Exposure of patients with at least moderate depressive symptoms to an individually tailored intervention designed to increase patient engagement in depression care led to increased PCP discussion of suicidal thoughts .


Division of the parenchymal lung for lobectomy is performed in patients who have an incomplete fissure .


A stapler device can reduce postoperative air leak , but it is expensive .


to investigate the advantage of using a stapler , in terms of postoperative air leak and cost , compared to hand-sewn techniques .


A Non-blinded randomized controlled trial was conducted in Chiang Mai University Hospital , Thailand , from November @ , @ to September @ , @ .


Fifty-three adult patients were randomized to undergo a hand-sewn technique ( @ patients ) or stapler closure ( @ patients ) .


Postoperative air leak in the stapler group was less than that in the hand-sewn group ( @ % vs. @ % , p = @ ) , and the duration of air leak in the stapler group was significantly shorter than that in the hand-sewn group ( @ vs. @ days , p = @ ) .


The cost of treatment was not significantly different between groups ; however , the total cost in the stapler group was less than that in the hand-sewn group ( mean difference @ Thai baht ( US$ @ ) .


A stapler reduces postoperative air leaks and the duration of air leaks .


Furthermore , the total cost of treatment was comparable .


Therefore , using staples may provide substantial financial benefits .


During perioperative fasting , lipid metabolism gradually increases , resulting in free fatty acids ( FFA ) and/or ketone bodies .


Suppression of surgical stress by remifentanil may allow the safe administration of glucose infusions , avoiding both hyperglycemia and ketogenesis .


The effects of glucose infusion on glucose and lipid metabolism were therefore investigated in patients undergoing minor surgery with remifentanil anesthesia .


Thirty-four patients were randomized @:@ to receive no glucose ( @G group ) or low-dose glucose ( @ g/kg/h for @h followed by @ g/kg/h for @h ; LG group ) .


The concentrations of glucose , adrenocorticotropic hormone ( ACTH ) , @-methylhistidine ( @-MH ) , insulin , cortisol , FFA , creatinine ( Cr ) , and ketone bodies were measured before anesthetic induction , @ and @h after glucose infusion , at the end of surgery , and the next morning .


The concentrations of cortisol and ACTH decreased during surgery in both groups when compared with the concentrations before anesthesia and at the end of surgery ( P < @ ) .


Glucose and insulin concentrations were significantly higher in the LG than in the @G group at @ and @h after infusion .


No patient experienced hyperglycemia .


The concentrations of FFA and ketone bodies were lower in the LG than in the @G group during surgery , but there were no significant between group differences in @-MH/Cr .


Infusion of low-dose glucose attenuated fat catabolism without causing hyperglycemia , indicating that infusion of low-dose glucose during remifentanil-induced anesthesia may be safe for patients .


To explore the clinical roles of Jiawei Shentong Zhuyu Decoction ( JSZD ) in preventing the occurrence of failed back surgery syndrome ( FBSS ) , and to observe its effect on serum tumor necrosis factor-alpha ( TNF-alpha ) .


Totally @ patients prepared for surgical operation due to lumbar intervertebral disc herniation were randomly assigned to the treatment group and the control group according to random number table , @ cases in each group .


Patients in the treatment group additionally took JSZD , one dose per day , taken in two portions , once in the morning and once in the evening .


Those in the control group took Celecoxib Capsule ( @ mg each time , once per day ) and Mecobalamin Tablet ( @ mg each time , @ times per day ) .


They only took Mecobalamin Tablet from the @th day .


All patients were treated for @ days .


Japanese Orthopaedic Association ( JOA ) score was performed before treatment , at week @ , after treatment , at @ months of followed-ups , and at @ months of followed-ups .


And the levels of TNF-alpha in the peripheral blood were observed before treatment and at one month after treatment .


Totally @ patients completed the followed-up study .


The JOA scores were improved after treatment , at @ and @ months of followed-ups ( P < @ , P < @ ) .


The JOA score at @ months of followed-ups was superior in the treatment group to that of the control group ( P < @ ) .


Five patients ( accounting for @ % ) suffered from FBSS in the treatment group , while @ ( accounting for @ % ) suffered from FBSS in the control group .


The treatment group was superior to the control group ( P < @ ) .


The TNFalpha level was improved after treatment in the two groups .


Of them , the improvement of TNF-alpha in the treatment group was better than that of the control group ( P < @ ) .


The application of JSZD was effective for preventing the occurrence of FBSS , and improved the serum TNF-alpha level .


The current study was conducted to investigate the dependence between progression-free survival ( PFS ) and overall survival ( OS ) in patients with metastatic renal cell carcinoma ( mRCC ) and to explore whether PFS can be used as an intermediate endpoint of OS in this patient population .


A total of @ patients from @ prospective phase @ trials ( Cancer and Leukemia Group B -LSB- CALGB -RSB- @ and AVOREN ) of interferon-alpha with or without bevacizumab were analyzed .


Both trials recruited previously untreated patients with clear cell mRCC with an Eastern Cooperative Oncology Group performance status of @ to @ ; adequate bone marrow , hepatic , cardiac , and renal function ; and controlled blood pressure .


The CALGB study served as the training data set , and the AVOREN study served as the testing data set .


The dependence between PFS and OS was investigated using the Kendall tau for bivariate time-to-event endpoints .


In the training data set , the median OS times among patients who experienced progressive disease at @ months or @ months were @ months and @ months , respectively , compared with @ months and @ months , respectively , ( P < @ ) in patients who did not develop disease progress .


The adjusted hazard ratios ( HR ) were @ ( P < @ ) and @ ( P < @ ) , respectively , for patients who did and did not progress at @ months or @ months .


The dependence between PFS and OS was @ .


These associations were confirmed in the testing data set .


In patients with mRCC who were treated with interferon-alpha with or without bevacizumab , the PFS at @ months and @ months was found to be predictive of OS .


A high dependence between PFS and OS was observed , suggesting that PFS may be used as a surrogate endpoint for OS .


Although this is a novel observation for RCC , these findings require validation in patients with mRCC who are treated with other targeted agents .


Clinical application of an antibiotic 's pharmacokinetic/pharmacodynamic ( PK/PD ) properties may improve the outcome of severe infections .


No data are available on the use of linezolid ( LNZ ) continuous infusion in critically ill obese patients affected by ventilator-associated pneumonia ( VAP ) .


We conducted a prospective randomized controlled trial to compare LNZ concentrations in plasma and epithelial lining fluid ( ELF ) , when administered by intermittent and continuous infusion ( II , CI ) , in obese critically ill patients affected by VAP .


Twenty-two critically ill obese patients were enrolled .


At the steady state , in the II group , mean SD total and unbound maximum-minimum concentrations ( C max/C max , u - C min/Cmin , u ) were @ @ / @ @ mg/L and @ @ / @ @ mg/L , respectively .


In the CI group , the mean SD total and unbound plasma concentrations ( C ss and C ss , u ) were @ @ and @ @ mg/L , respectively .


Within a minimum inhibitory concentration ( MIC ) range of @-@ mg/L , the median ( IQR ) time LNZ plasma concentration persisted above MIC ( % T > MIC ) was significantly higher in the CI than the II group -LSB- @ ( @-@ ) vs @ ( @-@ ) , p = @ ; @ ( @-@ ) vs @ ( @-@ @ ) , p = @ ; @ ( @-@ ) vs @ ( @-@ @ ) , p = @ ; respectively -RSB- .


Pulmonary penetration ( % ) was higher in the CI group , as confirmed by a Monte Carlo simulation -LSB- @ ( IQR @-@ @ ) vs @ ( IQR @-@ @ ) ; p < @ -RSB- .


In critically ill obese patients affected by VAP , LNZ CI may overcome the limits of standard administration but these advantages are less evident with difficult to treat pathogens ( MIC = @ mg/L ) .


These data support the usefulness of LNZ continuous infusion , combined with therapeutic drug monitoring ( TDM ) , in selected critically ill populations .


The long-term efficacy and safety of responsive direct neurostimulation was assessed in adults with medically refractory partial onset seizures .


All participants were treated with a cranially implanted responsive neurostimulator that delivers stimulation to @ or @ seizure foci via chronically implanted electrodes when specific electrocorticographic patterns are detected ( RNS System ) .


Participants had completed a @-year primarily open-label safety study ( n = @ ) or a @-year randomized blinded controlled safety and efficacy study ( n = @ ) ; @ participants transitioned into an ongoing @-year study to assess safety and efficacy .


The average participant was @ ( @ ) years old with epilepsy for @ ( @ ) years .


The median preimplant frequency of disabling partial or generalized tonic-clonic seizures was @ seizures a month .


The median percent seizure reduction in the randomized blinded controlled trial was @ % at @ year and @ % at @ years ( p < @ , generalized estimating equation ) and ranged from @ % to @ % over postimplant years @ through @ in the long-term study .


Improvements in quality of life were maintained ( p < @ ) .


The most common serious device-related adverse events over the mean @ years of follow-up were implant site infection ( @ % ) involving soft tissue and neurostimulator explantation ( @ % ) .


The RNS System is the first direct brain responsive neurostimulator .


Acute and sustained efficacy and safety were demonstrated in adults with medically refractory partial onset seizures arising from @ or @ foci over a mean follow-up of @ years .


This experience supports the RNS System as a treatment option for refractory partial seizures .


This study provides Class IV evidence that for adults with medically refractory partial onset seizures , responsive direct cortical stimulation reduces seizures and improves quality of life over a mean follow-up of @ years .


Patients with diabetes often develop ocular complications .


The most common and most blinding of these complications , however , is diabetic retinopathy .


The objective of this study was to compare the retinal neovessels regression in Proliferative Diabetic Retinopathy ( PDR ) treated with Pan Retinal Photocoagulation ( PRP ) versus panretinal photocoagulation plus Intra Vitreal Bevacizumab ( IVB ) .


A comparative study was conducted at Khyber Institute of Ophthalmic Medical Sciences , Hayatabad Medical Complex , Peshawar from @st October @ to @st August @ .


A total of @ eyes were randomised into two groups .


Neovessels status was assessed before and at every follow up visit .


Neo Vessels on the Disc ( NVDs ) were assessed as per percentage of NVD occupying the disc surface whereas Neo Vessels Elsewhere ( NVE ) were also assessed as per reference to disc surface diameter .


Neovascularization on the disc was @ + / - @ % at presentation which increased to @ + / - @ % on @th day and stabilised to @ + / - @ % on day @ in PRP group .


In PRP-plus group , @ + / - @ % NVD regressed to @ + / - @ % on @th day and @ + / - @ % on day @ .


The NVE in PRP group was @ + / - @ % at baseline , @ + / - @ % on @th day , and @ + / - @ % on day @ .


In PRP-plus group it was @ + / - @ % at baseline , @ + / - @ % on day @ , and @ + / - @ % on day @ .


On day @ both the groups had highly significant different NVD ( p = @ ) and NVE ( p = @ ) .


Intra Vitreal Bevacizumab in short term is effective as adjunctive treatment to PRP with early and higher rate of retinal neovessels regression than PRP alone in PDR patients .


To determine the efficacy of combining of Boswellia serrata L. resin and the root of Cyperus scariosus L. plus PFMT in reproductive age women with stress urinary incontinence .


A prospective , single-blind , placebo-controlled , randomized trial was conducted .


The patients were randomized to receive orally either combination of equal quantity of B.serrata and C.scariosus ( @g ) ( n = @ ) or placebo ( n = @ ) respectively twice daily for @ weeks in addition to pelvic floor muscle training in both groups .


The outcome was one hour pad test .


The results were analyzed using parametric and nonparametric test .


The improvement in the test and control group was @ % and @ % respectively .


Between the group comparison was statistically significant ( P = @ ) .


The intra group comparison of one hour pad test was statistically significant in both groups ( P < @ ) .


No adverse effects were noted .


The test group was more effective than control group in women with SUI .


Surgical resection has been the mainstay of curative treatment of early stage lung cancer in selected patients .


We evaluated survival and patterns of recurrence after surgical resection for early stage lung cancer from the American College of Surgeons Oncology Group Z@/Alliance trial .


One thousand eighteen patients enrolled in the Z@ trial were analyzed according to clinical T stage .


Differences between groups were compared using the @-sample rank test or ( @ ) test .


Log rank test and Cox proportional hazards regression were used to compare survival and recurrence .


To compare patients who underwent open versus video-assisted thoracoscopic surgery ( VATS ) resections , propensity-score matched analysis was performed .


Seven hundred fifty-two patients ( @ undergoing VATS and @ undergoing open surgery ) were classified into @ equal-sized propensity-score groups .


Proportional hazards regression was used to compare these outcomes .


There were @ patients with cT@ tumors and @ patients with cT@ tumors .


Median follow-up was @ years .


Median overall survival was @ years ( stage T@ ) and @ years ( stage T@ ) .


Overall survival at @ years was @ % ( stage T@ ) and @ % ( stage T@ ) .


Local recurrence-free survival at @ years was @ % ( stage T@ ) and @ % ( stage T@ ) ( P = @ ) .


Among patients with stage T@ cancer , @ % ( @ out of @ ) had local recurrences , whereas @ % ( @ out of @ ) of those with stage T@ tumors had local failure .


There was no difference in the development of new primary tumors between stage T@ and stage T@ groups .


In the propensity-score matched analysis of VATS versus open lobectomy patients , there was no difference in overall survival , disease-free survival , and freedom from development of a new primary tumor .


Results of patients with resected early stage non-small cell carcinoma from a large-scale , multicenter trial serve as benchmarks against which to compare nonsurgical therapies for early stage lung cancer .


Propensity-score matched analysis shows no difference in survival between patients undergoing VATS and open lobectomy .


This study was conducted to investigate the effects of creatine loading and resistance training on the homocysteine and lipid profiles of young males .


Sixty male University students ( @ @ years , @ @ m , @ @ kg , @ @ % body fat ) were randomly divided in to three groups ; control ( CG = @ ) , creatine supplement ( CEG = @ ) and placebo ( PEG = @ ) .


Both CEG and PEG participated in a same resistance-training regimen and either taking a creatine supplement ( @ g/d for the first @ days followed @ g/d thereafter ) or the same amount of placebo for @ weeks .


Participants in CG did not take any creatine supplementation and not engage any exercise program .


After the body composition were assessed , the homocysteine ( Hcy ) concentrations , blood lipids , folic acid and vitamin B@ levels of all the participants were measured at the beginning and end of the eight weeks of resistance training .


The analysis of the data indicated that the Hcy levels of the CEG after resistance training and receiving the creatine supplement ( @ @ ) was significantly lower than that of baseline ( @ @ ) measurements , F ( @,@ ) = @ , P = @ .


No significant differences were seen in the Hcy levels of the PEG ( @ @ ) after @ weeks of training and receiving a placebo ( @ @ ) , F ( @,@ ) = @ , P = @ .


Furthermore , there were no significant differences among groups in terms of Hcy levels , F ( @,@ ) = @ , P = @ .


The present study suggests that as well as strength gain ; creatine supplementation with resistance training may afford some protection against emerging cardiovascular risk factors .


To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens ( IOL ) implantation .


Prospective randomized clinical trial .


A total of @ infants were enrolled in the Infant Aphakia Treatment Study , a randomized , multi-center ( @ ) clinical trial comparing the treatment of unilateral aphakia in patients under @ months of age with a primary IOL implant or contact lens .


The rate , character , and severity of intraoperative complications , adverse events , and additional intraocular surgeries during the first @ postoperative years in the @ groups were examined .


There were more patients with intraoperative complications ( @ % vs @ % , P = @ ) , adverse events ( @ % vs @ % , P = @ ) , and more additional intraocular surgeries ( @ % vs @ % , P < @ ) in the IOL group than in the contact lens group .


However , the number of patients with adverse events in the contact lens group increased ( @ to @ ) in postoperative years @-@ compared to the first postoperative year , while it decreased ( @ to @ ) in years @-@ compared to the first postoperative year in the IOL group .


If only one half of the patients in the contact lens ( aphakic ) group eventually undergo secondary IOL implantation , the number of additional intraocular surgeries in the @ groups will be approximately equal .


The increased rate of complications , adverse events , and additional intraocular surgeries associated with IOL implantation in infants < @ months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction .


The aims of this study were ( @ ) to assess the long-term effects of a collaborative care intervention for patients with depression on process of care outcomes , and ( @ ) to describe whether case management was continued after the end of the original one-year intervention .


This @-month follow-up of a randomized controlled trial took place @ months after the end of the @-year intervention .


Data collection occurred by means of self-rating questionnaires and from medical records .


We calculated linear mixed and logistic generalized estimating equation models .


Of the @ patients included at baseline , @ ( @ % ) participated in this follow-up .


Intervention recipients gave higher ratings than control recipients in terms of mean overall Patient Assessment of Chronic Illness Care ( PACIC ) scores ( @ vs. @ ; P = @ ) , but no difference was found in medication adherence ( mean Morisky score @ vs. @ , P = @ ) , prescribed antidepressant medications ( @ % vs. @ % ; P = @ ) , visits to the family physician ( @ vs. @ , P = @ ) or mental health specialist ( @ vs. @ , P = @ ) over the @ month follow-up period .


Case management was continued for @ ( @ % ) selected intervention patients after the original intervention had ended .


At @ months , intervention and control recipients had different PACIC ratings , but other process of care outcomes did not differ .


The main effects of the intervention are apparent at @ months .


Effective lifestyle interventions are needed to prevent noncommunicable diseases in low - and middle-income countries .


We analyzed the effects of a school-based health promotion intervention on physical fitness after @ months and explored if the effect varied with important school characteristics .


We also assessed effects on screen time , physical activity and BMI .


We performed a cluster-randomized pair matched trial in schools in urban Ecuador .


The intervention included an individual and environmental component tailored to the local context and resources .


Primary outcomes were physical fitness ( EUROFIT battery ) , screen time ( questionnaires ) and physical activity ( accelerometers ) .


Change in BMI was a secondary outcome .


A total of @ grade @ and @ adolescents ( intervention : n = @ , @ % ) and @ schools ( intervention : n = @ , @ % ) participated .


Data of @ adolescents ( intervention : n = @ , @ % ) from @ schools were analyzed .


A school-based intervention with an individual and environment component can improve physical fitness and can minimize the decline in physical activity levels from childhood into adolescence in urban Ecuador .


Recently , various near-infrared vascular imaging devices aimed at facilitating peripheral intravenous cannulation ( PIC ) were introduced , all claiming to increase success rate of PIC .


We evaluated the clinical utility of a near-infrared vascular imaging device ( VascuLuminator ( ) ) in pediatric patients who were referred to the anesthesiologist because of difficult cannulation .


There were @ consecutive children referred to pediatric anesthesiologists by the treating pediatrician of the in - and outpatient clinic , because of difficulties with intravenous cannulation , were included in this cluster randomized clinical trial .


The presence and use of the near-infrared vascular imaging device for PIC was randomized in clusters of @ week .


Success at first attempt ( Fisher exact test ) and time to successful cannulation ( Log-rank test ) were assessed to evaluate differences between groups .


Success at first attempt in the group with the VascuLuminator ( ) ( @ % ) was not significantly different from the control group ( @ % , P = @ ) , neither was the median time to successful cannulation : @ s and @ s , respectively ( P = @ ) .


Visualization of blood vessels with near-infrared light and with near-infrared vascular imaging device did not improve success of PIC in pediatric patients who are known difficult to cannulate .


The high prevalence of obstructive sleep apnea in patients with resistant hypertension could be mediated by an activation of the renin-angiotensin-aldosterone system .


This study assessed the impact of continuous positive airway pressure ( CPAP ) treatment on plasma aldosterone concentration ( PAC ) .


One hundred and twenty-four patients with resistant hypertension were assessed , and those who fulfilled inclusion criteria ( n = @ ) underwent full night polysomnography , @-h ambulatory blood pressure monitoring , and PAC measurement .


Patients with an apnea-hypopnea index above @ ( n = @ ) were randomized to CPAP ( n = @ ) or to conventional treatment ( n = @ ) for @ months .


Seventy-eight patients completed the follow-up ( @ CPAP , @ conventional treatment ) ; @ had true resistant hypertension ( @ % ) , whereas @ had white-coat resistant hypertension ( @ % ) .


Most patients were men ( @ % ) , age @ years , and the mean apnea-hypopnea index was @ .


In patients with true resistant hypertension , CPAP achieved a significant decrease in most @-h BP measurements and a nonsignificant decrease in PAC ( @ vs. @ ng/dl ; P < @ ) .


In patients with white-coat resistant hypertension , CPAP achieved a significant decrease in PAC ( @ vs. @ ng/dl ; P < @ ) and in night-time DBP .


After adjustment , a weak but significant association was found between cumulative time spent with SaO@ below @ % ( CT@ % ) and baseline PAC ( P < @ , R @ ) , and between changes in PAC and changes in office DBP ( P < @ , R @ ) CONCLUSIONS : : Night-time hypoxemia and changes in DBP showed an association with baseline and changes in PAC , respectively .


CPAP achieved a significant reduction in PAC only in patients with white-coat resistant hypertension , although the CPAP effect on BP was highest in patients with true resistant hypertension .


The Swiss health ministry launched a national quality program ` QualiCCare ' in @ to improve health care for patients with COPD.The aim of this study is to determine whether participation in the COPD quality initiative ( ` QualiCCare ' ) improves adherence to recommended clinical processes and shows impact on patients ' COPD care and on the impact of COPD on a person 's life .


CAROL is a cluster-randomized controlled trial with randomization on the general practioner ( GP ) level .


Thirty GPs will be randomly assigned to equally sized intervention group or control group.Each GP will approach consecutively and regardless of the reason for the current consultation , patients aged @ years or older , with a smoking history of ten pack-years ( PY ) .


Patients with confirmed ( by spirometric evaluation ) COPD will be included in the study .


GPs in the intervention group will receive ` QualiCCare ' education , which addresses knowledge , decision-making and behavioural aspects as well as delivery of care according to COPD quality indicators and evidence-based key elements .


In the control group , no educational intervention will be applied and COPD patients will be treated as usual .


The study period is one year.The primary outcome measure is an aggregated score of relevant clinical processes defining elements in the care of patients with COPD : smoking cessation counseling , influenza vaccination , motivation for physical activity , appropriate pharmacotherapy , patient education and collaborative care .


Given a power of @ % and a significance level alpha of @ % , @ GPs recruiting eight patients each will be necessary in both study arms .


With an assumed dropout rate of @ % , @ patients will need to be included .


It is important to develop and implement interventions that add value to COPD care considering quality and efficiency .


Care pathways modifying the knowledge and behavior of physicians have the potential for improving care by transferring knowledge to clinical practice .


There is a lack of knowledge about the patient 's experience of excess skin after bariatric surgery in patients with body mass index , ( BMI ) > @ kg/m ( @ ) .


The objective of this study was to evaluate experience of excess skin after laparoscopic biliopancreatic diversion with duodenal switch ( BPD/DS ) or laparoscopic Roux-en-Y gastric bypass ( LRYGB ) and explore possible gender differences .


Another aim was to analyze possible correlation between the reported experiences of excess skin with changes in weight , BMI , and hip and waist circumference after surgery .


One and/or @ years after gastric bypass or duodenal switch surgery @ patients responded to a specific questionnaire .


The questionnaire included questions about the amount of excess skin and how much discomfort it caused .


Furthermore , the patients were measured concerning weight and waist and hip circumference .


One year after surgery , a majority of the patients experienced excess skin scored as > @ ( `` a lot of '' or `` very much '' ) .


The patients in the BPD/DS group experienced significantly more excess skin compared to patients in the LRYGB group .


Women experienced more excess skin and discomfort on several body parts than men .


The correlations between changes in BMI and the reported experience and discomfort of excess skin were low .


There was a low to moderate correlation between changes in waist and hip circumference measures and the experience of excess skin on stomach and buttocks .


Weight loss after LRYGB and BPD/DS in super-obese patients is associated with substantial discomfort from excess skin .


Women reported more discomfort and experienced more excess skin than men .


There was a low correlation between experience of excess skin and changes in weight , BMI , and circumference measures .


To compare the efficacy of @ mg and @ mg doxazosin XL treatments in patients with benign prostatic hyperplasia-related lower urinary tract symptoms and determine the efficiency of @ mg in those patients with inadequate response to @ mg .


A total of @ patients were included in this study .


Of the patients , @ were randomized to receive @ mg doxazosin XL ( group @ ) , and @ were randomized to receive @ mg ( group @ ) treatments .


After @ month of treatment , @ patients in group @ whose quality of life ( QoL ) score was unchanged or had deteriorated were switched to @ mg doxazosin XL treatment ( group @b ) .


The mean age was @ years .


After @ month of treatment , the mean alteration in the International Prostate Symptom Score was @ and @ ( P = @ ) , for the maximum urinary flow rate ( Q ( max ) ) , it was @ and @ mL/s ( P = @ ) , and for the QoL score it was @ and @ ( P = @ ) in groups @ and @ , respectively .


For group @b , during the period in which the patients were receiving @ and @ mg doxazosin XL treatments ; the International Prostate Symptom Score changes were @ and @ ( P < @ ) , the Q ( max ) changes were @ and @ mL/s ( P < @ ) , and the QoL changes were @ and @ ( P < @ ) in groups @ and @ , respectively .


With no changes in side effects , @ mg doxazosin XL treatment is an efficient choice for patients who did not have an adequate response to @ mg doxazosin XL treatment .


Studies conducted in large populations of patients and providing full information on Helicobacter pylori ( H. pylori ) antibiotic resistance are needed to determine the efficacy of sequential therapy ( SQT ) against this pathogen .


This study compared eradication rates with SQT and standard triple therapy ( STT ) , and evaluated the impact of antibiotic resistance on outcomes .


The study population included adults with positive H. pylori culture presenting at four centers in China between March @ and December @ .


Patients were randomly assigned to @ days of treatment with esomeprazole , amoxicillin , and clarithromycin ( STT ; n = @ ) or to @ days of treatment with esomeprazole and amoxicillin , followed by @ days of esomeprazole , clarithromycin , and tinidazole ( SQT ; n = @ ) .


Eradication was assessed @-@ weeks after treatment .


There was no significant difference between the eradication rates achieved with STT ( @ % ( @ % confidence interval ( CI ) @-@ @ ) ) and SQT ( @ % ( @-@ @ ) ; P = @ ) in either the intention-to-treat analysis or the per-protocol analysis ( @ % ( @-@ @ ) and @ % ( @-@ @ ) , respectively ; P = @ ) .


Clarithromycin resistance ( CLA-R , odds ratio ( OR ) = @ ( @-@ @ ) , P < @ ) and metronidazole resistance ( MET-R , OR = @ ( @-@ @ ) , P = @ ) both independently predicted treatment failure in the SQT group .


Patients in the SQT group with dual CLA-R and MET-R had a lower eradication rate ( @ % ) than those with isolated CLA-R ( @ % , P = @ ) or isolated MET-R ( @ % , P < @ ) .


H. pylori eradication rates with STT and SQT were compromised by antibiotic resistance .


SQT may be suitable in regions with high prevalence of isolated CLA-R , but it is unsatisfactory when both CLA-R and MET-R are present .


Pruritus is common among patients with end-stage renal disease undergoing dialysis , and the pathogenesis can be explained by several mechanisms .


However , there is no definite evidence supporting them , which limits the relative efficacy of any individual treatment option .


In this paper , we aimed to compare pregabalin with ondansetron in treatment of uraemic pruritus ( UP ) in dialysis patients .


In this @-week prospective , randomized , and double-blind trial , we assessed the efficacy and side effects in UP patients undergoing dialysis .


Patients were randomly assigned to receive @ weeks of @ mg twice-weekly pregabalin or @ mg/day ondansetron or a placebo .


Visits were scheduled at @ , @ , @ , @ , @ , and @ weeks after treatment .


The severity of pruritus was evaluated using Visual Analogue Scale and modified Duo 's VAG Scale .


Quality of sleep was evaluated using the Pittsburgh sleep quality index .


The effect of UP on health-related quality of life was assessed using the Chinese version of the @-item short-form ( SF-@ ) general health survey .


Baseline laboratory data and demographic characteristics were recorded from patient charts .


Finally , @ ( @ males , @ females , aged @ years old ) out of the @ patients completed the @-week study .


Of five patients who stopped pregabalin treatment due to side effects , two patients reported an improvement in nausea and vomiting among those receiving ondansetron .


Two patients dropped out for renal transplantation .


The @ patients included @ cases from the pregabalin group , @ from the ondansetron group , and @ from the placebo group .


Over the @ weeks , only pregabalin improved UP significantly .


The severity of pruritus was reduced significantly in the pregabalin group compared with the ondansetron and the placebo groups .


The final pruritus scores were not different between the ondansetron and the placebo groups .


Pruritus absolutely disappeared in two patients following renal transplantation .


Pregabalin is an effective alternative for treatment of uraemic pruritus .


Ondansetron has negligible effect on uremic pruritus and is expensive .


A larger sample size may be needed to demonstrate the effect of ondansetron in uraemic pruritus .


To investigate whether granulocyte colony-stimulating factor ( G-CSG ) affects endometrial thickness , implantation rates , and clinical pregnancy rates in routine , unselected IVF cycles .


Registered , individually randomized , two-group , parallel double-blinded placebo-controlled clinical trial .


Academically affiliated private clinical and research center .


@ consecutive , unselected , consenting women with no history of renal disease , sickle cell disease , or malignancy who were undergoing IVF .


Sealed , numbered , opaque envelopes assigned @ patients to receive G-CSF ( Filgrastim , Amgen , @ g/@ @ mL ) and @ to receive placebo ( saline ) .


Endometrial thickness , clinical pregnancy , and embryo implantation rates .


The mean age for the whole study group was @ @ years ( G-CSF : @ @ years ; placebo : @ @ years ) .


Endometrial thickness statistically significantly increased over the @-day observation period for the whole group by approximately @ mm .


The increase in the G-CSF group was not statistically significantly different from the control group .


Statistical models looking at treatment effects on clinical pregnancy and implantation rates demonstrated no effect of G-CSF treatment .


There were no adverse events for either treatment group .


In normal IVF patients , G-CSF does not affect endometrial thickness , implantation rates , or clinical pregnancy rates .


Because these results were obtained in an older patient population , they may not necessarily apply to younger women .


Dilated cardiomyopathy is characterized by left ventricular dilatation and dysfunction .


Inflammation and adverse remodeling of the extracellular matrix may be involved in the pathogenesis .


Statins reduce levels of low density lipoprotein cholesterol , but may also attenuate inflammation and affect matrix remodeling .


We hypothesized that treatment with rosuvastatin would reduce or even reverse left ventricular remodeling in dilated cardiomyopathy .


In this multicenter , randomized , double blind , placebo-controlled study , @ patients were randomized to @ mg of rosuvastatin or matching placebo .


Physical examination , blood sampling , echocardiography and cardiac magnetic resonance imaging were performed at baseline and at six months ' follow-up .


The pre-specified primary end point was the change in left ventricular ejection fraction from baseline to six months .


Over all , left ventricular ejection fraction improved @ percentage points over the duration of the study , but there was no difference in the change in left ventricular ejection fraction between patients allocated to rosuvastatin and those allocated to placebo .


Whereas serum low density lipoprotein cholesterol concentration fell significantly in the treatment arm , rosuvastatin did not affect plasma or serum levels of a wide range of inflammatory variables , including C-reactive protein .


The effect on markers of extracellular matrix remodeling was modest .


Treatment with rosuvastatin does not improve left ventricular ejection fraction in patients with dilated cardiomyopathy .


Current studies have demonstrated the efficacy and safety of laser intervention in the treatment of onychomycosis .


The objective of this study was to compare the efficacy of long-pulsed Nd : YAG @ nm laser for treatment of toenails onychomycosis with fingernails onychomycosis .


One hundred and twelve affected fingernails or toenails in @ patients with onychomycosis were randomized into Group @ ( @ patients with @ affected fingernails ) and Group @ ( @ patients with @ affected toenails ) .


These patients were further classified into three subgroups ( Grade II , III , and IV ) according to Scoring Clinical Index of Onychomycosis .


All the affected nails were treated with long-pulse Nd : YAG @ nm laser intervention , once weekly , for continuous weeks , and were followed up for @ weeks .


The response rates at weeks @ , @ , and @ were @ , @ and @ % , respectively , for Group @ , and @ , @ and @ % for Group @ .


The inter-group difference in efficacy was statistically significant ( P < @ ) .


Even in the same subgroup , the response rate of Group @ was higher than that of Group @ .


The efficacy of long-pulsed Nd : YAG @ nm laser intervention against affected toenails is superior to that against fingernails .


It is also effective for treatment of onychomycosis with different severity .


Physical therapy is recommended for the management of axial spondyloarthritis ( axSpA ) and flexibility exercises have traditionally been the main focus .


Cardiovascular ( CV ) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases .


Therefore , the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA .


In a single blinded randomized controlled pilot study the exercise group ( EG ) performed @ weeks of endurance and strength exercise while the control group ( CG ) received treatment as usual .


The primary outcome was the Ankylosing Spondylitis ( AS ) Disease Activity Score ( ASDAS ) .


Secondary outcomes included patient reported disease activity ( Bath AS Disease Activity Index -LSB- BASDAI -RSB- ) , physical function ( Bath AS Functional Index -LSB- BASFI -RSB- ) , and CV risk factors measured by arterial stiffness ( Augmentation Index -LSB- Alx -RSB- ) and Pulse Wave Velocity -LSB- PWV -RSB- ) , cardiorespiratory fitness ( VO@ peak ) and body composition .


ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences , and Mann Whitney U-test was used for outcomes with skewed residuals .


Twenty-eight patients were included and @ ( EG , n = @ , CG , n = @ ) completed the study .


A mean treatment effect of -@ ( @ % CI : -@ , @ ) was seen in ASDAS score .


Treatment effects were also observed in secondary outcomes ( mean group difference -LSB- @ % CI -RSB- ) : BASDAI : -@ ( -@ , -@ ) , BASFI : -@ ( -@ , -@ ) , arterial stiffness ( estimated median group differences -LSB- @ % CI -RSB- ) : AIx ( % ) : -@ ( -@ , -@ ) , and for PVW ( m/s ) : -@ ( -@ , @ ) , VO@ peak ( ml/kg/min ) ( mean group difference -LSB- @ % CI -RSB- : @ ( @ , @ ) and trunk fat ( % ) : -@ ( -@ , -@ ) .


No adverse events occurred .


High intensity exercise improved disease activity and reduced CV risk factors in patients with active axSpA .


These effects will be further explored in a larger trial .


Low vitamin D status is linked to increased mortality and morbidity in patients who are critically ill .


It is unknown if this association is causal .


To investigate whether a vitamin D@ treatment regimen intended to restore and maintain normal vitamin D status over @ months is of health benefit for patients in ICUs .


A randomized double-blind , placebo-controlled , single-center trial , conducted from May @ through September @ at @ ICUs that included a medical and surgical population of @ critically ill adult white patients with vitamin D deficiency ( @ ng/mL ) assigned to receive either vitamin D@ ( n = @ ) or a placebo ( n = @ ) .


Vitamin D@ or placebo was given orally or via nasogastric tube once at a dose of @,@ IU followed by monthly maintenance doses of @,@ IU for @ months .


The primary outcome was hospital length of stay .


Secondary outcomes included , among others , length of ICU stay , the percentage of patients with @-hydroxyvitamin D levels higher than @ ng/mL at day @ , hospital mortality , and @-month mortality .


A predefined severe vitamin D deficiency ( @ ng/mL ) subgroup analysis was specified before data unblinding and analysis .


A total of @ patients were included in the final analysis ( @ in the vitamin D@ group and @ in the placebo group ) .


The median ( IQR ) length of hospital stay was not significantly different between groups ( @ days -LSB- IQR , @-@ @ -RSB- for vitamin D@ vs @ days -LSB- IQR , @-@ @ -RSB- for placebo ; P = @ ) .


Hospital mortality and @-month mortality were also not significantly different ( hospital mortality : @ % -LSB- @ % CI , @ % -@ % -RSB- for vitamin D@ vs @ % -LSB- @ % CI , @ % -@ % -RSB- for placebo ; hazard ratio -LSB- HR -RSB- , @ -LSB- @ % CI , @-@ @ -RSB- ; P = @ ; @-month mortality : @ % -LSB- @ % CI , @ % -@ % -RSB- for vitamin D@ vs @ % -LSB- @ % CI , @ % -@ % -RSB- for placebo ; HR , @ -LSB- @ % CI , @-@ @ -RSB- ; P = @ ) .


For the severe vitamin D deficiency subgroup analysis ( n = @ ) , length of hospital stay was not significantly different between the @ study groups : @ days ( IQR , @-@ @ ) for vitamin D@ vs @ days ( IQR , @-@ @ ) for placebo .


Hospital mortality was significantly lower with @ deaths among @ patients ( @ % -LSB- @ % CI , @ % -@ % -RSB- ) for vitamin D@ compared with @ deaths among @ patients ( @ % -LSB- @ % CI , @ % -@ % -RSB- ) for placebo ( HR , @ -LSB- @ % CI , @-@ @ -RSB- , P for interaction = @ ) , but not @-month mortality ( @ % -LSB- @ % CI , @ % -@ % -RSB- for vitamin D@ vs @ % -LSB- @ % CI , @ % -@ % -RSB- for placebo ; HR , @ -LSB- @ % CI , @-@ @ -RSB- , P for interaction = @ ) .


Among critically ill patients with vitamin D deficiency , administration of high-dose vitamin D@ compared with placebo did not reduce hospital length of stay , hospital mortality , or @-month mortality .


Lower hospital mortality was observed in the severe vitamin D deficiency subgroup , but this finding should be considered hypothesis generating and requires further study .


To assess the role of sexual relationships on levels and patterns of adherence to medication for pre-exposure prophylaxis against HIV .


We enrolled @ HIV-negative individuals in long-term serodiscordant relationships at @ sites in Uganda from the Partners Pre-exposure Prophylaxis Study , a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir .


We used generalized estimation equations to assess the effects of sexual relationships on low adherence ( < @ % ) and on gaps in adherence .


Fifty-three percent were male , @ % were @-@ years and @ % were polygamous .


Participants who reported sex in the past month with someone other than their primary partner and with < @ % condom use were more than twice as likely to have low adherence -LSB- adjusted odds ratio ( aOR ) = @ , @ % CI : @ to @ -RSB- compared with those who had sex with only their primary partners and @ % condom use .


Using the same reference group , those who abstained from sex in the previous month had @ % increased odds of low adherence ( aOR = @ , @ % CI : @ to @ ) and participants in nonpolygamous marriages who reported sex with both their primary and other partners and < @ % condom use were almost twice as likely to be low adherers ( aOR = @ , @ % CI : @ to @ ) .


At least one @-hour gap in adherence was seen in @ participants ( @ % ) ; @ % had at least one @-week gap .


Risk of low overall adherence was higher in participants who reported sex outside primary partnerships and suboptimal condom use , as well as in those who abstained from sex .


Adherence gaps were common , potentially creating risk for HIV acquisition .


Excessive and inadequate gestational weight gain can complicate a woman 's pregnancy and put her and her child at risk for poor delivery and birth outcomes .


Further , feeding and activity habits established early in life can significantly impact the development of childhood obesity .


The on-going Delta Healthy Sprouts Project is a randomized , controlled , comparative trial testing the efficacy of two Maternal , Infant , and Early Childhood Home Visiting programs on weight status and health behaviors of @ mothers and their infants residing in the rural Mississippi Delta region of the United States .


Women are enrolled in their second trimester of pregnancy and randomized to one of two treatment arms .


The control arm curriculum is based on Parents as Teachers , an evidence based approach to increase parental knowledge of child development and improve parenting practices .


The experimental arm , labeled Parents as Teachers Enhanced , builds upon the control curriculum by including culturally tailored nutrition and physical activity components specifically designed for the gestational and postnatal periods .


We hypothesize that , as compared to the control arm , the experimental arm will be more effective in preventing inappropriate gestational weight gain , reducing postnatal weight retention , and decreasing infant obesity rates .


We also will evaluate mother and child dietary and physical activity outcomes , breastfeeding initiation and continuation , and child feeding practices .


The Delta Healthy Sprouts Project tests a novel , combined approach to maternal weight management and childhood obesity prevention in pregnant women and their children at high risk for obesity and chronic disease .


General practitioners/dermatologists may be aware of musculoskeletal symptoms in patients with psoriasis but may have difficulty accurately detecting psoriatic arthritis ( PsA ) .


We sought to evaluate @ PsA screening questionnaires-the Psoriasis and Arthritis Screening Questionnaire ( PASQ ) , Psoriasis Epidemiology Screening Tool ( PEST ) , and Toronto Psoriatic Arthritis Screen ( ToPAS ) - based on rheumatologist assessment in patients with psoriasis .


Consecutive unselected patients with psoriasis , initially evaluated by dermatologists for plaque psoriasis , were randomized to receive @ of @ questionnaires .


Patients were subsequently evaluated by rheumatologists to establish/exclude clinical PsA diagnosis .


Using clinical PsA diagnosis as the standard for comparison , questionnaire accuracy was assessed by calculating sensitivity/specificity and positive/negative predictive values .


Of @ patients with psoriasis evaluated by rheumatologists , @ ( @ % ) received a clinical diagnosis of PsA ( @ % confidence interval @ % -@ % ) .


Probable PsA was detected in @ % , @ % , and @ % of patients using PASQ , PEST , and ToPAS , respectively .


Sensitivity ranged from @ to @ ; specificity , @ to @ ; positive predictive value , @ to @ ; and negative predictive value , @ to @ .


Not all patients completed all questionnaires ; lack of standardized diagnostic criteria introduced possible bias .


PASQ , PEST , and ToPAS are useful screening tools that can help dermatologists identifypatients without PsA and patients with possible PsA who may benefit from rheumatologist assessment .


The purpose of this study was to assess the time of onset and time course of efficacy over @ hours of extended-release multilayer bead formulation of methylphenidate ( MPH-MLR ) compared with placebo in children @-@ years of age with attention-deficit/hyperactivity disorder ( ADHD ) in a laboratory school setting .


This randomized double-blind placebo-controlled study included children @-@ years of age with ADHD .


Enrolled children went through four study phases : @ ) Screening period ( @ weeks ) and a @ day medication washout period ; @ ) open-label period with dose initiation of MPH-MLR @mg daily and individual dose optimization treatment period ( @-@ weeks ) ; @ ) double-blind crossover period in which participants were randomized to sequences ( @ week each ) of placebo and the optimized MPH-MLR dose given daily ; and @ ) follow-up safety call .


Analog classroom time course evaluations were performed at the end of each double-blind week .


The primary efficacy end-point was the mean of the on-treatment/postdose Swanson , Kotkin , Agler , M-Flynn , and Pelham ( SKAMP ) - Total scores over time points collected @-@ @ hours after dosing .


End-points were evaluated using a mixed-effects analysis of covariance .


The evaluable population included @ participants .


The least-squares mean postdose SKAMP-Total score was higher for placebo than for MPH-MLR ( @ vs. @ , respectively ; p = @ ) , indicating fewer symptoms with MPH-MLR therapy than with placebo .


No difference in SKAMP-Total score between participants who received sequence @ or sequence @ was noted .


From each of hours @-@ @ , least-squares mean SKAMP-Total score was significantly lower for those receiving MPH-MLR than for those receiving placebo ( p@ @ ) .


Neither serious adverse events nor new or unexpected safety findings were noted during the study .


MPH-MLR showed a significant decrease in SKAMP scores compared with placebo in children with ADHD @-@ years of age , indicating a decrease in ADHD symptoms .


The estimated onset was observed within @ hour , and duration was measured to @ hours postdose .


Examine the short-term ( acute ) effects of methylphenidate ( MPH ) on math performance in children with attention-deficit hyperactivity disorder ( ADHD ) and what factors predict improvement in math performance .


One hundred ninety-eight children with ADHD participated in a double-blind , placebo-controlled , randomized crossover MPH trial .


Math response to MPH was determined through administration of math problems adjusted to their academic level during the Restricted Academic Situation Scale ( RASS ) .


Student t tests were conducted to assess change in math performance with psychostimulants .


Correlation between change on the RASS and change on the math performance was also examined .


Linear regression was performed to determine predictor variables .


Children with ADHD improved significantly in their math with MPH ( P < @ ) .


The degree of improvement on the RASS ( which evaluates motor activity and orientation to task ) and on math performance on MPH was highly correlated .


A child 's age at baseline and Wechsler Individual Achievement Test ( WIAT ) - Numerical Operations standard scores at baseline accounted for @ % of variances for acute math improvement .


MPH improves acute math performance in children with ADHD .


Younger children with lower math scores ( as assessed by the WIAT ) improved most on math scores when given psychostimulants .


Atopic dermatitis ( AD ) is an inflammatory skin disease arising as a result of immune system and skin barrier defects .


Topical corticosteroids are safe and effective treatments for AD , when used in short courses .


Prolonged use is associated with skin barrier damage .


Topical calcineurin inhibitors are alternative immune-modulating treatments for AD purported to have no negative effects on the skin barrier .


To compare the effects of betamethasone valerate @ % cream ( BMVc ) and tacrolimus @ % ointment ( TACo ) on the skin barrier .


Twenty volunteers with quiescent AD ( no active signs for @months ) participated in a randomized observer-blind study , wherein BMVc was applied to one forearm and TACo to the other , twice daily for @weeks .


The biophysical/biological properties of the stratum corneum were assessed before and after treatment .


Nine volunteers with active disease and @ with healthy skin were assessed at untreated sites .


BMVc significantly reduced skin barrier function , integrity and cohesion , and the levels of pyrrolidone carboxylic acid ( PCA ) and urocanic acid ( UCA ) towards the subclinical barrier defect observed in patients with AD ( nonlesional sites ) .


TACo preserved skin barrier function , integrity , cohesion and PCA and UCA levels , while significantly increasing skin hydration to levels comparable with healthy skin .


Both treatments reduced skin surface pH and trypsin-like protease activity , with TACo doing so to a significantly greater degree .


In quiescent AD , @weeks of BMVc treatment adversely affected the biophysical properties of the skin and reduced the levels of natural moisturizing factor , whereas TACo improved the condition of the skin barrier .


Mental and physical fatigue while at work is common among emergency medical services ( EMS ) shift workers .


Extended shifts ( for example @ hours ) and excessive amounts of overtime work increase the likelihood of negative safety outcomes and pose a challenge for EMS fatigue-risk management .


Text message-based interventions are a potentially high-impact , low-cost platform for sleep and fatigue assessment and distributing information to workers at risk of negative safety outcomes related to sleep behaviors and fatigue .


We will conduct a pilot randomized trial with a convenience sample of adult EMS workers recruited from across the United States using a single study website .


Participants will be allocated to one of two possible arms for a @-day study period .


The intervention arm will involve text message assessments of sleepiness , fatigue , and difficulty with concentration at the beginning , during , and end of scheduled shifts .


Intervention subjects reporting high levels of sleepiness or fatigue will receive one of four randomly selected intervention messages promoting behavior change during shiftwork .


Control subjects will receive assessment only text messages .


We aim to determine the performance characteristics of a text messaging tool for the delivery of a sleep and fatigue intervention .


We seek to determine if a text messaging program with tailored intervention messages is effective at reducing perceived sleepiness and/or fatigue among emergency medicine clinician shift workers .


Additional aims include testing whether a theory-based behavioral intervention , delivered by text message , changes ` alertness behaviors ' .


The SleepTrackTXT pilot trial could provide evidence of compliance and effectiveness that would support rapid widespread expansion in one of two forms : @ ) a stand-alone program in the form of a tailored/individualized sleep monitoring and fatigue reduction support service for EMS workers ; or @ ) an add-on to a multi-component fatigue risk management program led and maintained by employers or by safety and risk management services .


This study reports @-month follow-up data from a randomized controlled trial of preschool-based social communication treatment for young children with autism .


A total of @ children ( @ males ) with autism , @ to @ months of age , had earlier been randomized either to @ weeks of preschool-based social communication treatment in addition to standard preschool program ( n = @ ) or to standard preschool program only ( n = @ ) .


Significant short-term effects on targeted social communication skills have previously been published .


Long-term gains in social communication , language and global social functioning and communication were assessed from video-taped preschool teacher-child and mother-child interactions , Early Social Communication Scales , Reynell Developmental Language Scale , and Social Communication Questionnaire .


Compared with those in the control group , the treated children achieved significantly larger improvements in joint attention and joint engagement from baseline to @-month follow-up .


However , no effects were detected on language and global ratings of social functioning and communication .


The treatment effect on child initiation of joint attention increased with increasing level of sociability at baseline , whereas nonverbal IQ and expressive language had no moderating effect .


This study is the first to show that , similar to specialist-delivered treatment , preschool-based treatment may produce small but possibly clinically important long-term changes in social communication in young children with autism .


The treatment did not affect language and global ratings of social functioning and communication .


More studies are needed to better understand whether treatment effects may be improved by increasing the intensity and duration of the treatment .


Clinical trial registration information -- Joint Attention Intervention and Young Children With Autism ; http://clinicaltrials.gov/; NCT@ .


Protocolized sedation improves clinical outcomes in critically ill adults , but its effect in children is unknown .


To determine whether critically ill children managed with a nurse-implemented , goal-directed sedation protocol experience fewer days of mechanical ventilation than patients receiving usual care .


Cluster randomized trial conducted in @ US pediatric intensive care units ( PICUs ) .


A total of @ children ( mean age , @ years ; range , @ weeks to @ years ) mechanically ventilated for acute respiratory failure were enrolled in @-@ and followed up until @ hours after opioids were discontinued , @ days , or hospital discharge .


Intervention PICUs ( @ sites ; n = @ patients ) used a protocol that included targeted sedation , arousal assessments , extubation readiness testing , sedation adjustment every @ hours , and sedation weaning .


Control PICUs ( @ sites ; n = @ patients ) managed sedation per usual care .


The primary outcome was duration of mechanical ventilation .


Secondary outcomes included time to recovery from acute respiratory failure , duration of weaning from mechanical ventilation , neurological testing , PICU and hospital lengths of stay , in-hospital mortality , sedation-related adverse events , measures of sedative exposure ( wakefulness , pain , and agitation ) , and occurrence of iatrogenic withdrawal .


Duration of mechanical ventilation was not different between the @ groups ( intervention : median , @ -LSB- IQR , @-@ @ -RSB- days ; control : median , @ -LSB- IQR , @-@ @ -RSB- days ) .


Sedation-related adverse events including inadequate pain and sedation management , clinically significant iatrogenic withdrawal , and unplanned endotracheal tube/invasive line removal were not significantly different between the @ groups .


Intervention patients experienced more postextubation stridor ( @ % vs @ % ; P = @ ) and fewer stage @ or worse immobility-related pressure ulcers ( < @ % vs @ % ; P = @ ) .


In exploratory analyses , intervention patients had fewer days of opioid administration ( median , @ -LSB- IQR , @-@ -RSB- days vs @ -LSB- IQR , @-@ -RSB- days ; P = @ ) , were exposed to fewer sedative classes ( median , @ -LSB- IQR , @-@ -RSB- classes vs @ -LSB- IQR , @-@ -RSB- classes ; P < @ ) , and were more often awake and calm while intubated ( median , @ % -LSB- IQR , @ % -@ % -RSB- of days vs @ % -LSB- IQR , @ % -@ % -RSB- of days ; P = @ ) than control patients , respectively ; however , intervention patients had more days with any report of a pain score @ ( median , @ % -LSB- IQR , @ % -@ % -RSB- of days vs @ % -LSB- IQR , @ % -@ % -RSB- of days ; P < @ ) and any report of agitation ( median , @ % -LSB- IQR , @ % -@ % -RSB- vs @ % -LSB- IQR , @ % -@ % -RSB- ; P = @ ) , respectively .


Among children undergoing mechanical ventilation for acute respiratory failure , the use of a sedation protocol compared with usual care did not reduce the duration of mechanical ventilation .


Exploratory analyses of secondary outcomes suggest a complex relationship among wakefulness , pain , and agitation .


Pertrochanteric hip fractures occur in an elderly population and cause considerable morbidity and loss of functional ability as the fracture heals .


Recently , parathyroid hormone ( PTH ) , which is licensed for the treatment of osteoporosis , has been shown to potentially accelerate bone healing in animal and human studies .


If its administration could allow a faster functional recovery after pertrochanteric hip fracture , then a patient 's hospital stay may be reduced and rehabilitation could be potentially accelerated .


PTH can currently only be administered by subcutaneous injection .


The acceptability of this intervention is unknown in this elderly population .


The aim of this pilot study is to inform the design of a future powered study comparing the functional recovery after pertrochanteric hip fracture in patients undergoing standard care versus those who undergo administration of subcutaneous injection of PTH .


The study is an open label , prospective , randomised , comparative pilot study with blinded outcomes assessment to establish feasibility of the trial design .


Patients will be randomised to receive a @-week course of PTH or usual treatment .


Functional outcomes will be assessed at @ weeks and @ weeks .


Blinded assessment will be used to minimise the effect of bias of an open label study design .


A nested qualitative study will investigate the patient experience of , and expectations following , hip fracture and the patient important aspects of recovery compared with the outcome measures proposed .


Results will be analysed to establish the potential recruitment , compliance and retention rates using @ % CIs , and trial outcomes quoted with SDs and @ % CIs for the effect size .


Myrtle ( Myrtus communis L. ) has been used in the Iranian Traditional Medicine as a treatment for abnormal uterine bleeding-menometrorrhagia .


The main aim of this study is to evaluate the effect of myrtle fruit syrup on abnormal uterine bleeding-menometrorrhagia .


A randomized , double-blind , placebo-controlled pilot study was conducted on @ women suffering from abnormal uterine bleeding-menometrorrhagia .


Treatment comprised of giving @ml oral myrtle syrup daily ( @ml three times a day ) for @days starting from the onset of bleeding .


The myrtle syrup along with placebo was repeated for @ consecutive menstrual periods .


Menstrual duration and number of used pads were recorded by the Pictorial Blood loss Assessment Chart at the end of each menstrual period .


The quality of life was also evaluated using the menorrhagia questionnaire .


The mean number of bleeding days significantly declined from @ days to @ days after @months treatment with the syrup ( p = @ ) and consequently the participants in the intervention group used fewer pads after @months ( @ ) compared with the number of pads used at the beginning of the treatment ( @ , p = @ ) .


Bleeding days and number of pads used by the participants in the placebo group did not change significantly .


Also significant changes of quality of life scores were observed in the intervention group after @months compared to the baseline .


Myrtle syrup is introduced as a potential remedy for abnormal uterine bleeding-menometrorrhagia .


Despite positive effects of incretins on insulin secretion , little is known about the effect of exercise on these hormones .


Metformin can affect incretin concentrations and is prescribed to a large proportion of people with diabetes .


We , therefore , examined the effects of aerobic exercise and/or metformin on incretin hormones .


Ten participants with type @ diabetes were recruited for this randomized crossover study .


Metformin or placebo was given for @ days , followed by the alternate treatment for @ days .


On the last @ days of each condition , participants were assessed during a non-exercise day and a subsequent exercise day .


Aerobic exercise took place in the morning and blood samples were taken in the subsequent hours ( before and after lunch ) .


Aerobic exercise did not increase total plasma glucagon-like peptide-@ ( GLP-@ ) or glucose-dependent insulinotropic polypeptide ( GIP ) in the pre - or post-lunch periods ( all p > @ ) .


GLP-@ was higher in the pre-lunch ( p = @ ) and post-lunch ( p = @ ) periods of the metformin conditions compared with the placebo .


Total plasma GIP was higher in the pre-lunch period ( p = @ ) , but not in the post-lunch period ( p = @ ) , with metformin compared with placebo .


In contrast to our hypothesis , aerobic exercise did not acutely increase total GLP-@ and GIP levels in patients with type @ diabetes .


Metformin , independent of exercise , significantly increased total plasma GLP-@ and GIP concentrations in these patients .


The aim of this study was to investigate the effects of two exercise programs on lower extremity function in patients with juvenile idiopathic arthritis .


Thirty patients with juvenile idiopathic arthritis participated in this study .


Pain , passive range of motion , muscle strength , balance , and functional abilities were assessed with the Numeric Rating Scale , goniometer , handheld dynamometer , Flamingo Balance Test , Functional Reach Test , @-meter walking test , @-stair climbing test , and Childhood Health Assessment Questionnaire .


Participants were randomly assigned to the strengthening exercise group ( group @ , n = @ ) or the proprioceptive-balance exercise group ( group @ , n = @ ) .


Intragroup analysis showed statistically significant improvements in all outcome measures except muscle strength in the hip and ankle after strengthening exercises in group @ .


However , statistically significant improvements were found in all outcome measures after the proprioceptive-balance exercises in group @ .


Intergroup analysis showed statistically significant improvement in all outcome measures in group @ except for the Numeric Rating Scale , Childhood Health Assessment Questionnaire , and passive range of motion scores and hip extension and knee flexion muscle strengths .


This study demonstrates that exercise treatment significantly improves musculoskeletal symptoms in patients with juvenile idiopathic arthritis .


However , balance-proprioceptive exercises prove to be effective more than strengthening exercises for improving lower extremity function such as walking , climbing stairs , and balance in patients with juvenile idiopathic arthritis .


A high-frequency steady-state visual evoked potential ( SSVEP ) has been suggested for the reduction of eye fatigue for SSVEP-based brain-computer interfaces ( BCIs ) .


However , the poor performance of high-frequency SSVEP requires a novel stimulus of better performance even with low eye fatigue .


As an alternative to the high-frequency SSVEP , we explore the SSVEP response to an amplitude-modulated stimulus ( AM-SSVEP ) to verify its availability for brain-computer interfaces ( BCIs ) .


An amplitude-modulated stimulus was generated as the product of two sine waves at a carrier frequency ( fc ) and a modulating frequency ( fm ) .


The carrier frequency was higher than @ Hz to reduce eye fatigue , and the modulating frequency ranged around the - band ( @-@ Hz ) to utilize low-frequency harmonic information .


Four targets were used in combinations of three different modulating frequencies and two different carrier frequencies in the offline experiment , and two additional targets were added with one additional modulating and one carrier frequency in online experiments .


In the AM-SSVEP spectra , seven harmonic components were identified at @fc , @fm , fcfm , fc@fm , and @fc-@fm .


Using an optimized combination of the harmonic frequencies , online experiments demonstrated that the accuracy of the AM-SSVEP was equivalent to that of the low-frequency SSVEP .


Furthermore , subject evaluation indicated that an AM stimulus caused lower eye fatigue and less sensing of flickering than a low-frequency stimulus , in a manner similar to a high-frequency stimulus .


The actual stimulus frequencies of AM-SSVEPs are in the high-frequency band , resulting in reduced eye fatigue .


Furthermore , AM-SSVEPs can utilize both fundamental stimulus frequencies and non-integer harmonic frequencies including low frequencies for SSVEP recognition .


The feasibility of AM-SSVEP with high BCI performance and low eye fatigue was confirmed through offline and online experiments .


AM-SSVEPs combine the advantages of both low - and high-frequency SSVEPs -- high power and low eye fatigue , respectively .


AM-SSVEP-based BCI systems exploit these advantages , making them promising for application in practical BCI systems .


The use of supplemental oxygen in the setting of suspected acute myocardial infarction ( AMI ) is recommended in international treatment guidelines and established in prehospital and hospital clinical routine throughout the world .


However , to date there is no conclusive evidence from adequately designed and powered trials supporting this practice .


Existing data are conflicting and fail to clarify the role of supplemental oxygen in AMI .


A total of @,@ normoxemic ( oxygen saturation -LSB- SpO@ -RSB- @ % ) patients with suspected AMI will be randomly assigned to either supplemental oxygen @ L/min delivered by Oxymask ( MedCore Sweden AB , Kista , Sweden ) for @ to @ hours in the treatment group or room air in the control group .


Patient inclusion and randomization will take place at first medical contact , either before hospital admission or at the emergency department .


The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry will be used for online randomization , allowing inclusion of a broad population of all-comers .


Follow-up will be carried out in nationwide health registries and Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies .


The primary objective is to evaluate whether oxygen reduces @-year all-cause mortality .


Secondary end points include @-day mortality , major adverse cardiac events , and health economy .


Prespecified subgroups include patients with confirmed AMI and certain risk groups .


In a @-month pilot study , the study concept was found to be safe and feasible .


The need to clarify the uncertainty of the role of supplemental oxygen therapy in the setting of suspected AMI is urgent .


The DETO@X-AMI trial is designed and powered to address this important issue and may have a direct impact on future recommendations .


Despite the intensive global efforts to control intestinal parasitic infections , the prevalence of soil-transmitted helminth ( STH ) infections is still very high in many developing countries particularly among children in rural areas .


A randomized , double-blind , placebo-controlled trial was conducted on @ Aboriginal schoolchildren in Malaysia to investigate the effects of a single high-dose of vitamin A supplementation ( @,@ IU ) on STH reinfection .


The effect of the supplement was assessed at @ and @ months after receiving interventions ; after a complete @-day deworming course of @ mg/daily of albendazole tablets .


Almost all children ( @ % ) were infected with at least one STH species .


The overall prevalence of ascariasis , trichuriasis and hookworm infection was @ % , @ % and @ % , respectively .


Reinfection rates of Ascaris , Trichuris and hookworm were high ; at @ months , assessment reached @ % of the prevalence reported before treatment .


There were no significant differences in the reinfection rates and intensities of STH between vitamin A supplemented-children and those who received placebo at @ and @ months ( p > @ ) .


Vitamin A supplementation showed no protective effect against STH reinfection and this could be due to the high endemicity of STH in this community .


Long-term interventions to reduce poverty will help significantly in reducing this continuing problem and there is no doubt that reducing intestinal parasitic infection would have a positive impact on the health , nutrition and education of these children .


Diet and lifestyle modification is commonly used in constipation management .


As there is a dearth of studies on this topic in Malaysia , we aim to elucidate the relations between stool patterns , dietary intake and physical activity levels among adults with functional constipation .


From a database collected via surveys at public events , a convenience sample of @ adults diagnosed with Rome II-defined functional constipation was enrolled in this cross-sectional study .


After severity assessment using the Chinese Constipation Questionnaire , subjects completed @-week bowel movement diaries to determine stool frequency , consistency and output .


Dietary intake and physical activity levels were assessed twice using three-day @-hour diet recalls and International Physical Activity Questionnaire , respectively .


Ninety subjects who completed the study were included in the analysis .


Mean weekly stool frequency was @ + / - @ times , consistency score was @ + / - @ ( range @-@ @ ) , output was @ + / - @ balls ( @ mm diameter ) and severity score was @ + / - @ ( range @-@ @ ) .


Mean daily dietary intakes were : energy @,@ + / - @kcal , dietary fibre @ + / - @ g and fluid @ + / - @ L.


The majority of subjects were physically inactive .


Stool frequency and output were positively associated with dietary fibre ( r ( s ) = @ , P < @ ; r ( s ) = @ , P < @ ) and fluid intake ( r ( s ) = @ , P < @ ; OR = @ , @ % CI -LSB- @-@ @ -RSB- ) .


Constipation severity was associated with higher physical activity levels ( OR = @ , @ % CI -LSB- @-@ @ -RSB- ) .


Insufficient intake of dietary fibre and fluid are associated with aggravated constipation symptoms .


Further studies are necessary to confirm usefulness of dietary intervention in treatment of constipation as dietary factors alone may not influence overall severity and stool consistency , an integral element of constipation .


Patients with CKD have a high prevalence of cardiovascular disease associated with or exacerbated by inactivity .


This randomized , controlled study investigated whether a renal rehabilitation exercise program for patients with stages @ or @ CKD would improve their physical function and quality of life .


In total , @ adults with CKD stages @ and @ were randomized , and @ of these patients proceeded to usual care or the renal rehabilitation exercise intervention consisting of usual care plus guided exercise two times per week for @ weeks ( @ sessions ) .


Physical function was determined by three well established performance-based tests : @-minute walk test , sit-to-stand test , and gait-speed test .


Health-related quality of life was assessed by the RAND @-Item Short Form Health Survey .


At baseline , no differences in self-reported level of activity , @-minute walk test , and sit-to-stand test scores were observed between the usual care ( n = @ ) and renal rehabilitation exercise ( n = @ ) groups , although baseline gait-speed test score was higher in the renal rehabilitation exercise group ( P < @ ) .


At follow-up , the renal rehabilitation exercise group but not the usual care group showed significant improvements in the @-minute walk test ( +@ ft -LSB- @ % improvement -RSB- versus -@ ft ; P < @ ) , the sit-to-stand test ( +@ % of age prediction -LSB- @ % improvement -RSB- versus +@ % of age prediction ; P < @ ) , and the RAND-@ physical measures of role functioning ( P < @ ) , physical functioning ( P < @ ) , energy/fatigue levels ( P = @ ) , and general health ( P = @ ) and mental measure of pain scale ( P = @ ) .


The renal rehabilitation exercise regimen was generally well tolerated .


A @-week/@-session renal rehabilitation exercise program improved physical capacity and quality of life in patients with CKD stages @ and @ .


Longer follow-up is needed to determine if these findings will translate into decreased mortality rates .


Youth in war-affected regions are at risk for poor psychological , social , and educational outcomes .


Effective interventions are needed to improve mental health , social behavior , and school functioning .


This randomized controlled trial tested the effectiveness of a @-session cognitive-behavioral therapy ( CBT ) - based group mental health intervention for multisymptomatic war-affected youth ( aged @-@ years ) in Sierra Leone .


War-affected youth identified by elevated distress and impairment via community screening were randomized ( stratified by sex and age ) to the Youth Readiness Intervention ( YRI ) ( n = @ ) or to a control condition ( n = @ ) .


After treatment , youth were again randomized and offered an education subsidy immediately ( n = @ ) or waitlisted ( n = @ ) .


Emotion regulation , psychological distress , prosocial attitudes/behaviors , social support , functional impairment , and posttraumatic stress disorder ( PTSD ) symptoms were assessed at pre - and postintervention andat @-month follow-up .


For youth in school , enrollment , attendance , and classroom performance were assessed after @ months .


Linear mixed-effects regressions evaluated outcomes .


The YRI showed significant postintervention effects on emotion regulation , prosocial attitudes/behaviors , social support , and reduced functional impairment , and significant follow-up effects on school enrollment , school attendance , and classroom behavior .


In contrast , education subsidy was associated with better attendance but had no effect on mental health or functioning , school retention , or classroom behavior .


Interactions between education subsidy and YRI were not significant .


YRI produced acute improvements in mental health and functioning as well as longer-term effects on school engagement andbehavior , suggesting potential to prepare war-affected youth for educational and otheropportunities .


Clinical trial registration information-Trial of the Youth Readiness Intervention ( YRI ) ; http://clinicaltrials.gov; NCT@ .


Images depicting morbidly obese models -LSB- i.e. body mass index ( BMI ) > @ -RSB- often accompany media articles about the health risks of being overweight ( i.e. BMI @-@ ) .


Little is known about the effect of this mismatch on people 's understanding of risk , and perceptions of message relevance .


In total , @ participants ( @ overweight/obese and @ healthy weight ) were randomly allocated to read a health message about the risk of heart disease posed by being overweight , presented alongside ( i ) a photo of an overweight model , ( ii ) a morbidly obese model or ( iii ) no photo .


Between-group differences in the primary outcomes of message relevance , and the body size perceived to be ` at risk ' , were assessed , and the potential moderating effects of motivation , weight concern and existing risk knowledge explored .


Overweight and obese participants in the exaggerated ( morbidly obese ) image condition interpreted health risks to relate to a larger body size than those who saw no image ( F ( @ , @ ) = @ , P = @ ) .


There was no experimental effect on perceived personal relevance ( F ( @ , @ ) = @ , P = @ ) .


No significant moderation effects were detected , and there was no effect of study condition in healthy weight participants for either outcome .


The findings suggest that the use of morbidly obese models in messages regarding the health risks of being overweight may undermine the impact of these messages among those who they most aim to reach ; the reader may perceive a reduced risk of being ` only ' overweight , and that a higher weight is needed for the negative effects of excess weight to occur .


To evaluate the anti-spasticity effects of anodal transcranial direct current stimulation ( tDCS ) in individuals with spastic cerebral palsy ( CP ) .


Forty-six children and adolescents with cerebral palsy were randomly assigned to either active ( @ mA anodal ) or sham ( placebo ) tDCS over the left primary motor cortex ( Ml ) on five consecutive days .


Both group also received routine physical therapy .


Measures of spasticity and passive range of motion ( PROM ) were administered before treatment , immediately after treatment , and at @ - and @-hours follow-up .


Participants assigned to active tDCS treatment evidenced significantly more pre - to immediately post-treatment reductions in spasticity than participants assigned to the sham ( p = @ , p < O. @l , andp = @ for shoulder wrist , and fingers respectively ) and these improvement in spasticity maintainedfor at least @ hours for wrist joints ( p = @ ) .


There was only one participant in the active tDCS condition developed erythematous rash .


However , all participants tolerated the tDCS well without any serious adverse events .


Anodal tDCS appeared to reduce CP-relatedspasticity ( but not PROM ) in the short term .


Researches examine the long term benefits of this intervention on spasticity are warranted .


The aim of this study was to evaluate the effect of dietary omega-@ fatty acid ( O@FA ) supplementation on dry eye symptoms , tear film tests , and conjunctival impression cytology in patients with contact lens wear-associated dry eye .


In this randomized , double-blind , multicentric trial , contact lens wearers ( n = @ ) were randomized to receive either O@FAs or placebo capsules ( corn oil ) twice daily for @ months .


Subjects underwent examinations at baseline , @ months , and @ months .


At each visit , a questionnaire of dry eye symptoms and lens wear comfort was administered .


Subjects further underwent measurement of tear film break-up time ( TBUT ) and a Schirmer test .


Conjunctival impression cytology was performed by the transfer method .


Improvement in symptoms and lens wear comfort were primary outcome measures .


Changes from baseline in TBUT , Schirmer , and Nelson grade at @ months were secondary outcome measures .


The mean improvement in symptom score in the O@FA group was @ @ ( @ ) as compared with @ @ ( @ ) in the placebo group ( P < @ ) .


Lens wear comfort levels improved significantly ( P < @ ) from baseline .


There was a significant increase in TBUT -LSB- @ @ ( @ ) -RSB- and Nelson grade -LSB- @ @ ( @ ) -RSB- in the O@FA group ( P < @ ) as compared with @ @ ( @ ) and @ @ ( @ ) in the placebo group ( P = @ and @ , respectively ) .


However , the magnitude of increase in Schirmer score -LSB- @ @ ( @ ) -RSB- was relatively small ( P = @ ) .


The results of this study point toward benefits of orally administered O@FAs in alleviating dry eye symptoms , improving lens wear comfort , and cytological changes in contact lens wearers .


To evaluate and compare the effects of @ manual therapy interventions on cervical spine range of motion ( ROM ) , head repositioning accuracy , and balance in patients with chronic cervicogenic dizziness .


Randomized controlled trial with @-week follow-up using blinded outcome assessment .


University School of Health Sciences .


Participants ( N = @ ; mean age SD , @ @ y ; @ % women ) with chronic cervicogenic dizziness .


Participants were randomly assigned to @ of @ groups : sustained natural apophyseal glides ( SNAGs ) with self-SNAG exercises , passive joint mobilization ( PJM ) with ROM exercises , or a placebo .


Participants each received @ to @ treatments over @ weeks .


Cervical ROM , head repositioning accuracy , and balance .


SNAG therapy resulted in improved ( P @ ) cervical spine ROM in all @ physiological cervical spine movement directions immediately posttreatment and at @ weeks .


Treatment with PJM resulted in improvement in @ of the @ cervical movement directions posttreatment and @ movement direction at @ weeks .


There was a greater improvement ( P < @ ) after SNAGs than PJM in extension ( mean difference , -@ ; @ % confidence interval -LSB- CI -RSB- , -@ to -@ ) and right rotation ( mean difference , -@ ; @ % CI , -@ to -@ ) posttreatment .


Manual therapy had no effect on balance or head repositioning accuracy .


SNAG treatment improved cervical ROM , and the effects were maintained for @ weeks after treatment .


PJM had very limited impact on cervical ROM .


There was no conclusive effect of SNAGs or PJMs on joint repositioning accuracy or balance in people with cervicogenic dizziness .


In early postpartum haemorrhage ( PPH ) , a low concentration of fibrinogen is associated with excessive subsequent bleeding and blood transfusion .


We hypothesized that pre-emptive treatment with fibrinogen concentrate reduces the need for red blood cell ( RBC ) transfusion in patients with PPH .


In this investigator-initiated , multicentre , double-blinded , parallel randomized controlled trial , we assigned subjects with severe PPH to a single dose of fibrinogen concentrate or placebo ( saline ) .


A dose of @ g or equivalent was given to all subjects independent of body weight and the fibrinogen concentration at inclusion .


The primary outcome was RBC transfusion up to @ weeks postpartum .


Secondary outcomes were total blood loss , total amount of blood transfused , occurrence of rebleeding , haemoglobin < @ g litre ( -@ ) , RBC transfusion within @ h , @ h , and @ days , and as a composite outcome of ` severe PPH ' , defined as a decrease in haemoglobin of > @ g litre ( -@ ) , transfusion of at least @ units of RBCs , haemostatic intervention ( angiographic embolization , surgical arterial ligation , or hysterectomy ) , or maternal death .


Of the @ randomized subjects , @ of @ in the fibrinogen group and @ of @ in the placebo group were included in the intention-to-treat analysis .


At inclusion the subjects had severe PPH , with a mean blood loss of @ ( sd @ ) ml and a mean fibrinogen concentration of @ ( sd @ ) g litre ( -@ ) .


The intervention group received a mean dose of @ mg kg ( -@ ) fibrinogen concentrate , thereby significantly increasing fibrinogen concentration compared with placebo by @ g litre ( -@ ) ( @ % confidence interval , @-@ @ ; P = @ ) .


Postpartum blood transfusion occurred in @ ( @ % ) of the fibrinogen group and @ ( @ % ) of the placebo group ( relative risk , @ ; @ % confidence interval , @-@ @ ; P = @ ) .


We found no difference in any predefined secondary outcomes , per-protocol analyses , or adjusted analyses .


No thromboembolic events were detected .


We found no evidence for the use of @ g fibrinogen concentrate as pre-emptive treatment for severe PPH in patients with normofibrinogenaemia .


The therapeutic outcomes of low-level laser therapy ( LLLT ) on closed bone fractures ( CBFs ) in the wrist and hand were investigated in this controlled study .


Animal research has confirmed that LLLT increases osteocyte quantity ; however , little research has been conducted to determine the effect of LLLT on the treatment of human bone fractures .


In this study , the therapeutic outcomes of administering @nm LLLT to treat CBFs in the wrist or hand were examined .


Fifty patients with CBFs in the wrist and hand , who had not received surgical treatment , were recruited and randomly assigned to two groups .


The laser group underwent a treatment program in which @nm LLLT ( average power @mW , peak power @W , @Hz , @sec , and @ J/cm ( @ ) per fracture site ) was administered five times per week for @ weeks .


Participants in a placebo group received sham laser treatment .


The pain , functional disability , grip strength , and radiographic parameters of the participants were evaluated before and after treatment and at a @-week follow-up .


After treatment and at the follow-up , the laser group exhibited significant changes in all of the parameters compared with the baseline ( p < @ ) .


The results of comparing the two groups after treatment and at the follow-up indicated significant between-group differences among all of the parameters ( p < @ ) .


LLLT can relieve pain and improve the healing process of CBFs in the human wrist and hand .


Oral antibiotics use in infants in developing countries is challenging because liquid formulations are often unavailable .


However , dissolving solid formulation of drugs in water poses a risk of gastrointestinal infection .


Although mother 's milk may be a potential vehicle , no evidence exists to indicate that antibiotics dissolved in human milk are bioequivalent to those dissolved in water .


Therefore , we compared pharmacokinetic parameters of an orally administered antibiotic , amoxicillin , dissolved in human milk , to those of water-dissolved amoxicillin .


A pharmacokinetic study was conducted in @ healthy adult volunteers in a randomised crossover design .


Marketed amoxicillin powder for suspension was dissolved in either human milk or water at a final concentration of @ mg/mL , and @ mL was given orally in a fasting state .


Timed blood samples were obtained and plasma amoxicillin was quantified using liquid chromatography-mass spectrometry .


Results showed that pharmacokinetic parameters , including area-under-the-curve , Cmax and half-life of the water-based and milk-based amoxicillin administration were not significantly different .


@ % CIs of the ratios of these parameters in concomitant breast milk administration to those of water were within @ % and @ % , suggesting they are bioequivalent ( defined as a range between @ % and @ % ) .


We conclude that oral administration of amoxicillin dissolved in human milk at @ mg/mL results in pharmacokinetics profiles comparable to amoxicillin dissolved in water .


Pharmaceutical interactions between amoxicillin and breast milk are unlikely , suggesting no need to modify dosing schedules .


Patients with stroke suffer from nutrition impairments and often rely on enteral nutrition ( EN ) , which is associated with respiratory complications such as regurgitation and aspiration .


To evaluate the incidence of regurgitation and aspiration in patients with severe stroke infused with different volumes of EN .


A randomized controlled trial was conducted on @ patients with severe stroke undergoing EN therapy .


Patients were randomly assigned into two groups .


Subjects in the treatment group received EN with an initial rate defined according to the total volume and the infusion rate was adjusted based on gastric residual volume ( GRV ) assessed every @ hours .


Subjects of the control group received EN without monitoring the GRV and reached the target infusion volume within @ hours .


The incidence of reflux and aspiration was recorded .


The incidences of regurgitation and aspiration were significantly lower in treatment group ( @ % and @ % , respectively ) than control group ( @ % and @ % , respectively ) .


In the treatment group , @ patient developed regurgitation while @ developed aspiration when EN was @ mL .


When EN increased to @ mL , @ patients developed regurgitation and @ developed aspiration , and @ patients developed regurgitation and @ had aspiration when EN was @ mL .


There was no significant difference in the risk of reflux and aspiration when total volume of EN increased from @ to @ mL .


During EN therapy for patients with stroke , using feeding pump with a continuous infusion for @ hours and adjusting infusion rate based on GRV could reduce the incidence of respiratory complications .


Acute decompensated heart failure ( ADHF ) is associated with significant morbidity and mortality but the relationship between LVEF and outcomes is unclear .


We explored the association between LVEF and @ and @day mortality in @ ADHF patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure ( ASCEND-HF ) trial .


We explored the association between LVEF and @ and @ day mortality in @ ADHF patients enrolled in the Acute Studies of Nesiritide in Decompensated Heart Failure ( ASCEND-HF ) trial .


LVEF was analysed both as a continuous variable and according to three categories : < @ % ( LowEF ) , @-@ % -LSB- intermediate EF ( IntEF ) -RSB- , and > @ % -LSB- preserved ejection fraction ( PresEF ) -RSB- .


Of the patients in the trial , @ ( @ % ) had LowEF , @ ( @ % ) had IntEF , and @ ( @ % ) had PresEF .


The unadjusted @ and @ day mortality was similar for LowEF ( @ % , @ % ) , IntEF ( @ % , @ % ) , and PresEF ( @ % , @ % ) , respectively ( P > @ ) .


After multivariable adjustment , the hazard ratio ( HR ) for @ day mortality remained similar for the LowEF -LSB- HR @ , @ % confidence interval ( CI ) @-@ @ ; P = @ -RSB- and IntEF ( @ , @ % CI @-@ @ ; P = @ ) compared to PresEF patients .


By contrast , when LVEF was evaluated as a continuous measure , it exhibited a U-shaped pattern with mortality .


After matching for age and sex , the mortality risk attributed to LVEF was attenuated , as the LVEF increased as a continuous variable over @ % .


However , in patients with EF < @ % , the mortality risk continue to increase as the LVEF declined .


Among patients with ADHF , the unadjusted mortality rates are similar across LVEF strata .


However , after accounting for key patient variables , the mortality risk increases as EF falls below @ % .


These data will be useful in planning future studies of ADHF .


Two randomized intraoperative radiation therapy trials for early-stage breast cancer were recently published .


The ELIOT Trial used electrons ( IOERT ) , and the TARGIT-A Trial Update used @-kV X-rays ( IORT ) .


These studies were compared for similarities and differences .


The results were analyzed and used to determine which patients might be suitable for single-dose treatment .


The primary sources of data were the ELIOT Trial and TARGIT-A Trial , as well as a comprehensive analysis of the peer-reviewed literature of accelerated partial breast irradiation ( APBI ) using @-kV X-rays or electrons .


Studies published or presented prior to March @ were analyzed for efficacy , patient restrictions , complications , and outcome .


With a median follow-up of @ years , the @-year recurrence rates for ELIOT versus EBRT patients were @ and @ % , respectively , p = @ .


A low-risk ELIOT group was identified with a @-year recurrence rate of @ % .


With a median follow-up of @months , the @-year recurrence rates for the TARGIT-A versus EBRT patients were @ and @ % , respectively , p = @ .


With @ years of median follow-up , IOERT appears to have a subset of low risk women for whom IOERT is acceptable .


With @months of median follow-up the results of IORT with @-kV devices are promising , but longer follow-up data are required .


At the current time , single-fraction IOERT or IORT patients should be treated under strict institutional protocols .


Advantages of using efavirenz as part of treatment for children infected with human immunodeficiency virus ( HIV ) include once-daily dosing , simplification of co-treatment for tuberculosis , preservation of ritonavir-boosted lopinavir for second-line treatment , and harmonization of adult and pediatric treatment regimens .


However , there have been concerns about possible reduced viral efficacy of efavirenz in children exposed to nevirapine for prevention of mother-to-child transmission .


To evaluate whether nevirapine-exposed children achieving initial viral suppression with ritonavir-boosted lopinavir-based therapy can transition to efavirenz-based therapy without risk of viral failure .


Randomized , open-label noninferiority trial conducted at Rahima Moosa Mother and Child Hospital , Johannesburg , South Africa , from June @ to December @ , enrolling @ HIV-infected children exposed to nevirapine for prevention of mother-to-child transmission who were aged @ years or older and had plasma HIV RNA of less than @ copies/mL during ritonavir-boosted lopinavir-based therapy ; @ were randomized and @ ( @ % ) were followed up to @ weeks after randomization .


Participants were randomly assigned to switch to efavirenz-based therapy ( n = @ ) or continue ritonavir-boosted lopinavir-based therapy ( n = @ ) .


Risk difference between groups in ( @ ) viral rebound ( ie , @ HIV RNA measurement of > @ copies/mL ) and ( @ ) viral failure ( ie , confirmed HIV RNA > @ copies/mL ) with a noninferiority bound of -@ .


Immunologic and clinical responses were secondary end points .


The Kaplan-Meier probability of viral rebound by @ weeks was @ ( n = @ ) in the efavirenz group and @ ( n = @ ) in the ritonavir-boosted lopinavir group .


Probabilities of viral failure were @ ( n = @ ) in the efavirenz group and @ ( n = @ ) in the ritonavir-boosted lopinavir group .


The risk difference for viral rebound was @ ( @-sided @ % CI , @ to ) and for viral failure was -@ ( @-sided @ % CI , -@ to ) .


We rejected the null hypothesis that efavirenz is inferior to ritonavir-boosted lopinavir ( P < @ ) for both end points .


By @ weeks , CD@ cell percentage was @ % ( @ % CI , @ % -@ % ) higher in the efavirenz group than in the ritonavir-boosted lopinavir group .


Among HIV-infected children exposed to nevirapine for prevention of mother-to-child transmission and with initial viral suppression with ritonavir-boosted lopinavir-based therapy , switching to efavirenz-based therapy compared with continuing ritonavir-boosted lopinavir-based therapy did not result in significantly higher rates of viral rebound or viral failure .


This therapeutic approach may offer advantages in children such as these .


White rice is the main staple for the majority in the world .


The effects of protein , fat and vegetables on the glycaemic and insulinaemic responses to a white rice-based meal have not been reported .


The aim of this study was to determine the effect of co-ingesting a high-protein food ( breast chicken ) , a fat ( ground nut oil ) , a leafy vegetable or all three on the glycaemic and insulinaemic responses of white rice in healthy adults .


This was a randomized crossover trial conducted at the Clinical Nutrition Research Centre in Singapore .


Twelve healthy volunteers were given five test meals ( white rice alone , white rice with chicken , white rice with oil , white rice with vegetable and white rice with chicken , oil and vegetable ) once and the reference food ( glucose solution ) three times in a random order at @-week intervals .


Capillary blood samples were then drawn serially for @ h , and glucose and insulin were analysed .


The glycaemic response ( GR ) to white rice with chicken breast , ground nut oil and vegetable was significantly lower than to white rice alone .


The glycaemic index ( GI ) of pure white rice was @ , whereas combined with chicken breast , ground nut oil and vegetable , it was @ .


The addition of oil delayed the peak glucose response and reduced the iAUC , resulting in a GI value of @ .