Postoperative epidural hematoma and empyema occurred in the control group but not in the study group .


Dural leakage after elective craniotomy/durotomy occurs more frequently in association with diabetes mellitus , elevated preoperative CRP levels , and the intraoperative need of a dural patch .


This randomized controlled trial showed no statistically significant reduction of postoperative CSF leakage and surgical site infections upon addition of TachoSil on the dural suture , but there was a significant reduction in the length of stay in the IMC unit .


Dural augmentation with TachoSil was safe and not related to adverse events .


Clinical trial registration no .


NCT@ ( http://www.ClinicalTrials.gov ) .


To assess over a @-month period functional results of the modified INTRACOR femtosecond laser-based intrastromal procedure to treat presbyopia .


@ eyes of @ presbyopic patients with mild hyperopia were included .


The INTRACOR procedure with a modified pattern ( six concentric intrastromal ring cuts ) was performed using the FEMTEC femtosecond laser ( Bausch + Lomb/Technolas Perfect Vision , Munich , Germany ) .


Patients were also randomly divided into three subgroups to compare the effect of three different small inner ring diameters ( @ / @ / @ mm ( Groups A/B/C ) ) .


Follow-up examinations were performed at @ , @ , @ , @ , @ and @months , and included near and distance visual acuity tests , slit-lamp examinations and corneal topography .


Median uncorrected near visual acuity ( UNVA ) increased from @ / @ / @ logMAR ( Groups A/B/C ) to -@ / @ / @ logMAR @months after surgery .


Uncorrected distance visual acuity changed slightly from @ / @ / @ logMAR to @ / @ / @ logMAR .


Losses of two lines of binocular corrected distance visual acuity ( CDVA ) were noted in @/@/@ % of eyes .


Median spherical equivalent changed from @ / @ / @ dioptres to -@ / @ / -@ dioptres .


Overall patient satisfaction with the procedure was @ % .


INTRACOR with a modified pattern improved UNVA in all patients over a @-month follow-up period .


The possibility of reduced CDVA underlines the need for careful patient selection .


To observe the effect of medicinal-cake-separated moxibustion combined with acupuncture on back-leg activities and plasma substance P ( SP ) levels in patients with lumbar disc herniation , so as to reveal its mechanism underlying pain relief .


A total of @ patients with lumbar disc herniation were randomly divided into control group ( n = @ ) and treatment group ( n = @ ) according to a random digits table .


Patients of the control group were treated by manual acupuncture stimulation of main acupoints Jiaji ( EX-B @ ) , Huantiao ( GB @ , affected side ) , Chengshan ( BL @ , affected side ) , Kunlun ( BL @ , affected side ) , and supplemented acupoints Yanglingquan ( GB @ ) , Weizhong ( BL @ ) and Zusanli ( ST @ ) in combination with wheat-flour-cake separated moxibustion at the main acupoints , and patients of the treatment group were treated by medicinal-cake -LSB- Chuanwu ( Radix Aconiti ) , Caowu ( Radix Aconiti Kusnezoffii ) , Ruxiang ( Olibanum ) , etc. -RSB- - separated moxibustion in combination with manual acupuncture stimulation of the same acupoints mentioned above .


Acupuncture treatment was conducted for @ min , followed by moxibustion for @ min .


The treatment was given once daily for @ days .


The patients ' back-leg functional activity ability was assessed using straight-leg raising test , and the pain state assessed using visual analogue scale ( VAS ) and Japanese Orthopaedic Association ( JOA ) scores , respectively .


The therapeutic effect was evaluated by using `` Crite - ria for Diagnosis and Outcome Evaluation of Clinical Disorders or Syndromes of Chinese Medicine '' issued in @ and plasma SP content was detected by radioimmunoassay .


After the therapy , the back-leg activity score and JOA score of both groups were significantly higher than those of pre-treatment in the same one group ( P < @ , P < @ ) , and those of the treatment group were significantly higher than those of the control group ( P < @ ) .


The VAS score of the treatment group was re - markably lower than that of the control group ( P < @ ) .


After the treatment , the plasma SP content was markedly lower in the treatment group than in the control group ( .


P < @O .


Medicinal-cake-separated moxibustion therapy can ame - liorate pain severity and functional activity of the back-leg pain patients with lumbar disc hernia , which may be related to its effect in reducing blood SP level .


To evaluate the efficacy and safety of etanercept plus Tripterygium wilfordii polyglycoside ( TWP ) in elderly patients with active rheumatoid arthritis ( RA ) .


Totally @ elderly patients with active RA were randomly assigned to the treatment group ( @ cases ) and the control group ( @ cases ) .


All patients received subcutaneous injection of etanercept , @ mg each time , twice per week .


The dosage was reduced to once per week @ months later .


Patients in the treatment group took TWP Tablet ( @ mg each time , three times per day ) , while those in the control group took methotrexate ( MTX ) , @ mg each time , once per week .


The whole course lasted for @ weeks .


Patients ' rest pain , tender joint number , swollen joint number , health assessment questionnaire ( HAQ ) , patients ' global assessment , physicians ' global assessment , erythrocyte sediment rate ( ESR ) , C reactive protein ( CRP ) , rheumatic factor were assessed at week @ , @ , @ , @ , and @ .


The curative effect was statistically evaluated by the United States Institute of Rheumatology ACR@ , ACR@ , and ACR@ improvement criteria .


Meanwhile , any adverse event was recorded and evaluated .


Totally @ completed the trial , and @ dropped off ( @ in the treatment group and @ in the control group ) .


Compared with the control group , there was no statistical difference in ACR@ , ACR@ , or ACR@ in the treatment group ( P > @ ) .


Compared with before treatment in the same group , there was some improvement in tender joint number , swollen joint number , visual analogue scale ( VAS ) for patients ' global assessment , VAS for physicians ' global assessment , ESR , CRP , and HAQ between the two groups , showing statistical difference ( P < @ ) .


Compared with the control group in the same phase , there was no statistical difference in the treatment group ( P > @ ) .


There was no statistical difference in the occurrence of adverse events between the two groups .


Etanercept plus TWP could achieve equivalent therapeutic effect to that of Etanercept plus MTX .


The two regimens could improve clinical signs , symptoms , and QOL related to RA .


They were well tolerated in the treatment of elderly patients with active RA .


Proficiency and self-confidence in the physical examination is poor among internal medicine residents and interest in ultrasound technology has expanded .


We aimed to determine whether a pocket-sized ultrasound improves the diagnostic accuracy and confidence of residents after a @-h training session and @ month of independent practice .


This was a randomized parallel group controlled trial .


Forty internal medicine residents in a single program at an academic medical center participated in the study .


Three hours of training on use of pocket-sized ultrasound was followed by @ month of independent practice .


The primary outcome was a comparison of the diagnostic accuracy of a physical exam alone versus a physical examination augmented with a pocket-sized ultrasound .


Other outcomes included confidence in exam findings and a survey of attitudes towards the physical exam and the role of ultrasound .


Residents in the intervention group using a pocket-sized ultrasound correctly identified an average of @ of the @ abnormal findings ( accuracy rate of @ % ) .


Those in the control group correctly identified an average of @ abnormal findings ( accuracy rate of @ % , p = @ ) .


Residents in the intervention group identified on average @ findings as abnormal when no abnormality existed ( false positive rate of @ % ) .


Those in the control group incorrectly identified an average of @ positive findings ( false positive rate of @ % ) .


There was no difference between groups regarding self-assessed confidence in physical examination .


Residents in the intervention group identified @ of @ abnormal cardiac findings versus the control group 's @ of @ , an accuracy rate of @ % versus @ % ( p = @ ) .


The diagnostic ability of internal medicine residents did not significantly improve with use of a pocket-sized ultrasound device after a @-h training session and @ month of independent practice .


To evaluate whether using long-axis or short-axis view during ultrasound-guided internal jugular and subclavian central venous catheterization results in fewer skin breaks , decreased time to cannulation , and fewer posterior wall penetrations .


Prospective , randomized crossover study .


Urban emergency department with approximate annual census of @,@ .


Emergency medicine resident physicians at the Denver Health Residency in Emergency Medicine , a postgraduate year @-@ training program .


Resident physicians blinded to the study hypothesis used ultrasound guidance to cannulate the internal jugular and subclavian of a human torso mannequin using the long-axis and short-axis views at each site .


An ultrasound fellow recorded skin breaks , redirections , and time to cannulation .


An experienced ultrasound fellow or attending used a convex @-@ MHz transducer during cannulation to monitor the needle path and determine posterior wall penetration .


Generalized linear mixed models with a random subject effect were used to compare time to cannulation , number of skin breaks and redirections , and posterior wall penetration of the long axis and short axis at each cannulation site .


Twenty-eight resident physicians participated : eight postgraduate year @ , eight postgraduate year @ , five postgraduate year @ , and seven postgraduate year @ .


The median ( interquartile range ) number of total internal jugular central venous catheters placed was @ ( interquartile range , @-@ ) and subclavian was six catheters ( interquartile range , @-@ ) .


The median number of previous ultrasound-guided internal jugular catheters was @ ( interquartile range , @-@ ) , and ultrasound-guided subclavian catheters were three ( interquartile range , @-@ ) .


The long-axis view was associated with a significant decrease in the number of redirections at the internal jugular and subclavian sites , relative risk @ ( @ % CI , @-@ @ ) and relative risk @ ( @ % CI , @-@ @ ) , respectively .


There was no significant difference in the number of skin breaks between the long axis and short axis at the subclavian and internal jugular sites .


The long-axis view for subclavian was associated with decreased time to cannulation ; there was no significant difference in time between the short-axis and long-axis views at the internal jugular site .


The prevalence of posterior wall penetration was internal jugular short axis @ % , internal jugular long axis @ % , subclavian short axis @ % , and subclavian long axis @ % .


The odds of posterior wall penetration were significantly less in the subclavian long axis ( odds ratio , @ ; @ % CI , @-@ @ ) .


The long-axis view for the internal jugular was more efficient than the short-axis view with fewer redirections .


The long-axis view for subclavian central venous catheterization was also more efficient with decreased time to cannulation and fewer redirections .


The long-axis approach to subclavian central venous catheterization is also associated with fewer posterior wall penetrations .


Using the long-axis view for subclavian central venous catheterization and avoiding posterior wall penetrations may result in fewer central venous catheter-related complications .


IGF-I is thought to mediate many of the anabolic actions of GH , and there are anecdotal reports that IGF-I is misused by elite athletes .


There is no published evidence regarding the effects of IGF-I administration on athletic performance .


The objective of the study was to investigate the effects of IGF-I administration on body composition and physical fitness in recreational athletes .


This was a randomized , double-blind , placebo-controlled recombinant human ( rh ) IGF-I/rhIGF binding protein ( IGFBP ) -@ administration study at Southampton General Hospital ( Southampton , United Kingdom ) .


Fifty-six recreational athletes ( @ men , @ women ) participated in the study .


Participants were randomly assigned to receive placebo , low-dose rhIGF-I/rhIGFBP -@ ( @ mg/d ) , or high dose rhIGF-I/rhIGFBP -@ ( @ mg/d ) for @ days .


Body composition ( assessed by dual energy x-ray absorptiometry ) and cardiorespiratory fitness ( assessed by incremental treadmill test ) were measured before and immediately after treatment .


Within-individual changes after treatment were analyzed using paired t tests .


There were no significant changes in body fat mass or lean body mass in women or men after the administration of the rhIGF-I/rhIGFBP -@ complex .


There was a significant increase in maximal oxygen consumption ( VO@ max ) after treatment .


When women and men and low - and high-dose treatment groups were combined , mean VO@ max increased by approximately @ % ( P = @ ) .


No significant change in VO@ max was observed in the placebo group .


rhIGF-I/rhIGFBP -@ administration for @ days improves aerobic performance in recreational athletes , but there are no effects on body composition .


To compare the effectiveness of conventional and game-based oral health education on the oral health-related knowledge and oral hygiene status among @ - to @-year-old schoolchildren .


A total of @ children aged @ to @ years were divided into @ groups .


Each group had @ children aged @ to @ years and @ children aged @ to @ years .


A pretest evaluation of their knowledge regarding oral health and the estimation of Debris Index-Simplified ( DI-S ) was carried out .


Children in group A were given oral health education through flash cards once daily for @ days .


Children in group B were educated through the play method ( i.e. snakes and ladders game combined with flash cards ) .


The evaluations regarding oral hygiene and DI-S were recorded on post-intervention day @ and @ months after the intervention .


In group B , high knowledge scores of @ and @ were obtained by the @ - to @-year-olds and @ - to @-yearolds , respectively , on post-intervention day @ .


The lowest mean percentage difference of @ was seen in @ - to @-yearold children of group A after @ months .


In group B ( @-@ and @-@ ) and group A ( @-@ ) there was a significant increase in good oral hygiene scores and a significant decrease in fair and poor debris scores on post-intervention day @ and at the @-month follow-up .


The knowledge scores of both the younger and older groups of children increased considerably when the game-based teaching intervention was used .


Hence , it can be an effective aid for teaching basic oral health concepts to children .


This single-center , randomized , clinical trial was designed to determine the @-year comparative efficacy and durability of carotid angioplasty and stenting ( CAS ) versus carotid endarterectomy ( CEA ) in preventing ipsilateral ischemic stroke in symptomatic and asymptomatic patients with high-grade carotid artery stenosis .


Modern clinical trials with short-term follow-up indicate CAS and CEA are equivalent in reducing the risk for ipsilateral ischemic stroke secondary to carotid stenosis .


A paucity of data exists regarding long-term outcomes .


Patients of all surgical risks with symptomatic and asymptomatic carotid stenosis ( > @ % ) were randomly selected for CEA or CAS and followed a minimum of @ years .


Long-term follow-up was achieved in @ patients ( @ % ) .


Eighty-seven ( @ % ) died within this period , most commonly of nonvascular causes .


No difference in the risk of stroke ipsilateral to the treated artery was noted among treatment groups ( p > @ ) .


Restenosis determined by sequential ultrasound was assessed only in the CAS group ( @ % ) and remained asymptomatic .


The combined risk of fatal or nonfatal heart attack over the @-year period was highest in individuals with symptomatic versus asymptomatic stenosis ( @ % vs. @ % ; hazard ratio -LSB- HR -RSB- : @ , @ % confidence interval -LSB- CI -RSB- : @ to @ , p = @ ) and was higher in all patients treated with CEA ( HR : @ , @ % CI : @ to @ , p = @ ) .


Long-term protection against ipsilateral stroke provided by CAS and CEA did not differ in this trial .


The @-year risk of fatal/nonfatal myocardial infarction was highest in all patients harboring symptomatic carotid stenosis at enrollment .


The risk of fatal/nonfatal heart attack was significantly more prevalent in those symptomatic or asymptomatic patients randomized to CEA .


Reductions in drinking among individuals randomised to control groups in brief alcohol intervention trials are common and suggest that asking study participants about their drinking may itself cause them to reduce their consumption .


We sought to test the hypothesis that the statistical artefact regression to the mean ( RTM ) explains part of the reduction in such studies .


@ participants in a cohort study of alcohol consumption in New Zealand provided data at baseline and again six months later .


We use graphical methods and apply thresholds of @ , @ , @ and @ in AUDIT scores to explore RTM .


There was a negative association between baseline AUDIT scores and change in AUDIT scores from baseline to six months , which in the absence of bias and confounding , is RTM .


Students with lower baseline scores tended to have higher follow-up scores and conversely , those with higher baseline scores tended to have lower follow-up scores .


When a threshold score of @ was used to select a subgroup , the observed mean change was approximately half of that observed without a threshold .


The application of higher thresholds produced greater apparent reductions in alcohol consumption .


Part of the reduction seen in the control groups of brief alcohol intervention trials is likely to be due to RTM and the amount of change is likely to be greater as the threshold for entry to the trial increases .


Quantification of RTM warrants further study and should assist understanding assessment and other research participation effects .


Clinical trials are increasingly being conducted as new products seek to enter the market .


Deployment of such interventions is based on evidence obtained mainly from the gold standard of randomized controlled clinical trials ( RCCT ) .


A crucial factor in the ability of RCCTs to provide credible and generalisable data is sample size and retention of the required number of subjects at completion of the follow-up period .


However , recruitment and retention in clinical trials are hindered by prevalent peculiar challenges in Africa that need to be circumvented .


This article shares experiences from a phase II trial that recorded a high retention rate at @ months follow-up at a new clinical trial site .


Mothers bringing children less than two months of age to the health facility were given information and invited to have their child enrolled if the inclusion criteria were fulfilled .


Participants were enrolled over @ months .


Trial procedures , duration and risks/benefits were painstakingly and sequentially explained to the communities , parents and relevant relatives before and during the trial period .


The proportions of participants that completed or did not complete the trial were analyzed including the reasons for failure to complete all trial procedures .


@ individuals received information regarding the trial of which @ returned for screening .


@ ( @ % ) of them who fulfilled the inclusion criteria and did not meet any exclusion criteria were enrolled and @ % of these completed the trial .


Consent withdrawal was the main reason for not completing the trial largely ( @ % ) due to the father not being involved at the point of consenting or parents no longer being comfortable with blood sampling .


Participant retention in clinical trials remains a crucial factor in ensuring generalisability of trial data .


Appropriate measures to enhance retention should include continuous community involvement in the process , adequate explanation of trial procedures and risks/benefits ; and innovative tracing of participants adapted for the setting .


Symptomatic hip osteoarthritis ( OA ) is a disabling condition with up to a @ % cumulative lifetime risk .


Total hip arthroplasty ( THA ) is effective in relieving patients ' symptoms and improving function .


It is , however , associated with substantial risk of complications , pain and major functional limitation before patients can return to full function .


In contrast , hip arthroscopy ( HA ) is less invasive and can postpone THA .


However , there is no evidence regarding the delay in the need for THA that patients would find acceptable to undergoing HA .


Knowing patients ' values and preferences ( VP ) on this expected delay is critical when making recommendations regarding the advisability of HA .


Furthermore , little is known on the optimal amount of information regarding interventions and outcomes needed to present in order to optimally elicit patients ' VP .


We will perform a multinational , structured interview-based survey of preference in delay time for THA among patients with non-advanced OA who failed to respond to conservative therapy .


We will combine these interviews with a randomised trial addressing the optimal amount of information regarding the interventions and outcomes required to elicit preferences .


Eligible patients will be randomly assigned ( @:@ ) to either a short or a long format of health scenarios of THA and HA .


We will determine each patient 's VP using a trade-off and anticipated regret exercises .


Our primary outcomes for the combined surveys will be : ( @ ) the minimal delay time in the need for THA surgery that patients would find acceptable to undertaking HA , ( @ ) patients ' satisfaction with the amount of information provided in the health scenarios used to elicit their VPs .


From @ to @ , the annual incidence of inpatient treatment for distal radius fracture in Germany rose from @ to @ per @ @ persons .


It is unclear whether open reduction and volar angle-stable plate osteosynthesis ( ORIF ) , a currently advocated treatment , yields a better functional outcome or quality of life than closed reposition and casting .


In the ORCHID multi-center trial , @ patients aged @ and older with an AO type C distal radial fracture were randomly assigned to ORIF or closed reposition and casting .


Their health-related quality of life and hand/arm function were assessed @ and @ months afterward with the Short Form @ ( SF-@ ) questionnaire and the Disability of the Arm , Shoulder and Hand ( DASH ) questionnaire .


The radiological findings , range of movement of the wrist , and EuroQol-@D ( EQ-@D ) scores were documented as well .


Among the @ patients in the intention-to-treat-analysis , there was no significant difference in SF-@ scores between the two treatment groups at one year ( mean difference , @ points in favor of ORIF ; @ % confidence interval , -@ +@ points ; p = @ ) .


The DASH scores showed moderately strong , but clinically unimportant effects in favor of ORIF , and there was no difference in EQ-@D scores .


ORIF led to better radiological results and wrist mobility at @ months , with comparable results at @ months .


@ of the patients initially allotted to nonsurgical treatment underwent secondary surgery due to significant loss of reduction .


The findings with respect to mobility , functionality , and quality of life at @ months provide marginal and inconsistent evidence for the superiority of volar angle-stable plate osteosynthesis over closed reduction and casting in the treatment of intra-articular distal radius fractures .


Primary nonsurgical management is also effective in suitable patients .


Secondary acute myeloid leukemia ( sAML ) , defined as AML arising after a prior myelodysplastic syndrome or after antineoplastic therapy , responds poorly to current therapies .


It is often associated with adverse karyotypic abnormalities and overexpression of proteins that mediate drug resistance .


We performed a phase III trial to determine whether induction therapy with cytarabine and amonafide L-malate , a DNA intercalator and non-ATP-dependent topoisomerase II inhibitor that evades drug resistance mechanisms , yielded a superior complete remission rate than standard therapy with cytarabine and daunorubicin in sAML .


Patients with previously untreated sAML were randomly assigned at a one-to-one ratio to cytarabine @ mg/m ( @ ) continuous intravenous ( IV ) infusion once per day on days @ to @ plus either amonafide @ mg/m ( @ ) IV over @ hours on days @ to @ ( A + C arm ) or daunorubicin @ mg/m ( @ ) IV over @ minutes once per day on days @ to @ ( D + C arm ) .


The complete remission ( CR ) rate was @ % ( @ of @ patients ) in A + C arm and @ % ( @ of @ patients ) in D + C arm ( P = @ ) .


The @ - and @-day mortality rates were @ % and @ % in A + C arm and @ % and @ % in D + C arm , respectively .


Induction treatment with A + C did not improve the CR rate compared with D + C in patients with sAML .


To investigate the clinical efficacy of three toothpastes in controlling established gingivitis and plaque over @ months .


@ subjects were enrolled in a single-center , double-blind , parallel group , randomized clinical study .


Subjects were randomly assigned to one of three treatments : triclosan/copolymer/fluoride dentifrice containing @ % triclosan , @ % copolymer and @,@ ppm F as sodium fluoride in a silica base ; herbal/bicarbonate dentifrice containing herbal extract and @,@ ppm F as sodium fluoride in a sodium bicarbonate base ; or fluoride dentifrice containing @ ppm F as sodium fluoride , and @,@ ppm F as sodium monofluorophosphate .


Subjects were instructed to brush their teeth twice daily for @ minute for @ months .


After @ months , subjects assigned to the triclosan/copolymer/fluoride group exhibited statistically significant reductions in gingival index scores and plaque index scores as compared to subjects assigned to the herbal/bicarbonate group by @ % and @ % , respectively .


There were no statistically significant differences in gingival index and plaque index between subjects in the herbal / bicarbonate group and those in the fluoride group .


The triclosan/copolymer/fluoride dentifrice was statistically significantly more effective in reducing gingivitis and dental plaque than the herbal/bicarbonate dentifrice , and this difference in efficacy was clinically meaningful .


Although asthma is characterized by variable airways obstruction , most studies of asthma phenotypes are cross-sectional .


The stability of phenotypes defined either by biomarkers or by physiological variables was assessed by repeated measures over @year in the Pan-European BIOAIR cohort of adult asthmatics .


A total of @ patients , @ with severe asthma ( SA ) and @ with mild-to-moderate asthma ( MA ) , were examined at six or more visits during @year .


Asthma phenotype clusters were defined by physiological variables ( lung function , reversibility and age of onset of the disease ) or by biomarkers ( eosinophils and neutrophils in induced sputum ) .


After @year of follow-up , the allocation to clusters was changed in @ % of all asthma patients when defined by physiological phenotypes and , remarkably , in @ % of the patients when stratified according to sputum cellularity ( P = @ ) .


In the SA cohort , @ % and @ % of the patients changed allocation according to physiological and biomarker clustering , respectively .


Variability of phenotypes was not influenced by change in oral or inhaled corticosteroid dose , nor by the number of exacerbations .


Lower stability of single and repeated measure was found for all evaluated biomarkers ( eosinophils , neutrophils and FeNO ) in contrast to good stability of physiological variables ( FEV@ ) , quality of life and asthma control .


Phenotypes determined by biomarkers are less stable than those defined by physiological variables , especially in severe asthmatics .


The data also imply that definition of asthma phenotypes is improved by repeated measures to account for fluctuations in lung function , biomarkers and asthma control .


To investigate women 's understanding of prenatal testing options and of their own experience with screening , diagnostic genetic testing , or both .


This was a secondary analysis of data from a randomized controlled trial of enhanced information and values clarification regarding prenatal genetic testing in the absence of financial barriers to testing .


Women in the third trimester of pregnancy were asked whether they had discussed prenatal genetic testing with their health care providers , whether they understood this testing was optional , and whether they had undergone testing during their pregnancy .


Multivariable logistic regression models were fit to determine independent predictors of these outcomes .


Data were available from @ study participants .


Discussions about screening tests were reported by @ participants ( @ % ) ; only @ ( @ % ) reported discussing diagnostic testing .


That screening and diagnostic testing were optional was evident to approximately two thirds of women ( n = @ and @ , respectively ) .


Recall of actual tests undergone was correct for @ ( @ % ) for screening and for @ ( @ % ) for diagnostic testing .


Racial , ethnic and socioeconomic variation existed in the understanding of whether screening and diagnostic tests were optional and in the correct recall of whether screening had been undertaken in the current pregnancy .


In the usual care group , women receiving care in low-income settings were less likely to recall being offered diagnostic testing ( adjusted odds ratio @ -LSB- @-@ @ -RSB- ) .


Disparities exist in women 's recall of prenatal genetic testing discussions and their understanding of their own experience .


Interventions that explain testing options to women and help clarify their preferences may help to eliminate these differences .


New antithrombotic drugs for prevention and treatment of thromboembolic disorders in AF that are less demanding on local staff and facilities than warfarin should be welcomed if proved successful .


The comparative value and possible dangers of substituting the new drug dabigatran as a replacement remain to be established .


Its safety and effectiveness must be reviewed and assessed by further study .


Clinical results of the European Action on Anticoagulation ( EAA ) computer-assisted dosage study and the Randomized Evaluation of Long-Term Anticoagulation Therapy ( RE-LY ) trial have been compared .


Clinical events were lower in patients on warfarin in the EAA study compared to patients on both warfarin and dabigatran in the RE-LY study .


Evaluations should recognize optimum requirements for safe and effective administration of both types of drug .


In the warfarin arm improvements in effectiveness and safety recently introduced ( i.e. the PT/INR line and variance growth analysis ) should be included as they have been shown to be successful in improved prediction of bleeding and further thromboembolism .


The incidence of bleeding with dabigatran , for which there is no antidote , will require evaluation .


Cardiac troponin and B-type natriuretic peptide ( BNP ) concentrations are associated with adverse cardiovascular outcome in primary prevention populations .


Whether statin therapy modifies this association is poorly understood .


We measured high-sensitivity cardiac troponin I ( hsTnI ) in @ and BNP in @ participants without cardiovascular disease in the Justification for the Use of Statins in Prevention : An Intervention Trial Evaluating Rosuvastatin ( JUPITER ) trial before randomization to rosuvastatin @ mg/d or placebo .


Nearly @ % of participants had detectable circulating hsTnI , and @ % of men and @ % of women had levels above proposed sex-specific reference limits of @ and @ ng/L , respectively .


hsTnI concentrations in the highest tertile were associated with a first major cardiovascular event ( adjusted hazard ratio -LSB- aHR -RSB- , @ ; @ % confidence interval , @-@ @ ; P for trend < @ ) .


BNP levels in the highest tertile were also associated a first cardiovascular event ( aHR , @ ; @ % confidence interval , @-@ @ ; P for trend < @ ) .


The risk of all-cause mortality was elevated for the highest versus the lowest tertiles of hsTnI ( aHR , @ ; @ % confidence interval , @-@ @ ; P for trend < @ ) and BNP ( aHR , @ ; @ % confidence interval , @-@ @ ; P for trend @ ) .


Rosuvastatin was equally effective in preventing a first cardiovascular event across categories of hsTnI ( aHR range , @-@ @ ) and BNP ( aHR range , @-@ @ ) with no statistically significant evidence of interaction ( P for interaction = @ and @ , respectively ) .


In a contemporary primary prevention population , baseline cardiac troponin I and BNP were associated with the risk of vascular events and all-cause mortality .


The benefits of rosuvastatin were substantial and consistent regardless of baseline hsTnI or BNP concentrations .


To test the efficacy of nutritional guidelines for school lunch cooks aiming to reduce added sugar in school meals and their own sugar intake .


A controlled randomized cluster trial was carried out in twenty public schools in the municipality of Niteroi in Rio de Janeiro , Southeastern Brazil , from March to December @ .


A nutrition educational program was implemented in the schools in question through messages , activities and printed educational materials encouraging reduced levels of added sugar in school meals and in the school lunch cooks ' own intake .


The reduced availability of added sugar in schools was evaluated using spreadsheets including data on the monthly use of food item supplies .


The cooks ' individual food intake was evaluated by a Food Frequency Questionnaire .


Anthropometric measurements were taken according to standardized techniques and variation in weight was measured throughout the duration of the study .


There was a more marked reduction in the intervention schools compared to the control schools ( -@ kg versus @ kg ) , but no statistically significant difference ( p = @ ) , although the study power was low .


Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages , but the difference in sugar intake was not statistically significant .


Weight loss and a reduction in total energy consumption occurred in both groups , but the difference between them was not statistically significant , and there was no alteration in the percentages of adequacy of macronutrients in relation to energy consumption .


The strategy of reducing the use and consumption of sugar by school lunch cooks from public schools could not be proved to be effective .


To characterize via NMR spectroscopy the full spectrum of metabolic changes in umbilical vein blood plasma of newborns diagnosed with different clinical forms of intrauterine growth restriction ( IUGR ) .


@ early IUGR cases and matched @ adequate-for-gestational-age ( AGA ) controls and @ late IUGR cases with @ matched AGAs were included in this study .


Early IUGR was defined as a birth weight < @ ( th ) centile , abnormal umbilical artery ( UA ) Doppler and delivery < @ weeks .


Late IUGR was defined as a birth weight < @ ( th ) centile with normal UA Doppler and delivery > @ weeks .


This group was subdivided in @ vasodilated ( VD ) and @ non-VD late IUGR fetuses .


All AGA patients had a birth weight > @ ( th ) centile .


( @ ) H nuclear magnetic resonance ( NMR ) metabolomics of the blood samples collected from the umbilical vein at delivery was obtained .


Multivariate statistical analysis identified several metabolites that allowed the discrimination between the different IUGR subgroups , and their comparative levels were quantified from the NMR data .


The NMR-based analysis showed increased unsaturated lipids and VLDL levels in both early and late IUGR samples , decreased glucose and increased acetone levels in early IUGR .


Non-significant trends for decreased glucose and increased acetone levels were present in late IUGR , which followed a severity gradient when the VD and non-VD subgroups were considered .


Regarding amino acids and derivatives , early IUGR showed significantly increased glutamine and creatine levels , whereas the amounts of phenylalanine and tyrosine were decreased in early and late-VD IUGR samples .


Valine and leucine were decreased in late IUGR samples .


Choline levels were decreased in all clinical subforms of IUGR .


IUGR is not associated with a unique metabolic profile , but important changes are present in different clinical subsets used in research and clinical practice .


These results may help in characterizing comprehensively specific alterations underlying different IUGR subsets .


To compare intraocular lens implantation using a motorized injector vs standard manual injector through a @-mm clear corneal incision .


Patients underwent standard phacoemulsification using a @-mm clear corneal incision .


Hydrophobic acrylic aspheric intraocular lens ( Acrysof SN@WF intraocular lens ( IOL ) ) was inserted using D cartridge with manual monarch injector or autosert motorized injector .


IOL safety , final incision size and wound integrity in terms of anterior and posterior wound gape , and descemet 's membrane detachment were compared between the two groups at post-operative day @ and at @ month using Anterior Segment Optical Coherence Tomography .


The study recruited @ patients in the group I ( manual injector ) and @ patients in group II ( motorized injector ) .


In group I , the final incision after IOL insertion increased by @ mm ( @ % CI : @-@ @ ) ( P < @ ) , which was seen in @ % of the patients .


In group II , the incision enlarged by @ ( @ % CI : @-@ @ ) ( P = @ ) and was seen in only @ % of the cases .


IOL nicks were seen in @ % of the cases in group I only .


Although the incidence of descemet 's membrane detachment and anterior wound gape was similar for both groups , posterior wound gape was seen more often with the manual injector in the immediate post-operative period .


( P = @ ) CONCLUSION : The motorized insertion system was gentle and safe for the IOLs with lesser incidence of IOL nicks .


Regarding wound safety , it caused significantly less incision enlargement and better posterior wound integrity .


To discuss the drug intervention in diversity changes of TCRVbeta gene in AIDS patients with incomplete immune reconstitution .


PBMCs were isolated from @ cases of AIDS patients failure to immune reconstitution before and after treatment with immune @ and @ cases of HIV negative healthy donors .


The human gene TCRVbeta CDR@ diversity quantitative detection reagent box were used , and mapped the distribution of gene scanning and calculated different CDR@ fragme of each Vbeta family size .


Compared with the normal group , there appeared some single or oligoclonal amplification of Vbeta CDR@ region in the patients , which were improved or recovered after treatment .


Among them , D value of four families ( @ , @ , @ , @ ) decreased after treatment in both groups .


The decrease in family @ and @ was significant ( P < @ ) in treatment group compared with the control group .


And family @ was decreased in treatment group and increased significantly in control group ( P < @ ) .


Study of the mechanism showed oligoclonal of TCRVbeta family can get recovery in some degrees after treated by Immune @ plus HAART , suggesting that the medicine may promote T-cell receptor gene rearrangement , helping immune cells to effectively identify the virus to reduce T-cell apoptosis .


Mother-to-child transmission of HIV remains an important public health problem in sub-Saharan Africa .


As HIV testing and linkage to PMTCT occurs in antenatal care ( ANC ) , major challenges for any PMTCT option in developing countries , including Tanzania , are delays in the first ANC visit and a low overall number of visits .


Community health workers ( CHWs ) have been effective in various settings in increasing the uptake of clinical services and improving treatment retention and adherence .


At the beginning of this trial in January @ , the World Health Organization recommended either of two medication regimens , Option A or B , for prevention of mother-to-child transmission of HIV ( PMTCT ) .


It is still largely unclear which option is more effective when implemented in a public healthcare system .


This study aims to determine the effectiveness , cost-effectiveness , acceptability , and feasibility of : ( @ ) a community health worker ( CWH ) intervention and ( @ ) PMTCT Option B in improving ANC and PMTCT outcomes .


This study is a cluster-randomized controlled health systems implementation trial with a two-by-two factorial design .


All @ administrative wards in the Kinondoni and Ilala districts in Dar es Salaam were first randomly allocated to either receiving the CHW intervention or not , and then to receiving either Option B or A. Under the standard of care , facility-based health workers follow up on patients who have missed scheduled appointments for PMTCT , first through a telephone call and then with a home visit .


In the wards receiving the CHW intervention , the CHWs : ( @ ) identify pregnant women through home visits and refer them to antenatal care ; ( @ ) provide education to pregnant women on antenatal care , PMTCT , birth , and postnatal care ; ( @ ) routinely follow up on all pregnant women to ascertain whether they have attended ANC ; and ( @ ) follow up on women who have missed ANC or PMTCT appointments .


Spinal anesthesia is widely used for caesarean section due to its rapid onset , low failure rate , complete analgesia .


Addition of intrathecal ketamine and opioids to local anaesthetics seems to improve the quality of block and prolong the duration of analgesia .


The purpose of this study was to compare the effect of intrathecal ketamine mixed with hyperbaric bupivacaine to intrathecal fentanyl mixed with hyperbaric bupivacaine .


One hundred parturients ASA Grade I scheduled for elective or semiurgent caesarean section under spinal anaesthesia were randomly divided into two groups .


Group A received @ml ( @ mg ) hyperbaric bupivacaine @ % plus @ mg preservative free ketamine .


Group B received @ml ( @mg ) hyperbaric bupivacaine @ % plus @g fentanyl .


The patients were observed intraoperatively for the onset of sensory block , degree of motor block and total duration of analgesia .


The time to achieve Bromage scale @ motor blockade was shorter in Group A than in Group B. ( p = @ ) whereas time to achieve highest dermatomal level of sensory block was shorter in Group A than in Group B ( p = @ ) .


The duration of spinal analgesia was longer in Group B than in Group A ( p = @ ) .


The frequency of side effect such as sedation score was higher in Group A compared to Group B ( p = @ ) .


The incidence of pruritus was significantly higher in Group B compared to Group A ( p = @ ) .


Addition of preservative free ketamine lead to faster onset of sensory and motor blockade , although it did not prolong the duration of spinal analgesia compared to addition of fentanyl in parturients undergoing caesarean section with spinal anaesthesia .


This study aims to determine the outcome of double-bundle anterior cruciate ligament ( ACL ) reconstruction using an allograft in comparison with ACL reconstruction using a double-bundle autograft or a single-bundle allograft .


A total of @ patients who accepted primary ACL reconstructions were divided randomly into three groups : double-bundle technique with autograft ( DB-AU group , n = @ ) , double-bundle technique with allograft ( DB-AL group , n = @ ) , and single-bundle technique with allograft ( SB group , n = @ ) .


The KT-@ arthrometer and pivot-shift tests were performed at @ , @ , and @ months after surgery , and clinical outcome measurements include the Lysholm score and the IKDC rating scales .


Radiological assessments evaluated arthritic changes and tunnel expansion at @ months postoperatively .


The KT-@ test scores in the DB-AU and DB-AL groups were significantly better than those in the SB group at @ and @ months postoperatively ( P < @ ) .


The pivot-shift tests scores in the DB-AU and DB-AL groups were significantly better than those in the SB group at the @ , @ , and @ month follow-ups ( P < @ ) .


Based on the IKDC score and Lysholm score , there were no significant difference between the three groups during follow-up ( P > @ ) .


At @ months postoperatively , @ % of patients in the SB group showed a progression in arthritic changes , which was greater than in the DB-AU ( @ % ) and DB-AL ( @ % ) groups ( P < @ ) .


At @ months , the rates of tunnel expansion in the DB-AU group and the DB-AL group were lower than in the SB group ( P < @ ) .


Double-bundle ACL reconstruction can be used to achieve better anterior and rotational stability and has a lower rate of arthritic progression and tunnel expansion than the single-bundle procedure .


Fixed-dose combination of isosorbide dinitrate and hydralazine ( FDC-I/H ) reduced mortality by @ % and death or first hospitalization for heart failure ( HF ) by @ % in the African-American Heart Failure Trial ( A-HeFT ) .


Reduction in mortality makes it difficult to determine the effect on hospitalizations unless the analysis adjusts for death as a competing risk .


In A-HeFT , @ self-identified black patients with moderate to severe HF were randomized to FDC-I/H or placebo .


The effects of FDC-I/H on first and all hospitalizations and @-day readmission rates were analyzed .


Deaths as competing risks were adjusted using Fine-Gray regression and joint models of hospitalizations and mortality .


There were @ all-cause and @ HF hospitalizations in placebo compared with @ and @ hospitalizations in the FDC-I/H group .


Adjusting for deaths as a competing risk , the effect of FDC-I/H on the first hospitalization for HF , expressed in hazard ratio ( @ % confidence interval ) , was @ ( @-@ @ ; P < @ ) and @ ( @-@ @ ; P = @ ) on the first all-cause hospitalization .


The effect of FDC-I/H on all recurrent hospitalizations for HF was @ ( @-@ @ ; P = @ ) , similar to the effect on the first hospitalizations for HF , whereas the effect on all hospitalizations for any cause was @ ( @-@ @ ; P = @ ) .


The @-day all-cause readmission rate after the first hospitalization for HF was @ % ( @ of @ ) in placebo versus @ % ( @ of @ ) in the FDC-I/H group , but the effect ( @ ; @-@ @ ; P = @ ) in this small subgroup was not significant .


Treatment with FDC-I/H was associated with a substantial reduction in the first and recurrent HF hospitalizations , and in total all-cause hospitalizations , reducing the total burden of costly and distressing hospitalizations .


Hemodialysis patients are at risk of serious health complications , yet treatment non-adherence remains high .


Warnings about health risks associated with non-adherence may trigger defensive reactions .


We studied whether an intervention based on self-affirmation theory ( Steele @ ) reduced patients ' resistance to health-risk information and improved adherence .


One hundred twelve patients either self-affirmed or completed a matched control task before reading about the risks associated with a lack of phosphate control .


Serum phosphate was collected from baseline up to @months .


Self-affirmed patients had significantly reduced serum phosphate levels at @ and @months .


However , contrary to the predictions derived from self-affirmation theory , self-affirmed participants and controls did not differ in their evaluation of the health-risk information , behavioural intention or self-efficacy .


A low-cost , high-reach health intervention based on self-affirmation theory was shown to reduce serum phosphate over a @month period .


Further work is required to identify mediators of the observed effects .


Bardoxolone methyl , an Nrf@-activating and nuclear factor-B-inhibiting semisynthetic oleanane triterpenoid compound , was evaluated in a phase @ trial ( BEACON ) in patients with type @ diabetes mellitus ( T@DM ) and stage @ chronic kidney disease ( CKD ) .


The trial was terminated because of an increase in heart failure events in the bardoxolone methyl group , many of which appeared related to fluid retention .


Thus , additional analyses were conducted to explain these serious adverse events .


Patients ( n = @,@ ) were randomized to receive once-daily bardoxolone methyl ( @ mg ) or placebo .


Twenty-four-hour urine collections were analyzed in a subset of the BEACON population and from a separate , open-label pharmacology study in patients with stage @b/@ CKD and T@DM administered @ mg bardoxolone methyl once daily for @ consecutive days .


Bardoxolone-methyl-treated patients in the BEACON substudy had a clinically meaningful reduction in urine volume and sodium excretion at week @ relative to baseline ( p < @ ) , and a separate study revealed that decreased sodium excretion and urine output occurred in some patients with stage @ CKD but not those with stage @b CKD .


The clinical phenotype of fluid overload and heart failure in BEACON was similar to that observed with endothelin receptor antagonists in advanced CKD patients , and preclinical data demonstrate that bardoxolone methyl modifies endothelin signaling .


The totality of the evidence suggests that through modulation of the endothelin pathway , bardoxolone methyl may pharmacologically promote acute sodium and volume retention and increase blood pressure in patients with more advanced CKD .


Continuous theta burst stimulation ( cTBS ) of the human primary motor cortex ( M@ ) induces long-term depression ( LTD ) - like plastic changes in corticospinal excitability , but several studies have reported high inter-subject variability of this effect .


Most studies use a tonic voluntary contraction of the target muscle before cTBS to set stimulation intensity ; however , it is unclear how this might affect response variability .


To examine the influence of pre-activation of the target hand muscle on inter-subject response variability to cTBS of the human M@ .


The response to cTBS was assessed by changes in motor evoked potential ( MEP ) amplitude in the right first dorsal interosseous ( FDI ) muscle .


For Study @ , ten healthy subjects attended two sessions .


They were instructed in one session to keep their FDI relaxed for the entire testing period ( pre-relax ) , and in the other to perform a @-min @ % of maximal voluntary tonic contraction @ min before cTBS ( pre-active ) .


For Study @ , data from our previous study were re-analyzed to extend the pre-relax condition to an additional @ subjects ( total n = @ ) .


cTBS-induced highly consistent LTD-like MEP depression in the pre-relax condition , but not in the pre-active condition .


Inter-subject response variability increased in the pre-active condition .


cTBS induces consistent LTD-like plasticity with low inter-subject variability if pre-activation of the stimulated motor cortex is avoided .


This affirms a translational potential of cTBS in clinical applications that aim at reducing cortical excitability .


Current thinking , which is based mainly on rodent studies , is that physiologic doses of folic acid ( pterylmonoglutamic acid ) , such as dietary vitamin folates , are biotransformed in the intestinal mucosa and transferred to the portal vein as the natural circulating plasma folate , @-methyltetrahydrofolic acid ( @-MTHF ) before entering the liver and the wider systemic blood supply .


We tested the assumption that , in humans , folic acid is biotransformed ( reduced and methylated ) to @-MTHF in the intestinal mucosa .


We conducted a crossover study in which we sampled portal and peripheral veins for labeled folate concentrations after oral ingestion with physiologic doses of stable-isotope-labeled folic acid or the reduced folate @-formyltetrahydrofolic acid ( @-FormylTHF ) in @ subjects with a transjugular intrahepatic porto systemic shunt ( TIPSS ) in situ .


The TIPSS allowed blood samples to be taken from the portal vein .


Fifteen minutes after a dose of folic acid , @ @ % of labeled folate in the hepatic portal vein was unmodified folic acid .


In contrast , after a dose of labeled @-FormylTHF , only @ @ % of labeled folate in the portal vein was unmodified @-FormylTHF , and the rest had been converted to @-MTHF after @ min ( postdose ) .


The human gut appears to have a very efficient capacity to convert reduced dietary folates to @-MTHF but limited ability to reduce folic acid .


Therefore , large amounts of unmodified folic acid in the portal vein are probably attributable to an extremely limited mucosal cell dihydrofolate reductase ( DHFR ) capacity that is necessary to produce tetrahydrofolic acid before sequential methylation to @-MTHF .


This process would suggest that humans are reliant on the liver for folic acid reduction even though it has a low and highly variable DHFR activity .


Therefore , chronic liver exposure to folic acid in humans may induce saturation , which would possibly explain reports of systemic circulation of unmetabolized folic acid .


Ankle sprains continue to pose a significant burden to the individual athlete , as well as to society as a whole .


However , despite ankle sprains being the single most common sports injury and despite an active approach by various Dutch organisations in implementing preventive measures , large-scale community uptake of these preventive measures , and thus actual prevention of ankle sprains , is lagging well behind .


In an attempt to bridge this implementation gap , the Dutch Consumer Safety Institute VeiligheidNL developed a freely available interactive App ( ` Strenghten your ankle ' translated in Dutch as : ` Versterk je enkel ; available for iOS and Android ) that contains - next to general advice on bracing and taping - a proven cost-effective neuromuscular program .


The ` Strengthen your ankle ' App has not been evaluated against the ` regular ' prevention approach in which the neuromuscular program is advocated through written material .


The aim of the current project is to evaluate the implementation value of the ` Strengthen your ankle ' App as compared to the usual practice of providing injured athletes with written materials .


In addition , as a secondary outcome measure , the cost-effectiveness will be assessed against usual practice .


The proposed study will be a randomised controlled trial .


After stratification for medical caregiver , athletes will be randomised to two study groups .


One group will receive a standardized eight-week proprioceptive training program that has proven to be cost-effective to prevent recurrent ankle injuries , consisting of a balance board ( machU / MSG Europe BVBA ) , and a traditional instructional booklet .


The other group will receive the same exercise program and balance board .


However , for this group the instructional booklet is exchanged by the interactive ` Strengthen your ankle ' App .


This trial is the first randomized controlled trial to study the implementation effectiveness of an App for proprioceptive balance board training program in comparison to a traditional printed instruction booklet , with the recurrence of ankle sprains among athletes as study outcome .


Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains and in the use of mobile applications for injury prevention .


Results will become available in @ .


Topical glaucoma medications lower intraocular pressure and alter the course of the disease .


Because adherence with glaucoma medications is a known problem , interventions are needed to help those patients who do not take their medications as prescribed .


To assess the ability of an automated telecommunication-based intervention to improve adherence with glaucoma medications .


We performed a prospective cohort study of medication adherence , followed by a randomized intervention for those found to be nonadherent , of individuals recruited from a university-based glaucoma subspecialty clinic .


A total of @ participants were enrolled in the initial assessment of adherence .


Of those , @ were nonadherent with their medications after @ months of electronic monitoring and randomized to intervention and control groups .


A personal health record was used to store the list of patient medications and reminder preferences .


On the basis of those data , participants randomized to the intervention received daily messages , either text or voice , reminding them to take their medication .


Participants randomized to the control group received usual care .


Difference in adherence before and after initiation of the intervention .


Using an intent-to-treat analysis , we found that the median adherence rate in the @ participants randomized to the intervention increased from @ % to @ % ( P < @ ) .


There was no statistical change in @ participants in the control group .


To assess the real efficacy of the intervention , the same comparison was performed for the participants who successfully completed the study after randomization .


Analyzed this way , the adherence rate in the @ participants in the intervention group increased from @ % to @ % ( P < @ ) , whereas there was again no statistical change in the @ participants in the control group .


Eighty-four percent of the participants who received reminders agreed they were helpful and would continue using them outside the study .


Automated telecommunication-based reminders linked to data in a personal health record improved adherence with once-daily glaucoma medications .


This is an effective method to improve adherence that could realistically be implemented in ophthalmology practices with a minimum amount of effort on the part of the practice or the patient .


Rifapentine has potent activity in mouse models of tuberculosis chemotherapy but its optimal dose and exposure in humans are unknown .


We conducted a randomized , partially blinded dose-ranging study to determine tolerability , safety , and antimicrobial activity of daily rifapentine for pulmonary tuberculosis treatment .


Adults with sputum smear-positive pulmonary tuberculosis were assigned rifapentine @ , @ , or @ mg/kg or rifampin @ mg/kg daily for @ weeks ( intensive phase ) , with isoniazid , pyrazinamide , and ethambutol .


The primary tolerability end point was treatment discontinuation .


The primary efficacy end point was negative sputum cultures at completion of intensive phase .


A total of @ participants were enrolled .


At completion of intensive phase , cultures on solid media were negative in @ % of participants in the rifampin group versus @ % ( P = @ ) , @ % ( P = @ ) , and @ % ( P = @ ) in the rifapentine @ , @ , and @ mg/kg groups .


Liquid cultures were negative in @ % ( rifampin group ) versus @ % ( P = @ ) , @ % ( P = @ ) , and @ % ( P = @ ) , respectively .


Compared with the rifampin group , the proportion negative at the end of intensive phase was higher among rifapentine recipients who had high rifapentine areas under the concentration-time curve .


Percentages of participants discontinuing assigned treatment for reasons other than microbiologic ineligibility were similar across groups ( rifampin , @ % ; rifapentine @ , @ , or @ mg/kg , @ , @ , and @ % , respectively ) .


Daily rifapentine was well-tolerated and safe .


High rifapentine exposures were associated with high levels of sputum sterilization at completion of intensive phase .


Further studies are warranted to determine if regimens that deliver high rifapentine exposures can shorten treatment duration to less than @ months .


Clinical trial registered with www.clinicaltrials.gov ( NCT @ ) .


Rhomboid excision with Limberg flap repair ( RELIF ) is an effective surgical procedure in pilonidal sinus disease ( PSD ) treatment .


This study aimed to compare outcome of diathermy and scalpel in RELIF procedure in PSD surgery .


Patients undergoing RELIF procedure due to PSD at Adana Numune Training and Research Hospital between January @ and September @ were randomly assigned to diathermy ( n = @ ) or scalpel ( n = @ ) groups .


The primary outcomes measured were duration of operation , drainage volume , postoperative numerical pain intensity scale ( NPIS ) scores , complications , duration of hospitalization length and time to return to daily activity .


The mean age was @ years ( @-@ years ) .


The mean operation duration was significantly lower in diathermy group ( p = @ ) .


Postoperative total NPIS score within the first @ h was significantly lower in diathermy group ( p = @ ) .


However , there were not any significant differences in term of NPIS scores in day @ and day @ .


There were no significant differences in terms of total drain output , drain removal time and length of hospital stay .


There were no significant differences between groups in terms of duration to sit comfortably , return to daily activity and work .


Recurrence of PSD was emerged in one patient in the diathermy group .


Diathermy dissection in RELIF procedure in pilonidal sinus surgery is a safe technique and decreased operation time and postoperative pain .


A self-control study was designed to compare the process of creeping substitution between allograft bone and local bone grafting in lumbar interbody fusion .


From December @ to July @ , @ patients ( mean age : @ ) were included in this study and randomly allocated to two groups .


Leopard cages were using in unilateral instrumentation transforaminal lumbar interbody fusion .


In group @ , the cages were filled with the local bone on the side of the instrumentation and allograft bone on the other side .


In group @ , they were totally filled with the local bone chips .


Then , the special CT-reconstructions were made at @ - and @-month follow-up .


On the sagittal section , the sections of CT-reconstructions were perpendicular to the lateral axis of the cage from the side of the cage to the other side .


Similarly , they were parallel to the lateral axis of the cage on the coronal section and intervertebral space on the cross section .


The mean area size of bone mass on both sides of the cage was calculated , respectively , using image analysis software ( Osirix , version @ ) on each section in two groups .


In group @ , at @ - and @-month follow-up , significant differences were observed in the mean area size of bone mass between allograft bone and local bone grafting on the coronal , cross , and sagittal section .


In group @ , the mean area size of local bone on both sides of the cage had no significant differences at @ - and @-month follow-up on each section .


The results of our study showed a superiority of local bone grafting over allograft bone .


To evaluate the efficacy of sequential therapy of cryotherapy and sinecatechins @ % ointment BID versus cryotherapy alone in treatment of external genital warts ( EGW ) .


Forty-two subjects with at least two EGW lesions underwent cryotherapy to all lesions .


One week following cryotherapy , subjects were randomized @:@ to receive either no additional treatment or treatment with sinecatechins @ % ointment BID up to @ weeks or until complete clearance .


The total number of visible baseline and new EGW were recorded at each visit .


Subjects were followed for a total of @ weeks post-treatment .


There was a significant reduction in mean number of lesions from baseline after @ weeks of treatment in the cryotherapy-sinecatechins ointment group compared to cryotherapy alone ( -@ lesions vs -@ lesions respectively , P = @ ) .


Cryotherapy plus sinecatechins @ % ointment BID resulted in a significant improvement in the reduction of EGW compared to cryotherapy alone .


Clinicaltrials.gov registration identifier : NCT@ .


The MEK inhibitor , selumetinib , suppresses soft-tissue sarcoma ( STS ) cell proliferation in vitro .


Mammalian target of rapamycin inhibitors possess modest activity against STS ; however , resistance develops via MAPK pathway feedback activation .


The combination of selumetinib and temsirolimus synergistically inhibits STS cell line growth .


Therefore , a randomized phase II trial of selumetinib vs selumetinib plus temsirolimus was conducted .


Seventy-one adults with advanced STS who received @ prior chemotherapeutics were randomized to selumetinib @ mg p.o. bid and allowed to crossover upon progression , or to selumetinib @ mg p.o. bid plus temsirolimus @ mg i.v. weekly , with primary endpoint of progression-free survival ( PFS ) .


There was no difference in PFS between the two arms for the overall cohort ( median @ vs @ months ) ; an improved median PFS was observed in the combination arm ( N = @ ) over single agent ( N = @ ) in the prespecified leiomyosarcoma stratum ( median @ vs @ months ; P = @ ) .


Four-month PFS rate was @ % ( @ % confidence interval @-@ @ ) with the combination vs @ % with selumetinib alone in the leiomyosarcoma cohort .


Most common grade @/@ adverse events with the combination were mucositis ( @ % ) , lymphopenia ( @ % ) , neutropenia and anaemia ( @ % each ) .


While single-agent selumetinib has no significant activity in STS , the combination may be active for leiomyosarcomas .


More than seven out of @ Dutch construction workers describe their work as physically demanding .


Ergonomic measures can be used to reduce these physically demanding work tasks .


To increase the use of ergonomic measures , employers and workers have to get used to other working methods and to maintaining them .


To facilitate this behavioural change , participatory ergonomics ( PE ) interventions could be useful .


For this study a protocol of a PE intervention is adapted in such a way that the intervention can be performed by an ergonomics consultant through face-to-face contacts or email contacts .


The objective of this study is to evaluate the effectiveness of the face-to-face guidance strategy and the e-guidance strategy on the primary outcome measure : use of ergonomic measures by individual construction workers , and on the secondary outcome measures : the work ability , physical functioning and limitations due to physical problems of individual workers .


The present study is a randomised intervention trial of six months in @ companies to establish the effects of a PE intervention guided by four face-to-face contacts ( N = @ ) or guided by @ email contacts ( N = @ ) on the primary and secondary outcome measures at baseline and after six months .


Construction companies are randomly assigned to one of the guidance strategies with the help of a computer generated randomisation table .


In addition , a process evaluation for both strategies will be performed to determine reach , dose delivered , dose received , precision , competence , satisfaction and behavioural change to find possible barriers and facilitators for both strategies .


A cost-benefit analysis will be performed to establish the financial consequences of both strategies .


The present study is in accordance with the CONSORT statement .


The outcome of this study will help to @ ) evaluate the effect of both guidance strategies , and @ ) find barriers to and facilitators of both guidance strategies .


When these strategies are effective , implementation within occupational health services can take place to guide construction companies ( and others ) with the implementation of ergonomic measures .


The reported prevalence of radiological osteoarthritis ( OA ) after anterior cruciate ligament ( ACL ) reconstruction varies from @ % to @ % .


Purpose /


To report the prevalence of OA after ACL reconstruction and to compare the OA prevalence between quadrupled semitendinosus tendon ( ST ) and bone-patellar tendon-bone ( BPTB ) grafts .


The hypothesis was that there would be no difference in OA prevalence between the graft types .


The secondary aim was to study whether patient characteristics and additional injuries were associated with long-term outcomes .


Randomized controlled trial ; Level of evidence , @ .


Radiological examination results , Tegner activity levels , and Knee injury and Osteoarthritis Outcome Score ( KOOS ) values were determined in @ ( @ % ) of @ patients at a mean of @ years after ACL reconstruction randomized to an ST or a BPTB graft .


Osteoarthritis was defined according to a consensus by at least @ of @ radiologists of Kellgren-Lawrence grade @ .


Using regression analysis , graft type , sex , age , overweight , time between injury and reconstruction , additional meniscus injury , and a number of other variables were assessed as risk factors for OA @ years after ACL reconstruction .


Osteoarthritis of the medial compartment was most frequent , with @ % of OA cases in the ACL-reconstructed knee and @ % of OA cases in the contralateral knee ( P < @ ) .


There was no difference between the graft types : @ % of OA of the medial compartment for BPTB grafts and @ % for ST grafts ( P = @ ) .


The KOOS results were lower for patients with OA in all subscales , indicating that OA was symptomatic .


No difference in the KOOS between the graft types was found .


Meniscus resection was a strong risk factor for OA of the medial compartment ( odds ratio , @ ; @ % CI , @-@ @ ) in the multivariable logistic regression analysis .


A @-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee .


No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found .


An initial meniscus resection was a strong risk factor for OA ; the time between injury and reconstruction was not .


Microencapsulated sodium butyrate ( MSB ) has been previously associated with anti-inflammatory and regenerative properties regarding large bowel mucosa .


We aimed to examine a role of MSB in patients with diverticulosis , hypothesizing its potential for reduction of diverticulitis episodes and diverticulitis prevention .


Seventy-three patients with diverticulosis ( diagnosed in colonoscopy or/and barium enema or/and CT colography ) were recruited for the study and randomized .


The investigated group was administered MSB @ mg daily ; the control group was administered placebo .


After @ months , a total of @ patients completed the study and were subject to analysis ( @ subjects and @ controls ) .


During the study , the number of episodes of diverticulitis ( symptomatic diagnosis with acute pain , fever , and leukocytosis ) , hospitalizations , and surgery performed for diverticulitis were recorded .


Additionally , a question regarding subjective improvement of symptoms reflected changes in quality of life during the analysis .


After @ months , the study group noted a significantly decreased number of diverticulitis episodes in comparison to the control group .


The subjective quality of life in the study group was higher than in the control group .


There were no side effects of the MSB during the therapy .


MSB reduces the frequency of diverticulitis episodes , is safe , and improves the quality of life .


It can play a role in the prevention of diverticulitis .


Based on the early results of the Placement of Aortic Transcatheter Valves ( PARTNER ) trial , transcatheter aortic valve replacement ( TAVR ) is an accepted treatment for patients with severe aortic stenosis who are not suitable for surgery .


However , little information is available about the late clinical outcomes in such patients .


We did this randomised controlled trial at @ experienced valve centres in Canada , Germany , and the USA .


We enrolled patients with severe symptomatic inoperable aortic stenosis and randomly assigned ( @:@ ) them to transfemoral TAVR or to standard treatment , which often included balloon aortic valvuloplasty .


Patients and their treating physicians were not masked to treatment allocation .


The randomisation was done centrally , and sites learned of the assignment only after a patient had been screened , consented , and entered into the database .


The primary outcome of the trial was all-cause mortality at @ year in the intention-to-treat population , here we present the prespecified findings after @ years .


This study is registered with ClinicalTrials.gov , number NCT@ .


We screened @ patients , of whom @ were enrolled ( mean age @ years , Society of Thoracic Surgeons Predicted Risk of Mortality @ % , @ % female ) .


@ were assigned to TAVR treatment and @ were assigned to standard treatment .


@ patients crossed over from the standard treatment group and ten withdrew from study , leaving only six patients at @ years , of whom five had aortic valve replacement treatment outside of the study .


The risk of all-cause mortality at @ years was @ % in the TAVR group versus @ % in the standard treatment group ( hazard ratio @ , @ % CI @-@ ; p < @ ) .


At @ years , @ ( @ % ) of @ survivors in the TAVR group had New York Heart Association class @ or @ symptoms compared with three ( @ % ) of five in the standard treatment group .


Echocardiography after TAVR showed durable haemodynamic benefit ( aortic valve area @ cm ( @ ) at @ years , mean gradient @ mm Hg at @ years ) , with no evidence of structural valve deterioration .


TAVR is more beneficial than standard treatment for treatment of inoperable aortic stenosis .


TAVR should be strongly considered for patients who are not surgical candidates for aortic valve replacement to improve their survival and functional status .


Appropriate selection of patients will help to maximise the benefit of TAVR and reduce mortality from severe comorbidities .


Hepatitis C virus ( HCV ) infection is an important sociomedical problem worldwide because the chronification of the disease is frequent and the occurance of liver cirrhosis and hepatocellular carcinoma can be expected .


The aim of this study was to determine the way of infection , pathohistological changes of the liver , virus genotype presence and sustained virological response after pegylated interferon and ribavirin therapy in prison inmates .


The study included @ patients with chronic HCV infection classified in two groups managed during @-@ .


The first group consisted of prisoners ( n = @ ) and the second one of `` non-prisoners '' ( n = @ ) .


The patients from both groups underwent diagnostic preparation ( biochemical analyses , liver biopsy , hepatitis virus detection and genotypisation using polymerase chain reaction issue ) .


The treatment lasted for @ weeks for virus genotypes @ and @ , and @ weeks for genotypes @ and @ .


All the patients were males , approximately the same age ( @ + / - @ and @ + / - @ years ) .


Virus genotype @ was significantly more frequent in the prisoners ( p < @ ) , that demanded longer treatment ( @ weeks ) .


At the same time , statistically significant higher number of patients , `` non-prisoners '' , achieved a sustained virological response ( p < @ ) .


Intravenous drug abuse and tattoos , separately or together , are the most frequent way of infection in prisoners .


The dominant presence of virus genotype @ resulted in lower number of patients with sustained virological response , probably regardless prison environment and regime .


During spinal surgery , intraoperative monitoring of motor-evoked potentials ( MEPs ) is a useful means of assessing the intraoperative integrity of corticospinal pathways .


However , MEPs are known to be particularly sensitive to the suppressive effects of inhalational halogenated anesthetic agents .


To investigate the effects of increasing end-tidal concentrations of desflurane and sevoflurane anesthesia in a background of propofol and remifentanil with multipulse cortical stimulation on intraoperative monitoring of MEPs .


In this randomized crossover trial , @ consecutive patients ( @ in each arm ) undergoing major spine surgery , under a background anesthetic of propofol ( @ to @ mcg/kg/min ) and remifentanil ( @ to @ mcg/kg/min ) , were randomly assigned to receive the sequence of inhalational agents studied : either DES-SEVO ( desflurane followed by sevoflurane ) ; or SEVO-DES ( sevoflurane followed by desflurane ) .


Multiples ( @ , @ , and @ ) of minimum alveolar concentration ( MAC ) of desflurane and sevoflurane were administered .


After a washout period of @ minutes using high fresh oxygen/air flows , each of the patients then received the other gas as the second agent .


Cortical stimulation was achieved with a train of @ equivalent square pulses , each @ ms in duration , delivered at @ ms intervals .


MEP recordings were made in the upper limb ( UL ) from first dorsal interosseus and lower limb ( LL ) from tibialis anterior with subdermal needle electrodes .


At @ MAC desflurane , there was no statistical significant difference in transcranial-evoked MEP amplitudes from the baseline in both UL and LL stimulation .


However , this was not the case for sevoflurane for which even a low concentration at @ MAC significantly depressed MEP amplitudes of LL ( but not UL ) from baseline value .


Desflurane at @ and @ MAC depresses LL MEP to @ % and @ % of baseline , respectively ( P < @ ) , whereas sevoflurane at @ , @ , and @ MAC depresses LL MEP to @ % , @ % , and @ % of baseline , respectively ( P < @ ) .


There was no difference in latency of the responses at any MAC .


Inhalational anesthetic agents ( sevoflurane > desflurane ) suppress MEP amplitudes in a dose-dependent manner .


The use of @ MAC of desflurane ( but not sevoflurane ) provided good MEP recordings acceptable for clinical interpretation for both upper and LLs .


The LL appears to be more sensitive to anesthetic-induced depression compared with the UL .


All patients studied had normal neurological examination hence , these results may not be applicable to those with preexisting deficits .


Artemether-lumefantrine and artesunate-amodiaquine are first-line treatment for uncomplicated malaria in Cameroon .


No study has yet compared the efficacy of these drugs following the WHO recommended @-day follow-up period .


The goal of this study was to compare the clinical efficacy , tolerability and safety of artesunate-amodiaquine ( ASAQ ) , artemether-lumefantrine ( AL ) and dihydroartemisinin piperaquine ( DHAP ) among children aged less than ten years in two malaria-endemic ecological regions of Cameroon .


A three-arm , randomized , controlled , non-inferiority trial was conducted among children of either gender aged six months ( > @kg ) to ten years ( n = @ ) with acute uncomplicated Plasmodium falciparum infection .


Parents/guardians of children provided consent prior to randomization to receive ASAQ , DHAP or AL in the ratio of @:@:@ , respectively .


Treatment outcome was assessed based on standard WHO @ classification after @days of follow-up .


The primary outcome was PCR-corrected day-@ cure rates .


The non-inferiority , one-sided , lower limit asymptotic @ % confidence interval ( CI ) on the difference in PCR-corrected cure rates of ASAQ and DHAP when compared to AL was accepted if the lower limit of the CI was greater than -@ % .


Secondary outcomes were parasite and fever clearances and day @ haemoglobin changes .


PCR-corrected PP cure rates of @ , @ and @ , respectively , for AL , ASAQ and DHAP was observed .


The lower bound of the one-sided @ % CI calculated around the difference between day-@ cure rate point estimates in AL and ASAQ groups , AL and DHAP groups were , -@ % and -@ % respectively .


There were no statistical significant differences in parasite or fever clearance times between treatments , although fever clearance pattern was different between ASAQ and DHAP .


No statistical significant differences were observed in the occurrence of adverse events among treatment groups .


ASAQ and DHAP are considered safe and tolerable and are not inferior to AL in the treatment of uncomplicated P. falciparum malaria in Cameroonian children .


To study the effect of therapeutic hypothermia ( TH ) on deoxyribonucleic acid ( DNA ) damage and the neurodevelopmental outcome in term babies with perinatal asphyxia .


Babies in the hypothermia group were cooled for the first @ h , using gel packs .


Rectal temperature of @-@C was maintained .


Blood sample was collected before , at @ h and after completion of TH for assessment of comet assay and @-hydroxy@-deoxyguanosine ( @-OHdG ) .


Infants were followed up till @ months .


Baseline parameters were similar .


After @ h , the hypothermia group showed lower olive tail moment ( @ @ ) than the control group ( @ @ ) ( p < @ ) .


@-HDG levels increased significantly in the control group ( @ @ ) as compared to the hypothermia group ( @ @ ) ( p < @ ) .


Neurodevelopmental assessment at @ months showed significantly low motor and mental developmental quotient in the control than hypothermia group .


TH reduces oxidative stress-induced DNA damage and improves neurodevelopmental outcome .


< Trial registration No : CTRI/@/@ / @ >


To compare integrated automated load distributing band CPR ( iA-CPR ) with high-quality manual CPR ( M-CPR ) to determine equivalence , superiority , or inferiority in survival to hospital discharge .


Between March @ , @ and January @ , @ a randomized , unblinded , controlled group sequential trial of adult out-of-hospital cardiac arrests of presumed cardiac origin was conducted at three US and two European sites .


After EMS providers initiated manual compressions patients were randomized to receive either iA-CPR or M-CPR .


Patient follow-up was until all patients were discharged alive or died .


The primary outcome , survival to hospital discharge , was analyzed adjusting for covariates , ( age , witnessed arrest , initial cardiac rhythm , enrollment site ) and interim analyses .


CPR quality and protocol adherence were monitored ( CPR fraction ) electronically throughout the trial .


Of @ randomized patients , @ ( @ % ) met post enrollment exclusion criteria .


Therefore , @ ( @ % ) received iA-CPR and @ ( @ % ) M-CPR .


Sustained ROSC ( emergency department admittance ) , @h survival and hospital discharge ( unknown for @ cases ) for iA-CPR compared to M-CPR were @ ( @ % ) vs. @ ( @ % ) , @ ( @ % ) vs. @ ( @ % ) , @ ( @ % ) vs. @ ( @ % ) patients , respectively .


The adjusted odds ratio of survival to hospital discharge for iA-CPR compared to M-CPR , was @ ( @ % CI @-@ @ ) , meeting the criteria for equivalence .


The @ min CPR fraction was @ % for iA-CPR and @ % for M-CPR .


Compared to high-quality M-CPR , iA-CPR resulted in statistically equivalent survival to hospital discharge .


Certain disorders , such as depression and anxiety , to which serotonin dysfunction is historically associated , are also associated with lower assessments of other people 's trustworthiness .


Serotonergic changes are known to alter cognitive responses to threatening stimuli .


This effect may manifest socially as reduced apparent trustworthiness of others .


Trustworthiness judgments can emerge from either direct observation or references provided by third parties .


We assessed whether explicit judgments of trustworthiness and social influences on those judgments are altered by changes within serotonergic systems .


We implemented a double-blind between-subject design where @ healthy female volunteers received a single dose of the selective serotonin reuptake inhibitor ( SSRI ) citalopram ( @ mg ) , while @ control subjects ( matched on age , intelligence , and years of education ) received a placebo .


Subjects performed a face-rating task assessing how trustworthy they found @ unfamiliar others ( targets ) .


After each rating , the subjects were told how other subjects , on average , rated the same target .


The subjects then performed @ min of distractor tasks before , unexpectedly , being asked to rate all @ faces again , in a random order .


Compared to subjects receiving a placebo , subjects receiving citalopram rated targets as less trustworthy .


They also conformed more to opinions of others , when others rated targets to be even less trustworthy than subjects had initially indicated .


The two effects were independent of negative effects of citalopram on subjective state .


This is evidence that serotonin systems can mediate explicit assessment and social learning of the trustworthiness of others .


Sarcoplasmic reticulum ( SR ) Ca ( @ + ) - handling proteins play an important role in myocardial dysfunction after acute ischemia/reperfusion injury .


We hypothesized that nitrite would improve postresuscitation myocardial dysfunction by increasing nitric oxide ( NO ) generation and that the mechanism of this protection is related to the modulation of SR Ca ( @ + ) - handling proteins .


We conducted a randomized prospective animal study using male Sprague-Dawley rats .


Cardiac arrest was induced by intravenous bolus of potassium chloride ( @ g/g ) .


Nitrite ( @ nmol/g ) or placebo was administered when chest compression was started .


No cardiac arrest was induced in the sham group .


Hemodynamic parameters were monitored invasively for @ minutes after the return of spontaneous circulation ( ROSC ) .


Echocardiogram was performed to evaluate cardiac function .


Myocardial samples were harvested @ minutes and @ hour after ROSC .


Myocardial function was significantly impaired in the nitrite and placebo groups after resuscitation , whereas cardiac function ( i.e. , ejection fraction and fractional shortening ) was significantly greater in the nitrite group than in the placebo group .


Nitrite administration increased the level of nitric oxide in the myocardium @ min after resuscitation compared to the other two groups .


The levels of phosphorylated phospholamban ( PLB ) were decreased after resuscitation , and nitrite increased the phosphorylation of phospholamban compared to the placebo .


No significant differences were found in the expression of sarcoplasmic reticulum Ca ( @ + ) ATPase ( SERCA@a ) and ryanodine receptors ( RyRs ) .


postresuscitation myocardial dysfunction is associated with the impairment of PLB phosphorylation .


Nitrite administered during resuscitation improves postresuscitation myocardial dysfunction by preserving phosphorylated PLB protein during resuscitation .


Group medical clinics may improve diabetes and hypertension control , but data about dyslipidemia are limited .


We examined the impact of group medical clinics on lipids among patients with uncontrolled diabetes and hypertension .


Prespecified secondary analysis of @ veterans randomized to group medical clinics or usual care .


Lipids were assessed at study baseline , midpoint , and end .


We used linear mixed models to compare lipid levels between arms and generalized estimating equation models to compare low-density lipoprotein cholesterol ( LDL-C ) goal attainment .


An additional post hoc analysis examined intensification of cholesterol-lowering medications in both arms .


At baseline , mean total cholesterol was @ mg/dL ( SD @ ) , LDL-C @ mg/dL ( SD @ ) , and high-density lipoprotein cholesterol ( HDL-C ) @ mg/dL ( SD @ ) .


Median baseline triglycerides were @ mg/dL ( interquartile range @ ) .


By study end , mean total cholesterol and LDL-C in group medical clinics were @ mg/dL ( P = @ ) and @ mg/dL ( P = @ ) lower than usual care , respectively ; @ % of group medical clinic patients met goals for LDL-C , versus @ % of usual care patients ( P = @ ) .


Triglycerides and HDL-C remained similar between study arms .


Treatment intensification occurred in @ % of group medical clinic patients , versus @ % of usual care patients between study baseline and end ( P = @ ) .


The mean statin dose was higher in group medical clinic patients at study midpoint and end .


Group medical clinics appear to enhance lipid management among patients with diabetes and hypertension .


This may be a result of greater intensification of cholesterol-lowering medications in group medical clinics relative to usual care .


Red ginseng is prepared by steaming raw ginseng , a process believed to increase the pharmacological efficacy .


Further bioconversion of red ginseng through fermentation is known to increase its intestinal absorption and bioactivity , and bioconversion diminishes the toxicity of red ginseng 's metabolite .


This study was conducted to investigate the effects of daily supplementation with fermented red ginseng ( FRG ) on glycemic status in subjects with impaired fasting glucose or type @ diabetes .


This study was a four-week long , randomized , double-blind , placebo-controlled trial .


Forty-two subjects with impaired fasting glucose or type @ diabetes were randomly allocated to two groups assigned to consume either the placebo or fermented red ginseng ( FRG ) three times per day for four weeks .


Fasting and postprandial glucose profiles during meal tolerance tests were assessed before and after the intervention .


FRG supplementation led to a significant reduction in postprandial glucose levels and led to an increase in postprandial insulin levels compared to the placebo group .


There was a consistently significant improvement in the glucose area under the curve ( AUC ) in the FRG group .


However , fasting glucose , insulin , and lipid profiles were not different from the placebo group .


Daily supplementation with FRG lowered postprandial glucose levels in subjects with impaired fasting glucose or type @ diabetes .


The aim of the study was to determine whether docosahexaenoic acid ( DHA ) supplementation improves the behavior of children with autism .


A group of @ - to @-year-old children with autism were randomized in a double-blind fashion to receive a supplement containing @ mg of DHA or a placebo for @ months .


The parents and the investigator completed the Clinical Global Impressions-Improvement scale to rate changes in core symptoms of autism after @ and @ months .


The parents completed the Child Development Inventory and the Aberrant Behavior Checklist , and both parents and teachers completed the Behavior Assessment Scale for Children ( BASC ) at enrollment and after @ months .


A total of @ children ( @ -LSB- @ % -RSB- boys , mean age -LSB- standard deviation -RSB- @ -LSB- @ -RSB- years ) were enrolled ; @ received DHA and @ placebo .


Despite a median @ % increase in total plasma DHA levels after @ months , the DHA group was not rated as improved in core symptoms of autism compared to the placebo group on the CGI-I .


Based on the analysis of covariance models adjusted for the baseline rating scores , parents ( but not teachers ) provided a higher average rating of social skills on the BASC for the children in the placebo group compared to the DHA group ( P = @ ) , and teachers ( but not parents ) provided a higher average rating of functional communication on the BASC for the children in the DHA group compared to the placebo group ( P = @ ) .


Dietary DHA supplementation of @ mg/day for @ months does not improve the core symptoms of autism .


Our results may have been limited by inadequate sample size .


We evaluated the efficacy and safety of an early invasive strategy post-fibrinolysis in relation to glycoprotein ( GP ) IIb/IIIa inhibitor use .


The Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction ( TRANSFER-AMI ) randomised @ ST elevation myocardial infarction patients to an early invasive strategy or standard therapy post-fibrinolysis .


The primary end point was the composite of death , reinfarction , recurrent ischaemia , new or worsening heart failure , or cardiogenic shock at @ days .


In this pre-specified analysis , we examined efficacy and safety outcomes of an early invasive strategy after stratification by GPIIb/IIIa inhibitor use , which was permitted during percutaneous coronary intervention ( PCI ) at the discretion of the treating physician .


A total of @ patients ( @ % ) received GPIIb/IIIa inhibitors .


There was significant heterogeneity ( p < @ ) in the efficacy of an early invasive strategy compared to standard therapy , between the strata with GPIIb/IIIa inhibitor use ( primary end point @ % vs @ % respectively , p < @ ) and without GPIIb/IIIa inhibitor use ( primary end point @ % vs @ % respectively , p = @ ) .


Patients who received GPIIb/IIIa inhibitors had lower Global Registry of Acute Coronary Events ( GRACE ) risk scores compared to those without GPIIb/IIIa inhibitor use ( median @ vs @ , p < @ ) .


After adjusting for the interaction between GRACE risk score and treatment assignment , the heterogeneity in the efficacy of an early invasive strategy with respect to GPIIb/IIIa inhibitor use was no longer significant ( p interaction = @ ) .


The apparent difference in the efficacy of an early invasive strategy between GPIIb/IIIa inhibitor strata likely reflects an association between GPIIb/IIIa inhibitor use and baseline risk .


GPIIb/IIIa inhibitor use during PCI at the discretion of the treating physician does not appear to modulate the efficacy of an early invasive strategy post-fibrinolysis .


To determine the safety and efficacy of a @ ns Q switched Nd YAG laser vs. a @ ns Q switched Nd YAG laser for clearance of melasma .


To compare subject satisfaction , efficacy , and comfort level between the two lasers .


This is a prospective , randomized split face clinical study .


The study was approved by the Scripps IRB .


Ten healthy female subjects with moderate to severe melasma were enrolled .


Each subject had three laser treatments one month apart .


Patients were followed up approximately @ month , @ months , and @ months after the final laser treatment .


A treatment session consisted of a microdermabrasion , @ nm QS laser , and topicals .


Subjects were asked to rate treatment pain based on a numerical scale range @-@ ( @ = no pain and @ = worst pain ) .


A melasma area and severity index ( MASI ) grading system was applied .


Also , melanin measurements were acquired by a reflectance spectrophotometer .


Side effects were documented during the study including post treatment erythema .


Eight patients completed the study .


Subjects showed improvement on both sides of the face .


From baseline to @ month post the final laser treatment , the average MASI scores showed a @ % reduction for the @ ns QS @ nm laser vs. a @ % reduction for the @ ns QS @ nm laser ( both significant versus baseline pigment , P < @ ) .


This difference in MASI scores between the two lasers was not statistically significant ( P = @ ) .


Laser treatments displayed mild erythema that resolved after one day .


The melanin meter measurements showed a reduction in pigment readings on both sides .


Three months after the final treatment there was some relapse in the melasma , as the mean pigment reduction fell to @ % for the @ ns laser and @ % for the @ ns laser .


By @ months pigment reduction was not statistically significant for either laser , and no significant differences in pigment reduction were noted between the two pulse durations .


There was a statistically significant difference ( P < @ ) in pain scores reported by the subjects ( scale @-@ ) , the mean pain score for @ ns QS @ nm laser was @ and for the @ ns QS @ the score was @ .


In this study , we showed that a combination of microdermabrasion , QS@ nm laser , and topicals decreased the MASI and meter scores without clinically significant side effects .


Moreover , the longer pulsed Q switched @ nm laser i.e. ( @ ns ) was associated with less pain than its shorter pulse width counterpart .


Evidence supports that adequate treatment of hyperglycemia , hypercholesterolemia , and hypertension can reduce morbidity and mortality in people with diabetes , however achieving treatment goals remains elusive .


The majority of diabetes care occurs in the primary care setting ; however there are often missed opportunities for timely intervention during office visits .


This paper describes a systematic redesign of current diabetes treatment in primary care by implementing evidence-based protocols .


This is a cluster randomized controlled trial using certified diabetes educators ( CDEs ) to intensify therapeutic management .


Fifteen primary care practices from the University of Pittsburgh Medical Center were recruited .


Practices were randomized to intervention ( implementation of diabetes management protocols ) or usual care .


Eligibility criteria included diagnosis of type @ diabetes at least one year prior to baseline and an A@C @ % , LDLc @ mg/dl or blood pressure @/@ mmHg which were the goal levels established by the American Diabetes Association at study inception .


Treatment was intensified according to preapproved protocols .


Participants also received diabetes education during their visits .


Research assessments were done at baseline , three , six and twelve months .


Clinical visits were scheduled between research visits , as needed , to adjust medications .


Primary outcomes were achievement of glycemic , blood pressure , or lipid control goals .


Secondary outcomes included quality of life , medication and diabetes care satisfaction , medication adherence , and cost-effectiveness .


Results from this study will provide the evidence to support expanded roles for CDEs in primary care .


Using this model to deliver diabetes care may offer a more cost-effective approach for diabetes management .


Long-term oral anticoagulant treatment is obligatory in patients with atrial fibrillation ( AF , score of CHADSVASc@ ) .


When these patients undergo percutaneous coronary intervention with a drug-eluting stent ( PCI-eS ) , there is also an indication for aspirin and clopidogrel treatment , according to the ESC Guidelines .


However , triple therapy has been known to increase the risk of bleeding complications .


Unfortunately , there is little prospective data available to resolve this issue .


Therefore , it is imperative that an optimal therapy for AF patients with indications of both anticoagulation and antiplatelet intervention to prevent thrombotic complications without increasing the risk of bleeding is found .