Breath-hold PC cine MR images of the coronary sinus were obtained with a @T MR imager with @ channel coils at rest and during a CPT performed after immersing one foot in ice water .


MBF was calculated as coronary sinus flow divided by the left ventricular ( LV ) mass which was given as a total LV myocardial volume measured on cine MRI multiplied by the specific gravity ( @ g/mL ) .


In non-smokers , MBF was @ mL/min/g at rest , with a significant increase to @ mL/min/g seen during CPT ( percentage change of MBF ( MBF ( % ) ) ; @ % @ % , p < @ ) .


Inter-study reproducibility for MBF ( % ) measurements by different MR technologist was good , as indicated by the intraclass correlation coefficient of @ and reproducibility coefficient of @ % .


There was no significant difference between smokers and non-smokers for resting MBF ( @ mL/min/g , p = @ ) .


However , MBF ( % ) in smokers was significantly reduced ( -@ % vs. @ % , p = @ ) .


PC cine MRI can be used to reproducibly quantify MBF response to CPT and to detect impaired flow response in smokers .


This MR approach may be useful for monitoring the sequential change of coronary blood flow in various potentially pathologic conditions and for investigating its relationship with cardiovascular risk .


We compared the efficacy of melatonin and placebo as adjuvants in the withdrawal of patients from long term temazepam , zopiclone or zolpidem ( here ` BZD ' ) use .


A double-blind , placebo-controlled , randomized trial was conducted in a primary health care outpatient clinic .


Ninety-two men or women ( @ years ) with primary insomnia and chronic BZD use received controlled release melatonin @ mg ( CRM ) ( n = @ ) or placebo ( n = @ ) during the @ month withdrawal from BZDs .


Psychosocial support was provided .


Follow-up continued for up to @ months .


Successful BZD withdrawal by the end of @ month was confirmed by BZD plasma determinations , while reduction in BZD use and abstinence continuing for @ months were noted .


There were two drop-outs on CRM and one on placebo .


After a @ month withdrawal , @ participants ( @ % ; @ % CI @ , @ ) on CRM and @ ( @ % ; @ , @ ) on placebo had withdrawn completely ( intention-to-treat analysis between groups , P = @ ; per protocol P = @ ) .


Reduction in BZD use was similar or even more rare in the CRM than in the placebo group ( P = @ per protocol ) .


After @ months , @ participants in the CRM group and @ in the placebo group remained non-users of BZD ( NS between groups ) .


BZD doses were higher in the CRM than in the placebo group at the end of the @ month follow-up ( P = @ ) .


Withdrawal symptoms did not differ between the groups .


Gradual dose reduction of BZDs combined with CRM or placebo , and psychosocial support produced high short term and moderate long term BZD abstinence .


CRM showed no withdrawal benefit compared with placebo .


Pain due to bone metastases is a common cause of cancer-related morbidity , with few options available for patients refractory to medical therapies and who do not respond to radiation therapy .


This study assessed the safety and efficacy of magnetic resonance-guided focused ultrasound surgery ( MRgFUS ) , a noninvasive method of thermal tissue ablation for palliation of pain due to bone metastases .


Patients with painful bone metastases were randomly assigned @:@ to receive MRgFUS sonication or placebo .


The primary endpoint was improvement in self-reported pain score without increase of pain medication @ months after treatment and was analyzed by Fisher 's exact test .


Components of the response composite , Numerical Rating Scale for pain ( NRS ) and morphine equivalent daily dose intake , were analyzed by t test and Wilcoxon rank-sum test , respectively .


Brief Pain Inventory ( BPI-QoL ) , a measure of functional interference of pain on quality of life , was compared between MRgFUS and placebo by t test .


Statistical tests were two-sided .


One hundred forty-seven subjects were enrolled , with @ and @ randomly assigned to MRgFUS and placebo treatments , respectively .


Response rate for the primary endpoint was @ % in the MRgFUS arm and @ % in the placebo arm ( P < @ ) .


MRgFUS was also superior to placebo at @ months on the secondary endpoints assessing worst score NRS ( P < @ ) and the BPI-QoL ( P < @ ) .


The most common treatment-related adverse event ( AE ) was sonication pain , which occurred in @ % of MRgFUS patients .


Two patients had pathological fractures , one patient had third-degree skin burn , and one patient suffered from neuropathy .


Overall @ % of all AEs resolved on the treatment day .


This multicenter phase III trial demonstrated that MRgFUS is a safe and effective , noninvasive treatment for alleviating pain resulting from bone metastases in patients that have failed standard treatments .


Intestinal immunity induced by oral poliovirus vaccine ( OPV ) is imperfect and wanes with time , permitting transmission of infection by immunised children .


Inactivated poliovirus vaccine ( IPV ) does not induce an intestinal mucosal immune response , but could boost protection in children who are mucosally primed through previous exposure to OPV .


We aimed to assess the effect of IPV on intestinal immunity in children previously vaccinated with OPV .


We did an open-label , randomised controlled trial in children aged @-@ years from Chinnallapuram , Vellore , India , who were healthy , had not received IPV before , and had had their last dose of OPV at least @ months before enrolment .


Children were randomly assigned ( @:@ ) to receive @ mL IPV intramuscularly ( containing @ , @ , and @ D antigen units for serotypes @ , @ , and @ ) or no vaccine .


The randomisation sequence was computer generated with a blocked randomisation procedure with block sizes of ten by an independent statistician .


The laboratory staff did blinded assessments .


The primary outcome was the proportion of children shedding poliovirus @ days after a challenge dose of serotype @ and @ bivalent OPV ( bOPV ) .


A second dose of bOPV was given to children in the no vaccine group to assess intestinal immunity resulting from the first dose .


A per-protocol analysis was planned for all children who provided a stool sample at @ days after bOPV challenge .


This trial is registered with Clinical Trials Registry of India , number CTRI/@/@ / @ .


Between Aug @ , @ , and Sept @ , @ , @ children were enrolled and randomly assigned into study groups .


@ children received IPV and @ no vaccine .


@ children in the no vaccine group and @ children in the IPV group had stool samples available for primary analysis @ days after bOPV challenge .


In the IPV group , @ ( @ % ) children shed serotype @ poliovirus and @ ( @ % ) shed serotype @ poliovirus compared with @ ( @ % ) and @ ( @ % ) in the no vaccine group ( risk ratio @ , @ % CI @-@ , p = @ ; @ , @-@ , p < @ ) .


No adverse events were related to the study interventions .


The substantial boost in intestinal immunity conferred by a supplementary dose of IPV given to children younger than @ years who had previously received OPV shows a potential role for this vaccine in immunisation activities to accelerate eradication and prevent outbreaks of poliomyelitis .


It is unclear how much the length of a cardiopulmonary resuscitation ( CPR ) training program can be reduced without ruining its effectiveness .


The authors aimed to compare CPR skills @ months and @ year after training between shortened chest compression-only CPR training and conventional CPR training .


Participants were randomly assigned to either the compression-only CPR group , which underwent a @-minute training program consisting of chest compressions and automated external defibrillator ( AED ) use with personal training manikins , or the conventional CPR group , which underwent a @-minute training program with chest compressions , rescue breathing , and AED use .


Participants ' resuscitation skills were evaluated @ months and @ year after the training .


The primary outcome measure was the proportion of appropriate chest compressions @ year after the training .


A total of @ persons were enrolled , and @ ( @ % ) in the compression-only CPR group and @ ( @ % ) in the conventional CPR group completed the @-year evaluation .


The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression ( mean SD = @ % @ % vs. @ % @ % ; p = @ ) and the number of appropriate chest compressions ( mean SD = @ @ vs. @ @ ; p = @ ) .


Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group ( mean SD = @ @ seconds vs. @ @ seconds ; p < @ ) .


The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program .


Hangeshashinto ( TJ-@ , a Kampo medicine ) , which reduces the level of prostaglandin E@ and affects the cyclooxygenase activity , alleviates chemotherapy-induced oral mucositis ( COM ) .


We conducted a double-blind , placebo-controlled , randomized comparative trial to investigate whether TJ-@ prevents and controls COM in patients with colorectal cancer .


Ninety-three patients with colorectal cancer who developed moderate-to-severe COM ( WHO grade @ ) during any cycle of chemotherapy using FOLFOX , FOLFIRI , and/or XELOX treatment were randomly assigned to receive either TJ-@ ( n = @ ) or placebo ( n = @ ) .


Patients received the administration of placebo or TJ-@ for @weeks at the start of the next course of chemotherapy .


Patients were assessed three times per week for safety and for COM incidence and its severity using the WHO grading .


Ninety eligible patients ( TJ-@ ; @ , placebo ; @ ) per protocol set analysis were included in the analysis after the key-opening .


Although the incidence of grade @ oral mucositis was lower for patients treated with TJ-@ compared to those treated with placebo , there was no significant difference ( @ vs. @ % ; p = @ ) .


The median duration of grade @ mucositis was @ versus @ days ( p = @ ) .


No difference in other treatment toxicity was observed between the two groups , and patients exhibited high compliance in dosing administration .


The present study results did not meet the primary endpoint .


However , TJ-@ demonstrated a significant effect in the treatment of grade @ mucositis in patients with colorectal cancer compared to the placebo .


This preliminary study aimed to investigate the effects of the probiotic Saccharomyces boulardii on proinflammatory and anti-inflammatory cytokines in patients with diarrhea-dominant irritable bowel syndrome ( IBS-D ) .


The other objectives were to document any clinical improvement as judged by symptoms , quality of life , and histology .


This was a randomized , double blind , placebo-controlled trial in which S. boulardii , @ mg/day , or placebo was administered for @ weeks in IBS-D patients , in addition to ispaghula husk standard treatment .


Thirty-seven patients received S. boulardii and @ patients received the placebo .


As compared with placebo , the S. boulardii group showed a significant decrease in blood and tissue levels of proinflammatory cytokines interleukin-@ ( IL-@ ) and tumor necrosis factor - ( P < @ ) and an increase in anti-inflammatory IL-@ levels , as well as an increase in the tissue IL-@ / IL-@ ratio ( P < @ ) .


No significant change in the blood and tissue levels of cytokines was found in the placebo group .


Bowel-related IBS-D symptoms reported in the patients ' daily diary improved in both groups .


However , overall improvement in the quality of life was more marked in the S. boulardii group .


Although baseline histological findings were mild , an improvement was observed in the probiotic group in the lymphocyte and neutrophil infiltrates ( P = @ and @ ) , epithelial mitosis ( P = @ ) , and intraepithelial lymphocytes ( P = @ ) .


No serious adverse events were found in either group .


S. boulardii with ispaghula husk was superior to placebo with ispaghula husk in improving the cytokine profile , histology , and quality of life of patients with IBS-D .


These preliminary results need to be confirmed in a well-powered trial .


Intermittent preventive treatment with sulphadoxine-pyrimethamine ( IPTp-SP ) is being implemented in most malaria endemic countries as a standard two-doses regimen as it reduces the risk of low birth weight ( LBW ) and the prevalence of maternal anaemia .


Nevertheless , where the risk of infection close to delivery is high because of intense transmission , a third IPTp-SP dose may further reduce the negative effects of malaria on pregnancy outcome .


Pregnant women in the @nd or @rd trimester were randomized to receive either @ ( SP@ ) or @ doses ( SP@ ) of SP .


Trained field workers paid home visits to the women for drug administration according to a predefined drug delivery schedule .


Women were encouraged to attend their scheduled ANC visits and to deliver at the health facilities where the new-born was weighed .


The prevalence of LBW ( < @ g ) , severe anaemia ( Hb < @ g/dL ) and premature birth was analysed using intention-to-treat ( ITT ) and per-protocol ( PP ) analysis .


Data from @ singleton pregnancies were analysed ( @ in the SP@ and @ in the SP@ group ) .


The uptake of the intervention appeared to be low .


Though the prevalence of LBW in both intervention groups was similar ( adjusted Incident Rate Ratio , AIRR = @ , @ % CI : @-@ @ ) in the ITT analysis , the risk of severe anaemia was significantly lower in the SP@ group compared to the SP@ group ( AIRR = @ , @ % CI : @ - @ ) .


The PP analysis showed a trend of reduced risk of LBW , severe anaemia and premature delivery in the SP@ group , albeit the difference between two and three IPTp-SP did not reach statistical significance .


The risk of LBW and severe anaemia tended to be lower in the SP@ group , though this was not statistically significant , probably due to the low uptake of the intervention which reduced the power of the study .


Further studies are needed for establishing whether a third SP dose has a real benefit in preventing the negative effects of malaria in pregnancy in settings where transmission is markedly seasonal .


Safety and efficacy of long-term olanzapine treatment in Japanese patients with bipolar depression were assessed .


An integrated analysis of data from two studies was performed in olanzapine-treated patients ( n = @ ) with bipolar depression .


Study @ was a @-week , double-blind , global study .


Patients were randomly assigned to olanzapine or placebo followed by @ weeks of open-label treatment .


Study @ was an open-label extension of Study @ involving only Japanese patients .


Patients assigned to Pre-olanzapine and Pre-placebo in Study @ were treated for @ weeks ( total olanzapine exposure @ or @ weeks ) and newly recruited patients ( New-olanzapine ) were treated for @ weeks .


Safety outcomes included treatment-emergent adverse events and changes in metabolic parameters .


Efficacy outcome was assessed with Montgomery-sberg Depression Rating Scale score .


Forty-three percent of patients completed the @ - or @-week olanzapine treatment period .


The most common treatment-emergent adverse event was weight increased ( @ % ) .


Significant increases were seen in weight ( @ kg ) , and in fasting glucose ( @ mg/dL ) , fasting total cholesterol ( @ mg/dL ) , and fasting triglycerides ( @ mg/dL ) .


Remission rates ( Montgomery-sberg Depression Rating Scale total score @ at any time ) were @ % for the Pre-olanzapine group , @ % for the Pre-placebo group , and @ % for the New-olanzapine group .


No patents developed mania during treatment .


Long-term use of olanzapine in a Japanese population with bipolar depression is associated with increases in weight and fasting metabolic measures , and also with improved depressive symptoms with avoidance of mania .


Clinicians must carefully consider the benefits and risks of long-term therapy with olanzapine .


To evaluate the prevalence of significant aortic valve stenosis ( AS ) in a randomly selected study population of elderly individuals representing the general population of Iceland .


Furthermore , to predict the number of individuals likely to have severe AS in the future .


Echocardiography and computed tomography ( CT ) data from individuals who participated in the AGES-Reykjavik study were used .


Echocardiography data from @ individuals ( @ % females ) aged @-@ years were available .


In both sexes combined , the prevalence for severe AS , defined as an aortic valve area index of < @ cm@/m@ , in the age groups < @ , @-@ and @ years was @ % , @ % and @ % , respectively .


A ROC analysis on the relation between the echocardiography data and the aortic valve calcium score on CT defined a score@ to be indicative of severe AS .


Subsequently , in a CT study cohort of @ individuals the prevalence of severe AS in the same age groups was @ % , @ % and @ % , respectively .


Overall , the prevalence of severe AS by echocardiography and CT in individuals@ years was @ % and @ % , respectively .


A prediction on the number of elderly@ years for the coming decades demonstrated that patients with severe AS will have increased @ fold by the year @ and will more than triple by the year @ .


This study , in a cohort of elderly individuals representative of the general population in a Nordic country , predicts that AS will be a large health problem in the coming decades .


Endometrial hyperplasia is clinically important , because it can lead to abnormal uterine bleeding ( AUB ) which itself can precede endometrial cancer .


Endometrial carcinoma is the most common malignancy of the female genital tract , occurring in about @ % -@ % younger , perimenopausal women as endometrial hyperplasia .


The treatment is hysterectomy or hormone therapy with progesterone .


The aim of this study was , therefore , to compare the effect of levonorgestrel intrauterine device ( LNG-IUD ) with medroxyprogesterone acetate ( MPA ) on simple endometrial hyperplasia for fertility preservation .


Forty women in reproductive age ( @-@ years ) with AUB with endometrial biopsies confirming simple hyperplasia , were enrolled in this study and then randomly divided into two groups .


All patients presented with designed special checklist which was filled with satisfaction .


Complete history and physical examination especially blood pressure ( BP ) , body mass index ( BMI ) , breast examination , bimanual vaginal examination , and transvaginal sonography ( to measure the thickness of endometrial and exclude the other pathologic lesions ) were performed .


In the first group , treatment was performed with MPA ( @ mg/daily ) for ten days and in other group with LNG-IUD was prescribed .


After three months , transvaginal sonography and biopsy of endometrium were done .


The status of AUB and side-effects of two methods , along with the rate of satisfactory were evaluated .


The findings showed the significant differences in the treatment of simple hyperplasia between two groups ( LNG-IUD group vs. MPA group ) ( p < @ ) .


Recovery of AUB in the group LNG was enhanced ( p < @ ) .


Endometrial thickness was reduced in both groups ( p < @ ) , but further reduction in LNG group was seen .


Also , LNG was tolerated more than MPA .


Side-effects of MPA were more and reached significance ( p < @ ) .


The rate of satisfaction with LNG was higher than MPA and reached significance ( p < @ ) .


The results of this study show that LNG-IUD is more effective than MPA in treatment of simple endometrial hyperplasia and can be helpful in young women who want to preserve their fertilities .


Evidence of the effectiveness of printed educational messages in narrowing the gap between guideline recommendations and practice is contradictory .


Failure to screen for retinopathy exposes primary care patients with diabetes to risk of eye complications .


Screening is initiated by referral from family practitioners but adherence to guidelines is suboptimal .


We aimed to evaluate the ability of printed educational messages aimed at family doctors to increase retinal screening of primary care patients with diabetes .


Design : Pragmatic @ factorial cluster trial randomized by physician practice , involving @,@ general practitioners ( with @,@ patients with diabetes ) .


Setting : Ontario family practitioners .


Interventions : Reminders ( that retinal screening helps prevent diabetes-related vision loss and is covered by provincial health insurance for patients with diabetes ) with prompts to encourage screening were mailed to each physician in conjunction with a widely-read professional newsletter .


Alternative printed materials formats were an ` outsert ' ( short , directive message stapled to the outside of the newsletter ) , and/or a two-page , evidence-based article ( ` insert ' ) and a pre-printed sticky note reminder for patients .


Main Outcome Measure : A successful outcome was an eye examination ( which includes retinal screening ) provided to a patient with diabetes , not screened in the previous @ months , within @ days after visiting a family practitioner .


Analysis accounted for clustering of doctors within practice groups .


No intervention effect was detected ( eye exam rates were @ % for patients of control physicians , @ % for the insert , @ % for the outsert , @ % for those who received both , and @ % for those who received both plus the patient reminder with the largest @ % confidence interval around any effect extending from -@ % to @ % ) .


This large trial conclusively failed to demonstrate any impact of printed educational messages on screening uptake .


Despite their low cost , printed educational messages should not be routinely used in attempting to close evidence-practice gaps relating to diabetic retinopathy screening .


Individually , levosimendan and nesiritide have been associated with substantial clinical benefits for the treatment of acute decompensated heart failure ( ADHF ) .


The aim of this study was to evaluate the efficacy of the combination of levosimendan and nesiritide for the treatment of ADHF .


One hundred and twenty patients were randomly assigned to control , levosimendan , nesiritide or combination groups .


The patients received @ drugs : @ was levosimendan or placebo A and the other was nesiritide or placebo B.


The primary end points were rates of clinical effectiveness at @ , @ , @ and @ days after the start of therapy .


Nine days after the initiation of drug infusion , the clinical effectiveness rate in the combination group was better than that in the control group ( odds ratio : @ , @ % confidence interval : @-@ @ , P = @ ) .


The combination treatment also resulted in higher rates of clinical effectiveness than individually provided levosimendan or nesiritide at @ day ( both P = @ ) or placebo at @ , @ or @ days ( P = @ , @ and @ , respectively ) .


The combination method was associated with fewer deaths and readmissions , as compared with the rate observed in the placebo group during the @-month follow-up ( hazard ratio : @ , @ % confidence interval : @-@ @ , P = @ ) .


Among patients with ADHF , intravenous infusion of levosimendan and nesiritide was superior to placebo and single-drug therapies in terms of improvements in clinical conditions during the early stages of therapy .


The aim of the study was to compare ligation anopexy ( LA ) and conventional hemorrhoidectomy ( CH ) in treatment of second - and third-degree hemorrhoids .


A prospective controlled randomized clinical trial included @ patients who underwent CH ( CH group ) and @ patients who underwent LA ( LA group ) .


A detailed history was taken from all the patients .


The effectiveness , safety , postoperative complications , operative time , length of hospital stay , time until first bowel movement , time until return to work , and postoperative pain score were assessed .


There was no significant difference between groups regarding age , sex , and preoperative symptoms .


The LA group had significantly shorter operative times , earlier first bowel movement , and an earlier return to work/activities .


The postoperative pain score in the LA group was significantly lower than that in the CH group on days @ , @ , @ , and @ after surgery .


There was no significant difference between groups as regards postoperative complications .


LA is safe , and as effective as CH in the treatment of grade II and grade III hemorrhoids , with shorter operative times , earlier mobilization , and lower postoperative pain scores .


Repetitive transcranial magnetic stimulation of the left temporo-parietal junction area has been studied as a treatment option for auditory verbal hallucinations .


Although the right temporo-parietal junction area has also shown involvement in the genesis of auditory verbal hallucinations , no studies have used bilateral stimulation .


Moreover , little is known about durability effects .


We studied the short and long term effects of @ Hz treatment of the left temporo-parietal junction area in schizophrenia patients with persistent auditory verbal hallucinations , compared to sham stimulation , and added an extra treatment arm of bilateral TPJ area stimulation .


In this randomized controlled trial , @ patients diagnosed with schizophrenia and persistent auditory verbal hallucinations were randomly allocated to treatment of the left or bilateral temporo-parietal junction area or sham treatment .


Patients were treated for six days , twice daily for @ minutes .


Short term efficacy was measured with the Positive and Negative Syndrome Scale ( PANSS ) , the Auditory Hallucinations Rating Scale ( AHRS ) , and the Positive and Negative Affect Scale ( PANAS ) .


We included follow-up measures with the AHRS and PANAS at four weeks and three months .


The interaction between time and treatment for Hallucination item P@ of the PANSS showed a trend for significance , caused by a small reduction of scores in the left group .


Although self-reported hallucination scores , as measured with the AHRS and PANAS , decreased significantly during the trial period , there were no differences between the three treatment groups .


We did not find convincing evidence for the efficacy of left-sided rTMS , compared to sham rTMS .


Moreover , bilateral rTMS was not superior over left rTMS or sham in improving AVH .


Optimizing treatment parameters may result in stronger evidence for the efficacy of rTMS treatment of AVH .


Moreover , future research should consider investigating factors predicting individual response .


The period from the mid-@s to the mid-@s saw a rapid increase in long-term sick leave in Sweden , primarily due to mental illness and often related to job burnout .


This led to an urge for effective treatment programs that could prevent the often long sick leaves .


In @ we presented a newly developed work-place intervention method , showing that @ % of the intervention group had returned to work at a @ year follow-up , compared to @ % of the control group .


The main aim of this study was to assess the long-term stability of these promising results .


Sick leave registry data from the Regional Social Insurance Office were analyzed for an additional year ( @weeks ) beyond the original @ year period ( @weeks ) .


Data from @ matched pairs of intervention participants ( IP ) and controls were available .


The proportions of participants being on full-time sick leave versus having returned to work to any extent were computed for every @th week .


Generalized estimating equations were used with GROUP ( IP versus controls ) as between-subjects factor , WEEKS and AGE as covariates , and return-to-work ( RTW ) as dependent variable .


Significant differences ( Wald @ with @ ) was followed up with polynomial contrasts .


Individual relapses to higher degrees of sick leave ( e.g. from @ % to @ % ) and whether partial RTW led to later full-time RTW , were also analyzed .


The omnibus test over all @weeks showed a GROUP * WEEKS interaction effect ( p = @ ) , indicating differential group developments in RTW , though similarly high at week @ in both groups with @ % of the IP and @ % of the controls having RTW ( p = @ ; @-test ) .


A significant interaction with age led to separate analyses of the younger and older subgroups , indicating a stable pattern of superior RTW only among younger IP ( week @ : @ % vs. @ % , p = @ ; @-test ) .


There was no group difference in relapses into increased degree of sick leave .


Part-time sick leave did not predict a later stable full-time RTW .


The previously reported improvement in RTW with the newly developed workplace-oriented intervention showed a long-term stability only among younger participants .


To assess the effectiveness of nasal saline irrigation in adult patients with chronic rhinosinusitis .


PubMed , EMBASE , the Cochrane Library .


A comprehensive search was performed , and @ authors independently screened publications .


The design of selected studies was assessed on directness of evidence and risk of bias .


Of @ publications , @ open-label randomized trial with high directness of evidence and moderate risk of bias was included .


In this study , @ patients were randomly allocated to isotonic nasal saline irrigation or isotonic nasal saline spray , as added to their usual medication .


The mean @-Item Sinonasal Outcome Test ( SNOT-@ ) scores of those treated with nasal irrigation improved more than those allocated to nasal spray .


While the authors consider an improvement of @ or more to be clinically meaningful , the changes from baseline in mean SNOT-@ scores of those treated with irrigation ( and the differences with those treated with nasal spray ) at @ , @ , and @ weeks were @ ( difference @ , -LSB- @ % confidence interval -@ to @ -RSB- ) , @ ( difference @ -LSB- @ to @ -RSB- ) , and @ ( difference @ -LSB- @ to @ -RSB- ) , respectively .


Side effects of posttreatment nasal dripping were common but minor and did not lead to discontinuation of treatment .


It should be explained to adult patients with chronic rhinosinusitis that there is limited information on the relative effect of nasal saline irrigation and nasal saline spray on subjective symptom improvement , since there is only @ trial available with a moderate risk of bias showing limited benefit of irrigation over spray .


The paper presents clinical-radiological research on the impact of the new semi-cement luting agent in the immediately loaded implant-supported restoration on alveolar ridge resorption .


@ patients with a partially edentulous alveolar ridge in the anterior section of the maxilla or mandible were included in the study .


The implants were inserted with the application of traditional burs or with a Piezosurgery device supplied by Mectron .


Taking into account the method of implant bed preparation , the scientific material was divided into two groups .


The implants were loaded immediately with single crown restorations cemented with the Implantlink semi cement application .


The following indices were taken into consideration : pocket depth around implant calculated at four measuring points , marginal alveolar bone loss measured using radio-visiography , the @-degree Wachtel scale of healing of the soft tissue .


In addition , the presence and possible width or height of any recession around the implants was measured .


The success of the implant treatment was assessed according to the Albrektsson success criteria .


The research results were subjected to statistical analysis .


The results of our study revealed no influence of the Implant-link semi cement on the crestal bone level , regardless of the bone bed preparation technique .


We developed and validated a Patient Satisfaction with Cancer-Related Care ( PSCC ) measure using classical test theory methods .


The present study applied item response theory ( IRT ) analysis to determine item-level psychometric properties , facilitate development of short forms , and inform future applications for the PSCC .


We applied unidimensional IRT models to PSCC data from @,@ participants ( @ % female ; @ to @ years ) .


An unconstrained graded response model ( GRM ) and a Rasch Model were fitted to estimate indices for model comparison using likelihood ratio ( LR ) test and information criteria .


We computed item and latent trait parameter estimates , category and operating characteristic curves , and tested information curves for the better fitting model .


The GRM fitted the data better than the Rasch Model ( LR = @ , df = @ , p < @ ) .


The log-likelihood ( -@,@ vs. -@,@ ) was larger , and the AIC and BIC were smaller for the GRM compared to the Rash Model ( AIC = @,@ vs. @,@ ; BIC = @,@ vs. @,@ ) .


Item parameter estimates ( IPEs ) showed substantial variation in items ' discriminating power ( @ to @ ) .


Standard errors of the IPEs were small ( threshold parameters mostly around @ ; discrimination parameters @ to @ ) , confirming the precision of the IPEs .


The GRM provides precise IPEs that will enable comparable scores from different subsets of items , and facilitate optimal selections of items to estimate patients ' latent satisfaction level .


Given the large calibration sample , the IPEs can be used in settings with limited resources ( e.g. , smaller samples ) to estimate patients ' satisfaction .


Glutathione ( GSH ) , the most abundant endogenous antioxidant , is a critical regulator of oxidative stress and immune function .


While oral GSH has been shown to be bioavailable in laboratory animal models , its efficacy in humans has not been established .


Our objective was to determine the long-term effectiveness of oral GSH supplementation on body stores of GSH in healthy adults .


A @-month randomized , double-blinded , placebo-controlled trial of oral GSH ( @ or @,@ mg/day ) on GSH levels in blood , erythrocytes , plasma , lymphocytes and exfoliated buccal mucosal cells was conducted in @ non-smoking adults .


Secondary outcomes on a subset of subjects included a battery of immune markers .


GSH levels in blood increased after @ , @ and @ months versus baseline at both doses .


At @ months , mean GSH levels increased @-@ % in erythrocytes , plasma and lymphocytes and @ % in buccal cells in the high-dose group ( P < @ ) .


GSH levels increased @ and @ % in blood and erythrocytes , respectively , in the low-dose group ( P < @ ) .


In most cases , the increases were dose and time dependent , and levels returned to baseline after a @-month washout period .


A reduction in oxidative stress in both GSH dose groups was indicated by decreases in the oxidized to reduced glutathione ratio in whole blood after @ months .


Natural killer cytotoxicity increased > twofold in the high-dose group versus placebo ( P < @ ) at @ months .


These findings show , for the first time , that daily consumption of GSH supplements was effective at increasing body compartment stores of GSH .


To compare femtosecond laser-assisted cataract surgery without the use of ophthalmic viscosurgical device ( OVD ) with standard phacoemulsification using OVD .


This was a prospective , randomized , single-center trial of @ patients ( @ eyes ) diagnosed as having significant cataract in both eyes .


Randomly , one eye underwent standard phacoemulsification with OVD ( the OVD group ) ; this group acted as controls .


The other eye was treated with the femtosecond laser ; the subsequent manual part of the procedure was performed without OVD ( non-OVD group ) .


Time of surgery , amount of fluid used during phacoemulsification , central corneal thickness , intraocular pressure , endothelial cell count , and visual acuity were documented over the @-month follow-up .


There were no major complications and no significant difference in overall surgery time ( non-OVD : @ @ seconds ; OVD : @ @ seconds ; P = @ ) and in the quantity of fluid passing through the eye ( non-OVD : @ @ mL ; OVD : @ @ mL ; P = @ ) between groups .


Endothelial cell loss after @ months was not significantly different between groups ( non-OVD : -@ % ; OVD : -@ % ; P = @ ) .


Central corneal thickness was not different at @ week postoperatively between groups ( non-OVD : @ @ m ; OVD : @ @ m ; P = @ ) .


Three patients in the OVD group and one patient in the non-OVD group experienced intraocular pressure greater than @ mm Hg at @ day postoperatively .


There were no significant differences in corrected distance visual acuity between groups ( logMAR non-OVD : @ ; OVD : @ ; P = @ ) .


Femtosecond laser-assisted treatment allows the cataract surgeon to perform phacoemulsification and intraocular lens implantation without the use of OVD at no additional risk to the corneal endothelium .


Furthermore , there was a tendency toward fewer increases in intraocular pressure in patients treated with the femtosecond laser .


To evaluate the clinical efficacy and safety of the three therapies of strong stimulation for children peripheral facial palsy so as to deal with the problem on the inactive acceptance of acupuncture in children .


Eighty cases of children peripheral facial palsy were randomized into a moxa stick group ( group A ) and a group with three therapies of strong stimulation ( group B ) .


Baihui ( GV @ ) , Sibai ( ST @ ) , Dicang ( ST @ ) , Jiache ( ST @ ) and the other acupoints were selected in the two groups and stimulated with half-needling technique .


In the group A , @ moxa sticks were bunched together for surrounding moxibustion over one of Dazhui ( GV @ ) , Yangbai ( GB @ ) , Xiaguan ( ST @ ) and Jiache ( ST @ ) in each treatment .


In the group B , the strong pricking therapy , strong cupping therapy and strong moxibustion were adopted at the same acupoints as the group A.


The treatment was given twice every day in the first @ days .


Afterwards , the clinical efficacy was analyzed statistically .


The treatment was kept on for the effective case .


Those with failed effect were transferred to the other group .


Since the @th day , the treatment was given once every day .


In @ days , the clinical efficacy was compared between the two groups and House-Brackmann ( H-B ) facial nerve function grade was compared before and after treatment .


In @ days of treatment , the total effective rate was @ % ( @/@ ) in the group B , which was better than @ % ( @/@ ) in the group A , ( P < @ ) .


In @ days of treatment , the cured rate and the total effective rate in the group B were @ % ( @/@ ) and @ % ( @/@ ) , which were better than @ % ( @/@ ) and @ % ( @/@ ) in the group A , respectively ( P < @ , P < @ ) .


Additionally , the result of H-B facial nerve function grade in the group B was superior to the group A ( P < @ ) .


The half-needling technique and the three therapies of strong stimulation in combination achieve the superior efficacy on children peripheral facial palsy as compared with the half-needling technique combined with moxa stick therapy .


And the obvious adverse reaction has not been found .


Tofacitinib , an orally administered Janus kinase inhibitor , blocks signaling through - chain-containing cytokines ( interleukins @ , @ , @ , @ , @ , and @ ) .


We performed a phase @ trial to measure its efficacy in patients with moderate-to-severe active Crohn 's disease .


Patients ( N = @ ; age , @ y ) with moderate-to-severe active Crohn 's disease were assigned randomly to groups given @ mg ( n = @ ) , @ mg ( n = @ ) , or @ mg ( n = @ ) tofacitinib or placebo ( n = @ ) , twice daily for @ weeks , at @ centers in @ countries .


The primary end point was the proportion of clinical responders at week @ ( decrease from baseline in the Crohn 's Disease Activity Index score of @ points -LSB- Response-@ -RSB- ) .


Secondary end points included clinical remission ( Crohn 's Disease Activity Index score of < @ points ) at week@ .


A clinical response was observed in @ % ( P = @ ) , @ % ( P = @ ) , and @ % ( P @ ) of patients given the @ - , @ - , and @-mg doses of tofacitinib , compared with @ % of patients given placebo .


Clinical remission was observed in @ % ( P = @ ) , @ % ( P = @ ) , and @ % ( P = @ ) of patients given the @ - , @ - , and @-mg doses of tofacitinib , compared with @ % of patients given placebo .


The @-mg dose of tofacitinib reduced levels of C-reactive protein and fecal calprotectin from baseline .


Adverse and serious adverse events were similar among groups .


Dose-dependent increases in low - and high-density lipoprotein cholesterol were observed in patients given the @ - or @-mg doses of tofacitinib .


There were no significant differences in the percentage of patients with moderate-to-severe active Crohn 's disease who achieved clinical responses ( Response-@ ) or clinical remission after @ weeks ' administration of tofacitinib ( @ , @ , or @ mg ) or placebo twice daily .


However , a large percentage of patients given placebo achieved Response-@ or remission .


Reductions in C-reactive protein and fecal calprotectin levels among patients given the @-mg dose of tofacitinib indicate its biologic activity .


ClinicalTrials.gov number : NCT@ .


Triple negative breast cancer ( TNBC ) has higher rates of recurrence and distant metastasis , and poorer outcome as compared to non-TNBC .


Aberrant activation of WNT signaling has been detected in TNBC , which might be important for triggering oncogenic conversion of breast epithelial cell .


Therefore , we directed our focus on identifying the WNT ligand and its underlying mechanism in TNBC cells .


We performed large-scale analysis of public microarray data to screen the WNT ligands and the clinical significance of the responsible ligand in TNBC .


WNT@B was identified and its overexpression in TNBC was confirmed by immunohistochemistry staining , Western blot and ELISA .


ShRNA was used to knockdown WNT@B expression ( shWNT@B ) .


Cellular functional alteration with shWNT@B treatment was determined by using wound healing assay , mammosphere assay ; while cell cycle and apoptosis were examined by flowcytometry .


Mitochondrial morphology was photographed by electron microscope .


Biological change of mitochondria was detected by RT-PCR and oxygen consumption assay .


Activation of WNT pathway and its downstream targets were evaluated by liciferase assay , immunohistochemistry staining and immunoblot analysis .


Statistical methods used in the experiments besides microarray analysis was two-tailed t-test .


WNT@B was elevated both in the tumor and the patients ' serum .


Suppression of WNT@B remarkably impaired cell growth , migration and mammosphere formation .


Additionally , G@/G@ cell cycle arrest and caspase-independent apoptosis was observed .


Study of the possible mechanism indicated that these effects occurred through suppression of mitochondrial biogenesis , as evidenced by reduced mitochondrial DNA ( MtDNA ) and compromised oxidative phosphorylation ( OXPHOS ) .


In Vivo and in vitro data uncovered that WNT@B modulated mitochondrial physiology was mediated by MCL@ , which was regulated by WNT / - catenin responsive gene , Myc .


Clinic data analysis revealed that both WNT@B and MCL@ are associated with enhanced metastasis and decreased disease-free survival .


All our findings suggested that WNT@B/MCL@ cascade is critical for TNBC and understanding its regulatory apparatus provided valuable insight into the pathogenesis of the tumor development and the guidance for targeting therapeutics .


Radial head subluxation , also known as ` pulled elbow ' , ` dislocated elbow ' or ` nursemaid 's elbow ' , is one of the most common upper extremity injuries in young children and a common reason to visit Emergency Department ( ED ) .


To compare supination of the wrist followed by flexion of the elbow ( the traditional reduction technique ) to hyperpronation of the wrist in the reduction of radial head subluxations ( nursemaid 's elbow ) maneuvers in children presented to ED with painful pronation and to determine which method is less painful by children .


This prospective randomize study involved a consecutive sampling of children between @-@ year old who were presented to the ED with painful pronation .


The initial procedure was repeated if baseline functioning did not return @ minutes after the initial reduction attempt .


Failure of that technique @ minutes after the initial reduction attempt resulted in a cross-over to the alternate method of reduction .


Datas were analyzed using SPSS for Windows @ .


Mean , standard deviation , independent samples t test , Chi-square test , and paired t test were used in the assessment of pain scores before and after reduction .


When pain scores before and after reduction were compared between groups to determine which technique is less painful by children , no significant difference was found between groups .


It was found that in the reduction of radial head subluxations , the hyperpronation technique is more effective in children who were presented to ED with painful pronation compared with supination-flexion .


However , there was no significant difference between these techniques in terms of pain .


Isomaltulose attenuates postprandial glucose and insulin concentrations compared with sucrose in patients with type @ diabetes mellitus ( T@DM ) .


However , the mechanism by which isomaltulose limits postprandial hyperglycemia has not been clarified .


The objective was therefore to assess the effects of bolus administration of isomaltulose on glucose metabolism compared with sucrose in T@DM .


In a randomized , double-blind , crossover design , @ participants with T@DM initially underwent a @-h euglycemic-hyperinsulinemic ( @ mU kg ( -@ ) min ( -@ ) ) clamp that was subsequently combined with @ g/kg body wt of an oral ( @ ) C-enriched isomaltulose or sucrose load .


Hormonal responses and glucose kinetics were analyzed during a @-h postprandial period .


Compared with sucrose , absorption of isomaltulose was prolonged by @ min ( P = @ ) .


Mean plasma concentrations of insulin , C-peptide , glucagon , and glucose-dependent insulinotropic peptide were @-@ % lower ( P < @ ) .


In contrast , glucagon-like peptide @ ( GLP-@ ) was @ % higher ( P < @ ) after isomaltulose ingestion , which results in an increased insulin-to-glucagon ratio ( P < @ ) compared with sucrose .


The cumulative amount of systemic glucose appearance was @ % lower after isomaltulose than after sucrose ( P = @ ) because of the reduction in orally derived and endogenously produced glucose and a higher first-pass splanchnic glucose uptake ( SGU ) .


Insulin action was enhanced after isomaltulose compared with sucrose ( P = @ ) .


Ingestion of slowly absorbed isomaltulose attenuates postprandial hyperglycemia by reducing oral glucose appearance , inhibiting endogenous glucose production ( EGP ) , and increasing SGU compared with ingestion of rapidly absorbed sucrose in patients with T@DM .


In addition , GLP-@ secretion contributes to a beneficial shift in the insulin-to-glucagon ratio , suppression of EGP , and enhancement of SGU after isomaltulose consumption .


This trial was registered at clinicaltrials.gov as NCT@ .


Ultrasound guidance may decrease the procedural time for many peripheral nerve blocks compared to nerve stimulation , but these studies have generally excluded obese patients .


This single-blinded randomized clinical trial was designed to compare procedural times and related outcomes for ultrasound - versus nerve stimulation-guided lateral popliteal-sciatic nerve blockade specifically in obese patients .


With Institutional Review Board approval and informed consent , patients with a body mass index greater than @ kg/m ( @ ) who were scheduled for foot/ankle surgery and desiring a peripheral nerve block were offered enrollment .


Study patients were randomly assigned to receive a lateral popliteal-sciatic nerve block under either ultrasound or nerve stimulation guidance .


The patient and assessor were blinded to group assignment .


The primary outcome was procedural time in seconds .


Secondary outcomes included number of needle redirections , procedure-related pain , patient satisfaction with the block , success rate , sensory and motor onset times , block duration , and complication rates .


Twenty-four patients were enrolled and completed the study .


All patients had successful nerve blocks .


The mean procedural times ( SD ) were @ ( @ ) seconds under nerve stimulation and @ ( @ ) seconds with ultrasound guidance ( P < @ ; @ % confidence interval for difference , @-@ seconds ) .


Patients in the ultrasound group had fewer needle redirections and less procedure-related pain , required less opioids , and were more satisfied with their block procedures .


There were no statistically significant differences in other outcomes .


The results of this study show that , for obese patients undergoing lateral popliteal-sciatic nerve blocks , ultrasound guidance reduces the procedural time and procedure-related pain and increases patient satisfaction compared to nerve stimulation while providing similar block characteristics .


To determine the extent that social variables influence cognitive development of very low birth weight ( VLBW ) infants across the preschool years .


Participants were VLBW ( @-@ g ) children enrolled in the Caffeine for Apnea of Prematurity randomized trial between @ and @ .


We investigated the relationships between @ potential social advantages : higher maternal education , higher paternal education , caregiver employment , and @ biologic parents in the same home -- and gain in cognitive scores .


Cognitive assessments were performed at the corrected ages of @ months ( Mental Development Index score on the Bayley Scales of Infant Development II ) and @ years ( Full Scale IQ on the Wechsler Preschool and Primary Scale of Intelligence III ) .


Cognitive gain was computed by subtracting each individual @-month Mental Development Index score from the corresponding Full Scale IQ at @ years .


Data were available for @ children .


Mean ( SD ) cognitive scores were @ ( @ ) at @ months and @ ( @ ) at @ years .


Multivariable regression showed that higher maternal education , higher paternal education , and caregiver employment had independent and additive effects of similar size on cognitive gain ( P < @ ) ; the mean cognitive gain between @ months and @ years increased by @ points in the presence of each of these advantages .


When all @ were present , cognitive scores improved on average by @ points compared with children without any of these advantages .


In VLBW children , a count of @ social advantages strongly predicts gains in cognitive scores across the preschool years .


Detectable levels of troponins are often found in serum of patients with atrial fibrillation ( AF ) , and recent reports suggest that Tn concentrations are independently related to patient prognosis .


We hypothesized that treatment with common rate-reducing drugs might lower the levels of cardiac troponin T ( TnT ) in patients with permanent AF .


We also wanted to investigate whether the different drugs would impact the Tn levels differently .


Sixty patients were included ( mean age @ @ years , @ women ) in this randomized crossover study .


All patients had stable , permanent AF without ischemic heart disease or congestive heart failure .


Diltiazem @ mg , verapamil @ mg , metoprolol @ mg , and carvedilol @ mg were administered once daily for @ weeks , in a randomized sequence .


At baseline and on the last day of each treatment period , TnT concentrations were measured at rest and after a maximal exercise test .


TnT was detectable in all patients .


In @ % of the patients , TnT concentrations were above the threshold normally used for diagnosing myocardial infarction .


All drugs reduced the levels of TnT significantly compared with baseline ( P < @ for all ) , but there were no significant differences between the treatments .


Levels of TnT increased significantly in response to exercise testing ( P < @ for all ) .


Elevated TnT was demonstrated in a large proportion of stable patients with permanent AF without ischemic heart disease .


A moderate reduction of heart rate by the study drugs was associated with a significant reduction in levels of TnT .


Pain and depression are prevalent and treatable symptoms among patients with cancer , yet they are often undetected and undertreated .


The Indiana Cancer Pain and Depression ( INCPAD ) trial demonstrated that telecare management can improve pain and depression outcomes .


This article investigates the incremental cost effectiveness of the INCPAD intervention .


The INCPAD trial was conducted in @ community-based urban and rural oncology practices in Indiana .


Of the @ participants , @ were randomized to the intervention group and @ to the usual-care group .


Intervention costs were determined , and effectiveness outcomes were depression-free days and quality-adjusted life years .


The intervention group was associated with a yearly increase of @ depression-free days ( S.E. = @ ; P < @ ) and an increase of between @ and @ quality-adjusted life years compared to the usual care group .


Total cost of the intervention per patient was US$ @ , which included physician , nurse care manager and automated monitoring set-up and maintenance costs .


Incremental cost per depression-free day was US$ @ , which yields a range of US$ @,@ to US$ @,@ per quality-adjusted life year when converted to that metric .


When measured directly , the incremental cost per quality-adjusted life year ranged from US$ @,@ based on the modified EQ-@D to US$ @,@ based on the SF-@ .


Centralized telecare management , coupled with automated symptom monitoring , appears to be a cost effective intervention for managing pain and depression in cancer patients .


The administration of uterotonic agents during cesarean delivery is highly variable .


The authors hypothesized a `` rule of threes '' algorithm , featuring oxytocin @ IU , timed uterine tone evaluations , and a systematic approach to alternative uterotonic agents , would reduce the oxytocin dose required to obtain adequate uterine tone .


Sixty women undergoing elective cesarean delivery were randomized to receive a low-dose bolus or continuous infusion of oxytocin .


To blind participants , the rule group simultaneously received intravenous oxytocin ( @ IU/@ ml ) and a `` wide-open '' infusion of @ % normal saline ( @ ml ) ; the standard care group received intravenous @ % normal saline ( @ ml ) and a `` wide-open '' infusion of oxytocin ( @ IU in @ % normal saline/@ ml ) .


Uterine tone was assessed at @ , @ , @ , and @ min , and if inadequate , additional uterotonic agents were administered .


Uterine tone , total dose and timing of uterotonic agent use , maternal hemodynamics , side effects , and blood loss were recorded .


Adequate uterine tone was achieved with lower oxytocin doses in the rule versus standard care group ( mean , @ vs. @ IU ; point estimate of the difference , @ @ IU ; @ % CI , @ to @ ; P < @ ) .


No additional oxytocin or alternative uterotonic agents were needed in either group after @ min .


No differences in the uterine tone , maternal hemodynamics , side effects , or blood loss were observed .


A `` rule of threes '' algorithm using oxytocin @ IU results in lower oxytocin doses when compared with continuous-infusion oxytocin in women undergoing elective cesarean delivery .


Glucagon-like peptide-@ ( GLP-@ ) and the insulin-like growth factor ( IGF ) system are important factors in metabolic regulation and cellular growth .


Interactions between the systems exist but these are vaguely explored and only in vitro , where GLP-@ has been reported to stimulate IGF-binding protein @ ( IGFBP-@ ) .


This study , therefore , aimed to elucidate the effects of GLP-@ on IGF-I and the IGFBPs , which regulate IGF-I bioactivity .


We investigated the effects of a @-hour intravenous GLP-@ infusion on the IGF system in @ overnight fasted healthy humans , using a randomized , double-blinded , cross-over study design .


Serum samples were assessed for immunoreactive levels of IGF-I , IGFBP-@ and -@ as well as for bioactive IGF-I , which was determined by a cell-based IGF-I kinase receptor activation assay .


GLP-@ infusion markedly increased insulin levels ( p < @ ) , reduced IGFBP-@ levels ( p = @ ) , and tended to increase IGF-I bioactivity ( p = @ ) .


There were no significant changes in IGFBP-@ or immunoreactive IGF-I levels .


In this short-term study , GLP-@ reduced IGFBP-@ levels in vivo and tended to increase IGF-I bioactivity .


The IGFBP-@ outcome is opposite to the in vitro situation , hereby demonstrating that in vivo the ability of GLP-@ to stimulate insulin and hereby suppress IGFBP-@ outweighs any direct stimulatory effects of GLP-@ on IGFBP-@ .


Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs .


We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population .


We also explored whether reductions in glycated hemoglobin ( HbA@c ) will be more marked in minority persons .


We conducted an open-label randomized controlled trial of @ patients with type @ diabetes aged @years and whose last measured HbA@c was @ % ( @mmol/mol ) .


Participants were randomized to : @ ) a Chronic Disease Self-Management Program ( CDSMP ; n = @ ) ; @ ) a diabetes self-care software on a personal digital assistant ( PDA ; n = @ ) ; @ ) a combination of interventions ( CDSMP + PDA ; n = @ ) ; or @ ) usual care ( control ; n = @ ) .


Enrollment occurred January @-June @ at seven regional clinics of a university-affiliated multi-specialty group practice .


The primary outcome was change in HbA@c from randomization to @months .


Data were analyzed using a multilevel statistical model .


Average baseline HbA@c in the CDSMP , PDA , CDSMP + PDA , and control arms were @ % , @ % , @ % , and @ % , respectively .


HbA@c reductions at @months for the groups averaged @ % , @ % , @ % , and @ % , respectively and did not differ significantly from baseline based on the model ( P = @ ) .


Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts ( P < @ ) , no other significant differences were observed in participants ' diabetes self-care activities .


Exploratory sub-analysis did not reveal any marked reductions in HbA@c for minority persons but rather modest reductions for all racial/ethnic groups .


Although behavioral and technological interventions can result in some modest improvements in glycemic control , these interventions did not fare significantly better than usual care in achieving glycemic control .


More research is needed to understand how these interventions can be most effective in clinical practice .


The reduction in HbA@c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control .


Immunological non-responders ( INRs ) lacked CD@ increase despite HIV-viremia suppression on HAART and had an increased risk of disease progression .


We assessed immune reconstitution profile upon intensification with maraviroc in INRs .


We designed a multi-centric , randomized , parallel , open label , phase @ superiority trial .


We enrolled @ patients on HAART with CD@ + < @/L and/or CD@ + recovery @ % and HIV-RNA < @ cp/mL .


Patients were randomized @:@ to HAART + maraviroc or continued HAART .


CD@ + and CD@ + CD@ + RA/RO , Ki@ expression and plasma IL-@ were quantified at W@ , W@ and W@ .


By W@ both groups displayed a CD@ increase without a significant inter-group difference .


A statistically significant change in CD@ favored patients in arm HAART + maraviroc versus HAART at W@ ( p = @ ) and W@ ( p = @ ) .


The CD@ > @/L and CD@ > @/L + CD@ gain @ % end-points were not satisfied at W@ ( p = @ and p = @ ) nor at W@ ( p = @ and p = @ ) .


Patients continuing HAART displayed no major changes in parameters of T-cell homeostasis and activation .


Maraviroc-receiving patients experienced a significant rise in circulating IL-@ by W@ ( p = @ ) , and a trend in temporary reduction in activated HLA-DR + CD@ + CD@ + by W@ ( p = @ ) that was not maintained at W@ .


Maraviroc intensification in INRs did not have a significant advantage in reconstituting CD@ T-cell pool , but did substantially expand CD@ .


It resulted in a low rate of treatment discontinuations .


Matrix - carboxyglutamate protein is an inhibitor of cardiovascular calcification .


The objective of this substudy of the Aortic Stenosis Progression Observation : Measuring Effects of Rosuvastatin ( ASTRONOMER ) trial was to examine the relationship between total ( ie , carboxylated -LSB- active -RSB- form + uncarboxylated -LSB- inactive -RSB- form ) circulating desphosphorylated matrix - carboxyglutamate protein ( dpMGP ) level and the progression rate of aortic stenosis ( AS ) .


Among the patients included in the ASTRONOMER trial , @ patients had measures of baseline circulating total dpMGP level and an echocardiographic follow-up ( mean follow-up : @ @ years ) .


Progression of AS was assessed according to the measurement of the annualized increase in peak aortic jet velocity .


In the whole cohort , baseline dpMGP level was associated with faster progression rate of peak aortic jet velocity ( r = @ ; P = @ ) in individual analysis but not in multivariable analysis ( P = @ ) .


However , there was a significant interaction ( P = @ ) between dpMGP level and age , with respect to the effect on AS progression .


After dichotomization according to median value of age ( ie , @ years old ) , total dpMGP level was associated with faster AS progression rate ( r = @ ; P = @ ) in the younger patients , and this association remained significant in multivariable analysis ( P = @ ) , but not in the older ones .


The independent correlates of dpMGP level were fasting glucose ( P = @ ) and oxidized low-density lipoprotein ( P = @ ) .


This is the first prospective study to demonstrate a relationship between increased circulating levels of total dpMGP and faster progression rate of AS in younger individuals .


Future studies are needed to determine if dpMGP is simply a marker or a contributing factor to ectopic mineralization of aortic valve .


Endoscopic variceal ligation ( EVL ) is recommended to treat esophageal varices ( EV ) in cirrhosis and portal hypertension .


A program of endoscopic surveillance is not clearly established .


The aim of this prospective randomized trial was to assess the most effective timing of endoscopic monitoring after variceal eradication and its impact on the patient 's outcome and on the costs .


A hundred and two cirrhotic patients with esophageal varices treated by EVL were evaluated .


After variceal eradication patients were randomized to receive first endoscopic control at @ ( Group @ ) and @ ( Group @ ) months respectively .


Variceal obliteration was achieved in all patients .


Variceal recurrence was observed in @ cases at the first control ( @ % ) without difference between the two groups ( @ % vs @ % in group @ and @ respectively , p = @ ) .


The incidence of large varices is similar in the two groups ( @ % vs @ % respectively ) .


Using a multivariate analysis , medical therapy with B blockers was the only independent predictor of lowest risk of variceal recurrence -LSB- OR @ , @ % CI ( @-@ @ ) -RSB- .


Bleeding related to recurrent varices occurred in @ % of cases and was associated with portal thrombosis .


Child Pugh score @ was the only predictor of mortality ( p = @ ) .


Recurrence of varices after banding ligation is not rare but it is associated with a low risk of variceal progression and bleeding .


Accordingly , a first endoscopic control at @ months after variceal eradication associated with a good risk stratification might be a cost-effective strategy of monitoring .


To determine the incidence and risk factors for readmission to the intensive care unit ( ICU ) among preterm infants who required mechanical ventilation at birth .


We studied preterm newborns ( birth weight @-@ g ) who required mechanical ventilation at birth and were enrolled in a multicenter trial of inhaled nitric oxide therapy .


Patients were assessed up to @ years of age via annual in-person evaluations and structured telephone interviews .


Univariate and multivariable analyses of baseline and birth hospitalization predictors of ICU readmission were performed .


Of @ subjects providing follow-up data , @ % were readmitted to the hospital ( @ % of these had multiple readmissions , averaging @ readmissions per subject ) , @ % were readmitted to an ICU , and @ % required additional mechanical ventilation support .


In univariate analyses , ICU readmission was more common among male subjects ( OR @ ; @ % CI @-@ @ ) , infants with grade @-@ intracranial hemorrhage ( OR @ ; @ % CI @-@ @ ) , increasing duration of birth hospitalization ( OR @ per day ; @ % CI @-@ @ ) , and prolonged oxygen therapy ( OR @ per day ; @ % CI @-@ @ ) .


In the first year after birth hospitalization , children readmitted to an ICU incurred greater health care costs ( median $ @,@ vs $ @,@ for subjects admitted to the ward and $ @ for subjects never admitted ) .


Small preterm infants who were mechanically ventilated at birth have substantial risk for readmission to an ICU and late mechanical ventilation , require extensive health care resources , and incur high treatment costs .


Although often investigated in locally advanced esophageal cancer ( EC ) , the impact of neoadjuvant chemoradiotherapy ( NCRT ) in early stages is unknown .


The aim of this multicenter randomized phase III trial was to assess whether NCRT improves outcomes for patients with stage I or II EC .


The primary end point was overall survival .


Secondary end points were disease-free survival , postoperative morbidity , in-hospital mortality , R@ resection rate , and prognostic factor identification .


From June @ to June @ , @ patients in @ centers were randomly assigned to surgery alone ( group S ; n = @ ) or NCRT followed by surgery ( group CRT ; n = @ ) .


CRT protocol was @ Gy in @ fractions over @ weeks with two courses of concomitant chemotherapy composed of fluorouracil @ mg/m ( @ ) and cisplatin @ mg/m ( @ ) .


We report the long-term results of the final analysis , after a median follow-up of @ months .


Pretreatment disease was stage I in @ % , IIA in @ % , and IIB in @ % of patients .


For group CRT compared with group S , R@ resection rate was @ % versus @ % ( P = @ ) , with @-year overall survival rate of @ % versus @ % ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ; P = @ ) and postoperative mortality rate of @ % versus @ % ( P = @ ) , respectively .


Because interim analysis of the primary end point revealed an improbability of demonstrating the superiority of either treatment arm ( HR , @ ; @ % CI , @ to @ ; P = @ ) , the trial was stopped for anticipated futility .


Compared with surgery alone , NCRT with cisplatin plus fluorouracil does not improve R@ resection rate or survival but enhances postoperative mortality in patients with stage I or II EC .


To examine the long-term safety of oral ospemifene , a non-estrogen tissue-selective estrogen agonist/antagonist , for the treatment of moderate to severe dyspareunia , a symptom of vulvar and vaginal atrophy ( VVA ) due to menopause .


This multicenter , long-term , open-label , safety extension study was conducted in women without a uterus aged @-@ years ( N = @ ) who received oral ospemifene @ mg/day for @ weeks .


Participants either continued their @-mg/day ospemifene dose from the initial @-week pivotal efficacy study or switched from blinded placebo or ospemifene @ mg/day to open-label ospemifene @ mg/day .


The @-week open-label extension period plus initial @-week treatment period totaled up to @ weeks of ospemifene exposure .


A @-week posttreatment follow-up ensued ( @ weeks total ) .


Safety assessments included adverse events , laboratory studies , physical and gynecologic examination , vital signs , breast palpation , and mammography .


Most treatment-emergent adverse events ( TEAEs ) during the extension study were mild or moderate in severity .


The most common TEAE related to study drug was hot flushes ( @ % ; leading to discontinuation for @ % of patients ) .


One serious TEAE , a non-ST-elevation myocardial infarction in a patient with pre-existing cardiac disease , was considered possibly related to study medication .


One mild breast-related TEAE , considered unrelated to study drug , was ongoing at study completion .


There were no instances of pelvic organ prolapse , incontinence , venous thromboembolism , fractures , breast cancers or death .


No clinically significant adverse changes were observed in other safety parameters .


Ospemifene is clinically safe and generally well tolerated in postmenopausal patients with dyspareunia , a symptom of VVA .


Although the need for hand hygiene ( HH ) is generally accepted , studies continue to document inadequate compliance .


Medical students are taught about the importance of HH to prevent nosocomial infections , and receive training in the correct procedures for HH .


However , personality traits ( social orientation and achievement orientation ) may influence HH compliance .


People with high social orientation feel socially responsible and act cooperatively , and people with high achievement orientation are ambitious and competitive .


To evaluate the relationship between HH compliance and personality traits of medical students .


The HH compliance of @ students was observed during objective standardized clinical examinations ( OSCEs ) .


Social orientation and achievement orientation were measured using the corresponding scales of the Freiburg Personality Inventory - Revised .


Social orientation did not differ between students with high HH compliance and students with low HH compliance -LSB- F ( @ ) = @ , P = @ , ( @ ) = @ -RSB- .


For achievement orientation , a moderate effect was found between low and high HH compliance -LSB- F ( @ ) = @ , P = @ , ( @ ) = @ -RSB- , and students with high HH compliance were found to be more achievement orientated than students with low HH compliance .


Achievement orientation plays a major role during OSCEs , while social orientation is less emphasized .


To the authors ' knowledge , this is the first study to show that HH compliance is associated with achievement orientation in achievement situations .


The objective of this study was to explore the effects of hypotonic and isotonic oral mannitol on intestinal distention and fluorine-@ fluorodeoxyglucose ( ( @ ) F-FDG ) intake in PET/computed tomography ( CT ) imaging .


A total of @ patients without gastrointestinal disease were evaluated with PET/CT imaging and divided into four groups using a random number table .


Group @ drank plain water , group @ drank @ % mannitol , group @ drank @ % mannitol and also received @mg of scopolamine butylbromide , and group @ drank @ % mannitol and also received @mg of scopolamine butylbromide .


The patients in each group underwent PET/CT imaging @min after ( @ ) F-FDG injection .


In these groups , differences such as age , sex , disease distribution , oral liquid amount , and adverse reactions were compared .


Gastrointestinal distention and F-FDG intake were analyzed by two experts in nuclear medicine by visual observation .


Data were statistically analyzed using a rank-sum test , RC contingency table , one-way analysis of variance , and a paired t-test .


There were no significant differences in blood glucose levels after oral administration of @ % mannitol ( t = @ , P > @ ) .


Gastrointestinal distention of patients in groups @ , @ , and @ was superior to that of patients in group @ ( P < @ / @ ) .


In addition to the sigmoid colon and rectum , ( @ ) F-FDG intake in each part of the gastrointestinal tract in groups @ , @ , and @ was less than that in group @ ( P < @ / @ ) .


Patients in group @ experienced significantly more adverse reactions compared with patients in the other groups ( P < @ ) .


Oral negative contrast agent and hypotonic bowel preparation decreased the physiological intake of ( @ ) F-FDG , increased the distention of the gastrointestinal tract , and thus improved the image quality .


The present study investigated whether prochlorperazine affects vestibulo-ocular reflex ( VOR ) and vestibulo-perceptual function .


We studied @ healthy nave subjects @ h after a single dose of oral prochlorperazine @ mg in a randomised , placebo-controlled , double-blind , crossover study in healthy young subjects .


Two rotational tests in yaw were used : ( @ ) a threshold task investigating perceptual motion detection and nystagmic thresholds ( acceleration steps of @ / s ( @ ) ) and ( @ ) suprathreshold responses to velocity steps of @/s in which vestibulo-ocular and vestibuloperceptual time constants of decay , as well as VOR gain , were measured .


Prochlorperazine had no effect upon any measure of nystagmic or perceptual vestibular function compared to placebo .


This lack of effects on vestibular-mediated motion perception suggests that the drug is likely to act more as an anti-emetic than as an antivertiginous agent .


Craving is viewed as a core feature of substance use disorders and has been shown to predict future drug use , particularly over the short term .


Accordingly , craving is often assessed in treatment settings as a marker of risk for subsequent drug use .


The identification of the briefest measure that maintains predictive validity is of particular value for both clinical and research settings to minimize assessment burden while maintaining utility for the prediction of use .


Data from a multi-site clinical trial of treatment for prescription opioid dependence were examined to evaluate whether a brief , @-item craving scale administered each week predicted urine-confirmed self report of prescription opioid use in the subsequent week .


Logistic regression models examining the association between craving and presence or absence of opioid use in the following week were conducted , controlling for opioid use in the previous week , treatment condition , and lifetime history of heroin use .


Greater craving was associated with a higher odds of prescription opioid use in the following week .


For each one-unit increase on this @-point scale , the odds of using opioids in the subsequent week was @ % higher .


In addition to an item assessing urges , items assessing cue-induced craving and perceived likelihood of relapse in an environment where drugs were previously used contributed uniquely to this association .


A brief measure of prescription opioid craving predicted prescription opioid use among individuals in treatment .


This measure offers an efficient strategy to inform the assessment of risk for use in this population .


Ciclosporin and MTX are used in idiopathic inflammatory myopathies ( DM and PM ) when patients incompletely respond to glucocorticoids .


Their effectiveness is unproved in randomized controlled trials ( RCTs ) .


We evaluated their benefits in a placebo-controlled factorial RCT .


A @-week multicentre factorial-design double-blind placebo-controlled RCT compared steroids alone , MTX ( @-@ mg weekly ) plus steroids , ciclosporin ( @-@ mg/kg/day ) plus steroids and all three treatments .


It enrolled adults with myositis ( by Bohan and Peter criteria ) with active disease receiving corticosteroids .


A total of @ patients were screened and @ randomized .


Of the latter , @ patients completed @ months of treatment , @ were lost to follow-up and @ discontinued treatment .


Patients completing @ months of treatment showed significant improvement ( P < @ on paired t-tests ) in manual muscle testing ( @ % change ) , walking time ( @ % change ) and function ( @ % change ) .


Intention to treat and completer analyses indicated that ciclosporin monotherapy , MTX monotherapy and ciclosporin/MTX combination therapy showed no significant treatment effects in comparison with placebo .


Neither MTX nor ciclosporin ( by themselves or in combination ) improved clinical features in myositis patients who had incompletely responded to glucocorticoids .


To analyze the underlying risk factors in patients with nonarteritic central retinal artery occlusion ( CRAO ) in a well-defined and homogenous group of patients enrolled in the European Assessment Group for Lysis in the Eye ( EAGLE ) study .


Analysis of the cardiovascular risk factors in a prospective , randomized clinical trial .


Seventy-seven EAGLE patients with nonarteritic CRAO .


Analysis of vascular risk factors and underlying diseases detected by questionnaire and standardized physical examination within @ month after occlusion .


The standardized physical examination included carotid Doppler ultrasonography , echocardiography , electrocardiography , blood pressure monitoring , pulse rate , urine analysis , body mass index analysis , and laboratory tests .


Seventy-seven of @ patients had complete datasets for analysis .


Fifty-two ( @ % ) patients had cardiovascular risk factors in their medical history , and comprehensive phenotyping identified at least @ new risk factor in @ patients ( @ % ; @ % confidence interval , @ % -@ % ) .


Thirty-one ( @ % ) had carotid artery stenosis of at least @ % .


Eleven patients experienced a stroke , @ of those within @ weeks after the CRAO occurred .


Arterial hypertension was found in @ ( @ % ) patients and was newly diagnosed in @ ( @ % ) study participants .


Cardiac diseases were also highly prevalent ( @ % coronary artery disease , @ % atrial fibrillation , and @ % valvular heart disease ) .


Previously undiagnosed vascular risk factors were found in @ % of all CRAO patients .


The most meaningful risk factor was ipsilateral carotid artery stenosis .


A comprehensive and prompt diagnostic work-up is mandatory for all CRAO patients .


To evaluate the effectiveness of electrical stimulation of the posterior tibialis nerve in men with neurogenic overactive bladder secondary to ischemic stroke at @ days and @ months after treatment .


We studied @ patients older than @ years , with ischemic stroke that occurred between @ months and @ years previously and with no prior urinary symptoms .


These patients were randomly allocated to receive electrical stimulation of the posterior tibialis nerve twice weekly for @ weeks ( treatment group , n = @ ) or general advice and stretching sessions @ to @ times monthly for @ weeks ( control group , n = @ ) .


Each session lasted @ minutes in both groups .


The primary outcomes were reduction in urinary frequency , reduction in urinary urgency , and overall improvement in voiding diary variables .


Patients in the electrical stimulation group , in relation to baseline and to control group , experienced improvement in urinary symptoms , reducing urinary urgency and frequency , and reported subjective improvement after treatment .


This effect persisted after @ months of follow-up .


The patients with lesion in right hemisphere , advanced age , and with higher body mass index presented more chance to develop urinary symptoms .


Electrical stimulation of the posterior tibialis nerve is a safe and effective option for the treatment of poststroke neurogenic overactive bladder in men , reducing urinary frequency and urgency .


The aim of this study was to evaluate whether an iron-fortified formula with a concentration of lactoferrin would significantly improve the hematologic indexes and iron status in term infants compared with those same values in infants fed an iron-fortified formula without lactoferrin .


In this prospective , multicenter , controlled intervention study , @ infants ages @ to @mo were selected from six maternal and children 's health care hospitals in the area .


All infants were divided into two groups with the sequence of outpatient : lactoferrin-fortified formula milk group ( fortified group , FG , containing lactoferrin @mg/@g milk and iron element @mg/@g milk ) and no lactoferrin fortified milk ( control group , CG , containing lactoferrin @mg/@g milk and iron element @mg/@g milk ) for @mo .


The levels of weight , height , and head circumference and the concentration of hemoglobin ( Hb ) , serum ferritin ( SF ) , and serum transferring receptor ( sTfR ) were measured and sTfR-SF index ( TFR-F index ) , total body iron content ( TBIC ) and low height for age ( HAZ ) , low weight for age ( WAZ ) , and low weight for height ( WHZ ) were computed before and after the intervention , respectively .


In all , @ ( @ in FG and @ in CG ) infants completed the intervention trial and all measurements of biochemical indicators .


There were no significant differences in the average amount of daily intake of formula milk ( @ g versus @ gfor FG and CG ; P > @ ) and iron element ( @ mg versus @ mg for FG and CG ; P > @ ) .


The average amount of daily intake of lactoferrin for infants in FG group was @ mg .


The levels of weight , WAZ , WHZ , Hb , SF , TFR-F index , and TBIC after intervention of infants in FG were all significantly higher than those of infants in CG weight , @g versus @g ; WAZ , @ versus @ ; WHZ , @ versus @ ; Hb , @ g/L versus @ g/L ; SF , @ g/L versus @ g/L ; TFR-F index , @ versus @ ; TBIC , @ mg/kg versus @ mg/kg for FG and CG ; P < @ ) , but significantly lower ( P < @ ) for the prevalence of anemia ( @ % versus @ % ) , iron deficiency ( @ % versus @ % ) , and iron-deficient anemia ( @ % versus @ % ) .


When infants who were exclusively breastfed were supplemented with lactoferrin-fortified milk , significant increases in TBIC and iron absorption in the intestine were seen .


Homecare re-ablement services have been developed by local authorities in England in response to the government agenda for health and social care .


These services aim to optimize users ' independence and ability to cope at home , and reduce the need for ongoing health and social care services .


However , there is currently limited evidence and guidance regarding the optimum configuration and delivery of re-ablement services .


In particular , the impact of occupational therapy input on service user outcomes has been highlighted as a specific research priority .


This feasibility randomized controlled trial ( RCT ) will recruit @ people from one local authority led homecare re-ablement service in England .


Those who provide informed consent will be randomized to receive either usual homecare re-ablement ( without routine occupational therapy input ) or usual homecare re-ablement plus an enhanced program targeted at activities of daily living ( ADL ) , delivered by an occupational therapist .


The primary aim of this study is to assess the feasibility of conducting a further , powered study .


The participant outcomes assessed will be independence in personal and extended ADL , health and social care-related quality of life , number of care support hours , falls , acute and residential admissions and use of health and social care services .


These will be assessed at two weeks , three months and six months post-discharge from the re-ablement service .


To our knowledge , this is the first RCT of occupational therapy in homecare re-ablement services .


The results of this study will lay the foundations for a further powered study .


The findings will be relevant to researchers , clinicians , commissioners and users of adult social care services .


Patients usually suffer significant pain after lumbar laminectomy .


Wound infiltration with local anesthetics is a useful method for postoperative pain control .


Our aim was to compare the efficacies of preemptive wound infiltration with bupivacaine and levobupivacaine .


@ patients were randomized three groups as follows : Group L wound infiltration with @ mL @ % levobupivacaine and @ mg methylprednisolone just before wound closure ; Group B wound infiltration with @ mL @ % bupivacaine and @ mg methylprednisolone before closure ; Group C had this region infiltrated with @ ml physiological saline .


Demographic data , vital signs , postoperative pain scores and morphine usage were recorded .


First analgesic requirement time was significantly shorter in the control group compared to other two groups ( p < @ ) .


Group B had the lowest cumulative morphine consumption at the end of @ hours within @-@ , @-@ and @-@ hours time intervals and the values were not significant when compared with Group L , however the consumption of both groups was significantly lower compared to the control group ( p < @ ) .


Our data suggest that preoperative infiltration of the wound site with bupivacaine or levobupivacaine provides similarly effective pain control with reduced opiate dose after unilateral lumbar laminectomy .


To examine the impact of night-shift duration ( @ hours or > @ hours ) on efficacy and tolerability of armodafinil in patients with shift work disorder ( SWD ) .


This was a post hoc analysis of a @ week , multicenter , randomized , double-blind , placebo-controlled , parallel-group study .


Shift workers with diagnosed SWD and late-in-shift sleepiness ( between @am and @am , including the commute home ) received armodafinil @mg or placebo before their night shift .


Proportion of patients with at least minimal improvement in late-in-shift sleepiness , late-in-shift Clinical Global Impressions-Change ( CGI-C ) rating and Karolinska Sleepiness Scale ( KSS ) , as well as overall Global Assessment of Functioning ( GAF ) scale and modified Sheehan Disability Scale ( SDS-M ) , were assessed at baseline and final visit .


Of the @ patients enrolled , @ ( @ % ) worked shifts @ hours and @ ( @ % ) worked shifts > @ hours .


A greater percentage of patients receiving armodafinil had at least minimal improvement in late-in-shift CGI-C ( @ hours : @ % vs @ % , P = @ ; > @ hours : @ % vs @ % , P = @ ) regardless of shift duration .


Armodafinil patients also demonstrated significantly greater improvements in GAF score ( @ hours : @ vs @ , P < @ ; > @ hours : @ vs @ , P = @ ) and KSS score ( @ hours : -@ vs -@ , P = @ ; > @ hours : -@ vs -@ , P = @ @ ) .


Improvement in SDS-M composite score was significantly greater for armodafinil patients working > @ hours ( -@ vs -@ , P = @ ) .


Headache was the most frequent adverse event in all treatment groups .


Patients receiving armodafinil had significantly greater improvements in late-in-shift clinical condition and in wakefulness and overall global functioning than did placebo-treated patients , regardless of shift duration .


Prospectively designed , randomized clinical trials that include objective measures of sleepiness are needed to support these findings .


Cognitive Behaviour Therapy for Insomnia ( CBT-I ) delivered through the Internet is effective as a treatment in reducing insomnia in individuals seeking help for insomnia .


CBT-I also lowers levels of depression in this group .


However , it is not known if targeting insomnia using CBT-I will lower depressive symptoms , and thus reduce the risk of major depressive episode onset , in those specifically at risk for depression .


Therefore , this study aims to examine whether Internet delivery of fully automated self-help CBT-I designed to reduce insomnia will prevent depression .


A sample of @,@ community-dwelling adults ( aged @-@ ) , who screen positive for both subclinical levels of depressive symptoms and insomnia , will be recruited via various media and randomised to either a @-week online insomnia treatment programme , Sleep Healthy Using The internet ( SHUTi ) , or an online attention-matched control group ( HealthWatch ) .


The primary outcome variable will be depression symptom levels at the @-month post-intervention on the Patient Heath Questionnaire-@ ( PHQ-@ ) .


A secondary outcome will be onset of major depressive episodes assessed at the @-month post-intervention using ` current ' and ` time from intervention ' criteria from the Mini International Neuropsychiatric Interview .


This trial is the first randomised controlled trial of an Internet-based insomnia intervention as an indicated preventative programme for depression .


If effective , online provision of a depression prevention programme will facilitate dissemination .


Blood hemoglobin can be monitored continuously and noninvasively with a noninvasive spectrophotometric sensor ( Masimo SpHb ) .


The perfusion index ( PI ) of the finger is directly related to the clinical accuracy of SpHb .


We evaluated those variables that influence PI without the influences of surgery and anesthesia .


Based on our past studies , @ awake adult volunteers were studied .


A SpHb sensor was attached to the same finger of each hand .


The temperature of each finger was measured via a skin surface probe .


A digital nerve block ( DNB ) was performed with @ % lidocaine on one finger and @ % bupivacaine on the other finger of the opposite hand .


SpHb , PI , and finger temperature were monitored continuously @ minutes before and @ to @ hours after placement of the DNB .


A random effects spline regression was used to flexibly model the outcomes before and after the DNB and to compare the effects of lidocaine and bupivacaine .


The DNBs increased the PI for both lidocaine and bupivacaine ( P < @ ) and finger temperature from both lidocaine ( P < @ ) and bupivacaine ( P = @ ) .


The duration of action of bupivacaine was markedly longer than that of lidocaine ( P < @ ) .


Between @ and @ minutes after insertion of the DNB , the PI with bupivacaine was substantially higher than that of lidocaine .


The PI was directly related to changes in finger temperature and SpHb .


During this time interval , @ of the @ volunteers receiving bupivacaine descriptively had increases in finger temperature ranging from no change to @ C.


In contrast , only @ of the @ lidocaine volunteers had increases in finger temperature ranging from no change to @C .


Changes in PI were directly correlated with SpHb values ( correlation coefficient = @ ) .


A DNB increases PI and finger temperature .


These increases lasted @ to @ hours longer with bupivacaine than lidocaine .


The increases in PI were associated with slightly higher SpHb values .


We conclude that the DNB induces increases in PI and temperature of the finger .


Because of the close relationship between finger temperature , PI , and SpHb , consistently increasing finger temperature and PI could increase the accuracy of SpHb .


The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain .


A pilot study was designed to evaluate the frequency of extubation failure , develop a randomization approach , and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within @ hours in children with respiratory failure .


Prospective pilot study .


PICU at a university-affiliated hospital .


Children aged between @ days and @ years undergoing invasive mechanical ventilation for greater than or equal to @ hours with respiratory failure after programmed extubation .


Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May @ to May @ .


Length of stay in PICU and hospital , oxygenation index , blood gas before and after tracheal extubation , failure and reason for tracheal extubation , complications , mechanical ventilation variables before tracheal extubation , arterial blood gas , and respiratory and heart rates before and @ hour after tracheal extubation were analyzed .


One hundred eight patients were included ( noninvasive positive-pressure ventilation group , n = @ and inhaled oxygen group , n = @ ) , with @ exclusions .


Groups did not significantly differ for gender , age , disease severity , Pediatric Risk of Mortality at admission , tracheal intubation , and mechanical ventilation indications .


There was no statistically significant difference in reintubation rate ( noninvasive positive-pressure ventilation group , @ % ; inhaled oxygen group , @ % ; p > @ ) and length of stay ( days ) in PICU ( noninvasive positive-pressure ventilation group , @ -LSB- @-@ -RSB- ; inhaled oxygen group , @ -LSB- @-@ -RSB- ; p > @ ) or hospital ( noninvasive positive-pressure ventilation group , @ -LSB- @-@ -RSB- ; inhaled oxygen group , @ -LSB- @-@ -RSB- ) .


The study indicates that a larger randomized trial comparing noninvasive positive-pressure ventilation and standard oxygen therapy in children with respiratory failure is feasible , providing a basis for a future trial in this setting .


No differences were seen between groups .


The number of excluded patients was high .


The rate of prophylactic mastectomies ( PM ) is increasing .


Patients generally report high levels of health related quality of life and satisfaction after the procedure , whereas body image perception and sexuality may be negatively affected .


The aim of the study was to evaluate the interest in physical therapy as a means of improving body image and sexuality in women after PM .


Patients undergoing PM at Karolinska University Hospital between @ and @ were eligible .


The following patient-reported outcome measures were used at study baseline and @ years postoperatively : the body image scale ( BIS ) , the sexual activity questionnaire ( SAQ ) , the short-form health survey ( SF-@ ) , the hospital anxiety and depression scale ( HAD ) , and a study specific `` pain/motion/sensation scale '' .


Out of @ patients invited to participate in this prospective randomized study , @ ( @ % ) consented and were randomized into the intervention ( n = @ , @ % ) or control ( n = @ , @ % ) groups .


There were no statistically significant between-group differences found with respect to BIS , SAQ , SF-@ , HAD , and `` pain/motion/sensation '' .


Two years postoperatively , more than half of the patients in both groups reported problems like feeling less attractive , less sexually attractive , their body feeling less whole , and being dissatisfied with their body .


A majority marked a decreased sensation in breast area .


The interest in a physiotherapy intervention was limited among women who had undergone PM .


The intervention did not show any substantial effects .


A large proportion of patients reported specific body image related and pain/motion/sensation problems postoperatively .


Understanding and enhancing change capabilities , including Practice Adaptive Reserve ( PAR ) , of Community Health Centers ( CHCs ) may mitigate cancer-related health disparities .


Using stratified random sampling , we recruited @ staff from seven CHCs serving Asian Pacific Islander communities to complete a self-administered survey .


We performed multilevel regression analyses to examine PAR composite scores by CHC , position type , and number of years worked at their clinic .


The mean PAR score was @ ( s.d. @ ) .


Higher scores were associated with a greater perceived likelihood that clinic staff would participate in an evidence-based intervention ( EBI ) .


Constructs such as communication , clinic flow , sensemaking , change valence , and resource availability were positively associated with EBI implementation or trended toward significance .


PAR scores are positively associated with perceived likelihood of clinic staff participation in cancer screening EBI .


Future research is needed to determine PAR levels most conducive to implementing change and to developing interventions that enhance Adaptive Reserve .


Although several plaque indices exist , they rarely assess in detail the plaque adjacent to the gingival margin , an area most important for periodontal health .


This study aims to develop a new marginal plaque index ( MPI ) and to assess its validity and treatment sensitivity compared to the internationally accepted Turesky modification of the Quigley and Hein Index ( TQHI ) .


Data from two studies with n = @ and n = @ participants , respectively , are reported here .


Convergence of MPI with TQHI and concurrent and predictive validity with papillary bleeding index were assessed , as was treatment sensitivity to a treatment of proximal hygiene ( study @ ) or toothbrushing ( study @ ) , respectively .


Convergent validity with TQHI is very good .


Concurrent and predictive validity parameters of the MPI are similar to the TQHI .


The treatment sensitivity of MPI exceeds TQHI by far .


This results in a reduction by > @ % of the sample size needed to discover significant treatment effects .


As expected , the largest treatment sensitivity was observed for proximal MPI measures in study @ , whereas study @ showed largest effects for cervical measures .


MPI appears to be a valid plaque-scoring system that assesses plaque at the gingival margin .


It responds with high sensitivity to treatments aimed at plaque reduction at the gingival margin .


Its treatment sensitivity and capacity to differentiate between proximal and cervical plaque make it a promising tool for periodontal research .


We compared the effects of two uniquely different lower extremity power training interventions on changes in muscle power , physical performance , neuromuscular activation , and muscle cross sectional area in mobility-limited older adults .


Fifty-two subjects ( @ years , short physical performance battery score : @ ) were randomized to either @ weeks of progressive high velocity resistance training performed at low external resistance ( @ % of the @-repetition maximum -LSB- @-RM -RSB- -LSB- LO -RSB- ) or high external resistance ( @ % of @RM -LSB- HI -RSB- ) .


Both groups completed three sets of leg and knee extension exercises at maximum voluntary velocity , two times per week .


Neuromuscular activation was assessed using surface electromyography and muscle cross sectional area ( CSA ) was measured using computed tomography .


At @ weeks , LO and HI exhibited significant and similar within-group increases of leg extensor peak power ( ~ @ % vs ~ @ % ) , strength ( ~ @ % vs ~ @ % ) , and SPPB score ( @ vs @ units ) , respectively ( all P < @ ) .


Improvements in neuromuscular activation occurred in LO ( P = @ ) while small gains in mid-thigh muscle CSA were detected in LO ( @ % , P = @ ) and HI ( @ % , P = @ ) .


No significant between-group differences were evident for any measured parameters ( all P > @ ) .