Incident AF was examined in @ black and @,@ nonblack hypertensive patients with electrocardiographic left ventricular hypertrophy ( LVH ) with no history of AF in sinus rhythm on their baseline electrocardiogram , who were randomly assigned to losartan - or atenolol-based treatment .


During a mean of @ years of follow-up , new-onset AF occurred in @ patients ( @ % ) ; @-year AF incidence was significantly lower in black than nonblack patients ( @ vs. @ % ; P = @ ) .


In univariable Cox analyses , black race was associated with a @ % lower risk of new AF ( hazard ratio ( HR ) = @ ; @ % confidence interval ( CI ) = @-@ @ ; P = @ ) .


In multivariable Cox analyses adjusting for randomized treatment , age , sex , diabetes , history of heart failure , myocardial infarction , ischemic heart disease , stroke , peripheral vascular disease , smoking status , baseline body mass index , serum total and high-density lipoprotein cholesterol , creatinine , glucose , and urine albumin/creatinine ratio as standard risk factors , and for incident myocardial infarction , in-treatment heart rate , systolic and diastolic pressure , Cornell product , and Sokolow-Lyon voltage LVH treated as time-varying covariables , black race remained associated with a @ % decreased risk of developing new AF ( HR = @ ; @ % CI = @-@ @ ; P = @ ) .


Incident AF is substantially less common among black than nonblack hypertensive patients .


For children with upper-extremity cerebral palsy ( CP ) who meet standard indications for tendon transfer surgery , we hypothesized that surgical treatment would result in greater functional improvement than treatment with botulinum toxin injections or regular , ongoing therapy .


Thirty-nine children with upper-extremity CP , who were four to sixteen years of age and surgical candidates for the transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis , pronator teres release , and extensor pollicis longus rerouting with adductor pollicis release , were prospectively assigned , either randomly ( twenty-nine patients ) or by patient/family preference ( ten patients ) , to one of three treatment groups : surgical treatment ( Group @ ) ; botulinum toxin injections ( Group @ ) ; or regular , ongoing therapy ( Group @ ) .


Seven centers participated .


Assessment measurements included active range of motion , pinch and grip strength , stereognosis , and scores as measured with eight additional functional or patient-oriented outcome instruments .


Thirty-four patients ( twenty-five randomized and nine from the patient-preference arm ) were evaluated twelve months post-treatment as the study cohort .


For the primary outcome of the Shriners Hospital Upper Extremity Evaluation ( SHUEE ) dynamic positional analysis ( DPA ) , significantly greater improvement was seen in Group @ than in the other two groups ( p < @ ) .


Improvements in SHUEE DPA reflected improved supination and wrist extension during functional activities after surgical treatment .


Group @ showed more improvement in the Pediatric Quality of Life Inventory ( PedsQL ) CP module domain of movement and in the Canadian Occupational Performance Measure ( COPM ) score for satisfaction than Groups @ and @ .


Both Groups @ and @ showed more improvement in pinch strength than did Group @ .


For children with upper-extremity CP who were candidates for standard tendon transfer , surgical treatment was demonstrated to provide greater improvement , of modest magnitude , than botulinum toxin injections or regular , ongoing therapy at twelve months of follow-up for the SHUEE DPA , the PedsQL CP module domain of movement , and COPM satisfaction .


Urban schools lag behind non-urban schools in attending to the behavioral health needs of their students .


This is especially evident with regard to the level of use of evidence-based interventions with school children .


Increased used of evidence-based interventions in urban schools would contribute to reducing mental health services disparities in low-income communities .


School-wide positive behavioral interventions and supports ( SWPBIS ) is a service delivery framework that can be used to deliver universal preventive interventions and evidence-based behavioral health treatments , such as group cognitive behavioral therapy .


In this article , we describe our ongoing research on creating internal capacity for program implementation .


We also examine the cost-effectiveness and resulting school climate when two different levels of external support are provided to personnel as they implement a two-tier SWPBIS program .


The study follows six K - @ schools in the School District of Philadelphia randomly assigned to consultation support or consultation-plus-coaching support .


Participants are : approximately @ leadership team members , @ school staff and @,@ students in Tier @ , and @ counselors , and @ child participants in Tier @ .


Children who meet inclusion criteria for Tier @ will participate in group cognitive behavioral therapy for externalizing or anxiety disorders .


The study has three phases , baseline/training , implementation , and sustainability .


We will measure implementation outcomes , service outcomes , child outcomes , and cost .


Findings from this study will provide evidence as to the appropriateness of school-wide prevention and treatment service delivery models for addressing services disparities in schools .


The effectiveness and cost-effectiveness analyses of the two levels of training and consultation should help urban school districts and policymakers with the planning and deployment of cost-effective strategies for the implementation of evidence-based interventions for some of the most common behavioral health problems in school children .


Topical nonsteroidal antiinflammatory drugs ( NSAIDs ) are administered topically for a variety of ophthalmologic conditions .


Brand diclofenac and brand ketorolac were previously shown to have topical anesthetic effects in addition to analgesic effects .


Using the same method , we measured similar anesthetic effects of the @ currently available topical NSAIDs -- generic diclofenac , generic ketorolac , brand bromfenac , and brand nepafenac .


Baseline corneal sensitivity was measured on @ healthy adult volunteers with a Cochet-Bonnet esthesiometer .


One drop of the agent being studied was applied to the right eye every @ minutes for a total of @ drops .


Corneal sensitivity was measured immediately after the last topical application and every @ minutes for @ minutes .


After a @-week washout period , a different agent was studied until all @ NSAIDs were evaluated .


Corneal sensitivity profiles over time were similar for all NSAIDs .


Corneal sensitivity decreased significantly from baseline immediately after topical application remaining flat from @ to @ minutes and then rising from @ to @ minutes back toward baseline in all treatment groups ( P < @ ) .


The maximal absolute drop in corneal sensitivity as measured by pressure thresholds was greatest for diclofenac -LSB- @ mm ( @ % confidence intervals -LCB- CI -RCB- , @-@ @ ) -RSB- , followed by ketorolac -LSB- @ mm ( @ % CI , @-@ @ ) -RSB- , bromfenac -LSB- @ mm ( @-@ @ ) -RSB- , and nepafenac -LSB- @ mm ( @ % CI , @-@ @ ) -RSB- .


Only diclofenac and nepafenac were statistically different in maximal decrease in sensitivity .


All @ currently available NSAIDs demonstrated anesthetic effects similar to brand diclofenac and brand ketorolac .


To compare the difference in clinical efficacy on polycystic ovary syndrome ( PCOS ) between electroacupuncture ( EA ) and dyne-@ and to explore the effect mechanism .


Sixty-five patients were randomized into an EA group ( @ cases ) and a western medication group ( @ cases ) .


In the EA group , the selected acupoints were Danzhong ( CV @ ) , Qimen ( LR @ ) , Zhongwan ( CV @ ) , Tianshu ( ST @ ) , Guanyuan ( CV @ ) , Zigong ( EX-CA @ ) , Sanyinjiao ( SP @ ) , Zusanli ( ST @ ) and Taichong ( LR @ ) , etc. .


After the arrival of qi , electric stimulation was attached to the acupoints for @ min .


The treatment was given @ times a week .


In the western medication group , dyne-@ was prescribed on the @th day of natural menstruation or withdrawal bleeding , one tablet a day , continuously for @ days .


The treatment cycle was @ months in the two groups .


The menstrual condition , body mass , body mass index ( BMI ) , serum testosterone ( T ) , luteinizing hormone ( LH ) , follicle-stimulating hormone ( FSH ) and LH/FSH were compared before and after treatment in the two groups .


The clinical efficacy was assessed in the two groups .


The total effective rate was @ % ( @/@ ) in the EA group and was @ % ( @/@ ) in the western medication group .


The efficacy was similar in the two groups ( P > @ ) .


After treatment , the levels of LH and LH/FSH were all reduced significantly in the two groups ( all P < @ ) .


After treatment , T level in serum was reduced apparently in the western medication group ( P < @ ) .


Before and after treatment , the differences in body mass and BMI in the EA group were more significant than those in the western medication group ( P < @ , P < @ ) .


EA is the effective method for PCOS , similar to that of dyne-@ .


The effect of it for weight loss is superior to dyne-@ and no apparent adverse reactions happen .


The effect mechanism of EA is related to the regulation of serum sexual hormone levels and their ratio , as well as to the regulation of body lipid metabolism .


Nonpathogenic Escherichia coli strain Nissle @ ( EcN ) has immunomodulatory properties and can act on different cells which are important for the allergic immune response .


Herein , we investigated the efficacy and tolerability of EcN in subjects with grass pollen-dependent allergic rhinoconjunctivitis .


Grass pollen-allergic subjects were randomly allocated to receive EcN in a double-blind , placebo-controlled manner .


The treatment was performed from @ months before onset until the end of one grass pollen season ( in total : @ months ) .


The clinical symptom score and the intake of symptomatic medications were assessed .


A skin prick test and grass pollen-specific immunoglobulin ( Ig ) E and IgA were evaluated before and after treatment .


Our results show that coseasonal treatment with EcN in grass pollen-allergic subjects was not superior to placebo as assessed using the symptom-medication score ( p = @ ) .


Interestingly , an increase -LSB- median ( range ) -RSB- in grass pollen-specific IgA was detectable in the EcN group -LSB- @,@ LU/ml ( @,@-@ ,@ ) -RSB- versus placebo -LSB- @,@ LU/ml ( @-@ ,@ ) -RSB- ( p = @ ) .


The results indicate that @ months of coseasonal nonspecific immunomodulation by EcN is not sufficient to achieve clinical efficacy in grass pollen-allergic subjects .


Future approaches in which such immunomodulators are combined with an allergen-specific protocol might enhance the clinical efficacy of the allergen-specific treatment .


Evidence is accumulating that circulating tumor cells ( CTC ) out of peripheral blood can serve as prognostic marker not only in metastatic but also in early breast cancer ( BC ) .


Various methods are available to detect CTC .


Comparisons between the different techniques , however , are rare .


We evaluate two different methods for CTC enrichment and detection in primary BC patients : the FDA-approved CellSearch System ( CSS ; Veridex , Warren , USA ) and a manual immunocytochemistry ( MICC ) .


The cut-off value for positivity was @ CTC .


The two different nonoverlapping patient cohorts evaluated with one or the other method were well balanced regarding common clinical parameters .


Before adjuvant CHT @ % ( @ out of @ ) and @ % ( @ out of @ ) of the patients were CTC-positive , while after CHT @ % ( @ out of @ ) and @ % ( @ out of @ ) of the patients were CTC-positive using CSS or MICC , respectively .


CTC positivity rate before CHT was thus similar and not significantly different ( P = @ ) , while CTC positivity rate immediately after CHT was significantly lower using MICC compared to CSS ( P < @ ) .


Using CSS or MICC for CTC detection , we found comparable prevalence of CTC before but not after adjuvant CHT .


Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition .


One negative consequence of undernutrition is increased health care costs .


Several potentially modifiable nutritional risk factors increase the likelihood of weight loss or poor nutrition .


Hence a structured and multidisciplinary approach , focusing on the nutritional risk factors and involving e.g. dieticians , occupational therapists , and physiotherapist , may be necessary to achieve benefits .


Up till now a few studies have been done evaluating the cost-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach .


An @week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care , identified by screening with the Eating validation Scheme .


Before start of the study there will be performed a train-the-trainer intervention involving educated nutrition coordinators.In addition to the nutrition coordinator , the participants assigned to the intervention group strategy will receive multidisciplinary nutrition support .


Focus will be on treatment of the potentially modifiable nutritional risk factors identified by screening , by involving physiotherapist , registered dietician , and occupational therapist , as relevant and independent of the municipality 's ordinary assessment and referral system.The primary outcome parameter will be change in quality of life ( by means of Euroquol-@D-@L ) .


Secondary outcomes will be : physical performance ( chair stand ) , nutritional status ( weight , Body Mass Index and hand-grip strength ) , oral care , fall incidents , hospital admissions , rehabilitation stay , moving to nursing homes ( for participants from home-care ) , use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary support.Furthermore , interviews with nursing home and home-care management , nursing staff and nutrition coordinators in both the control and intervention groups , participants in the intervention group and the involved multidisciplinary team will be performed .


In this study we will evaluate in a randomized controlled trial whether multidisciplinary nutritional support is cost-effective , in undernourished older adults in home-care and nursing home and contribute to important research .


To investigate the effect of Lactobacillus-containing commercially available probiotic formulations in Germany during antibiotic treatment with an analysis of cost-efficiency .


In an observational study , we analyzed the frequency of bowel movements from @ patients with infections in a primary care hospital in western Germany ; @ of the patients were offered a probiotic drink containing at least @ billion cultures of Lactobacillus casei DN @ b.i.d.


The economic analysis was based on the costs of patient isolation vs preventive intake of probiotics .


In a second pilot study , two commercially available probiotic drinks with different Lactobacillus casei strains were directly compared in @ patients in a randomized controlled fashion .


In the first study , the incidence of antibiotic-associated diarrhea ( AAD ) was significantly reduced in the intervention group ( @ % vs @ % ) , and the duration of AAD in days was significantly shorter ( @ @ vs @ @ ) .


Higher age and creatinine and lower albumin were identified as risk factors for AAD .


Ampicillin was the antibiotic with the highest rate of AAD ( @ % ) and with the greatest AAD reduction in the probiotic group ( @ % , relative risk reduction @ % ) .


The economic analysis showed a cost advantage of nearly @ / year in a department of this size .


The second study confirmed the preventive effect of the drink with Lactobacillus casei DN@ ; however , there were no advantages found for the other tested probiotic drink containing Lactobacillus casei Shirota .


In contrast to a drink containing Lactobacillus casei Shirota , a commercially available probiotic drink containing Lactobacillus casei DN @ cost-efficiently reduces the prevalence of AAD during antibiotic treatment .


In vitro data and pilot data suggest that green tea catechins may possess chemopreventive activity for cervical cancer and precursor lesions .


We conducted a randomized , double-blind , placebo-controlled trial of Polyphenon E ( decaffeinated and enriched green tea catechin extract ) in women with persistent human papillomavirus ( HPV ) infection and low-grade cervical intraepithelial neoplasia ( CIN@ ) to evaluate the potential of Polyphenon E for cervical cancer prevention .


Ninety-eight eligible women were randomized to receive either Polyphenon E ( containing @ mg epigallocatechin gallate ) or placebo once daily for @ months .


The primary study outcome was oncogenic HPV clearance and clearance of CIN@ .


Polyphenon E was shown to be acceptable , safe and well tolerated .


There was no difference in the response rate by treatment allocation .


Complete response , defined as negative for high-risk HPV and normal histopathology , was noted in @ ( @ % ) and @ ( @ % ) women in the Polyphenon E and placebo arms , respectively .


Progression , defined as persistent oncogenic HPV with histopathologic evidence of progression , was more common in the Polyphenon E group than in the placebo group -LSB- @ ( @ % ) vs. @ ( @ % ) -RSB- .


Based on the largest randomized placebo-controlled trial of a green tea extract for HPV related cervical disease , we conclude that @ months of Polyphenon E intervention did not promote the clearance of persistent high-risk HPV and related CIN@ .


Further studies may be necessary to better delineate the risk factors for persistent HPV infection and biology of the disease to facilitate the evaluation of chemopreventive strategies .


The prevalence of central venous catheters ( CVCs ) for hemodialysis remains high and , despite infection-control protocols , predisposes to bloodstream infections ( BSIs ) .


Stratified , cluster-randomized , quality improvement initiative .


All in-center patients with a CVC within @ facility pairs matched by region , facility size , and rate of positive blood cultures ( January to March @ ) at Fresenius Medical Care , North America .


Incorporate the use of @ % chlorhexidine with @ % alcohol swab sticks for exit-site care and @ % alcohol pads to perform `` scrub the hubs '' in dialysis-related CVC care procedures compared to usual care .


The primary outcome was positive blood cultures for estimating BSI rates .


Comparison of @-month baseline period from April @ to June @ and follow-up period from August @ to October @ , @ .


Baseline BSI rates were similar ( @ vs @ / @,@ CVC-days ) , but follow-up rates differed at @ / @,@ CVC-days in intervention facilities versus @ / @,@ CVC-days in controls ( P = @ ) .


Intravenous antibiotic starts during the follow-up period also were lower , at @ / @,@ CVC-days versus @ / @,@ CVC-days in controls ( P < @ ) .


Cluster-adjusted Poisson regression confirmed @ % -@ % reductions in both ( P < @ ) .


Extended follow-up for @ successive quarters demonstrated a sustained reduction of bacteremia rates for patients in intervention facilities , at @ / @,@ CVC-days ( @ % reduction ; P < @ ) .


Hospitalizations due to sepsis during @-year extended follow-up were @ / @,@ CVC-days ( @ / CVC-year ) versus @ / @,@ CVC-days ( @ / CVC-year ) in controls ( @ % difference ; P < @ ) .


Inability to capture results from blood cultures sent to external laboratories , underestimation of sepsis-specific hospitalizations , and potential crossover adoption of the intervention protocol in control facilities .


Adoption of the new catheter care procedure ( consistent with Centers for Disease Control and Prevention recommendations ) resulted in a @ % lower rate of BSIs and intravenous antibiotic starts , which were sustained over time and associated with a lower rate of hospitalizations due to sepsis .


Vitamin D insufficiency is common in primary hyperparathyroidism ( pHPT ) .


Patients with pHPT frequently have a reduced health-related quality of life ( HRQoL ) .


Our objectives were to evaluate whether HRQoL in pHPT is associated with vitamin D insufficiency and whether vitamin D supplementation after parathyroidectomy ( PTX ) could improve HRQoL .


A randomized , double-blind study ( ClinicalTrials.gov identifier : NCT@ ) .


The study included @ pHPT patients randomized , @ weeks after PTX , to daily treatment with either cholecalciferol @IU and calcium carbonate @mg ( D + ) or calcium carbonate alone ( D - ) .


HRQoL was estimated with SF-@ before and after PTX and after @ months of study medication .


Three-quarters ( @ % ) of the pHPT patients had vitamin D insufficiency , defined as @OHD < @nmol/l .


The pHPT patients scored lower than a reference population in all domains of SF-@ .


A total of @ patients completed the entire study period .


Improvements in nearly all domains were registered at the follow-up @ weeks after PTX .


At the end of the study medication period , the D + group had a significantly higher median serum ( s - ) @OHD concentration ( @ ( @ ; @ ) ( lower ; upper interquartile ranges ) vs @ ( @ ; @ ) nmol/l , P < @ ) and a lower plasma ( p - ) parathyroid hormone concentration ( @ ( @ ; @ ) vs @ ( @ ; @ ) ng/l , P = @ ) than the D - group .


The improvements in HRQoL remained unchanged at the follow-up @ year after PTX .


Postoperative vitamin D supplementation had no obvious effect on HRQoL .


PTX resulted in significant improvements in HRQoL .


Despite a high prevalence of vitamin D insufficiency , @ year of postoperative vitamin D supplementation had no obvious beneficial effect on HRQoL .


Pilot study results suggested that a new form of nicotine oral soluble film relieved smoking cue-provoked acute craving faster than nicotine lozenge or gum .


The new nicotine film may provide smokers another choice to relieve acute craving .


This study compared the efficacy of the @ mg nicotine oral soluble film to @mg nicotine lozenge for acute relief of smoking cue-provoked craving .


A randomized , open label , active comparator controlled , parallel group study was conducted with @ smokers enrolled .


After @h of abstinence from smoking , eligible subjects were exposed to smoking cues as provocation .


Immediately after the post-provocation baseline craving assessment using a @-@mm visual analogue scale ( VAS ) , subjects took a randomized single dose of either the @ mg nicotine film or the @ mg nicotine lozenge .


Craving assessments were completed at @s , @min , @min , @min , @min , @min , @min and @min after drug administration .


Both treatments reduced cue-induced craving and had similar maximum effects on craving relief .


However , the @ mg nicotine film relieved cue-induced craving to a greater degree than the @ mg nicotine lozenge at @s ( mean difference : -@ , p = @ ) , @min ( mean difference : -@ , p = @ ) , and @min ( mean difference : -@ , p = @ ) post-treatment .


The study confirmed the results from the pilot study .


The @ mg nicotine film relieved cue-provoked craving much quicker than the @ mg nicotine lozenge while both having similar maximum effects .


Nicotine film could be useful to provide quick craving relief for low dependence smokers .


Pneumococcal vaccination is recommended for human immunodeficiency virus-infected ( HIV + ) persons ; the best timing for immunization with respect to initiation of antiretroviral therapy ( ART ) is unknown .


Double-blind , placebo-controlled trial in HIV + with CD@ ( + ) T cells/L ( CD@ ) @ randomized to receive the @-valent pneumococcal polysaccharide vaccine ( PPV@ ) or placebo at enrollment , followed by placebo or PPV@ , respectively , @-@ months later ( after @ months of ART ) .


Capsular polysaccharide-specific immunoglobin ( Ig ) G and IgM levels to serotypes @ , @ , @ , @B , and @F , and opsonophagocytic killing activity ( OPA ) to serotypes @B and @F were evaluated @ month postvaccination .


One hundred seven subjects were enrolled , @ ( @ % ) were evaluable ( @/group ) .


Both groups had significant increases in pre - to @-month postvaccination IgG levels , but negligible to IgM , and significant increases in OPA titers to serotype @B but not to @F .


There were no significant differences between groups in serotype-specific IgM or IgG levels or OPA titers .


For the combined groups , there was a significant correlation between serotype-specific IgG and OPA titers to @F but not to @B .


There was no correlation between CD@ , viral load and IgG responses .


In HIV + with CD@ @ , delaying PPV@ until @ months of ART does not improve responses and may lead to missed opportunities for immunization .


The aim of this study was to explore the learning effect of engaging trainees by assessing peer performance during simulation-based training .


Eighty-four final year medical students participated in the study .


The intervention involved trainees assessing peer performance during training .


Outcome measures were in-training performance and performance , both of which were measured two weeks after the course .


Trainees ' performances were videotaped and assessed by two expert raters using a checklist that included a global rating .


Trainees ' satisfaction with the training was also evaluated .


The intervention group obtained a significantly higher overall in-training performance score than the control group : mean checklist score @ ( SD @ ) versus @ ( SD @ ) P = @ and mean global rating @ SD ( @ ) versus @ ( SD @ ) P = @ .


Postcourse performance did not show any significant difference between the two groups .


Trainees who assessed peer performance were more satisfied with the training than those who did not : mean @ ( SD @ ) versus @ ( SD @ ) P = @ .


Engaging trainees in the assessment of peer performance had an immediate effect on in-training performance , but not on the learning outcome measured two weeks later .


Trainees had a positive attitude towards the training format .


Balance training has been demonstrated to improve postural control in patients with Parkinson 's disease ( PD ) .


The objective of this pilot randomized clinical trial was to investigate whether a balance training program using augmented visual feedback is feasible , safe , and more effective than conventional balance training in improving postural control in patients with PD .


Thirty-three patients with idiopathic PD participated in a five-week training program consisting of ten group treatment sessions of @min .


Participants were randomly allocated to ( @ ) an experimental group who trained on workstations consisting of interactive balance games with explicit augmented visual feedback ( VFT ) , or ( @ ) a control group receiving conventional training .


Standing balance , gait , and health status were assessed at entry , at six weeks , and at twelve weeks follow-up .


Sixteen patients were allocated to the control group and seventeen to the experimental group .


The program was feasible to apply and took place without adverse events .


Change scores for all balance measures favored VFT , but the change in the primary outcome measure , i.e. the Functional Reach test , did not differ between groups ( t ( @ ) = -@ , p = @ ) .


No other differences between groups were statistically significant .


VFT proved to be a feasible and safe approach to balance therapy for patients with PD .


In this proof-of-concept study VFT was not superior over conventional balance training although observed trends mostly favored VFT .


These trends approached clinical relevance only in few cases : increasing the training load and further optimization of VFT may strengthen this effect .


To determine whether the use of ultrasound can reduce the incidence of incorrect diagnosis of the fetal head position at instrumental delivery and subsequent morbidity .


Two-arm , parallel , randomised trial , conducted from June @ to December @ .


Two maternity hospitals in the Republic of Ireland .


A cohort of @ nulliparous women at term ( @ weeks of gestation ) with singleton cephalic pregnancies , aiming to deliver vaginally , were recruited prior to an induction of labour or in early labour .


If instrumental delivery was required , women who had provided written consent were randomised to receive clinical assessment ( standard care ) or ultrasound scan and clinical assessment ( ultrasound ) .


-LSB- Correction added on @ April @ , after first online publication : Sentence was amended . -RSB-


Incorrect diagnosis of the fetal head position .


The incidence of incorrect diagnosis was significantly lower in the ultrasound group than the standard care group ( @/@ , @ % , versus @/@ , @ % ; odds ratio @ ; @ % confidence interval @-@ @ ; P < @ ) .


The decision to delivery interval was similar in both groups ( ultrasound mean @ minutes , SD @ minutes , versus standard care mean @ minutes , SD @ minutes , P = @ ) .


The incidence of maternal and neonatal complications , failed instrumental delivery , and caesarean section was not significantly different between the two groups .


An ultrasound assessment prior to instrumental delivery reduced the incidence of incorrect diagnosis of the fetal head position without delaying delivery , but did not prevent morbidity .


A more integrated clinical skills-based approach is likely to be required to prevent adverse outcomes at instrumental delivery .


To compare performance and preferences of students who were randomly allocated to classroom or online sections of an elective course on immunization .


Students were randomly assigned to either the classroom or online section .


All course activities ( lectures , quizzes , case discussions , vaccine administration , and final examination ) were the same for both sections , except for the delivery of lecture material .


Students were surveyed on their preferences at the beginning and end of the semester .


At the end of the semester , the majority of students in the classroom group preferred classroom or blended delivery while the majority of students in the online group preferred blended or online delivery ( p < @ ) .


Student performance was compared at the end of the semester .


There was no significant difference for any of the grades in the course between the @ sections .


There was no difference in student performance between the classroom and online sections , suggesting that online delivery is an effective way to teach students about immunization .


Assess insulin sensitivity after treatment with a selective PPAR-alpha agonist compared to an HMG CoA reductase inhibitor in human subjects with type @ diabetes mellitus .


Thirteen subjects with Type @ diabetes mellitus were studied in a double-blind crossover design with @-week placebo run-in and washout and @-week treatment periods , randomised to micronised fenofibrate @ mg or atorvastatin @mg daily followed by the alternate drug in the second period .


Insulin resistance was measured using the isoglycaemic hyperinsulinaemic clamp method with isotope dilution .


Weight , physical activity and other medications did not change .


Total cholesterol ( mean + / - standard error ) was @ + / -@ versus @ + / -@ mmol/L after fenofibrate and atorvastatin respectively , p < @ .


LDL was @ + / -@ versus @ + / -@ mmol/L , p < @ and triglyceride @ + / -@ versus @ + / -@ mmol/L , p < @ .


Insulin-stimulated whole-body glucose disposal ( @ + / -@ versus @ + / -@ mol/kg/min ) and nadir endogenous glucose production ( @ + / -@ versus @ + / -@ mol/kg/min ) revealed no significant differences in effects of the treatments .


In human subjects with Type @ diabetes mellitus there were characteristic differences in lipid profile changes but no difference in insulin sensitivity after treatment with micronised fenofibrate compared to atorvastatin .


This study finds no evidence of increased insulin sensitivity using this selective PPAR-alpha agonist over a commonly used statin at these doses .


Decision-making involves two fundamental axes of control namely valence , spanning reward and punishment , and action , spanning invigoration and inhibition .


We recently exploited a go/no-go task whose contingencies explicitly decouple valence and action to show that these axes are inextricably coupled during learning .


This results in a disadvantage in learning to go to avoid punishment and in learning to no-go to obtain a reward .


The neuromodulators dopamine and serotonin are likely to play a role in these asymmetries : Dopamine signals anticipation of future rewards and is also involved in an invigoration of motor responses leading to reward , but it also arbitrates between different forms of control .


Conversely , serotonin is implicated in motor inhibition and punishment processing .


To investigate the role of dopamine and serotonin in the interaction between action and valence during learning.Methods We combined computational modeling with pharmacological manipulation in @ healthy human volunteers , using levodopa and citalopram to affect dopamine and serotonin , respectively .


We found that , after administration of levodopa , action learning was less affected by outcome valence when compared with the placebo and citalopram groups .


This highlights in this context a predominant effect of levodopa in controlling the balance between different forms of control.Citalopram had distinct effects , increasing participants ` tendency to perform active responses independent of outcome valence , consistent with a role in decreasing motor inhibition .


Our findings highlight the rich complexities of the roles played by dopamine and serotonin during instrumental learning .


The clinical benefits associated with the use of the bispectral index ( BIS ) to monitor the depth of sedation during flexible fiberoptic bronchoscopy ( FFB ) are questionable .


To evaluate the added value in terms of procedural safety and patients ' awareness of monitoring sedation depth using the BIS compared to conventional clinical judgment alone in patients undergoing FFB under propofol sedation .


The cohort included @ patients undergoing diagnostic or therapeutic bronchoscopy under propofol sedation that were prospectively randomized to guide the depth of sedation by BIS monitoring ( BIS group ; n = @ ) or conventional monitoring ( control group ; n = @ ) .


The mean durations of the procedure were @ and @ min in the BIS and control groups , respectively .


No significant difference was noted in the dosage of propofol used between the BIS and control groups ( @ vs. @ mg , respectively ) .


Average sedation-related oxygen saturation drop and transcutaneous CO@ rise were not significantly different between groups .


There was also no significant difference in the percentage of patients that required either hemodynamic support ( @ vs. @ % , respectively ) , oxygen supplementation by @ % O@ mask ( @ vs. @ % , respectively ) or Ambu face mask manual ventilation ( @ vs. @ % , respectively ) between the groups .


No significant difference was noted in terms of patients ' awareness during the procedure , which was assessed following recovery by a structured Brice interview .


Using BIS to guide the depth of sedation during propofol sedation in patients undergoing FFB of relatively short duration offers no clinically significant advantages over conventional monitoring .


The goal of this work was to compare the demineralization of enamel associated with two different self-etching primers and traditional acid etching .


A total of @ volunteers ( @-@ years , @ male and @ female ) were provided with a removable archwire/resin appliance to be worn @ h/day for @ days .


The device was attached to the mandibular posterior teeth and included samples of human enamel ( from extracted third molars ) located in both posterior vestibules .


Both sides featured the same distribution of samples , including one untreated control sample ( group A ) and three samples with brackets ( Victory APC II ) bonded to their surface after conditioning with a self-etching non-fluoride primer ( iBond Gluma Inside ; group B ) , a self-etching fluoride-releasing primer ( Transbond Plus ; group C ) , or traditional acid-etching with @ % phosphoric acid and Transbond XT ( group D ) .


Mineral loss was assessed extraorally under standardized conditions using quantitative light-induced fluorescence ( QLF ) with a specialized camera system ( Inspektor Pro ) .


Results were expressed as relative fluorescence loss ( F in % ) .


A baseline measurement ( T@ ) was taken before the appliance was first inserted but with the brackets already bonded .


Fluorescence loss was analyzed after @ ( T@ ) , @ ( T@ ) , @ ( T@ ) , and @ days ( T@ ) and compared to the baseline loss ( T@ ) for each of the four study groups ( A to D ) .


Kruskal-Wallis and Mann-Whitney U tests were used to compare the results for statistical significance .


The lowest percentages of fluorescence loss both at baseline and during the follow-up assessments was found in group C.


While all three experimental groups ( B , C , D ) presented total decreases in fluorescence loss after @ days , indicating remineralization , the decrease in group C was the largest .


The Kruskal-Wallis test yielded no significant differences between the three groups other than a significantly lower percentage of fluorescence loss in group C than in group D during the last assessment ( T@ ) .


The untreated samples of control enamel ( group A ) revealed increasing percentages of fluorescence loss over the entire study period .


Use of the self-etching primers ( groups B and C ) was not associated with patterns of enamel demineralization different from those noted after traditional etching with phosphoric acid ( group D ) .


The only significant difference we observed was between the self-etching fluoride-releasing primer ( group C ) and traditional etching ( group D ) at the final assessment ( T@ ) .


Thus , the fluoride-releasing system Transbond Plus was advantageous .


Musicians are frequently affected by playing-related musculoskeletal disorders ( PRMD ) .


Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs , but their results are sometimes disappointing .


To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians , using numeric visual scale ( NVS ) .


We performed a prospective , controlled , single-blinded , randomized study with musicians suffering from PRMD .


Participating musicians were randomly distributed into the experimental ( n = @ ) and the control ( n = @ ) groups .


After an individual diagnostic assessment , specific Tuina self-administered exercises were developed and taught to the participants .


Musicians were instructed to repeat the exercises every day for @ weeks .


Pain intensity was measured by NVS before the intervention and after @ , @ , @ , @ , @ and @ d of treatment .


The procedure was the same for the control group , however the Tuina exercises were executed in points away from the commonly-used acupuncture points .


In the treatment group , but not the control group , pain intensity was significantly reduced on days @ , @ , @ , @ , @ and @ .


The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD .


Although our results are very promising , further studies are needed employing a larger sample size and double blinding designs .


Peripheral arterial disease ( PAD ) of the lower limbs is a cardiovascular disease highly prevalent particularly in the asymptomatic form .


Its prevalence starts to be a concern in low coronary risk countries like Spain .


Few studies have analyzed the relationship between ankle-brachial index ( ABI ) and cardiovascular morbi-mortality in low cardiovascular risk countries like Spain where we observe significant low incidence of ischemic heart diseases together with high prevalence of cardiovascular risk factors .


The objective of this study is to determine the relationship between pathological ABI and incidence of cardiovascular events ( coronary disease , cerebrovascular disease , symptomatic aneurism of abdominal aorta , vascular surgery ) and death in the > @year population-based cohort in Spain ( ARTPER ) .


Baseline ABI was measured in @,@ randomly selected patients from @ Primary Health Centers in Barcelona , distributed as : ABI < @ peripheral arterial disease ( PAD ) , ABI @ arterial calcification ( AC ) , ABI @-@ @ healthy ; and followed during @years .


@,@ subjects were included after excluding those with previous vascular events .


Subjects with abnormal ABI were older with higher proportion of men , smokers and diabetics .


@ people presented cardiovascular events ( incidence @,@ / @,@ person-years ) and @ died from any cause ( incidence @/@ ,@ person-years ) .


PAD had two-fold greater risk of coronary disease ( adjusted hazard ratio ( HR ) = @ , @ % confidence interval ( CI ) @-@ @ ) and increased risk of vascular surgery ( HR = @ , @ % CI @-@ @ ) and mortality ( HR = @ , @ % CI @-@ @ ) .


AC increased twice risk of cerebrovascular events ( HR = @ , @ % CI @-@ @ ) with no relationship with ischemic heart disease .


PAD increases coronary disease risk and AC cerebrovascular disease risk in low cardiovascular risk Mediterranean population .


ABI could be a useful tool to detect patients at risk in Primary Health Care .


Peeling is a procedure which aims to accelerate the process of skin exfoliation .


Development of formulations containing lactic acid at @ % or glycolic acid at @ % and the evaluation of these formulations on clinical efficacy in reduction of fine wrinkles .


Preliminary stability tests were carried out and an in vivo study was performed with three groups with @ representatives each .


One was the control group , which used only sunscreen ; another one used lactic acid + sunscreen , and the last group used acid glycolic + sunscreen .


Clinical efficacy was assessed with a CCD color microscope , through the digitization of images before and after treatment .


The applications were carried out by a dermatologist , once a mont h every @ days , during @ months .


The area with wrinkles was calculated by planimetry point counting , in accordance with Mandarin-de-Lacerda .


The formulations were stable in the visual and Ph evaluation .


There was no improvement in the control group ; for lactic acid , there was significant improvement after the second peeling application on the outer lateral area of the right eye and after the third application on the outer lateral area of the left eye .


For the glycolic acid group , there was significant improvement in the outer lateral area of the left eye after the first application , and of the right eye region , after three applications .


The formulations used must be kept under refrigeration and should be manipulated every @ days .


Both peelings were effective in reducing fine wrinkles of the outer lateral eye area after three applications ( p @ % ) .


It was observed that peeling efficacy in the external-lateral region of one eye might be different compared with that in skin of the external-lateral region of the other eye , relative to the speed of skin improvement .


The Ponseti method of congenital idiopathic clubfoot correction has traditionally specified plaster of Paris ( POP ) as the cast material of choice ; however , there are negative aspects to using POP .


We sought to determine the influence of cast material ( POP v. semirigid fibreglass -LSB- SRF -RSB- ) on clubfoot correction using the Ponseti method .


Patients were randomized to POP or SRF before undergoing the Ponseti method .


The primary outcome measure was the number of casts required for clubfoot correction .


Secondary outcome measures included the number of casts by severity , ease of cast removal , need for Achilles tenotomy , brace compliance , deformity relapse , need for repeat casting and need for ancillary surgical procedures .


We enrolled @ patients : @ randomized to POP and @ to SRF .


There was no difference in the number of casts required for clubfoot correction between the groups ( p = @ ) .


According to parents , removal of POP was more difficult ( p < @ ) , more time consuming ( p < @ ) and required more than @ method ( p < @ ) .


At a final follow-up of @ months , the mean times to deformity relapse requiring repeat casting , surgery or both were @ and @ months for the SRF and POP groups , respectively .


There was no significant difference in the number of casts required for correction of clubfoot between the @ materials , but SRF resulted in a more favourable parental experience , which can not be ignored as it may have a positive impact on psychological well-being despite the increased cost associated .


To evaluate whether the acute pain experienced during in-hospital recovery from thoracotomy can be effectively reduced by the use of intraoperative measures ( dissection of the neurovascular bundle prior to the positioning of the Finochietto retractor and preservation of the intercostal nerve during closure ) .


We selected @ patients who were candidates for elective thoracotomy in the Thoracic Surgery Department of the Federal University of So Paulo/Paulista School of Medicine , in the city of So Paulo , Brazil .


The patients were randomized into two groups : conventional thoracotomy ( CT , n = @ ) and neurovascular bundle preservation ( NBP , n = @ ) .


All of the patients underwent thoracic epidural anesthesia and muscle-sparing thoracotomy .


Pain intensity was assessed with a visual analog scale on postoperative days @ , @ , and @ , as well as by monitoring patient requests for/consumption of analgesics .


On postoperative day @ , the self-reported pain intensity was significantly lower in the NBP group than in the CT group ( visual analog scale score , @ vs. @ ; p = @ ) .


No significant differences were found between the groups regarding the number of requests for/consumption of analgesics .


In patients undergoing thoracotomy , protecting the neurovascular bundle prior to positioning the retractor and preserving the intercostal nerve during closure can minimize pain during in-hospital recovery .


Developmental assessment is a core paediatric competency , but research demonstrates teaching gaps .


This single-blinded , randomised controlled study compares three teaching approaches to developmental assessment in a large group setting based on a student 's self-perception and objective competency assessment .


Students were randomised into one of the following : a didactic lecture followed by self-study with online resources ( control group ) , a didactic lecture and small group tutorial ( small group ) a combined didactic lecture and interactive component using audio-visual equipment ( Interactive Developmental Teaching-IDT group ) .


Competency scores ( based on the Royal College of Paediatrics and Child Health ( RCPCH ) scoring system , adapted for undergraduates ) , mean scores of self-reported confidence and degree of motivation were compared between groups .


@ students participated .


Statistically significant difference between mean assessment scores was demonstrated for the small group ( @ ; @ % CI @ to @ ) and the IDT group ( @ ; @ % CI @ to @ ) compared to the control group ( @ ; @ % CI @ to @ ) .


Students ' self-reported confidence , acquisition of knowledge and degree of motivation to practice was higher in IDT and small groups compared to the didactically taught control group .


Teaching costs , if measured by trainer 's time , were one-fifth in the IDT group compared to the small group teaching .


The IDT is an effective teaching method in large groups , improves competencies compared to didactic lecturing , and is as effective as small group teaching .


Adoption of the IDT appears to facilitate learning and can be easily delivered with falling ratios of teachers to students .


Patients undergoing orthognathic surgery are at high risk of developing emergence agitation .


We hypothesised that a single-dose of dexmedetomidine would reduce emergence agitation in adults with nasotracheal intubation after orthognathic surgery .


Seventy adults ( @-@ years old ) undergoing orthognathic surgery were randomly assigned to two groups .


Patients received intravenous dexmedetomidine @g/kg ( dex group ) or normal saline ( control group ) for @min at the end of surgery .


Remifentanil was infused at @ g/kg/min during emergence in both groups .


The severity of emergence agitation was assessed with the Richmond agitation-sedation scale .


Cough , haemodynamic and respiratory profiles , pain , and time to eye opening were evaluated .


The incidence of emergence agitation was not different between dex group and control group ( @ % vs. @ % , P = @ ) .


However , severe cough during emergence was reduced in the dex group ( P = @ ) .


Tachycardia during emergence and recovery phases was attenuated in the dex group .


The verbal numeric rating of pain was lower in the dex group .


There were no differences in respiratory rate between the two groups .


Time to eye opening was prolonged in the dex group .


The addition of a single dose of dexmedetomidine ( @g/kg ) to low-dose remifentanil infusion did not attenuate emergence agitation in intubated patients after orthognathic surgery compared with low-dose remifentanil infusion alone .


However , single-dose dexmedetomidine suppressed coughing , haemodynamic changes , and pain during emergence and recovery phases , without respiratory depression .


Delayed awakening might be associated with this treatment .


The purpose of this study was to investigate the effects of a cognitive behavioral therapy-oriented anger management and stress control program on smokers ' quit rates .


Of @ smokers , @ were randomly allocated into study and control groups ( n = @ each ) .


An individualized therapy cessation technique was selected for each participant ( combination of behavioral counseling , nicotine replacement therapy , and/or pharmacotherapy ) .


The participants in the control group attended a standard quit program , whereas the study group also received an additional @-session ( @ minutes each ) cognitive behavioral therapy-oriented program aimed at improving their anger and stress coping skills .


At the beginning of the study , both groups were asked to complete the Trait Anger Scale ( TAS ) of the State and Trait Anger Scale and the Self-Confident ( SCS ) and Hopeless ( HS ) subscales of the Stress Coping Styles Inventory ; pretest smoking status of both groups and their coping skills were compared with each other as soon as the program ended ( post-test results ) and after @ and @ months ( first and second follow-up tests ) .


Although there was no difference between pretest scores on the TAS ( P = @ ) , SCS ( P = @ ) , and HS ( P = @ ) subscales , post-test results indicate that the study groups ' TAS and HS scores decreased and SCS scores increased ( P < @ ) , whereas there was no change in the control group ( P > @ ) .


The study group had a better quit level after @ months compared with the control group ( @ % vs @ % ; P < @ ) .


The anger management and stress control program was found to have a significant effect on cessation ( odds ratio , @ ; @ % confidence interval , @-@ @ ) .


The anger and stress coping skills program may increase the success of quitting smoking .


Different kinds of gums from various sources enjoy an extremely broad range of commercial and industrial use , from food and pharmaceuticals to printing and adhesives .


Although generally recognized as safe by the US Food and Drug Administration ( FDA ) , gums have a history of association with sensitive or allergic reactions .


In addition , studies have shown that gums have a structural , molecular similarity to a number of common foods .


A possibility exists for cross-reactivity .


Due to the widespread use of gums in almost every aspect of modern life , the overall goal of the current investigation was to determine the degree of immune reactivity to various gum antigens in the sera of individuals representing the general population .


The study was a randomized , controlled trial .


@ sera purchased from a commercial source .


The sera was screened for immunoglobulin G ( IgG ) and immunoglobulin E ( IgE ) antibodies against extracts of mastic gum , carrageenan , xantham gum , guar gum , gum tragacanth , locust bean gum , and - glucan , using indirect enzyme-linked immunosorbent assay ( ELISA ) testing .


For each gum antigen , inhibition testing was performed on the @ sera that showed the highest IgG and IgE immune reactivity against the different gums used in the study .


Inhibition testing on these same sera for sesame albumin , lentil , corn , rice , pineapple , peanut , pea protein , shrimp , or kidney bean was used to determine the cross-reactivity of these foods with the gum .


Of the @ samples , @ % -@ % of the specimens showed a significant elevation in IgG antibodies against various gums .


Only @ of @ , or @ % , showed a simultaneous elevation of the IgG antibody against all @ gum extracts .


For the IgE antibody , @ % -@ % of the specimens showed an elevation against the various gums .


A significant percentage of the specimens , @ % , simultaneously produced IgE antibodies against all @ tested extracts .


Overall , the percentage of elevation in IgE antibodies against different gum extracts , with the exception of carrageenan , was much higher than for the IgG antibody .


The results of the current study showed that a subgroup of healthy individuals who produced not only IgG but also IgE antibodies against various gums may suffer from hidden food immune reactivities and sensitivities .


Further study is needed to examine the clinical importance of gums and cross-reactive food antibodies in symptomatic individuals .


To investigate the effect of low-dose carvedilol combined with candesartan in the prevention of acute and chronic cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer .


Forty patients were randomly divided into two groups : the experimental group with chemotherapy plus low-dose carvedilol combined with candesartan ( @ cases ) and control group with chemotherapy alone ( @ cases ) .


The same chemotherapy was given to the two groups .


All the @ patients had no contraindication for carvedilol and candesartan .


Patients of the experimental group received low-dose carvedilol from @ mg orally twice a day at first cycle to @ mg twice a day gradually if no side reactions , and candesartan @ mg orally once a day .


Electrocardiogram , ultrasonic cardiogram , arrhythmia , troponin and non-hematologic toxicity were recorded and compared after the second , forth and sixth cycle of chemotherapy .


Each cycle included @ days .


LVEF was decreased along with the prolongation of chemotherapy in the experimental group and control group .


LVEDD and LVESD showed no significant changes in the experimental group , but gradually increased in the control group .


After four and six cycles of chemotherapy , LVEF were ( @ @ ) % and ( @ @ ) % , respectively , in the control group , significantly lower than that of ( @ @ ) % and ( @ @ ) % , respectively , in the experimental group ( P < @ ) .


After six cycles of chemotherapy , LVEDD and LVESD were ( @ @ ) mm and ( @ @ ) mm , respectively , in the control group , significantly higher than those before chemotherapy ( P < @ ) and experimental group ( P < @ ) .


The rate of ST segment and T wave abnormalities was @ % in the control group after six cycles of chemotherapy , significantly higher than that of @ % after four cycles of chemotherapy ( P = @ ) and @ % after two cycles of chemotherapy ( P < @ ) .


The reduction of QRS voltage , arrhythmia and abnormal troponin were @ % , @ % and @ % , respectively , in the control group , significantly higher than those in the experimental group ( @ % , P < @ ) , ( @ % , P = @ ) and ( @ % , P < @ ) , respectively .


The rate of abnormal expression of troponin was @ % in the control group , significantly higher than the @ % in the experimental group ( P < @ ) .


The use of low-dose carvedilol combined with candesartan can reduce the acute and chronic cardiotoxicity of anthracycline drugs , and with tolerable toxicities .


This may provide a new approach to prevent cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer .


To compare the image quality at coronary multidetector computed tomography ( MDCT ) using low-dose and low-iodine protocol study in comparison with the standard protocol .


In study included @ patients undergoing coronary computed tomography angiography .


All examinations were performed with @-row MDCT using prospective ECG-gating and ASIR @ % .


@ patients were examined using a low-concentration ( Iodixanol , @ mg I/ml ) iodinated contrast medium and low tube voltage ( @ kV ) ( group @ ) , @ patients -- using of high-concentration ( Iodixanol , @ mg I/ml ) iodinated contrast medium and standard tube voltage ( @ kV ) ( group @ ) .


Image quality of coronary arteries was evaluated using a four-point grading scale , images were randomised .


Intra-arterial density was measured for the proximal and distal segments of left anterior descending artery ( LAD ) and right coronary artery ( RCA ) .


Age , heart rate , BMI and scan parameters were not statistically different between the two groups .


Analysis of coronaries visualization revealed the same image quality for group @ and group @ ( image quality scores were @ @ vs. @ @ , p = @ ) .


There was no significant difference between mean enhancement values in the distal segments of RCA and LAD for the two groups .


Intraarterial density for proximal LAD and proximal RCA for the nazpyara , umepamuenas group @ were significantly lower ( p < @ ) than those values for the group @ .


Conclusion .


Theuse of low-dose and low-iodine protocol can be beneficial for patient safety and or image quality ithout loss of diag - stic information .


Intertrochanteric fractures of the femur are prevalent in the elderly , and leave patients with functional restrictions after surgical treatment .


The aim of this study was to compare the functional recovery at @-year follow-up of elderly patients with intertrochanteric fractures treated surgically with the dynamic hip screw ( DHS ) or proximal femoral nail ( PFN ) fixation techniques .


This prospective , randomised , blinded trial included patients aged over @ years with intertrochanteric fractures classified as AO group @ .


A@ or @ .


A@ .


The patients were allocated into one of two treatment groups : one treated with DHS and the other with PFN .


Data on functional recovery were obtained using the Functional Recovery Score developed by Zuckerman for elderly patients with hip fracture .


Variables were described as means and standard deviations , and the non-parametric Kolmogorov-Smirnov test was used to verify the normality of data distribution .


Non-normally distributed variables were compared using the non-parametric Friedman and Mann-Whitney U tests .


Data processing and analysis were carried out in SPSS @ .


Results were deemed significant at the @ % level ( p @ ) .


There were no significant between-group differences in age ( p = @ ) , sex ( p = @ ) , or American Society of Anaesthesiologists ( ASA ) score ( p = @ ) .


Functional recovery scores in the DHS group at @ and @ months after surgery were significantly reduced from preoperative baseline scores ( p = @ ) compared with in the PFN group .


However , there were no statistically significant differences between the two groups in functional recovery scores at baseline ( p = @ ) or at @ months ( p = @ ) , @ months ( p = @ ) , and @ months ( p = @ ) after surgery .


There was no between-group difference in mortality ( p = @ ) .


At @-year follow-up , functional recovery scores were similar in elderly patients treated with the DHS and PFN techniques .


However , DHS-treated patients exhibited significant loss of function in the first @ months after surgery , which did not occur in the PFN-treated group .


This is the first randomized , double-blind , placebo-controlled trial ( EUDRACT No. @-@-@ ) evaluating nickel oral hyposensitizing treatment ( NiOHT ) in patients with `` systemic nickel allergy syndrome '' ( SNAS ) , characterized by Ni-allergic contact dermatitis and systemic reactions after eating Ni-rich food .


Adults with positive Ni-patch test , who reported symptoms suggesting SNAS , which improved after Ni-poor diet , and were positive to Ni-oral challenge were eligible .


Patients were randomly assigned to three treatments ( @ g , @ g , or @ ng Ni/week ) or placebo for a year , with progressive reintroduction of Ni-rich foods form the @ ( th ) month .


Out of @ patients randomized , @ completed the trial .


Endpoints were efficacy and tolerability of treatment .


During Ni-rich food re-introduction , the @ g Ni/week group had a mean VAS score significantly higher than placebo ( p = @ ) , with significant improvement of gastrointestinal symptoms ( p = @ ;) and significantly fewer rescue medications .


Cutaneous manifestations also improved but without reaching statistical significance .


After the treatment , oral challenge with higher Ni doses than at baseline were needed to cause symptoms to flare-up in significantly more patients given @ g Ni/week than placebo ( p = @ ) .


Patients reported no side-effects .


NiOHT is effective in SNAS , in particular on gastrointestinal manifestations , with trend toward improvement of cutaneous symptoms .


Surgery for subacromial impingement syndrome is often performed in working age and postoperative physiotherapy exercises are widely used to help restore function .


A recent Danish study showed that @ % of a nationwide cohort of patients retired prematurely within two years after surgery .


Few studies have compared effects of different postoperative exercise programmes on shoulder function , and no studies have evaluated workplace-oriented interventions to reduce postoperative work disability .


This study aims to evaluate the effectiveness of physiotherapy exercises and occupational medical assistance compared with usual care in improving shoulder function and reducing postoperative work disability after arthroscopic subacromial decompression .


The study is a mainly pragmatic multicentre randomised controlled trial .


The trial is embedded in a cohort study of shoulder patients referred to public departments of orthopaedic surgery in Central Denmark Region .


Patients aged @-@ years , who still have shoulder symptoms @-@ weeks after surgery , constitute the study population .


Around @ participants are allocated to : @ ) physiotherapy exercises , @ ) occupational medical assistance , @ ) physiotherapy exercises and occupational medical assistance , and @ ) usual care .


Intervention manuals allow individual tailoring .


Primary outcome measures include Oxford Shoulder Score and sickness absence due to symptoms from the operated shoulder .


Randomisation is computerised with allocation concealment by randomly permuted block sizes .


Statistical analyses will primarily be performed according to the intention-to-treat principle .


The paper presents the rationale , design , methods , and operational aspects of the Shoulder Intervention Project ( SIP ) .


SIP evaluates a new rehabilitation approach , where physiotherapy and occupational interventions are provided in continuity of surgical episodes of care .


If successful , the project may serve as a model for rehabilitation of surgical shoulder patients .


The strongest risk factor for depression is having a family history of the condition .


Many individuals with a family history of depression are concerned about their personal risk for depression and report unmet educational and psychological support needs .


No supportive and/or educational interventions are currently available that target this group of individuals .


In this study we will develop and evaluate the first online psycho-educational intervention targeted to individuals with a family history of depression .


Genetic risk information and evidence-rated information on preventive strategies for depression will be provided to such individuals in a general practice setting .


The intervention will also incorporate a risk assessment tool .


The content and delivery of the intervention will be pilot-tested .


The proposed intervention will be evaluated in the general practitioner ( GPs ) setting , using a cluster randomized controlled trial .


GP practices will be randomized to provide either access to the online , targeted psycho-educational intervention or brief generic information about depression ( control ) to eligible patients .


Eligibility criteria include having at least one first-degree relative with either major depressive disorder ( MDD ) or bipolar disorder ( BD ) .


The primary outcome measure is ` intention to adopt , or actual adoption of , risk-reducing strategies ' .


Secondary outcome measures include : depression symptoms , perceived stigma of depression , knowledge of risk factors for development of depression and risk-reducing strategies , and perceived risk of developing depression or having a recurrence of family history .


Over the course of the study , participants will complete online questionnaires at three time points : at baseline , and two weeks and six months after receiving the intervention or control condition .


This novel psycho-educational intervention will provide individuals with a family history of depression with information on evidence-based strategies for the prevention of depression , thus , we hypothesize , enabling them to make appropriate lifestyle choices and implement behaviors designed to reduce their risk for depression .


The online psycho-educational intervention will also provide a model for similar interventions aimed at individuals at increased familial risk for other psychiatric disorders .


This study aimed to evaluate cervical lesions by the Swede coloscopy system , histologic finding , liquid-based cytology , and human papillomavirus ( HPV ) in women who resulted positive for visual inspection of the cervix with acetic acid ( VIA ) by using a pocket-sized battery-driven colposcope , the Gynocular ( Gynius AB , Sweden ) .


This study was a crossover , randomized clinical trial at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University in Dhaka , Bangladesh , with @ VIA-positive women .


Swede scores were obtained by the Gynocular and stationary colposcope , as well as samples for liquid-based cytology , HPV , and cervical biopsies .


The Swede scores were compared against the histologic diagnosis and used as criterion standard .


The percentage agreement and the statistic for the Gynocular and standard colposcope were also calculated .


The Gynocular and stationary colposcope showed high agreement in Swede scores with a statistic of @ , P value of less than @ , and no difference in detecting cervical lesions in biopsy .


Biopsy detected cervical intraepithelial neoplasia ( CIN ) @ + ( CIN@ , CIN@ , and invasive cancer ) in @ ( @ % ) of the women , whereas liquid-based cytology detected CIN@ + in @ ( @ % ) of the women .


Forty-four ( @ % ) women who were tested resulted positive for HPV ; @ ( @ % ) women had HPV-@ , @ ( @ % ) had HPV-@ , and @ ( @ % ) had other high-risk HPV .


Our study showed that few VIA-positive women had CIN@ + lesions or HPV infection .


Colposcopy by Swede score identified significantly more CIN@ + lesions than liquid-based cytology and could offer a more accurate screening and selection for immediate treatment of cervical lesions in low-resource settings .


Catheter ablation is less successful for persistent atrial fibrillation than for paroxysmal atrial fibrillation .


Guidelines suggest that adjuvant substrate modification in addition to pulmonary-vein isolation is required in persistent atrial fibrillation .


We randomly assigned @ patients with persistent atrial fibrillation in a @:@:@ ratio to ablation with pulmonary-vein isolation alone ( @ patients ) , pulmonary-vein isolation plus ablation of electrograms showing complex fractionated activity ( @ patients ) , or pulmonary-vein isolation plus additional linear ablation across the left atrial roof and mitral valve isthmus ( @ patients ) .


The duration of follow-up was @ months .


The primary end point was freedom from any documented recurrence of atrial fibrillation lasting longer than @ seconds after a single ablation procedure .


Procedure time was significantly shorter for pulmonary-vein isolation alone than for the other two procedures ( P < @ ) .


After @ months , @ % of patients assigned to pulmonary-vein isolation alone were free from recurrent atrial fibrillation , as compared with @ % of patients assigned to pulmonary-vein isolation plus complex electrogram ablation and @ % of patients assigned to pulmonary-vein isolation plus linear ablation ( P = @ ) .


There were also no significant differences among the three groups for the secondary end points , including freedom from atrial fibrillation after two ablation procedures and freedom from any atrial arrhythmia .


Complications included tamponade ( three patients ) , stroke or transient ischemic attack ( three patients ) , and atrioesophageal fistula ( one patient ) .


Among patients with persistent atrial fibrillation , we found no reduction in the rate of recurrent atrial fibrillation when either linear ablation or ablation of complex fractionated electrograms was performed in addition to pulmonary-vein isolation .


( Funded by St. Jude Medical ; ClinicalTrials.gov number , NCT@ . )


Psychopathology in women after childbirth represents a significant risk factor for parenting and infant mental health .


Regarding child development , these infants are at increased risk for developing unfavorable attachment strategies to their mothers and for subsequent behavioral , emotional and cognitive impairments throughout childhood .


To date , the specific efficacy of an early attachment-based parenting group intervention under standard clinical outpatient conditions , and the moderators and mediators that promote attachment security in infants of mentally ill mothers , have been poorly evaluated .


This randomized controlled clinical trial tests whether promoting attachment security in infancy with the Circle of Security ( COS ) Intervention will result in a higher rate of securely attached children compared to treatment as usual ( TAU ) .


Furthermore , we will determine whether the distributions of securely attached children are moderated or mediated by variations in maternal sensitivity , mentalizing , attachment representations , and psychopathology obtained at baseline and at follow-up .


We plan to recruit @ mother-infant dyads when infants are aged @-@ months with @ dyads being randomized to each treatment arm .


Infants and mothers will be reassessed when the children are @-@ months of age .


Methodological aspects of the study are systematic recruitment and randomization , explicit inclusion and exclusion criteria , research assessors and coders blinded to treatment allocation , advanced statistical analysis , manualized treatment protocols and assessments of treatment adherence and integrity .


The aim of this clinical trial is to determine whether there are specific effects of an attachment-based intervention that promotes attachment security in infants .


Additionally , we anticipate being able to utilize data on maternal and child outcome measures to obtain preliminary indications about potential moderators of the intervention and inform hypotheses about which intervention may be most suitable when offered in a clinical psychiatric outpatient context .


We aimed to investigate , in patients with ST-segment elevation myocardial infarction ( STEMI ) , whether the previously reported clinical benefits of sirolimus-eluting stent ( s ) ( SES ) in terms of reducing a major adverse cardiac and cerebrovascular event ( MACCE ) compared with bare-metal stent ( s ) ( BMS ) were maintained over a @-year time period .


In the prospective single-centre randomized DEBATER trial , SES significantly reduced the rate of MACCE in STEMI patients within @ year compared with BMS , mainly driven by a reduction of target lesion revascularization .


Randomized data on the long-term safety and efficacy of SES in STEMI patients are conflicting and limited .


Between January @ and May @ , a total of @ STEMI patients were randomized to receive SES or BMS .


The primary endpoint was MACCE defined as the composite of death , myocardial infarction , stroke , repeat revascularization and bleeding .


Five-year follow-up data were collected by reviewing hospital records , telephone calls and a written questionnaire .


At @ years , the rate of MACCE between the SES group and the BMS group was no longer significantly different ( @ vs. @ % , P = @ ) .


The cumulative incidence of death and myocardial infarction was similar in both groups ( @ vs. @ % , P = @ ) .


Repeat revascularization was performed in @ and @ % of patients , respectively ( P = @ ) .


The rate of very late stent thrombosis ( @-@ years of follow-up ) was very low in both groups ( @ vs. @ % , P = @ ) .


The benefits of SES in STEMI patients in terms of reducing MACCE faded over time .


We found no safety concerns in terms of SES in the long term , with extremely low rates of very late stent thrombosis .


The aims of the study protocol are to investigate different adapted physical training programs in patients with advanced lung cancer undergoing palliative chemo - or radiotherapy and to evaluate their effects on physical performance , quality of life , symptom burden , and efficacy of oncologic treatment .


Patients will be randomized into three study arms : interventional group @ performing aerobic exercise , interventional group @ performing resistance training , and a control group without specific physical training .


Interventional training will be performed for @ weeks consisting of two supervised and one self-instructed training sessions per week each .


Respiratory therapy over @ weeks is provided in all three study arms as an established supportive therapy in lung cancer patients .


Primary efficacy endpoint is physical performance measured by peak oxygen consumption ( VO ( @ ) peak ) .


Secondary efficacy endpoints include additional parameters of physical performance ( resistance , lung function , perceived exertion , level of physical activity and IPAQ-questionnaire ) , health-related quality of life ( EORTC QLQ C@-questionnaire ) , disease and treatment related symptoms ( Memorial Symptom Assessment Scale ) , biologic parameter ( e.g. body composition , blood values of immune system , chronic inflammation , glucose and lipid metabolisms ) , and parameter of efficacy of oncologic treatment .


The results of this study will offer an overview over possible effects of specific training interventions on health related quality of life , physical and psychological symptoms , and on the efficacy of oncologic treatment .


The primary aim of this study is to detect adapted intervention programs for metastatic lung cancer undergoing palliative chemotherapy .


The purpose of the current study was to examine the effect of an oncologist 's exercise recommendation with and without an exercise motivation package on the amount of exercise participation and quality of life ( QOL ) in survivors of breast and colorectal cancer .


A total of @ survivors of early-stage breast and colorectal cancer who completed primary and adjuvant treatments were recruited for the current study .


Participants were randomly assigned into @ of @ groups : @ ) control ( @ patients ) ; @ ) those receiving an oncologist 's exercise recommendation ( @ patients ) ; and @ ) those receiving an oncologist 's exercise recommendation with an exercise motivation package ( @ patients ) .


At baseline and after @ weeks , the level of exercise participation and QOL were assessed .


Of the @ participants , @ ( @ % ) completed the trial .


Intention-to-treat analysis indicated that participants who received an oncologist 's exercise recommendation with an exercise motivation package significantly increased their level of exercise participation in terms of minutes ( @ added minutes per week ; @ % confidence interval , @-@ @ minutes -LSB- P = @ -RSB- vs control ) and in Metabolic Equivalent of Task ( MET ) - hours per week ( @ additional MET-hours per week ; @ % confidence interval , @-@ @ MET-hours -LSB- P = @ -RSB- vs control ) compared with the control group .


Participants who received only their oncologist 's exercise recommendation did not increase their exercise participation level .


Further analysis demonstrated that role functioning was significantly improved among participants who received an oncologist 's exercise recommendation with an exercise motivation package .


Providing an exercise motivation package in addition to the oncologist 's exercise recommendation to increase the level of exercise among survivors of breast and colorectal cancer should be considered .


Thoracic epidural analgesia ( TEA ) is recommended for post-operative pain relief in patients undergoing major abdominal surgery via a midline incision .


However , the effectiveness of TEA is variable with high failure rates reported post-operatively .


Common side effects such as low blood pressure and motor block can reduce mobility and hinder recovery , and a number of rare but serious complications can also occur following their use.Rectus sheath catheters ( RSC ) may provide a novel alternative approach to somatic analgesia without the associated adverse effects of TEA .


The aim of this study is to compare the efficacy of both techniques in terms of pain relief , patient experience , post-operative functional recovery , safety and cost-effectiveness .


This is a single-centre randomised controlled non-blinded trial , which also includes a nested qualitative study .


Over a two-year period , @ patients undergoing major abdominal surgery via a midline incision will be randomised to receive either TEA or RSC for post-operative analgesia .


The primary outcome measures pain scores on moving from a supine to a sitting position at @ hours post wound closure , and the patient experience between groups evaluated through in-depth interviews .


Secondary outcomes include pain scores at rest and on movement at other time points , opiate consumption , functional recovery , morbidity and cost-effectiveness .


This will be the first randomised controlled trial comparing thoracic epidurals to ultrasound-guided rectus sheath catheters in adults undergoing elective midline laparotomy .


The standardised care provided by an Enhanced Recovery Programme makes this a comparison between two complex pain packages and not simply two analgesic techniques , in order to ascertain if RSC is a viable alternative to TEA .


Trigeminal neuralgia ( TN ) is a rare severe unilateral facial pain condition .


Current guidelines in trigeminal neuralgia management recommend sodium channel blockers -- carbamazepine or oxcarbazepine -- as the first-line treatment .


However , the currently available drugs are often associated with poor tolerability resulting in sub-optimal pain control .


CNV@ is a novel sodium channel blocker that is being assessed in the treatment of trigeminal neuralgia .


Due to the severity of the condition , it is not ethical to conduct a traditional placebo-controlled randomized controlled trial .


It is also difficult to use an active control such as carbamazepine , the current gold standard , because of its complex pharmacology and potential for drug interactions .


The trial uses a randomized withdrawal design to assess efficacy in this rare condition .


There is a @-day open-label phase followed by a randomized @-day placebo-controlled phase for responders .


Thirty patients will be randomized .


The primary outcome measure will be pain relief , but secondary measures of quality of life will be of significant importance given the effect of this condition on activities of daily living .


Safety and adverse event endpoints are described .


There have been very few well-controlled , randomized , placebo-controlled studies in trigeminal neuralgia , and the majority of drugs have had other primary uses .


Due to the severity of the pain , minimizing the time a patient is administered placebo was a key factor in designing this study .


This study will not only provide data on the efficacy of CNV@ in trigeminal neuralgia , but will also provide information on the effectiveness and acceptability of a novel trial design in trigeminal neuralgia .


To evaluate the therapeutic effect of UV-A/riboflavin collagen cross-linking ( CXL ) on moderate bacterial corneal ulcers .


Thirty-two patients with moderate bacterial keratitis were selected .


All patients were treated according to the standard medical treatment protocol .


The patients were randomly allocated to @ groups : case and control groups of @ patients each using a numerical randomization table .


The case group received CXL treatment .


In the CLX group , corneal epithelium was removed and @ % riboflavin drops were applied .


Then the corneas were irradiated with UV-A ( @ nm ) with an irradiance of @ mW/cm for @ minutes .


The grade of ulcers , size of epithelial defects , and area of infiltrates were recorded on days @ , @ , and @ of treatment .


There was no statistically significant difference between the groups @ day after the treatment .


The mean treatment duration was @ @ days in the CXL group and @ @ days in the control group .


The epithelial defects were smaller in the CXL group at @ days ( P = @ ) and @ days ( P = @ ) after the beginning of treatment .


The area of infiltrates in CXL group was smaller than the control group at both @ days ( P = @ ) and @ days ( P < @ ) after the start of treatment .


Our results support the beneficial effect of CXL in patients with moderate bacterial keratitis .


In addition to accelerating epithelialization , this method shortens the course of treatment and may minimize or remove the need for surgery or other serious sequelae , such as corneal perforation .


Little is known about the ability of community pharmacists who are inexperienced in medication review to identify drug-related problems ( DRPs ) .


The objective of our study was to investigate the completeness of DRPs in terms of number , type and clinical relevance identified by community pharmacists when performing home medication reviews ( HMRs ) .


This is a cross-sectional study within the intervention arm of a randomized controlled trial among community-dwelling patients ( @years , @ drugs ) in ten Dutch community pharmacies .


Community pharmacists , who were inexperienced in medication review , received @-day training in medication review .


These pharmacists interviewed patients at home about their medicines , identified potential DRPs and made recommendations in combination with medication and clinical records .


Expert reviewers completed the number of potential DRPs and recommendations by reviewing all available information , including patient interview reports .


In @ patients , community pharmacists identified a mean of @ ( SD @ ) potential DRPs per patient and expert reviewers added @ ( SD @ ) DRPs .


Community pharmacists formulated @ ( SD @ ) recommendations per patient and reviewers added @ ( SD @ ) recommendations .


Community pharmacists identified a higher proportion of clinically relevant DRPs compared with expert reviewers , as assessed by DRPs with high priority -LSB- OR = @ ( @ % CI @-@ ) -RSB- , DRPs associated with recommendations for drug change -LSB- OR = @ ( @ % CI @-@ ) -RSB- and implemented recommendations for drug change -LSB- OR = @ ( @ % CI @-@ ) -RSB- .


This study shows that the completeness of medication reviews by inexperienced community pharmacists with limited training could be improved , although they identified a higher proportion of potentially clinically relevant DRPs compared with expert reviewers .


The results suggest that community pharmacists with limited experience in medication review may need more intensive post-graduate training .


In @ , the Danish Government launched the Danish national return-to-work ( RTW ) programme to reduce sickness absence and promote labour market attainment .


Multidisciplinary teams delivered the RTW programme , which comprised a coordinated , tailored and multidisciplinary effort ( CTM ) for sickness absence beneficiaries at high risk for exclusion from the labour market .


The aim of this article was to evaluate the effectiveness of the RTW programme on self-support .


Beneficiaries from three municipalities ( denoted M@ , M@ and M@ ) participated in a randomized controlled trial .


We randomly assigned beneficiaries to CTM ( M@ : n = @ ; M@ : n = @ ; M@ : n = @ ) or to ordinary sickness absence management ( OSM ) ( M@ : n = @ ; M@ : n = @ ; M@ : n = @ ) .


We used the Cox proportional hazards model to estimate hazard ratios ( HR ) comparing rates of becoming self-supporting between beneficiaries receiving CTM and OSM .


In M@ , beneficiaries from employment receiving CTM became self-supporting faster compared with beneficiaries receiving OSM ( HR = @ , @ % CI : @-@ @ ) .


In M@ , beneficiaries receiving CTM became self-supporting slower than beneficiaries receiving OSM ( HR = @ , @ % CI : @-@ @ ) .


In M@ , we found no difference between the two groups ( HR = @ , @ % CI : @-@ @ ) .


The effect of the CTM programme on return to self-support differed substantially across the three participating municipalities .


Thus , generalizing the study results to other Danish municipalities is not warranted .


Treatment of chronic wounds using traditional surgical procedures is challenging because of the low graft take rates .


This study investigated the combination approach of split-thickness autografts with harvested skin cell suspension for chronic wound treatment .


This randomized clinical trial enrolled patients with chronic wounds between March @ and December @ .


Patients who were assigned randomly to the active treatment received a split-thickness autograft combined with harvested skin cell suspension .


Control patients received the split-thickness autograft alone .


The primary outcome was the rate of complete wound closure by postoperative day @ .


Analysis was by intention to treat .


Patients who achieved wound closure were followed up for a minimum of @ months to evaluate the quality of healing .


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


More patients achieved complete wound closure in the skin cell group than in the control group ( @ versus @ patients ; P = @ ) .


Complete wound closure was observed at a median of @ ( @ per cent c.i. @ to @ ) days in the skin cell group and @ ( @ to @ ) days in the control group ( P = @ ) .


The skin cell group had significantly fewer complications ( @ versus @ patients ; P = @ ) .


The autografted sites displayed better physical attributes and a reduced tendency for wound recurrence in the skin cell group .


Complementary split-thickness autologous skin grafting with autologous skin cells harvested using ReCell ( Avita Medical , Cambridge , UK ) technology improved the healing rate of chronic wounds .


Prior receipt of a trivalent seasonal influenza vaccine ( TIV ) can affect hemagglutination inhibition ( HI ) antibody responses to pandemic influenza vaccines .


We investigated the effect of TIV priming on humoral responses to AS@-adjuvanted and nonadjuvanted A ( H@N@ ) pdm@ vaccines , the role of AS@ on cell-mediated immune ( CMI ) responses , and vaccine safety .


Healthy adults ( aged @-@ years ) were randomized @:@:@:@ to receive TIV or saline followed @ months later by @ doses , @ weeks apart , of adjuvanted or nonadjuvanted A ( H@N@ ) pdm@ vaccine and followed up to study end ( day @ ) .


Pre - and postvaccination responses of HI and neutralizing antibody , CD@ ( + ) / CD@ ( + ) T cells , memory B cells , and plasmablasts were assessed .


Ninety-nine of the @ participants enrolled completed the study .


No vaccine-related serious adverse events were recorded .


In TIV-primed participants , A ( H@N@ ) pdm@-specific antibody and CD@ ( + ) T-cell and memory B-cell responses to the pandemic vaccine tended to be diminished .


Vaccine adjuvantation led to increased responses of vaccine-homologous and - heterologous HI and neutralizing antibodies and CD@ ( + ) T cells , homologous memory B cells , and plasmablasts .


In healthy adults , prior TIV administration decreased humoral and CMI responses to A ( H@N@ ) pdm@ vaccine .


Adjuvantation of A ( H@N@ ) pdm@ antigen helped to overcome immune interference between the influenza vaccines .


No safety concerns were observed .


All-oral combination therapy is desirable for patients with chronic hepatitis C virus ( HCV ) infection .


We evaluated daclatasvir ( an HCV NS@A replication complex inhibitor ) plus sofosbuvir ( a nucleotide analogue HCV NS@B polymerase inhibitor ) in patients infected with HCV genotype @ , @ , or @ .


In this open-label study , we initially randomly assigned @ previously untreated patients with HCV genotype @ infection and @ patients infected with HCV genotype @ or @ to daclatasvir at a dose of @ mg orally once daily plus sofosbuvir at a dose of @ mg orally once daily , with or without ribavirin , for @ weeks .


The study was expanded to include @ additional patients with genotype @ infection who were randomly assigned to daclatasvir plus sofosbuvir , with or without ribavirin , for @ weeks ( @ previously untreated patients ) or @ weeks ( @ patients who had previous virologic failure with telaprevir or boceprevir plus peginterferon alfa-ribavirin ) .


The primary end point was a sustained virologic response ( an HCV RNA level of < @ IU per milliliter ) at week @ after the end of therapy .


Overall , @ patients received treatment .


Among patients with genotype @ infection , @ % of @ previously untreated patients and @ % of @ patients who did not have a sustained virologic response with HCV protease inhibitors had a sustained virologic response at week @ after the end of therapy .


A total of @ % of @ patients with genotype @ infection and @ % of @ patients with genotype @ infection had a sustained virologic response at week @ .


High rates of sustained virologic response at week @ were observed among patients with HCV subtypes @a and @b ( @ % and @ % , respectively ) and those with CC and non-CC IL@B genotypes ( @ % and @ % , respectively ) , as well as among patients who received ribavirin and those who did not ( @ % and @ % , respectively ) .


The most common adverse events were fatigue , headache , and nausea .


Once-daily oral daclatasvir plus sofosbuvir was associated with high rates of sustained virologic response among patients infected with HCV genotype @ , @ , or @ , including patients with no response to prior therapy with telaprevir or boceprevir .


( Funded by Bristol-Myers Squibb and Pharmasset ( Gilead ) ; A@ ClinicalTrials.gov number , NCT@ . )


To explore changes in current source density locations after remifentanil infusion in healthy volunteers using source localization of the electroencephalography ( EEG ) .


EEG data was collected from @ males using a @-electrode system .


Additionally , cognitive performance was evaluated by a continuous reaction time paradigm , and pain scores were obtained for experimental bone and heat stimuli .


Data were recorded before and during treatment with remifentanil and placebo .


Source localization was performed by sLORETA at delta ( @-@ @ Hz ) , theta ( @-@ @ Hz ) , alpha ( @-@ Hz ) , beta@ ( @-@ Hz ) , and beta@ ( @-@ Hz ) frequency bands .


Pre-treatment recordings demonstrated reproducible source characteristics .


The alterations ( i.e. , pre - versus post-treatment ) due to remifentanil were significantly and robustly different from placebo infusions .


The results indicated that neurons in several brain areas including inferior frontal gyrus and insula at frontal lobe oscillated more strongly after remifentanil infusion compared to placebo .


Furthermore , the source activity at delta band was correlated with continuous reaction time index .


These results indicate that alterations in brain oscillations during remifentanil are mostly localized to frontal , fronto-temporal and fronto-central lobes and related to cognitive function .


The approach offers the potential to be used for understanding the underlying mechanism of action of remifentanil on brain activity .


Healthcare workers may be exposed to people with respiratory viral infections more often than other working adults .


Understanding the risk and the effectiveness of different preventive measures is of great importance .


To estimate adherence to prophylactic antiviral medication for a full influenza season , to the compare efficacy of antiviral prophylaxis to that of the seasonal influenza vaccine and to identify exposures that increase risk of acute respiratory illnesses ( ARI ) in healthy adults .


Participants were randomized @:@ to receive the @-@ influenza vaccine or daily prophylaxis with @ mg of zanamivir during the season .


Web-based questionnaires collected information on demographics , symptoms , exposures , medication use and side effects .


Sixty-four healthy adults were recruited in November @ .


Three of @ active participants discontinued zanamivir due to side effects ; the remaining @ took > @ % of scheduled doses for a median of @ days .


Symptomatic , laboratory-confirmed influenza was detected in one person randomized to zanamivir ( @ % ) and @/@ ( @ % ) who received the vaccine ( P = @ ) .


Forty-seven participants reported @ episodes of ARI .


Factors associated with an ARI were exposure to a spouse ( OR @ ) , child ( OR @ ) or patient ( OR @ ) with symptoms of an ARI in the previous @ days .


Breakthrough influenza infection occurred in both vaccinated participants and those receiving antiviral prophylaxis .


Most adults were willing and able to comply with season-long prophylaxis .


Report of recent exposure to family members and patients with an ARI increased the risk of developing an ARI in healthy adults .


To evaluate risks for adverse pregnancy outcomes by number of embryos transferred ( ET ) and fetal heartbeats ( FHB ) in assisted reproductive technology-conceived singleton live births .


Longitudinal cohort using cycles reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System between @ and @ among women who were treated and gave birth in Massachusetts .


Not applicable .


Assisted reproductive technology data on @,@ births between @ and @ were linked to vital records and hospital data .


Likelihood of ET @ vs. @-@ , FHB > @ vs. @ , and risks of preterm birth ( PTB , < @weeks ' gestation ) , low birth weight ( LBW , < @,@ g ) , and small-for-gestational-age birth weight ( SGA , < @th percentile ) with FHB > @ were modeled with binary logistic regression using a backward-stepping algorithm , and presented as adjusted odds ratios ( @ % confidence intervals ) .


None .


ET @ , FHB > @ , PTB , LBW , and SGA .


Higher ET was significantly more likely with older maternal age , intracytoplasmic sperm injection , assisted hatching , cleavage-stage embryos , and thawed embryos .


The likelihood of FHB > @ with @ ET vs. @-@ ET was @ ( @-@ @ ) .


Risks of PTB and LBW with FHB > @ were @ ( @-@ @ ) and @ ( @-@ @ ) , respectively ; the risk of SGA was not significant .


Nulliparity was associated with higher risks of PTB ( @ -LSB- @-@ @ -RSB- ) , LBW ( @ -LSB- @-@ @ -RSB- ) , and SGA ( @ -LSB- @-@ @ -RSB- ) .


Number of embryos transferred was strongly associated with FHBs , with twice the risk of FHB > @ with @ ET vs. @-@ ET .


Increasing FHBs were associated with significantly greater risks for PTB and LBW outcomes .


The study was designed to compare the effectiveness of @ video laryngoscopes with the Miller laryngoscope during pediatric resuscitation .


This was a randomized crossover study involving @ paramedics and @ nurses .


The primary end point of the study was the success rate of blind tracheal intubation , whereas the secondary end point was defined as the time from insertion of a device to the first manual ventilation of the manikin 's lungs .


The median time to intubation using the Pentax , Truview , GlideScope , and Miller varied with the times being @ ( interquartile range -LSB- IQR -RSB- , @-@ ) vs @ ( IQR , @-@ @ ) vs @ ( IQR , @-@ ) vs @ ( IQR , @-@ @ ) seconds , respectively .


The overall success ratios of intubation for the devices were @ % vs @ % vs @ % vs @ % .


We concluded that , in a pediatric manikin scenario , the video laryngoscopes are safe devices and can be used for pediatric intubation during uninterrupted chest compressions .


Further clinical studies are necessary to confirm these initial positive findings .


Heart failure with preserved ejection fraction ( HFpEF ) comprises a large portion of heart failure patients and portends poor prognosis with similar outcome to heart failure with reduced ejection fraction ( HFrEF ) .


Thus far , no medical therapy has been shown to improve clinical outcome in this common condition .


The study is a randomized-controlled , multicenter clinical trial aimed to determine whether early posthospitalization comprehensive cardiac rehabilitation ( CR ) including exercise training ( ET ) in recently hospitalized HFpEF patients reduces the composite end point of all-cause mortality and hospitalizations in comparison with usual care ( UC ) .


After undergoing baseline evaluation , patients are randomized to either UC or to ambulatory comprehensive CR program .


Patients in the CR arm will participate in a @-month biweekly ET program according to a predefined protocol , in addition to a complementary home exercise prescribed by a specialist in CR .


Exercise training will include endurance and low-intensity resistance training .


Patients in the UC arm will be followed up at the outpatient clinic , with management according to current heart failure guidelines .