This study evaluated the efficacy of a probiotic containing Bacillus toyonensis spores ( Toyocerin ( ) ) in postweaning piglets against enteric pathogens .


Seven hundred and ninety-two healthy weaning pigs of a commercial farrow-to-finish pig farm were used .


The negative control group fed without Toyocerin ( ) and two experimental groups fed similar to the negative control group , but supplemented with Toyocerin ( ) at t @ mg kg ( -@ ) diet ( Toyocerin @ group ) and @ mg kg ( -@ ) diet ( Toyocerin @ group ) , respectively .


No significant difference ( P > @ ) in morbidity and mortality rate between groups was noticed .


The Toyocerin groups showed higher body weight ( P < @ ) and lower feed conversion ratio compared to the negative control group .


Diarrhoea score was less in both Toyocerin groups than negative control group ( P < @ ) .


Moreover , the use of Toyocerin ( ) at @ mg kg ( -@ ) diet resulted in higher average daily feed intake compared to other groups ( P < @ ) , reduction of some enteric pathogens and increase of the number of lactic acid bacteria .


The use of Toyocerin ( ) in weaning pigs , especially at @ mg kg ( -@ ) diet , improved their health and growth performance .


This study shows that a feed additive containing B. toyonensis ( Toyocerin ( ) ) protects against enteric pathogens in postweaning piglets when fed this additive at a proper dose .


The use of Toyocerin ( ) at @ mg kg ( -@ ) diet resulted in higher average daily feed intake , decrease of some enteric pathogens and higher number of lactic acid bacteria .


The effect of the probiotic in other age groups remains to be established .


Inhalation of thermal water with antioxidant properties is empirically used for COPD .


To evaluate the effects of sulphurous thermal water ( reducing agents ) on airway oxidant stress and clinical outcomes in COPD .


Forty moderate-to-severe COPD patients were randomly assigned to receive @-day inhalation with sulphurous thermal water or isotonic saline .


Patients were assessed for superoxide anion ( O@ ( - ) ) production in the exhaled breath condensate and clinical outcomes at recruitment , the day after the conclusion of the @-day inhalation treatment , and one month after the end of the inhalation treatment .


Inhalation of reducing agents resulted in a significant reduction of O@ ( - ) production in exhaled breath condensate of COPD patients at the end of the inhalatory treatment and at followup compared to baseline .


A significant improvement in the COPD assessment test ( CAT ) questionnaire was shown one month after the end of the inhalatory treatment only in patients receiving sulphurous water .


Thermal water inhalation produced an in vivo antioxidant effect and improvement in health status in COPD patients .


Larger studies are required in order to evaluate whether inhalation of thermal water is able to modify relevant clinical outcomes of the disease ( the study was registered at clinicaltrial.gov-identifier : NCT@ ) .


The phase III BEYOND trial was undertaken to confirm in a Chinese patient population the efficacy seen with first-line bevacizumab plus platinum doublet chemotherapy in globally conducted studies .


Patients age @ years with locally advanced , metastatic , or recurrent advanced nonsquamous non-small-cell lung cancer ( NSCLC ) were randomly assigned to receive carboplatin ( area under the curve , @ ) intravenously and paclitaxel ( @ mg/m ( @ ) ) intravenously ( CP ) on day @ of each @-week cycle , for six cycles , plus placebo ( Pl + CP ) or bevacizumab ( B+CP ) @ mg/kg intravenously , on day @ of each cycle , until progression , unacceptable toxicity , or death .


The primary end point was progression-free survival ( PFS ) ; secondary end points were objective response rate , overall survival , exploratory biomarkers , safety .


A total of @ patients were randomly assigned , @ to each arm .


PFS was prolonged with B+CP versus Pl + CP ( median , @ v @ months , respectively ; hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ; P < @ ) .


Objective response rate was improved with B+CP compared with Pl + CP ( @ % v @ % , respectively ) .


Overall survival was also prolonged with B+CP compared with Pl + CP ( median , @ v @ months , respectively ; HR , @ ; @ % CI , @ to @ ; P = @ ) .


Median PFS was @ months with B+CP and @ months with Pl + CP ( HR , @ ; @ % CI , @ to @ ) in EGFR mutation-positive tumors and @ and @ months , respectively ( HR , @ ; @ % CI , @ to @ ) , in wild-type tumors .


Safety was similar to previous studies of B+CP in NSCLC ; no new safety signals were observed .


The addition to bevacizumab to carboplatin/paclitaxel was well tolerated and resulted in a clinically meaningful treatment benefit in Chinese patients with advanced nonsquamous NSCLC .


The aim of this study was to assess the effects of the Dietary Approaches to Stop Hypertension ( DASH ) diet on lipid profiles and biomarkers of oxidative stress in overweight and obese women with polycystic ovary syndrome ( PCOS ) .


This randomized controlled clinical trial was conducted with @ women diagnosed withPCOS .


The women were randomly assigned to consume either the control ( n = @ ) or DASH diet ( n = @ ) for @ wk .


Both diets were designed to be calorie-restricted .


Both diets consisted of @ % carbohydrates , @ % proteins , and @ % total fats .


The DASH diet was designed to be rich in fruits , vegetables , whole grains , and low-fat dairy products and to be low in saturated fats , cholesterol , and refined grains .


Fasting blood samples were taken at baseline and after @-wk intervention to measure lipid profiles and biomarkers of oxidative stress including plasma total antioxidant capacity ( TAC ) and total glutathione ( GSH ) .


Adherence to the DASH diet , compared with the control diet , resulted in a significant decrease in weight ( -@ versus -@ kg ; P < @ ) and body mass index ( -@ versus -@ kg/m ( @ ) ; P < @ ) , decreased serum triglycerides ( -@ versus +@ mg/dL ; P interaction = @ ) and very-low-density lipoprotein cholesterol levels ( -@ versus +@ mg/dL ; P interaction = @ ) .


Increased concentrations of TAC ( +@ versus -@ mmol/L ; P interaction < @ ) and GSH ( +@ versus -@ mol/L ; P interaction = @ ) also were found in the DASH group compared with the control group .


Consumption of DASH diet for @ wk led to a significant reduction in serum insulin , triglycerides and very-low-density lipoprotein cholesterol and a significant increase in TAC and GSH levels .


To describe the implementation process of a birth preparation program , the activities in the protocol for physical and birth preparation exercises , and the educational activities that have been evaluated regarding effectiveness and women 's satisfaction .


The birth preparation program described was developed with the following objectives : to prevent lumbopelvic pain , urinary incontinence and anxiety ; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor ; and to discuss information that would help women to have autonomy during labor .


The program comprised the following activities : supervised physical exercise , relaxation exercises , and educational activities ( explanations of lumbopelvic pain prevention , pelvic floor function , labor and delivery , and which non-pharmacological pain relief to use during labor ) provided regularly after prenatal consultations .


These activities were held monthly , starting when the women joined the program at @-@ weeks of pregnancy and continuing until @ weeks of pregnancy , fortnightly thereafter from @ to @ weeks of pregnancy , and then weekly from the @th week until delivery .


Information and printed materials regarding the physical exercises to be performed at home were provided .


Clinicaltrials.gov : NCT@ .


The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical , educational and home-based activities .


The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings .


Hemodialysis ( HD ) patients are educated and counseled during the HD procedure .


There are few studies assessing whether cognitive performance varies with dialysis .


Using a randomized cross-over design , @ patients were assigned to one of two sequences : testing @ h before dialysis followed @ month later by testing during the first hour of dialysis ( n = @ ) versus testing during the first hour of dialysis followed @ month later by @ h before dialysis ( n = @ ) .


Cognitive tests were administered at each testing period .


Mixed regression models evaluated for a dialysis effect ( difference between test performance before vs. during dialysis ) while adjusting for potential learning ( difference between first and second tests ) .


In models accounting for period of testing , there was no difference in test performance between @ h before versus during the first hour of HD for all administered cognitive tests ( p > @ ) .


A learning effect was detected between first and second test administration in two tests , specifically , the Word List Learning and the Digit Symbol Substitution Test .


We found no difference in cognitive performance depending on the time of testing , suggesting that cognitive tests performed during the first hour of dialysis are a valid assessment of cognitive performance .


Increases to radiotherapy dose are constrained by normal tissue effects .


The relationship between bowel dose volume data and late bowel toxicity in patients with muscle-invasive bladder cancer treated with radical radiotherapy was assessed .


The bowel was contoured retrospectively on radiotherapy plans of @ patients recruited to the BC@ trial ( CRUK/@/@ ) .


The relationship between bowel volume at various dose levels and prospectively collected late bowel toxicity was explored .


Fifteen per cent and @ % of patients experienced grade @ and grade @ or more late bowel toxicity , respectively .


The mean bowel volume was significantly less at doses @ Gy in those treated with reduced high dose volume radiotherapy compared with standard radiotherapy .


The probability of late bowel toxicity increased as bowel volume increased ( P @ for dose levels @-@ Gy ) .


No grade @ or more late bowel toxicity was observed in patients with bowel volumes under the thresholds given in the model that predict for @ % probability of late bowel toxicity .


There is a dose volume effect for late bowel toxicity in radical bladder radiotherapy .


We have modelled the probability of late bowel toxicity from absolute bowel volumes to guide clinicians in assessing radical bladder radiotherapy plans .


Thresholds predicting for a @ % probability of late bowel toxicity are proposed as dose volume constraints .


Questions remain regarding the consequences of illicit drug use on adolescent adjustment and the nature of mechanisms that may explain these consequences .


In this study , we examined whether early-onset illicit drug use predicts subsequent academic and psychosocial adjustment and whether associations are socially-mediated by decreased school engagement and increased peer deviancy .


@ adolescents were followed throughout secondary school .


We used regressions to determine whether illicit drug use in grade @ predicted academic achievement , school dropout , depressive symptoms , and conduct problems in grades @-@ , adjusting for potential confounders .


We used path analysis to test whether significant associations were mediated by school engagement and peer deviancy in grade @ .


Illicit drug use predicted conduct problems and school dropout , but not academic achievement and depressive symptoms .


The association between illicit drug use and conduct problems was fully mediated by increased peer deviancy .


The association between illicit drug use and school dropout was partially mediated by increased peer deviancy , but remained mostly direct .


No indirect association via decreased school engagement was found .


Examination of reverse pathways revealed that conduct problems and academic achievement in grade @ predicted drug use in grades @-@ .


These associations were mediated by peer deviancy and school engagement ( conduct problems only ) .


Adolescent illicit drug use influences the risk of school dropout and conduct problems in part by contributing to deviant peer affiliation .


Reciprocal social mediation characterizes the association between drug use and conduct problems .


A reverse mechanism best explains the association with academic achievement .


Cough is one of the most common reasons why children visit a health care professional .


To compare the effect of a novel formulation of pasteurized agave nectar vs placebo and no treatment on nocturnal cough and the sleep difficulty associated with nonspecific acute cough in infants and toddlers .


In this randomized clinical trial performed in @ university-affiliated outpatient , general pediatric practices from January @ , @ , through February @ , @ , children @ to @ months old with nonspecific acute cough duration of @ days or less were studied .


Surveys were administered to parents on @ consecutive days , the day of presentation ( when no medication had been given the prior evening ) and the next day ( when agave nectar , placebo , or no treatment had been administered to their child before bedtime ) according to a partially double-blind randomization scheme .


A single dose of agave nectar , placebo , or no treatment administered @ minutes before bedtime .


Cough frequency , cough severity , cough bothersomeness , congestion severity , rhinorrhea severity , and cough effect on child and parent sleep .


Significant differences in symptom improvement were detected between the study groups ( P < @ for all , except P = @ for cough bothersomeness ) , with agave nectar and placebo proving to be superior to no treatment , but no significant differences for any outcome were found when comparing agave nectar against placebo .


In a comparison of agave nectar , placebo , and no treatment , a placebo effect was demonstrated , with no additional benefit offered by agave nectar .


Health care professionals should consider the potential benefits and costs when recommending a treatment with only a placebo effect for infants and toddlers with nonspecific acute cough .


Drug effects on the function of smell and taste are occasionally mentioned in prescription information however , most originate from anecdotal reports without even distinguishing between gustatory or olfactory deteriorations .


This includes the antifungal fluconazole .


In a randomized , placebo-controlled , double-blind , two-way crossover study , @ healthy men and @ healthy women ( age @ @ years ) took oral doses of @ mg fluconazole or placebo once daily for @ days .


Gustatory and olfactory functions were tested before and after the treatment using clinically validated tests ( `` Taste Strips '' and `` Sniffin ' Sticks '' , respectively ) .


Baseline taste scores of @ @ and @ @ for the fluconazole and placebo conditions , respectively , corresponded to normative values .


Similarly , baseline ( pretreatment ) composite olfactory TDI scores ( odor `` threshold discrimination identification '' ) of @ @ and @ @ for men and @ @ and @ @ for women during the fluconazole or placebo conditions , respectively , corresponded to normative values .


Neither gustation nor olfaction was significantly affected by the fluconazole treatment .


The present study provided a negative result regarding fluconazole effects contrasting , for example , with those of sildenafil in a comparatively powered study -LSB- @ -RSB- .


Up to the tested dose of @ mg/d , fluconazole does not have general and reproducible effects on taste and smell in healthy humans .


However , it was unlikely to detect rare disturbances with the present study cohort size , and , therefore , rare fluconazole side effects on human chemosensation , as occasionally reported , remain a possibility .


To assess the efficacy and safety of latanoprostene bunod ( LBN ) compared with latanoprost @ % , and to determine the optimum drug concentration ( s ) of LBN in reducing intraocular pressure ( IOP ) in subjects with open angle glaucoma or ocular hypertension .


Randomised , investigator-masked , parallel-group , dose-ranging study .


Subjects instilled one drop of study medication in the study eye once daily each evening for @days and completed five study visits .


The primary efficacy endpoint was the reduction in mean diurnal IOP at Day @ .


Of the @ subjects randomised ( LBN @ % , n = @ ; LBN @ % , n = @ ; LBN @ % , n = @ ; LBN @ % , n = @ ; latanoprost , n = @ ) , @ subjects completed the study .


Efficacy for LBN was dose-dependent reaching a plateau at @ % -@ % .


LBN @ % led to significantly greater reductions in diurnal IOP compared with latanoprost at the primary endpoint , Day @ ( p = @ ) , as well as Days @ ( p = @ ) and @ ( p = @ ) .


The incidence of adverse events , mostly mild and transient , was numerically higher in the LBN treatment groups compared with the latanoprost group .


Hyperaemia was similar across treatments .


LBN @ % dosed once daily was the lower of the two most effective concentrations evaluated , with significantly greater IOP lowering and comparable side effects relative to latanoprost @ % .


LBN dosed once daily for @days was well tolerated .


Injury is the number one cause of death and disability in children in the United States and an increasingly important public health problem globally .


While prevention of injuries is an important goal , prevention efforts are currently fragmented , poorly funded , and rarely studied .


Among school-aged children , pedestrian crashes are a major mechanism of injury .


We hypothesized that we could develop a game-based educational tool that would be effective in teaching elementary school children the principles of pedestrian safety .


Between November @ and June @ , second - and third-grade children in Los Angeles Unified School District were randomly assigned to play a unique interactive video game ( Ace 's Adventure ) about pedestrian safety or to a traditional didactic session about pedestrian safety .


A pretest and posttest were administered to the study participants .


Afterward , study participants were observed for appropriate pedestrian behavior on a simulated street set called Street Smarts .


All statistical analyses were performed using SAS version @ .


A total of @ study participants took the pretest and posttest .


There were @ who were randomized to the didactic and @ who were randomized to the video game .


The didactic group demonstrated a higher mean score increase ( @ , p < @ ) as compared with the video game group ( @ , p < @ ) .


However , observation of study participants revealed that participants who played the video game , as compared with the didactic group , more frequently exhibited appropriate behavior during the following : exiting a parked car ( p = @ ) , signaling to a car that was backing up ( p = @ ) , signaling to a stopped car ( p = @ ) , and crossing the street ( p = @ ) .


Students who played the educational video game about pedestrian safety performed similarly to those who attended a more traditional and labor-intensive didactic learning .


Innovative educational methods , such as game playing , could significantly change our approach to injury prevention and have the potential to decrease the burden of injury among children worldwide .


Little is known about duration of protection after the infant primary series of hepatitis B ( HB ) vaccine in settings of low HB endemicity .


This study sought to determine the proportion of adolescents immunized as infants who had protective titers of antibody to hepatitis B surface antigen ( anti-HBs ) before and after a challenge dose of vaccine .


US-born @ - through @-year-olds who received a recombinant HB vaccine @-dose series initiated within @ days of birth ( group @ ) or at @ weeks of age ( group @ ) and completed by @ months of age were enrolled .


Participants had serologic testing before and @ weeks after randomization to receive a challenge dose of @ g or @ g of Engerix-B .


Baseline and postchallenge levels of anti-HBs were compared by group , challenge dosage , and demographic and behavioral characteristics .


At baseline , @ % had protective anti-HBs levels of @ IU/mL ; @ % achieved protective levels after challenge dose .


Although group @ had a lower proportion of seroprotection at baseline , group and challenge dosage were not associated with postchallenge proportion of seroprotection .


Being in group @ , higher test dosage , higher baseline geometric mean titer , and nonwhite race were associated with significantly higher geometric mean titer after challenge dose .


More than @ % of study participants immunized against HB as infants exhibited a seroprotective response to a challenge dose of vaccine .


Duration of protection from the primary infant HB vaccine series extended through the adolescent years in the setting of low HB endemicity .


To investigate the accuracy of measuring intraocular pressure over a silicone hydrogel contact lens using Goldmann applanation tonometry in eyes with glaucoma .


This was a prospective , randomized study and enrolled @ patients ( @ right eyes ) with primary open angle glaucoma .


Intraocular pressure was taken with and without a silicone hydrogel contact lens ( -@ D ) , in situ ( using Goldmann applanation tonometry ) , in a randomized order of measurements .


Statistical analysis was performed using paired t-test and Bland-Altman plot .


The mean difference ( standard deviation ) found between intraocular pressure measurement without ( mean @ @ mmHg ) and with ( mean @ @ mmHg ) contact lens was found to be -@ @ mmHg ( @ % confidence interval , -@ to @ ) .


No significant statistical difference was found between the two groups with paired t-test ( p = @ ) .


The Bland Altman plot showed some evidence of increasing variability of differences between two measures of intraocular pressure , with increasing intraocular pressure .


The @ % limits of agreement of the Bland Altman plot were unacceptably large ( -@ mmHg to @ mmHg ) .


Agreement between Goldmann applanation tonometry with and without contact lenses seems to be poor in patients with glaucoma , especially for high intraocular pressure .


@-Hydroxy-@ ,@,@,@ - tetramethylpentadecanedioic acid ( ETC-@ ) is a small molecule with a unique mechanism of action shown in nonclinical studies to modulate pathways of cholesterol , fatty acid , and carbohydrate metabolism .


In previous phase @ clinical trials , once daily oral treatment with ETC-@ significantly reduced low-density lipoprotein-cholesterol in patients with hypercholesterolemia .


In this trial , the lipid-lowering efficacy of ETC-@ was evaluated in patients with type @ diabetes mellitus and hypercholesterolemia .


Additional cardiometabolic biomarkers , including glycemic measures , were also assessed .


A single-center , double-blind , placebo-controlled trial evaluated @ patients with type @ diabetes mellitus and elevated low-density lipoprotein-cholesterol .


Patients discontinued all diabetes mellitus and lipid-regulating drugs and were randomized to receive ETC-@ @ mg QD for @ weeks followed by @ mg QD for @ weeks or placebo for @ weeks .


ETC-@ lowered low-density lipoprotein-cholesterol levels by @ % ( least squares meanSE ) , compared with a reduction of @ % by placebo at day @ ( P < @ ; primary end point ) .


Non-high-density lipoprotein-cholesterol and total cholesterol were also significantly lowered by ETC-@ compared with placebo ( P < @ ) .


High-sensitivity C-reactive protein was reduced by @ % ( median ) compared with a placebo reduction of @ % ( P = @ ) .


No clinically meaningful safety findings were observed .


ETC-@ lowered low-density lipoprotein-cholesterol and other lipids and demonstrated improvement in high-sensitivity C-reactive protein in patients with type @ diabetes mellitus and hypercholesterolemia without worsening glycemic control .


ETC-@ was well tolerated in this population .


To evaluate the therapeutic effect of topical unoprostone isopropyl ( unoprostone ) on patients with retinitis pigmentosa ( RP ) .


Forty patients with typical forms of RP were included in the study.Seventeen of @ patients were treated with @ % topical unoprostone twice daily in a randomly selected eye .


Patients underwent follow-up examinations every @ months after treatment .


The efficacy of the treatment was monitored by visual acuity and visual field measurement testing using the Humphrey Field Analyzer ( HFA : the central @-@ programme ) .


Moreover , @ RP patients who were included this study and @ normal subjects were evaluated in terms of their macular blood flow of both eyes after instillation of unoprostone using the laser speckle method .


One year after treatment , the ` macular sensitivity ' , calculated by HFA as the average sensitivity of the central @ points , was preserved in the fellow eyes as well as the unoprostone-treated eyes .


On the other hand , that in the eyes of the control RP patient was significantly decreased .


Moreover , there were significantly greater improvements of the ` macular sensitivity ' in the unoprostone-treated eyes than the fellow eyes .


The change ratios of macular blood flow obtained from both RP patients and normal subjects were significantly increased in both the treated and the fellow eyes .


No severe side-effects were observed .


These results demonstrate that topical unoprostone might have a therapeutic efficacy in patients with RP as a consequence of the macular bloodflow improvement as well as its direct neuroprotective effect .


Ginger is one of the most commonly used herbal medicines for irritable bowel syndrome ( IBS ) but no data exists about its effectiveness .


Double blind randomized controlled trial .


University of North Carolina , Chapel Hill , North Carolina , USA .


Forty-five IBS patients were randomly assigned to three groups : placebo , @g of ginger , and @g of ginger daily for @ days .


The IBS severity scale ( IBS-SS ) was administered , as well as adequate relief of symptoms scale .


A responder was defined as having at least @ % reduction in IBS-SS post-treatment .


There were @ % responders to placebo , @ % to @g and @ % to @g of ginger .


Adequate relief was reported by @ % on placebo and @ % in both ginger groups combined .


Side effects were mild and reported by @ % in the placebo and @ % in the ginger groups .


This double blind randomized controlled pilot study suggests ginger is well tolerated but did not perform better than placebo .


Larger trials are needed before any definitive conclusions can be drawn .


The aim of this study was to conduct a cluster randomized control trial to assess the efficacy of screening and brief intervention ( SBI ) for conjoint alcohol and tobacco use among hospital out-patients .


In all @ hospital out-patients who screened positive for both tobacco and alcohol moderate risk in four hospitals were randomized into @ control and @ intervention condition using the hospital as a unit of randomization ( @ intervention and @ control hospitals ) to @ patients in the two control groups ( tobacco only intervention , n = @ , and alcohol only intervention , n = @ ) and @ in the intervention group .


The intervention or control consisted of three counselling sessions .


Results of the interaction ( GroupTime ) effects using GEE indicated that there were statistically significant differences between the three study groups over the @-month follow-up on the ASSIST tobacco score ( Wald ( @ ) = @ , P = @ ) , and past week tobacco use abstinence ( Wald ( @ ) = @ , P = @ ) .


Although there were no significant interaction effects on the other outcomes ( Alcohol ASSIST score , low alcohol risk score , past week tobacco abstinence or low alcohol risk score , and past week tobacco abstinence and low alcohol risk score ) , the scores in all of the six outcome measures showed consistent improvements .


For past week tobacco abstinence the tobacco only intervention was more effective than the alcohol only intervention and the integrated alcohol and tobacco intervention .


For the outcome of low alcohol risk , the alcohol only intervention and the integrated alcohol and tobacco intervention was more effective than the tobacco only or alcohol only intervention .


The study found that for past week tobacco abstinence the tobacco only intervention was more effective than the alcohol only intervention and the polydrug use ( alcohol and tobacco ) integrated intervention .


To compare the effects of two physical therapy exercise in-hospital programs in pulmonary function and functional capacity of patients in the postoperative period of heart transplantation .


Twenty-two heart transplanted patients were randomized to the control group ( CG , n = @ ) and training group ( TG , n = @ ) .


The control group conducted the exercise program adopted as routine in the institution and the training group has had a protocol consisting of @ stages , with incremental exercises : breathing exercises , resistance training , stretching and walking .


The programs began on the first day after extubation and stretched until hospital discharge .


Assessed pulmonary function , distance walked in six minutes walk test ( @MWT ) and peripheral muscle strength by one repetition maximum test ( @RM ) .


Similar behavior was observed between the two groups treated , with statistically significant increases between the first and second test of the following variables : FVC ( @ % in CG and @ % in TG ) ; MIP ( @ % in CG and @ % in TG ) , MEP ( @ % in CG and @ % in TG ) and @MWT ( @ % in CG and @ % in TG ) .


There was an increase of peripheral strength by @RM test , over time , to the muscle groups of the elbow flexors , shoulder flexors , hip abductors and knee flexors .


Heart transplant patients benefit from exercise programs in hospital , regardless of the program type applied .


A new training proposal did not result in superiority compared to routine programme applied .


Exercise protocols provided improves in ventilatory variables and functional capacity of this population .


Chronic neck/shoulder pain ( CNSP ) is one of the most common pain conditions .


The understanding of mechanisms , including the peripheral balance between nociceptive and antinociceptive processes , is incomplete .


N-acylethanolamines ( NAEs ) are a class of endogenous compounds that regulate inflammation and pain .


The aim of this study was to investigate the levels of two NAEs : the peroxisome proliferator-activated receptor type - ligand palmitoylethanolamide ( PEA ) and stearoylethanolamide ( SEA ) in the muscle interstitium of the trapezius muscle in women with CNSP randomized to two different neck specific training programs and in a healthy pain-free control group ( CON ) .


Fifty-seven women with CNSP were randomized to strength + stretch or stretch alone exercise programs .


Twenty-nine subjects underwent microdialysis procedure before and after @-@ months of exercise .


Twenty-four CON subjects underwent microdialysis procedure before and after @-@ months without any intervention in between .


Microdialysate samples were collected from the trapezius muscle and analyzed by mass spectrometry for PEA and SEA levels .


PEA and SEA levels were significantly higher in CNSP patients compared with CON .


PEA was significantly higher in CNSP than in CON after both training programs .


SEA was significantly higher in CNSP than in CON after stretch alone but not after strength + stretch training .


A significant positive correlation was found between changes in pain intensity and in SEA levels in the strength + stretch group , but not in the stretch alone group .


Our results indicate that exercise interventions differentially affect the levels of the bioactive lipids PEA and SEA in the interstitium of the trapezius muscle in women with CNSP .


To examine safety , tolerability , and efficacy of PF-@ , an inhibitor of the receptor for advanced glycation end products ( RAGE ) , in mild to moderate Alzheimer disease ( AD ) .


Double-blind , placebo-controlled trial at @ academic centers ( United States ) .


Subjects with AD and Mini-Mental State Examination score @-@ were randomized to PF-@ @ mg/day @ days , then @ mg daily ( high dose ) ; @ mg/day @ days , then @ mg daily ( low dose ) ; or placebo , for @ months .


Clinical and laboratory measures were used to evaluate safety and tolerability .


The primary efficacy measure was the Alzheimer 's Disease Assessment Scale-cognitive ( ADAS-cog ) .


Secondary measures assessed clinical stage , function , behavior , MRI , and CSF biomarkers .


A total of @ subjects were randomized .


In a prespecified interim analysis , when @ % of subjects had completed the @-month visit , the high dose was associated with confusion , falls , and greater ADAS-cog decline and was discontinued .


A second prespecified analysis compared low-dose and placebo groups for futility and safety approximately @ months after all subjects were randomized .


This analysis met criteria for futility , and treatment was discontinued .


There were no safety concerns in the low-dose group .


Analyses including post-futility data showed decreased decline on the ADAS-cog in the low-dose group at month @ .


Other clinical and biomarker measures showed no differences between low-dose treatment and placebo .


PF-@ at @ mg/d was associated with increased adverse events and cognitive decline .


At @ mg/d , PF-@ had a good safety profile .


A potential benefit for this low dose on the ADAS-cog is not conclusive , because of high dropout and discontinuation rates subsequent to the interim analyses .


This study provides Class I evidence that in patients with AD high-dose PF-@ increased cognitive decline at @ months and Class IV evidence that low-dose PF-@ slowed cognitive decline at @ months .


To investigate the effects of trimetazidine on renal function in patients with shock .


A prospective randomized controlled double-blind study was conducted .


@ patients with shock admitted to intensive care unit ( ICU ) of Guangzhou Red Cross Hospital from April @ to April @ were enrolled and randomly divided into control group and trimetazidine treatment group , each n = @ .


All patients received anti-shock treatment , while the patients in trimetazidine group received trimetazidine treatment ( @ mg orally , tid ) for @ days , and patients in control group received placebo ( @ mL of sterile water for injection , tid ) for @ days .


The urinary output , serum creatinine ( SCr ) , blood urea nitrogen ( BUN ) , cystatin C , and creatinine clearance ( CCr ) reflecting renal function were recorded in both groups , and the values were compared before treatment , @ hours after treatment , and @ week after the treatment .


At the same time , dynamic mean arterial pressure ( MAP ) was monitored , and @-hour and @-week mortality rates were recorded .


There was no significant difference in results in all the renal function parameters before the treatment between two groups .


The levels of SCr , BUN , cystatin C were gradually decreased after treatment in both groups , but CCr and MAP were gradually increased .


Compared with the control group , cystatin C at @ hours after treatment was significantly decreased , while CCr was significantly increased in treatment group ( cystatin C : @ mg/L vs. @ mg/L , t = @ , P = @ ; CCr : @ mL/s vs. @ mL/s , t = @ , P = @ ) .


SCr and BUN at @ week after treatment were significantly decreased in treatment group ( SCr : @ mol/L vs. @ mol/L , t = @ , P = @ ; BUN : @ mmol/L vs. @ mmol/L , t = @ , P = @ ) .


Urine output per hour and MAP was improved after treatment in both groups , and no significant difference was found between treatment group and control group ( urine output : @ hours after treatment @ mL vs. @ mL , t = @ , P = @ ; @ week after treatment @ mL vs. @ mL , t = @ , P = @ ; MAP : @ hours after treatment @ mmHg vs. @ mmHg , t = @ , P = @ ; @ week after treatment @ mmHg vs. @ mmHg , t = @ , P = @ -RSB- .


Mortality rate in treatment group was lowered compared with control group , however no statistical significance was found -LSB- @ hours after treatment : @ % ( @/@ ) vs. @ % ( @/@ ) , @ = @ , P = @ ; @ week after treatment : @ % ( @/@ ) vs. @ % ( @/@ ) , @ = @ , P = @ -RSB- .


Trimetazidine can improve renal function in patients with shock .


The aim of this study is to compare the effects of sevoflurane and propofol on one lung ventilation ( OLV ) induced ischemia-reperfusion injury ( IRI ) by determining the blood gas , ischemia-modified albumin ( IMA ) , and malonyldialdehyde ( MDA ) .


Forty-four patients undergoing thoracic surgery with OLV were randomized in two groups ( sevoflurane Group S , propofol Group P ) .


Anesthesia was inducted with thiopental and was maintained with @-@ @ % of sevoflurane within the @/@ % of O@/N@O mixture in Group S.


In Group P anesthesia was inducted with propofol and was maintained with infusion of propofol and remifentanil .


Hemodynamic records and blood samples were obtained before anesthesia induction ( t @ ) , @ min before two lung ventilation ( t @ ) , @ min after two lung ventilation ( t @ ) , and postoperative sixth hours ( t @ ) .


Heart rate at t @ and t @ in Group P was significantly lower than that in Group S.


While there were no significant differences in terms of pH and pCO@ , pO@ at t @ and t @ in Group S was significantly lower than that in Group P. IMA levels at t @ in Group S were significantly lower than those in Group P.


Sevoflurane may offer protection against IRI after OLV in thoracic surgery .


The Low Molecular Weight Fraction of @ % human serum Albumin ( LMWF-@A ) is being investigated as a treatment for knee pain from osteoarthritis .


This was a multicenter randomized , vehicle-controlled , double-blind , parallel study designed to evaluate the safety and efficacy of two doses of an intra-articular injection of LMWF-@A .


Patients with symptomatic knee osteoarthritis were randomized @ to receive a single @ mL or @ mL intra-articular knee injection of either LMWF-@A or vehicle control ( saline ) .


The primary efficacy endpoint was the difference between treatment groups in the Western Ontario and McMaster Universities ( WOMAC ) pain change from baseline over @ weeks .


Safety was examined as the incidence and severity of adverse events ( AEs ) .


A total of @ patients were randomized and received treatment .


LMWF-@A resulted in a significant decrease in pain at @ weeks compared to vehicle control ( -@ vs -@ ; estimated difference from control : -@ , p = @ ) ; an injection volume effect was not observed ( p = @ ) .


The effect of LMWF-@A on pain was even more pronounced in patients with severe knee OA ( Kellgren Lawrence Grade IV ) : the estimated difference from control was -@ ( p = @ ) .


Adverse events were generally mild and were similar in patients who received vehicle control ( @ % ) and LMWF-@A ( @ % ) .


This clinical trial demonstrated that LMWF-@A is safe and effective at providing relief for the pain of moderate to severe OA of the knee over @ weeks when administered by intra-articular injection into the knee .


Severe childhood obesity has become a major health problem , and effective , evidence-based interventions are needed .


The relative effectiveness of inpatient compared with ambulatory treatment remains unknown .


To determine whether an inpatient treatment program is more effective than an ambulatory treatment program at achieving a sustained weight loss in children and adolescents with severe obesity .


We conducted a randomized clinical trial with a @-year follow-up at a tertiary referral center for pediatric obesity in the Netherlands .


We recruited @ children and adolescents aged @ to @ years with severe obesity ( body mass index -LSB- BMI -RSB- z score , @ or > @ with obesity-related health problems ) .


Patients were randomly assigned to an inpatient ( @ months of hospitalization on working days ) or an ambulatory ( @ days of hospital visits at increasing intervals during a @-month period ) treatment program .


Both treatment programs involved an intensive , family-based , lifestyle intervention , including exercise , nutritional education , and behavior modification for the patients and their caregiver ( s ) .


Change in BMI z score .


Secondary outcomes included fasting insulin , fasting plasma glucose , @-hour plasma glucose , and lipid levels , insulin sensitivity , liver function test results , waist circumference , blood pressure , body composition , and aerobic fitness ( peak oxygen consumption , Vo ) .


Outcomes were analyzed by intention to treat .


Immediately after treatment , reductions in the BMI z score were significantly larger for the inpatient than the ambulatory groups ( mean -LSB- SE -RSB- difference , -@ -LSB- @ ; @ % CI , -@ to -@ -RSB- ; P = @ ) .


Change from baseline for the BMI z score in the inpatient group was -@ % ( P = @ ) immediately after treatment , -@ % ( P = @ ) at @ months , and -@ % ( P = @ ) at @ months ; in the ambulatory group , changes from baseline were -@ % ( P = @ ) , -@ % ( P = @ ) , and -@ % ( P > @ ) , respectively .


The favorable outcomes of the inpatient group could not be sustained at @ and @ months after treatment .


In addition , significant differences in favor of the inpatient group immediately after treatment were found for levels of fasting insulin ( -@ IU/L ; P = @ ) , total cholesterol ( -@ mg/dL ; P = @ ) , low-density lipoprotein cholesterol ( -@ mg/dL ; P = @ ) , and triglycerides ( -@ mg/dL ; P = @ ) , and insulin sensitivity ( -@ ; P = @ ) , fat mass ( -@ % ; P = @ ) , and peak Vo ( @ mL/min ; P = @ ) .


In severely obese children and adolescents , inpatient treatment was superior to ambulatory treatment immediately after treatment , but effects were not sustained at long-term follow-up .


These findings stress the need to further study maintenance strategies for sustainable weight loss .


To determine the efficacy of topical ketorolac tromethamine in preventing cystoid macular edema ( CME ) after uncomplicated cataract surgery .


This single-center , prospective , double-masked , randomized clinical trial consisted of @ patients who were scheduled for cataract surgery .


Patients were randomized to receive hypromellose/dextran @ as a placebo ( n = @ ) or ketorolac tromethamine @ % ( n = @ ) as an adjuvant therapy .


These eye drops were administered @ times daily ( QID ) for @ days before surgery and @ weeks postoperatively .


All patients received prednisolone acetate @ % QID during the same period as basal/standard anti-inflammatory therapy .


The primary outcome was the incidence of angiographic CME @ weeks after surgery .


The secondary outcomes were mean change in best-corrected visual acuity ( BCVA ) -LSB- Early Treatment Diabetic Retinopathy study ( ETDRS ) -RSB- , clinical CME incidence , intraocular pressure , and retinal thickness measured using optical coherence tomography ( OCT ) .


In the placebo group , @/@ ( @ % ) patients and in the ketorolac group , @/@ ( @ % ) patients presented with angiographic CME ( P = @ ) .


The mean change in postoperative BCVA was @ letters in the placebo group and @ letters in the ketorolac group ( P = @ ) .


There were no statistically significant between-group differences in the mean central subfield thickness ( P = @ ) , minimal central thickness ( P = @ ) , or central macular volume ( P = @ ) .


There was no difference between ketorolac tromethamine and a placebo with regard to BCVA results or prevention of CME after uncomplicated cataract surgery .


Several pre - and intraoperative factors have been associated with incisional surgical site infection ( SSI ) , but little is known about the influence of postoperative wound care and especially , the use of different dressings on incisional SSI .


The aim of this study was to compare @ methods of wound dressings ( conventional dressing , silver-containing dressing , and mupirocin ointment dressing ) for their ability to prevent SSI , as measured by SSI rates , in patients with colorectal cancer undergoing elective open surgery .


A prospective , randomized study was performed .


Inclusion criteria were diagnosis of colorectal neoplasms and plans to undergo elective surgery with curative aims .


Patients were randomized using a @:@:@ allocation into @ groups : patients receiving an ionic silver-containing dressing ( ISD ) ( group @ ) , a mupirocin ointment application ( MOA ) ( group @ ) , and a conventional dressing ( group @ or standard dressing ) .


The primary outcomes variable was occurrence of incisional SSI .


Follow-up was @ days postoperatively .


A total of @ patients were included , @ in each group .


Incisional SSI occurred in @ patients ( @ % ) in the ISD group , @ ( @ % ) in the MOA group , and @ ( @ % ) in the standard dressing group ( p = @ ) .


Adjusting for multiple comparisons , there were no significant differences between ISD and standard dressing groups ; a significant difference was observed between ISD and MOA ( relative risk -LSB- RR -RSB- @ ; @ % CI ( @ to @ ) ; p = @ ) and between the standard group and the MOA group ( RR @ ; @ % CI ( @ to @ ) ; p = @ ) .


Topical application of mupirocin ointment achieves better results for the prevention of SSI than ionic silver-containing dressing or standard dressing in patients undergoing elective open colorectal surgery .


It is assumed that laparoscopic surgery generally induces less inflammatory responses than open surgery .


Since few studies have compared immune responses after laparoscopic and open surgery in children , we examined inflammatory markers in children randomized to open ( ONF ) or laparoscopic Nissen fundoplication ( LNF ) .


Blood samples were collected prior to surgery ( D@ ) , and on postoperative day @ ( D@ ) and day @ ( D@ ) .


Inflammatory markers were measured using a multiplex antibody bead kit .


The postoperative levels of inflammatory markers were statistically analyzed using a linear mixed model .


A P value < @ was considered statistically significant .


Twenty-nine patients randomized to ONF or LNF were included .


Median age was @ years ( range @-@ @ ) in the ONF group and @ years ( range @-@ @ ) in the LNF group .


Plasma levels of the anti-inflammatory cytokine interleukin ( IL ) -@ were significantly higher in the ONF group than in the LNF group postoperatively ( P = @ ) .


However , there were no significant differences between the groups in the levels of pro-inflammatory markers tumor necrosis factor - , IL-@ , IL-@ , monocyte chemoattractant protein-@ , white blood cell count , or C-reactive protein .


We did not find that laparoscopy induced a substantially less inflammatory response than laparotomy in children undergoing fundoplication .


To assess the feasibility and efficacy of a novel , minimally invasive spinal surgery technique for the correction of lumbar spinal stenosis involving unilateral approach for bilateral decompression .


Cross-sectional observational study .


Neurosurgery Department of PGMI , Lady Reading Hospital , Peshawar , from January to December @ .


A total of @ patients with lumbar stenosis were randomly assigned to undergo either a conventional laminectomy ( @ patients , Group A ) , or a unilateral approach ( @ patients , Group B ) .


Clinical outcomes was measured using the scale of Finneson and Cooper .


All the data was collected by using a proforma and different parameters were assessed for a minimum follow-up period of three months .


Data was analyzed by descriptive statistics using SPSS software version @ .


Adequate decompression was achieved in all patients .


Compared with patients in the conventional laminectomy group , patients who received the novel procedure ( unilateral approach ) had a reduced mean duration of hospital stay , a faster recovery rate and majority of the patients ( @ % ) had an excellent to fair operative result according to the Finneson and Cooper scale .


Five major complications occurred in all patient groups , @ patients had unintended dural rent and @ wound dehiscence each and fifth patient had worsening of symptoms .


There was no mortality in the series .


The ultimate goal of the unilateral approach to treat lumbar spinal stenosis is to achieve adequate decompression of the neural elements .


An additional benefit of a minimally invasive approach is adequate preservation of vertebral stability , as it requires only minimal muscle trauma , preservation of supraspinous/intraspinous ligament complex and spinous process , therefore , allows early mobilization .


This also shortens the hospital stay , reduces postoperative back pain , and leads to satisfactory outcome .


Fatigue is a distressing symptom occurring in more than @ % of patients with cancer .


The CNS stimulants modafinil and methylphenidate are recommended for the treatment of cancer-related fatigue , despite a limited evidence base .


We aimed to evaluate the efficacy and tolerability of modafinil in the management of fatigue in patients with non-small-cell lung cancer ( NSCLC ) .


Adults with advanced NSCLC and performance status of @ to @ , who were not treated with chemotherapy or radiotherapy within the last @ weeks , were randomly assigned to daily modafinil ( @ mg on days @ to @ ; @ mg on days @ to @ ) or matched placebo .


The primary outcome was change in Functional Assessment of Chronic Illness Therapy ( FACIT ) - Fatigue score from baseline to @ days , adjusted for baseline fatigue and performance status .


Secondary outcomes included safety and patient-reported measures of depression , daytime sleepiness , and quality of life .


A total of @ patients were randomly assigned , and @ patients ( modafinil , n = @ ; placebo , n = @ ) completed questionnaires at both baseline and day @ and were included in the modified intention-to-treat analysis .


FACIT-Fatigue scores improved from baseline to day @ ( mean score change : modafinil , @ ; @ % CI , @ to @ ; placebo , @ ; @ % CI , @ to @ ) , but there was no difference between treatments ( @ ; @ % CI , -@ to @ ) .


There was also no difference between treatments for the secondary outcomes ; @ % of the modafinil group and @ % of the placebo group stated that the intervention was not helpful .


Modafinil had no effect on cancer-related fatigue and should not be prescribed outside a clinical trial setting .


Its use was associated with a clinically significant placebo effect .


To observe the clinical efficacy of Bushen Huoxue Sanyu Decoction ( BHSD ) in treatment of adenomyosis ( AM ) patients .


Seventy AM patients of Shen deficiency blood stasis syndrome ( SDBSS ) were randomly assigned to two groups , the CM treatment group ( @ cases ) and the Mirena group ( @ cases ) .


Patients in the CM treatment group were treated with BHSD , one dose per day .


Levonorgestrel intrauterine system ( Mirena ) was placed in the uterine cavity of those in the Mirena group .


The therapeutic course for all was @ months .


Changes of dysmenorrhea , menstrual quantity , SDBSS , CM syndrome , uterine volume , and serum CA@ levels were observed before and after treatment .


Compared with before treatment in the same group , scores for dysmenorrhea integral , scores for menstrual quantity , scores for SDBSS , and scores for CM syndrome all decreased in the two groups after treatment ( P < @ ) .


Compared with before treatment in the same group , the uterine volume was reduced after treatment in the two groups ( P < @ ) and serum carbohydrate antigen CA@ levels decreased between the two groups ( P < @ , P < @ ) .


Compared with the Mirena group , scores for dysmenorrhea integral increased and scores for SDBSS decreased in the CM treatment group ( P < @ , P < @ ) .


There was no statistical difference in the uterine volume or serum carbohydrate antigen CA@ levels ( P > @ ) .


BHSD could effectively alleviate main symptoms of AM patients of QSBSS such as dysmenorrhea , profuse menstrual blood volume , and increased uterine volume , and lower scores for QSBSS and the total score for CM syndrome .


Effective measures are needed to prevent methicillin-resistant Staphylococcus aureus ( MRSA ) skin and soft tissue infections ( SSTIs ) in high-risk community settings .


The study objective was to evaluate the effect of personal hygiene-based strategies on rates of overall SSTI and MRSA SSTI .


We conducted a prospective , field-based , cluster-randomized trial in US Army Infantry trainees from May @ through January @ .


There were @ study groups with incrementally increased education and hygiene-based interventions : standard ( S ) , enhanced standard ( ES ) , and chlorhexidine ( CHG ) .


The primary endpoints were incidence of overall SSTI and MRSA SSTI .


The study included @ @ trainees constituting @ platoons ( @ S , @ ES , and @ CHG ) .


A total of @ ( @ % ) participants developed SSTI , @ ( @ % ) due to MRSA .


The overall SSTI rate was @ ( @ % confidence interval -LSB- CI -RSB- , @-@ @ ) per @ person-cycles .


SSTI rates by study group were @ ( @ % CI , @-@ @ ) for S , @ ( @ % CI , @-@ @ ) for ES , and @ ( @ % CI , @-@ @ ) for CHG .


The MRSA SSTI rate per @ person-cycles for all groups was @ ( @ % CI , @ -@ ) .


MRSA SSTI rates by study group were @ ( @ % CI , @ -@ ) for S , @ ( @ % CI , @ -@ ) for ES , and @ ( @ % CI , @ -@ ) for CHG .


Personal hygiene and education measures , including once-weekly use of chlorhexidine body wash , did not prevent overall SSTI or MRSA SSTI in a high-risk population of military trainees .


The growing incidence of infections caused by Enterobacteriaceae producing ESBLs has led to increased use of carbapenems .


Temocillin , which resists most - lactamases , may be a useful alternative .


The aim of this study was to assess the pharmacokinetics and target attainment rates of @ g of temocillin daily divided into three administrations every @ h ( three times daily ) or administered by continuous infusion in critically ill patients .


This was a prospective , two-centre , randomized , controlled study in patients with intra-abdominal or lower respiratory tract infections caused by Enterobacteriaceae .


Thirty-two patients were included and analysed for clinical efficacy , and pharmacokinetics were measured in @ of them .


Four patients undergoing continuous veno-venous haemofiltration ( CVVH ) were analysed separately .


Mean , median and range of percentages of the dosing interval during which the free drug concentration remained > @ mg/L were @ , @ and @-@ @ in patients treated three times daily and @ , @ and @-@ @ in patients with continuous infusion , respectively .


Clinical cure rates were @ % and @ % in each of these groups , respectively ( not significant ) .


Patients with CVVH received a daily dose of @ mg given by continuous infusion and had a mean free drug concentration of only @ mg/L .


No adverse event attributable to temocillin was observed .


Temocillin ( @ g daily ) given by continuous infusion allows a larger proportion of critically ill patients to have free drug serum concentrations covering infections caused by Enterobacteriaceae with an MIC of @ mg/L compared with administration three times daily .


Clinical efficacy compared with carbapenems in documented severe infections needs to be further studied .


Tourniquet application is still a common practice in total knee arthroplasty ( TKA ) surgery despite being associated with several adverse effects .


We evaluated the effects of tourniquet use on functional and clinical outcome and on knee range of motion ( ROM ) .


@ patients who underwent TKA were randomized into a tourniquet group ( n = @ ) and a non-tourniquet group ( n = @ ) .


All operations were performed by the same surgeon and follow-up was for @ year .


Primary outcomes were functional and clinical outcomes , as evaluated by KOOS and knee ROM .


Secondary outcomes were intraoperative blood loss , surgical time and visibility , postoperative pain , analgesic consumption , and transfusion requirements .


Patients in the non-tourniquet group showed a better outcome in all KOOS subscores and better early knee ROM from surgery to week @ .


No difference was detected at the @ - and @-month follow-ups .


Postoperative pain and analgesic consumption were less when a tourniquet was not used .


Surgical time and visibility were similar between groups .


Intraoperative blood loss was greater when not using a tourniquet , but no postoperative transfusions were required .


This study shows that TKA without the use of a tourniquet results in faster recovery in terms of better functional outcome and improved knee ROM .


Furthermore , reduced pain and analgesic use were registered and no intraoperative difficulties were encountered .


Countries in sub-Saharan Africa ( SSA ) are experiencing an epidemic of cardiovascular disease ( CVD ) propelled by rapidly increasing rates of hypertension .


Barriers to hypertension control in SSA include poor access to care and high out-of-pocket costs .


Although SSA bears @ % of the global disease burden , it has only @ % of the global health workforce .


Given such limited resources , cost-effective strategies , such as task shifting , are needed to mitigate the rising CVD epidemic in SSA .


Ghana , a country in SSA with an established community health worker program integrated within a national health insurance scheme provides an ideal platform to evaluate implementation of the World Health Organization ( WHO ) task-shifting strategy .


This study will evaluate the comparative effectiveness of the implementation of the WHO Package targeted at CV risk assessment versus provision of health insurance coverage , on blood pressure ( BP ) reduction .


Using a cluster randomized design , @ community health centers ( CHCs ) and district hospitals in Ghana will be randomized to either the intervention group ( @ CHCs ) or the control group ( @ CHCs ) .


A total of @ patients with uncomplicated hypertension ( BP @-@/@ -@ mm Hg and absence of target organ damage ) will be enrolled in this study ( @ patients per CHC ) .


The intervention consists of WHO Package of CV risk assessment , patient education , initiation and titration of antihypertensive medications , behavioral counseling on lifestyle behaviors , and medication adherence every three months for @ months .


The primary outcome is the mean change in systolic BP from baseline to @ months .


The secondary outcomes are rates of BP control at @ months ; levels of physical activity , percent change in weight , and dietary intake of fruits and vegetables at @ months ; and sustainability of intervention effects at @ months .


All outcomes will be assessed at baseline , six months and @ months .


Trained community health nurses will deliver the intervention as part of Ghana 's community-based health planning and services ( CHPS ) program .


Findings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy with respect to comprehensive CV risk reduction and hypertension control in resource-poor settings .


Because insulin dosing requires optimization of glycemic control , it is important to use a single metric of benefit and risk to determine best insulin dosing practices .


We retrospectively applied a multiplicative clinical utility index ( CUI ) to a study of LY@ ( Eli Lilly and Company , Indianapolis , IN ) , a novel , long-acting basal insulin .


A CUI was developed to transform the multidimensional problem of assessing benefit/risk of multiple dosing algorithms into a single decision-making metric to evaluate two LY@ dosing algorithms relative to the insulin glargine ( GL ) dosing algorithm .


The CUI was applied to data in a @-week , open-label , Phase @ trial in patients with type @ diabetes mellitus who were randomized to one of two dosing algorithms for LY@ ( LY@ or LY@ ) or GL ( algorithm similar to LY@ ) .


The CUI was created ( via expert input ) by weighing the relative benefit/risk of four components ( glycosylated hemoglobin -LSB- HbA@c -RSB- , percentage of patients with HbA@c @ % , hypoglycemia rate , and time to steady-state dose ) ; individual utility values were multiplied to compute CUI values for LY@ and LY@ relative to GL , and bootstrap samples were used to determine variability .


The mean CUI was @ for LY@ and @ for LY@ .


Based on @,@ bootstrap samples , there was a @ % probability of LY@ performing better than LY@ and a @ % probability of LY@ performing better than LY@ .


CUI methodology , and in particular this CUI , is a useful tool for comparing dosing algorithms .


Based on this CUI , LY@ is likely to be a better dosing algorithm than LY@ .


Patients undergoing open heart surgery with cardiopulmonary bypass ( CPB ) often develop a systemic immune reaction , characterized by an increase of proinflammatory and anti-inflammatory mediators .


We previously demonstrated that continued mechanical ventilation during CPB reduces this response .


We hypothesized that this strategy may also impact on matrix metalloproteinase ( MMP ) release .


Thirty consecutive patients undergoing coronary artery bypass grafting with CPB were randomized into a ventilated ( VG ) ( n = @ ) and a standard non-ventilated group ( NVG ) ( n = @ ) .


Blood was collected at the beginning , at the end of surgery , and on the five consecutive days .


MMPs , tissue inhibitor of matrix metalloproteinase @ ( TIMP-@ ) , and lipocalin @ ( LCN@ ) were measured by enzyme-linked immunosorbent assay .


Parameters of transpulmonary oxygen transport were assessed at different time points .


MMP-@ , MMP-@ , and LCN@ were significantly lower at the end of surgery in VG compared with those in NVG patients ( MMP-@ -LSB- ng/mL -RSB- : @ -LSB- @ -RSB- versus @ -LSB- @ -RSB- , P = @ ; MMP-@ -LSB- ng/mL -RSB- : @ -LSB- @ -RSB- versus @ -LSB- @ -RSB- , P = @ ; LCN@ -LSB- ng/mL -RSB- : @ -LSB- @ -RSB- versus @ -LSB- @ -RSB- , P = @ ) .


TIMP-@ concentrations were lower on postoperative day one , ( TIMP-@ -LSB- ng/mL -RSB- : @ -LSB- @ -RSB- versus @ -LSB- @ -RSB- , P = @ ) , whereas MMP-@ levels were lower on postoperative days four and five ( MMP-@ -LSB- ng/mL -RSB- : @ -LSB- @ -RSB- versus @ -LSB- @ -RSB- , P = @ ) .


The arterial partial pressure of oxygen/fraction of inspired oxygen ratio was significantly higher in VG patients throughout the postoperative observation period , which did not affect the length of postoperative ventilatory support .


Continued mechanical ventilation during CPB reduces serum levels of MMPs , their inhibitor TIMP-@ and LCN@ , which preserves MMP-@ activity .


The present study suggests that continued mechanical ventilation improves postoperative oxygenation and could potentially prevent aggravation of lung injury after CPB .


Opicapone is a novel third generation catechol-O-methyltransferase ( COMT ) inhibitor .


The purpose of this study was to compare the levodopa pharmacokinetic profile throughout a day driven by the COMT inhibition either following repeated doses of opicapone or concomitant administration with entacapone .


A randomized , double-blind , gender-balanced , parallel-group study was performed in @ groups of @ healthy subjects each .


Four subjects in each group received placebo during the entire study .


Sixteen subjects in one group received placebo once daily for @ days and on day @ , @ mg entacapone concomitantly with each levodopa/carbidopa dose ( three times separated by a @-h interval ) .


Sixteen subjects in each of the remaining three groups received respectively @ , @ , and @ mg opicapone once daily for @ days and on day @ , placebo concomitantly with each levodopa/carbidopa dose .


Levodopa minimum plasma concentration ( Cmin ) for each levodopa/carbidopa dose and for the mean of all levodopa/carbidopa doses increased substantially with all active treatments ( entacapone and opicapone ) when compared to the control group ( placebo ) , with values ranging from @-fold ( @ mg entacapone ) to @-fold ( @ mg opicapone ) .


No statistical difference was found for levodopa peak of systemic exposure ( as assessed by maximum observed plasma concentration ( Cmax ) ) between all active treatments and placebo .


A significant increase in the levodopa extent of systemic exposure ( as assessed by concentration-time curve ( AUC ) ) occurred with all opicapone treatments in relation to placebo .


No statistical difference was found for levodopa AUC when entacapone was compared to placebo .


When compared to entacapone , both @ and @ mg opicapone presented a significant increase for the levodopa AUC .


All active treatments significantly inhibited both peak ( as assessed by Emax ) and extent ( as assessed by effect-time curve ( AUEC ) ) of the COMT activity in relation to placebo .


When compared to entacapone , all opicapone treatments significantly decreased the extent ( AUEC ) of the COMT activity due to a long-lasting and sustained effect .


The tolerability profile was favorable for all active treatments .


Opicapone , a novel third generation COMT inhibitor , when compared to entacapone , provides a superior response upon the bioavailability of levodopa associated to more pronounced , long-lasting , and sustained COMT inhibition .


The tolerability profile was favorable .


On the basis of the results presented in this study and along with the earlier pharmacology studies , it is anticipated that opicapone adjunct therapy at the dosages of @ and @ mg will provide an enhancement in levodopa availability that will translate into clinical benefit for Parkinson 's disease patients .


To analyze the acute physiological response to aerobic short-interval training ( AESIT ) at various high-intensity running speeds .


A minor anaerobic glycolytic energy supply was aimed to mimic the characteristics of slow continuous runs .


Eight trained male runners ( maximal oxygen uptake -LSB- VO ( @max ) -RSB- @ @ mL kg ( -@ ) min ( -@ ) ) performed an incremental treadmill exercise test ( increments : @ km h ( -@ ) min ( -@ ) ) .


Two lactate turn points ( LTP@ , LTP@ ) were determined .


Subsequently , @ randomly assigned AESIT sessions with high-intensity running-speed intervals were performed at speeds close to the speed ( v ) at VO ( @max ) ( vVO ( @max ) ) to create mean intensities of @ % , @ % , and @ % of vLTP@ .


AESIT sessions lasted @ min and consisted of @-s work phases , alternated by @-s passive recovery phases .


To produce mean velocities of @ % , @ % , and @ % of vLTP@ , running speeds were calculated as @ @ km/h ( @ % vVO ( @max ) ) , @ @ km/h ( @ % vVO ( @max ) ) , and @ @ km/h ( @ % vVO ( @max ) ) , which gave a mean blood lactate concentration ( La ) of @ @ mmol/L , @ @ mmol/L , and @ @ mmol/L , respectively .


La at @ % of vLTP@ was not significantly different from La at vLTP@ ( P = @ ) .


Mean VO ( @ ) was found at @ % , @ % , and @ % of VO ( @max ) , while at the end of the sessions VO ( @ ) rose to @ % , @ % , and @ % of VO ( @max ) , respectively .


The results showed that AESIT with @-s work phases alternating with @ s of passive rest and a running speed close to vVO ( @max ) gave a systemic aerobic metabolic profile similar to slow continuous runs .


Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures .


There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain .


The purposes of this study were : ( @ ) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and ( @ ) to examine subgroup influence on @-week clinical pain intensity and disability outcomes .


A secondary analysis of data from @ randomized trials was conducted .


Baseline and @-week outcome data from @ participants with low back pain ( n = @ ) and neck pain ( n = @ ) were examined .


Participants completed demographic , psychological , and clinical information and were assessed using pain sensitivity protocols , including pressure ( suprathreshold pressure pain ) and thermal pain sensitivity ( thermal heat threshold and tolerance , suprathreshold heat pain , temporal summation ) .


A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses .


Differences in data for baseline variables , clinical pain intensity , and disability were examined .


Three pain sensitivity cluster groups were derived : low pain sensitivity , high thermal static sensitivity , and high pressure and thermal dynamic sensitivity .


There were differences in the proportion of individuals meeting a @ % change in pain intensity , where fewer individuals within the high pressure and thermal dynamic sensitivity group ( adjusted odds ratio = @ ; @ % confidence interval = @ , @ ) achieved successful outcomes .


Only @-week outcomes are reported .


Distinct pain sensitivity cluster groups for individuals with spine pain were identified , with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity .


Future studies should aim to confirm these findings .


To evaluate attainment of diabetes-related quality measures with canagliflozin , a sodium glucose cotransporter @ inhibitor , versus sitagliptin in patients with type @ diabetes mellitus ( T@DM ) .


This post hoc analysis included data from a @-week , randomized , double-blind , phase @ study comparing canagliflozin @ mg and sitagliptin @ mg in patients with T@DM on metformin plus sulfonylurea .


Individual and composite diabetes-related quality measures based on glycated hemoglobin ( A@C ) , blood pressure ( BP ) , low-density lipoprotein cholesterol ( LDL-C ) level , body mass index ( BMI ) , and body weight were assessed in the overall population and a subgroup with a baseline BMI of at least @ kg/m .


At baseline , the proportion of patients meeting criteria for quality measures was similar between groups .


At week @ , more canagliflozin-treated patients achieved quality measures of an A@C less than @ % or less than @ % , and fewer canagliflozintreated patients had an A@C greater than @ % , compared with sitagliptin .


More patients achieved BP measurement less than @/@ mm Hg , less than @/@ mm Hg , or less than @/@ mm Hg with canagliflozin versus sitagliptin .


The proportion of patients with an LDL-C level less than @ mg/dL was similar between groups .


More patients had a BMI of at least @ kg/m and a greater than @ lb ( @ kg ) weight loss from baseline , and a BMI less than @ kg/m at week @ , with canagliflozin versus sitagliptin .


A greater proportion of patients achieved composite end points based on A@C , BP , and LDL-C level with canagliflozin versus sitagliptin .


Similar results were observed in the subgroup of patients with a baseline BMI of at least @ kg/m .


In this study involving patients with T@DM on metformin plus sulfonylurea , after @ weeks , patients treated with canagliflozin @ mg demonstrated better attainment of individual and composite diabetes-related quality measures compared with patients treated with sitagliptin @ mg .


The purpose of this study was to determine the safety and efficacy of adjuvant albendazole medication in percutaneous liver hydatid cyst treatment with puncture , aspiration , injection , and reaspiration ( PAIR ) method .


Between November @ and May @ , total of @ patients with newly diagnosed liver hydatid cyst ( total of @ cysts ) were prospectively randomized and enrolled in @ groups .


In the first group , cysts ( n = @ ) were treated with PAIR without albendazole .


In the second ( n = @ ) and third groups ( n = @ ) , cysts were treated with PAIR with albendazole @ week before and @ month after the procedure , with albendazole @ week before and @ months after the procedure respectively .


Technical and clinical success rates were @ and @ % respectively .


In @ of @ cysts ( @ % ) , findings of recurrence were detected on US imaging .


All recurrent cysts were in group @ and recurrence rates in this group were statistically different from cysts of second and third groups ( p = @ ) .


Side effects of albendazole were detected in @ of @ patients ( @ % ) , and no statistically significant difference was observed between the second ( @ % ) and third ( @ % ) groups ( p = @ ) .


Use of albendazole medication as an adjuvant to percutaneous treatment of liver hydatid cyst decreases the recurrence rate .


Although there is no statistically significant difference between groups @ and @ in terms of efficacy and recurrence rate , patients in group @ had a higher rate of side effect .


Therefore , we conclude that albendazole treatment @ week before and @ month after PAIR treatment is sufficient to reduce/prevent recurrences .


Liver cirrhosis is one of the major consequences of hepatitis B virus ( HBV ) infection , and transplantation of autologous bone marrow mesenchymal stem cells ( ABMSCs ) is one of promising therapies for patients with HBV-related liver cirrhosis ( HBV-LC ) .


However , the mechanism is unclear .


The aim of the current study was to explore the role of Treg/Th@ cells in ABMSCs transplantation in patients with HBV-LC .


In this prospective study , @ patients were enrolled and randomly assigned to transplantation group and control group .


After @-week follow-up , @ patients completed the study ( @ cases in transplantation group and @ cases in control group ) .


The Model for End-Stage Liver Disease scores , liver function , changes of Treg/Th@ cells , as well as related transcription factors and serum cytokines , were determined .


Although patients in both groups showed significant improvement after Entecavir treatment , ABMSC transplantation further improved patients ' liver function .


Moreover , there was a significant increase in Treg cells and a marked decrease in Th@ cells in the transplantation group compared with control , leading to an increased Treg/Th@ ratio .


Furthermore , mRNA levels of Treg-related transcription factor ( Foxp@ ) and Th@-related transcription factor ( RORt ) were increased and decreased , respectively .


In addition , serum transforming growth factor - levels were significantly higher at early weeks of transplantation , while serum levels of interleukin-@ , tumor necrosis factor - , and interleukin-@ were significantly lower in patients in the transplantation group compared with control .


ABMSCs transplantation was effective in improving liver function in patients with HBV-LC , which was mediated , at least in part , through the regulation of Treg/Th@ cell balance .


To study the effect of melatonin ( melaxen ) on sleep disorders in patients with mild cranial-brain injury ( CBI ) in the early rehabilitation period .


Sixty patients were randomized to equal groups treated or not treated with melaxen .


Along with neurological and somatic examination , polysomnography and scales for measurement depression and quality of life ( ESS , BDI , EuroQol etc ) were used .


Melatonin improved sleep ( sleep latency , number of wakings per night etc ) and decreased the severity of depression in the early rehabilitation period after mild CBI .


Further research is needed to fully understand the effect of melatonin on sleep disorders in CBI , in particular in its later stages .


To evaluate factors associated with low consumption of fruits and vegetables among preschoolers from families treated at basic health centers in Porto Alegre , RS , Brazil .


This was a cohort study nested in a randomized field trial .


Data collection was performed through structured questionnaires to obtain demographic and dietary data , combined with two @-hour recalls in the age groups @-@ months and again at @-@ years of age .


Data on the consumption of one daily serving of fruits ( @ g ) and vegetables ( @ g ) were evaluated , as well as consumption of non-recommended foods such as candy , chocolate , and soft drinks .


Statistical analyses were performed using Poisson regression with robust estimation .


A total of @ children aged @-@ years were evaluated ; of these , @ % and @ % did not consume one daily serving of fruits and vegetables , respectively .


The following factors were negatively associated with fruit consumption : family income higher than four minimum wages , ( p = @ ) , lower paternal educational level ( p = @ ) , and lower fruit consumption at @-@ months ( p = @ ) .


Factors negatively associated with the consumption of vegetables were low paternal educational level ( p = @ ) and consumption of high-sugar content beverages at @-@ months ( p = @ ) .


This study demonstrated a high prevalence of children who consumed less than one daily serving of fruit and vegetables ; early feeding practices , parental education , and family income were associated with this process .


Pilonidal sinus is a common infectious process which occurs in buttocks and sacral area which involves a wide range of symptoms that are different from an asymptomatic sinus abscess to acute and chronic sinus track .


Basically non-surgical treatment for this disease is not recommended .


In this study , we have been compared two methods of primary repair and rotation flap in terms of factors such as duration of hospitalization , recurrence , infection etc. .


@ patients with chronic pilonidal sinus were randomly divided into two groups and underwent surgery .


Diabetic and obese patients with underlying diseases and patients with acute pilonidal abscess or prior surgery were excluded .


The patients ' hospital stay , duration of postoperative pain , itching and hematoma , were investigated .


In this study , patients ' sex and mean age were examined in terms of frequency of complications of hematoma , wound infection , recurrence , itching , and duration of hospitalization and the presence of seroma , there is no significant difference between the two methods of primary surgical repair and rotation flap ( P > @ ) But in terms of the opening of the surgical wound , in primary surgical method , @ patients ( @ % ) , wound dehiscence were reported , in rotation flap , any case of wound dehiscence were reported .


There is significant difference between wound dehiscence in patients with chronic pilonidal sinus and two methods of surgery .


( P = @ ) .


The mean duration of pain relief was @ @ days in the primary surgical repair method and rotation flap was @ @ days .


According to the test there is significant difference between mean duration of pain relief and two surgical methods .


The mean duration of sutures was @ @ days in the primary repair method and in rotational flap was @ @ days .


There is significant difference between the mean duration of sutures and two surgical methods ( P = @ ) CONCLUSION : Considering these results , rotational flap is the preferred method due to fewer complications , lower recurrence after surgery and faster healing time of surgical wounds and as a result , the effective force 's early return to economic cycle .


Finally , we can say that each surgeon according to the type and size of the sinuses and occupational status and social class , personality and individuality of the patient can select the appropriate method of surgery .


This study aims to prospectively assess the incidence of hypercalciuria and hypercalcemia with different doses of vitamin D and with a calcium intake of approximately @,@ mg/day .


This was a @-year randomized placebo-controlled study of vitamin D ( @-@ ,@ IU/d ) in @ white women aged @ to @ years .


Calcium citrate tablets ( @ mg ) were added to the diet to achieve a total calcium intake of approximately @,@ mg/day in all groups .


All women had vitamin D insufficiency at baseline , with serum @-hydroxyvitaminD levels lower than @ ng/mL ( @ nmol/L ) .


Serum and @-hour urine calcium were collected every @ months on supplementation , any test result above the upper reference range represented an episode of hypercalcemia or hypercalciuria .


Mixed-effects models and multivariate logistic regression were used in the analysis .


Hypercalcemia ( > @ mg/dL -LSB- @ mmol/L -RSB- ) occurred in @ % of white women .


Hypercalciuria ( > @ mg/d -LSB- @ mmol -RSB- ) occurred in @ % of white women .


Episodes of hypercalciuria were transient in half of the group and recurrent in the other half .


No relationship between hypercalcemia or hypercalciuria and vitamin D dose was found , and hypercalciuria was equally common in the placebo group .


Hypercalciuria and hypercalcemia commonly occur with vitamin D and calcium supplements .


Whether hypercalciuria and hypercalcemia are caused by calcium , vitamin D , or both is unclear .


These findings may have relevance to the reported increase in kidney stones in the Women 's Health Initiative trial .


Because calcium @,@ mg and vitamin D @ IU/day are widely recommended in postmenopausal women , systematic evaluation of the safety of supplements is warranted in clinical management and in future studies .


A universal Internet-based preventive intervention has been shown to reduce alcohol and cannabis use .


The aim of this study was to examine if this program could also reduce risk-factors associated with substance use in adolescents .


A cluster randomised controlled trial was conducted in Sydney , Australia in @-@ to assess the effectiveness of the Internet-based Climate Schools : Alcohol and Cannabis course .


The evidence-based course , aimed at reducing alcohol and cannabis use , consists of two sets of six lessons delivered approximately six months apart .


A total of @ students ( mean @ years ) from @ secondary schools were randomly allocated to receive the preventive intervention ( n = @ , five schools ) , or their usual health classes ( n = @ , five schools ) over the year .


Participants were assessed at baseline , immediately post , and six and twelve months following the intervention on their levels of truancy , psychological distress and moral disengagement .


Compared to the control group , students in the intervention group showed significant reductions in truancy , psychological distress and moral disengagement up to twelve months following completion of the intervention .


These intervention effects indicate that Internet-based preventive interventions designed to prevent alcohol and cannabis use can concurrently reduce risk-factors associated with substance use in adolescents .


To assess the efficacy of collaborative care for behavior problems , attention-deficit/hyperactivity disorder ( ADHD ) , and anxiety in pediatric primary care ( Doctor Office Collaborative Care ; DOCC ) .


Children and their caregivers participated from @ pediatric practices that were cluster randomized to DOCC ( n = @ ) or enhanced usual care ( EUC ; n = @ ) .


In DOCC , a care manager delivered a personalized , evidence-based intervention .


EUC patients received psychoeducation and a facilitated specialty care referral .


Care processes measures were collected after the @-month intervention period .


Family outcome measures included the Vanderbilt ADHD Diagnostic Parent Rating Scale , Parenting Stress Index-Short Form , Individualized Goal Attainment Ratings , and Clinical Global Impression-Improvement Scale .


Most measures were collected at baseline , and @ - , @ - , and @-month assessments .


Provider outcome measures examined perceived treatment change , efficacy , and obstacles , and practice climate .


DOCC ( versus EUC ) was associated with higher rates of treatment initiation ( @ % vs @ % ; P < @ ) and completion ( @ % vs @ % , P < @ ) , improvement in behavior problems , hyperactivity , and internalizing problems ( P < @ to @ ) , and parental stress ( P < @ -@ ) , remission in behavior and internalizing problems ( P < @ , @ ) , goal improvement ( P < @ to @ ) , treatment response ( P < @ ) , and consumer satisfaction ( P < @ ) .


DOCC pediatricians reported greater perceived practice change , efficacy , and skill use to treat ADHD ( P < @ to @ ) .


Implementing a collaborative care intervention for behavior problems in community pediatric practices is feasible and broadly effective , supporting the utility of integrated behavioral health care services .


Self-collected human papillomavirus ( HPV ) testing could reduce barriers to cervical cancer screening , with performance comparable to clinician-collected specimens .


The ability of self-collected specimens to cross-sectionally and prospectively detect precursor lesions was investigated in an HPV vaccine randomized trial in Costa Rica .


In the trial , @ women age @ to @ years received an HPV@/@ or control vaccine and were followed at least annually for four years .


In this secondary analysis , we included all women who provided a self-collected cervicovaginal specimen six months after enrollment ( @ women = full analytical cohort ) .


A subset ( @ women = restricted cohort ) also had clinician-collected specimens at the six-month postenrollment visit .


High-grade squamous intraepithelial lesion or repeat low-grade squamous intraepithelial lesion prompted colposcopic referral throughout the study .


HPV testing was performed with SPF@PCR/DEIA/LiPA@ .


Cross-sectional and prospective sensitivity , specificity , and predictive values were estimated .


In the full cohort , one-time HPV testing on self-collected samples detected prevalent CIN@ + with a sensitivity of @ % ( @ % confidence interval -LSB- CI -RSB- = @ % to @ % ) and a specificity of @ % ( @ % CI = @ % to @ % ) .


For predicting incident CIN@ + in the subsequent four years , sensitivity was @ % ( @ % CI = @ % to @ % ) and specificity @ % ( @ % CI = @ % to @ % ) .


In the restricted cohort , for incident CIN@ + , self-collected HPV was much more sensitive than cytology ( @ % vs @ % ) ; relative sensitivity was @ ( @ % CI = @ % to @ % ) .


Furthermore , three times more women with normal baseline cytology developed incident CIN@ + than those with negative self-collected HPV .


Self-collected and clinician-collected HPV testing had comparable performance .


Agreement between self - and clinician-collected samples was @ % ( kappa = @ , McNemar @ = @ ) for carcinogenic HPV types .


Self-collected specimens can be used for HPV-based screening , providing sensitivity and specificity comparable with clinician-collected specimens and detecting disease earlier than cytology .


To investigate the effect of parenteral insulin therapy on endogenous insulin secretion in the Diabetes Prevention Trial-Type @ ( DPT-@ ) .


In the parenteral insulin arm of DPT-@ , subjects without diabetes at high risk of future type @ diabetes randomized to active treatment received a yearly @-day intravenous insulin infusion ( IV-I ) and daily subcutaneous insulin ( SC-I ) .


To examine the effects of these insulin therapies on endogenous insulin secretion , C-peptide and glucose levels were compared during oral glucose tolerance tests ( OGTTs ) performed on and off IV-I and SC-I .


Forty-six paired OGTTs were performed in @ subjects from DPT-@ to determine the effect of IV-I .


Twenty paired OGTTs were performed in @ subjects from DPT-@ to determine the effect of SC-I .


IV-I suppressed fasting and OGTT-stimulated C-peptide ( @ % and @ % , respectively ) , and it significantly lowered fasting glucose ( @ @ mg/dL during IV-I vs. @ @ mg/dL off insulin ; P < @ ) .


By contrast , post-OGTT glucose levels were significantly higher during IV-I : Glucose during IV-I versus off insulin at @ min was @ @ vs. @ @ mg/dL , respectively ( P < @ ) ; @ % of OGTTs became transiently diabetic ( > @ mg/dL at @ min ) when receiving IV-I .


Fasting glucose was significantly lower when receiving SC-I versus when off insulin ( @ @ vs. @ @ mg/dL , respectively ; P < @ ) , but SC-I did not significantly alter fasting or OGTT-stimulated C-peptide compared with being off insulin .


These data demonstrate that the IV-I used in the DPT-@ markedly suppressed endogenous insulin secretion , which was frequently associated with postprandial glucose intolerance .


SC-I , however , did not .


Some of the health advantages of breast-fed as compared to formula-fed infants have been suggested to be due to metabolic programming effects resulting from early nutrition .


In a prospective double-blinded randomized trial , @ infants < @ mo of age were randomized to experimental formula ( EF ) with added milk fat globule membrane ( MFGM ) or standard formula ( SF ) until @ mo of age .


A breast-fed reference ( BFR ) group consisted of @ infants .


Measurements were made at inclusion and at @ , @ , and @ mo of age .


During the intervention , the EF group had higher total serum cholesterol concentration than the SF group , reaching the level of the BFR group .


The EF group had a low-density lipoprotein to high-density lipoprotein ratio not significantly different from the SF group but lower than the BFR group .


Supplementation of infant formula with MFGM modified the fat composition of the formula and narrowed the gap between breast-fed and formula-fed infants with regard to serum lipid status at @ mo. .


Chronic obstructive pulmonary disease ( COPD ) is associated with increased morbidity and mortality and reduced quality of life ( QoL ) .


Novel interventions are needed to improve outcomes in COPD patients .


The present study assessed the effects of a telephone-based coping skills intervention on psychological and somatic QoL and on the combined medical end point of COPD-related hospitalizations and all-cause mortality .


We conducted a dual-site , randomized clinical trial with assessments at baseline and after @ weeks of treatment .


The study population comprised @ outpatients with COPD aged @ to @ years , randomized to coping skills training ( CST ) or to COPD education ( COPD-ED ) .


Patients completed a battery of QoL instruments , pulmonary function tests , and functional measures and were followed up for up to @ years to assess medical outcomes .


The CST group exhibited greater improvements in psychological QoL compared with controls ( p = @ ) , including less depression ( Cohen d = @ -LSB- @ % confidence interval , or CI = @-@ @ -RSB- ) and anxiety ( d = @ -LSB- @ % CI = @-@ @ -RSB- ) , and better overall mental health ( d = @ -LSB- @ % CI = @-@ @ -RSB- ) , emotional role functioning ( d = @ -LSB- @ % CI = @-@ @ -RSB- ) , vitality ( d = @ -LSB- @ % CI = @ , @ -RSB- ) , and social functioning ( d = @ -LSB- @ % CI = @-@ @ -RSB- ) .


A significant baseline psychological QoL by treatment group interaction revealed that CST with lower QoL at baseline achieved even greater improvements in psychological QoL compared with COPD-ED .


CST participants also exhibited greater improvements in somatic QoL ( p = @ ) , including greater improvements in pulmonary QoL ( d = @ -LSB- @ % CI = @-@ @ -RSB- ) , less fatigue ( d = @ -LSB- @ % CI = @-@ @ -RSB- ) , and less shortness of breath ( d = @ -LSB- @ % CI = -@ to @ -RSB- ) and greater improvement in distance walked on the Six-Minute Walk test ( d = @ -LSB- @ % CI = @-@ @ -RSB- ) .


However , there was no significant difference in risk of time to COPD-related hospitalization or all-cause mortality between CST ( @ events ) and COPD-ED ( @ events ; p = @ ) .


A telehealth CST intervention produced clinically meaningful improvements in QoL and functional capacity , but no overall improvement in risk of COPD-related hospitalization and all-cause mortality .


Comparison of visual acuity , refractive , and wavefront outcomes associated with optimized prolate ablation ( OPA ) and optical path difference custom aspheric treatment ( OPDCAT ) algorithms for correction of myopia exceeding @ diopters ( D ) .


Patients were randomly assigned to have photorefractive keratectomy ( PRK ) with OPA ( n = @ ) or OPDCAT ( n = @ ) algorithms .


Visual acuity , manifest refraction , ocular and corneal higher-order aberrations , corneal asphericity , modulated-transfer function , and point-spread function were compared @ , @ , and @ months postoperatively .


Mean manifest-refraction spherical equivalents at @ months were -@ D in both groups .


All patients in both groups had an uncorrected-distance visual acuity of @/@ or better .


Predictability ( @D from intended refraction ) at @ months was @ % in the OPA group , and in the OPDCAT group it was @ % .


The OPA group had less induced corneal and ocular spherical aberrations ( SAs ) than the OPDCAT group .


Postoperative corneal asphericity change was lowest in the OPA group .


Both the groups exhibited significantly-improved AreaRatio-Total value and insignificantly deteriorated AreaRatio-HO value throughout the postoperative period .


The OPA group had significantly-higher AreaRatio-Total compared with OPDCAT group at both @ and @ months after the operation .


Six months after surgery , the Strehl ratio had decreased in both groups , and there was no significant difference between the groups .


The OPA algorithms yielded higher-objective visual quality and predictability , induced less corneal and ocular SAs , and preserved more preoperative-corneal asphericity than the OPDCAT algorithms .


This study draws on baseline data from the At Home/Chez Soi demonstration project to examine the association between parenting status and mental health among homeless women and whether the association varies by duration of homelessness .


Structured interviews were conducted with participants in five cities across Canada including Moncton , Montreal , Toronto , Vancouver and Winnipeg .


Eligibility criteria included those with legal adult status , with a mental illness , and who lacked a regular , fixed shelter .


All @ women who participated in the larger project were selected for inclusion in this analysis .


The mental health conditions of interest include depression , post-traumatic stress disorder ( PTSD ) , alcohol dependence and substance dependence .


The relationship between parenting status and depression , as well as PTSD , varied by duration of homelessness .


Among women who had been homeless for less than @ years , no relationship was found between parenting status and depression , or PTSD .


However , among women who had been homeless for @ or more years , the odds of depression was twice as high among parenting women compared with others ( aOR = @ , p@ @ ) .


A similar relationship was found between parenting status and PTSD ( aOR = @ , p@ @ ) .


The odds of substance dependence was found to be @ times greater among parenting women compared with others and this relationship did not vary by duration of homelessness ( aOR = @ ; @ % CI @ to @ ) .


No relationship was found between parenting and alcohol dependence .


Overall , the findings from this study suggest that there is a relationship between long-term homelessness and mothers ' risk of poor mental health .


Given the multiple demands mothers face , a failure to recognise their unique needs is likely to contribute to intergenerational legacies of homelessness and mental health problems .


To investigate the effectiveness of the Shikani optical stylet ( SOS ) and GlideScope video laryngoscope ( GVL ) for tracheal intubation of thyroid tumor patients with a difficult airway .


One hundred and twenty thyroid tumor patients with a difficult airway , who were undergoing elective surgery requiring general anesthesia , were enrolled in the study .


They were randomly allocated to @ groups ( n = @ each ) who underwent direct laryngoscopy ( DL ) , SOS or GVL .


The outcomes recorded were time to intubation , first-attempt success rate , mean artery pressure ( MAP ) , heart rate ( HR ) and incidence of complications .


The mean time to intubation in the SOS group ( group S ; @ @ s ) and the GLV group ( group G ; @ @ s ) was significantly less than that in the DL group ( group D ) ( @ @ s ) .


The first-attempt success rate in group S ( @ % ) and group G ( @ % ) was significantly higher than that in group D ( @ % ; all p < @ ) .


The HR and MAP at @ min after intubation were lowest in group S ( @ @ beats/min and @ @ kPa ) , followed by group G ( @ @ beats/min and @ @ kPa ) and then group D ( @ @ beats/min and @ @ kPa ) .


The difference was statistically significant ( all p < @ ) .


The incidence of lip or mucosal trauma was lowest in group S , followed by group G and then group D.


The SOS and the GLV had advantages over the DL in the management of thyroid tumor patients with a difficult airway in terms of a shorter time to intubation , a higher first-attempt success rate and a reduced incidence of complications .


Thus , a rational choice of one of these techniques may be better for the perioperative safety of thyroid tumor patients with a difficult airway .


We aim to evaluate in-hospital events and long-term clinical outcomes in patients over @ years of age with stable coronary artery disease and preserved left ventricular ejection fraction undergoing off-pump or on-pump coronary artery bypass grafting .


The MASS III was a single-center randomized trial that evaluate @ patients with stable coronary artery disease and preserved ventricular function assigned for : @ to off-pump and @ to on-pump CABG .


Of this , @ ( @ % ) patients were @ years or older at the time of randomization ( @ of-pump and @ on-pump ) .


The primary short-term end point was a composite of myocardial infarction , stroke , and overall mortality occurring within @ days after surgery or before discharge , whichever was later .


The primary long-term end point was death from any cause within @ years , non-fatal myocardial infarction between @ days and @ years , or additional revascularization between @ days and @ years .


On-pump CABG had a higher incidence of @-day composite outcome than off-pump CABG ( @,@ % and @ % , respectively ; P = @ ) .


However , after the multivariate analysis , this association lost statistical significance , P = @ .


After @-year follow-up , there were no significant differences between both strategies of CABG in the composite end points @ % and @ % ; Hazard Ratio @ ; CI @ - @ ; P = @ , for off-pump and on-pump CABG respectively .


On-pump and off-pump CABG achieved similar results of combined events at short-term and @-year follow-up .


The combination of daclatasvir , a hepatitis C virus ( HCV ) NS@A inhibitor , and the NS@B inhibitor sofosbuvir has shown efficacy in patients with HCV monoinfection .


Data are lacking on the efficacy and safety of this combination in patients coinfected with human immunodeficiency virus type @ ( HIV-@ ) .