Although operational control , such as lead-car following , has been studied , the influence of in-vehicle distractions on higher levels of control , including tactical and strategic , remains unclear .


Two secondary tasks were designed to independently represent visual-manual and cognitive-audio distractions , based on multiple resource theory .


Drivers performed operational vehicle control maneuvers ( lead-car following ) or tactical control maneuvers ( passing ) along with the distraction tasks in a driving simulator .


Response measures included driving performance and visual behavior .


Results revealed drivers ' ability to accommodate either visual or cognitive distractions in following tasks but not in passing .


The simultaneous distraction condition led to the greatest decrement in performance .


Findings support the need to assess the impacts of in-vehicle distraction on different levels of driving control .


Future study should investigate driver distraction under strategic control .


The PARAMOUNT Phase III trial showed that maintenance pemetrexed after pemetrexed plus cisplatin induction was well tolerated and effective for patients with advanced nonsquamous non-small-cell lung cancer .


Approximately @ % of patients receiving maintenance therapy in this study were @ years of age or older .


Here we report efficacy and safety results from the PARAMOUNT study for elderly ( @ years ) and non-elderly ( < @ years ) patients .


Final efficacy and safety data from the PARAMOUNT study were analyzed post hoc using subgroup analyses for elderly and non-elderly patients .


The median age was @ years in the elderly subgroup ( n = @ ) and @ years in the non-elderly subgroup ( n = @ ) .


Subgroups had similar baseline characteristics , except for a higher percentage of males and patients with a performance status of one in the elderly subgroup .


For elderly patients , the median PFS was @ months for pemetrexed and @ months for placebo ; the median OS was @ months for pemetrexed and @ months for placebo .


For non-elderly patients , the median PFS was @ months for pemetrexed and @ months for placebo ; the median OS was @ months for pemetrexed and @ months for placebo .


Elderly patients experienced similar levels of low-grade toxicities , but had a higher percentage of grade @/@ anemia and neutropenia than non-elderly patients , although importantly , this did not translate into increased febrile neutropenia .


Continuation maintenance pemetrexed had comparable survival and toxicity profiles in the elderly and non-elderly subgroups .


However , grade @/@ anemia and neutropenia were numerically higher for elderly patients .


Ticagrelor is a reversibly binding and selective P@Y@ - receptor antagonist approved for the prevention of atherothrombotic events in patients with acute coronary syndromes .


As bleeding events remain a hazard with antiplatelet therapy , this study investigated the effect of the vasopressin agonist , desmopressin , on ticagrelor-induced bleeding time prolongation .


Desmopressin has previously been shown to improve primary haemostasis and is widely used as first-line therapy for individuals with bleeding disorders .


In a randomized , double-blind , @-period crossover study , healthy volunteers received ticagrelor ( @mg loading dose ; @mgbid ) for @days .


On Day @ , desmopressin ( @g/kg ) or saline intravenous infusions were administered .


The impact of desmopressin on bleeding time , inhibition of platelet aggregation ( IPA ) , platelet function and ticagrelor pharmacokinetic parameters was investigated .


Twenty-one volunteers ( @ % male ) were enrolled .


Median -LSB- range -RSB- bleeding times were slightly reduced with ticagrelor plus desmopressin compared with ticagrelor alone ( @ -LSB- @-@ -RSB- vs. @ -LSB- @-@ -RSB- min at @h ) .


Median reductions in bleeding time from baseline were generally similar between ticagrelor plus desmopressin compared with ticagrelor alone at all time points .


Co-administration of desmopressin had no impact on IPA , although platelet reactivity was significantly increased ( von Willebrand Factor antigen : GLS mean AUEC was @ % .


h for ticagrelor plus desmopressin compared with @ % .


h for ticagrelor alone ) .


Desmopressin did not influence the pharmacokinetics of ticagrelor .


Desmopressin had no significant effect on bleeding time or inhibition of platelet aggregation by ticagrelor , although primary haemostatic activity was significantly increased .


Ticagrelor pharmacokinetic parameters were not affected by co-administration with desmopressin .


Therefore , desmopressin is unlikely to be an effective therapeutic agent for control of the potential bleeding events associated with ticagrelor .


Sedation with dexmedetomidine may facilitate ventilator liberation and limit the occurrence of delirium .


No trial has assessed patient recall or the development of psychological outcomes after dexmedetomidine sedation .


This pilot study evaluated whether transitioning benzodiazepine sedation to dexmedetomidine alters patient recall and the incidence of anxiety , depression , or acute stress disorder ( ASD ) .


This investigation was a randomized , double-blind , single-center study .


Existing continuous benzodiazepine sedation was converted to dexmedetomidine or midazolam when patients qualified for daily awakenings .


Sedation was titrated to achieve Riker sedation agitation scores of @ to @ .


The intensive care unit ( ICU ) Stressful Experiences Questionnaire , hospital anxiety and depression scale , and the impact of event scale-revised were administered before hospital discharge to assess recall , anxiety , depression , and manifestations of ASD .


A total of @ patients received dexmedetomidine , and @ patients received midazolam .


Median dosing was @ g/kg/h for @ days for dexmedetomidine and @ mg/h for @ days for midazolam .


Attainment of goal sedation and analgesia was similar ; however , more dexmedetomidine patients experienced agitation and pain .


The median duration of mechanical ventilation from study drug initiation to extubation was @ days in dexmedetomidine patients and @ days in midazolam patients .


Dexmedetomidine patients remembered @ experiences compared with @ in midazolam patients ( P = @ ) .


Rates of anxiety and depression were similar .


In all , @ ( @ % ) dexmedetomidine patients and @ ( @ % ) midazolam patient manifested ASD ( P = @ ) , and @ dexmedetomidine patient and @ midazolam patients developed new-onset delirium ( P = @ ) .


Hypotension occurred in @ ( @ % ) dexmedotomidine patients and @ ( @ % ) midazolam patients ( P = @ ) .


Transitioning benzodiazepine sedation to dexmedetomidine when patients qualify for daily awakenings may reduce the development of delirium and facilitate remembrance of ICU experiences but may lead to manifestations of ASD .


Monitoring hypotension is required for both the sedatives .


Additional comparative studies focusing on the long-term impact of ICU recall and psychological outcomes are needed .


We investigated the efficacy of concurrent chemoradiotherapy ( CCRT ) over radiotherapy ( RT ) in Chinese patients with locally advanced cervical carcinoma .


Between January @ and January @ , @ patients with squamous cell carcinoma of the cervix were included in the study : @ in arm A ( CCRT with @ mg/m@ cisplatin for @ days ) and @ in arm B ( RT ) .


The overall response rate was the primary endpoint .


The secondary endpoints included overall survival , progression-free survival , and toxicity .


The @-year overall response rate was @ % and @ % for the CCRT and RT arms , respectively , and the difference was statistically significant , while the median overall survival was @ months ( range @-@ months ) and @ months ( range @-@ months ) , respectively ( P = @ ) .


In addition , the median progression-free survival for CCRT was @ months ( range @-@ months ) , whereas it was @ months ( range @-@ months ) for the RT arm ( P = @ ) .


The toxicity profile , both acute and late , was comparable in both arms .


In summary , we demonstrate that CCRT was effective and better tolerated than RT alone in Chinese patients with locally advanced cervical carcinoma .


To investigate an effectiveness of walking exercise program applying the Theory of Planned Behavior in people at risk of hypertension in Samut Sakorn province .


The present study is a quasi-experimental research .


The inclusion criteria were people aged @-@ years old , systolic blood pressure @-@ mmHg , and diastolic blood pressure @-@ mmHg .


Participants were randomly selected into the experimental group ( n = @ ) and the comparison group ( n = @ ) .


The experimental group received activities including health information , benefits of walking exercise , group discussion in exercise barriers , modeling and experience exchange , walking exercise practice , and practice on using walking monitoring booklet at the baseline and the @nd week , whereas the comparison group received only health information and the booklet practice at the beginning of the intervention .


Data were collected by self-administered questionnaires at the baseline , @nd week , and @th week .


Statistical analysis was performed using Chi-square , Independent t-test , and repeated measures ANOVA .


The experimental group made significant improvements in attitude towards walking exercise , perceived behavior control , subjective norm , walking exercise intention , and walking exercise over time ( p < @ ) .


However , no statistically significant differences between the experimental and the comparison groups were found in subjective norm , systolic and diastolic blood pressure from baseline to the @th week .


The experimental group had a significant higher mean difference score of attitude towards walking exercise , perceived behavior control , walking exercise intention , walking exercise , weight , and BMI compared to those in the comparison group ( p < @ ) .


Subjective norm scores in the experimental group were more likely to increase from baseline to the @th week , but not a significant difference .


Walking exercise programs applying the Theory of Planned Behavior should be recommended in people at risk of hypertension .


Health professionals should also be motivated to practice with this program .


Alcohol consumption has substantially increased in China during the last @ decades .


Socioeconomic status ( SES ) most likely influences the development of alcoholic liver disease ( ALD ) in Chinese people who excessively consume alcohol .


At the present time , however , little information is available in this field .


The objectives of this study were to investigate the population-based prevalence of ALD and to identify the correlation of socioeconomics with the development of ALD .


A cross-sectional survey was conducted in @,@ individuals who resided in Shandong Province and were over @ years old in @ using a randomized multistage clustered sampling approach .


Among these subjects , @,@ ( @ % ) were interviewed .


Questionnaires covered demographic characteristic , medical history , current medication , and health-relevant behavior , particularly alcohol consumption , dietary habit , and physical activity .


Anthropometric measurements , biochemical tests , and abdominal ultrasonography were also performed .


Among the @,@ subjects , @ ( @ % ) were diagnosed with ALD .


The prevalence rate was significantly higher in males than in females ( @ % in males vs. @ % in females , p < @ ) .


In this population , the risk of ALD was highest in the @ - to @-year-old group .


The incidence of ALD was highest in individuals who had a high level of occupation .


Individuals who had received a low level of education had the highest incidence of ALD .


Subjects with a low family income were more likely to have ALD than did those with an abundant family income .


Currently , unmarried individuals had a higher incidence of ALD in the overall population .


ALD is prevalent in north-eastern China .


SES correlates with the development of ALD .


Socioeconomic risk factors for ALD in north-eastern China include male gender , middle age , currently unmarried , low level of education , low family income , and high level of occupation .


When switching from usual brand cigarettes , very low nicotine content ( VLNC ) cigarettes lead to a reduction in the number of cigarettes smoked , toxicant exposure , withdrawal symptoms and dependence .


One area that has been relatively unexplored is what factors might moderate the effects of VLNC cigarettes .


This exploratory analysis focuses on sex differences in responses to VLNC cigarettes and nicotine replacement therapy .


An exploratory secondary analysis of a randomized trial of @ participants ( @ % female , mean age @ years ) comparing a ) @-@ @ mg nicotine yield cigarettes ; b ) @ mg nicotine patch and @ ) @-@ @ nicotine yield cigarettes with @ mg nicotine patch was conducted .


We focused on sex differences in product use , and impact of products on withdrawal response from usual brand cigarettes and abstinence by randomized group .


The combination of VLNC cigarettes and nicotine patch was more effective in reducing use of VLNC cigarettes and withdrawal symptoms among males than females , whereas females were equally responsive to VLNC cigarettes with and without the nicotine patch .


Females were more likely to quit smoking than males when assigned to either of the conditions that incorporated the VLNC cigarettes ; however , males were more likely to quit smoking in the nicotine patch alone condition than females .


Sex of the smoker may be an important determinant for effects of VLNC cigarettes and nicotine patch .


Future large randomized trials to confirm these results are needed .


This study investigated whether early intervention based on additional use of sidestream capnography could reduce the incidence of oxygen desaturation and hypoxic events in patients receiving propofol anesthesia during surgical abortion .


We recruited @ ASAI-III female patients , @-@ years old and scheduled for planned painless surgical abortion , and randomized them into a control group ( n = @ ) receiving standard monitoring and an experimental group ( n = @ ) receiving standard monitoring and additional capnography .


Exclusion criteria were preexisting cardiovascular disease , preexisting hypotension , bradycardia or arrhythmia , and drug allergy .


Anesthesia was induced in all patients with propofol using target-controlled infusion at a target propofol plasma concentration of @ g/ml .


All patients received flurbiprofen axetil @ mg and @ g/kg fentanyl @ min before anesthesia .


Bispectral index was used and maintained between @ and @ .


Main outcome measures were apnea or abnormal ventilation status , rate of oxygen desaturation , occurrence of hypoxia and severe hypoxia , and perioperative side effects .


The experimental group had significantly higher rate of apnea or abnormal ventilation , significantly lower rate of oxygen desaturation , and significant lower occurrence of hypoxia and severe hypoxia compared to the control group .


We found no statistically significant differences between the @ groups in the rates of increased oxygen supplementation , assisted ventilation , bradycardia , hypotension , dosage of atropine , dosage of ephedrine or phenylephrine , and the amount of propofol consumed .


Sidestream capnographic monitoring improves early detection of alterations in ventilation parameters and reduces the incidence of oxygen desaturation and hypoxemia resulting from propofol anesthesia during surgical abortion .


Sympathetic response associated with laryngoscopy and endotracheal intubation is recognised as a potential cause for a number of complications especially in hypertensive patients .


Various methods have been used to attenuate these haemodynamic responses ; however most of the studies are in normotensive patients .


The aim of our study was to compare the effect of oral clonidine and @/V fentanyl with oral placebo and I/V fentanyl in attenuating the haemodynamic responses to laryngoscopy and intubation in known hypertensive patients .


In a double blind randomised controlled trial .


@ hypertensive patients , taking antihypertensive drugs and with systolic blood pressure below @ ( mmHg and diastolic blood pressure below @ mmHg scheduled for elective surgeries , requiring oral endotracheal intubation and age ranging from @-@ years were included in this study and randomly divided into Group A ( clonidine @ mg + fentanyl @ microg/Kg ) and Group B ( Placebo + fentanyl @ microg/Kg ) .


Demographic data were comparable in both groups .


There were no statistically significant differences between the two groups in the duration of laryngoscopy and intubation .


There was statistically significant attenuation in heart rate in both groups ( p = @ ) .


The trends of attenuation of systolic blood pressure , diastolic blood pressure and mean arterial pressure in Group A compared to Group B , were statistically significant ( p = @ , @ , @ respectively ) .


Clonidine , under the present study design attenuates the haemodynamic response to laryngoscopy and endotracheal intubation in known hypertensive patients .


Borderline Personality Disorder ( BPD ) is a serious psychiatric condition associated with substantial mortality , burden and public health costs .


DBT is the treatment model with the largest number of published research articles showing effectiveness .


However , some patients are not sufficiently engaged in outpatient treatment while presenting severe parasuicidal behavior , making hospitalization necessary .


The Center for Personality Disorders Jelgersma developed an intensive @-week inpatient DBT program that ( i ) rapidly reduces core borderline symptoms like suicidal behavior , ( ii ) minimizes the negative effects of an inpatient setting , and ( iii ) enhances compliance with outpatient treatment .


We evaluate the ( cost - ) effectiveness of this experimental program .


Seventy patients , aged @ to @years with a primary diagnosis of BPD , showing a chronic pattern of parasuicidal gestures and/or reporting high degrees of severity of other borderline symptoms , are randomly allocated to the control and intervention groups .


Subjects in the control group receive standard outpatient DBT , provided in one of three regular mental health settings in GGZ Rivierduinen .


Subjects in the intervention group receive @weeks of intensified inpatient DBT plus six months of standard DBT , provided in the Center for Personality Disorders Jelgersma .


The primary outcome is the number of suicide attempts/self-harming acts .


Secondary outcomes are severity of other borderline complaints , quality of life , general psychopathological symptoms and health care utilization and productivity costs .


Data are gathered using a prospective , two ( group : intervention and control ) by five ( time of measurement ) repeated measures factorial design.Participants will complete three-monthly outcome assessments in the course of therapy : at baseline , and @ , @ , @ and @weeks after the start of the treatment .


The period of recruitment started in March @ and the study will end in December @ .


Highly suicidal outpatient patients can pose a dilemma for mental health care professionals .


Although hospitalization seems inevitable under some circumstances , it has proven to be harmful in its own right .


This paper outlines the background and methods of a randomized trial evaluating the possible surplus value of a short-term inpatient DBT program .


Poor CD@ lymphocyte recovery on antiretroviral therapy ( ART ) is associated with reduced function of the thymus .


Palifermin ( keratinocyte growth factor ) , by providing support to the thymic epithelium , promotes lymphopoiesis in animal models of bone marrow transplantation and graft-versus-host disease .


In AIDS Clinical Trials Group A@ , a randomized , double-blind , placebo-controlled study , @ HIV-infected patients on ART with plasma HIV-@ RNA levels @ copies per milliliter for @ months and CD@ lymphocyte counts < @ cells per cubic milliliter were randomized @:@:@:@ to receive once daily intravenous administration of placebo or @ , @ , or @ g/kg of palifermin on @ consecutive days .


The median change in the CD@ T-cell count from baseline to week @ was not significantly different between the placebo arm -LSB- @ ( -@ , @ ) cells/mm -RSB- and the @-g/kg dose -LSB- @ ( @ , @ ) cells/mm -RSB- , the @-g/kg dose -LSB- @ ( -@ , @ ) cells/mm -RSB- , or the @-g/kg dose arm -LSB- @ ( -@ , @ ) cells/mm -RSB- of palifermin .


No significant changes were observed in thymus size or in the number of naive T cells or recent thymic emigrants .


Palifermin in the doses studied was not effective in improving thymic function and did not raise CD@ lymphocyte counts in HIV-infected patients with low CD@ cell counts despite virologically effective ART .


The Centers for Disease Control and Prevention highlights the importance of evaluating interventions rigorously and recommends evaluating new interventions against interventions with established efficacy .


Competencias para adolescentes con una sexualidad saludable ( COMPAS ) is a school-based HIV prevention program that has been shown to be effective in reducing sexual risk behaviors among adolescents in Spain .


This study evaluates the efficacy of COMPAS program compared with a Spanish-culture adapted version of Cudate !


( Take Care of Yourself ) , an evidence-based HIV prevention curriculum designed for Latino adolescents in the US .


This cluster randomized controlled trial involved @,@ adolescents attending @ public high schools located in @ provinces of Spain .


The schools invited to participate were enrolled and randomly assigned to the three experimental conditions : COMPAS , Cudate !


, and control group ( CG ; no intervention ) .


Generalized estimating equation analyses revealed that both interventions improved attitudes toward people living with human immunodeficiency syndrome ( HIV ) / AIDS and the HIV test and increased HIV/sexually transmitted infection knowledge and intention to engage in safer sex behaviors compared with the CG .


Although only COMPAS increased participants ' sexual risk perception and attitude toward condom use compared with the CG , the two interventions did not significantly differ on any outcome .


When compared with an established program , COMPAS was at least as effective at increasing the intention to engage in safer sex behaviors as the evidence-based intervention .


Childbirth has been recognised as the most painful experience known to women .


This study aimed at studying the efficacy and safety of the single shot spinal analgesia for pain relief in labour .


One hundred and twelve parturients in labour were randomized into two groups of @ paturients each .


Group B received @ mg of spinal plain bupivacaine only while Group BF had @ mg plain bupivacaine with @ gg of fentanyl .


Onset of sensory block , time to achieve maximum sensory block , duration of sensory and motor block and the level of block were recorded .


The need for oxytocin augmentation , instrumental delivery , neonatal Apgar scores and umbilical artery blood pH were recorded .


The numeric rating pain scores for groups B and BF were significantly reduced from a mean prespinal score of @ + / - @ cm and @ + / - @ cm respectively to a mean post-spinal pain score of @ + / - @ cm and @ + / - @ cm respectively , p = @ .


The mean duration of analgesia in Group B was @ + / - @ mins while it was @ + / - @ mins in Group BF , p = @ .


The study showed that low dose spinal bupivacaine either alone or in combination with fentanyl is safe for labour analgesia , but the combination f bupivacaine with fentanyl provided much more prolonged pain relief


Treatment of women at risk for preterm birth with repeat doses of glucocorticoids reduces neonatal morbidity but could have adverse long-term effects on cardiometabolic health in offspring .


We assessed whether exposure to repeat antenatal betamethasone increased risk factors for later cardiometabolic disease in children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids .


Women were randomized to betamethasone or placebo treatment , @ days after an initial course of glucocorticoids , repeated each week that they remained at risk for preterm birth at < @ weeks ' gestation .


In this follow-up study , children were assessed at @ to @ years ' corrected age for body composition , insulin sensitivity , ambulatory blood pressure , and renal function .


Of @ eligible childhood survivors , @ were studied ( @ % ; @ repeat betamethasone group ; @ placebo -LSB- single course -RSB- group ) .


Children exposed to repeat antenatal betamethasone and those exposed to placebo had similar total fat mass ( geometric mean ratio @ , @ % confidence interval -LSB- CI -RSB- @ to @ ) , minimal model insulin sensitivity ( geometric mean ratio @ , @ % CI @ to @ ) , @-hour ambulatory blood pressure ( mean difference systolic @ mm Hg , @ % CI -@ to @ ; diastolic @ mm Hg , @ % CI -@ to @ ) , and estimated glomerular filtration rate ( mean difference @ mL/min/@ @ m ( @ ) , @ % CI -@ to @ ) .


Exposure to repeat doses of antenatal betamethasone compared with a single course of glucocorticoids does not increase risk factors for cardiometabolic disease at early school age .


The impact of Hatha yoga as add-on treatment to quetiapine fumarate extended release ( QXR ) or escitalopram ( ESC ) in depressed patients on hypothalamic-pituitary-adrenal ( HPA ) axis activity was assessed .


@ inpatients suffering from major depressive disorder ( MDD ) according to DSM-IV were randomized for a @ week treatment with Yoga or not ( control group ) and with either QXR ( @mg/day ) or ESC ( @mg/day ) .


Serial dexamethasone/corticotropin releasing hormone ( DEX/CRH ) tests were performed to assess HPA axis function .


The Hamilton Depression Rating Scale ( @-HAMD ) was used weekly .


A more pronounced down regulation of the HPA axis activity due to yoga could not be detected .


The stepwise long term cortisol reduction was seen in both medication groups , irrespectively of yoga add-on treatment .


In addition , cortisol improvers in week @ of therapy ( reduction in cortisol peak value within the DEX/CRH test ) reached significant greater amelioration of depressive symptoms after @ weeks .


Our results suggest that antidepressant agents down regulate HPA axis function to a greater extent than additional Hatha yoga treatment .


Moreover , an early reduction of HPA system hyperactivity after one week of pharmacological treatment seems to raise the possibility of a favorable treatment response .


Difficult patients comprise at least @ % of ambulatory visits and are associated with clinician burnout .


No structured procedure has been reported to assist health care practitioners with these challenging relationships .


This randomized trial evaluated whether a pre - and postvisit patient-centered and clinician-reflective technique called BREATHE OUT improved clinician satisfaction during visits with patients perceived by the clinician as difficult .


Six family medicine residency clinics paired as urban , suburban , and rural sites were randomized by clinic to the BREATHE OUT intervention or usual care of difficult patients .


A total of @ physician faculty , nurse practitioners , physician assistants , and residents participated .


The validated Physician Satisfaction Scale ( PSS ) was administered and analyzed using hierarchical linear modeling to assess differences between the intervention and control groups .


The BREATHE OUT intervention improved the PSS score ( P = @ ) in the intervention group compared with the usual care group .


Female practitioners reported worse PSS scores compared with their male counterparts despite whether they used BREATHE OUT ( P = @ ) .


Application of the BREATHE OUT questionnaire before and after visits improved clinician satisfaction with difficult patient encounters .


Helicobacter pylori infection is a common chronic human bacterial infection .


Triple - therapy regimen containing a proton pump inhibitor , clarithromycin , and either amoxicillin or metronidazole is commonly used as first-line treatment for its eradication .


However , it may not provide the acceptable eradication rate .


The present study was designed to evaluated efficacy of low dose furazolidone with amoxicillin and omeprazole for eradication of H - pylori .


One hundred twenty patients with non - ulcer dyspepsia or peptic ulcer confirmed by upper GI endoscopy , plus H - pylori infection confirmed by rapid urease test were included in the study .


They were randomly divided into two groups , and then received clarithromycin , amoxicillin , and omeprazole , or furazolidone ( @ mg PO bid ) , amoxicillin , and omeprazole .


They were evaluated using urea breath test at the end of the study .


The eradication rates were @ % and @ % in clarithromycin and furazolidone groups , respectively .


Their difference was statistically significant ( P value @ ) .


No side effect was seen in the furazolidone group .


Low dose furazolidone rather than clarithromycin can be used as low - cost and effective drug for eradication of H - pylori , in combination with amoxicillin and omeprazole .


We examined the effect of a @-week family-based cognitive behavioural weight management programme developed for use in primary care settings .


The sample consisted of @ children with obesity ( aged @-@ years ; mean SD : @ @ ) .


Families were randomly assigned to immediate start-up of treatment or to a @-week waiting list condition .


Outcome measures were body mass index standard deviation score ( BMI SDS ) , self-esteem , symptoms of depression and blood parameters indicative of cardio-metabolic risk .


Assessments were conducted at baseline , post-treatment , post-waiting list and @ months after treatment termination .


The mean reduction for the treatment group was -@ BMI SDS units compared with an increase of @ units for the waiting list group ( p = @ ) .


For the entire sample , there was a significant post-treatment improvement on BMI SDS ( p = @ ) , all self-esteem measures ( p = @ -@ ) and symptoms of depression ( p = @ ) .


The mean BMI SDS reduction was -@ units post-treatment , and it was maintained at @-month follow-up .


Significant reductions were found in blood lipid levels of total cholesterol ( p = @ ) , LDL-cholesterol ( p = @ ) and HDL-cholesterol ( p = @ ) at @-month follow-up .


The favourable effect on most of the psychological measures waned from post-treatment to follow-up , but not approaching baseline levels .


Boys demonstrated significantly greater reductions in BMI SDS than girls ( p = @ ) , while baseline psychiatric co-morbidity did not influence BMI SDS outcome .


The treatment shows significant and favourable effects on BMI SDS , self-esteem and symptoms of depression compared with a waiting list condition .


To determine , at @ weeks postsurgery , if a monitored home exercise program ( HEP ) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement ( TKR ) surgery for osteoarthritis .


We conducted a multicenter , randomized clinical trial .


Patients ages @-@ years were allocated at the time of hospital discharge to usual care rehabilitation ( n = @ ) or the HEP ( n = @ ) .


Outcomes assessed @ weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales , knee range of motion , and the @-foot walk time .


The upper bound of the @ % confidence interval ( @ % CI ) mean difference favoring usual care was used to determine noninferiority .


At @ weeks after surgery there were no significant differences between usual care and HEP , respectively , for pain ( @ and @ ; @ % CI mean difference -LSB- MD -RSB- -@ , @ ) , physical function ( @ and @ ; @ % CI MD -@ , @ ) , knee flexion ( @ and @ ; @ % CI MD -@ , @ ) , knee extension ( -@ and -@ ; @ % CI MD -@ , @ ) , or the @-foot walk time ( @ and @ seconds ; @ % CI MD -@ , @ seconds ) .


At @ weeks , @ patients ( @ % ) allocated to usual care and @ ( @ % ) to the HEP did not achieve @ knee flexion .


There was no difference between the treatment allocations in the number of hospital readmissions .


The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR .


To evaluate muscle fatigue and participant pain in the upper back , cervical , and arm muscles associated with microlaryngeal surgery ( MLS ) in standardized favorable and unfavorable ergonomic positions .


Individual randomized counterbalanced design .


Electromyographic sensors were placed on targeted muscles involved with performing MLS on @ otolaryngology residents/fellows .


Subjects were randomly counterbalanced in both favorable and unfavorable positions while completing simulated laryngeal microsurgical tasks .


Participants reported their extent of muscle discomfort in targeted muscle regions on a standardized survey .


Muscle fatigue and self-reported pain were reduced , and productivity was improved in the favorable position .


In the lower trapezius , significantly less muscle activation ( P = @ ) and less pain ( P < @ ) were found while in the favorable position compared to the unfavorable position .


This is the first study to demonstrate electromyographic evidence of decreased muscle activation and fatigue , in addition to self-reported pain with a more favorable microsurgical ergonomic position , which may help surgeons avoid musculoskeletal injuries .


To determine if functional discharge readiness and mobility following total knee arthroplasty ( TKA ) for osteoarthritis is delayed after femoral nerve block ( FNB ) with or without patient-controlled analgesia ( PCA ) opioid compared with PCA opioid alone .


We analyzed secondary outcomes from a randomized controlled trial with @ patients undergoing unilateral TKA .


Experimental group @ received single-injection FNB with intravenous PCA opioid , experimental group @ received continuous FNB , and the control group received PCA opioid alone .


FNB was administered using bupivacaine .


Patients followed a structured TKA pathway .


Discharge readiness outcomes included achievement of @ knee flexion , independent walking , and stair climbing , and were assessed daily before discharge or day @ , whichever came first .


Mobility outcomes included the Timed Up and Go ( TUG ) test , the @-Minute Walk Distance ( @MWD ) , and self-reported physical function , and were assessed at weeks @ and @ .


TUG was also assessed on days @ to @ , postoperation .


Both FNB groups ( @ % ) were more likely to achieve @ knee flexion compared with the control group ( @ % ) ; odds ratio ( OR ) @ , @ % confidence interval ( @ % CI ) @ , @ for single-injection FNB , and OR @ , @ % CI @ , @ for continuous FNB .


There were no significant differences in independent walking and stair-climbing ability before discharge , TUG , @MWD , or self-reported physical function , between the FNB groups compared with the control group .


After TKA , FNB ( single-injection with PCA opioid or continuous ) does not delay achievement of @ knee flexion or other measures of functional discharge readiness and mobility compared with PCA opioid alone .


In preterm infants receiving supplemental oxygen , routine manual control ( RMC ) of the fraction of inspired oxygen ( FIO@ ) is often difficult and time consuming .


We developed a system for closed-loop automatic control ( CLAC ) of the FIO@ and demonstrated its short-term safety and efficacy in a single-center study .


The objective of this study was to test the hypothesis that this system is more effective than RMC alone in maintaining arterial oxygen saturation within target levels when evaluated over @ hours under routine conditions and with different target levels .


We performed a multicenter , randomized controlled , crossover clinical trial in @ preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure and supplemental oxygen .


Twenty-four-hour periods with RMC were compared with @-hour periods of RMC supported by CLAC .


The median ( range ) percentage of time with arterial oxygen saturation levels within target range was @ ( @-@ @ ) for RMC and @ ( @-@ @ ) for CLAC ( P < @ ) .


The median ( range ) number of manual FIO@ adjustments was reduced from @ ( @-@ @ ) for RMC to @ ( @-@ @ ) for CLAC ( P = @ ) .


CLAC may improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload related to RMC .


Dacomitinib is an irreversible pan-EGFR family tyrosine kinase inhibitor .


Findings from a phase @ study in non-small cell lung cancer showed favourable efficacy for dacomitinib compared with erlotinib .


We aimed to compare dacomitinib with erlotinib in a phase @ study .


In a randomised , multicentre , double-blind phase @ trial in @ centres in @ countries , we enrolled patients who had locally advanced or metastatic non-small-cell lung cancer , progression after one or two previous regimens of chemotherapy , Eastern Cooperative Oncology Group ( ECOG ) performance status of @-@ , and presence of measurable disease .


We randomly assigned patients in a @:@ ratio to dacomitinib ( @ mg/day ) or erlotinib ( @ mg/day ) with matching placebo .


Treatment allocation was masked to the investigator , patient , and study funder .


Randomisation was stratified by histology ( adenocarcinoma vs non-adenocarcinoma ) , ethnic origin ( Asian vs non-Asian and Indian sub-continent ) , performance status ( @-@ vs @ ) , and smoking status ( never-smoker vs ever-smoker ) .


The coprimary endpoints were progression-free survival per independent review for all randomly assigned patients , and for all randomly assigned patients with KRAS wild-type tumours .


The study has completed accrual and is registered with ClinicalTrials.gov , number NCT@ .


Between June @ , @ , and March @ , @ , we enrolled @ patients and randomly assigned @ to dacomitinib ( @ KRAS wild type ) and @ ( @ KRAS wild type ) to erlotinib .


Median progression-free survival was @ months ( @ % CI @-@ ) in both the dacomitinib group and the erlotinib group ( stratified hazard ratio -LSB- HR -RSB- @ , @ % CI @-@ , one-sided log-rank p = @ ) .


For patients with wild-type KRAS , median progression-free survival was @ months for dacomitinib ( @ % CI @-@ ) and erlotinib ( @ % CI @-@ ; stratified HR @ , @ % CI @-@ , one-sided p = @ ) .


In patients who received at least one dose of study drug , the most frequent grade @-@ adverse events were diarrhoea ( @ -LSB- @ % -RSB- patients in the dacomitinib group vs ten -LSB- @ % -RSB- patients in the erlotinib group ) , rash ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , and stomatitis ( @ -LSB- @ % -RSB- vs two -LSB- < @ % -RSB- ) .


Serious adverse events were reported in @ ( @ % ) patients receiving dacomitinib and @ ( @ % ) patients receiving erlotinib .


Irreversible EGFR inhibition with dacomitinib was not superior to erlotinib in an unselected patient population with advanced non-small-cell lung cancer or in patients with KRAS wild-type tumours .


Further study of irreversible EGFR inhibitors should be restricted to patients with activating EGFR mutations .


The aim of this study is to assess efficacy and safety of reinforced H. pylori eradication therapy .


During @-@ , @ outpatients were examined .


The study included men and women @-@ y.o.


They have been devided in to @ group by randomized choice ( @ patients in each group ) .


Patients were treated with the reinforced H. pylori eradication therapy : PPI ( @ mg , / q@h ) , clarithromycin ( @mg/q@h ) , amoxicillin ( @ mg/q@h ) , bismuth subcitrate ( @ mg/q@h ) for @ days .


The first group given bismuth subcitrate -- De-Nol , the second group given Novobismol .


Eradication was confirmed by a @C-urea breath test and monoclonal stool antigen test @-@ weeks after therapy .


A total of @ patients underwent eradication treatment .


Two were lost to follow-up ( one patient in each group ) , four patients ( two patients in each group ) did not complete treatment due to adverse events .


The eradication rates were @ % ( @ % CI , @ % -@ % ) by per-protocol ( PP ) and @ % ( @ % CI , @ % - @ % ) by intention-to-treat ( ITT ) in the two groups .


The ITT analyses resulted in rates of @ % ( @ % CI , @-@ @ ) for the @-d reinforced therapy with DeNol and was @ % ( @ % CI : @-@ @ ) for the @-d reinforced therapy with Novobismol ( P = @ ) , while the PP analyses resulted in @ % ( @ % CI , @-@ @ ) and @ % ( @ % CI : @-@ @ ) , respectively ( P = @ ) .


The reinforced H. pylori eradication therapy ( @-day high-dose PPI bismuth-containing standard triple therapy ) achieves a significantly high eradication rates in patients with H. pylori - associated diseases .


Both drugs ( De - Nol and Novobismol ) are both effective and safe for the first-line eradication of H. pylori .


Emergency department discharge instructions are variably understood by patients , and in the setting of emergency department crowding , innovations are needed to counteract shortened interaction times with the physician .


We evaluated the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions .


In this prospective , single-center , randomized controlled trial conducted between November @ and January @ , we randomized emergency department patients who were discharged with one of @ diagnoses to either view ( after they left the emergency department ) a vetted online video of diagnosis-specific discharge instructions , or to usual care .


Patients were subsequently contacted by telephone and asked three standardized questions about their discharge instructions ; one point was awarded for each correct answer .


Using an intention-to-treat analysis , differences between groups were assessed using univariate testing , and with logistic regression that accounted for clustering on managing physician .


A secondary outcome measure was patient satisfaction with the videos , on a @-point scale .


Among @ patients enrolled , mean age was @ ( s.d.D. @ ) and @ % were female .


Patients in the video group had @ % higher mean scores ( @ , s.d. @ ) than patients in the control group ( @ , s.d. @ ) ( p = @ ) .


After adjustment for patient age , sex , first language , triage acuity score , and clustering , the odds of achieving a fully correct score ( @ out of @ ) were @ ( @ % CI , @ to @ ) times higher in the video group , compared to the control group .


Among those who viewed the videos , median rating of the videos was @ ( IQR @ to @ ) .


In this single-center trial , patients who viewed an online video of their discharge instructions scored higher on their understanding of key concepts around their diagnosis and subsequent care .


Those who viewed the videos found them to be a helpful addition to standard care .


Anesthesiologists have encountered various difficulties in securing the airway .


Therefore , we compare the intubation times and hemodynamic changes between the McGrath Series @ video laryngoscope and the Macintosh laryngoscope .


A total of @ obstetric patients were divided into @ groups , orotracheally intubated with either the McGrath video laryngoscope or the Macintosh laryngoscope .


The intubation times , Cormack-Lehane grade , percentage of glottic opening , mean arterial blood pressure , and heart rates were compared among the groups .


Intubation time in the McGrath video laryngoscope group was significantly longer than in the Macintosh laryngoscope group ( P < @ ) .


The percentage of glottic opening was found to be higher in the McGrath video laryngoscope group ( P = @ ) .


The McGrath Series @ video laryngoscope provides excellent views during orotracheal intubation in obstetric anesthesia with normal airways .


Smoking-related cues can trigger drug-seeking behaviors , and computer-based interventions that reduce cognitive biases towards such cues may be efficacious and cost-effective cessation aids .


In order to optimize such interventions , there needs to be better understanding of the mechanisms underlying the effects of cognitive bias modification ( CBM ) .


Here we present a protocol for an investigation of the neural effects of CBM and varenicline in non-quitting daily smokers .


We will recruit @ daily smokers who report smoking at least @ manufactured cigarettes or @ roll-ups per day and who smoke within one hour of waking .


Participants will attend two sessions approximately one week apart .


At the first session participants will be screened for eligibility and randomized to receive either varenicline or a placebo over a seven-day period .


On the final drug-taking day ( day seven ) participants will attend a second session and be further randomized to one of three CBM conditions ( training towards smoking cues , training away from smoking cues , or control training ) .


Participants will then undergo a functional magnetic resonance imaging scan during which they will view smoking-related pictorial cues .


Primary outcome measures are changes in cognitive bias as measured by the visual dot-probe task , and neural responses to smoking-related cues .


Secondary outcome measures will be cognitive bias as measured by a transfer task ( modified Stroop test of smoking-related cognitive bias ) and subjective mood and cigarette craving .


This study will add to the relatively small literature examining the effects of CBM in addictions .


It will address novel questions regarding the neural effects of CBM .


It will also investigate whether varenicline treatment alters neural response to smoking-related cues .


These findings will inform future research that can develop behavioral treatments that target relapse prevention .


Total hip arthroplasty ( THA ) is an increasingly common treatment for older patients with hip osteoarthritis .


The best strategy for a physiotherapy intervention for older people after THA is not clear in the literature .


The purpose of this protocol study is to test the feasibility of undertaking a full trial clinical to evaluate the effect of ergometer cycling-associated conventional exercises on functional results and health-related quality of life ( HRQOL ) of older patients with THA .


This study protocol is a prospective , single center , randomized controlled pilot clinical trial .


Older patients ( @ years ) in the postoperative phase after primary unilateral THA for hip osteoarthritis will be consecutively recruited for this study and randomly allocated to @ treatment groups .


Group I will perform cycle ergometer and conventional exercises , and group II will perform only conventional exercises .


The sessions will be conducted twice a week for @ weeks .


Assessments will be made at baseline ( @ weeks postoperatively : the moment that the patients receive a referral for physical therapy , which will start after suture removal ) , after intervention ( @ weeks postoperatively ) , and at @ months of follow-up ( @ weeks postoperatively ) .


The primary outcomes are the function , evaluated using the Harris Hip Score ( HHS ) and the Short Physical Performance Battery ( SPPB ) .


The secondary outcome is HRQOL , measured using @ evaluation instruments : the Medical Outcomes Study @-Item Short-Form Health Survey ( SF-@ ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) .


Data collectors will be blinded and will not have contact with participants during the interventions .


This randomized controlled trial will provide evidence regarding the effect of this exercise therapy on physical function and quality of life in older patients after THA .


If our hypothesis is correct , both interventions will be effective , but the exercises on the cycle ergometer conferring better results in function , physical performance and quality of life .


The study follows Consolidated Standards of Reporting Trials ( CONSORT ) guidelines , and the approval of the local ethics committee has been obtained .


To examine the effects of intravitreal ranibizumab ( Lucentis ; Genentech , Inc. , South San Francisco , CA ) treatment on patient-reported vision-related function , as assessed by @-item National Eye Institute Visual Function Questionnaire ( NEI VFQ-@ ) scores , in patients with visual impairment secondary to center-involved diabetic macular edema ( DME ) .


Within @ randomized , double-masked , phase @ clinical trials ( RIDE -LSB- A Study of Ranibizumab Injection in Subjects With Clinically Significant Macular Edema -LCB- ME -RCB- With Center Involvement Secondary to Diabetes Mellitus ; NCT@ -RSB- and RISE -LSB- A Study of Ranibizumab Injection in Subjects With Clinically Significant Macular Edema -LCB- ME -RCB- With Center Involvement Secondary to Diabetes Mellitus ; NCT@ -RSB- ) , the NEI VFQ-@ was administered at baseline and at the @ - , @ - , @ - , and @-month follow-up visits .


Three hundred eighty-two ( @ % ) RIDE patients and @ ( @ % ) RISE patients .


Patients were randomized @:@:@ to monthly injections of intravitreal ranibizumab @ or @ mg or sham .


Study participants could receive macular laser for DME from month @ onward if specific criteria were met .


Exploratory post hoc analysis of mean change from baseline in NEI VFQ-@ scores at @ and @ months .


Across all treatment arms , @ % to @ % of enrolled eyes were the better-seeing eye .


For all eyes in RIDE and RISE , the mean change in NEI VFQ-@ composite score improved more in ranibizumab-treated eyes at both the @ - and @-month visits compared with sham treatment .


For the better-seeing eyes at baseline , the mean change in composite score with @ mg ranibizumab at the @-month visit was @ more ( @ % confidence interval -LSB- CI -RSB- , @-@ @ ) than sham for RIDE patients and @ more ( @ % CI,-@ @ to @ ) than sham for RISE patients .


For the worse-seeing eyes at baseline , the mean change in composite score with @ mg ranibizumab at the @-month visit was @ more ( @ % CI,-@ @ to @ ) than sham for RIDE patients and @ more ( @ % CI,-@ @ to @ ) than sham for RISE patients .


Similar results for most of these outcomes were seen with @ mg ranibizumab .


These phase @ trials demonstrated that ranibizumab treatment for DME likely improves patient-reported vision-related function outcomes compared with sham , further supporting treatment of DME with ranibizumab .


Robot-aided exercise therapy is a promising approach to enhance walking ability in stroke survivors .


This study was designed to test a new robotic knee brace for restoring mobility in stroke survivors .


Twenty-four ambulatory individuals with chronic hemiparesis after stroke were enrolled in this pilot study .


The participants were randomly assigned in equal numbers to either treatment with the experimental device or to a group exercise program and received a total of @ hrs of their assigned therapy during a @-wk training period .


The primary outcome was gait velocity , as measured with the @-m walk test .


Secondary measures included @-min walk test , Timed Up and Go test , Five-Times-Sit-to-Stand test , Romberg test , Emory Functional Ambulation Profile , Berg Balance scale , and the California Functional Evaluation @ .


Twenty subjects completed the entire protocol and all follow-up visits .


No significant differences between the two groups were found for the primary outcome measure at either the completion of training ( week @ ) or at the @-mo follow-up ( week @ ) , with inconsistent findings for secondary measures .


No within-group changes were seen in the primary outcome measure ( @-m walk test ) in either group .


Within-group improvements were seen in several of the secondary measures for both groups .


No complications of robotic therapy were observed .


Robotic therapy for ambulatory stroke patients with chronic hemiparesis using a robotic knee brace resulted in only modest functional benefits that were comparable with a group exercise intervention .


Apixaban is approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation .


However , the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation ( ARISTOTLE ) trial included a substantial number of patients with valvular heart disease and only excluded patients with clinically significant mitral stenosis or mechanical prosthetic heart valves .


We compared the effect of apixaban and warfarin on rates of stroke or systemic embolism , major bleeding , and death in patients with and without moderate or severe valvular heart disease using Cox proportional hazards modeling .


Of the @ patients enrolled in ARISTOTLE , @ ( @ % ) had a history of moderate or severe valvular heart disease or previous valve surgery .


Patients with valvular heart disease had higher rates of stroke or systemic embolism and bleeding than patients without valvular heart disease .


There was no evidence of a differential effect of apixaban over warfarin in patients with and without valvular heart disease in reducing stroke and systemic embolism ( hazard ratio -LSB- HR -RSB- , @ ; @ % confidence interval -LSB- CI -RSB- , @-@ @ and HR , @ ; @ % , CI @-@ @ ; interaction P = @ ) , causing less major bleeding ( HR , @ ; @ % CI , @-@ @ and HR , @ ; @ % CI , @-@ @ ; interaction P = @ ) , and reducing mortality ( HR , @ ; @ % CI , @-@ @ and HR , @ ; @ % CI , @-@ @ ; interaction P = @ ) .


More than a quarter of the patients in ARISTOTLE with nonvalvular atrial fibrillation had moderate or severe valvular heart disease .


There was no evidence of a differential effect of apixaban over warfarin in reducing stroke or systemic embolism , causing less bleeding , and reducing death in patients with and without valvular heart disease .


Prior studies have reported that elevated concentrations of several plasma amino acids ( AA ) , particularly branched chain ( BCAA ) and aromatic AA predict the onset of type @ diabetes .


We sought to test the hypothesis that circulating BCAA , aromatic AA and related AA metabolites decline in response to the use of insulin sensitizing agents in overweight/obese adults with impaired fasting glucose or untreated diabetes .


We performed a secondary analysis of a randomized , double-blind , placebo , controlled study conducted in twenty five overweight/obese ( BMI ~ @kg/m ( @ ) ) adults with impaired fasting glucose or untreated diabetes .


Participants were randomized to three months of pioglitazone ( @mg per day ) plus metformin ( @mg twice per day , N = @ participants ) or placebo ( N = @ ) .


We measured insulin sensitivity by the euglycemic-hyperinsulinemic clamp and fasting concentrations of AA and AA metabolites using ultra-pressure liquid chromatography tandem mass spectrometry before and after the three-month intervention .


Insulin sensitizer therapy that significantly enhanced insulin sensitivity reduced @ out of @ AA and AA metabolites measured compared to placebo treatment .


Moreover , insulin sensitizer therapy significantly reduced three functionally clustered AA and metabolite pairs : i ) phenylalanine/tyrosine , ii ) citrulline/arginine , and iii ) lysine / - aminoadipic acid .


Reductions in plasma concentrations of several AA and AA metabolites in response to three months of insulin sensitizer therapy support the concept that reduced insulin sensitivity alters AA and AA metabolites .


To compare the clinical efficacy difference in dysantonomia between transcutaneous electrical stimulation at Renying ( ST @ ) combined with stellate ganglion block ( SGB ) and simple SGB .


Sixty patients in accord with the diagnostic criteria of dysantonomia were randomly divided into two groups ,@ cases in each group .


In the observation group , transcutaneous electrical stimulation at Renying ( ST @ ) combined with SGB were adopted ; in the control group , simple SGB was applied .


In the two groups , treatment was used three times a week , and nine treatments were considered as one course .


There was an interval of one week between courses , and two courses were treated .


Total seven weeks were required .


Scores were evaluated according to subjective symptoms before treatment , one month and three months after treatment in the two groups .


The scores of subjective symptoms were not statistically different before treatment in the two groups ( P > @ ) .


The scores of subjective symptoms one month and three months after treatment were all lower than those before treatment ( all P < @ ) , and subjective symptoms scores in the observation group were lower than those in the control group ( both P < @ ) .


Transcutaneous electrical stimulation at Renying ( ST @ ) combined with SGB could obviously enhance the clinical effects for dysantonomia , and the control and improvement for clinical symptoms are apparently superior to simple SGB .


Patients with subocclusive Crohn 's disease ( CD ) who received azathioprine ( AZA ) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a @-year period .


We investigated whether AZA also was effective for prevention of recurrent bowel obstruction .


Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine .


We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups .


There was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group ( @ % ) compared with the mesalazine group ( @ % ; OR @ , @ % CI @-@ @ ; P = @ ) , with the number needed to treat in order to prevent @ subocclusion episode of @ favoring AZA .


The occlusion-free time interval was longer in the AZA group compared with the mesalazine group ( @ vs. @ months ; P = @ ) .


The occlusion-free survival at @ , @ , and @ months was significantly higher in the AZA group ( @ % , @ % , and @ % , respectively ) than in the mesalazine group ( @ % , @ % , and @ % , respectively ; P < @ for all comparisons ) .


In an exploratory analysis of patients with subocclusive ileocecal CD , maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during @ years of therapy .


This comparative study was aimed at determining the effectiveness of oral Misoprostol compared with intravenous Ergometrine and intravenous Oxytocin in reducing vaginal bleeding following surgical evacuation for first trimester abortions .


This was a single-blind placebo-controlled study in which patients with first trimester uncomplicated abortions were divided into three groups using computer-generated randomization table .


The first group was administered oral Misoprostol , the second group had intravenous Ergometrine , and the third group was administered intravenous Oxytocin .


The uterotonic agents were administered before the surgical evacuation was carried out .


There was statistically significant reduction in blood loss after the evacuation in the Misoprostol group ( P < @ ) .


There was also significant reduction in the number of days of bleeding in the Misoprostol group ( @ @ ) compared with @ @ and @ @ days in the Ergometrine and Oxytocin groups , respectively ( P < @ ) .


There were , however , more gastrointestinal side effects in the Misoprostol and Ergometrine groups ( @ % and @ % , respectively ) compared with the Oxytocin group .


Oral Misoprostol appeared to demonstrate superior efficacy in reducing uterine bleeding after surgical evacuation , compared to the other commonly used uterotonic agents .


Data on preoperative chemotherapy in resectable oral cavity cancer are conflicting .


We present the long-term results of a randomized trial of induction chemotherapy in resectable oral cavity cancer .


A randomized , parallel , multicentre trial evaluated the impact of three cycles of cisplatin @ mg/m@ and fluorouracil @ mg/m@ ( @-h infusion administered every @ days ) in stage T@-T@ , N@-N@ , previously untreated patients with advanced disease .


Control group received upfront surgery .


Postoperative radiation was offered to both arms when pathologic risk features were identified .


The co-primary end points were the occurrence of locoregional or distant tumour relapse , and death .


Among the @ enrolled patients , with a median follow-up of @ years , there was no difference in the incidence of locoregional relapse between chemotherapy and control group ( P = @ ) , nor in distant metastasis development ( P = @ ) .


There was also no difference between groups in overall survival ( P = @ ) .


Patients with a pathological complete response ( pCR ) had higher probability of survival than those without ( @-year OS : @ % versus @ % , P = @ ) .


Late toxicities in patients with a minimum follow-up of @ months ( @ in each group ) were similar between arms , except from fibrosis ( cumulative incidence @ % versus @ % in chemotherapy arm ) and grade @ dysphagia ( @ % versus @ % ) .


Long-term follow-up of this randomized trial confirmed the absence of survival benefit with preoperative chemotherapy in oral cavity cancer .


Late toxicity was similar in the two arms except for fibrosis and dysphagia , which were less in the chemotherapy arm .


The survival benefit for patients achieving a pCR was maintained .


To evaluate recombinant human luteinizing hormone ( r-hLH ) versus urine-derived human chorionic gonadotropin ( u-hCG ) to trigger ovulation in women ( aged @-@ years ) with WHO Group II anovulatory infertility undergoing ovulation induction ( OI ) with recombinant human follicle-stimulating hormone ( r-hFSH ) ( @ IU/day starting dose ) .


For this Phase II , open-label , dose-finding pilot study , patients were randomized to doses of @ , @,@ , @,@ , @,@ , or @,@ IU r-hLH or u-hCG ( @,@ IU ) .


Primary endpoints were ovulation and ratio of ruptured follicles/follicle > or = @ mm ( day of r-hLH / u-hCG administration ) .


Secondary endpoints included monofollicular ovulation and clinical pregnancy rates .


All @ randomized patients completed treatment .


All patients in the r-hLH @,@ ( @/@ ) , @,@ ( @ / @ ) , @,@ IU ( @/@ ) , and u-hCG @,@ IU ( @ / @ ) groups ovulated ; @/@ patients in the r-hLH @ IU and @/@ in the r-hLH @,@ IU group failed to ovulate ( p = @ between evaluable groups ) .


The mean ratio of ruptured follicles / follicle > or = @ mm was @ ( p = @ between groups ) .


The monofollicular ovulation rate was @/@ ( @ % ) .


Two cases of ovarian hyperstimulation syndrome were reported .


This open-label , pilot study ( conducted in @-@ ) suggests that the minimal effective dose of r-hLH to trigger ovulation in women with WHO Group II anovulatory infertility undergoing OI with r-hFSH ( @ IU starting dose ) was @,@ IU .


To compare intraocular pressure ( IOP ) and wound architecture immediately after cataract surgery using a scleral tunnel incision or clear corneal incision .


Prospective randomized clinical trial .


Bilateral eyes of @ patients undergoing phacoemulsification were randomized to @ groups : @ mm scleral tunnel incision or @ mm clear corneal incision .


IOP was adjusted upon completion of surgery to between @ and @ mm Hg .


The wound was hydrated in @ % of eyes in the clear corneal incision group .


IOP was measured using a rebound tonometer preoperatively ; at the conclusion of surgery ; and at @ , @ , @ , @ , and @ minutes postoperatively .


The Seidel test and anterior segment optical coherence tomography ( AS OCT ) were performed at @ minutes postoperatively .


In the scleral tunnel incision group , mean IOP decreased to the preoperative level within @ minutes postoperatively and did not change significantly for up to @ minutes .


In the clear corneal incision group , IOP decreased to lower than the preoperative IOP at @ minutes postoperatively .


Mean IOP was significantly higher in the scleral tunnel incision group than in the clear corneal incision group throughout the postoperative period ( P. @ ) .


Hypotony ( < @ mm Hg ) was observed in @ eyes ( @ % ) that underwent clear corneal incision and in no eyes that underwent scleral tunnel incision ( P = @ ) .


Wound leakage and loss of wound coaptation were not observed in any eyes .


IOP was significantly higher immediately after scleral tunnel incision without hydration than after clear corneal incision with hydration , and both incisions closed within @ minutes postoperatively without leakage based on AS OCT. .


To understand clinician adoption of CDS tools as this may provide important insights for the implementation and dissemination of future CDS tools .


Clinicians ( n = @ ) at a large academic center were randomized into intervention and control arms to assess the impact of strep and pneumonia CDS tools .


Intervention arm data were analyzed to examine provider adoption and clinical workflow .


Electronic health record data were collected on trigger location , the use of each component and whether an antibiotic , other medication or test was ordered .


Frequencies were tabulated and regression analyses were used to determine the association of tool component use and physician orders .


The CDS tool was triggered @ times over the study period .


Diagnosis was the most frequent workflow trigger of the CDS tool ( @ % ) as compared to chief complaint ( @ % ) and diagnosis/antibiotic combinations ( @ % ) .


Conversely , chief complaint was associated with the highest rate ( @ % ) of triggers leading to an initiation of the CDS tool ( opening the risk prediction calculator ) .


Similar patterns were noted for initiation of the CDS bundled ordered set and completion of the entire CDS tool pathway .


Completion of risk prediction and bundled order set components were associated with lower rates of antibiotic prescribing ( OR @ ; CI @-@ @ and OR @ ; CI @-@ @ , respectively ) .


Different CDS trigger points in the clinician user workflow lead to substantial variation in downstream use of the CDS tool components .


These variations were important as they were associated with significant differences in antibiotic ordering .


These results highlight the importance of workflow integration and flexibility for CDS success .


Patterns of inhaled @-agonist therapy use during severe asthma exacerbations before hospital attendance are poorly understood .


To assess @-agonist use prior to hospital attendance .


We undertook an exploratory post hoc analysis of data from a @-month clinical trial of @ patients randomised to combination budesonide/formoterol inhaler according to a Single combination inhaler as Maintenance And Reliever Therapy regimen ( ` SMART ' ) or fixed-dose budesonide/formoterol with salbutamol as reliever ( ` Standard ' ) .


Patterns of @-agonist use for @ days before hospital attendance with a severe asthma exacerbation were determined by electronic monitoring of inhaler use .


There were @ hospital attendances in @ patients during the study .


Seven and nine hospital attendances were eligible for analysis in the SMART and Standard groups , respectively .


In both regimens , @-agonist use increased before hospital attendance , with a median ( range ) maximum daily number of actuations of @ ( @ to @ ) budesonide/formoterol in SMART and @ ( @ to @ ) salbutamol in Standard with @ ( @ to @ ) budesonide/formoterol actuations on the day of maximal salbutamol use .


There was delay in obtaining medical review despite high @-agonist use , in @/@ patients .


Different patterns of use were observed , including repeated days of no inhaled corticosteroid despite marked salbutamol use , which occurred in @/@ patients in the Standard group .


Delay in obtaining medical review in association with high @-agonist use is common in patients before hospital presentation with severe exacerbations of asthma .


The SMART regimen reduced nonadherence with inhaled corticosteroid therapy during severe exacerbations .


Hypotension is a common problem during spinal anesthesia for cesarean delivery .


Intravenous fluid loading is used to correct preoperative dehydration and reduce the incidence and severity of hypotension .


Different fluid regimens have been studied but colloid preload and crystalloid co-load have not been compared .


In this randomized double-blind study , @ patients scheduled for elective cesarean section under spinal anesthesia were randomly allocated to receive either @ % hydroxyethyl starch @/@ @ @ mL before spinal anesthesia ( colloid preload ) or Ringer 's acetate solution @ mL administered rapidly starting with intrathecal injection ( crystalloid co-load ) .


Maternal hypotension ( systolic blood pressure < @ % of baseline or < @ mmHg ) and severe hypotension ( systolic blood pressure < @ mmHg ) were treated with @ and @mg ephedrine boluses , respectively .


The primary outcome was the incidence of hypotension .


Secondary outcomes included the incidence of severe hypotension , total ephedrine dose , nausea and vomiting and neonatal outcome assessed by Apgar scores and umbilical artery blood gas analysis .


Data analysis was performed on @ patients ; @ in the colloid preload group and @ in the crystalloid co-load group .


There were no significant differences in the incidence of hypotension ( @ % vs. @ % ; P = @ ) or severe hypotension ( @ % vs. @ % ; P = @ ) between colloid preload and crystalloid co-load groups , respectively .


The median -LSB- range -RSB- ephedrine dose was @ -LSB- @-@ -RSB- mg in the colloid preload group and @ -LSB- @-@ -RSB- mg in the crystalloid co-load group ( P = @ ) .


There were no significant differences in maternal nausea or vomiting or neonatal outcomes between groups .


The use of @ mL crystalloid co-load has similar effect to @ mL colloid preload in reducing the incidence of hypotension after spinal anesthesia for elective cesarean delivery .


Neither technique can totally prevent hypotension and should be combined with vasopressor use .


Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities ( LTCF ) is essential to organize and optimize individual tailored care .


We examined changes in care dependency in LTCF residents over two @-month periods , explored the possible predictive factors of change and the effect of care dependency on mortality .


A prospective follow-up study in @ Dutch long-term care facilities .


@ LTCF residents , median age @ ( Interquartile range @-@ ) years participated .


At baseline , @ and @ months , care dependency was assessed by the nursing staff with the Care Dependency Scale ( CDS ) , range @-@ points .


Since the median CDS score differed between men and women ( @ vs. @ , P = @ ) , CDS groups ( low , middle and high ) were based on gender-specific @ % of CDS scores at baseline and @ months .


At baseline , the CDS groups differed in median length of stay on the ward , urine incontinence and dementia ( all P < @ ) ; participants in the low CDS group stayed longer , had more frequent urine incontinence and more dementia .


They had also the highest mortality rate ( log rank @ ; df = @ ; P for trend < @ ) .


Per point lower in CDS score , the mortality risk increased with @ % ( @ % CI @ % -@ % ) .


Adjustment for age , gender , cranberry use , LTCF , length of stay , comorbidity and dementia showed similar results .


A one point decrease in CDS score between @ and @ months was related to an increased mortality risk of @ % ( @ % CI @ % -@ % ) .


At the @-month follow-up , @ % improved to a higher CDS group , @ % were in the same , and @ % had deteriorated to a lower CDS group ; a similar pattern emerged at @-month follow-up .


Gender , age , urine incontinence , dementia , cancer and baseline care dependency status , predicted an increase in care dependency over time .


The majority of residents were stable in their care dependency status over two subsequent @-month periods .


Highly care dependent residents showed an increased mortality risk .


Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options .


The purpose of this study was to assess the influence of axial length on spectral-domain optical coherence tomography ( SD-OCT ) thickness measurements in patients with subretinal visual implants .


Data from eight emmetropic pseudophakic eyes of eight patients with subretinal visual implants were analyzed retrospectively .


These patients participated in the monocentric part of a multicenter trial .


The axial length was measured in three short ( < @ mm ) , three medium ( @-@ @ mm ) , and two long ( > @ mm ) eyes .


Using Heidelberg Spectralis , the known thickness of a subretinal implant microchip ( @ m ) was measured on @ images per eye with SD-OCT , using the software calipers .


The mean axial length was @ @ mm in short eyes , @ @ mm in medium eyes , and @ @ mm in long eyes .


We found in short eyes , in medium eyes , and in long eyes a mean value of microchip thickness measurements from SD-OCT of @ @ m , @ @ m , and @ @ m , respectively .


The thickness measurements decreased in SD-OCT measurements with longer axial lengths significantly ( P < @ ) .


Axial length influences SD-OCT thickness measurements .


Our findings demonstrate accuracy of the scaling in SD-OCT thickness measurements in emmetropic medium eyes .


Caution is recommended when comparing the measured values of short and long eyes with the normative database of the instrument .


There is a need for larger sample-size studies to confirm our results .


( ClinicalTrials.gov number , NCT@ . )


Renal transplantation is the best treatment for kidney failure , in terms of length and quality of life and cost-effectiveness .


However , most transplants fail after @ to @ years , consigning patients back onto dialysis .


Damage by the immune system accounts for approximately @ % of failing transplants and it is possible to identify patients at risk by screening for the presence of antibodies against human leukocyte antigens .


However , it is not clear how best to treat patients with antibodies .


This trial will test a combined screening and treatment protocol in renal transplant recipients .


Recipients > @ year post-transplantation , aged @ to @ with an estimated glomerular filtration rate > @ mL/min will be randomly allocated to blinded or unblinded screening arms , before being screened for the presence of antibodies .


In the unblinded arm , test results will be revealed .


Those with antibodies will have biomarker-led care , consisting of a change in their anti-rejection drugs to prednisone , tacrolimus and mycophenolate mofetil .


In the blinded arm , screening results will be double blinded and all recruits will remain on current therapy ( standard care ) .


In both arms , those without antibodies will be retested every @ months for @ years .


The primary outcome is the @-year kidney failure rate for the antibody-positive recruits , as measured by initiation of long-term dialysis or re-transplantation , predicted to be approximately @ % in the standard care group but < @ % in biomarker-led care .


The secondary outcomes include the rate of transplant dysfunction , incidence of infection , cancer and diabetes mellitus , an analysis of adherence with medication and a health economic analysis of the combined screening and treatment protocol .


Blood samples will be collected and stored every @ months and will form the basis of separately funded studies to identify new biomarkers associated with the outcomes .


We have evidence that the biomarker-led care regime will be effective at preventing graft dysfunction and expect this to feed through to graft survival .


This trial will confirm the benefit of routine screening and lead to a greater understanding of how to keep kidney transplants working longer .


Venipuncture is one of the most painful events for children in hospitals .


Valsalva maneuver ( VM ) decreases the incidence and severity of pain on venipuncture pain in adults .


This study was designed to evaluate VM as compared with Eutectic Mixture of Local Anesthetic ( EMLA ( ) ) cream for venipuncture pain in children .


In this study , we evaluated the effect of VM on venipuncture pain in children .


@ patients scheduled for elective surgery were randomly divided into three groups .


In Group V , children were punctured during VM .


In Group E , EMLA ( ) @ % cream and in Group C ( control group ) vaseline was applied on the non-dominant hand @ min before the venipuncture .


Patients made a pain assessment using visual analog score ( VAS ) .


Mean arterial pressure ( MAP ) , heart rate ( HR ) , and SpO@ measurements were obtained during the venous cannulation .


Respectively , the VAS was @ @ for Group V and @ @ for Group E and @ @ for Group C.


A significant reduction in the severity of pain was observed in Group E.


The difference being statistically significant ( p < @ ) , the VAS of Group V was higher than Group E but lower than Group C ( p > @ ) .


On the basis of data from this study , the VM is a simple and a practical method to reduce venipuncture pain in children but not as effectively as EMLA ( ) .


Is a combination of standing , electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury ?


A multi-centre randomised trial with concealed allocation , assessor blinding and intention-to-treat analysis .


Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures .


All participants underwent a @-week program .


The experimental group received tilt table standing , electrical stimulation and ankle splinting .


The control group received tilt table standing alone .


The primary outcome was passive ankle dorsiflexion with a @Nm torque .


Secondary outcomes included : passive dorsiflexion with lower torques ( @ , @ , @ and @Nm ) ; spasticity ; the walking item of the Functional Independence Measure ; walking speed ; global perceived effect of treatment ; and perceived treatment credibility .


OUTCOME MEASURES were taken at baseline ( Week @ ) , end of intervention ( Week @ ) , and follow-up ( Week @ ) .


The mean between-group differences ( @ % CI ) for passive ankle dorsiflexion at Week @ and Week @ were -@ degrees ( -@ to @ ) and -@ degrees ( -@ to @ ) , respectively , in favour of the control group .


There was a small mean reduction of @ point in spasticity at Week @ ( @ % CI @ to @ ) in favour of the experimental group , but this effect disappeared at Week @ .


There were no differences for other secondary outcome measures except the physiotherapists ' perceived treatment credibility .


Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury .


The purpose of this study was to determine the cost implications of the Coronary Artery Bypass Graft Off or On Pump Revascularization Study ( CORONARY ) at @ year .


Country-specific healthcare costs were obtained from public databases or local experts from each country in the CORONARY trial .


Purchasing power parities were applied to these costs of consumed healthcare resources .


Analyses of subgroups included in the CORONARY clinical trial were also conducted .


Costs are reported in US dollars .


After @ year , the total cost per patient in the off-pump coronary artery bypass graft surgery ( CABG ) arm was $ @,@ ( $ @,@ to $ @,@ ) compared with $ @,@ ( $ @,@ to $ @,@ ) for the on-pump CABG arm ; that resulted in a nonsignificant increase of $ @ ( - $ @ to $ @ ) .


Similar findings were noted for various subgroups .


There were also no differences due to late conversions .


The CORONARY trial demonstrated that off-pump CABG was clinically as safe and effective as on-pump CABG with no difference in costs .


Thus , the decision as to which method to choose is free from costs considerations and should be based on patient preference and surgeon expertise ( Coronary Artery Bypass Graft -LSB- CABG -RSB- Off or On Pump Revascularization Study -LSB- CORONARY -RSB- ; clinicaltrials.gov NCT@ ) .


Statin intolerance has been a major limitation in the use of statins , especially at higher doses .


New effective treatments are needed for lowering low-density lipoprotein cholesterol ( LDL-C ) in patients who can not tolerate daily statin doses .


ODYSSEY ALTERNATIVE ( NCT@ ) evaluates efficacy and safety of alirocumab , a fully human proprotein convertase subtilisin/kexin type @ monoclonal antibody , in patients with well-documented statin intolerance and moderate to very high cardiovascular risk .


This is a phase @ , multicenter , randomized , double-blind , double-dummy study in statin-intolerant patients .


Intolerance was defined as inability to take at least @ different statins because of muscle-related adverse events ( AEs ) , @ at the lowest approved starting dose .


Patients first received single-blind subcutaneous and oral placebo for @ weeks , and were withdrawn if they developed muscle-related AEs after the placebo treatment .


Continuing patients were randomized ( @:@:@ ratio ) to alirocumab @ mg self-administered via single @ mL prefilled pen every @ weeks or ezetimibe @ mg/day or atorvastatin @ mg/day ( statin rechallenge ) , for @ weeks .


Alirocumab dose was increased to @ mg every @ weeks ( also @ mL ) at week @ depending on week @ LDL-C level .


The primary endpoint is percent change in LDL-C from baseline to week @ by intent-to-treat analysis .


Muscle-related AEs were assessed by spontaneous patient reports and clinic queries .


A total of @ patients have been randomized .


This is the first and only study of a new class of LDL-C-lowering agents in patients selected with a rigorously documented intolerance to statins , using a placebo run-in and statin control arm .


The optimal strategy for the reconstruction of the pancreas following pancreaticoduodenectomy ( PD ) is still debated .


The aim of this study was to compare the outcomes of isolated Roux loop pancreaticojejunostomy ( IRPJ ) with those of pancreaticogastrostomy ( PG ) after PD .


Consecutive patients submitted to PD were randomized to either method of reconstruction .


The primary outcome measure was the rate of postoperative pancreatic fistula ( POPF ) .


Secondary outcomes included operative time , day to resumption of oral feeding , postoperative morbidity and mortality , and exocrine and endocrine pancreatic functions .


Ninety patients treated by PD were included in the study .


The median total operative time was significantly longer in the IRPJ group ( @min versus @min ; P = @ ) .


Postoperative pancreatic fistula developed in nine of @ patients in the IRPJ group and @ of @ patients in the PG group ( P = @ ) .


Seven IRPJ patients and four PG patients had POPF of type B or C ( P = @ ) .


Time to resumption of oral feeding was shorter in the IRPJ group ( P = @ ) .


Steatorrhea at @ year was reported in nine of @ IRPJ patients and @ of @ PG patients ( P = @ ) .


Albumin levels at @ year were @ g/dl in the IRPJ group and @ g/dl in the PG group ( P = @ ) .


Isolated Roux loop PJ was not associated with a lower rate of POPF , but was associated with a decrease in the incidence of postoperative steatorrhea .


The technique allowed for early oral feeding and the maintenance of oral feeding even if POPF developed .


The increasing number of patients with implantable cardiac devices raises the need for more efficient outpatient follow-up care .


Due to technological progress in communication and transmission systems and in the implantable devices themselves , telemonitoring can be widely used as an important part of care for patients and devices .


Our objective was to evaluate the benefits of continuous remote monitoring using the BIOTRONIK Home Monitoring ( HM ) system compared to standard outpatient follow-ups .


@ patients with single - or dual-chamber implantable cardioverter-defibrillator ( ICD ) implanted for primary or secondary prevention of sudden cardiac death were randomized into a group of patients followed through standard outpatient visits ( HM - ) and a group telemonitored by the HM system ( HM + ) .


Planned and emergency visits , ICD-related hospitalizations , and delivered shocks and their appropriateness were evaluated in the respective groups .


A significant reduction was achieved in the number of planned ( by @ % , p < @ ) and total visits ( by @ % , p < @ ) during a three-year evaluation .


A comparable number of patients experienced one or more shocks .


Mortality rates were equivalent , as was the number of patients hospitalized in relation to their ICD .


However , there was a significant reduction in the number and proportion of inappropriate shocks delivered in the HM + patient group : by @ % ( p = @ ) in outpatient follow-up care and by @ % ( p < @ ) when multiple shocks requiring hospitalization were included .


The HM system was an effective and safe method of follow-up in patients with an implanted ICD .


Remote monitoring reduces the number of outpatient visits and inappropriate shocks .


Recent publications have shown an infection rate of @-@ % for acetabular fractures treated with the Kocher-Langenbeck ( K-L ) approach .


Using metallic staples to close hip skin incisions has been considered the gold standard .


The purpose of this study was to answer the following : ( @ ) will closure of a K-L incision after acetabular fracture surgery with a running subcuticular monocryl suture , then sealing the wound with @-octyl cyanoacrylate ( OCA ) , result in a lower infection rate compared to metallic staple closure ?


( @ ) Do incisions closed with subcuticular monocryl and OCA exhibit decreased drainage ?


( @ ) Is there a cost difference between these two methods ?


In a prospective clinical study , @ patients with acetabular fractures treated using the K-L approach were randomized into two groups : skin closure with metallic staples ( n = @ ) versus subcuticular running monocryl suture sealed with OCA ( n = @ ) .


Two postoperative deep infections ( @ % ) in the staples group required multiple debridements ; no infections developed in the OCA group .


However , there was no statistical difference between the groups , ( p = @ ) .


There was a statistically significant difference ( p = @ ) comparing days from surgery to a dry incision favoring OCA ( @ versus @ days ) .


The patient charge was approximately $ @ greater on average in the OCA group due to the increased time in the operating room required for the subcuticular closure .


Closure with OCA and subcuticular monocryl showed no clinical disadvantages and appears to have a clinical advantage when compared to standard metallic staple skin closure in acetabular fracture surgery .


However , additional patient costs may be incurred .


The aim of this work was to investigate cardiorespiratory fitness in breast cancer patients at different time points of anti-cancer treatment .


Non-metastatic breast cancer patients ( n = @ , mean age @ years ) were categorized into four subgroups according to their treatment status .


Cardiopulmonary exercise testing ( CPET ) was used to measure patients ' cardiorespiratory fitness , including oxygen delivery and metabolic muscle function .


Testing was performed by bicycle ergometry , and maximal oxygen uptake ( VO@peak ) was measured .


Heart rate during exercise at @ watts ( HR@ ) was assessed as a cardiocirculatory parameter and ventilatory threshold ( VT ) was used as an indicator of the O@ supply to muscle .


Analysis of covariance was used to estimate the impact of different cancer treatments on cardiorespiratory fitness with adjustment for clinical factors .


Submaximal measures were successfully assessed in @ ( @ % ) and @ ( @ % ) patients for HR@ and VT , while criteria for maximal exercise testing were met by @ patients ( @ % ) , respectively .


The mean VO@peak was @ @ ml/kg/min , mean VT @ @ ml/min/kg and mean HR@ @ @ beats/min .


Chemotherapy was significantly associated with decreased VO@peak , with significantly lower adjusted mean VO@peak among patients post adjuvant chemotherapy compared to patients with no chemotherapy or those who just started chemotherapy regime ( all p < @ ) .


Patients post adjuvant chemotherapy reached only @ % of the VO@peak level expected for their age - and BMI-category ( mean VO@peak @ @ ml/kg/min ) .


Similarly , HR@ was significantly associated with treatment .


However , VT was not associated with treatment .


Breast cancer patients have marked and significantly impaired cardiopulmonary function during and after chemotherapy .


Hereby , chemotherapy appears to impair cardiorespiratory fitness by influencing the oxygen delivery system rather than impacting metabolic muscle function .


Our findings underline the need of exercise training in breast cancer patients to counteract the loss of cardiorespiratory fitness during the anti-cancer treatment .


The treatment of massive pulmonary embolisms with an associated cardiac arrest is controversial ; however , surgical thrombectomy with extracorporeal circulation ( ECC ) is an option for treatment .


It is difficult to remove all thromboembolic material .


Theoretically , retrograde blood perfusion through the lungs may be beneficial .


To investigate whether retrograde blood perfusion through the lungs during a thrombectomy is beneficial .


Twelve pigs were prepared for ECC .


Repetitive injections of preformed blood thrombi into the right atrium resulted in cardiac arrests .


ECC was established after @ minutes of cardiac arrest , and after a sternotomy , the main pulmonary artery was incised and as much thrombotic material as possible was removed from the pulmonary arteries .


The pigs were randomised to ECC for one hour either with or without retrograde perfusion in the pulmonary circulation .


After one hour , the released material was removed from the pulmonary arteries , and the incision was sutured .


The pigs were weaned from the ECC .


After sacrificing the pigs , they were autopsied with special attention to the amount of remaining thrombi .


Additional histological analyses were performed with special attention to microembolisms , atelectases , and signs of tissue damage .


All of the pigs were weaned from the ECC .


The amount of the embolic material removed varied considerably , as did the amount removed after the retrograde or antegrade perfusion , and there was no significant difference between the two treatment modalities .


There were no signs of tissue damage in the lungs .


Retrograde lung perfusion was not generally beneficial in the treatment of massive pulmonary embolism in this setup ; however , it may be an option if only a modest amount of material is accessible in the pulmonary artery .


Infantile hemangiomas have a dramatic response to propranolol , a nonselective beta-blocker .


However , this treatment is not risk-free and many patients are excluded because of respiratory comorbidities .


Atenolol is a cardioselective beta-blocker that may have fewer adverse events .


We sought to evaluate the effectiveness of atenolol against propranolol in a noninferiority trial .


In all , @ patients met the inclusion criteria and were randomized to receive either atenolol or propranolol .


Thirteen patients were treated with atenolol and @ with propranolol .


Follow-up was made at baseline , @ weeks , @ weeks , and then monthly for @ months .


Patients treated with atenolol had a complete response of @ % and @ % with propranolol , respectively .


These results were nonsignificant ( P = @ ) .


Relevant adverse events were not reported .


The reduced number of patients could have influenced our results .


Atenolol appears to be as effective as propranolol .


We did not find significant differences between these results or any adverse events .


Erectile dysfunction is prevalent in men over @ years , affecting their quality of life and that of their partners .


The aims of this study were : a ) To evaluate the internal reliability of the male erectile dysfunction specific quality of life ( MED-QoL ) scale and explore its factor structure.b ) To evaluate the effect of simvastatin on subscales of the MED-QoL in men over forty years with erectile dysfunction .


This is a double blind randomised controlled trial of @ mg simvastatin or placebo given once daily for six months to men over forty years with untreated erectile dysfunction , who were not at high cardiovascular risk and were not on anti-hypertensive or lipid-lowering medication .


@ eligible men were recruited from @ general practices in East of England .


Data were collected at two points over @ weeks.We report on the factor structure of MED-QoL , the internal reliability of the scale and the derived subscales , and the effect of simvastatin on MED-QoL subscales .


An initial analysis of the MED-QoL items suggested that a number of items should be removed ( MED-QoL-R ) .


Exploratory factor analysis identified three subscales within the MED-QoL-R which accounted for @ % of the variance , related to feelings of Control , initiating Intimacy , and Emotional response to erectile dysfunction .


The alpha value for the revised scale ( MED-Qol-R ) was > @ and exceeded @ for each subscale .


Regression analysis showed that patients in the placebo group experienced a significantly reduced feeling of Control over erectile dysfunction than those in the statin group .


Those in the placebo group had significantly lower Emotional response than those in the statin group at the close of trial , but there was no significant treatment effect on Intimacy .


Our revised MED-QoL-R identified three subscales .


Secondary analysis showed a significant improvement in sexual health related quality of life , specifically in relation to perception of control and emotional health in men with untreated erectile dysfunction given @ mg simvastatin for six months .


A high dose of continuous intravenous infusion of proton pump inhibitor ( PPI ) is the standard treatment for peptic ulcer bleeding .


The optimal dose for the prevention of bleeding after endoscopic submucosal dissection ( ESD ) is unclear .


The purpose of this study was to determine whether stronger acid suppression more effectively prevents bleeding and high risk ulcer stigma ( HRS ) after gastric ESD .


A total of @ patients who underwent ESD were randomly assigned to one of two treatment groups : the continuous infusion group and the bolus injection group .


Second-look endoscopy was performed on the following day after ESD .


The incidences and risk factors of HRS identified by second-look endoscopy and delayed bleeding were analyzed .


There were no differences in the incidences of HRS and delayed bleeding between two treatment groups .


The incidence of HRS was @ % ( @/@ ) and the gross morphology ( flat or depressed ) was identified as a significant factor associated with HRS .


The incidence of delayed bleeding was @ % ( @/@ ) and the gross morphology ( flat ) and the presence of submucosal invasive cancer were identified as the associated risk factors for delayed bleeding .


The incidences of delayed bleeding and HRS identified by second-look endoscopy were not affected by PPI infusion methods .


Flat or depressed morphologic lesions and submucosal invasive cancer should be closely monitored .


Ultrasound ( US ) - guided needling with subacromial corticosteroid injection is more effective than extracorporeal shock wave therapy ( ESWT ) for function restoration and pain relief in patients with calcific tendinitis of the shoulder .


Fifty-four patients diagnosed with unilateral painful calcific tendinitis were randomly allocated to a US needling or ESWT group .


The US needling group underwent US-guided needling and received a subacromial corticosteroid injection .


The ESWT group received ESWT @ times a week .


All patients were prospectively evaluated ; American Shoulder and Elbow Surgeons , Simple Shoulder Test , and visual analog scale for pain scores were recorded before the procedure and at @ weeks , @ weeks , @ months , @ months , and the last follow-up .


The size and morphology of the deposits were evaluated by radiography .


The average follow-up period was @ months .


At last follow-up , the mean size of the deposits was significantly different between the @ groups ( P = @ ) ; it decreased to @ mm from @ mm in the US needling group and to @ mm from @ mm in the ESWT group .


There were also significant improvements in clinical outcomes in both groups after treatment ( P < @ ) .


At @-year follow-up , the US needling group had significantly better scores than the ESWT group with regard to the American Shoulder and Elbow Surgeons assessment ( @ and @ , respectively ; P = @ ) , Simple Shoulder Test ( @ and @ , respectively ; P = @ ) , and visual analog scale for pain ( @ and @ , respectively ; P = @ ) .


The initial calcium deposit sizes and clinical outcomes were weakly correlated in both groups ( P > @ ) .


Both treatment modalities for calcific tendinitis improved clinical outcomes and eliminated calcium deposits .


US-guided needling treatment , however , was more effective in function restoration and pain relief in the short term .


Meta-analyses suggest that an intravenous bolus or a high dose continuous infusion of somatostatin reduces the incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography ( ERCP ) .


Clinical guidelines , however , do not recommend this prophylaxis .


The aim of this randomized , double-blind clinical trial was to evaluate the effect of somatostatin on the incidence of post-ERCP pancreatitis .


Patients undergoing ERCP at a single center were randomized to either intravenous bolus of somatostatin followed by a short ( @-hour ) continuous infusion , or to a similar placebo regimen .


The primary outcome was post-ERCP pancreatitis , defined as abdominal pain with an amylase level at least three times higher than the upper limit of normality @ hours after the ERCP and requiring admission for at least @ days .


A total of @ patients were enrolled ( @ patients per group ) and all completed follow-up .


The main indications for ERCP were choledocholithiasis ( @ % ) , and biliary malignant stricture ( @ % ) .


Post-ERCP pancreatitis occurred in @ patients ( @ % ) in the somatostatin group and @ patients ( @ % ) in the placebo group ( relative risk -LSB- RR -RSB- @ , @ % confidence interval -LSB- @ % CI -RSB- @-@ @ ; P = @ ) .