Skin biopsies were taken before and after supplementation from unexposed and exposed skin , and intercellular adhesion molecule @ ( ICAM-@ ) mRNA expression was assessed by real-time polymerase chain reaction .


Prior to supplementation , skin lesions were induced in all patients with comparable PLE scores .


After @ weeks , intake of the supplement significantly reduced the PLE score after one exposure as compared with patients taking placebo ( P < @ ) .


After two exposures , these differences were no longer significant .


At a molecular level , the development of skin lesions was associated with an increased expression of ICAM-@ mRNA , which was significantly reduced after supplementation ( P = @ ) , but not with placebo .


The nutritional supplement provides protection against the development of UVA-induced PLE lesions at clinical and molecular levels .


DECISION + @ , a training program for physicians , is designed to implement shared decision making ( SDM ) in the context of antibiotics use for acute respiratory tract infections ( ARTIs ) .


We evaluated the impact of DECISION + @ on SDM implementation as assessed by patients and physicians , and on physicians ' intention to engage in SDM .


From @ to @ , a multi-center , two-arm , parallel randomized clustered trial appraised the effects of DECISION + @ on the decision to use antibiotics for patients consulting for ARTIs .


We randomized @ family practice teaching units ( FPTUs ) to either DECISION + @ or usual care .


After the consultation , both physicians and patients independently completed questionnaires based on the D-Option scale regarding SDM behaviors during the consultation .


Patients also answered items assessing the role they assumed during the consultation ( active/collaborative/passive ) .


Before and after the intervention , physicians completed a questionnaire based on the Theory of Planned Behavior to measure their intention to engage in SDM .


To account for the cluster design , we used generalized estimating equations and generalized linear mixed models to assess the impact of DECISION + @ on the outcomes of interest .


A total of @ physicians ( @ % women ) participated in the study .


After DECISION + @ , patients ' D-Option scores were @ @ out of @ in the intervention group and @ @ in the control group ( p = @ ) .


Physicians ' D-Option scores were @ @ in the intervention group and @ @ in the control group ( p = @ ) .


However , subgroup analyses showed that teacher physicians D-Option scores were @ @ and @ @ respectively ( p = @ ) .


More patients reported assuming an active or collaborative role in the intervention group ( @ % ) , than in the control group ( @ % ) ( p = @ ) .


There was a significant relation between patients ' and physicians ' D-Option scores ( p < @ ) and also between patient-reported assumed roles and both D-Option scores ( as assessed by patients , p < @ ; and physicians , p = @ ) .


DECISION + @ had no impact on the intention of physicians to engage in SDM .


DECISION + @ positively influenced SDM behaviors as assessed by patients and teacher physicians .


Physicians ' intention to engage in SDM was not affected by DECISION + @ .


To compare the efficacy of fentanyl administered via the subcutaneous ( s.c. ) or intranasal ( i.n. ) route with intramuscular ( i.m. ) pethidine in labouring women requesting analgesia .


A randomised controlled trial three-armed , parallel-design .


A regional hospital and the largest tertiary maternity centre in South Australia .


One hundred and fifty-six healthy parturients birthing at term .


Women were randomised to receive s.c. fentanyl ( n = @ ) , i.n. fentanyl ( n = @ ) , or i.m. pethidine ( n = @ ) .


The outcomes were analysed by intention-to-treat .


Pain scores measured before and @ minutes after opioid administration .


All groups reported clinically significant reductions in pain scores ( mean range @-@ @ ; P < @ ) , with no significant differences between groups .


Significantly more women in the fentanyl groups reported satisfaction with using the study drug again , compared with women receiving i.m. pethidine ( @ % i.n. fentanyl , @ % s.c. fentanyl , and @ % i.m. pethidine ; P < @ ) .


Women in the fentanyl groups experienced less sedation ( i.n. fentanyl @ % , s.c. fentanyl @ % , i.m. pethidine @ % ; P @ ) , shorter labours by at least @ hours ( P < @ ) , and fewer difficulties establishing breastfeeding ( @ % i.m. pethidine , @ % i.n. fentanyl , and @ % s.c. fentanyl ; P < @ ) .


Neonates in the pethidine group were more likely to require nursery admission ( P < @ ) .


Fentanyl administered by s.c. and i.n. routes is as efficacious in relieving labour pain as i.m. pethidine , but resulted in greater satisfaction , less sedation , shorter labour , fewer nursery admissions , and fewer difficulties in establishing breastfeeding .


Fentanyl appears to be a suitable alternative to pethidine when providing parenteral pain relief to labouring women .


Prior studies adjusting self-reported measures of alcohol intake for drink size and ethanol ( EtOH ) content have relied on single-point assessments .


A prospective @-day diary study investigated magnitudes of drink-EtOH adjustments and factors associated with these adjustments .


Transdermal alcohol sensor ( TAS ) readings and prediction of alcohol-related problems by number of drinks versus EtOH-adjusted intake were used to validate drink-EtOH adjustments .


Self-completed event diaries listed up to @ beverage types and @ drinking events/d .


Eligible volunteers had weekly drinking and @ + drinks per occasion with @ reported days and pre - and postsummary measures ( n = @ ) .


Event reports included drink types , sizes , brands or spirits contents , venues , drinks consumed , and drinking duration .


Wine drinks averaged @ , beer @ , and spirits @ U.S. standard drinks ( @g EtOH ) .


Mean-adjusted alcohol intake was @ % larger using drink size and strength ( brand/EtOH concentration ) data .


Adjusted drink levels were larger than `` raw '' drinks in all quantity ranges .


Individual-level drink-EtOH adjustment ratios ( EtOH adjusted/unadjusted amounts ) averaged across all days drinking ranged from @ to @ ( mean @ ) .


Adjustment ratio was only marginally ( and not significantly ) positively related to usual quantity , frequency , and heavy drinking ( all ps < @ ) , independent of gender , age , employment , and education , but those with lower incomes ( both p < @ ) drank stronger/bigger drinks .


Controlling for raw number of drinks and other covariates , degree of adjustment independently predicted alcohol dependence symptoms ( p < @ ) and number of consequences ( p < @ ) .


In @ respondents with sufficiently high-quality TAS readings , higher correlations ( p = @ ) were found between the adjusted versus the raw drinks/event and TAS areas under the curve .


Absent drink size and strength data , intake assessments are downward biased by at least @ % .


Between-subject variation in typical drink content and pour sizes should be addressed in treatment and epidemiological research .


T-cell activation independently predicts mortality , poor immune recovery and non-AIDS illnesses during combination antiretroviral therapy ( cART ) .


Atorvastatin showed anti-immune activation effects among HIV-infected cART-nave individuals .


We investigated whether adjunct atorvastatin therapy reduces T-cell activation among cART-treated adults with suboptimal immune recovery .


A randomised double-blind placebo-controlled crossover trial , of atorvastatin @ mg daily vs. placebo for @ weeks , was conducted among individuals with CD@ increase < @ cells/l after seven years of suppressive cART .


Change in T-cell activation ( CD@ + CD@ + / CD@ + CD@ + HLADR + ) and in T-cell exhaustion ( CD@ + CD@ + / CD@ + PD@ + ) was measured using flow cytometry .


Thirty patients were randomised , @ to each arm .


Atorvastatin resulted in a @ % greater reduction in CD@ T-cell activation ( @ % reduction ) than placebo ( @ % reduction ) ; P = @ .


Atorvastatin also resulted in a @ % greater reduction in CD@-T-cell activation than placebo ( @ % vs. @ % , P = @ ) , CD@ T-cell exhaustion ( @ % vs. @ % in placebo ) , P = @ and CD@ T-cell exhaustion ( @ % vs. @ % ) , P = @ .


There was no carry-over/period effect .


Expected adverse events were comparable in both groups , and no serious adverse events were reported .


Atorvastatin reduced T-cell immune activation and exhaustion among cART-treated adults in a Ugandan cohort .


Atorvastatin adjunct therapy should be explored as a strategy to improve HIV treatment outcomes among people living with HIV in sub-Saharan Africa .


Among the multiple conservative modalities , physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain .


Despite the scientific progresses with regard to pain and motor control neuroscience , treatment of chronic spinal pain ( CSP ) often tends to stick to a peripheral biomechanical model , without targeting brain mechanisms .


With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP , the development of clinical strategies targeted at ` training the brain ' is to be pursued .


Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care , but confirmation is required in a larger , multi-center trial with appropriate evidence-based control intervention and long-term follow-up .


The aim of this study is to assess the effectiveness of a modern neuroscience approach , compared to usual care evidence-based physiotherapy , for reducing pain and improving functioning in patients with CSP .


A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP .


The study is a multi-center , triple-blind , two-arm ( @:@ ) randomized clinical trial with @-year follow-up .


@ CSP patients will be randomly allocated to either the experimental ( receiving pain neuroscience education followed by cognition-targeted motor control training ) or the control group ( receiving usual care physiotherapy ) , each comprising of @ months treatment .


The main outcome measures are pain ( including symptoms and indices of central sensitization ) and self-reported disability .


Secondary outcome measures include brain gray matter structure , motor control , muscle properties , and psychosocial correlates .


Clinical assessment and brain imaging will be performed at baseline , post-treatment and at @-year follow-up .


Web-based questionnaires will be completed at baseline , after the first @ treatment sessions , post-treatment , and at @ and @-months follow-up .


Findings may provide empirical evidence on : ( @ ) the effectiveness of a modern neuroscience approach to CSP for reducing pain and improving functioning , ( @ ) the effectiveness of a modern neuroscience approach for normalizing brain gray matter in CSP patients , and ( @ ) factors associated with therapy success .


Hence , this trial might contribute towards refining guidelines for good clinical practice and might be used as a basis for health authorities ' recommendations .


Stroke is a major cause of long-term adult disability with many survivors living in the community relying on family members for on-going support .


However , reports of inadequate understanding of rehabilitation techniques are common .


A self-management DVD-based observational learning tool may help improve functional outcomes for survivors of stroke and reduce caregivers ' burden .


This article describes the methodology of the stroke self-management rehabilitation trial .


The overall aim of this pilot trial is to assess the feasibility and preliminary efficacy of a DVD-based intervention for improving functional outcomes of survivors of stroke @ months postrandomization to inform the design of a full-scale randomized clinical trial .


Recruitment of a minimum of @ survivors of stroke and their informal caregivers ( where available ) in each of the participating centers will occur across multiple international sites .


After baseline assessments , participants will be randomly assigned to an intervention or standard care group .


The intervention comprises a structured DVD observation and practice schedule over @ weeks .


All participants will complete follow-up assessments .


The outcome measures will include a global shift in the Rankin Scale scores and dichotomized scores , changes in quality of life , general health , depression , and caregiver burden at @ months postrandomization .


A qualitative analysis of the effects of the intervention will also be undertaken .


The results of the pilot study will provide knowledge of whether observational learning techniques delivered via DVD can effectively improve recovery after stroke and reduce caregiver burden .


Ankle sprain is the most common sports-related injury with a high rate of recurrence and associated costs .


Recent studies have emphasised the effectiveness of both neuromuscular training and bracing for the secondary prevention of ankle sprains .


To evaluate the effectiveness of combined bracing and neuromuscular training , or bracing alone , against the use of neuromuscular training on recurrences of ankle sprain after usual care .


@ athletes , aged @-@ , who had sustained a lateral ankle sprain , were included ( training group n = @ ; brace group n = @ ; combi group n = @ ) .


The training group received an @-week home-based neuromuscular training programme , the brace group received a semirigid ankle brace to be worn during all sports activities for @months , and the combi group received both the training programme , as well as the ankle brace , to be worn during all sports activities for @ weeks .


The main outcome measure was self-reported recurrence of the ankle sprain .


During the @-year follow-up , @ participants ( @ % ) reported a recurrent ankle sprain : @ ( @ % ) in the training group , @ ( @ % ) in the brace group and @ ( @ % ) in the combi group .


The relative risk for a recurrent ankle sprain in the brace group versus the training group was @ ( @ % CI @ to @ ) .


No significant differences were found for time losses or costs due to ankle sprains between the intervention groups .


Bracing was superior to neuromuscular training in reducing the incidence but not the severity of self-reported recurrent ankle sprains after usual care .


Recruiting cancer patients is a barrier often encountered in research trials .


However , very few randomized trials explore strategies to improve participation rates .


The purpose of this study was to evaluate the effectiveness of a pre-recruitment primer letter to recruit persons diagnosed with colorectal cancer for a research trial .


Potentially eligible participants were identified by the Victorian Cancer Registry .


A total of @,@ participants were randomized to receive either a mailed explanatory primer letter designed to encourage research participation , or no primer letter .


Two weeks after the intervention , the Victorian Cancer Registry sought permission from patients to release their contact details to researchers .


Those who agreed were contacted and invited to the study .


Pre-recruitment encouragement was not effective at increasing recruitment , with no significant differences demonstrated between experimental groups .


Overall , @ % ( n = @ ) consented to participate , @ % ( n = @ ) refused and @ % ( n = @ ) did not respond .


While this study demonstrated disappointing outcomes , pre-recruitment letters should not be ruled out as an approach altogether .


Rather , future research should explore whether other factors to increase motivation , such as intensity and timing , are feasible and acceptable for contacting cancer patients .


Endoscopic retrograde cholangiopancreatography ( ERCP ) is associated with radiation exposure to the endoscopist and staff that may be significant in high-volume centers .


We investigated whether a radiation-attenuating drape over the fluoroscopy image intensifier reduces radiation exposure during ERCP .


We performed a prospective , randomized , double-blind trial of @ therapeutic ERCPs at a tertiary-care university center .


Procedures were randomly assigned to groups receiving lead-free radiation-attenuating drapes ( n = @ ) or identical sham drapes ( n = @ ) .


The drapes were suspended around the fluoroscopy image intensifier during ERCP .


The primary end point was the effective dose of radiation measured at the endoscopist 's eye and neck , and at the assisting nurse 's neck .


The cumulative annual radiation exposure was also estimated .


Fluoroscopy time , absorbed radiation dose , and dose area product were similar in the study groups .


Mean effective dose for sham vs. radiation-attenuating drape was @ vs. @ mSv at the endoscopist 's eye , @ vs. @ mSv at the endoscopist 's neck , and @ vs. @ mSv at the nurse 's neck ( P < @ for all comparisons ) .


The relative risk reduction in radiation was @ % , @ % , and @ % at the three sites .


At a high-volume center in which an endoscopist performs @ therapeutic ERCPs per year , the estimated cumulative annual effective dose at the endoscopist 's eye level is @mSv with conventional protection and @mSv with a radiation-attenuating drape , with the recommended limit being @mSv .


The addition of a radiation-attenuating drape around the image intensifier during ERCP significantly decreases radiation exposure to endoscopists and staff by @ % .


The ALIGN study ( NCT@ ) evaluated the efficacy and safety of sarilumab , the first fully human monoclonal antibody against interleukin-@ receptor - ( IL-@R ) , in patients with ankylosing spondylitis ( AS ) .


Patients with active AS despite conventional treatment were randomised to placebo , or one of five subcutaneous dose regimens of sarilumab ( @ , @ or @mg every other week , or @ or @mg every week ) , for @weeks .


The primary efficacy end point was the percentage of patients achieving the Axial SpondyloArthritis international Society ( ASAS ) @ response criteria at week @ .


Secondary endpoints included ASAS@ response , ASAS partial remission , AS Disease Activity Score , high-sensitivity C-reactive protein ( hs-CRP ) value , and safety .


Baseline demographic and disease characteristics of the @ patients enrolled were similar across treatment groups .


At week @ , there was no statistically significant difference in ASAS@ response rate between placebo ( ASAS@ = @ % ) and any sarilumab dose group .


A significantly greater reduction in hs-CRP value was achieved with the higher sarilumab doses versus placebo .


No other statistically significant differences were evident for secondary efficacy endpoints .


The most common treatment-emergent adverse events reported for sarilumab included infections ( non-serious ) , neutropenia , and increase in alanine aminotransferase .


No cases of tuberculosis , opportunistic , or fungal infections , or bowel perforations were reported .


Seven patients experienced a treatment-emergent serious adverse event ( all in sarilumab treatment groups ) .


No deaths occurred .


The ALIGN study shows that IL-@R blockade with sarilumab was not an effective treatment for AS .


Sarilumab was generally well tolerated with a manageable safety profile .


A new formulation of tacrolimus that is characterized by prolonged release has been developed to facilitate treatment and patient compliance .


Initial therapy with prolonged release formula in heart transplantation is not widely accepted .


We enrolled @ patients into a randomized analysis divided into @ groups with different initial regimens .


There were @ patients with a mean age of @ @ years treated by Advagraf , and @ patients with a mean age of @ @ years treated by Prograf .


Serum concentration of immunosuppressive drug was followed by its oral dosage and endomyocardial biopsy results .


Arterial hypertension , kidney function , and incidence of diabetes mellitus were recorded .


There were no perioperative deaths .


The risk of acute rejection within @ months following surgery was @ ( @ % ) in the Advagraf group and @ ( @ % ) in the Prograf group .


Although the serum tacrolimus results were comparable between groups , the drug 's daily dosages were different after @ months of therapy ( @ @ mg in the Advagraf group and @ @ mg in the Prograf group ( p < @ ) .


The low rate of adverse effects throughout the study was noted .


Prolonged-release tacrolimus formula is an efficient immunosuppressant in heart transplantation .


Its initial application after surgery has low risk of adverse effects with similar results to conventional formula .


This small study has determined the effect of vitamin C on myocardial reperfusion in patients undergoing elective percutaneous coronary intervention ( PCI ) .


This study was to explore whether antioxidant vitamin C infusion before the procedure is able to affect the incidence of periprocedural myocardial injury ( PMI ) in patients undergoing PCI .


In this prospective single-centre randomized study , @ patients were randomized into @ groups : the vitamin C group , which received a @-g vitamin C infusion within @ hours before PCI , and a control group , which received normal saline .


The primary end point was the troponin I-defined PMI , and the second end point was the creatine kinase ( CK ) - MB-defined PMI .


Separate analyses using both end points were performed .


PMI was defined as an elevation of cardiac biomarker values ( CK-MB or troponin I ) > @ times the upper limit of normal ( ULN ) , alone or associated with chest pain or ST-segment or T-wave changes .


After PCI , the incidence of PMI was reduced , whether defined by troponin or by CK-MB , compared with the control group ( troponin I , @ % vs @ % ; P = @ ; CK-MB , @ % vs @ % ; P = @ ) .


Logistic multivariate analysis showed that preprocedure use of vitamin C is an independent predictor of PMI either defined by troponin I ( odds ratio -LSB- OR -RSB- , @ ; @ % confidence interval -LSB- CI -RSB- , @-@ @ ; P = @ ) or by CK-MB ( OR , @ ; @ % CI , @-@ @ ; P = @ ) .


In patients undergoing elective PCI , preprocedure intravenous treatment with vitamin C is associated with less myocardial injury .


HIV infection has been associated with an increased risk of chronic kidney disease ( CKD ) .


Little is known about the prevalence of CKD in individuals with high CD@ cell counts prior to initiation of antiretroviral therapy ( ART ) .


We sought to address this knowledge gap .


We describe the prevalence of CKD among @ ART-nave adults ( mean age @ years ) with CD@ cell counts > @ cells/L at enrolment in the Strategic Timing of AntiRetroviral Treatment ( START ) study .


CKD was defined by estimated glomerular filtration rate ( eGFR ) < @mL/min/@ @ m ( @ ) and/or dipstick urine protein @ + .


Logistic regression was used to identify baseline characteristics associated with CKD .


Among @ -LSB- @ % ; @ % confidence interval ( CI ) @ % , @ % -RSB- participants with CKD , the majority had isolated proteinuria .


A total of @ participants had urine protein @ + , including @ with urine protein @ + .


Only @ participants ( @ % ) had an estimated glomerular filtration rate < @mL/min/@ @ m ( @ ) , including four who also had proteinuria .


Baseline characteristics independently associated with CKD included diabetes -LSB- adjusted odds ratio ( aOR ) @ ; @ % CI @ , @ -RSB- , hypertension ( aOR @ ; @ % CI @ , @ ) , and race/ethnicity ( aOR @ ; @ % CI @ , @ for Hispanic vs. white ) .


We observed a low prevalence of CKD associated with traditional CKD risk factors among ART-nave clinical trial participants with CD@ cell counts > @ cells/L .


Most patients remain symptomatic after an initial intervention with approved treatments for generalized social anxiety disorder .


This randomized controlled trial provides systematic , prospectively derived data on the relative benefits of `` next-step '' pharmacotherapies to improve outcomes for individuals with generalized social anxiety disorder who remain symptomatic after initial treatment .


This three site , @-week , double-blind randomized controlled trial compared the relative benefits of three strategies for patients remaining symptomatic ( Liebowitz Social Anxiety Scale -LSB- LSAS -RSB- score > @ ) after a @-week trial of sertraline alone : the addition of up to @ mg/day of clonazepam ( sertraline plus clonazepam ) , a switch to up to @ mg/day of venlafaxine , or prolonged sertraline treatment with placebo ( sertraline plus placebo ) .


A total of @ participants received at least one dose of sertraline ; @ nonresponders ( LSAS score > @ ) at week @ were randomly assigned to sertraline plus clonazepam , switch to venlafaxine , or sertraline plus placebo .


Overall , @ % of patients achieved remission ( LSAS score @ ) at the endpoint , and @ % of patients assigned to sertraline plus clonazepam achieved remission compared with patients assigned to sertraline plus placebo ( @ % ) or venlafaxine ( @ % ) , but the differences did not reach significance .


Sertraline plus clonazepam was associated with a significantly greater drop in LSAS severity ( p = @ ) and disability ( p = @ ) compared with sertraline plus placebo ; no significant differences were observed on these parameters between venlafaxine and either sertraline plus placebo or sertraline plus clonazepam .


In supplemental analysis , the overall response rate ( LSAS score @ ) was @ % , including a significantly greater proportion of patients in the sertraline plus clonazepam group ( @ % ) compared with the sertraline plus placebo group responding ( @ % ; p = @ ) ; differences did not reach significance between venlafaxine and sertraline plus placebo or sertraline plus clonazepam .


The findings suggest that the clonazepam augmentation strategy provides relative benefits for sertraline nonresponders in social anxiety disorder .


To observe the effects of transcutaneous acupoint electrical stimulation ( TAES ) combined with general anesthesia ( acupuncture analgesia combined with general anesthesia ) on postoperative pain , nausea and vomiting and exhausted defecation symptoms in patients undergoing gynecological laparoscopic operation .


Sixty patients with gynecological laparoscopic operation were randomly divided into TAES group and control group , with @ cases in each group .


Patients of the control group received simple general anesthesia and those of the TAES group were treated with general anesthesia and TAES of bilateral Zusanli ( ST @ ) and Liangqiu ( ST @ ) .


Visual Analogue Scale ( VAS ) was used for measuring the patients ' pain reaction at @ h , @ h and @ h after surgery .


Symptoms of patients ' nausea and vomiting , post-operation exhaust and defecation time were recorded after operation .


The VAS scores at time-points of @ h , @ h and @ h and nausea level in the TAES group were significantly lower than those of the control group ( P < @ , P < @ ) .


The vomiting severity of the TAES group was also relatively lower in comparison with the control group , but without significant difference between the two groups ( P > @ ) .


The post-operation exhaust and defecation time of patients in the TAES group apparently appeared earlier than those of patients in the control group ( P < @ ) .


TAES combined with general anesthesia is effective in reducing post-operative pain and nausea , and improving gastrointestinal function in patients undergoing laparoscopic operation .


Postmenopausal women with hormone receptor-positive ( HR ( + ) ) breast cancer in whom disease progresses or there is recurrence while taking a nonsteroidal aromatase inhibitor ( NSAI ) are usually treated with exemestane ( EXE ) , but no single standard of care exists in this setting .


The BOLERO-@ trial demonstrated that adding everolimus ( EVE ) to EXE improved progression-free survival ( PFS ) while maintaining quality of life when compared with EXE alone .


Because many women with HR ( + ) advanced breast cancer are elderly , the tolerability profile of EVE plus EXE in this population is of interest .


BOLERO-@ , a phase III randomized trial , compared EVE ( @mg/d ) and placebo ( PBO ) , both plus EXE ( @ mg/d ) , in @ postmenopausal women with HR ( + ) advanced breast cancer recurring/progressing after treatment with NSAIs .


Safety and efficacy data in elderly patients are reported at @-month median follow-up .


Baseline disease characteristics and treatment histories among the elderly subsets ( @ years , n = @ ; @ years , n = @ ) were generally comparable with younger patients .


The addition of EVE to EXE improved PFS regardless of age ( hazard ratio , @ -LSB- @ years -RSB- and @ -LSB- @ years -RSB- ) .


Adverse events ( AEs ) of special interest ( all grades ) that occurred more frequently with EVE than with PBO included stomatitis , infections , rash , pneumonitis , and hyperglycemia .


Elderly EVE-treated patients had similar incidences of these AEs as did younger patients but had more on-treatment deaths .


Adding EVE to EXE offers substantially improved PFS over EXE and was generally well tolerated in elderly patients with HR ( + ) advanced breast cancer .


Careful monitoring and appropriate dose reductions or interruptions for AE management are recommended during treatment with EVE in this patient population .


The current study tested whether self-affirmation in the context of a threatening health message helps promote a health behavior ( fruit and vegetable consumption ) over a @-month period , and whether adding a manipulation to support the translation of intentions into behavior ( an implementation intentions induction ) enhances the impact of self-affirmation .


Participants ( N = @ , @ % women ) reported their baseline consumption and were randomly assigned to condition in a @ ( self-affirmation : yes , no ) @ ( implementation intentions : formed , not formed ) between-subjects factorial design .


They completed a self-affirmation/control task and then read a health communication advising eating at least @ portions of fruit and vegetables daily .


Next participants reported intentions for behavior change , after which they formed/did not form relevant implementation intentions .


Consumption was measured again @ days and @ months postintervention .


Self-affirmed ( vs. nonaffirmed ) participants reported eating more fruit and vegetables at both follow-ups .


Forming ( vs. not forming ) implementation intentions was also beneficial for consumption .


At @ days , there was also a significant self-affirmation implementation intentions interaction : consumption was highest when self-affirmed participants also formed implementation intentions .


The present study offers new evidence concerning the impact and durability of self-affirmation on health behaviors and the role of implementation intentions in enhancing the impact of self-affirmation .


Classical conditioning of the eyeblink reflex is a simple form of motor learning which depends on the integrity of the cerebellum .


Acquisition of conditioned eyeblink responses is markedly reduced in patients with cerebellar disorders .


Noninvasive transcranial direct current stimulation ( tDCS ) has been reported to modify the excitability of the cerebellar cortex .


The aim of the study was to assess whether acquisition of conditioned eyeblink responses ( CR ) is altered by cerebellar tDCS .


A standard delay conditioning paradigm with a @ ms tone as conditioned stimulus ( CS ) coterminating with a @ ms air puff as unconditioned stimulus ( US ) was used in a total of @ healthy subjects ( @ female , @ male , mean age @ @ years ) .


One hundred paired CS-US trials and @ extinction CS alone trials were given .


tDCS ( @ mA intensity , ramp like onset ) was applied over the right cerebellar hemisphere ipsilaterally to the US during the acquisition phase .


Subjects were randomly assigned to three groups ( n = @ ) using anodal , cathodal or sham stimulation .


The investigator as well as the participants was blinded to the stimulation modality .


CR acquisition was significantly enhanced by anodal tDCS ( mean total CR incidence @ @ % ) and significantly reduced by cathodal stimulation ( @ @ % ) compared to sham stimulation ( @ @ % ) .


During anodal tDCS CR onset occurred significantly earlier , that is mean onset of responses was shifted closer to CS onset .


Acquisition and timing of conditioned eyeblink responses is modified by cerebellar tDCS in a polarity dependent manner .


This study aimed to test the effects of boiled Anethum Graveolens seeds on pain intensity and duration of labor stages .


A randomized clinical trial was conducted on @ eligible participants who had regular uterine contractions .


Participants were allocated to either intervention or control group receiving boiled Anethum Graveolens seeds or routine care , respectively .


Preparation of Anethum Graveolens boiled solution was as follows : @g ( two tablespoons ) of seed in @cc water boiled for @min .


After filtration , this solution used by intervention group only once after starting active phase ( @-@cm of cervix dilatation ) .


Participants were followed up to the delivery time .


Data were analyzed using T , and Chi square tests .


Findings showed that the length of the all stages of labor were significantly lower in intervention compared to control group in except for second stage in primiparous .


The second stage of labor in primiparous participants in intervention group was shorter than control group , although the difference is not significant .


Moreover , intervention group had a significantly better dilatation and effacement scores after @ , @ , @ and @h following the intervention compared to control group .


Results supported the boiled Anethum Graveolens seeds as an effective way to progress of the labor .


Results from an observational study involving neonates suggested that high-frequency oscillatory ventilation ( HFOV ) , as compared with conventional ventilation , was associated with superior small-airway function at follow-up .


Data from randomized trials are needed to confirm this finding .


We studied @ adolescents who had been born before @ weeks of gestation and had been enrolled in a multicenter , randomized trial that compared HFOV with conventional ventilation immediately after birth .


The trial involved @ neonates , of whom @ survived to hospital discharge .


We compared follow-up data from adolescents who had been randomly assigned to HFOV with follow-up data from those who had been randomly assigned to conventional ventilation , with respect to lung function and respiratory health , health-related quality of life , and functional status , as assessed with the use of questionnaires completed when the participants were @ to @ years of age .


The primary outcome was forced expiratory flow at @ % of the expired vital capacity ( FEF@ ) .


The HFOV group had superior results on a test of small-airway function ( z score for FEF@ , -@ with HFOV vs. -@ with conventional therapy ; adjusted difference , @ -LSB- @ % confidence interval , @ to @ -RSB- ) .


There were significant differences in favor of HFOV in several other measures of respiratory function , including forced expiratory volume in @ second , forced vital capacity , peak expiratory flow , diffusing capacity , and impulse-oscillometric findings .


As compared with the conventional-therapy group , the HFOV group had significantly higher ratings from teachers in three of eight school subjects assessed , but there were no other significant differences in functional outcomes .


In a randomized trial involving children who had been born extremely prematurely , those who had undergone HFOV , as compared with those who had received conventional ventilation , had superior lung function at @ to @ years of age , with no evidence of poorer functional outcomes .


( Funded by the National Institute for Health Research Health Technology Assessment Programme and others . )


There is a metabolic pathway by which mammals can convert the omega-@ ( n-@ ) essential fatty acid - linolenic acid ( ALA ) into longer-chain n-@ polyunsaturated fatty acids ( LC n-@ PUFA ) including eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) .


As far as we know there are currently no studies that have specifically examined sex differences in the LC n-@ PUFA response to increased dietary ALA intake in humans , although acute studies with isotope-labelled ALA identified that women have a significantly greater capacity to synthesise EPA and DHA from ALA compared to men .


Available data from a placebo-controlled , randomised study were re-examined to identify whether there are sex differences in the LC n-@ PUFA response to increased dietary ALA intake in humans .


There was a significant difference between sexes in the response to increased dietary ALA , with women having a significantly greater increase in the EPA content of plasma phospholipids ( mean +@ % of total fatty acids ) after six months of an ALA-rich diet compared to men ( mean +@ % , P = @ ) .


Age and BMI were identified as predictors of response to dietary ALA among women .


Women show a greater increase in circulating EPA than men during increased dietary ALA consumption .


Further understanding of individual variation in the response to dietary ALA could inform nutrition advice , with recommendations being specifically tailored according to habitual diet , sex , age and BMI .


Persistent use of guideline-recommended drugs after acute myocardial infarction ( AMI ) is frequently reported to be inadequate in the elderly and scarce knowledge exists about factors that influence persistence in outpatient care .


Our aim was to evaluate drug use and its predictors in survivors of AMI above @ years from hospital discharge to @-year post-AMI .


In a single-centre randomised controlled trial , discharge medication of @ patients with AMI was obtained from medical records at hospital stay .


Follow-up drug use and use of the healthcare system were self-reported to study nurses over @ year in @-month intervals .


Predictors for persistence were modelled with multivariate logistic regression analysis considering demographics , co-morbidities and treatment characteristics .


At discharge , @ % of the patients used anti-platelets , @ % beta blockers , @ % statins and @ % angiotensin-converting enzyme inhibitors or angiotensin receptor blockers .


Use of the combination of all four drug classes decreased from discharge to @ year post-AMI from @ to @ % and was significantly reduced by age @ years ( odds ratio -LSB- OR -RSB- @ ; @ % confidence interval -LSB- CI -RSB- @-@ @ ) and ten or more visits with general practitioners ( GPs ) over @ year ( OR @ ; @ % CI @-@ @ ) .


Persistence from month @ to @ was significantly associated with drug use at discharge for the single drug classes , but not for the drug combination .


Older age and frequent GP visits are associated with decreased use of the guideline-recommended drug combination after AMI .


Further research is needed to specify underlying reasons and develop measures to improve persistence .


Abiraterone acetate ( an androgen biosynthesis inhibitor ) plus prednisone is approved for treating patients with metastatic castration-resistant prostate cancer ( mCRPC ) .


Study COU-AA-@ evaluated abiraterone acetate plus prednisone versus prednisone alone in mildly symptomatic or asymptomatic patients with progressive mCRPC without prior chemotherapy .


Report the prespecified third interim analysis ( IA ) of efficacy and safety outcomes in study COU-AA-@ .


Study COU-AA-@ , a double-blind placebo-controlled study , enrolled patients with mCRPC from April @ to June @ .


A total of @ patients were stratified by Eastern Cooperative Oncology Group performance status ( @ vs @ ) .


Patients were randomised @:@ to abiraterone @mg plus prednisone @mg twice daily by mouth versus prednisone .


Co-primary end points were radiographic progression-free survival ( rPFS ) and overall survival ( OS ) .


Median times to event outcomes were estimated using the Kaplan-Meier method .


Hazard ratios ( HRs ) and @ % confidence intervals ( CIs ) were derived using the Cox model , and treatment comparison used the log-rank test .


The O'Brien-Fleming Lan-DeMets - spending function was used for OS .


Adverse events were summarised descriptively .


With a median follow-up duration of @ mo , improvement in rPFS was statistically significant with abiraterone treatment versus prednisone ( median : @ vs @ mo ; HR : @ -LSB- @ % CI , @-@ @ -RSB- ; p < @ ) .


Abiraterone improved OS ( median : @ vs @ mo ; HR : @ -LSB- @ % CI , @-@ @ -RSB- ; p = @ ) but did not reach the prespecified statistical efficacy boundary ( - level : @ ) .


A post hoc multivariate analysis for OS using known prognostic factors supported the primary results ( HR : @ -LSB- @ % CI , @-@ @ -RSB- ; p = @ ) , and all clinically relevant secondary end points and patient-reported outcomes improved .


While the post hoc nature of the long-term safety analysis is a limitation , the safety profile with longer treatment exposure was consistent with prior reports .


The updated IA of study COU-AA-@ in patients with mCRPC without prior chemotherapy confirms that abiraterone delays disease progression , pain , and functional deterioration and has clinical benefit with a favourable safety profile , including in patients treated for @ mo. .


Study COU-AA-@ , ClinicalTrials.gov number , NCT@ .


The updated results of this ongoing study showed that disease progression was delayed in patients with advanced prostate cancer who were treated with abiraterone acetate and prednisone , and there was a continued trend in prolongation of life compared with patients treated with prednisone alone .


Treatment with abiraterone acetate and prednisone was well tolerated by patients who were treated for > @ yr .


Both Miller and Macintosh blades are widely used for laryngoscopy in small children , though the Miller blade is more commonly recommended in pediatric anesthetic literature .


The aim of this study was to compare laryngoscopic views and ease and success of intubation with Macintosh and Miller blades in small children under general anesthesia .


One hundred and twenty children aged @-@ months were randomized for laryngoscopy to be performed in a crossover manner with either the Miller or the Macintosh blade first , following induction of anesthesia and neuromuscular blockade .


The tips of both the blades were placed at the vallecula .


Intubation was performed following the second laryngoscopy .


The glottic views with and without external laryngeal maneuver ( ELM ) and ease of intubation were observed .


Similar glottic views with both blades were observed in @/@ ( @ % ) children , a better view observed with the Miller blade in @/@ ( @ % ) children , and with the Macintosh blade in @/@ ( @ % ) .


Laryngoscopy was easy in @/@ ( @ % ) children with both the blades .


Restricted laryngoscopy was noted in @ children : in @ children with both the blades , @ with Miller , and @ with Macintosh blade .


Laryngoscopic view improved following ELM with both the blades .


In children aged @-@ months , the Miller and the Macintosh blades provide similar laryngoscopic views and intubating conditions .


When a restricted view is obtained , a change of blade may provide a better view .


Placing the tip of the Miller blade in the vallecula provides satisfactory intubating conditions in this age group .


Topical Cyperus rotundus oil is an effective and safe method to decrease hair growth .


The oil 's flavonoids have antiandrogenic activity on androgenic hair .


To date , there have been no randomized controlled trials comparing topical C rotundus oil to the available allopathic modalities , such as laser-assisted hair removal .


In an open-label pilot study , the author prospectively evaluated the efficacy of C rotundus essential oil , compared with the Alexandrite laser ( GentleLase ; Candela Laser Corp , Wayland , Massachusetts ) and saline , for reducing unwanted axillary hair .


Eligible participants ( n = @ ) with unwanted axillary hair were assigned randomly to @ of @ study groups : topical C rotundus oil ( group @ ) , saline ( group @ ) , and Alexandrite laser ( group @ ) .


Sixty patients completed the entire study .


Three methods were used to evaluate the results : hair counts , observations of independent professionals , and patient self-assessments .


Overall results did not differ significantly between C rotundus oil and the Alexandrite laser ( P > @ ) .


However , statistically significant differences were noted with respect to decreased growth of white hair ( P < @ ) , favoring the oil .


This finding was evident by all @ methods of assessment .


No side effects were detected .


Cyperus rotundus essential oil is as effective as the Alexandrite laser for decreasing the growth of axillary hair ( both dark and white ) .


To determine the optimal iodine mass ( IM ) to achieve a @-HU increase in hepatic attenuation for the detection of liver metastasis based on total body weight ( TBW ) or body surface area ( BSA ) at @-kVp computed tomography ( CT ) imaging of the liver .


One-hundred and fifty patients who underwent contrast-enhanced CT at @-kVp were randomised into three groups : @ gI/kg , @ gI/kg and @ gI/kg .


Portal venous phase images were evaluated for hepatic parenchymal enhancement ( HU ) and visualisation of liver metastasis .


Iodine mass per BSA ( gI/m ( @ ) ) calculated in individual patients were evaluated .


Mean HU for the @ gI/kg group ( @ HU ) was higher than in the @ gI/kg ( @ HU ) and @ gI/kg ( @ HU ) groups ( P < @ ) .


Linear correlation equations between HU and IM per TBW or BSA are HU = @ +@ IM/TBW ( r = @ , P < @ ) and HU = @ +@ IM/BSA ( r = @ , P < @ ) , respectively .


The three groups were comparable for the visualisation of hepatic metastases .


The iodine mass to achieve a @-HU increase in hepatic attenuation at @-kVp CT was estimated to be @ gI/kg of body weight or @ gI/m ( @ ) of body surface area .


Hepatic enhancement is expressed as HU = @ +@ IM -LSB- g -RSB- / TBW -LSB- kg -RSB- .


Hepatic enhancement is expressed as HU = @ +@ IM -LSB- g -RSB- / BSA -LSB- m ( @ ) -RSB- .


Essential iodine dose at @-kVp CT was @ gI/kg or @ gI/m ( @ ) .


The objective of this study was to investigate if a verbal task can improve alertness and if performance changes are associated with changes in alertness as measured by EEG .


Previous research has shown that a secondary task can improve performance on a short , monotonous drive .


The current work extends this by examining longer , fatiguing drives .


The study also uses EEG to confirm that improved driving performance is concurrent with improved driver alertness .


A @-min , monotonous simulator drive was used to place drivers in a fatigued state .


Four secondary tasks were used : no verbal task , continuous verbal task , late verbal task , and a passive radio task .


When engaged in a secondary verbal task at the end of the drive , drivers showed improved lane-keeping performance and had improvements in neurophysiological measures of alertness .


A strategically timed concurrent task can improve performance even for fatiguing drives .


Secondary-task countermeasures may prove useful for enhancing driving performance across a range of driving conditions .


The evidence base for the efficacy of cognitive behaviour therapy ( CBT ) for treating body dysmorphic disorder ( BDD ) is weak .


To determine whether CBT is more effective than anxiety management ( AM ) in an outpatient setting .


This was a single-blind stratified parallel-group randomised controlled trial .


The primary endpoint was at @ weeks , and the Yale-Brown Obsessive Compulsive Scale for BDD ( BDD-YBOCS ) was the primary outcome measure .


Secondary measures for BDD included the Brown Assessment of Beliefs Scale ( BABS ) , the Appearance Anxiety Inventory ( AAI ) and the Body Image Quality of Life Inventory ( BIQLI ) .


The outcome measures were collected at baseline and week @ .


The CBT group , unlike the AM group , had @ further weekly sessions that were analysed for their added value .


Both groups then completed measures at their @-month follow-up .


Forty-six participants with a DSM-IV diagnosis of BDD , including those with delusional BDD , were randomly allocated to either CBT or AM .


At @ weeks , CBT was found to be significantly superior to AM on the BDD-YBOCS -LSB- = -@ ; SE ( ) = @ ; p < @ ; @ % CI = -@ to -@ ; d = @ -RSB- as well as the secondary outcome measures of the BABS , AAI and BIQLI .


Further benefits occurred by week @ within the CBT group .


There were no differences in outcome for those with delusional BDD or depression .


CBT is an effective intervention for people with BDD even with delusional beliefs or depression and is more effective than AM over @ weeks .


The medical food Souvenaid , containing the specific nutrient combination Fortasyn Connect , is designed to improve synapse formation and function in patients with Alzheimer 's disease ( AD ) .


Two double-blind randomized controlled trials ( RCT ) with Souvenaid of @ and @ week duration ( Souvenir I and Souvenir II ) showed that memory performance was improved in drug-nave mild AD patients , whereas no effects on cognition were observed in a @-week RCT ( S-Connect ) in mild to moderate AD patients using AD medication .


Souvenaid was well-tolerated in all RCTs .


In this @-week open-label extension ( OLE ) study to the @-week Souvenir II RCT , long-term safety and intake adherence of the medical food Souvenaid was evaluated .


Patients with mild AD ( n = @ ) received Souvenaid once-daily during the OLE .


Main outcome parameters were safety and product intake adherence .


The memory domain z-score from a revised neuropsychological test battery was continued as exploratory parameter .


Compared to the RCT , a similar ( low ) incidence and type of adverse events was observed , being mainly ( @ % ) of mild intensity .


Pooled data ( RCT and OLE ) showed that @-week use of Souvenaid was well tolerated with high intake adherence ( @ % ) .


Furthermore , a significant increase in the exploratory memory outcome was observed in both the active-active and control-active groups during Souvenaid intervention .


Souvenaid use for up to @-weeks was well tolerated with a favorable safety profile and high intake adherence .


The findings in this OLE study warrant further investigation toward the long-term safety and efficacy of Souvenaid in a well-controlled , double-blind RCT .


Numerous studies have demonstrated that sleep promotes memory consolidation , but there is little research on the effect of hypnotics on sleep-dependent memory consolidation .


We compared bedtime administration of zolpidem-ER @ mg ( @ - to @-h duration of action ) , middle-of-the-night administration of zaleplon @ mg ( @ - to @-h duration of action ) , and placebo to examine the effect of different durations of hypnotic drug exposure on memory consolidation during sleep .


Twenty-two participants with no sleep complaints underwent @ conditions in a counterbalanced crossover study : ( @ ) zolpidem-ER @ mg ( bedtime dosing ) , ( @ ) zaleplon @ mg ( middle-of-the-night dosing ) , and ( @ ) placebo .


Memory testing was conducted before and after an @-h sleep period , using a word pair association task ( WPT ; declarative memory ) and a finger-tapping task ( FTT ; procedural memory ) .


ANOVA revealed a significant condition effect for the WPT ( p = @ ) and a trend for the FTT ( p = @ ) , which was significant when sex was added to the model ( p = @ ) .


Improvement in memory performance following sleep was lower with bedtime dosing of zolpidem-ER compared to placebo and middle-of-the-night dosing of zaleplon .


There were no differences between placebo and zaleplon .


The results suggest that in some circumstances hypnotics may have the potential to reduce the degree of sleep-dependent memory consolidation and that drug-free sleep early in the night may ameliorate this effect .


The aim of this study was to ascertain whether individual atrioventricular delay ( AVD ) optimization using impedance cardiography ( ICG ) offers beneficial hemodynamic effects as well as improved exercise tolerance and quality of life in patients with requiring constant right ventricular pacing .


There were @ patients with advanced AV block included in the study .


Several examinations were performed at the beginning .


Next , the optimization of AVD by ICG was done .


The next step of the study patients have been randomized into optimal AVD group ( AVDopt ) or factory setting group ( AVDfab ) .


After @ months , the follow-up all data were collected again and crossover was performed .


After another @ months , during the final follow-up all these measures were repeated .


In @ % patients , AVDopt were different than factory value .


Cardiac output ( CO ) , cardiac index ( CI ) , and stroke volume ( SV ) were significantly ( P < @ ) higher in AVDopt group than in AVDfab group ( CO : @ @ L/minute vs. @ @ L/minute ; SV : @ @ mL vs. @ @ mL ; CI : @ @ L/minute/m ( @ ) vs. @ @ L/minute/m ( @ ) ) .


There was a statistical significant ( P < @ ) reduction of proBNP and NYHA class in patients with AVDopt compared to AVDfab ( proBNP : @ @ pg/mL vs. @ @ pg/mL ; NYHA class : @ @ vs. @ @ ) .


Six-minute walking test was significantly ( P < @ ) higher in AVDopt group ( @ @ m ) than in AVDfab group ( @ @ m ) .


There were no statistically significant differences in echocardiographic parameters between AVDopt and AVDfab settings .


Our study results suggest that AVD optimization in patients with DDD pacemaker with ICG improves hemodynamic when compared to the default factory settings .


Furthermore , optimally programmed AVD reduces BNP and improves exercise tolerance and functional class .


The prevalence of smoke-free policies in multiunit housing ( MUH ) in South Dakota was examined .


Owner beliefs about smoke-free policies were identified .


Stratified random sampling included @ South Dakota counties classified as frontier , large rural , or urban .


Data collection with MUH owners in selected counties employed a telephone survey with mailed backup .


The owner response rate was @ % ( @/@ ) .


A written smoke-free policy was reported by @ ( @ % ) owners , and @ ( @ % ) reported a verbal smoke-free policy .


Owners in large rural counties ( @ % ) had more written smoke-free policies than owners in urban ( @ % ) and frontier ( @ % ) counties .


Only @ % of properties had policies covering both buildings and grounds .


Owners without policies were more than twice as likely to manage U.S. Department of Housing and Urban Development subsidized units and were three times as likely to be current smokers .


Owners without a smoke-free policy anticipated that a policy would decrease maintenance costs but increase turnover and vacancy rates .


Nearly one-half ( @ % ) of owners with no smoke-free policy had previously considered implementing a policy .


Owners self-reported beliefs about smoke-free policies identified perceived benefits such as decreased maintenance and costs , improved tenant safety and health , and conscientious tenants .


Perceived drawbacks included increased outdoor maintenance , enforcement problems , concerns about long-term tenants who smoke , and freedom/rights of smokers .


This study provides a baseline assessment of smoke-free polices in MUH settings .


Perceptions of owners without smoke-free policies focused on economic concerns that were inconsistent with reports from those owners with smoke-free policies .


As evidence-based practice ( EBP ) becomes a necessity in athletic training , Web-based modules have been developed and made available to the National Athletic Trainers ' Association membership as a mechanism to educate athletic trainers ( ATs ) on concepts of EBP .


To assess the effect of an educational intervention on enhancing knowledge of EBP among ATs .


Randomized controlled trial .


Web-based modules and knowledge assessment .


A total of @ of @ ATs ( @ % response rate ) , including professional athletic training students , graduate students , clinical preceptors , educators , and clinicians , were randomized into a control group ( @ men , @ women ) or experimental group ( @ men , @ women ) .


Ten Web-based modules were developed that covered concepts involved in the EBP process .


Both groups completed the Evidence-Based Practice Knowledge Assessment before and after the intervention phase .


During the intervention phase , the experimental group had access to the Web-based modules for @ weeks , whereas the control group had no direct responsibilities for the investigation .


The knowledge assessment consisted of @ multiple choice questions pertaining to concepts presented in the @ modules .


Test-retest reliability was determined to be good ( intraclass correlation coefficient -LSB- @,@ -RSB- = @ , @ % confidence interval = @ , @ ) .


Independent variables consisted of group ( control , experimental ) and time ( preassessment , postassessment ) .


Knowledge scores were tabulated by awarding @ point for each correct answer ( maximum = @ ) .


Between-group and within-group differences were calculated using a @ @ repeated-measures analysis of variance ( P @ ) , post hoc t tests , and Hedges g effect size with @ % confidence intervals .


We found a group time interaction ( F , = @ , P < @ ) .


No differences were identified between the control ( @ @ ) and experimental ( @ @ ) groups during the preassessment ( t = @ , P = @ ) .


The experimental group ( @ @ ) obtained higher scores on the postassessment than the control group ( @ @ ; t@ = @ , P = @ ) .


No differences were identified among time instances within the control group ( t = @ , P = @ ) ; however , the experimental group obtained higher scores on the postassessment than the preassessment ( t = @ , P < @ ) .


An educational intervention consisting of @ Web-based modules was an effective mechanism to increase knowledge of foundational EBP concepts among ATs .


However , it is not known whether ATs are integrating EBP into daily clinical practice .


Researchers should determine whether increased knowledge of EBP affects the daily clinical decision making of ATs .


The aim of this studywas to observe the effects of stellate ganglion block ( SGB ) on hemodynamic changes and intrapulmonary shunt during one-lung ventilation ( OLV ) .


Thirty ASA class I-II patients undergoing elective esophageal surgery were randomly divided into two groups : general anesthesia group ( group N , n = @ ) and general anesthesia combined SGB group ( group S , n = @ ) , patients in group S were received left SGB before induction .


Radial artery was cannulated for arterial blood pressure ( ABP ) monitoring and blood sampling and Swan-Ganz catheter was position in the pulmonary artery via right internal jugular vein under local anesthesia .


ECG , MAP , HR , CVP , continuous cardiac output ( CCO ) index and BIS were continuously monitored during anesthesia .


General anesthesia was induced with propofol @-@ @ mg/kg , sufentanil @ g/kg , and Rocuronium @-@ @ mg/kg .


Endobronchial occluder was placed blindly after tracheal indubation and the correct position was verified by auscultation and fiberoptic bronchoscopy .


The patients were mechanically ventilated .


The ventilation conditions were Fio@ = @ % , VT = @-@ ml/kg , I : E = @:@ and respiratory rate was adjusted to maintained PETCO@ at @-@ mmHg during both two-lung ventilation ( TLV ) and OLV .


Anesthesia was maintained with continuous infusion of propofol @-@ mg/kgh , sufentanil @ g/kgh , vecuronium o. @ mg/kgh , BIS was maintained at @-@ .


Blood samples were taken from radial artery and S-G catheter for blood gas analysis at following intervals : during spontaneous breathing when the patient was awake ( T@ ) , @ min after tracheal indubation ( T@ ) , @ min after patient was placed in lateral position ( T@ ) and @ min after it ( T@ ) , @ min after ribs was braced ( T@ ) , @ , @ , @ min during the course of OLV ( T@ , T@ , T@ ) , the two lungs were ventilated again for @ min ( T@ ) and Qs/Qt was calculated .


SVRI , MAP , HR in group N increased significantly at T@ , T@ , T@ compared with group S ( p < @ ) .


Qs/Qt was significantly increased after patient was placed in lateral position and increased further during OLV ; the calculated Qs/Qt values were highest at T@ PaO@ was significantly lower after OLV was started and reached the lowest level at T@ then was gradually increasing .


There was no significant difference in Qs/Qt and PaO@ at all time points between two groups .


SGB before induction effectively suppress the stress response work as stable blood dynamics and does not affect Qs/Qt and arterial oxygenation during OLV , SGB is a safe technique of anesthesia for general thoracic surgery .


Acute coronary syndromes ( ACSs ) are a major cause of morbidity and mortality , yet effective ACS treatments are frequently underused in clinical practice .


Randomized trials including the CPACS-@ study suggest that quality improvement initiatives can increase the use of effective treatments , but whether such programs can impact hard clinical outcomes has never been demonstrated in a well-powered randomized controlled trial .


The CPACS-@ study is a stepped-wedge cluster-randomized trial conducted in @ remote level @ hospitals without PCI facilities in China .


All hospitalized ACS patients will be recruited consecutively over a @-month period to an anticipated total study population of more than @,@ patients .


After a @-month baseline period , hospitals will be randomized to @ of @ groups , and a @-component quality improvement intervention will be implemented sequentially in each group every @months .


These components include the following : establishment of a quality improvement team , implementation of a clinical pathway , training of physicians and nurses , hospital performance audit and feedback , online technical support , and patient education .


All patients will be followed up for @months postdischarge .


The primary outcome will be the incidence of in-hospital major adverse cardiovascular events comprising all-cause mortality , myocardial infarction or reinfarction , and nonfatal stroke .


The CPACS-@ study will be the first large randomized trial with sufficient power to assess the effects of a multifaceted quality of care improvement initiative on hard clinical outcomes , in patients with ACS .


Strabismus surgery in children is often associated with undesirable intraoperative and postoperative side effects including pain , postoperative nausea and vomiting ( PONV ) , and occulocardiac reflex ( OCR ) .


Systemic analgesics have side effects and are contraindicated in some cases .


We hypothesized that the preoperative subtenon injection of bupivacaine would reduce postoperative pain and the incidence of side effects adverse effects .


Sixty children ( @ to @ years of age , ASA status I to II ) were randomized to receive either subtenon bupivacaine @ % or a saline injection before the beginning of surgery in a double-blind manner .


Pain scores using the Face , Legs , Cry , Activity , and Consolability ( FLACC ) scale , incidence of OCR and PONV , requirement of additional systemic analgesia , and time to discharge from the recovery room were compared .


The pain scores were significantly lower in the subtenon bupivacaine group at @ min ( p = @ ) and at @ min ( p = @ ) .


There was no significant difference between the two groups at the other time intervals .


There was a significant reduction in the incidence of occulocardiac reflex and the incidence of vomiting in the subtenon bupivacaine group .


Eight of the @ patients in the subtenon bupivacaine group required additional systemic analgesia compared to @ of @ controls .


The time to discharge from recovery room was lower in the subtenon bupivacaine group .


These data provide some evidence that a preoperative subtenon block with bupivacaine combined with general anesthesia allows efficient control of postoperative pain as well as a reduction in the incidence of OCR and PONV in young children undergoing strabismus surgery .


The aim of this study was to compare the diagnostic performances of multi-detector computed tomography ( MDCT ) reconstruction at two different slice thicknesses ( @mm , ` high resolution ' vs. @mm , ` routine ' ) with respect to the detection of blebs and bullae ( BBs ) in patients with primary spontaneous pneumothorax ( PSP ) .


Thirty-one patients underwent wedge resection of BBs ( @ unilateral and @ bilateral ) for PSP from January @ to January @ .


Two observers assessed the presence and locations of BBs independently using high-resolution CT ( HRCT ) and routine CT reconstruction , and compared the sensitivities of each reconstruction method for BB detection using operative findings as a standard reference .


In addition , the number of BBs in each CT image set was recorded and inter-observer agreements were evaluated .


Sensitivity for the detection of BBs was significantly better for HRCT than routine CT ( @ % vs. @ % for observer @ and @ % vs. @ % for observer @ , respectively , both P-values < @ ) .


On a per-bleb and a per-bulla basis , inter-observer agreements regarding BBs by HRCT were good and very good ( k = @ and @ , respectively ) and superior to those determined by routine CT ( k = @ and @ , respectively ) .


Different slice thickness reconstructions influence the diagnostic efficacy of MDCT for the detection of BBs in patients with PSP .


High-resolution thin slice CT reconstruction was found to have a significantly greater sensitivity than routine thicker slice thickness reconstruction for the detection of BBs .


The aim of this study is to conduct a preliminary examination of long-term outcomes on a broad range of affective disorder symptoms treated with a newly developed intervention : The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ( UP ) .


Maintenance of treatment gains at long-term follow-up ( LTFU ) were explored in patients ( N = @ , mean age = @ ; @ % female ) who completed a clinical trial of the UP .


Treatment gains observed at @-month follow-up ( @MFU ) on measures of clinical severity , general symptoms of depression and anxiety , and a measure of symptom interference in daily functioning were largely maintained @months later ( at an average of @months posttreatment ) , and any significant changes from @MFU to LTFU reflected small increases in symptoms that remained , on average , in the subclinical range .


These findings provide the first initial support for the durability of broad treatment gains following transdiagnostic treatment .


High-density lipoprotein ( HDL ) particles perform numerous vascular-protective functions .


Animal studies demonstrate that exposure to fine or ultrafine particulate matter ( PM ) can promote HDL dysfunction .


However , the impact of PM on humans remains unknown .


We aimed to determine the effect of exposure to coarse concentrated ambient particles ( CAP ) on several metrics of HDL function in healthy humans .


Thirty-two adults ( @ years ) were exposed to coarse CAP -LSB- @ gm ( -@ ) -RSB- in a rural location and filtered air ( FA ) for @h in a randomized double-blind crossover study .


Venous blood collected @ - and @-h post-exposures was measured for HDL-mediated efflux of -LSB- ( @ ) H -RSB- - cholesterol from cells and @-h exposures for HDL anti-oxidant capacity by a fluorescent assay and paraoxonase activity .


The changes -LSB- median ( first , third quartiles ) -RSB- between exposures among @ subjects with available results were compared by matched Wilcoxon tests .


HDL-mediated cholesterol efflux capacity did not differ between exposures at either time point -LSB- @ % ( @ , @ ) @-h post-CAP versus @ % ( @ , @ ) post-FA , p = @ and @ % ( @ , @ ) @-h post-CAP versus @ % ( @ , @ ) post-FA , p = @ -RSB- .


HOI -LSB- @ ( @ , @ ) versus @ ( @ , @ ) , p = @ -RSB- and paraoxonase activity -LSB- @ ( @ , @ ) versus @ molmin ( -@ ) mlplasma ( -@ ) ( @ , @ ) , p = @ -RSB- did not differ @-h post-CAP versus FA , respectively .


Brief inhalation of coarse PM from a rural location did not acutely impair several facets of HDL functionality .


Whether coarse PM derived from urban sites , fine particles or longer term PM exposures can promote HDL dysfunction warrant future investigations .


To compare the symptoms and lower airway inflammatory factors of patients with allergic rhinitis ( AR ) , and to observe the effect of nasal irrigation in the treatment of allergic rhinitis .


Sixty-one cases diagnosed as AR after skin prick test ( SPT ) were selected and randomly divided into three groups : @ patients in group A used nasal steroid spray ; @ cases in group B used nasal irrigation ; @ patients in group C combined ir rigation with nasal steroid .


Before and after @ months treatment , nasal visual analogue scale ( VAS ) score , rhino conjunctivtis quality of life questionnaire ( RQLQ ) score , fractional exhaled nitric oxide ( FENO ) values were observed and compared in each group .


Before treatment , there is no statistically difference between three groups ( P > @ ) .


After @ months of treatment , VAS , RQLQ , FENO of all patients was significantly decreased ( P < @ ) ; VAS , RQLQ score was not significantly different among the three groups ( P > @ ) , FENO value has no statistically significant difference between group A and group B ( P > @ ) , but were less than that in group C ( P < @ ) .


Nasal irrigation can ameliorate nasal symptoms , improve quality of life , decrease lower airway inflammation of allergic rhinitis patients .


Nasal irrigation is an effective treatment of allergic rhinitis .


Nasal irrigation combined with nasal steroid can achieve more significant efficacy .


The US public is increasingly using online rating sites to make decisions about a variety of consumer goods and services , including physicians .


We sought to understand , within the context of other types of rating sites , parents ' awareness , perceptions , and use of physician-rating sites for choosing primary care physicians for their children .


This cross-sectional , nationally representative survey of @ adults was conducted in September @ .


Participants were asked about rating Web sites in the context of finding a primary care physician for their children and about their previous experiences with such sites .


Overall , @ ( @ % ) of participants completed the survey .


Among these respondents , @ were parents who were included in the present analysis .


About three-quarters ( @ % ) of parents were aware of physician-rating sites , and about one-quarter ( @ % ) had used them to select a primary care physician for their children .


Based on @ vignettes for which respondents were asked if they would follow a neighbor 's recommendation about a primary care physician and using multivariate analyses , respondents exposed to a neighbor 's recommendation and positive online physician ratings were significantly more likely to choose the recommended physician ( adjusted odds ratio : @ -LSB- @ % confidence interval : @-@ @ -RSB- ) than respondents exposed to the neighbor 's recommendation alone .


Conversely , respondents exposed to the neighbor 's recommendation and negative online ratings were significantly less likely to choose the neighbor children 's physician ( adjusted odds ratio : @ -LSB- @ % confidence interval : @-@ @ -RSB- ) .


Parents are beginning to use online physician ratings , and these ratings have the potential to influence choices of their children 's primary care physician .


To evaluate the efficacy and safety of duloxetine hydrochloride in the treatment of patients affected by chronic prostatitis/chronic pelvic pain syndrome ( CP/CPPS ) .


Thirty-eight CP/CPPS patients completed the National Institutes of Health Chronic Prostatitis Symptom Index ( NIH-CPSI ) and International Index of Erectile Function-Erectile Function-@ ( IIEF-@ ) questionnaires , uroflowmetry , and evaluation of psychologic status using Hamilton Anxiety Scale ( HAM-A ) and Hamilton Depression Scale ( HAM-D ) .


Patients were randomly assigned to @ treatments groups .


Treatment in group @ consisted of a simultaneous oral administration of tamsulosin ( @ mg/d , @ mg/d ) , saw palmetto ( @ mg/d ) , and duloxetine ( @ mg/d ) .


Treatment in group @ consisted of tamsulosin ( @ mg/d ) and saw palmetto ( @ mg/d ) .


NIH-CPSI and IIEF-@ questionnaires , uroflowmetry , and evaluation of the psychological status were repeated at @ weeks of follow-up .


At @ weeks , a significant improvement in NIH-CPSI pain subscore , NIH-CPSI quality of life subscore , and NIH-CPSI total score were observed in group @ patients compared with those in group @ ( P < @ , respectively ) , together with a significant improvement in HAM-A and HAM-D scores ( P < @ , respectively ) .


Patients in group @ showed a significant improvement in NIH-CPSI total score , in the urinary symptoms subscore , and in the HAM-A total score .


No significant differences were observed in IIEF-@ scores in the @ groups .


Maximum flow rate significantly increased in both groups .


In group @ , @ % of patients stopped the study due to adverse effects .


The use of duloxetine in a multimodal treatment with an - blocker medication and a saw palmetto extract allowed better results in controlling clinical symptoms , psychologic status and quality of life patients affected by CP/CPPS .


Artificial language learning studies have demonstrated that learners exposed to many different nonword combinations representing a grammatical form demonstrate rapid learning of that form without explicit instruction .


However , learners presented with few exemplars , even when they are repeated frequently , fail to learn the underlying grammar .


This study translated this experimental finding in a therapeutic context .


Eighteen preschool children with language impairment received conversational recast treatment for morpheme errors .


Over a @-week period , half heard @ unique verbs twice each during recasts ( low-variability condition ) , and half heard @ unique verbs ( high-variability condition ) .


Children 's use of trained and untrained morphemes on generalization probes as well as spontaneous use of trained morphemes was tracked throughout treatment .


The high-variability condition only produced significant change in children 's use of trained morphemes , but not untrained morphemes .


Data from individual children confirmed that more children in the high - than the low-variability condition showed a strong treatment effect .


Children in the high-variability condition also produced significantly more unique utterances containing their trained morpheme than children in the low-variability condition .


The results support the use of highly variable input in a therapeutic context to facilitate grammatical morpheme learning .


To determine factors mediating the effects of a depression intervention for older African Americans on functional disability and , secondarily , whether functional improvements mediate intervention effects on depressive symptoms .


Structural equation modeling to examine mediators in a secondary analysis of a randomized trial with @-month follow-up .


Philadelphia region .


Community-dwelling African Americans ( @ ) with depressive symptoms living in an urban area ( N = @ ) .


Up to @ one-hour sessions over @ months conducted by licensed social workers who provided care management , referrals and linkages , stress reduction techniques , depression knowledge and symptom recognition , and behavioral activation techniques .


Main outcome was self-reported functional difficulty level for @ basic activities .


Mediators included depression severity ( Patient Health Questionnaire ) , depression knowledge and symptom recognition , behavioral activation , and anxiety .


At @ months , the intervention had positive effects on functional difficulty and all mediators ( P < @ ) .


Separate structural equation models indicated that two factors ( reduced depressive symptoms ( @ % mediated ) and improved depression knowledge and symptom recognition ( @ % mediated ) ) significantly mediated the intervention 's effect on functional disability .


Enhancing behavioral activation and decreasing anxiety were not found to mediate improvements in functional disability .


The two significant mediators jointly explained @ % of the intervention 's total effect on functional disability .


Functional improvement was not found to mediate the intervention 's effect on depressive symptoms .


This multicomponent depression intervention for African Americans has an effect on functional disability that is driven primarily by enhancing symptom recognition and decreasing depressive symptoms .


Reduction of functional difficulties did not account for improvements in depressive symptoms .


Nonpharmacological treatments for depressive symptoms that enhance symptom recognition in older African Americans can also reduce their functional difficulties with daily living activities .


Studies suggest that MRI is an accurate means for assessing tumor size after neoadjuvant chemotherapy ( NAC ) .


However , accuracy might be dependent on the receptor status of tumors .


MRI accuracy for response assessment after homogenous NAC in a relative large group of patients with stage II/III HER@-negative breast cancer has not been reported before .


@ patients from @ hospitals received NAC ( docetaxel , adriamycin and cyclophosphamide ) in the context of the NEOZOTAC trial .


MRI was done after @ cycles and post-NAC .


Imaging ( RECIST @ ) and pathological ( Miller and Payne ) responses were recorded .


Accuracy measures were calculated and MRI and pathologically assessed tumor sizes were correlated .


Tumor size over - and underestimation were quantified .


Accuracy of MRI for determining pathological complete response ( pCR ) was @ % .


The ROC-curve of MRI response and pCR had an area under the curve value of @ ( @ % C.I. @-@ @ ) .


The correlation coefficient of MRI and histopathological tumor measurements was @ ( p < @ ) .


Correlations were different for ER-positive ( r = @ , p < @ ) and ER-negative ( r = @ , p < @ ) breast tumors .


MRI under - and overestimated the tumor size in @ % and @ % of all patients .


In cases of substantial tumor size underestimation ( > @ cm ) , surgical margins were more often tumor positive compared to the rest of the patients ( @ % vs. @ % , p = @ ) .


MRI measurements correlated moderately with tumor size on the surgical specimen .


Only in ER-negative breast tumors , MRI tumor sizes correlated sufficiently with residual tumor size on the pathological specimen .


Therefore , post-NAC MRI should be interpreted with caution .


To evaluate the efficacy of alveolar corticotomy on orthodontic tooth movement when retracting upper canines compared with the conventional technique and to evaluate patients ' pain and discomfort levels after corticotomy .


A split-mouth design randomized controlled trial at the Department of Orthodontics ( University Al-Baath Dental School ) was performed .


A total of @ patients whose orthodontic treatment required canine retraction were included .


The predictor variable was the use of corticotomy to facilitate tooth movement .


The velocity of space closure was evaluated as the primary outcome variable by measuring the distance between the canine and first molar on each side of the mouth immediately after corticotomy and at @ , @ , @ , @ , and @ weeks after corticotomy .


The levels of pain and discomfort were evaluated as the secondary outcome variables using a questionnaire administered @ times during the first week after corticotomy .


Paired t tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences .


A total of @ patients ( @ males and @ females ) were recruited with a mean age of @ @ years ( range @ to @ ) .


The space closure velocity after corticotomy was significantly faster on the experimental side than on the control side ( mean = @ mm/week vs @ mm/week between @ week after and immediately after corticotomy , respectively ; P < @ ) .


The pain encountered during eating was high , with @ % and @ % of patients reporting severe pain at @ and @ days postoperatively , respectively .


No significant differences were detected between the male and female patients regarding the tooth movement velocity on the experimental side .


Alveolar corticotomy increased orthodontic tooth movement and was accompanied by moderate degrees of pain and discomfort .


The purpose of this study was to determine the effect of amoxicillin/clavulanic acid to prevent infection following completely bone-impacted lower third molar removal .


A random , double-blind placebo-controlled clinical trial including @ adults randomly allocated to placebo ( @ patients ) or antibiotic treatment ( @ patients ) : @g amoxicillin/@mg clavulanic acid @hours before the surgery and post-operatively twice a day for @days .


Infection was clinically assessed until @weeks after surgery .


Adverse events , as well as clinical and surgical variables , were recorded .


Analysis was by intention to treat .


Infections developed in five patients in the placebo group , all in the first postoperative week , and in two in the antibiotic group , both after the first week , the difference not being statistically significant ( P = @ , number needed to treat @ -LSB- @ - -RSB- ) .


There were no relationships between any variables studied and infection .


No serious adverse events were reported .


There is insufficient evidence to recommend routine use of this antibiotic treatment .


Treatment regimens for omalizumab are guided by a dosing table that is based on total serum IgE and body weight .


Limited data exist about onset and offset of omalizumab efficacy in children and adolescents or subgroups that most benefit from treatment .


Post hoc analyses were conducted to ( @ ) examine patient characteristics of those eligible and ineligible for omalizumab , ( @ ) describe onset of effect after initiation of omalizumab and offset of treatment effect after stopping therapy , and ( @ ) determine whether the efficacy differs by age , asthma severity , dosing regimen , and prespecified biomarkers .


Inner-city children and adolescents with persistent allergic asthma were enrolled in the Inner-City Anti-IgE Therapy for Asthma trial that compared omalizumab with placebo added to guidelines-based therapy for @ weeks .


Two hundred ninety-three of @ participants ( @ % ) clinically suitable for omalizumab were ineligible for dosing according to a modified dosing table specifying IgE level and body weight criteria .


Baseline symptoms were comparable among those eligible and ineligible to receive omalizumab , but other characteristics ( rate of health care utilization and skin test results ) differed .


The time of onset of omalizumab effect was < @ days and time of offset was between @ and @ days .


No difference in efficacy was noted by age or asthma severity , but high exhaled nitric oxide , blood eosinophils , and body mass index predicted efficacy .


A significant portion of children and adolescents particularly suited for omalizumab because of asthma severity status may be ineligible due to IgE > @ IU/mL .


Omalizumab reduced asthma symptoms and exacerbations rapidly ; features associated with efficacy can be identified to guide patient selection .


Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing .


There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease .


We sought to study the short - and long-term effects of prednisolone treatment of the first acute , moderate-to-severe , rhinovirus-induced wheezing episode in young children .


After confirming rhinovirus from nasopharyngeal aspirate by using PCR , @ children with a first wheezing episode at age @ to @ months were randomized to receive oral prednisolone ( first dose of @ mg/kg , followed by @ mg/kg/d in @ divided doses for @ days ) or placebo .


The trial was double blind throughout the @-month follow-up .


The primary outcomes were long term : new physician-confirmed wheezing episode within @ months , number of physician-confirmed wheezing episodes within @ months , and initiation of regular controller medication for asthma symptoms within @ months .


The primary interaction analysis examined rhinovirus load .


Seventy-four patients completed the study ( mean age , @ months ; @ % atopic ) .


Long-term outcomes did not differ between groups ( all P @ ) .


For short-term outcomes , the prednisolone group had less cough , rhinitis , noisy breathing , severe breathing difficulties , and nocturnal respiratory symptoms at home within @ weeks ( all P < @ ) .


The @ children with greater than @ rhinovirus copies/mL ( most sensitive cutoff ) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within @ and @ months compared with placebo ( both P < @ ) .


Prednisolone can not be routinely recommended for all young children experiencing their first acute , moderate-to-severe , rhinovirus-induced wheezing episode .


Prednisolone might be beneficial in a subgroup of children with high viral loads .


This study aims to investigate two different distraction methods , distraction cards and kaleidoscope , on pain and anxiety relief of children during phlebotomy .


This study is a prospective , randomized and controlled trial .


The sample consisted of @-@ year-old children who required blood tests .


Children were randomized into three groups : the distraction cards group , the kaleidoscope group , and the control group .


Data were obtained by interviewing the children with their parents and the observer before and after the procedure .


The pain levels of the children were assessed by the parent and observer reports as well as self report using the Wong Baker FACES Pain Rating Scale .


The anxiety levels of children were assessed by parent and observer reports using Children Fear Scale .


One hundred and eighty-eight children ( mean age , @ years ) were included .


The pain levels of children showed significant differences among the groups ( p = @ ) .


Both the distraction card group ( @ ) and the kaleidoscope group ( @ ) had lower pain levels than the control group did ( @ ) .


The distraction card group had the lowest pain levels ( @ ) among all groups .


The procedural anxiety levels of children were significantly different among the groups ( p = < @ ) .


Both the distraction card group ( @ ) and the kaleidoscope group ( @ ) had lower anxiety levels than the control group did ( @ ) .


The distraction card group had the lowest anxiety levels ( p = < @ ) .


The distraction cards were the most effective method for pain and anxiety relief of children during phlebotomy .


Also the distraction method with kaleidoscope was an effective method for pain and anxiety relief during phlebotomy in children .


Chronic obstructive pulmonary disease ( COPD ) affects millions worldwide .


Although many therapies exist and are being developed to relieve symptoms and reduce mortality , few data are available to understand which of the therapeutic alternatives is the most cost-effective for COPD patients in everyday clinical practice , especially for traditional Chinese medicine ( TCM ) .


Comparative effectiveness research can help patients , clinicians , and decision-makers make best informed treatment decisions where such evidence was previously lacking .


This study aims to compare the effectiveness and economic evaluation of three treatments : ( @ ) conventional Western medicine ; ( @ ) TCM treatments , which have been evaluated and have certain effect ; and ( @ ) a combination of both conventional Western medicine and TCM treatments , and then determine which treatment is the most suitable for COPD patients .


A multicenter , pragmatic , randomized , controlled trial is adopted .


A total of @ patients will be recruited and randomly assigned to one of the three treatments group , with @ in each group .


Patients in the conventional Western medicine group will be given Salbutamol , Formoterol , Salmeterol/fluticasone , respectively , according to the guidelines .


For the TCM group , patients will be given Bufei granule , Bu-Fei Jian-Pi granule , Bu-Fei Yi-Shen granule , and Yi-Qi Zi-Shen granule based on their corresponding TCM syndrome patterns , respectively .


For the combination of conventional medicine and TCM treatments group , patients will be given a combination of conventional Western medicine and TCM granules .


Treatments in each group are recognized as a whole comprehensive intervention .


After the @-week treatment , another @weeks will be followed up .


The outcome measures including the frequency and duration of acute exacerbations , lung function , dyspnea , exercise capacity , quality of life , and economic evaluation will be assessed .


It is hypothesized that each of the three treatments will have beneficial effects in reducing the frequency and duration of acute exacerbations , improving exercise capacity and psychosocial function of COPD patients .


In addition , the combination of conventional medicine and TCM treatments may be most suitable for COPD patients with better effectiveness and economic evaluation .


The objective was to evaluate the effects of aortic annulus size on valve hemodynamics and clinical outcomes in those patients included in the Placement of Aortic Transcatheter Valves ( PARTNER ) randomized controlled trial cohort A and the nonrandomized continued access cohort .


Patients included the randomized controlled trial ( n = @ ) and nonrandomized continued access ( n = @ ) cohorts were divided in tertiles according to aortic annulus diameter ( small aortic annulus tertile , medium aortic annulus tertile , and large aortic annulus tertile -LSB- LAA -RSB- , respectively ) as measured by transthoracic echocardiography .


Severe prosthesis-patient mismatch was defined as an effective aortic orifice area of < @ cm ( @ ) / m ( @ ) .


In the randomized controlled trial cohort , patients in the small aortic annulus tertile who underwent transcatheter aortic valve replacement had a lower incidence of severe prosthesis-patient mismatch ( @ % versus @ % ; P = @ ) and only a trend toward a higher incidence of moderate-to-severe paravalvular leaks compared with surgical aortic valve replacement ( @ % versus @ % ; P = @ ) .


In the LAA tertile , there were no differences in the rate of prosthesis-patient mismatch between groups , and a significant increase in moderate-to-severe paravalvular leaks was associated with transcatheter aortic valve replacement ( @ % versus @ % ; P = @ ) .


There were no differences in mortality between transcatheter aortic valve replacement and surgical aortic valve replacement .


In the nonrandomized continued access cohort , there were no differences in prosthesis-patient mismatch between the small aortic annulus and LAA tertiles , but a higher rate of moderate-to-severe paravalvular leaks was observed in the LAA tertile ( @ % versus @ % ; P = @ ) .


Patients in the LAA tertile had a higher mortality rate at @-year follow-up ( P = @ ) , and differences persisted in multivariable analysis ( P = @ for LAA versus medium aortic annulus tertile , P = @ for LAA versus small aortic annulus tertile ) .


Aortic annulus size had a major impact on valve hemodynamics and clinical outcomes after transcatheter aortic valve replacement and surgical aortic valve replacement .


This study highlights the importance of considering aortic annulus size in the evaluation of high-risk patients who are candidates for aortic valve replacement .


The survival benefits of colon cancer surveillance programs are well delineated , but less is known about the magnitude of false positive testing .


The objective of this study was to estimate the false positive rate and positive predictive value of testing as part of a surveillance program based on national guidelines , and to estimate the degree of testing and resource use needed to identify a curable recurrence .


Analysis of clinically significant events leading to suspicion of cancer recurrence , false positive events , true cancer recurrences , time to confirmation of diagnosis , and resource use ( radiology , blood samples , colonoscopies , consultations ) among patients included in a randomised colon cancer surveillance trial .


@ patients surgically treated for colon cancer were followed according to national guidelines for @ surveillance months .


@ tests ( @ blood samples , @ chest x-rays , @ liver ultrasounds , @ colonoscopies ) and @ health care consultations were performed .


Of the @ events leading to suspicion of cancer recurrence , @ ( @ % ) represented false positives .


Thirty-one ( @ % ) were initiated by new symptoms , and @ ( @ % ) were initiated by test results .


Fourteen patients had true cancer recurrence ; @ resections of recurrent disease were performed , @ of which were successful R@ metastasis Resections .


@ tests and @ healthcare consultations were needed per R@ resection ; the cost per R@ surgery was @ .


There was a @ % probability ( positive predictive value ) of recurrent cancer when a diagnostic work-up was initiated based on surveillance testing or patient complaints .


We observed a high false positive rate and low positive predictive value for significant clinical events suggestive of possible colorectal cancer relapse in the setting of a post-treatment surveillance program based on national guidelines .


Providers and their patients should have an appreciation for the modest positive predictive value inherent in colorectal cancer surveillance programs in order to make informed choices , which maximize quality of life during survivorship .


Better means of tailoring surveillance programs based on patient risk would likely lead to more effective and cost-effective post-treatment follow-up .


There are many instruments with different energy modalities or with different properties that are available for use in total laparoscopic hysterectomy .


The aim of the study was to compare the use of LigaSure ( Valleylab , Boulder , CO ) , HALO PKS cutting forceps ( Gyrus-ACMI , Maple Grove , MA ) , and ENSEAL tissue sealer ( SurgRx , Inc. .


Redwood City , CA ) in total laparoscopic hysterectomy with respect to operation time and blood loss as main outcomes .


Perioperative complications , return of gastrointestinal activity , and hospitalization time were assessed as secondary outcomes .


Randomized prospective study ( Canadian Task Force classification I ) .


Adana Numune Training and Research Hospital .


Forty-five patients with the indication of hysterectomy were randomized into @ groups for total laparoscopic hysterectomy .


Patients with malignancies , having @ or more previous abdominal surgeries , a uterus larger than @weeks of gestation , and who had to undergo additional surgical procedures during the same operation were excluded .


Total laparoscopic hysterectomy .


Operations were completed in all @ patients in the LigaSure and HALO PKS Cutting Forceps groups with the planned instruments .


In @ patients in the ENSEAL group , bleeding could not be controlled with ENSEAL , and additional instruments were used .


One patient in the ENSEAL group had bladder injury .


The mean operation time and blood loss were @ , @ , and @ minutes ( p > @ ) and @ , @ , and @ mL ( p < @ ) in the LigaSure , HALO PKS , and ENSEAL groups , respectively .


Changes in hemoglobin/hematocrit levels , return of gastrointestinal activity , and hospitalization time did not differ between groups .


These @ novel bipolar platforms had similar results in total laparoscopic hysterectomy .


These instruments were not determined to be independent predictors of operating time and amount of blood loss .


Parents often want to provide support to their children during medical procedures , but not all parents are effective in providing distraction after brief training .


The aim of this study was to investigate the effects of three doses of distraction intervention for children at high and medium risk for procedure-related distress .


Children undergoing scheduled intravenous insertions for diagnostic or treatment purposes and their parents participated .


A computerized application , Children , Parents and Distraction , was used to predict distress risk .


Doses of intervention were basic ( parents trained on providing distraction ) , enhanced ( basic training plus tailored instructions , environmental modifications , and support and guidance from the research assistant ) , and professional ( a trained research assistant provided distraction ) .


Outcome measures were Observational Scale of Behavioral Distress-Revised for behavioral distress , Oucher for self-reported pain , parent report of child distress , and salivary cortisol for physiological distress .


A total of @ children , ages @-@ , and their parents participated .


The Children , Parents and Distraction predicted that the risk for distress was high for @ children , medium for @ , and low for @ .


Children predicted to have higher risk for distress displayed more behavioral distress ( p < @ ) .


Children in the medium-risk group who had the professional intervention displayed significantly less behavioral distress ( p < @ ) .


Children in the high-risk group tended to have less behavioral distress when receiving the professional intervention ( p = @ ) .


There were no significant group differences for self-report of pain , parent report of distress , or cortisol levels .


Some parents may need additional training in providing distraction to their children during procedures , and some children at medium and high risk for distress may need professional support .


Parents should be asked about their preferences in acting as the distraction coach and , if willing , be provided as much training and support as possible in the clinical situation .


The purposes of this study were to evaluate the reproducibility for measuring the cold pressor test ( CPT ) - induced myocardial blood flow ( MBF ) alteration using phase-contrast ( PC ) cine MRI , and to determine if this approach could detect altered MBF response to CPT in smokers .


After obtaining informed consent , ten healthy male non-smokers ( mean age : @ years ) and ten age-matched male smokers ( smoking duration @ years , mean age : @ years ) were examined in this institutional review board approved study .