment was statistically significant .


Combining the @-week EA and standard rehabilitation treatment reduced the spasticity of the elbow for chronic stroke survivors .


However , no significant effect was observed in the spasticity of the wrist joints .


The choice of acupoints and the frequency of EA have to be taken into account to achieve a positive treatment effect .


The correlation between acupoints and motor points provides a model of acupoint selection to improve spasticity .


The goal of this study is to determine whether bronchodilator ( BD ) response can be used as a reliable measure of asthma control by analyzing the effects of a short course of oral corticosteroids ( OC ) or placebo ( P ) on spirometry , sputum cytology and BD response in controlled asthma patients scoring less than @ on the ACQ@ .


Seventy patients with moderate to severe asthma who were undergoing combination therapy and were considered to be controlled based on ACQ@ scores , but who exhibited persistent positive BD response , were randomly assigned to two groups , one receiving OC and the other P. Patients were evaluated before and after @ weeks of treatment .


Intervention response ( comparison of FEV ( @ ) before and after OC or P treatment ) was used as a measure of intervention efficacy , with values equal to or greater than @mL considered positive .


Patients who received OC showed significant improvement in FEV ( @ ) , and no longer exhibited a positive BD response .


Those in the P group showed no change .


In addition , sputum eosinophil counts significantly decreased in the OC group .


BD response can be used as a reliable measure of asthma control .


This study suggests that ACQ@ scores alone are not sufficient to fully assess asthma control , and that BD response should be included as an essential measurement in any algorithm of asthma control evaluation .


Previous research has demonstrated significant relationships between peri-shock pause and survival to discharge from out-of-hospital shockable cardiac arrest ( OHCA ) .


To determine the impact of peri-shock pause on survival from OHCA during the ROC PRIMED randomized controlled trial .


We included patients in the ROC PRIMED trial who suffered OHCA between June @ and November @ , presented with a shockable rhythm and had CPR process data for at least one shock .


We used multivariable logistic regression to determine the association between peri-shock pause duration and survival to hospital discharge .


Among @ patients studied , the median ( IQR ) shock pause duration was : pre-shock pause @s ( @ , @ ) ; post-shock pause @s ( @ , @ ) ; and peri-shock pause @ s ( @ , @ ) .


After adjusting for Utstein predictors of survival as well as CPR quality measures , the odds of survival to hospital discharge were significantly higher for patients with pre-shock pause < @s ( OR : @ , @ % CI : @ , @ ) and peri-shock pause < @s ( OR : @ , @ % CI : @ , @ ) when compared to patients with pre-shock pause @s and peri-shock pause @s .


Post-shock pause was not significantly associated with survival to hospital discharge .


Results for neurologically intact survival ( Modified Rankin Score @ ) were similar to our primary outcome .


In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial , shorter pre - and peri-shock pauses were significantly associated with higher odds of survival .


Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses .


In this study we assessed increased cortisol in Alzheimer 's disease ( AD ) patients .


The selective @ -- hydroxysteroid dehydrogenase type @ ( HSD-@ ) inhibitor ABT-@ blocked regeneration of active cortisol and this tests the hypothesis that intracellular hypercortisolism contributes to cognitive impairment .


In this double-blind , placebo - and active-controlled phase II study we examine the efficacy and safety of ABT-@ given @ mg or @ mg once daily , donepezil @ mg once daily , or placebo for @ weeks in subjects with mild-to-moderate AD .


The primary efficacy end point was the change from baseline to final evaluation on the @-item Alzheimer 's Disease Assessment Scale-Cognitive subscale ( ADAS-Cog ) total score .


The study was terminated for futility after randomization of @ subjects .


ABT-@ did not improve ADAS-Cog scores or any secondary end point ; however , donepezil significantly improved both cognition and functional end points .


Overall incidence of adverse events was similar among treatment groups .


ABT-@ , when tested at doses associated with complete brain HSD-@ inhibition , did not produce symptomatic improvement in AD .


Medical health care centres should aim at the application of a two-dimensional concept of quality -- technical quality and functional quality .


Technical quality means the compliance with norms and technical requirements which apply to medical services that are provided to patients .


This concerns medical standards , technology and the competence of medical staff .


Functional quality , which means the subjective estimate of patients , is an additional benefit for the patient and it becomes the best competitive advantage in conditions of comparable technical levels of provided medical services .


The patient will be satisfied with medical services if these elements are balanced .


The aim of the study was the evaluation of the quality of functional services in a specialist outpatient clinic in the Szczecin area by patients .


@ randomly-chosen patients of specialist outpatient clinics in Szczecin were asked to estimate the functional quality of services in specialist outpatient clinics .


A questionnaire was used .


The results were subjected to statistical analysis .


Most of the patients -- @ % had confidence in their physician .


@ % of the patients claimed that their doctor was not interested in their problems .


Almost half of the respondents -- @ % stated that there was no telephone contact with their doctor .


It is necessary to educate future physicians in problems of interpersonal communication .


Phase @ randomized trials have shown that maintenance rituximab ( MR ) therapy or radioimmunotherapy ( RIT ) consolidation following frontline therapy can improve progression-free survival for patients with follicular lymphoma ( FL ) , but the cost-effectiveness of these approaches with respect to observation has not been examined using a common modeling framework .


To evaluate and compare the economic impact of MR and RIT consolidation versus observation , respectively , following the first-line induction therapy for patients with advanced-stage FL .


We developed Markov models to estimate patients ' lifetime costs , quality-adjusted life-years ( QALYs ) , and life-years ( LYs ) after MR , RIT , and observation following frontline FL treatment from the US payer 's perspective .


Progression risks , adverse event probabilities , costs , and utilities were estimated from clinical data of Primary RItuximab and MAintenance ( PRIMA ) trial , Eastern Cooperative Oncology Group ( ECOG ) trial ( for MR ) , and First-line Indolent Trial ( for RIT ) and the published literature .


We evaluated the incremental cost-effectiveness ratio for direct comparisons between MR/RIT and observation .


Model robustness was addressed by one-way and probabilistic sensitivity analyses .


Compared with observation , MR provided an additional @ QALYs ( @ LYs ) and @ QALYs ( @ LYs ) on the basis of the PRIMA trial and the ECOG trial , respectively , and RIT provided an additional @ QALYs ( @ LYs ) .


The incremental cost per QALY gained was $ @,@ ( PRIMA ) or $ @,@ ( ECOG ) for MR and $ @,@ for RIT .


MR and RIT had comparable incremental QALYs before first progression , whereas RIT had higher incremental costs of adverse events due to higher incidences of cytopenias .


MR and RIT following frontline FL therapy demonstrated favorable and similar cost-effectiveness profiles .


The model results should be interpreted within the specific clinical settings of each trial .


Selection of MR , RIT , or observation should be based on patient characteristics and expected trade-offs for these alternatives .


To evaluate the effectiveness of a topically applied gel containing essential oils ( menthol and thymol ) and polyphenolic antioxidants ( phloretin and ferulic acid ) for reducing halitosis in dogs .


@ dogs .


A blinded crossover clinical trial was conducted .


Dogs received a dental cleaning and examination ( periodontal examination including periodontal probing and assessments of plaque , calculus , and gingivitis ) .


Owners then applied a gel ( active or placebo ) to oral soft tissues twice daily for a @-week period .


Teeth of the dogs were cleaned again , and owners applied the other gel for a @-week period .


Clinicians scored halitosis immediately after the initial cleaning and at @ and @ weeks , and owners scored halitosis weekly .


Halitosis assessment by clinicians revealed that both groups had improvement in halitosis scores .


Two dogs were removed because of owner noncompliance .


In the active-to-placebo group ( n = @ ) , halitosis was significantly reduced during application of the active gel but increased during application of the placebo .


Seven of @ owners reported increased halitosis when treatment was changed from the active gel to the placebo .


In the placebo-to-active group ( n = @ ) , halitosis decreased during application of the placebo and continued to decrease during application of the active gel .


Seven of @ owners reported a decrease in halitosis with the active gel .


An oral topically applied gel with essential oils and polyphenolic antioxidants applied daily after an initial professional dental cleaning decreased oral malodor in dogs .


The SNAP ( Smoking and Nicotine in Pregnancy ) trial compared nicotine replacement therapy ( NRT ) patches with placebo in pregnant smokers ; although NRT doubled cessation rates in the first @ weeks , by delivery no differences in maternal smoking or birth outcomes were noted .


As a result , NRT used in standard doses during pregnancy is considered ineffective for smoking cessation .


Subsequent effects of NRT on the children of treated mothers are unknown because no trials have investigated the effect of gestational NRT use beyond birth .


To assess whether NRT use in pregnancy might cause harm to infants , we aimed to compare effects of NRT and placebo on infant development @ years after delivery .


@ pregnant smokers aged @-@ years , at @-@ weeks ' gestation , and smoking at least five cigarettes per day were recruited from seven hospitals in England between May @ , @ , and Feb @ , @ , and followed up until their infants were @ years old .


Participants were randomly assigned ( @:@ ) to receive up to @-weeks treatment with NRT ( @ mg/@ h transdermal patches ) or identically packaged and visually matched placebo patches ( all patches manufactured by and purchased at market rate from United Pharmaceuticals , Amman , Jordan ) , issued as two @-week supplies ( @ for NRT group , @ for placebo group ) -LSB- Corrected -RSB- .


Randomisation was stratified by site with participants , health-care professionals , and research staff masked to treatment allocation .


The primary results for participants and infants at delivery were published in @ ; we present results from the trial cohort @ years after birth .


After delivery , questionnaires were posted to participants and , if there was no response , to family physicians .


The primary outcome at @ years was infants ' survival without developmental impairment ( ie , no disability or problems with behaviour or development ) .


Treatment groups were compared on an intention-to-treat basis .


The trial is registered with Controlled-Trials .


com , number ISRCTN@ .


Questionnaires were returned at @ years for @ ( @ % ) of @ live singleton births ( @ of ( @ % ) @ given NRT and @ ( @ % ) of @ given placebo ) .


Because of missing data , developmental outcomes , including four infant deaths , were documented for @ of ( @ % ) @ singleton infants ; @ ( @ % ) of @ infants in NRT group and @ ( @ % ) of @ infants in placebo .


In the NRT group , @ ( @ % ) of @ infants had no impairment compared with @ ( @ % ) of @ infants in the placebo group ( odds ratio -LSB- OR -RSB- @ , @ % CI @-@ @ , p = @ ) .


At @ years , @ ( @ % ) of @ mothers in the NRT group and nine ( @ % ) of @ mothers in the placebo groups self-reported prolonged smoking abstinence since a quit date set in pregnancy ( OR @ , @ % CI @-@ @ , p = @ ) .


Adverse events were not collected after delivery , but previously reported adverse pregnancy and birth outcomes were similar in the two groups .


Infants born to women who used NRT for smoking cessation in pregnancy were more likely to have unimpaired development .


NRT had no effect on prolonged abstinence from smoking but did cause a temporary doubling of smoking cessation shortly after randomisation during pregnancy , which could explain findings .


If findings are confirmed by subsequent research , this has potential implications for the management of smoking in pregnancy .


Isotretinoin has been used in combination with oral psoralen + UVA ( PUVA ) and narrowband UVB ( NBUVB ) for treating psoriasis , especially in women of child-bearing age .


The efficacy of oral psoralen + sun exposure ( PUVAsol ) is comparable to that of PUVA .


This study was planned to compare the efficacy of oral PUVAsol with that of the combination of oral isotretinoin and PUVAsol in patients with chronic plaque psoriasis .


Forty patients with psoriasis vulgaris were randomized to two groups .


Group A ( control group ) received PUVAsol only .


Group B ( intervention group ) received PUVAsol + isotretinoin ( @ mg/kg/day ) .


Psoriasis Area Severity Index ( PASI ) score was recorded at baseline and weeks @ , @ and @ .


Dermatology Life Quality Index was assessed at baseline and @ weeks .


The end point of the study was PASI @ or @ weeks , whichever came earlier .


Thirty-five patients completed the study .


There were statistically significant differences between the two study groups for the number of patients achieving the endpoint of PASI @ , PASI scores at the end of @ weeks , mean duration to achieve PASI @ , number of PUVAsol sessions needed to achieve PASI@ and mean cumulative dosage of @-methoxypsoralen needed to achieve PASI @ .


The combination of isotretinoin with PUVAsol is more effective compared with PUVAsol alone for treating chronic plaque psoriasis .


Leisure-time physical activity ( LTPA ) and exercise training are essential parts of current guidelines for patients with coronary artery disease ( CAD ) .


However , the contributions of LTPA and exercise training to cardiovascular ( CV ) risk in CAD patients with type @ diabetes ( T@D ) are not well established .


We examined the effects of LTPA ( n = @ and n = @ ; with and without T@D , respectively ) and @-year controlled , home-based exercise training ( n = @ plus @ control subjects with T@D and n = @ plus @ control subjects without T@D ) on the CV risk profile and composite end point among CAD patients .


During the @-year follow-up , patients with reduced LTPA at baseline had an increased risk of CV events ( adjusted hazard ratio @ -LSB- @ % CI @-@ @ ; P = @ -RSB- , @ -LSB- @-@ @ ; P = @ -RSB- , and @ -LSB- @-@ @ ; P = @ -RSB- for no LTPA , LTPA irregularly , and LTPA two to three times weekly , respectively ) compared with those with LTPA more than three times weekly .


Among patients who completed the @-year exercise intervention , exercise training resulted in favorable changes in exercise capacity both in CAD patients with T@D ( +@ @ vs. -@ @ MET , P = @ ) and without T@D ( +@ @ vs. -@ @ MET , P = @ ) as compared with the control group but did not have any significant effects on major metabolic or autonomic nervous system risk factors in CAD patients with or without T@D .


There is an inverse association between habitual LTPA and short-term CV outcome , but controlled , home-based exercise training has only minor effects on the CV risk profile in CAD patients with T@D .


Eating difficulty is a critical and common problem in head and neck cancer patients undergoing radiotherapy ( RT ) .


It leads to poor quality of life and extensive tube feeding use .


Nutri-jelly , a food gel with semisolid texture , water-releasing ability , and ready-to-eat by spoon , was recently developed to alleviate the trouble .


However , its efficacy was unknown .


This study investigated the potential effect of Nutri-jelly on health-related quality of life ( HRQOL ) and nasogastric tube feeding use .


A prospective quasi-randomized patients-preference controlled trial was conducted in @ head and neck cancer patients .


Subjects in study and control groups ( @ each ) had similar baseline HRQOL and body mass index and undergone definitive radiotherapy ( @-@ RT fractions , @,@-@ ,@ cGy ) .


Only study group received a @-ml box of Nutri-jelly as daily supplement throughout radiotherapy .


HRQOL was scored by validated questionnaires .


The use of tube feeding was collected from medical records .


From @ to @ RT fractions , the study group maintained higher overall HRQOL score than that of control group ( p < @ ) .


Multiple physiologic and psychological aspects of HRQOL especially swallowing difficulty and overall eating problems were significantly improved in study as compared to control group .


Promisingly , the percentage of tube feeding use in study group ( @ % ) was dramatically lower than control group ( @ % ) .


Continuous supplementation of Nutri-jelly throughout radiotherapy may improve HRQOL and reduce tube feeding demand in head and neck cancer patients who preferred to take them .


Nutri-jelly could be an alternative for head and neck cancer patients who have eating difficulty during radiotherapy .


To perform the first randomized controlled trial comparing soft contact lens ( SCL ) with rigid gas-permeable lens ( RGPL ) wearing in infantile nystagmus ( IN ) , using spectacle wear as a baseline .


Randomized , controlled cross-over trial with an intention-to-treat design .


A total of @ participants with IN ( @ idiopathic , @ with albinism ) .


Participants were randomized into @ of @ treatment arms receiving the following sequence of treatments ( @-@ weeks for each treatment ) : ( A ) spectacles , SCL , RGPL , and spectacle wear ; or ( B ) spectacles , RGPL , SCL , and spectacle wear .


The main outcome measure was mean intensity of nystagmus at the null region viewing at @ m. Secondary outcome measures included the same measure at @ m viewing and across the horizontal meridian ( measured over a @ range at @ intervals ) for distance and near .


The nystagmus foveation characteristics were similarly assessed over @ and at the null region at @ m and @ m viewing .


Visual outcome measures included best-corrected visual acuity ( BCVA ) at @ m and @ m , gaze-dependent visual acuity ( GDVA ) ( i.e. , visual acuity when maintaining gaze angles over a @ range at @ intervals ) at @ m , and reading performance at @ m derived from the Radner reading chart .


There were no significant differences between SCL and RGPL wearing for any nystagmus characteristics or compared with spectacle wearing .


The BCVA , reading acuity , and critical print size were significantly worse for SCL wearing compared with RGPL and baseline spectacle wear ( P < @ ) , although mean differences were less than @ logarithm of the minimum angle of resolution ( logMAR ) line .


Nystagmus was not significantly different during SCL and RGPL wearing in IN , and contact lens wearing does not significantly reduce nystagmus compared with baseline spectacle wearing .


The wearing of SCL leads to a small but statistically significant deterioration in visual function compared with both RGPL and spectacle wearing at baseline , although mean effect sizes were not clinically relevant .


The value of qigong in the treatment of chronic low back pain is unclear .


In a randomized controlled trial , we evaluated whether qigong is non-inferior to exercise therapy in patients with chronic low back pain .


German outpatients ( aged @ ) with chronic low back pain -LSB- mean visual analogue scale ( VAS ) , @ mm -RSB- were enrolled and randomly allocated in a @:@ ratio to receive either qigong ( @ patients , @ sessions with @min/week over @ months ) or exercise therapy ( @ patients , @ sessions @min/week ) .


The primary outcome measure was the average pain intensity over the last @ days on a VAS ( @-@mm , @ = no pain , @ = worst imaginable pain , non-inferiority margin = @mm ) after @ months .


Follow-up was measured after @ and @ months .


The mean adjusted low back pain intensity after @ months was @ mm -LSB- @ % confidence interval ( CI ) @ ; @ -RSB- in the qigong group and @ mm ( @ % CI @ ; @ ) in the exercise group .


Non-inferiority of the qigong group compared with the exercise group failed to show statistical significance ( p = @ ) .


In both groups , @ patients reported suspected adverse reactions ( e.g. , muscle soreness , dizziness , pain ) the total number was comparable in both groups ( qigong n = @ , exercise n = @ ) .


Qigong was not proven to be non-inferior to exercise therapy in the treatment of chronic low back pain .


Its role in the prevention of chronic low back pain might be addressed in further studies .


Maintaining target hemoglobin ( Hb ) with minimal variability is a challenge in hemodialysis ( HD ) patients .


The aim of this study is to compare the long - and short-acting erythropoietin-stimulating agents such as Aranesp and Eprex in achieving these targets .


Randomized , prospective , open-labeled study of @ weeks includes stable patients on HD > @ months , age > @ years , and on Eprex for > @ months .


Patients were randomized into two groups : A - ( Aranesp group ) : HD patients on Eprex Q TIW or BIW were converted to Aranesp Q weekly , by using the conversion factor of @:@ and those on Eprex Q weekly to Aranesp Q @ weeks ; B - ( Eprex group ) : patients continued on Eprex treatment .


Hemoglobin target was set at ( @-@ g/l ) .


Primary end points were percentage of patients achieving target Hb , hemoglobin variability , and number of dose changes in each group .


This study consisted of @ HD patients : @ in the Aranesp and @ in the Eprex-mean ( SD ) age @ ( @ ) years , @ ( @ % ) males .


About @ % were diabetic .


Target Hb achieved in @ % of the Aranesp and @ % in the Eprex ( p = @ ) .


Hb variability was less frequent in the Aranesp group ( p = @ ) .


Mean number of dose changes was @ ( @ ) in the Aranesp and @ ( @ ) in the Eprex ( p < @ ) .


There was @ vascular access thrombosis in the Aranesp and @ in the Eprex ( p < @ ) .


There was no difference in hospitalization and death number between the @ groups .


Aranesp Q weekly or every @ weeks is more efficient in achieving target Hb , with less dose changes and minor vascular access complications .


The vertebral column is the most common site of bone metastases irrespective of the primary tumor .


Vertebral metastases are a major cause of motor deficit of the lower extremities .


The use of radiotherapy is the treatment of choice in these patients .


A temporary worsening of pain shortly during the course of palliative radiotherapy is clinically a common problem .


Steroid infusion has well-documented neuroprotective effects .


Our study objective is to evaluate the effect of pre-emptive infusion of methylprednisolone on pain flare and motor function in patients with vertebral metastases .


One hundred twenty patients with vertebral metastases received short-course external beam radiotherapy as high-voltage irradiation with a @ MeV , via linear accelerator .


In addition to the short-course radiotherapy , @ patients received pre-emptive methylprednisolone infusion ( @ mg/kg ) the day just before initiation of radiotherapy ( Group @ -LSB- G@ -RSB- ) .


The other @ patients received short-course radiotherapy without pretreatment methylprednisolone infusion , and only normal saline was infused ( Group @ -LSB- G@ -RSB- ) .


The Brief Pain Inventory , incidence of pain flare during radiotherapy , and motor functions were evaluated using the Tomita scale at the time of initial assessment , at the end of external beam radiotherapy , and after two weeks .


Four patients ( @ % ) in G@ experienced pain flare compared with @ patients ( @ % ) in G@ during the two-week short-course radiotherapy .


The mean values of pain scores were significantly reduced in both groups at the end of radiotherapy ; the mean value of worst , average , and current pain scores in G@ remained statistically significant in comparison to pretreatment and G@ mean values two weeks later .


Significant increase was noticed in patients with normal motor and ambulatory status in G@ at two and four weeks of initial assessment .


Pre-emptive methylprednisolone infusion is an effective prophylactic agent in the prevention of radiation-induced pain flare and improves functional motor status after short-term radiotherapy in patients with vertebral metastases .


To evaluate the effectiveness of subconjunctival bevacizumab and topical bevacizumab in preventing neovascularisation on high-risk corneal grafts .


The randomised , controlled , parallel group study was carried out from February @ to April @ at Isra Postgraduate Institute of Ophthalmology and Yasin Eye Hospital , Karachi .


Eyes with high-risk corneal transplantation with corneal neovascularisation were included in the trial .


Patients were randomly allocated to @ groups : A , B and C.


After penetrating keratoplasty , Group A patients received subconjunctival bevacizumab ( @ mg / @ ml ) , Group B , patients received sham injection , while Group C patients received topical bevacizumab ( @ % , @ mg/ml ) .


lt was self-administered @ times a day for @ weeks .


Group B was the control group .


Corneal neovascular invasion area was measured using mathematical software programme Mat Lab .


Data analyses were done using SPSS version @ .


Of the total @ patients , there were @ ( @ % ) each in Group A and B , while Group C had @ ( @ % ) patients .


Among the @ groups , mean corneal neovascular invasion area was minimum in Group A ( n = @ ; @ % ) , while in Group B it was @ % ( n = @ ) .


Group C had the maximum corneal neovascular invasion area after @ weks ( n = @ ; @ % ) .


Maximum number of patients ( n = @ ; @ % ) attained visual acuity of @/@ or better in Group Afollowed by Group C ( n = @ ; @ % ) and Group B ( n = @ ; @ % ) .


Subconjunctival bevacizumab reduces the recurrence of neovascularisation and , thus , helps increasing the frequency of graft survival in cases of high-risk corneal transplants .


When used topically , it is less effective .


The acute consumption of dietary nitrate has been shown to improve exercise capacity in athletes , healthy adults and subjects with peripheral vascular disease .


Many COPD patients have reduced exercise capacity .


We hypothesized that acute nitrate consumption might increase incremental shuttle walk test ( ISWT ) distance in COPD subjects .


Eleven COPD subjects were randomly assigned to consume either a high nitrate or a matched , low nitrate beverage in a double-blind , randomized , placebo-controlled , crossover design .


ISWT distance was measured both before and @ h after the beverage and change was recorded .


After a @-day washout , ISWT distances were re-measured before and @ h after the alternate beverage and changes were recorded .


We observed an increase in ISWT distance after consuming the high nitrate juice ( @ m ) compared with a reduction after the low nitrate juice ( @ m ) ( p < @ ) .


This improvement in exercise capacity was associated with significant increases in serum nitrate ( p < @ ) and nitrite ( p < @ ) levels and a significant lowering of resting blood pressure ( < @ ) .


In patients with stable COPD , the acute consumption of dietary nitrate increased serum nitrate/nitrite levels and exercise capacity and was associated with a decrease in resting blood pressure .


Nitrate consumption might alter exercise capacity in COPD patients .


Induction chemotherapy is associated with anemia in non-small cell lung cancer ( NSCLC ) patients undergoing radiotherapy .


This randomized , open-label study compared the effect of sequential radiochemotherapy ( RCHT ) versus RCHT + epoetin alfa ( RCHT + EPO ) , with respect to @-year overall survival ( OS ) .


Patients @ years received sequential RCHT ; one arm also received EPO ( chemotherapy day @ , when Hb < @ g/dL ) .


Kaplan-Meier analysis with log-rank test , and Cox-regression methods were performed .


Of the @ patients randomized ( RCHT + EPO : n = @ ; RCHT : n = @ ) , @ ( RCTH + EPO : @ -LSB- @ % -RSB- ; RCHT : @ -LSB- @ % -RSB- ) were anemic at baseline .


Two-year OS was higher in RCHT + EPO-treated versus RCHT-treated ( @ % -LSB- @ % CI : @-@ @ % -RSB- versus @ % -LSB- @ % CI : @-@ @ % -RSB- -LSB- p = @ -RSB- ) , and requirement for RBC transfusion was lower ( @/@ -LSB- @ % -RSB- versus @/@ -LSB- @ % -RSB- ) .


In anemic ( baseline ) patients ( post hoc analysis ) , median survival was shorter in RCTH-treated ( @ days ) versus RCHT + EPO-treated ( @ days ) ( Hazard ratio = @ -LSB- @ % CI : @-@ @ -RSB- , p = @ ) .


Adverse events were documented in @ % ( RCHT + EPO : @ % ; RCHT : @ % ) patients , and thrombovascular events ( TVEs ) in @ patients ( RCHT + EPO : @ % ; RCHT : @ % ; p = @ ) .


A statistically non-significant trend for @-year OS was observed in a sub-group of EPO-treated NSCLC-patients with baseline anemia , although this trend was not maintained in the overall population with inoperable NSCLC .


The aim of the study was to investigate the functional differences between N@m and P@m components of somatosensory-evoked magnetic cortical field ( SEF ) in young and senior subjects .


Twenty-nine healthy subjects , @ younger ( mean age : @ years ) and @ senior ( @ years ) , participated .


Magnetic fields were measured using a @-channel , whole head MEG .


Single - and paired-pulse stimulations of @ artifact-free MEG signal epochs were averaged separately .


We calculated how aging affects recovery function of SEFs .


The senior showed a prolonged N@m peak latency compared to the younger , although the P@m peak latency was not significantly different between groups .


The N@m ratios at @ and @ ms in the senior were significantly increased compared to the ratios in the younger ( @ ms : P < @ , @ ms : P < @ ) .


The P@m ratios at inter-stimulus interval ( ISI ) of @ and @ ms showed even disinhibition in the senior than in the younger ( P < @ ) .


The younger also showed a significantly negative correlation between P@m and N@m components ' recovery curves ( R = @ , P < @ ) .


Aging-related changes that occurred in recovery functioning were the decrease in N@m component suppression and the increase in P@m component recovery , indicating that the N@m and P@m components have different functions in aging-related recovery changes .


Our results show that the N@m ratio at an ISI of @ ms was significantly increased in the senior group , indicating that the second stimulus-evoked SEF was less inhibited by the initial stimulus at this ISI , suggesting less refractory effect or increased disinhibition .


Cell-saving devices ( CS ) are frequently used in cardiac surgery to reduce transfusion requirements , but convincing evidence from randomized clinical trials is missing .


Filtration of salvaged blood in combination with the CS is widely used to improve the quality of retransfused blood , but there are no data to justify this approach .


To determine the contribution of CS and filters on transfusion requirements , we performed a multicenter factorial randomized clinical trial in two academic and four nonacademic hospitals .


Patients undergoing elective coronary , valve , or combined surgical procedures were included .


The primary end point was the number of allogeneic blood products transfused in each group during hospital admission .


From @ included patients , @ patients completed the study ( CS + filter , @ ; CS , @ ; filter , @ ; neither CS nor filter , @ ) .


There was no significant effect of CS or filter on the total number of blood products ( fraction -LSB- @ % confidence interval -RSB- : CS , @ -LSB- @ , @ -RSB- ; filter , @ -LSB- @ , @ -RSB- ) .


Use of a CS significantly reduced red blood cell transfusions within @ hours ( @ -LSB- @,@ -RSB- ) , but not during hospital stay ( @ -LSB- @ , @ -RSB- ) .


Use of a CS was significantly associated with increased transfusions of fresh frozen plasma ( @ -LSB- @ , @ -RSB- ) , but not with platelets ( @ -LSB- @ , @ -RSB- ) .


Use of a CS significantly reduced the percentage of patients who received any transfusion ( odds ratio -LSB- @ % confidence interval -RSB- : @ -LSB- @ , @ -RSB- ) , whereas filters did not ( @ -LSB- @ , @ -RSB- ) .


Use of a CS , with or without a filter , does not reduce the total number of allogeneic blood products , but reduces the percentage of patients who need blood products during cardiac surgery .


A prospective clinical study assessing new vertebral compression fracture after previous treatment .


The purpose of this study was to investigate the incidence and associated risk factors of new symptomatic osteoporotic vertebral compression fractures ( OVCFs ) in patients treated by percutaneous vertebroplasty ( PVP ) and kyphoplasty ( PKP ) versus conservative treatment , and to elucidate our findings .


There are a lot of reports concerning the feasibility and efficacy of this minimally invasive procedure compared with conservative treatment , especially in pain soothing .


However , it is still unclear whether the risk of subsequent fracture has increased among operative treatment patients in the long term .


From November @ to July @ , @ consecutive patients with @ OVCFs were randomly selected for PVP/PKP or conservative treatment and evaluated with a mean follow-up of @ months ( @-@ months ) .


Some parameters were characterized and statistically compared in this study .


Telephone questionnaires , clinical reexamine , and plain radiographs were performed in the follow-up .


Thirty-one of @ ( @ % ) patients had experienced @ newly developed symptomatic secondary OVCFs .


Among @ operation ( @ % vertebroplasty , @ % kyphoplasty ) and @ comparison patients , there is no significant statistical difference of new OVCFs incidence between the two groups calculated by patient proportion .


However , in separate , the rate of secondary adjacent fractures calculated by vertebral refracture number is significantly higher than non-adjacent levels in PVP/PKP group but no significant statistical difference was observed in conservative group .


The time interval of recompression after operative procedure was much shorter than that for comparison group ( @ @ versus @ @ months , p = @ ) .


In addition , older age , gender , fracture times , location of original fracture segment , the amount of cement , cement leakage , operation modality ( PVP or PKP ) , and initial number of OVCFs were documented , but these were not the influencing factors in this study ( p > @ ) .


Patients who had experienced PVP/PKP were not associated with an increased risk of recompression in new levels .


However , recompression in new levels of PVP/PKP group occurred much sooner than that of conservative group in the follow-up period .


The incidence of new vertebral fractures observed at adjacent levels was substantially higher but no sooner than at distant levels in PVP/PKP group .


No major risk factors involving new OVCFs have been found in this study and augmentation for sandwich situation is not necessary .


Viral load ( VL ) monitoring is recommended , but seldom performed , in resource-constrained countries .


RV@ is a US President 's Emergency Plan for AIDS Relief ( PEPFAR ) basic programme evaluation to determine the proportion of patients on treatment who are virologically suppressed and to identify predictors of virological suppression and recovery of CD@ cell count .


Analyses from Uganda are presented here .


In this cross-sectional , observational study , patients on first-line antiretroviral therapy ( ART ) ( efavirenz or nevirapine + zidovudine/lamivudine ) from Kayunga District Hospital and Kagulamira Health Center were randomly selected for a study visit that included determination of viral load ( HIV-@ RNA ) , CD@ cell count and clinical chemistry tests .


Subjects were recruited by time on treatment : @-@ , @-@ or > @ months .


Logistic regression modelling identified predictors of virological suppression .


Linear regression modelling identified predictors of CD@ cell count recovery on ART .


We found that @ % of @ subjects were virologically suppressed ( viral load < @ HIV-@ RNA copies/ml ) .


There was no difference in the proportion of virologically suppressed subjects by time on treatment , yet CD@ counts were higher in each successive stratum .


Women had higher median CD@ counts than men overall ( @ vs. @ cells/L , respectively ; P < @ ) and in each time-on-treatment stratum .


In a multivariate logistic regression model , predictors of virological suppression included efavirenz use -LSB- odds ratio ( OR ) @ ; @ % confidence interval ( CI ) @-@ @ ; P = @ -RSB- , lower cost of clinic visits ( OR @ ; @ % CI @-@ @ ; P = @ ) , improvement in CD@ percentage ( OR @ ; @ % CI @-@ @ ; P = @ ) , and care at Kayunga vs.Kangulamira ( OR @ ; @ % CI @-@ @ ; P = @ ) .


In a multivariate linear regression model of covariates associated with CD@ count recovery , time on highly active antiretroviral therapy ( ART ) ( P < @ ) , patient satisfaction with care ( P = @ ) , improvements in total lymphocyte count ( P < @ ) and haemoglobin concentration ( P = @ ) were positively associated , whereas age at start of ART ( P = @ ) was negatively associated with this outcome .


High virological suppression rates are achievable on first-line ART in Uganda .


The odds of virological suppression were positively associated with efavirenz use and improvements in CD@ cell percentage and total lymphocyte count and negatively associated with the cost of travel to the clinic .


CD@ cell reconstitution was positively associated with CD@ count at study visit , time on ART , satisfaction with care at clinic , haemoglobin concentration and total lymphocyte count and negatively associated with age .


The benefits and risks of prolonged dual antiplatelet therapy may be different for patients with acute myocardial infarction ( MI ) compared with more stable presentations .


This study sought to assess the benefits and risks of @ versus @ months of dual antiplatelet therapy among patients undergoing coronary stent implantation with and without MI .


The Dual Antiplatelet Therapy Study , a randomized double-blind , placebo-controlled trial , compared @ versus @ months of dual antiplatelet therapy after coronary stenting .


The effect of continued thienopyridine on ischemic and bleeding events among patients initially presenting with versus without MI was assessed .


The coprimary endpoints were definite or probable stent thrombosis and major adverse cardiovascular and cerebrovascular events ( MACCE ) .


The primary safety endpoint was GUSTO ( Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries ) moderate or severe bleeding .


Of @,@ randomized patients ( @,@ treated with drug-eluting stents , @,@ with bare-metal stents ) , @ % presented with MI .


Between @ and @ months , continued thienopyridine reduced stent thrombosis compared with placebo in patients with and without MI at presentation ( MI group , @ % vs. @ % , p < @ ; no MI group , @ % vs. @ % , p < @ ; interaction p = @ ) .


The reduction in MACCE for continued thienopyridine was greater for patients with MI ( @ % vs. @ % ; p < @ ) compared with those with no MI ( @ % vs. @ % ; p = @ ; interaction p = @ ) .


In both groups , continued thienopyridine reduced MI ( @ % vs. @ % , p < @ for MI ; @ % vs. @ % , p < @ for no MI ; interaction p = @ ) but increased bleeding ( @ % vs. @ % , p = @ for MI ; @ % vs. @ % , p = @ for no MI ; interaction p = @ ) .


Compared with @ months of therapy , @ months of dual antiplatelet therapy reduced the risk of stent thrombosis and MI in patients with and without MI , and increased bleeding .


( The Dual Antiplatelet Therapy Study -LSB- The DAPT Study -RSB- ; NCT@ ) .


Accurate restoration of mechanical alignment is an important factor in reconstructive surgery of the lower extremity .


Conventional intraoperative methods , such as using an electrocautery cable , provide only a momentary evaluation of alignment .


In this study , we evaluated a novel technique using a laser emitter , which projected the mechanical axis of the lower extremity , providing continuous intraoperative information on alignment .


Alignment of @ cadaver lower extremities was measured using the electrocautery cable method , the laser method , and CT scan as the standard measurement .


The mechanical axis was defined by a line from the center of the femoral head to the center of the ankle .


For simplifying measurements the intersection with the tibial plateau was divided into percentages from the medial border ( @ % ) to the lateral border ( @ % ) .


For using the laser method a laser emitting and laser catching device was developed , which is positioned and centered on the femoral head and the ankle using an image intensifier .


By catching the laser on the knee region the actual mechanical axis is marked .


The data demonstrated good correlation of the laser method when compared to the cable method ( P = @ ) .


Comparison of the average mechanical axis between cable method and CT ( P = @ ) and laser method and CT ( P = @ ) did not show a statistically significant difference .


Average radiation time in comparison between cable method and laser method showed a statistically significant difference ( P = @ ) , with the laser method requiring more radiation time .


Determination of the mechanical axis during surgery remains a difficult clinical problem .


Restoration of alignment is an important prognostic factor for surgical outcome .