The purpose of this study was to examine the relationship in change scores between regional lumbar motion and patient-rated pain of the previous week and back-related function in chronic low back pain patients enrolled in a randomized clinical trial and treated with either exercise therapy or spinal manipulation using @ different motion parameters .


Regional lumbar motions were sampled using a @ degrees of freedom instrumented spatial linkage system in @ participants at baseline and @-week follow-up .


The regional lumbar motion data were analyzed as a total cohort as well as relative to subgroup stratifications ; back pain only vs back and leg pain , and treatment modality .


For identifying clinically meaningful improvements in the measurements of back pain and back-related function , we used a @ % threshold .


The relationship between change scores in patient-rated outcomes and objective measures of regional lumbar motion was found to be weak .


In contrast , distribution of pain and treatment received affected associations between motion parameters and patient-rated outcomes .


Thus , stronger correlation coefficients and significant differences between clinically relevant improved vs no clinical relevant change were found in some motion parameters in the subgroup with back pain only and the treatment group receiving spinal manipulation .


Overall , changes in regional lumbar motion were poorly associated with patient-rated outcomes measured by back-related function and back pain intensity scores .


However , associations between regional lumbar motion vs patient-rated pain and back-related function were different in relative subgroups ( back pain only vs back and leg pain and treatment ) .


We investigated the hypothesis that rimonabant , a cannabinoid antagonist/inverse agonist , would increase anxiety in healthy subjects during a simulation of the public speaking test .


Participants were randomly allocated to receive oral placebo or @mg rimonabant in a double-blind design .


Subjective effects were measured by Visual Analogue Mood Scale .


Physiological parameters , namely arterial blood pressure and heart rate , also were monitored .


Twelve participants received oral placebo and @ received @mg rimonabant .


Rimonabant increased self-reported anxiety levels during the anticipatory speech and performance phase compared with placebo .


Interestingly , rimonabant did not modulate anxiety prestress and was not associated with sedation , cognitive impairment , discomfort , or blood pressure changes .


Cannabinoid-@ antagonism magnifies the responses to an anxiogenic stimulus without interfering with the prestress phase .


These data suggest that the endocannabinoid system may work on-demand to counteract the consequences of anxiogenic stimuli in healthy humans .


Hypovitaminosis D , especially during cold seasons , is quite prevalent among primary school children in Tehran .


The present study aimed to compare the efficacy of calcium-vitamin D-fortified-milk , - orange juice and supplement in primary school children .


Children aged @-@years from both sexes were randomly assigned to one of six groups to receive plain milk , fortified milk , plain orange juice , fortified orange juice , supplement or placebo .


Both fortified-milk and - juice contained @IU of vitamin D and @mg of calcium per @mL package , whereas supplement contained @IU of vitamin D and @mg of calcium .


The duration of intervention was @weeks , from November @ to March @ .


A total of @ children completed the study .


Regression analysis with adjustment for both sex and initial values of @ ( OH ) D revealed that consumption of either supplement , fortified orange juice or fortified milk resulted in a @ nm -LSB- confidence interval ( CI ) = @-@ @ -RSB- , @ nm ( CI = @-@ @ ) or @ nm ( CI = @-@ @ ) increase in circulating @ ( OH ) D compared to the related control groups .


However , changes in serum osteocalcin and intact parathyroid hormone in the supplement group did not differ from those of fortified milk or plain milk .


The increment of osteocalcin in both plain milk and fortified milk was more than in fortified orange juice , although the difference was statistically insignificant .


Despite having double amount of vitamin D and being more effective in raising serum @ ( OH ) D , supplementation did not confer additional benefit in terms of osteocalcin and intact parathyroid hormone compared to either fortified or plain milk .


Echocardiographic optimization of pacemaker settings is the current standard of care for patients treated with cardiac resynchronization therapy .


However , the process requires considerable time of expert staff .


The BRAVO study is a non-inferiority trial comparing echocardiographic optimization of atrioventricular ( AV ) and interventricular ( VV ) delay with an alternative method using non-invasive blood pressure monitoring that can be automated to consume less staff resources .


BRAVO is a multi-centre , randomized , cross-over , non-inferiority trial of @ patients with a previously implanted cardiac resynchronization device .


Patients are randomly allocated to six months in each arm .


In the echocardiographic arm , AV delay is optimized using the iterative method and VV delay by maximizing LVOT VTI .


In the haemodynamic arm AV and VV delay are optimized using non-invasive blood pressure measured using finger photoplethysmography .


At the end of each six month arm , patients undergo the primary outcome measure of objective exercise capacity , quantified as peak oxygen uptake ( VO@ ) on a cardiopulmonary exercise test .


Secondary outcome measures are echocardiographic measurement of left ventricular remodelling , quality of life score and N-terminal pro B-type Natriuretic Peptide ( NT-pro BNP ) .


The study is scheduled to complete recruitment in December @ and to complete follow up in December @ .


If exercise capacity is non-inferior with haemodynamic optimization compared with echocardiographic optimization , it would be proof of concept that haemodynamic optimization is an acceptable alternative which has the potential to be more easily implemented .


To evaluate the effects of clopidogrel on clinical and clinicopathologic variables in healthy horses with experimentally induced endotoxemia .


@ adult mares .


Procedures-Horses were assigned with a randomization procedure to receive clopidogrel ( @ mg/kg , once , then @ mg/kg , q @ h ; n = @ ) or a placebo ( @ ) through a nasogastric tube .


After @ hours of treatment , horses received lipopolysaccharide ( LPS ; @ ng/kg , IV ) .


Heart rate , respiratory rate , rectal temperature , CBC variables , plasma fibrinogen concentration , serum tumor necrosis factor - concentration , plasma von Willebrand factor concentration , and measures of platelet activation ( including ADP - and collagen-induced platelet aggregation and closure times , thrombelastography variables , and results of flow cytometric detection of platelet membrane P-selectin , phosphatidylserine , and microparticles ) were determined at various times before and after LPS administration by investigators unaware of the treatment groups .


Statistical analyses were performed with repeated-measures ANOVA .


@ of @ clopidogrel-treated horses had significant decreases in ADP-induced platelet aggregation before and after LPS administration .


Heart rate increased significantly after LPS administration only for the placebo group .


No significant differences were detected between groups for CBC variables , closure time , and plasma concentration of fibrinogen or serum concentration of tumor necrosis factor - , and no clinically relevant differences were detected for other hemostatic variables .


In this study , administration of LPS did not induce platelet hyperreactivity in horses on the basis of measures of platelet adhesion , aggregation , degranulation , and procoagulant activity .


Administration of clopidogrel was associated with variable platelet antiaggregatory activity and attenuated some clinical signs of endotoxemia .


Exercise has been reported to decrease cancer-related fatigue and to increase quality of life ( QoL ) in various breast cancer ( BC ) populations .


However , studies investigating exercise during radiotherapy or resistance training are scarce .


We conducted a randomized , controlled trial ( BEST study ) to assess the efficacy of @-week resistance training on fatigue beyond possible psychosocial effects of a group-based intervention .


One hundred sixty patients with BC stage @-III were randomly assigned to a @-week progressive resistance training ( @ times/week ) or a @-week relaxation control ( RC , @ times/week ) .


Both interventions were group-based .


The primary end point fatigue was assessed with a @-item multidimensional questionnaire , QoL with EORTC questionnaires .


Statistical analyses were based on analysis of covariance models for the individual changes from baseline to week @ .


Adherence to the intervention program as well as the completion rate ( @ % ) for the primary outcome variable fatigue was high .


In intention-to-treat analyses for the N = @ patients , significant between-group mean differences ( MD ) favoring the exercise group ( EX ) were observed for general fatigue ( P = @ ) , especially for the subscale physical fatigue -LSB- MD = -@ ; @ % confidence interval -@ to -@ , P = @ -RSB- , but not for affective ( P = @ ) or cognitive fatigue ( P = @ ) .


For QoL , significantly larger improvements regarding the role function ( P = @ ) and pain ( P = @ ) were noted among exercisers compared with RCs .


Future perspective improved significantly stronger in the RC group compared with the EX group ( P = @ ) .


The @-week resistance training program was a safe , feasible and efficacious strategy to improve cancer-related fatigue and components of QoL in BC patients during adjuvant radiotherapy .


As exercise was compared with another group-based intervention , results indicate that resistance training effects on fatigue and QoL go beyond psychosocial benefits , and that the clinically relevant overall benefit of resistance exercise compared with usual care can be assumed to be higher .


Chronic kidney disease ( CKD ) is associated with an increased risk of cardiovascular events following acute coronary syndrome ( ACS ) .


The underlying pathobiology and optimal treatments for this population continue to be evaluated .


Patients with CKD will receive fewer evidence-based therapies and experience high rates of adverse cardiovascular events in both the short - and long term .


The MERLIN-TIMI @ ( Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes-Thrombolysis in Myocardial Infarction @ ) trial randomized non-ST-elevation ACS patients to ranolazine or placebo , with no exclusion for renal dysfunction ( except dialysis ) .


We conducted a prespecified analysis among @ patients based on the degree of CKD .


Patients with worse renal function were older with more comorbidities ( P < @ for each ) .


They were less likely to receive evidence-based cardiovascular medicines ( P < @ for each ) .


Rates of an early invasive management strategy varied based on renal function ; however , among patients with the highest TIMI risk scores , the rates of an early invasive management strategy were similar regardless of glomerular filtration rate ( GFR ) ( Pinteraction = @ ) .


Lower GFR was associated with increased rates of cardiovascular disease or myocardial infarction in the short and long term , even after adjustment ( GFR < @ vs @ mL/min/@ @ m ( @ ) ; hazard ratio -LSB- HR -RSB- : @ -LSB- @ % confidence interval -LCB- CI -RCB- : @-@ @ -RSB- through @ days and HR : @ -LSB- @ % CI : @-@ @ -RSB- through @ year ) .


The effect of ranolazine vs placebo on clinical outcomes was similar among those with and without CKD ( Pinteraction = not significant ) .


Following ACS , patients with renal dysfunction had more cardiovascular risk factors but were less likely to receive evidence-based medical therapies .


A strong graded , independent relationship between the degree of CKD and poor clinical outcomes was observed over time .


Continued efforts to optimize ACS treatment strategies in patients with CKD are warranted .


Empiric circumferential pulmonary vein isolation ( CPVI ) has become the therapy of choice for drug-refractory atrial fibrillation ( AF ) .


Although results are suboptimal , it is unknown whether mechanistically-based strategies targeting AF drivers are superior .


This study sought to determine the efficacy and safety of localized high-frequency source ablation ( HFSA ) compared with CPVI in patients with drug-refractory AF .


This prospective , multicenter , single-blinded study of @ patients ( age @ @ years , @ males ) randomized those with paroxysmal AF ( n = @ ) to CPVI or HFSA-only ( noninferiority design ) and those with persistent AF ( n = @ ) to CPVI or a combined ablation approach ( CPVI + HFSA , superiority design ) .


The primary endpoint was freedom from AF at @ months post-first ablation procedure .


Secondary endpoints included freedom from atrial tachyarrhythmias ( AT ) at @ and @ months , periprocedural complications , overall adverse events , and quality of life .


In paroxysmal AF , HFSA failed to achieve noninferiority at @ months after a single procedure but , after redo procedures , was noninferior to CPVI at @ months for freedom from AF and AF/AT .


Serious adverse events were significantly reduced in the HFSA group versus CPVI patients ( p = @ ) .


In persistent AF , there were no significant differences between treatment groups for primary and secondary endpoints , but CPVI + HFSA trended toward more serious adverse events .


In paroxysmal AF , HFSA failed to achieve noninferiority at @ months but was noninferior to CPVI at @ year in achieving freedom of AF/AT and a lower incidence of severe adverse events .


In persistent AF , CPVI + HFSA offered no incremental value .


( Radiofrequency Ablation of Drivers of Atrial Fibrillation -LSB- RADAR-AF -RSB- ; NCT@ ) .


This study evaluated the non-inferiority of renoprotection afforded by benidipine versus hydrochlorothiazide in hypertensive patients with chronic kidney disease ( CKD ) .


In this prospective , multicenter , open-labeled , randomized trial , the antialbuminuric effects of benidipine and hydrochlorothiazide were examined in renin-angiotensin system ( RAS ) inhibitor-treated patients with blood pressure ( BP ) readings of @/@ mmHg and @/@ mmHg , a urinary albumin to creatinine ratio ( UACR ) of @ mg/g , and an estimated glomerular filtration rate ( eGFR ) of @ ml/min/@ @ m ( @ ) .


Patients received benidipine ( n = @ , final dose : @ mg/day ) or hydrochlorothiazide ( n = @ , @ mg/day ) for @ months .


Benidipine and hydrochlorothiazide exerted similar BP - and eGFR-decreasing actions .


The UACR values for benidipine and hydrochlorothiazide were @ ( @ % confidence interval : @ , @ ) and @ ( @ , @ ) mg/g at baseline , respectively .


These values were reduced to @ ( @ , @ ) and @ ( @ , @ ) mg/g at last observation carried forward ( LOCF ) visits .


The non-inferiority of benidipine versus hydrochlorothiazide was not demonstrated ( benidipine/hydrochlorothiazide ratio of LOCF value adjusted for baseline : @ ( @ , @ ) ) .


The present study failed to demonstrate the non-inferiority of the antialbuminuric effect of benidipine relative to that of hydrochlorothiazide in RAS inhibitor-treated hypertensive patients with macroalbuminuria .


A unilateral paravertebral ( PVB ) block with catheter can provide extendable analgesia without physiological changes .


The objective of this study was to assess the efficacy of PVB bupivacaine for providing perioperative pain relief in adults undergoing percutaneous nephrolithotomy ( PCNL ) under general anesthesia .


Fifty American Society of Anesthesiologists Grade I , II patients , aged @ to @ years , were included in this prospective , randomized , controlled , observer blinded trial .


PVB group patients received preinduction @mL of @ % bupivacaine in the T@-@ paravertebral space and a catheter in addition to general anesthesia .


Control group patients received only general anesthesia .


All patients received intravenous fentanyl ( @g/kg on induction , @ g/kg on @ % increase in heart rate or mean blood pressure ) and paracetamol every @ hours .


Postoperative pain was assessed using the visual analog scale ( VAS ) ( @-@cm ) at rest and movement by a blinded observer at @ , @ , @ , @ , @ , @ , and @ hours postoperatively .


Data of @ patients were analyzed .


Intraoperative fentanyl requirement was higher in the control group ( @ g/kg -LSB- @ % confidence interval ( CI ) @ , @ -RSB- ) than the PVB group ( @ g/kg -LSB- @ % CI @ , @ -RSB- ) , ( P = @ ) .


Time to first postoperative analgesic requirement was longer in the PVB group ( @min -LSB- @-@ -RSB- ) than the control group ( @min -LSB- @-@ -RSB- ) , ( P = @ ) .


The VAS on rest ( @ , @ , @ , and @h ) and movement ( all time points ) were significantly lower in the PVB group .


Postoperative fentanyl consumption was lower in this group ( @g -LSB- @-@ -RSB- ) compared with the control group ( @g -LSB- ( @-@ -RSB- ) , ( P = @ ) .


Unilateral PVB block with catheter provided effective perioperative analgesia for PCNL .


Glaucoma-related adverse events constitute major sight-threatening complications of cataract removal in infancy , yet their relationship to aphakia vs primary intraocular lens ( IOL ) implantation remains unsettled .


To identify and characterize cases of glaucoma and glaucoma-related adverse events ( glaucoma + glaucoma suspect ) among children in the Infant Aphakia Treatment Study by the age of @ years .


A multicenter randomized clinical trial of @ infants with unilateral congenital cataract in referral centers who were between ages @ and @ months at surgery .


Mean follow-up was @ years .


This secondary analysis was conducted from December @ , @ , to November @ , @ .


Participants were randomized at cataract surgery to either primary IOL or no IOL implantation ( contact lens ) .


Standardized definitions of glaucoma and glaucoma suspect were created for the Infant Aphakia Treatment Study and applied for surveillance and diagnosis .


Development of glaucoma and glaucoma + glaucoma suspect in operated on eyes for children up to age @ years , plus intraocular pressure , visual acuity , and axial length at age @ years .


Product limit estimates of the risk for glaucoma and glaucoma + glaucoma suspect at @ years after surgery were @ % ( @ % CI , @ % -@ % ) and @ % ( @ % CI , @ % -@ % ) , respectively .


The contact lens and IOL groups were not significantly different for either outcome : glaucoma ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @-@ @ ; P = @ ) and glaucoma + glaucoma suspect ( HR , @ ; @ % CI , @-@ @ ; P = @ ) .


Younger ( vs older ) age at surgery conferred an increased risk for glaucoma ( @ % vs @ % , respectively ) at @ years after surgery ( HR , @ ; @ % CI , @-@ @ ) , and smaller ( vs larger ) corneal diameter showed an increased risk for glaucoma + glaucoma suspect ( HR , @ ; @ % CI , @-@ @ ) .


Age and corneal diameter were significantly positively correlated .


Glaucoma was predominantly open angle ( @ of @ cases , @ % ) , most eyes received medication ( @ of @ , @ % ) , and @ of @ eyes ( @ % ) underwent surgery .


These results suggest that glaucoma-related adverse events are common and increase between ages @ and @ years in infants after unilateral cataract removal at @ to @ months of age ; primary IOL placement does not mitigate their risk but surgery at a younger age increases the risk .


Longer follow-up of these children may further characterize risk factors , long-term outcomes , potential differences between eyes having primary IOL vs aphakia , and optimal timing of unilateral congenital cataract removal .


DSM-@ has dropped subtyping of bulimia nervosa ( BN ) , opting to continue inclusion of the somewhat contentious diagnosis of BN-nonpurging subtype ( BN-NP ) within a broad BN category .


Some contend however that BN-NP is more like binge eating disorder ( BED ) than BN-P .


This study examines clinical characteristics , eating disorder symptomatology , and Axis I comorbidity in BN-NP , BN-P , and BED groups to establish whether BN-NP more closely resembles BN-P or BED .


Women with BN-P ( n = @ ) , BN-NP ( n = @ ) , and BED ( n = @ ) were assessed at baseline in an outpatient psychotherapy trial for those with binge eating .


Measures included the Structured Clinical Interviews for DSM-IV , Eating Disorder Examination , and Eating Disorder Inventory-@ .


The BN-NP subtype had BMIs between those with BN-P and BED .


Both BN subtypes had higher Restraint and Drive for Thinness scores than BED .


Body Dissatisfaction was highest in BN-NP and predicted BN-NP compared to BN-P .


Higher Restraint and lower BMI predicted BN-NP relative to BED .


BN-NP resembled BED with higher lifetime BMIs ; and weight-loss clinic than eating disorder clinic attendances relative to the BN-P subtype .


Psychiatric comorbidity was comparable except for higher lifetime cannabis use disorder in the BN-NP than BN-P subtype


These results suggest that BN-NP sits between BN-P and BED however the high distress driving inappropriate compensatory behaviors in BN-P requires specialist eating disorder treatment .


These results support retaining the BN-NP group within the BN category .


Further research is needed to determine whether there are meaningful differences in outcome over follow-up .


Preclinical studies and early pilot clinical investigations have suggested that N-acetylcysteine ( NAC ) may be useful in treatment of methamphetamine ( METH ) dependence .


The present study evaluated whether NAC would suppress craving to the METH .


In a double-blind , controlled crossover clinical trial , @ METH-dependent volunteers were chosen to receive either NAC ( @ mg/day ) or placebo , randomly .


They were intervened in two four-week sessions .


During first session they received either @ mg/day of NAC ( group A ) or placebo ( group B ) .


After three days of washout period , next session started with the crossover intervention of the previous regimen .


During these eight weeks , all participants received standardized , and Matrix Model of treatment .


Craving was assessed using the Cocaine Craving Questionnaire-Brief ( CCQ-Brief ) .


The data were analyzed using SPSS version @ ( SPSS Inc. .


Chicago , Illinois , USA ) .


In @ subjects who completed the study , the mean score of CCQ-Brief reduced in four consecutive weeks with NAC treatment .


The mean ( SD ) scores of carving in group A and B were @ ( @ ) and @ ( @ ) , at the end of first session ; and @ ( @ ) and @ ( @ ) , at the end of the second session , respectively .


Our findings indicate that the main effect was significant for NAC ( P < @ ) .


Across placebo and NAC conditions , only mild side effects were noted , and the number of subjects who reported side effects did not differ .


The NAC showed good efficacy in suppressing METH craving , and may be a useful pharmacological treatment for METH dependency .


Stroke is a leading cause of death worldwide .


Infections after stroke occur in @ % of stroke patients and are strongly associated with unfavourable outcome .


Preventive antibiotic therapy lowers infection rate in patients after stroke , however , the effect of preventive antibiotic treatment on functional outcome after stroke has not yet been investigated.The Preventive Antibiotics in Stroke Study ( PASS ) is an ongoing , multicentre , prospective , randomised , open-label , blinded end point trial of preventive antibiotic therapy in acute stroke .


Patients are randomly assigned to either ceftriaxone at a dose of @g , given every @hours intravenously for four-days , in addition to stroke-unit care , or standard stroke-unit care without preventive antibiotic therapy .


Aim of the study is to assess whether preventive antibiotic treatment improves functional outcome at three months by preventing infections .


To date , @,@ patients have been included in PASS .


Median stroke severity of the first @,@ patients ( second interim analysis ) is @ ( IQR @ to @ ) on the National Institutes of Health Stroke Scale ( NIHSS ) .


Due to the PROBE design , no outcome data are available yet .


In the initial trial protocol we proposed a dichotomisation of the mRS as primary analysis of outcome and ordinal regression analysis as secondary analysis of primary outcome , requiring a sample size of @,@ patients .


However , ordinal analysis of outcome data is becoming increasingly more common in acute stroke trials , as it increases statistical power .


For PASS , funding is insufficient for inclusion of @,@ patients with the overall inclusion rate of @ patients per week .


Therefore we change the analysis of our primary outcome from dichotomisation to ordinal regression analysis on the mRS. Power analysis showed that with similar assumptions @,@ patients are needed using ordinal regression analysis .


We expect to complete follow-up in June @ .


A full statistical analysis plan will be submitted for publication before treatment allocation will be unblinded .


The data from PASS will establish whether preventive antibiotic therapy in acute stroke improves functional outcome by preventing infection .


In this update , we changed our primary outcome analysis from dichotomisation to ordinal regression analysis .


HIV counselling and testing and linkage to care are crucial for successful HIV prevention and treatment .


Abbreviated counselling could save time ; however , its effect on HIV risk is uncertain and methods to improve linkage to care have not been studied .


We did this factorial randomised controlled study at Mulago Hospital , Uganda .


Participants were randomly assigned to abbreviated or traditional HIV counselling and testing ; HIV-infected patients were randomly assigned to enhanced linkage to care or standard linkage to care .


All study personnel except counsellors and the data officer were masked to study group assignment .


Participants had structured interviews , given once every @ months .


We compared sexual risk behaviour by counselling strategy with a @ % non-inferiority margin .


We used Cox proportional hazards analyses to compare HIV outcomes by linkage to care over @ year and tested for interaction by sex .


This trial is registered with ClinicalTrials.gov ( NCT@ ) .


We enrolled @ participants ; @ assigned to abbreviated counselling versus @ assigned to traditional .


Unprotected sex with an HIV discordant or status unknown partner was similar in each group ( @/@ -LSB- @ % -RSB- vs @/@ -LSB- @ % -RSB- , difference -@ % , one-sided @ % CI @ ) .


Loss to follow-up was lower for traditional counselling than for abbreviated counselling ( adjusted hazard ratio -LSB- HR -RSB- @ , @ % CI @-@ ) .


@ HIV-positive participants were assigned to enhanced linkage ( n = @ ) or standard linkage to care ( n = @ ) .


Linkage to care did not have a significant effect on mortality or receipt of co-trimoxazole .


Time to treatment in men with CD@ cell counts of @ cells per L or fewer was lower for enhanced linkage versus standard linkage ( adjusted HR @ , @ % CI @-@ ) and time to HIV care was decreased among women ( @ , @-@ ) .


Abbreviated HIV counselling and testing did not adversely affect risk behaviour .


Linkage to care interventions might decrease time to enrolment in HIV care and antiretroviral treatment and thus might affect secondary HIV transmission and improve treatment outcomes .


Tinea cruris , a pruritic superficial fungal infection of the groin , is the second most common clinical presentation for dermatophytosis .


This phase @ study evaluated the safety and efficacy of topical luliconazole cream @ % in patients with tinea cruris .


@ patients were enrolled and @ male and female patients aged @ years with clinically evident tinea cruris and eligible for modified intent-to-treat analysis were randomized @:@ to receive luliconazole cream @ % ( n = @ ) or vehicle ( n = @ ) once daily for @ days .


Efficacy was evaluated at baseline and at days @ , @ , @ , and @ based on mycology ( potassium hydroxide , fungal culture ) and clinical signs ( erythema , scaling , pruritus ) .


The primary outcome was complete clearance at day @ ( @ days posttreatment ) .


Safety evaluations included adverse events and laboratory assessments .


Complete clearance was obtained in @ % ( @/@ ) of patients treated with luliconazole cream @ % compared with @ % ( @/@ ) treated with vehicle ( P < @ ) .


The safety profile of luliconazole cream @ % was similar to vehicle .


The study was conducted under controlled conditions in a relatively small population .


Luliconazole cream @ % applied once daily for @ days is more effective than vehicle and well tolerated in patients with tinea cruris .


To compare the postoperative analgesic effects of lidocaine , morphine and lidocaine plus morphine administered by constant rate infusion ( CRI ) and analyzing their effects on opioid requirements after orthopedic surgery in dogs .


Twenty-four dogs underwent fracture repairs were premedicated with IM acepromazine ( @ mg/kg ) combined with morphine ( @ mg/kg ) .


Anesthesia was induced with IV propofol ( @ to @ mg / kg ) and maintained with isoflurane .


The dogs were randomly assigned to @ groups and administered a CRI IV of lidocaine ( T-L ) , morphine ( T-M ) or lidocaine plus morphine ( T-LM ) at the same doses .


Postoperative analgesia was assessed for @ hours using a Visual Analog Scale ( VAS ) and the Glasgow Composite Pain Scale ( GCPS ) .


Rescue analgesia was performed if the evaluation score exceeded @ % of the VAS and/or @ % of the GCPS .


The pain score and postoperative opioid requirements did not differ among the treatments .


Rescue analgesia was administered to @/@ dogs in the T-M and T-LM , and to @/@ dogs in the T-L .


Lidocaine , morphine or lidocaine/morphine CRI may be efficacious techniques for pain management in the first @ hours post-surgery .


However , the two drugs administered together did not reduce the postoperative opioid requirement in dogs undergoing fracture repair .


Key words : Anesthesia .


Analgesics .


Analgesics , Opioid .


Lidocaine .


Morphine .


Dogs .


The risk of cardiovascular diseases ( CVD ) is increased tremendously among menopausal women , and there is an increasing demand for alternative therapies for managing factors like dyslipidemia that contribute to CVD development .


In this study , Nigella sativa was evaluated for its hypolipidemic effects among menopausal women .


In a randomised trial , hyperlipidemic menopausal women were assigned to treatment ( n = @ ) or placebo groups ( n = @ ) , and given N. sativa or placebo for two months after their informed consents were sought .


At baseline , blood samples were taken and at one month intervals thereafter until one month after the end of the study .


The results showed that N. sativa significantly improved lipid profiles of menopausal women ( decreased total cholesterol , low density lipoprotein cholesterol and triglyceride , and increased high density lipoprotein cholesterol ) more than the placebo treatment over @ months of intervention .


One month after cessation of treatment , the lipid profiles in the N. sativa-treated group tended to change towards the pretreatment levels .


N. sativa is thought to have multiple mechanisms of action and is cost-effective .


Therefore , it could be used by menopausal women to remedy hypercholesterolemia , with likely more benefits than with single pharmacological agents that may cause side effects .


The use of N. sativa as an alternative therapy for hypercholesterolemia could have profound impact on the management of CVD among menopausal women especially in countries where it is readily available .


Overweight and obesity among young , adult women are increasing problems in Sweden as in many other countries .


The postpartum period may be a good opportunity to improve eating habits and lose weight in a sustainable manner .


The aim was to make a cost-utility analysis of a dietary behavior modification treatment alongside usual care , compared to usual care alone , among lactating overweight and obese women .


This study was a cost-utility analysis based on a randomized controlled and longitudinal clinical diet intervention .


Between @-@ , @ women living in Sweden were , after baseline measurement at @-@weeks postpartum , randomly assigned to a @-week dietary behavior modification treatment or control group .


Inclusion criteria were : self-reported pre-pregnancy body mass index ( BMI ) @-@kg / m@ , non-smoker , singleton term delivery , birth weight > @g , intention to breastfeed for @ mo and no diseases ( mother and child ) .


The women in the intervention group received @ hour of individual counseling at study start and @ hour at follow-up home visits after @ weeks of intervention , with support through cell phone text messages every two wk .


Dietary intervention aimed to reduce dietary intake by @kcal/day .


The control group received usual care .


Weight results have previously been reported .


Here we report on analyses carried out during @-@ of cost per quality adjusted life years ( QALY ) , based on the changes in quality of life measured by EQ-@D-@L and SF-@D .


Likelihood of cost-effectiveness was calculated using Net Monetary Benefit method .


Based on conservative assumptions of no remaining effect after @ year follow-up , the diet intervention was cost-effective .


Costs per gained QALY were @ @ - @ @ USD .


The likelihood for cost-effectiveness , considering a willingness to pay @ @ USD for a QALY , was @-@ % .


The diet intervention is cost-effective .


The energy source used for stone fragmentation is important in miniperc .


In this study , we compared the stone fragmentation characteristics and outcomes of laser lithotripsy and pneumatic lithotripsy in miniperc for renal calculi .


After Institutional Review Board approval , @ patients undergoing miniperc for renal calculi of @ to @ mm were equally randomized to laser and pneumatic lithotripsy groups .


Miniperc was performed using @ F Karl Storz miniperc sheath and a @F nephroscope .


Laser lithotripsy was performed using a @-m laser fiber and @ W laser with variable settings according to the need .


Pneumatic lithotripsy was performed using the EMS Swiss lithoclast .


Patient demographics , stone characteristics , intraoperative parameters , and postoperative outcomes were analyzed .


The baseline patient demographics and stone characteristics were similar in both groups .


The total operative time ( P = @ ) and fragmentation time ( P = @ ) were similar between the groups .


The surgeon assessed that the Likert score ( @ to @ ) for fragmentation was similar in both groups ( @ @ vs @ @ , P = @ ) .


Stone migration was lower with the laser ( @ @ vs @ @ , P = @ ) , and fragment removal was easier with the laser ( @ @ vs @ @ , P = @ ) .


The need for fragment retrieval using a basket was significantly more in the pneumatic lithotripsy group ( @ % vs @ % , P = @ ) .


The hemoglobin drop , complication rates , auxiliary procedures , postoperative pain , and stone clearance rates were similar between the groups ( P > @ ) .


Both laser lithotripsy and pneumatic lithotripsy are equally safe and efficient stone fragmentation modalities in miniperc .


Laser lithotripsy is associated with lower stone migration and easier retrieval of the smaller fragments it produces .


The role of nutrition in the treatment of attention-deficit hyperactivity disorder ( ADHD ) is gaining international attention ; however , treatments have generally focused only on diet restriction or supplementing with one nutrient at a time .


To investigate the efficacy and safety of a broad-based micronutrient formula consisting mainly of vitamins and minerals , without omega fatty acids , in the treatment of ADHD in adults .


This double-blind randomised controlled trial assigned @ adults with ADHD in a @:@ ratio to either micronutrients ( n = @ ) or placebo ( n = @ ) for @ weeks ( trial registered with the Australian New Zealand Clinical Trials Registry : ACTRN@ ) .


Intent-to-treat analyses showed significant between-group differences favouring active treatment on self - and observer - but not clinician-ADHD rating scales .


However , clinicians rated those receiving micronutrients as more improved than those on placebo both globally and on ADHD symptoms .


Post hoc analyses showed that for those with moderate/severe depression at baseline , there was a greater change in mood favouring active treatment over placebo .


There were no group differences in adverse events .


This study provides preliminary evidence of efficacy for micronutrients in the treatment of ADHD symptoms in adults , with a reassuring safety profile .


Patients with stable COPD show improvements in exercise capacity and muscular function after the application of whole body vibration .


We aimed to evaluate whether this modality added to conventional physiotherapy in exacerbated hospitalised COPD patients would be safe and would improve exercise capacity and quality of life .


@ hospitalised exacerbated COPD patients were randomized ( @:@ ) to undergo physiotherapy alone or physiotherapy with the addition of whole body vibration .


The primary endpoint was the between-group difference of the @-minute walking test ( day of discharge - day of admission ) .


Secondary assessments included chair rising test , quality of life , and serum marker analysis .


Whole body vibration did not cause procedure-related adverse events .


Compared to physiotherapy alone , it led to significantly stronger improvements in @-minute walking test ( @ @ m vs. @ @ m ; p = @ ) and St. Georges Respiratory Questionnaire ( -@ @ vs. @ @ , p = @ ) .


Whole body vibration increased the expression of the transcription factor peroxisome proliferator receptor gamma coactivator-@ - and serum levels of irisin , while it decreased serum interleukin-@ .


Whole body vibration during hospitalised exacerbations did not cause procedure-related adverse events and induced clinically significant benefits regarding exercise capacity and health-related quality of life that were associated with increased serum levels of irisin , a marker of muscle activity .


The purpose of this study was to evaluate the long-term safety and efficacy of risperidone in treating irritability and related behaviors in children and adolescents with autistic disorders .


In this @ month ( @ week ) open-label extension ( OLE ) study , patients ( @-@ years of age , who completed the previous fixed-dose , @ week , double-blind -LSB- DB -RSB- phase ) were flexibly dosed with risperidone based on body weight .


The maximum allowed dose was @ mg/day for those weighing @ to < @ kg , and @ mg/day for those weighing @ kg .


The study primarily assessed risperidone 's safety ; efficacy was assessed as a secondary end-point .


Fifty-six ( @ % ) out of @ enrolled patients completed the OLE ; the most common discontinuations were for insufficient response ( @ -LSB- @ % -RSB- ) or adverse events ( AE ) ( @ -LSB- @ % -RSB- ) .


The most common ( @ % frequency in the total group ) AEs were increased appetite ( @ % -LSB- n = @ -RSB- ) ; increased weight and vomiting ( @ % -LSB- n = @ -RSB- each ) ; sedation , pyrexia , and upper respiratory tract infection ( @ % -LSB- n = @ -RSB- each ) ; nasopharyngitis ( @ % -LSB- n = @ -RSB- ) ; and somnolence and fatigue ( @ % -LSB- n = @ -RSB- each ) .


Extrapyramidal AEs were reported in @ ( @ % ) patients .


Increase in mean weight ( @-@ % ) and body mass index ( @-@ % ) occurred ; one patient discontinued because of weight increase .


One potentially prolactin-related AE ( irregular menstruation ) was reported .


The risperidone high-dose group had the greatest mean improvement in sleep visual analog scale ( @ ) .


All groups showed additional improvement in efficacy scale scores during the OLE .


During this OLE , safety findings with risperidone treatment ( maximum weight-based dose of @ mg/day or @ mg/day ) were consistent with those observed in the DB phase , and with the current safety information for risperidone in autistic , psychiatric , and behavioral disorders .


Patients experienced some additional improvement in irritability and related behaviors .


For patients with acute iliofemoral deep vein thrombosis , it remains unclear whether the addition of intravascular high-frequency , low-power ultrasound energy facilitates the resolution of thrombosis during catheter-directed thrombolysis .


In a controlled clinical trial , @ patients ( mean age @ @ years , @ % women ) with acute iliofemoral deep vein thrombosis were randomized to receive ultrasound-assisted catheter-directed thrombolysis ( N = @ ) or conventional catheter-directed thrombolysis ( N = @ ) .


Thrombolysis regimen ( @ mg r-tPA over @ hours ) was identical in all patients .


The primary efficacy end point was the percentage of thrombus load reduction from baseline to @ hours according to the length-adjusted thrombus score , obtained from standardized venograms and evaluated by a core laboratory blinded to group assignment .


The percentage of thrombus load reduction was @ % @ % in the ultrasound-assisted catheter-directed thrombolysis group and @ % @ % in the conventional catheter-directed thrombolysis group ( P = @ ) .


Adjunctive angioplasty and stenting was performed in @ ( @ % ) patients and in @ ( @ % ) patients , respectively ( P > @ ) .


Treatment-related complications occurred in @ ( @ % ) and @ ( @ % ) patients , respectively ( P > @ ) .


At @-month follow-up , primary venous patency was @ % in the ultrasound-assisted catheter-directed thrombolysis group and @ % in the conventional catheter-directed thrombolysis group ( P = @ ) , and there was no difference in the severity of the post-thrombotic syndrome ( mean Villalta score : @ @ -LSB- range @-@ -RSB- versus @ @ -LSB- range @-@ -RSB- ; P = @ ) , respectively .


In this randomized controlled clinical trial of patients with acute iliofemoral deep vein thrombosis treated with a fixed-dose catheter thrombolysis regimen , the addition of intravascular ultrasound did not facilitate thrombus resolution .


To compare vaginoscopic hysteroscopic sterilization with traditional hysteroscopic approach for differences in pain , bilateral microinsert placement rates , and procedure time .


We performed a prospective , randomized , single-blinded study of hysteroscopic sterilization using the Essure System .


The study setting was an inner city ObGyn clinic .


Ninety patients were randomized to either vaginoscopy or traditional approach .


The traditional approach was speculum insertion , paracervical analgesia , and tenaculum .


All procedures were done with a @ mm , @ degree rigid hysteroscope .


Main outcome measures were pain scores ( @-point visual analog scale ) , bilateral placement rates , and procedure times .


Vaginoscopy was successful in @/@ patients ( @ % ) .


There was no statistically significant difference in pain-scores for microinsert placement between the groups ( p = @ ) .


First attempt , bilateral microinsert placement rate was @ % ( @/@ ) with vaginoscopy and @ % ( @/@ ) with traditional ( p = @ ) .


Time for treatment completion was @ minutes ( mean ) ( range , @-@ ) in the traditional group versus vaginoscopy time of @ minutes ( mean ) ( range , @-@ ) ( p = @ ) .


Hysteroscopic sterilization via vaginoscopy is feasible with bilateral microinsert rates comparable to those of traditional hysteroscopy .


Vaginoscopy is associated with less overall discomfort and is faster to perform .


To study sevoflurane inhalation general anesthesia using the laryngeal mask airway ( LMA ) and nasal endotracheal ( ET ) intubation to maintain the airway in pediatric day-case dental surgery .


A total of @ children aged @ to @ years received elective day-case dental surgical procedure under general anesthesia .


Children were randomly grouped into LMA groups ( L ) and nasal ET intubation group ( N ) .


In L groups , LMA was inserted after induction of anesthesia using @ % sevoflurane and were allowed to breathe spontaneously .


Rocuronium and remifentanil were given intravenously during @ % sevoflurane induction by nasal ET intubation in the N group .


The time of anesthetic induction , maintenance , recovery , surgical access , and bispectral index score were recorded .


Postoperative nausea and vomiting and the incidence of adverse events during induction and recovery period were also recorded .


The insertion time of LMA was significantly shorter than nasal ET ( P < @ ) .


The incidence of airway complications , the surgeons ' access , and bispectral index were not different between the @ groups .


However , recovery time was significantly shorter in group L ( P < @ ) .


The incidence of sore throat and postoperative nausea and vomiting ( P < @ ) were much less in group L as well .


Sevoflurane inhalation anesthesia through LMA is a safe and reliable method for pediatric day-case dental surgery .


Keloids are a burden for patients due to physical , aesthetic and social complaints and treatment remains a challenge because of therapy resistance and high recurrence rates .


The main goal of treatment is to improve the quality of life ( QoL ) ; this implies that , apart from surgical outcomes , patient-reported outcome measures ( PROMs ) need to be taken into account .


Decision making in keloid treatment is difficult due to heterogeneity of the condition and the lack of comparative studies .


This is a multicentre , randomised controlled open trial that compares @ ) intralesional cryotherapy versus excision and corticosteroids for primary keloids , and @ ) intralesional cryotherapy versus excision and brachytherapy for therapy-resistant keloids .


The primary outcome is the Patient and Observer Scar Assessment Scale ( POSAS ) , a @-item scale ( with score @ indicating the best and @ indicating the worst scar imaginable ) .


A difference of six points on the total score is considered to be of clinical importance .


Secondary outcomes are recurrence rates , volume reduction , Skindex-@ scores , SF-@ scores and complication rates .


Primary and secondary outcome measurements are taken at baseline , and at @ , @ , @ and @ weeks postoperatively .


For analysis , a linear mixed model is used .


A total of @ patients will be included over a period of @ years .


The protocol is approved by the Medical Ethics Committee of the Erasmus University Medical Centre Rotterdam and follows good clinical practice guidelines .


The outcomes of this study will improve evidence-based decision making for the treatment of keloids , as well as patient education .


The prevalence of depression is high and the elderly have an increased risk of developing chronic course .


International data suggest that depression in the elderly is under-recognised , the latency before clinicians provide a treatment plan is longer and elderly patients with depression are not offered psychotherapy to the same degree as younger patients .


Although recommendations for the treatment of elderly patients with depression exist , health-care professionals adhere to these recommendations to a limited degree only .


We conducted a systematic review to identify recommendations for managing depression in the elderly and prioritised six recommendations .


We identified and prioritised the determinants of practice related to the implementation of these recommendations in primary care , and subsequently discussed and prioritised interventions to address the identified determinants .


The objective of this study is to evaluate the effectiveness of these tailored interventions for the six recommendations for the management of elderly patients with depression in primary care .


We will conduct a pragmatic cluster randomised trial comparing the implementation of the six recommendations using tailored interventions with usual care .


We will randomise @ municipalities into one of two groups : an intervention group , to which we will deliver tailored interventions to implement the six recommendations , and a control group , to which we will not deliver any intervention .


We will randomise municipalities rather than patients , individual clinicians or practices , because we will deliver the intervention for the first three recommendations at the municipal level and we want to minimise the risk of contamination across GP practices for the other three recommendations .


The primary outcome is the proportion of actions taken by GPs that are consistent with the recommendations .


This trial will investigate whether a tailored implementation approach is an effective strategy for improving collaborative care in the municipalities and health-care professionals ' practice towards elderly patients with depression in primary care .


The effectiveness evaluation described in this protocol will be accompanied with a process evaluation exploring why and how the interventions were effective or ineffective .


The objective of this study was to use a randomized controlled trial design to test the impact of an educational intervention delivered by specially trained community health workers among Chinese , Korean , and Vietnamese participants ages @ to @ years on knowledge , attitudes , beliefs , and intentions regarding colorectal cancer screening .


Baseline data were collected on participants ' demographic characteristics , knowledge , attitudes , beliefs about cancer , its risk factors , and intention to keep up to date on cancer screening in the future .


Fifteen intervention sessions were held between April and June of @ .


Follow-up surveys were administered in the postintervention period to both intervention and control participants .


Those randomized to the control group received educational pamphlets in their native language .


The intervention had the greatest influence on the Chinese subgroup , which had improved scores relative to the control group for perceived behavior control and intentions ( preintervention vs postintervention change : control group , -@ ; intervention group , @ ; P = @ ) , behavioral beliefs on cancer screening ( preintervention vs postintervention change : control group , -@ ; intervention group , @ ; P = @ ) , and attitudes toward behavior ( preintervention vs postintervention change : control group , -@ ; intervention group , @ ; P @ ) .


The intervention had no effect on behavioral beliefs about cancer , control beliefs , or perceived behavioral control ( reliance on family ) .


Although the intention to stay up to date for cancer screening increased in @ study groups ( Chinese and Vietnamese ) , these increases were not significant .


An educational program delivered by culturally specific community health educators using culturally appropriate language influences some knowledge , attitude , and behavioral beliefs but not others .


Dumping syndrome is characterized by distinct pathophysiological features such as postprandial increase in hematocrit ( HT ) and pulse rate ( PR ) and delayed hypoglycemia ( HG ) .


Treatment is based on dietary measures and somatostatin analogs ( SA ) , but current SAs have incomplete efficacy , possibly through limited affinity for various somatostatin receptor subtypes .


We evaluated the effect of pasireotide , a novel SA with high affinity for @/@ human somatostatin receptors , on pathophysiological events and symptoms in dumping .


Randomized double-blind placebo-controlled cross-over study of nine patients ( six women , @years ) with postoperative dumping .


Baseline measurements included oral glucose tolerance testing ( OGTT ) , abdominal ultrasound , and dumping symptom severity score ( DSSS ) .


Patients were treated for @weeks with placebo or pasireotide @g s.c. t.i.d. with a @-week wash-out in a randomized fashion .


On day @ and @ of each treatment OGTT , DSSS , and solid and liquid gastric emptying ( GE ) were obtained .


Baseline OGTT was pathological in all patients based on PR ( n = @ ) , HT ( n = @ ) or HG ( n = @ ) .


Compared to placebo , pasireotide suppressed the increase in PR ( @ vs @ bpm ; p < @ ) and late HG ( nadir glycemia @ vs @ mg/dL ; p = @ ) , increased peak glycemia ( @ vs @ mg/dL ; p = @ ) and delayed GE of solids ( t@/@ @ vs @min ; p = @ ) and liquids ( t@/@ @ vs @min , p = @ ) .


The differences in DSSS did not reach statistical significance .


Two patients dropped out because of adverse gastrointestinal events under pasireotide .


Pasireotide affects pathophysiological features of both early and late dumping syndrome .


The aim of the present double-blind , randomized , controlled study was to evaluate and compare the efficacy of amnion allograft and connective tissue graft in covering denuded root surfaces .


Seventy-one teeth in @ patients with gingival recession were treated randomly with coronally displaced flap plus connective tissue graft ( control group , n = @ recessions in @ patients ) or coronally displaced flap plus amnion allograft ( test group , n = @ recessions in @ patients ) .


The amount of root coverage and clinical parameters ( probing depth , recession depth , clinical attachment level , recession width , gingival width , and papilla dimensions ) were measured at baseline and at @ and @ months postoperatively .


Average root coverage percentages after @ months in the test and control groups were @ % ( @ + / - @ mm ) and @ % ( @ + / - @ mm ) , respectively , with no statistically significant differences ( p = @ ) .


The changes in depth and width of recessions and in gingival width were significant @ and @ months after surgery compared to baseline ( p = @ ) .


Variations in the level of attachment and probing depths after @ months were statistically significant in the test group compared to the control group ( p = @ ) .


Papilla dimensions were significantly correlated with root coverage ( p = @ ) .


Amnion allograft might be a suitable alternative to connective tissue graft in procedures to cover denuded root surfaces and can reduce recession depth .


Based on the growing evidence of risk reduction from fresh fruit and vegetable consumption and an inverse relationship between serum @-hydroxyvitamin D ( @OHD ) and the risk of type @ diabetes ( T@D ) , we determined the benefits of regularly consuming vitamin D-enriched mushrooms in a prediabetic cohort .


Exposing edible mushrooms to ultraviolet B ( UVB ) light increases vitamin D@ ( D@ ) and raises serum @OHD@ in healthy young adults ; however , their benefit to deficient prediabetics and glucose metabolism remains untested .


Forty-three prediabetic , D-deficient adults ( @OHD@ng/ml ) , BMI > @ were randomized to four groups consuming daily entres containing @g fresh sliced cooked mushrooms prepared by a chef for @ weeks .


Two groups were fed UVB-treated mushrooms initially containing : @IU D@ or @IU D@ ; each one also received one capsule of placebo daily .


Two control groups were fed untreated mushrooms and D@ dietary supplements at two label doses : @IU D@ and @IU D@ .


D@ and D@ content were analyzed in mushrooms , before and after cooking and in over-the-counter supplements .


After @ weeks , both D@-UVB-mushroom entre doses , which were significantly lower after cooking , produced modest or no increases in @OHD@ or total @OHD relative to the positive control subjects who actually consumed about @ and @IU per day of D@ ( higher than stated on the label ) .


Unanticipated D@ cooking loss from fresh UVB mushrooms and probable low absorption and/or hydroxylation may explain the smaller increase in @OHD@ in our prediabetic overweight/obese cohort compared with past findings in younger , healthy subjects .


Moreover , no dose or vitamin D source was associated with modifying T@D risk factors .


To investigate the relationship between breastfeeding and snoring in childhood .


In a cohort of children with a family history of asthma who were recruited antenatally we prospectively recorded data on infant feeding practices throughout the first year of life .


Snoring status and witnessed sleep apnea were measured at age @ years by parent-completed questionnaire .


Associations were estimated by logistic regression with , and without , adjustment for sets of confounders designed to exclude biasing effects .


Habitual snoring was reported in @ % of the sample , and witnessed apnea in @ % .


Any breastfeeding for longer than one month was associated with a reduced risk of habitual snoring at age @ ( adjusted OR @ , @ % CI @ to @ ) and duration of breastfeeding was inversely associated with the prevalence of habitual snoring ( adjusted OR @ , @ % CI @ to @ ) .


Any breastfeeding for longer than @ month was associated with a lower risk of witnessed sleep apnea ( adjusted OR @ , @ % CI @ to @ ) .


The protective associations were not mediated by BMI , current asthma , atopy or rhinitis at age @ years .


Breastfeeding for longer than one month decreases the risk of habitual snoring and witnessed apneas in this cohort of children with a family history of asthma .


The underlying mechanism remains unclear but the finding would be consistent with a beneficial effect of the breast in the mouth on oropharyngeal development with consequent protection against upper airway dysfunction causing sleep-disordered breathing .


The purpose of this study was to assess accuracy of lung nodule volumetry in low-dose CT with application of iterative reconstruction ( IR ) according to nodule size , nodule density and CT tube currents , using artificial lung nodules within an anthropomorphic thoracic phantom .


Eight artificial nodules ( four diameters : @ , @ , @ and @ mm ; two CT densities : -@ HU that represents ground-glass nodule and +@ HU that represents solid nodule ) were randomly placed inside a thoracic phantom .


Scans were performed with tube current-time product to @ , @ , @ and @ mAs .


Images were reconstructed with IR and filtered back projection ( FBP ) .


We compared volume estimates to a reference standard and calculated the absolute percentage error ( APE ) .


The APE of all nodules was significantly lower when IR was used than with FBP ( @ @ % compared with @ @ % ; p < @ ) .


The effect of IR was more pronounced for smaller nodules ( p < @ ) .


IR showed a significantly lower APE than FBP in ground-glass nodules ( p < @ ) , and the difference was more pronounced at the lowest tube current ( @ @ % compared with @ @ % ; p < @ ) .


The effect of IR was most pronounced for ground-glass nodules in the lowest CT tube current .


Lung nodule volumetry in low-dose CT by application of IR showed reliable accuracy in a phantom study .


Lung nodule volumetry can be reliably applicable to all lung nodules including small , ground-glass nodules even in ultra-low-dose CT with application of IR .


IR significantly improved the accuracy of lung nodule volumetry compared with FBP particularly for ground-glass ( -@ HU ) nodules .


Volumetry in low-dose CT can be utilized in patient with lung nodule work-up , and IR has benefit for small , ground-glass lung nodules in low-dose CT. .


To evaluate the anatomical and functional efficacy of combination therapy of intravitreal ranibizumab with laser or intravitreal bevacizumab with laser treatment compared to only laser treatment for macular edema due to branch retinal vein occlusion ( BRVO ) .


Thirty eyes of @ patients with BRVO of at least @ weeks duration were randomized into three groups : Group @ received a single dose of intravitreal Ranibizumab followed by grid laser treatment , Group @ received a single dose of intravitreal Bevacizumab followed by grid laser treatment , and Group @ received grid laser alone .


Outcomes at @ months follow-up were reported .


Data were collected on best corrected visual acuity ( BCVA ) , central foveal thickness ( CFT ) , and gain in lines of Snellen acuity .


At @ month follow-up , the difference in the mean BCVA and CFT between the three treatment groups was not statistically significant ( P > @ , all comparisons ) .


Six eyes ( @ % ) in Group @ , four eyes ( @ % ) in Group @ and two eyes ( @ % ) in Group @ had a statistically significant gain of @ lines of Snellen acuity ( P < @ ) .


Both ranibizumab and bevacizumab combined with laser photocoagulation , resulted in better outcomes than grid laser treatment .


Tubeless percutaneous nephrolithotoomy ( PCNL ) , although an accepted technique by now , continues to suffer from two major limitations : The need for postoperative cystoscopy for ureteral stent removal and inability to perform a `` second-look '' procedure for any residual fragments .


We share our experience with a modification of the standard tubeless PCNL technique that allows us to overcome these shortcomings .


A total of @ patients selected to have PCNL were randomized into two groups of @ each .


In group A ( control group ) , the patients underwent standard PCNL with the insertion of a nephrostomy tube at completion ; in group B ( intervention group ) , modified tubeless PCNL was performed with a Double-J ( DJ ) stent inserted with a tether attached to its proximal end , taken out through the percutaneous tract .


The nephrostomy tube in group A was removed postoperatively on the second or third day , whereas those in group B had the stent removed directly by pulling the attached tether within the office setting @ to @ days postoperatively .


The need for postoperative analgesia was significantly higher in group A compared with group B ( mean dose of tramadol needed , @ mg vs @ mg ) ( P < @ ) .


Four patients in group A had postoperative urinary leakage from the nephrostomy site , whereas there were no leaks in patients in group B. Group B patients spent significantly shorter average time in hospital ( @ hours ) compared with group A ( @ hours ) ( P < @ ) .


Two of the patients in group B needed a second-look procedure , performed by the insertion of a guidewire down the stent , which was pulled out partially by its tether .


Presence of the tether in the flank or the process of subsequent removal did not cause any discomfort to any patient .


The present study demonstrates that tubeless PCNL with a tethered DJ stent overcomes its main drawback , namely , the need for cystoscopy for stent removal , and also allows access to the pelvicaliceal system for second-look nephroscopy .


The Y-@ ( Ginsan ) acidic polysaccharide from Korean Panax ginseng has been shown to function as an immunomodulatory molecule .


However , the efficacy of Y-@ has not been evaluated in clinical trial .


We verified Y-@ ( @ g/day ) for safety and immune efficacy in @ healthy volunteers aged @-@ years using a randomized , placebo-controlled , parallel , double-blind study .


The activities of natural killer ( NK ) cells and peripheral blood phagocytes , as well as serum levels of monocyte-derived mediators , were assessed before and after administration for @ and @ weeks .


This trial is registered at ClinicalTrials.gov ( NCT@ ) .


Y-@ significantly enhanced NK cell cytotoxic activity by @ % and @ % from baseline after administration for @ and @ weeks , respectively .


The phagocytic activity of peripheral blood cells was also significantly increased by @ % and @ % and serum level of TNF - by @ % and @ % after treatment for @ and @ weeks , respectively .


Differences in the efficacy of variables compared to the placebo group were also significant .


Administration of Y-@ was well tolerated without treatment-related adverse events or alteration of complete blood cell count or blood chemistry over the entire study period .


Y-@ was shown to be a safe and potentially effective natural alternative for enhancing immune function .


To evaluate the chronic effects of a static stretching program on the muscle architecture of biceps femoris ( BF ) and vastus lateralis ( VL ) muscles in ultrasound ( US ) images .


Randomized controlled longitudinal trial .


Biomechanics Laboratory of Physical Education School of the Army , Rio de Janeiro , Brazil .


The study included @ healthy and physically active male volunteers ( @ @ years , @ @ m , and @ @ kg ) , randomly allocated to @ of @ groups : stretching group ( SG , n = @ ) and control group ( n = @ ) .


The SG was submitted to @ sets of @ seconds of static stretching @ times a week during @ weeks .


Ultrasound equipment ( @ MHz ) was used for the evaluation of BF and VL muscle architecture variables ( pennation angle , fiber length , muscle thickness , and fascicle displacement ) before and after training .


Knee range of motion ( ROM ) and isometric flexion and extension torque ( TQ ) were also measured .


There were no significant changes in muscle architecture , TQ , and maximum knee flexion angle ( P > @ ) .


However , maximum knee extension angle ( MEA ) increased significantly in the SG ( pretraining : @ @ degrees and posttraining : @ @ degrees ; P < @ ) .


Volume or intensity ( or both ) of the stretching protocol was insufficient to cause structural changes in the VL and BF muscles .


The increase in MEA could not be explained by muscle architecture changes .


To describe changes in the VL and BF muscle tendon unit using US after a long-term stretching program to identify which structures are responsible for ROM increase .


To evaluate the influence of low-dose , enteric-coated aspirin tablets ( @mg/day for @years ) on colorectal tumour recurrence in Asian patients with single/multiple colorectal tumours excised by endoscopy .


A double-blinded , randomised , placebo-controlled multicentre clinical trial was conducted .


@ subjects with single/multiple colorectal adenomas and adenocarcinomas excised by endoscopy were enrolled in the study ( @ patients in the aspirin group and @ patients in the placebo group ) .


Enrolment began at the hospitals ( n = @ ) in @ and was completed in @ .


The subjects treated with aspirin displayed reduced colorectal tumourigenesis and primary endpoints with an adjusted OR of @ ( @ % CI @ to @ ) compared with the subjects in the placebo group .


Subgroup analysis revealed that subjects who were non-smokers , defined as those who had smoked in the past or who had never smoked , had a marked reduction in the number of recurrent tumours in the aspirin-treated group .


The adjusted OR for aspirin treatment in non-smokers was @ ( CI @ to @ , p < @ ) .


Interestingly , the use of aspirin in smokers resulted in an increased risk , with an OR of @ .


In addition , no severe adverse effects were observed in either group .


Low-dose , enteric-coated aspirin tablets reduced colorectal tumour recurrence in an Asian population .


The results are consistent with those obtained from other randomised controlled trials in Western countries .


THE CLINICAL TRIAL REGISTRY WEBSITE AND THE CLINICAL TRIAL NUMBER : http://www.umin.ac.jp ( number UMIN@ ) .


Lung cancer is the leading cause of cancer death worldwide and characterized by a poor prognosis .


It has a major impact on the psychological wellbeing of patients and their partners .


Recently , it has been shown that Mindfulness-Based Stress Reduction ( MBSR ) is effective in reducing anxiety and depressive symptoms in cancer patients .


The generalization of these results is limited since most participants were female patients with breast cancer .


Moreover , only one study examined the effectiveness of MBSR in partners of cancer patients .


Therefore , in the present trial we study the effectiveness of MBSR versus treatment as usual ( TAU ) in patients with lung cancer and their partners .


A parallel group , randomized controlled trial is conducted to compare MBSR with TAU .


Lung cancer patients who have received or are still under treatment , and their partners are recruited .


Assessments will take place at baseline , post intervention and at three-month follow-up .


The primary outcome is psychological distress ( i.e. anxiety and depressive symptoms ) .


Secondary outcomes are quality of life ( only for patients ) , caregiver appraisal ( only for partners ) , relationship quality and spirituality .


In addition , cost-effectiveness ratio ( only in patients ) and several process variables are assessed .


This trial will provide information about the clinical and cost-effectiveness of MBSR compared to TAU in patients with lung cancer and their partners .


Photodynamic therapy ( PDT ) is approved for selected nodular basal cell carcinomas ( nBCC ) but efficacy is reduced for large and thick tumours .


Ablative fractional lasers ( AFXL ) facilitate uptake of methyl aminolaevulinate ( MAL ) and may thus improve PDT outcome .


To evaluate efficacy and safety of AFXL-mediated PDT ( AFXL-PDT ) compared with conventional PDT of high-risk nBCC .


Patients with histologically verified facial nBCC ( n = @ ) defined as high-risk tumours were included ; diameter > @mm , tumours located in high-risk zones , or on severely sun-damaged skin .


Tumours were debulked and patients randomized to either AFXL-PDT ( n = @ ) or PDT ( n = @ ) .


Fractional CO@ laser treatment was applied at @ % density and @m ( @mJ ) ablation depth .


MAL was applied under occlusion for @h and illuminated with a @-nm light-emitting diode source , @Jcm ( -@ ) .


Clinical assessments were performed at @ , @ , @ and @months and biopsies were taken at @months .


Clinical cure rates at @months were @ % ( @ of @ AFXL-PDT ) and @ % ( @ of @ PDT , P = @ ) .


Recurrences tended to occur later and in lower numbers after AFXL-PDT at @ , @ and @months ( @ % , @ % , @ % ) than PDT ( @ % , @ % , @ % ) ( P = @ ) .


Histology at @months documented equal tumour clearance after AFXL-PDT ( @ % , @ of @ ) and PDT ( @ % , @ of @ ) .


Cosmetic outcomes were highly satisfactory after both treatments ( P > @ ) .


Long-term efficacy was similar after PDT and AFXL-PDT with a trend for a favourable short-term cure rate after AFXL-PDT .


AFXL-PDT needs further refinement for nBCC and at present is not recommended over PDT .


To examine the effects of activity-based therapy ( ABT ) on neurologic function , walking ability , functional independence , metabolic health , and community participation .


Randomized controlled trial with delayed treatment design .


Outpatient program in a private , nonprofit rehabilitation hospital .


Volunteer sample of adults ( N = @ ; @ men and @ women ; age , @-@y ) with chronic ( @mo postinjury ) , motor-incomplete ( ASIA Impairment Scale grade C or D ) spinal cord injury ( SCI ) .


A total of @h/wk of ABT for @ weeks including developmental sequencing ; resistance training ; repetitive , patterned motor activity ; and task-specific locomotor training .


Algorithms were used to guide group allocation , functional electrical stimulation utilization , and locomotor training progression .


Neurologic function ( International Standards for Neurological Classification of Spinal Cord Injury ) ; walking speed and endurance ( @-meter walk test , @-minute walk test , and Timed Up and Go test ) ; community participation ( Spinal Cord Independence Measure , version III , and Reintegration to Normal Living Index ) ; and metabolic function ( weight , body mass index , and Quantitative Insulin Sensitivity Check ) .


Significant improvements in neurologic function were noted for experimental versus control groups ( International Standards for Neurological Classification of Spinal Cord Injury total motor score -LSB- @ vs @ ; P = @ -RSB- and lower extremity motor score -LSB- @ vs -@ ; P = @ -RSB- ) .


Significant differences between experimental and control groups were observed for @-meter walk test speed ( @ m/s vs @ m/s ; P = @ ) and @-minute walk test total distance ( @ m vs @ m ; P = @ ) .


ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic , motor-incomplete SCI .


However , further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits .


Patients with recurrent and/or metastatic ( R/M ) head and neck squamous cell carcinoma ( HNSCC ) receiving platinum-based chemotherapy as their first-line treatment have a dismal prognosis , with a median overall survival ( OS ) of ~ @ months .


Methotrexate is sometimes used following platinum failure or in patients not fit enough for platinum therapy , but this agent has not demonstrated any OS improvement .


Targeted therapies are a novel approach , with the EGFR-targeting monoclonal antibody cetuximab ( plus platinum-based chemotherapy ) approved in the US and Europe in the first-line R/M setting , and as monotherapy following platinum failure in the US .


However , there is still a high unmet medical need for new treatments that improve outcomes in the second-line R/M setting following failure on first-line platinum-containing regimens .


Afatinib , an irreversible ErbB family blocker , was recently approved for the first-line treatment of EGFR mutation-positive metastatic non-small cell lung cancer .


Afatinib has also shown clinical activity similar to cetuximab in a Phase II proof-of-concept HNSCC trial .


Based on these observations , the Phase III , LUX-Head & Neck @ study is evaluating afatinib versus methotrexate in R/M HNSCC patients following progression on platinum-based chemotherapy in the R/M setting .


Patients with progressive disease after one first-line platinum-based chemotherapy are randomised @:@ to oral afatinib ( starting dose @ mg once daily ) or IV methotrexate ( starting dose @ mg/m ( @ ) once weekly ) administered as monotherapy with best supportive care until progression or intolerable adverse events .


Efficacy of afatinib versus methotrexate will be assessed in terms of progression-free survival ( primary endpoint ) .


Disease progression will be evaluated according to RECIST v@ @ by investigator and independent central review .


Secondary endpoints include OS , tumour response and safety .


Health-related quality of life and biomarker assessments will also be performed .


If the LUX-Head & Neck @ trial meets its primary endpoint , it will demonstrate the ability of afatinib to elicit an improved treatment benefit versus a commonly used chemotherapy agent in the second-line treatment of R/M HNSCC patients who have failed on first-line platinum-based therapy , confirm the clinical efficacy of afatinib observed in the Phase II proof-of-concept study , and establish a new standard of care for this patient population .


The present randomized controlled trial evaluated the impact of different exercise training modalities on functional fitness responses in apparently healthy older men .


A total of @ community-dwelling older men were randomly assigned to an aerobic training group ( ATG , n = @ ) , a combined aerobic and resistance training group ( CTG , n = @ ) or a control group ( n = @ ) .


Both exercise training programs were moderate-to-vigorous intensity , @ days/week for @ months .


Six independent functional fitness tests ( back scratch , chair sit-and-reach , @-s chair stand , arm curl , @-ft up-and-go , @-min walk ) were measured on five different occasions .


The data were analyzed using a mixed-model ANOVA .


ANOVA showed a significant main effect of group ( P < @ ) for all functional fitness tests , with significant differences between both training groups and controls .


However , the ATG only improved the chair sit-and-reach and the @-s chair stand performance , whereas CTG improved in all functional fitness tests .


ANOVA also identified a significant main effect of time for @-ft up-and-go ( P = @ ) in the CTG .


Only the combined exercise program was effective in improving all functional fitness components related to daily living activities .


Luseogliflozin is a selective sodium glucose cotransporter @ inhibitor under development for the treatment of type @ diabetes mellitus ( T@DM ) .


This phase II study was conducted to confirm the efficacy and safety of luseogliflozin monotherapy at doses of up to @mg in Japanese patients with T@DM .


Patients with hemoglobin A@c ( HbA@c ) of @-@ @ % on diet therapy were randomized in a double-blind manner to treatment with @ , @ , @ , or @mg luseogliflozin or placebo for @ weeks ( n = @ , @ , @ , @ , and @ , respectively ) .


Japan Pharmaceutical Information Center ( identifier : Japic CTI-@ ) .


The primary endpoint was the change in HbA@c from baseline to the end of treatment .


Other endpoints included fasting plasma glucose ( FPG ) , postprandial plasma glucose ( PPG ) and body weight .


Adverse events were recorded throughout the study .


HbA@c decreased significantly at the end of treatment in the @ , @ , @ , and @mg luseogliflozin groups compared with placebo ( -@ , -@ , -@ , and -@ % , respectively , versus +@ % ; all P < @ ) , as did FPG and PPG ( all P < @ ) .


Body weight also decreased significantly in all luseogliflozin groups compared with placebo ( all P < @ ) .


The incidence rates of adverse events ( @-@ @ % ) were not significantly different among the five groups .


The overall incidence of hypoglycemia was low .


Limitations of this study include the short study duration and the relatively small sample size .


In Japanese patients with T@DM , luseogliflozin was well tolerated , improved glycemic control , and reduced body weight over @ weeks of treatment at all tested doses .


Doses of @ mg achieved similar improvements in glycemic control .


The Individual Placement and Support ( IPS ) approach is an evidence-based form of supported employment for people with severe and persistent mental illness .


This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA .


One previous Australian randomised controlled trial found that IPS is effective for young people with first episode psychosis .


The aim of the current trial was to assess the effectiveness of evidence-based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems .


A four-site randomised control trial design ( n = @ ) was conducted in Brisbane ( two sites ) , Townsville and Cairns .


The intervention consisted of an IPS supported employment service hosted by a community mental health team .


The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area .


At @ months , those in the IPS condition had @ times greater odds of commencing employment than those in the control condition ( @ % vs. @ % ) .


The conditions did not differ on secondary employment outcomes including job duration , hours worked , or job diversity .


Attrition was higher than expected in both conditions with @ % completing the baseline interview but taking no further part in the study .


The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment .


IPS can be successfully implemented this way in Australia , but with a loss of effect strength compared to previous USA trials .


Compared to eccentric contractions , concentric contractions result in higher cardiovascular stress .


However , we do not know how these two types of contractions influence cardiac autonomic modulation during the post-exercise recovery period .


to compare the effect of resistance training that is performed with concentric vs. eccentric emphasis on muscle strength and on post-exercise recovery which was assessed by examining heart rate variability ( HRV ) , for the knee extensor muscle group in young healthy adults .


For this study , @ men between @ and @ years of age were randomized into @ groups : concentric control ( CONCC ) , eccentric control ( ECCC ) , concentric training ( CONCT ) and eccentric training ( ECCT ) .


The CONCC and ECCC groups underwent one session of resistance exercise ( RE ) using the knee extensor muscle group ( @ sets of @ repetition at @ % of the maximal repetition -LSB- @MR -RSB- ) and the CONCT and ECCT groups performed @ training sessions .


The HRV was analyzed at baseline and across four recovery periods ( T@ , T@ , T@ and T@ ) .


The ECCT group exhibited increased muscle strength at the end of the study .


Regarding cardiac autonomic modulation , the CONCC and ECCC groups exhibited increases in overall variability ( SDNN and SD@ ) at T@ compared to baseline , and the ECCT group demonstrated increases in variables reflecting vagal modulation and the recovery process ( RMSSD , SD@ and HF -LSB- ms@ -RSB- ) at T@ , T@ and T@ compared to baseline .


Resistance training with emphasis on eccentric contractions promoted strength gain and an increase in cardiac vagal modulation during recovery compared to baseline .


The objective of this study is to examine the independent associations of time spent in moderate-to-vigorous physical activity ( MVPA ) and sedentary ( SED-time ) , with total and abdominal body fat ( BF ) , and the bidirectionality of these associations in adults at high risk of type @ diabetes .


We measured MVPA ( min per day ) and SED-time ( h per day ) by accelerometry , and indices of total ( body weight , fat mass ( FM ) , BF % and FM index ) and abdominal BF ( waist circumference ( WC ) ) using standard procedures in @ adults ( @ @ years ) with parental history of type @ diabetes ( ProActive UK ) at baseline , @-year and @-year follow-up .


Mixed effects models were used to quantify the independent associations ( expressed as standardised - coefficients ( @ % confidence interval ( CI ) ) ) of MVPA and SED-time with fat indices , using data from all three time points .


All models were adjusted for age , sex , intervention arm , monitor wear time , follow-up time , smoking status , socioeconomic status and MVPA/SED-time .


MVPA was inversely and independently associated with all indices of total BF ( for example , @ s.d. higher MVPA was associated with a reduction in FM , = -@ ( @ % CI : -@ , -@ ) s.d. ) and abdominal BF ( for example , WC : = -@ ( -@ , -@ ) ) .


Similarly , higher fat indices were independently associated with a reduction in MVPA ( for example , WC : = -@ ( -@ , -@ ) ; FM : = -@ ( -@ , -@ ) ) .


SED-time was positively and independently associated with most fat indices ( for example , WC : = @ ( -@ , @ ) ; FM : = @ ( @ , @ ) ) .


Higher values of all fat indices independently predicted longer SED-time ( for example , WC : = @ ( @ , @ ) , FM : = @ ( @ , @ ) ) .


The associations of MVPA and SED-time with total and abdominal BF are bidirectional and independent among individuals at high risk for type @ diabetes .


The association between BF and MVPA is stronger than the reciprocal association , highlighting the importance of considering BF as a determinant of decreasing activity and a potential consequence .


Promoting more MVPA and less SED-time may reduce total and abdominal BF .


The objective of the study was to investigate the efficacy and safety of hexaminolevulinate ( HAL ) photodynamic therapy ( PDT ) , a novel therapy for women with cervical intraepithelial neoplasia ( CIN ) @/@ , to define the appropriate population and endpoints for a phase @ program .


This was a double-blind , randomized , placebo-controlled , dose-finding study that included a total of @ women with biopsy-confirmed CIN @/@ based on local pathology .


Patients received @ or @ topical treatments of HAL hydrochloride @ % , @ % , @ % , and placebo ointment and were evaluated for response after @-@ months based on biopsy , Papanicolaou test , and oncogenic human papillomavirus ( HPV ) test .


All efficacy analyses were performed on blinded central histology review to avoid interreader variability .


Adverse events , blood biochemistry , and vital signs were assessed after @ months .


There were no statistically significant differences between placebo and either the CIN @ or combined CIN @/@ populations .


A cleardose effect with a statistically significant response in theHAL@ % group of @ % ( @/@ patients ) compared to @ % ( @/@ patients ) in the placebo group ( P < @ ) was observed at @months in women with CIN @ , including an encouraging @ % ( @/@ patients ) clearance of HPV @/@ compared to @ % ( @/@ patients ) in the placebo group at @ months .


The treatment was easy to use and well accepted by patients and gynecologists .


Only local self-limiting adverse reactions including discharge , discomfort , and spotting were reported .


HAL PDT is a novel therapy that shows promise in the treatment of CIN @ including clearance of oncogenic HPV , but not of CIN @ .


The positive risk/benefit balance makes HAL PDT a tissue-preserving alternative in women of childbearing age who wish to preserve the cervix .


Confirmatory studies are planned .


Airway management and endotracheal intubation are essential skills for pediatric residents .


Simulation-based technology is used for training residents but it remains unclear whether high fidelity simulation results in better retention of skills compared to low fidelity .


The study assesses high fidelity simulation of endotracheal intubation and traditional low fidelity training in improving pediatric residents ' knowledge retention and technical skills ; and if the difference translates into higher `` real time '' intubation success rates .


Second and third year pediatric residents were randomized into high fidelity ( intervention ) or low fidelity simulation ( control ) groups .


Airway management and intubation skills were taught using a didactic lecture and demonstration on low fidelity mannequins .


Knowledge was assessed before randomization ( T@ ) and @ months after training ( T@ ) .


Other outcome measures were : @ ) airway management and intubation skills at T@ and T@ ( @ months later ) and @ ) successful intubation of actual patients by T@ .


@ out of @ residents completed the intervention .


Theoretical knowledge improved for both groups .


Participants made less mistakes ( M ) overtime : M ( T@ ) = @ and M ( T@ ) = @ for the intervention group , and M ( T@ ) = @ and M ( T@ ) = @ for the control .


There was no significant effect of fidelity on intubation skills or the number of successful intubations recorded in logbooks ( allp > @ ) .


In some instances intubation skills showed regression over time .


High fidelity simulation showed no impact on residents ' airway management and intubation skills .


Retention of theoretical knowledge persisted over time while practical skills remained at baseline or declined .


Endoscopic submucosal dissection ( ESD ) is a technically difficult and lengthy procedure requiring optimal depth of sedation .


The bispectral index ( BIS ) monitor is a non-invasive tool that objectively evaluates the depth of sedation .


The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol , and thus reduce the incidence of sedation - and/or procedure-related complications .


A total of @ patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups .


The control group ( n = @ ) was monitored by the Modified Observer 's Assessment of Alertness and Sedation scale and the BIS group ( n = @ ) was monitored using BIS .


The total doses of propofol and remifentanil , the need for rescue propofol , and the rates of complications were recorded .


The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group ( @ % vs. @ % , p = @ ) .


There were no significant differences in the incidence of sedation - and/or procedure-related complications .


BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures .


However , this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation .


The critical nursing shortage is particularly apparent in specialty areas such as intensive care units ( ICUs ) .


Some nurses develop resilient coping strategies and adapt to stressful work experiences , mitigating the development of common maladaptive psychological symptoms .


To determine if a multimodal resilience training program for ICU nurses was feasible to perform and acceptable to the study participants .


In a randomized and controlled @-week intervention study , treatment and control groups completed demographic questions and measures of resilience , anxiety , depression , posttraumatic stress disorder ( PTSD ) , and burnout syndrome before and after the intervention .


The intervention included a @-day educational workshop , written exposure sessions , event-triggered counseling sessions , mindfulness-based stress reduction exercises , and a protocolized aerobic exercise regimen .


Nurses in the intervention arm also completed satisfaction surveys for each component of the intervention .


This mulitmodal resilience training program was feasible to conduct and acceptable to ICU nurses .


Both nurses randomized to the treatment group and nurses randomized to the control group showed a significant decrease in PTSD symptom score after the intervention .


A multifaceted resilience training program for ICU nurses was both feasible and acceptable .


A sufficiently powered , randomized clinical trial is needed to assess the effect of the intervention on improving individuals ' level of resilience and improving psychological outcomes such as symptoms of anxiety , depression , burnout syndrome , and PTSD .


Depression is common among dialysis patients and is associated with adverse outcomes .


Problem-solving therapy ( PST ) is effective for treating depression in older patients with chronic illness , but its effectiveness has never been reported in hemodialysis ( HD ) patients .


We investigated the feasibility and satisfaction of PST and its impact on depression scores among older HD patients .


Patients at least @ years of age receiving maintenance HD at a single outpatient dialysis center were eligible for the study .


Randomized patients received either @ weeks of PST from a licensed renal social worker or usual care .


This study modeled the staff-patient ratio standard of most dialysis clinics , and therefore only one social worker provided the interventions .


Study outcomes included feasibility ( successful completion of @ weekly sessions ) and patient satisfaction with PST as well as impact on depression scores ( between-group comparison of mean Beck depression inventory ( BDI ) and Patient health questionnaire-@ ( PHQ-@ ) scores at @ weeks , and of mean change-from-baseline scores ) .


The recruitment rate was @ % ( @/@ ) .


All subjects randomized to the intervention arm ( n = @ ) and who initiated PST ( n = @ ) completed the study , and all reported overall satisfaction with the intervention .


@ % reported that PST helped them to better solve problems and improved their ability to cope with their medical condition .


At @ weeks , there were no significant differences in mean BDI and PHQ scores between the usual care and the intervention group ( BDI @ vs. @ , p = @ ; PHQ @ vs. @ , p = @ ) .


Mean change-from-baseline depression scores were significantly improved in the intervention group relative to the control group ( change in BDI @ vs. - @ , p = @ ; change in PHQ @ vs. @ , p < @ ) .


The results demonstrate that PST is feasible in the dialysis unit setting , acceptable to patients , and may positively impact depression among maintenance hemodialysis patients .


To examine the amount of objectively measured MVPA and LPA that is associated with long-term weight loss and the maintenance of clinically significant weight loss .


Adults ( N = @ ; BMI : @ to < @ kg/m ( @ ) ; age : @-@ years ) participated in an @-month behavioral weight loss intervention and were prescribed a low-calorie diet and increased physical activity .


Change in weight and objectively measured physical activity were assessed .


MVPA > @ ( MET-min/week ) was computed from bouts > @ min and > @ METs and MVPA < @ was computed from bouts < @ min in duration and > @ METs .


LPA was computed from bouts between @ to < @ METs .


When grouped on percent weight loss at @ months , there was a significant group time interaction effect ( P < @ ) for both MVPA > @ and LPA , with both measures being significantly greater at @ months in those with > @ % weight loss .


Similar results were observed for MVPA > @ and LPA with participants grouped on achieving > @ % weight loss at @ months and sustaining this at @ months .


MVPA > @ of @-@ min per week , coupled with increased amounts of LPA , are associated with improved long-term weight loss .


Interventions should promote engagement in these amounts and types of physical activity .


Studies with platelet glycoprotein IIb/IIIa receptor inhibitors ( GPIs ) showed conflicting results in primary percutaneous coronary intervention ( PPCI ) patients who were pretreated with @ mg clopidogrel .


We sought to investigate the short - and long-term efficacy and safety of the periprocedural administration of tirofiban in a largest Serbian PPCI centre .


We analysed @ consecutive PPCI patients enrolled in the Clinical Center of Serbia STEMI Register , between February @ and March @ .


All patients were pretreated with @ mg clopidogrel and @ mg aspirin .


Major adverse cardiovascular events , comprising all-cause death , nonfatal infarction , nonfatal stroke , and ischaemia-driven target vessel revascularization , was the primary efficacy end point .


TIMI major bleeding was the key safety end point .


Analyses drawn from the propensity-matched sample showed improved primary efficacy end point in the tirofiban group at @-day ( OR @ , @ % CI @-@ @ ) and at @-year ( OR @ , @ % CI @-@ @ ) follow up .


Moreover , tirofiban group had a significantly lower @-day all-cause mortality ( secondary end point ; OR @ , @ % CI @-@ @ ) , compared with patients who were not administered tirofiban .


At @ year , a trend towards a lower all-cause mortality was observed in the tirofiban group ( OR @ , @ % CI @-@ @ ) .


No differences were found with respect to the TIMI major bleeding during the follow-up period .


Tirofiban administered with PPCI , following @ mg clopidogrel pretreatment , improved primary efficacy outcome at @ days and at @ year follow up without an increase in major bleeding .


Chronic transplant dysfunction ( CTD ) is the leading cause of long-term loss of the renal allograft .


So far , no single test is available to reliably predict the risk for CTD .


Monitoring of tryptophan ( trp ) metabolism through indoleamine @-dioxygenase ( IDO ) has been previously proposed to predict acute rejection of human kidney transplants .


Here , we investigate the potential of IDO/trp degradation along the kynurenine ( kyn ) pathway to predict the long-term outcome of human kidney transplantation .


During the @-year follow-up blood , urine , and kidney biopsies were collected from @ renal transplant patients .


Concentrations of kyn and trp in serum and urine were measured at @ weeks , @ months , and @ years after transplantation .


Kynurenine to tryptophan ratio was calculated as an estimate of trp degradation .


To evaluate the histological changes and IDO expression , respectively , periodic acid schiff staining and immunohistochemistry for IDO were performed on biopsies taken at @ months and @ years .


Two years after transplantation , kyn/trp was increased in urine and decreased in serum as compared to @-week values .


In @-year biopsies , IDO expression was mainly found in infiltrating inflammatory cells and in the glomeruli .


The urine level of trp @ weeks after transplantation predicted the serum creatinine @ months and the estimated creatinine clearance @ years after transplantation .


Additionally , serum level of kyn @ months after transplantation predicted the serum creatinine @ years after transplantation .


Early serum and urine levels of trp and kyn may offer a novel route for early detection of patients at risk for developing CTD .


Regular aspirin use reduces colon adenoma and carcinoma incidence .


UDP-glucuronosyltransferases ( UGT ) are involved in aspirin metabolism and clearance , and variant alleles in UGT@A@ have been shown to alter salicylic acid metabolism and risk of colon neoplasia .


In a randomized , cross-over , placebo-controlled trial of @ healthy men and women , homozygous for UGT@A@ * @ or UGT@A@ * @ , we explored differences between global epithelial and stromal expression , using Affymetrix U@ +@ microarrays and tested effects of @-day aspirin supplementation ( @ mg/d ) on epithelial and stromal gene expression and colon prostaglandin E@ ( PGE@ ) levels .


No statistically significant differences in gene expression were observed in response to aspirin or UGT@A@ genotype , but tissue PGE@ levels were lower with aspirin compared to placebo ( p < @ ) .


Transcripts differentially expressed between epithelium and stroma ( N = @ , P < @ , false discovery rate < @ ) , included a high proportion of genes involved in cell signaling , cellular movement , and cancer .


Genes preferentially expressed in epithelium were involved in drug and xenobiotic metabolism , fatty acid and lipid metabolism , apoptosis signaling , and ion transport .


Genes preferentially expressed in stroma included those involved in inflammation , cellular adhesion , and extracellular matrix production .


Wnt-Tcf@ pathway genes were expressed in both epithelium and stroma but differed by subcellular location .


These results suggest that , in healthy individuals , subtle effects of aspirin on gene expression in normal colon tissue are likely overwhelmed by inter-individual variability in microarray analyses .


Differential expression of critical genes between colonic epithelium and stroma suggest that these tissue types need to be considered separately .


To investigate the effect of nutrient stimulation of gut hormones by oligofructose supplementation on appetite , energy intake ( EI ) , body weight ( BW ) and adiposity in overweight and obese volunteers .


In a parallel , single-blind and placebo-controlled study , @ healthy overweight and obese volunteers were randomly allocated to receive @ g day ( -@ ) oligofructose or cellulose for @ weeks following a @-week run-in .


Subjective appetite and side effect scores , breath hydrogen , serum short chain fatty acids ( SCFAs ) , plasma gut hormones , glucose and insulin concentrations , EI , BW and adiposity were quantified at baseline and post-supplementation .