The study group consisted of @ women who received an intra-amniotic injection of @mg ethacridine lactate , followed by oral administration of @mg mifepristone at @ , @ and @h ( total dose of mifepristone @mg ) .


The control group consisted of @ women who received an intra-amniotic injection of @mg ethacridine lactate alone .


The primary outcome measure was the induction-to-abortion interval .


Secondary outcomes included blood loss in @h , successful abortion rate , retained placental tissue rate , rate of uterine evacuation and cervical laceration .


Induction-to-abortion interval , blood loss in @h , rate of retained placental tissue and uterine evacuation were significantly less in the study group compared with the control group ( p < @ ) .


Termination was successful in @ of @ women ( @ % ) in the study group and @ of @ women ( @ % ) in the control group .


All women in the study group delivered within @h , and three nulliparous women in the control group did not deliver within @h .


The cervical laceration rate was @ and @ % ( @/@ ) in the study group and the control group , respectively .


No significant difference in the successful abortion rate ( p = @ ) or the cervical laceration rate ( p = @ ) was found between the two groups .


Mifepristone in combination with ethacridine lactate may significantly improve the outcomes of second trimester pregnancy termination compared with ethacridine lactate alone , without increasing complications and side effects apart from nausea .


Ticagrelor reduces thrombotic events compared with clopidogrel in patients with acute coronary syndrome , but may also increase bleeding complications .


Coronary artery bypass grafting ( CABG ) - related bleeding complications have not previously been compared in clopidogrel and ticagrelor-treated patients outside the controlled environment of clinical trials .


Four hundred and five consecutive CABG patients with acute coronary syndrome were included in a prospective observational study .


The patients were treated with aspirin and ticagrelor ( n = @ ) or aspirin and clopidogrel ( n = @ ) .


Ticagrelor/clopidogrel was discontinued @ days before surgery whenever deemed possible .


Major bleeding complications according to modified blood conservation using antifibrinolytics in a randomized trial criteria ( postoperative blood loss > @ ml/@ h , re-exploration , red blood cell transfusion > @ units or death because of bleeding ) were compared in all patients and when ticagrelor/clopidogrel was discontinued @ days ( n = @ ) , @-@ days ( n = @ ) or @-@ day before surgery ( n = @ ) .


Major bleeding complications did not differ significantly between ticagrelor - and clopidogrel-treated patients when all patients were compared ( @ vs @ % , P = @ ) .


Likewise , there were no significant differences between ticagrelor and clopidogrel when either drug was discontinued @ days before surgery ( @ vs @ % , P = @ ) or @-@ days before surgery ( @ vs @ % , P = @ ) .


When ticagrelor/clopidogrel was discontinued @-@ day before surgery , there was a strong trend towards higher incidence of major bleeding in ticagrelor-treated patients ( @ vs @ % , P = @ ) .


There was no difference in major bleeding complications overall or when ticagrelor or clopidogrel was used in accordance with guidelines .


In patients on dual antiplatelet medication up to @ day before surgery , there tended to be more bleeding complications in ticagrelor-treated patients .


Ventilator-associated pneumonia diagnosis remains a debatable topic .


New definitions of ventilator-associated conditions involving worsening oxygenation have been recently proposed to make surveillance of events possibly linked to ventilator-associated pneumonia as objective as possible .


The objective of the study was to confirm the effect of subglottic secretion suctioning on ventilator-associated pneumonia prevalence and to assess its concomitant impact on ventilator-associated conditions and antibiotic use .


Randomized controlled clinical trial conducted in five ICUs of the same hospital .


Three hundred fifty-two adult patients intubated with a tracheal tube allowing subglottic secretion suctioning were randomly assigned to undergo suctioning ( n = @ , group @ ) or not ( n = @ , group @ ) .


During ventilation , microbiologically confirmed ventilator-associated pneumonia occurred in @ patients ( @ % ) of group @ and @ patients ( @ % ) of group @ ( p = @ ) .


In terms of ventilatory days , ventilator-associated pneumonia rates were @ of @,@ ventilatory days and @ of @,@ ventilatory days , respectively ( p = @ ) .


Ventilator-associated condition prevalence was @ % in group @ and @ % in group @ ( p = @ ) .


Among the @ patients with ventilator-associated pneumonia , @ ( @ % ) experienced a ventilator-associated condition .


Neither length of ICU stay nor mortality differed between groups ; only ventilator-associated condition was associated with increased mortality .


The total number of antibiotic days was @,@ in group @ , representing @ % of the @,@ ICU days , and @,@ in group @ , representing @ % of the @,@ ICU days ( p < @ ) .


Subglottic secretion suctioning resulted in a significant reduction of ventilator-associated pneumonia prevalence associated with a significant decrease in antibiotic use .


By contrast , ventilator-associated condition occurrence did not differ between groups and appeared more related to other medical features than ventilator-associated pneumonia .


Recurrent respiratory infections ( RRI ) constitute a social problem for both the pharmaco-economic impact and the burden for the family .


Pidotimod is a synthetic immunostimulant .


The aim of this study was to evaluate the effects of pidotimod on RRI prevention in children .


Globally , @ children ( @ males , mean age @ @ years ) with RRI were enrolled in the study .


At baseline , children were randomly assigned to the treatment with pidotimod @ mg/die or not for two months .


Children were visited at baseline , after @ ( T@ ) and @ ( T@ ) days , and at follow-up ( @ days ; T@ ) .


Number of children with upper and lower airways symptoms , medications use , school attendance , and paediatric visits for RRI were evaluated .


Pidotimod treatment was able of significantly reducing the number of children with upper and lower airways symptoms , and medications use , increasing school attendance , and reducing pediatric visits for RRI .


This study provided the evidence that pidotimod may be able of preventing RRI in children .


Under Food and Drug Administration investigational device exemption , the Prospective Randomized On-X Anticoagulation Clinical Trial ( PROACT ) has been testing the safety of less aggressive anticoagulation than recommended by the American College of Cardiology/American Heart Association guidelines after implantation of an approved bileaflet mechanical valve .


In this first limb of the PROACT , patients with elevated risk factors for thromboembolism were randomized at @ US centers to receive lower dose warfarin ( test international normalized ratio -LSB- INR -RSB- , @-@ @ ) or continue standard warfarin ( control INR , @-@ @ ) , @ months after mechanical aortic valve replacement .


The INR was adjusted by home monitoring ; all patients received @ mg aspirin daily .


Adverse events were independently adjudicated .


A total of @ aortic valve replacement patients were randomized into control ( n = @ ) and test ( n = @ ) groups from September @ to December @ .


The mean age standard deviation was @ @ years ; @ % were men ; and @ % were in sinus rhythm preoperatively .


Calcific degeneration was present in @ % ; active endocarditis was excluded .


Concomitant procedures included coronary artery bypass grafting ( @ % ) , aortic aneurysm repair ( @ % ) , and other ( @ % ) .


The follow-up duration averaged @ years ( @ patient-years -LSB- pt-yrs -RSB- for control ; @ pt-yrs for test ) .


The mean INR was @ @ for the control and @ @ for the test groups ( P < @ ) .


The test group experienced significantly lower major ( @ % vs @ % / pt-yr ; P = @ ) and minor ( @ % vs @ % / pt-yr ; P = @ ) bleeding rates .


The incidence of stroke , transient ischemic attack , total neurologic events , and all-cause mortality were similar between the @ groups .


INR can be safely maintained between @ and @ after aortic valve replacement with this approved bileaflet mechanical prosthesis .


With low-dose aspirin , this resulted in a significantly lower risk of bleeding , without a significant increase in thromboembolism .


Addressing the two most important considerations in designing clinical trials , i.e. maximizing study power and minimizing patient exposure to ineffective treatment , is particularly challenging for trials of rare diseases .


The familial Mediterranean fever ( FMF ) rilonacept trial ( Hashkes et al. , Ann Intern Med @ ; @:@ -@ ) demonstrates a novel crossover design by enabling patient choice to early escape for rare disease .


To investigate the effect on study power , exposure to the ineffective treatment arm and dropout rate by implementing early escape to crossover design , and to propose a Bayesian modeling approach .


Based on the FMF trial data , simulation studies compared study power and dropout rate among three types of designs for crossover trial : traditional without early escape , early escape per-patient-choice , and early escape per-protocol .


The early escape per patient choice or per protocol design achieved @ @ and @ @ of the study efficiency when compared to the traditional crossover design assuming no dropout .


Early escape per patient choice compared to early escape per protocol improved power by @ @ , and reduced the dropout rate by @-@ % , but with greater patient exposure to the less effective treatment arm .


The results of the FMF trial and simulation studies suggest that allowing early escape in crossover trial enhanced the design by minimizing patient 's exposure to the ineffective treatment arm while maintaining a reasonable study power , which is particularly important for rare disease trials .


Choice between the two types of early escape presents tradeoff between study power and exposure to ineffective treatment .


Epidemiological studies suggest that exercise has a tremendous preventative effect on morbidity and premature death , but these findings need to be confirmed by randomised trials .


Generation @ is a randomised , controlled study where the primary aim is to evaluate the effects of @years of exercise training on mortality in an elderly population .


All men and women born in the years @-@ ( n = @ ) , who were residents of Trondheim , Norway , were invited to participate .


Between August @ and June @ , a total of @ individuals ( @ women ) were included and randomised to either @years of two weekly sessions of high-intensity training ( @min warm-up followed by @min intervals at @ % of peak heart rate ) or , moderate-intensity training ( @min of continuous work at @ % of peak heart rate ) , or to a control group that followed physical activity advice according to national recommendations .


Clinical examinations , physical tests and questionnaires will be administered to all participants at baseline , and after @ , @ and @years .


Participants will also be followed up by linking to health registries until year @ .


Opioid-induced constipation ( OIC ) is a common adverse effect associated with opioid use .


Naloxegol is a PEGylated derivative of naloxone in clinical development as a once-daily oral treatment of OIC .


A thorough QT/QTc study was conducted , according to International Conference on Harmonisation E@ guidelines , to characterize the effect of naloxegol on cardiac repolarization .


In this randomized , positive - and placebo-controlled crossover study , healthy men received a single dose of naloxegol @ mg ( therapeutic dose ) , naloxegol @ mg ( supratherapeutic dose ) , moxifloxacin @ mg ( positive control ) , or placebo in @ of @ sequences ( Williams Latin square design ) .


The washout time between treatment periods was at least @ days .


Digital @-lead ECGs were recorded at baseline and at @ time points over @ hours after dosing in each treatment period .


QT intervals were corrected for heart rate using the Fridericia formula ( QTcF ) and the Bazett formula ( QTcB ) .


A total of @ subjects were enrolled ( mean age , @ years ) , and @ received all @ treatments .


The placebo-corrected , baseline-adjusted , mean increases in QTcF with naloxegol @ and @ mg were both < @ msec at each time point , and all upper limits of the @-sided @ % CI were < @ msec .


Similar findings were observed using QTcB ; the upper limits of the @-sided @ % CI were < @ msec at all time points after dosing with naloxegol @ or @ mg .


With moxifloxacin @ mg , mean QTcF was increased by a maximum of @ msec ( @ % CI , @-@ @ msec ) , supporting assay sensitivity .


Naloxegol at @ and @ mg was not associated with QT/QTc interval prolongation in these healthy men , and at the proposed therapeutic dose of @ mg/d , naloxegol is not expected to have a clinically relevant effect on cardiac repolarization in patients with OIC .


ClinicalTrials.gov identifier : NCT@ .


Assess the effect of counter-advertisements on parents ' appraisals of unhealthy foods featuring front-of-package promotions ( FOPPs ) .


A @ @ @ between-subjects Web-based experiment .


Parents were randomly shown an advertisement ( counter-advertisement challenging FOPP/control advertisement ) and then a pair of food products from the same category : an unhealthy product featuring an FOPP ( nutrient content claim/sports celebrity endorsement ) and a healthier control product with no FOPP .


Australia .


A total of @,@ Australian-based parents of children aged @-@ years recruited from an online panel .


Parents nominated which product they would prefer to buy and which they thought was healthier , then rated the unhealthy product and FOPP on various characteristics .


Differences between advertisement conditions were assessed using logistic regression ( product choice tasks ) and analysis of variance tests ( ratings of unhealthy product and FOPP ) .


Compared with parents who saw a control advertisement , parents who saw a counter-advertisement perceived unhealthy products featuring FOPPs as less healthy , expressed weaker intentions for buying such products , and were more likely to read the nutrition facts panel before nominating choices ( all P < @ ) .


Counter-advertising may help reduce the misleading influence of unhealthy food marketing and improve the accuracy of parents ' evaluations of how nutritious promoted food products are .


Glucagon-like peptide-@ ( GLP-@ ) may provide beneficial cardiovascular effects , possibly due to enhanced myocardial energetic efficiency by increasing myocardial glucose uptake ( MGU ) .


We assessed the effects of GLP-@ on MGU in healthy subjects during normo - and hypoglycemia .


We included eighteen healthy men in two randomized , double-blinded , placebo-controlled cross-over studies .


MGU was assessed with GLP-@ or saline infusion during pituitary-pancreatic normo - ( plasma glucose ( PG ) : @ mM , n = @ ) and hypoglycemic clamps ( PG : @ mM , n = @ ) by positron emission tomography with ( @ ) fluoro-deoxy-glucose ( ( @ ) F-FDG ) as tracer .


In the normoglycemia study mean ( SD ) age was @ years , and BMI was @ kg/m ( @ ) and in the hypoglycemia study the mean age was @ years with a mean body mass index of @ kg/m ( @ ) .


GLP-@ did not change MGU during normoglycemia ( mean ( + / - SD ) @ + / -@ and @ + / -@ mol/g/min , P = @ ) or during hypoglycemia ( @ + / -@ and @ + / -@ mol/g/min , P = @ ) .


However , the effect of GLP-@ on MGU was negatively correlated to baseline MGU both during normo - and hypoglycemia , ( P = @ , r ( @ ) = @ and P = @ , r ( @ ) = @ , respectively ) and changes in MGU correlated positively with the level of insulin resistance ( HOMA @IR ) during hypoglycemia , P = @ , r ( @ ) = @ .


GLP-@ mediated an increase in circulating glucagon levels at PG levels below @ mM and increased glucose infusion rates during the hypoglycemia study .


No differences in other circulating hormones or metabolites were found .


While GLP-@ does not affect overall MGU , GLP-@ induces changes in MGU dependent on baseline MGU such that GLP-@ increases MGU in subjects with low baseline MGU and decreases MGU in subjects with high baseline MGU .


GLP-@ preserves MGU during hypoglycemia in insulin resistant subjects .


ClinicalTrials.gov registration numbers : NCT@ : ( hypoglycemia ) and NCT@ : ( normoglycemia ) .


The effectiveness of non-invasive positive pressure ventilation ( NIV ) in COPD patients with prolonged hypercapnia after ventilatory support for acute respiratory failure ( ARF ) remains unclear .


We investigated if nocturnal NIV in these patients prolongs the time to readmission for respiratory causes or death ( primary endpoint ) in the following @months .


@ COPD patients admitted to hospital with ARF and prolonged hypercapnia > @h after termination of ventilatory support were randomised to NIV or standard treatment .


Secondary outcomes were daytime arterial blood gasses , transcutaneous PCO@ during the night , lung function , health-related quality-of-life ( HRQL ) , mood state , daily activities and dyspnoea .


@year after discharge , @ % versus @ % of patients ( NIV vs standard treatment ) were readmitted to hospital for respiratory causes or had died ; time to event was not different ( p = @ ) .


Daytime PaCO@ was significantly improved in NIV versus standard treatment ( PaCO@ @ kPa ( @ % CI @ to @ , p = @ ) ) as was transcutaneous PCO@ during the night .


HRQL showed a trend ( p = @ , Severe Respiratory Insufficiency questionnaire ) in favour of NIV .


Number of exacerbations , lung function , mood state , daily activity levels or dyspnoea was not significantly different .


We could not demonstrate an improvement in time to readmission or death by adding NIV for @year in patients with prolonged hypercapnia after an episode of NIV for ARF .


There is no reason to believe the NIV was not effective since daytime PaCO@ and night-time PCO@ improved .


The trend for improvement in HRQL favouring NIV we believe nevertheless should be explored further .


This study evaluated the effect of either an intermediate application of adhesive resin or flowable resin application on the adhesion of particulate filler composite ( PFC ) to glass fiber-reinforced composite ( FRC ) .


Unidirectional , pre-impregnated S@-glass fiber bundles ( Dentapreg ) ( length : @ mm ; thickness : @ mm ) were obtained ( N = @ , n = @ per group ) and secured in translucent silicone material with the adhesion surface exposed and photopolymerized .


They were randomly divided into @ groups for the following adhesion sequence : A ) FRC+PFC , B ) FRC + intermediate adhesive resin + PFC , C ) FRC + flowable resin + PFC. The PFC was applied in a polyethylene mold onto the FRC and photopolymerized .


PFCs were debonded from the FRC surface using shear bond test in a universal testing machine ( @ mm/min ) .


After debonding , all specimens were analyzed using scanning electron microscopy to categorize the failure modes .


The data were statistically analyzed using one-way ANOVA and Tukey 's tests ( = @ ) .


A significant difference was observed between the groups ( p < @ ) .


The highest mean bond strength value was obtained with the application of an intermediate layer of adhesive resin ( group B : @ @ MPa ) ( p < @ ) followed by group A ( @ @ MPa ) and group C ( @ @ MPa ) , which were also significantly different from one another ( p < @ ) .


Group A exclusively presented a combination of partial cohesive failure in the PFC and adhesive failure between the FRC and PFC. While group B showed large cohesive defects in the FRC , in group C , only small cohesive failures were observed in the FRC .


Based on the highest mean bond strength and the large cohesive failures within the FRC , application of an intermediate layer of adhesive resin on the S@-glass FRC surface prior to incremental build up of the PFC seems to be compulsory .


In vitro and retrospective clinical studies suggest an association between anaesthetic technique during primary breast cancer surgery and cancer outcome .


Apoptosis is an important step in the mechanism of breast cancer metastasis , but whether it is influenced by anaesthetic technique is unknown .


Using serum from breast cancer surgery patients randomized to receive distinct anaesthetic techniques , we investigated its effect on apoptosis in oestrogen receptor ( ER ) - negative breast cancer cells in vitro .


Women with biopsy-proven breast cancer were randomized to receive either propofol general anaesthesia with paravertebral analgesia ( PPA ) or standard sevoflurane general anaesthesia with opioid analgesia ( SGA ) in an ongoing , prospective clinical trial ( NCT @ ) .


Serum from a randomly selected subset of these patients ( @ PPA and @ SGA ) who had donated @ ml venous blood immediately before anaesthetic induction and at @ h after operation was exposed to ER-negative MDA-MB-@ cells .


Apoptosis was measured using ApoLive-Glo Multiplex Assay .


Exposure of MDA-MB-@ cells to postoperative serum of PPA patients resulted in higher luminescence ratio ( apoptosis ) than SGA patients , median ( @-@ % ) , @ ( @-@ @ ) compared with @ ( @-@ @ ) , respectively ( P = @ ) .


The luminescence ratio of postoperative serum from SGA was reduced compared with preoperative SGA @ ( @-@ @ ) compared with @ ( @-@ @ ) ( P = @ ) .


Serum from patients given sevoflurane anaesthesia and opioids for primary breast cancer surgery reduces apoptosis in ER-negative breast cancer cells to a greater extent than serum from patients given propofol-paravertebral anaesthesia .


Anaesthetic technique might affect the serum milieu in a manner that impacts cancer cell apoptosis , and thereby tumour metastasis .


There is uncertainty regarding the optimal dosing regimen for the resumption of warfarin after interruption for invasive procedures .


To determine the efficacy and safety of warfarin resumption with loading doses or with the most recent maintenance dose .


Patients receiving warfarin treatment and planned for invasive procedures with an expected hospital stay of @ day were randomized to resume warfarin on the day of the procedure , defined as day @ , with most recent maintenance dose or with @ initial days of double maintenance dose .


Efficacy outcomes were proportion of international normalized ratio ( INR ) levels @ on day @ ( primary outcome ) and day @ .


Safety outcomes were bleeding and thromboembolic events .


In addition , D-dimer levels were analyzed on days @ and @ in a subset of the population .


There were @ patients analyzed in each group .


INR of @ had been achieved by day @ for @ % in the maintenance-dose group and for @ % in the loading-dose group ( relative risk -LSB- RR -RSB- @ , @ % confidence interval -LSB- CI -RSB- @-@ @ ) and by day @ for @ % and @ % , respectively ( RR @ , @ % CI @-@ @ ) .


There were no thromboembolic events , and there was one major bleed before resumption of warfarin and one minor bleed , both in the maintenance-dose group .


There was no difference between the groups in the proportion of patients with excessive INRs or elevated D-dimer levels or in the median D-dimer level .


Resumption of warfarin after minor-moderately invasive procedures with two loading doses achieves therapeutic INR faster than does only maintenance dose .


To determine if self-reported anxiety levels decreased after tracheostomy placement in a sample of mechanically ventilated intensive care unit patients .


There is limited research regarding the impact of a tracheostomy on patients ' anxiety .


Elevated anxiety delays healing and contributes to long-term mental health complications .


This was a secondary analysis of data from a large clinical trial conducted in urban Minnesota .


Fifty-one of @ patients received a tracheostomy .


Anxiety scores were obtained daily using the Visual Analog Scale-Anxiety .


Mixed model analysis was used to compare anxiety ratings pre - and post-tracheostomy .


There was no significant decrease in anxiety following tracheostomy after controlling for time and gender ( all p > @ ) .


Age was the only variable to impact anxiety levels : anxiety scores increased as age increased ( p = @ ) .


Prospective studies are needed to more accurately assess the impact of tracheostomy placement on patient anxiety and salient outcomes .


Myocardial iron overload leading to congestive heart failure ( HF ) or arrhythmias is a recognized complication in thalassemia patients undergoing chronic blood transfusion .


The relationship between myocardial iron load , subclinical systolic dysfunction , and clinical events remains less well known .


We studied a total of @ subjects , comprising @ thalassemia patients ( mean age : @ @ years ) with a history of repeated blood transfusions , in addition to @ age - and gender-matched controls ( mean age : @ @ years ) .


Serum ferritin levels were checked in all subjects , as well as semiautomated quantification of left ventricular ( LV ) longitudinal , circumferential , and radial deformations assessed by two-dimensional ( @D ) speckle tracking analysis .


Compared with the control group , thalassemia patients showed significantly larger LV mass index and lower myocardial deformations ( P < @ ) , but left ventricular ejection fraction ( LVEF ) did not differ significantly ( P = @ ) .


There was a significant linear correlation between serum ferritin level and longitudinal ( r = @ , P = @ ) and radial strain ( r = -@ , P = @ ) , with optimal cutoff provided to be -@ % , -@ % , and @ % for longitudinal , circumferential , and radial strain in predicting clinical events , respectively .


During a median of @ days follow-up , @ clinical composites ( HF incidence , ventricular tachyarrhythmia , and death ) occurred ( N = @ subjects ) ; subjects with composites had significantly reduced longitudinal and radial strain compared to those without ( both P < @ ) .


After adjusting for age , sex , serum ferritin level , and LV mass index , a worsening of longitudinal strain remained as an independent predictor of clinical events and death ( HR : @ , P = @ ) .


Subclinical systolic dysfunction appears more likely in thalassemia subjects with a history of repeated blood transfusions , which further correlated with serum ferritin levels .


In addition , worsening LV myocardial deformation parameters may play an independent role in predicting clinical outcomes beyond traditional measures in this population .


To evaluate the efficacy of extracorporeal magnetic innervation ( ExMI ) as a treatment for primary dysmenorrhea compared with nonsteroidal anti-inflammatory drugs ( NSAIDs ) and combined oral contraceptives ( COCs ) .


The cases were randomized into three groups ( NSAID = @ , ExMI = @ , COC = @ ) .


ExMI was applied for a total of @ sessions .


Women in the NSAID group used an oral NSAID at the start of each menstruation .


Women in the COC group were given combined pills .


Of the treatment options , ExMI was applied for only a single period , whereas NSAID and COC use continued for @ months .


At the first menstruation , visual analog scale ( VAS ) scores improved significantly in all groups ( p < @ ) .


NSAIDs and COCs continued to show efficacy over the entire study period ( p < @ ) .


However , in the ExMI group , VAS values increased from the first menstruation until @ months .


The VAS score at the @th month was significantly higher in the ExMI group than in the other groups ( p < @ ) , but markedly lower than the pretreatment value ( @ @ vs. @ @ , p < @ ) .


ExMI therapy might be a promising novel noninvasive option for primary dysmenorrhea .


Efficacy began to decline after @ months , but continued for @ months .


Physostigmine , a centrally acting acetylcholinesterase inhibitor , is most commonly used by anesthesiologists in the postanesthetic setting to reverse confusion caused by central anticholinergic medication effects .


It has also been proposed as a treatment for sleep-disordered breathing .


We investigated whether physostigmine was effective in decreasing the frequency of ventilatory arrhythmias produced during moderate sedation with midazolam and remifentanil during the conditions of breathing room air or @ L/min nasal O@ .


Ten healthy male volunteers participated in this randomized , double-blind control trial of physostigmine ( @ gkgmin ) versus placebo .


Moderate sedation was achieved with infusions of midazolam and remifentanil and monitored with full and processed electroencephalogram .


Analgesia was quantified with subjective pain score to thermal stimulation .


Ventilatory arrhythmias , as measured by the sedation apnea-hypopnea index ( S-AHI ) , were scored as the number of apneas and hypopneas during two @-hour periods on room air or @ L/min nasal O@ .


All subjects tolerated the sedation and physostigmine without significant adverse effects .


Sedation during placebo infusion resulted in clinically significant ( S-AHI > @ ) ventilatory arrhythmias in @ conditions in @ subjects ( @ on room air and then O@ , and @ on O@ only ) .


Physostigmine did not significantly ( P > @ ) reduce the total number of ventilatory arrhythmias on either room air or O@ ( @ @ events/h -LSB- mean SEM -RSB- , @ % confidence interval -LSB- CI -RSB- = -@ to @ ; and @ @ , @ % CI = -@ to @ , respectively ) .


Physostigmine did reduce the S-AHI in all @ instances of clinically significant ventilatory arrhythmias ( S-AHI decreased by @ @ ; CI = @-@ @ ; P = @ ) .


Physostigmine does not appear to be useful as a pretreatment to prevent ventilatory arrhythmias during moderate sedation .


However , it may be useful as a treatment for clinically significant ventilatory arrhythmias during moderate sedation .


Low HDL cholesterol ( HDL-C ) and small HDL particle size may directly promote hyperglycemia .


We evaluated associations of HDL-C , apolipoprotein A-I ( apoA-I ) , and HDL-C/apoA-I with insulin secretion , insulin resistance , HbA@c , and long-term glycemic deterioration , reflected by initiation of pharmacologic glucose control .


The @-year Fenofibrate Intervention and Event Lowering in Diabetes ( FIELD ) study followed @,@ type @ diabetic subjects .


We calculated baseline associations of fasting HDL-C , apoA-I , and HDL-C/apoA-I with HbA@c and , in those not taking exogenous insulin ( n = @,@ ) , with estimated - cell function ( homeostasis model assessment of - cell function -LSB- HOMA-B -RSB- ) and insulin resistance ( HOMA-IR ) .


Among the @,@ subjects prescribed lifestyle only , Cox proportional hazards analysis evaluated associations of HDL-C , apoA-I , and HDL-C/apoA-I with subsequent initiation of oral hypoglycemic agents ( OHAs ) or insulin .


Adjusted for age and sex , baseline HDL-C , apoA-I , and HDL-C/apoA-I were inversely associated with HOMA-IR ( r = -@ , -@ , and -@ ; all P < @ ; n = @,@ ) but not related to HbA@c ( all P > @ ; n = @,@ ) .


ApoA-I was also inversely associated with HOMA-B ( r = -@ ; P = @ ; n = @,@ ) adjusted for age , sex , and HOMA-IR .


Prospectively , lower baseline HDL-C and HDL-C/apoA-I levels predicted greater uptake ( per @-SD lower : hazard ratio -LSB- HR -RSB- @ -LSB- CI @-@ @ -RSB- , P < @ ; and HR @ -LSB- CI @-@ @ -RSB- , P < @ , respectively ) and earlier uptake ( median @ and @ months , respectively , for quartile @ vs. quartile @ ; both P < @ ) of OHAs and insulin , with no difference in HbA@c thresholds for initiation ( P = @ and P = @ ) .


Controlling for HOMA-IR and triglycerides lessened both associations , but HDL-C/apoA-I remained significant .


HDL-C , apoA-I , and HDL-C/apoA-I were associated with concurrent insulin resistance but not HbA@c .


However , lower HDL-C and HDL-C/apoA-I predicted greater and earlier need for pharmacologic glucose control .


The obesity epidemic has spread to young adults , leading to significant public health implications later in adulthood .


Intervention in early adulthood may be an effective public health strategy for reducing the long-term health impact of the epidemic .


Few weight loss trials have been conducted in young adults .


It is unclear what weight loss strategies are beneficial in this population .


To describe the design and rationale of the NHLBI-sponsored Cell Phone Intervention for You ( CITY ) study , which is a single center , randomized three-arm trial that compares the impact on weight loss of @ ) a behavioral intervention that is delivered almost entirely via cell phone technology ( Cell Phone group ) ; and @ ) a behavioral intervention delivered mainly through monthly personal coaching calls enhanced by self-monitoring via cell phone ( Personal Coaching group ) , each compared to @ ) a usual care , advice-only control condition .


A total of @ community-dwelling overweight/obese adults aged @-@ years were randomized to receive one of these three interventions for @ months in parallel group design .


Study personnel assessing outcomes were blinded to group assignment .


The primary outcome is weight change at @ -LSB- corrected -RSB- months .


We hypothesize that each active intervention will cause more weight loss than the usual care condition .


Study completion is anticipated in @ .


If effective , implementation of the CITY interventions could mitigate the alarming rates of obesity in young adults through promotion of weight loss .


ClinicalTrial.gov : NCT@ .


Subjective responses to alcohol represent a biologically based , genetically moderated , and clinically informative marker of alcoholism risk ; however , the physiology underlying this phenotype remains unclear .


This study tested whether subjective responses during alcohol administration predict neural responses to alcohol cues in the scanner and whether these neural responses differ between OPRM@ genotypes .


Twenty alcohol-dependent individuals were recruited ( @ G-allele carriers ; @ women ; Mage = @ ) for a within-subjects alcohol administration in the laboratory and a functional magnetic resonance imaging session consisting of an alcohol taste cues task .


Laboratory assessments of alcohol high , liking , craving , and positive and negative reinforcement during alcohol administration were entered as predictors of neural response to the presentation of alcohol cues versus water cues in the scanner and further tested for OPRM@ genotype moderation ( whole-brain cluster-corrected at Z > @ , p < @ ) .


Alcohol craving during alcohol administration predicted less neural activity , whereas alcohol reinforcement predicted greater neural activity to alcohol cues versus water cues in regions including the precuneus , posterior cingulate gyrus , and lingual gyrus .


Alcohol high predicted greater neural activity to alcohol cues in regions including the precuneus and anterior cingulate cortex .


OPRM@ genotype was found to moderate these relationships .


No results were observed for alcohol liking .


This study provides initial evidence that subjective responses to alcohol , namely craving , high , and the reinforcing properties of alcohol , predict neural markers of alcohol cue reactivity .


These results support the validity of laboratory and neuroimaging measures of subjective responses to alcohol and offer an integration of these methods in a sample of alcohol-dependent individuals .


Vitamin D co-regulates the synthesis of sex hormones in part by interaction with its nuclear receptor .


The aim of this study was to determine whether there is an association of vitamin D concentration vs the level of sex hormones in elderly Polish individuals with different genotypes of the vitamin D receptor ( VDR ) gene .


Rs@ , rs@ , rs@ , and rs@ polymorphisms of VDR , the serum sex hormone level , free estrogen index ( FEI ) and free androgen index ( FAI ) as well as vitamin D , were evaluated in @ persons ( @ women and @ men ) selected from @ Polish population , aged @-@years from the PolSenior survey .


We observed that women with GG ( rs@ ) , TT ( rs@ ) , BB ( rs@ ) and FF ( rs@ ) genotypes were characterized by a significant correlation between vitamin D vs testosterone concentration and FAI value .


We found a significant correlation between testosterone level and FAI vs vitamin D concentration in men with heterozygote AG in the rs@ polymorphism and in the GG ( rs@ ) , the BB ( rs@ ) , and the Ff ( rs@ ) genotypes .


In elderly selected Polish population with different genotypes of VDR polymorphisms , a statistically significant relationship between vitamin D concentration vs testosterone level was observed .


Evidence of effective treatment of childhood obesity in primary care settings is limited .


To examine the extent to which computerized clinical decision support ( CDS ) delivered to pediatric clinicians at the point of care of obese children , with or without individualized family coaching , improved body mass index ( BMI ; calculated as weight in kilograms divided by height in meters squared ) and quality of care .


We conducted a cluster-randomized , @-arm clinical trial .


We enrolled @ children aged @ to @ years with a BMI at the @ % percentile or higher from @ primary care practices in Massachusetts from October @ , @ , through June @ , @ .


Patients were followed up for @ year ( last follow-up , August @ , @ ) .


In intent-to-treat analyses , we used linear mixed-effects models to account for clustering by practice and within each person .


In @ practices randomized to CDS , pediatric clinicians received decision support on obesity management , and patients and their families received an intervention for self-guided behavior change .


In @ practices randomized to CDS + coaching , decision support was augmented by individualized family coaching .


The remaining @ practices were randomized to usual care .


Smaller age-associated change in BMI and the Healthcare Effectiveness Data and Information Set ( HEDIS ) performance measures for obesity during the @-year follow-up .


At baseline , mean ( SD ) patient age and BMI were @ ( @ ) years and @ ( @ ) , respectively .


At @ year , we obtained BMI from @ children ( @ % ) and HEDIS measures from @ visits ( @ % ) .


The @ randomization arms had different effects on BMI over time ( P = @ ) .


Compared with the usual care arm , BMI increased less in children in the CDS arm during @ year ( -@ -LSB- @ % CI , -@ to -@ -RSB- ) .


The CDS + coaching arm had a smaller magnitude of effect ( -@ -LSB- @ % CI , -@ to @ -RSB- ) .


We found substantially greater achievement of childhood obesity HEDIS measures in the CDS arm ( adjusted odds ratio , @ -LSB- @ % CI , @-@ @ -RSB- ) and CDS + coaching arm ( adjusted odds ratio , @ -LSB- @ % CI , @-@ @ -RSB- ) and higher use of HEDIS codes for nutrition or physical activity counseling ( CDS arm , @ % ; CDS + coaching arm , @ % ; P < @ compared with usual care arm ) .


An intervention that included computerized CDS for pediatric clinicians and support for self-guided behavior change for families resulted in improved childhood BMI .


Both interventions improved the quality of care for childhood obesity .


Recent studies have shown that neutrophils may display an antigen-presenting function and inhibit lymphocyte proliferation by expressing programmed cell death @ ligand @ ( PD-L@ ) .


The current study was performed to investigate the effect of neutrophils and their pathophysiological significance during sepsis .


Neutrophil PD-L@ expression was determined in both septic mice ( n = @ ) and patients ( n = @ ) .


Neutrophils from septic mice were subtyped into PD-L@ and PD-L@ populations to determine their phenotypes and functions .


Septic neutrophils were cocultured with lymphocytes to observe the effect of septic neutrophils on lymphocyte apoptosis .


The PD-L@ level on neutrophils from septic mice was significantly up-regulated ( @ @ % ) .


This level increased with the progression of sepsis and the migration of neutrophils from the bone marrow to the blood and peritoneal cavity .


The percentages of CD@a , CD@L , and C-C chemokine receptor type @ were lower , whereas the percentages of CD@ and CD@ were higher on PD-L@ neutrophils than on PD-L@ neutrophils .


The migratory capacity of PD-L@ neutrophils was compromised .


Septic neutrophils induced lymphocyte apoptosis via a contact mechanism , and this process could be reversed by anti-PD-L@ antibody .


PD-L@ was also up-regulated on neutrophils from patients with severe sepsis ( @ % -LSB- @ % , @ % -RSB- ) .


The levels were negatively correlated with the monocyte human leukocyte antigen-DR level and positively correlated with the severity of septic patients .


Neutrophil PD-L@ was a predictor for the prognosis of severe sepsis , with an area of @ under the receiver operating curve .


PD-L@ is up-regulated on neutrophils during sepsis , which may be related to sepsis-induced immunosuppression .


Daylight photodynamic therapy ( DL-PDT ) of actinic keratosis ( AK ) has shown preliminary efficacy and safety results comparable to conventional photodynamic therapy ( c-PDT ) , using methyl aminolevulinate ( MAL ) cream .


To demonstrate the efficacy and safety of DL-PDT vs. c-PDT in treating mild facial/scalp AK .


This @-week randomized , controlled , investigator-blinded , multicentre , intra-individual efficacy ( non-inferiority ) and safety ( superiority regarding pain ) study enrolled @ subjects .


AKs on the face/scalp were treated once , with DL-PDT on one side and c-PDT on the contralateral side .


Primary end points for DL-PDT at week @ were efficacy -LSB- non-inferiority regarding complete lesion response ( mild AK ) -RSB- and safety ( superiority regarding subject 's assessment of pain ) .


Lesions with complete response @weeks after one treatment session were followed until week @ .


The safety evaluation included incidence of adverse events .


Subject satisfaction was classified using a questionnaire .


At week @ , the complete lesion response rate with DL-PDT was non-inferior to c-PDT ( @ % vs. @ % , respectively ; @ % confidence interval -@ to -@ ) , confirmed by intention-to-treat analysis .


Additionally , regardless of the treatment used , @ % of mild lesions were maintained in complete response @weeks after the PDT session .


For DL-PDT , subject-reported pain was significantly lower ( @ vs. @ , respectively ; P < @ ) , with better tolerability and significantly higher subject satisfaction regarding convenience and outcome .


Daylight-mediated PDT was not inferior in efficacy to Metvix c-PDT ( mild AK response rate ) , better tolerated , nearly painless and more convenient for patients .


Brief motivational intervention ( BMI ) has shown promising results to reduce alcohol use in young adults .


Knowledge on mechanisms that predict BMI efficacy could potentially improve treatment effect sizes through data that optimize clinical training and implementation .


Particularly , little attention has been given to counselor influence on treatment mechanisms .


We investigated the influence of counselors on BMI efficacy in reducing alcohol use among non-treatment-seeking young men ( age @ ) screened as hazardous drinkers .


Participants were randomly allocated to ( i ) a group receiving a single BMI from @ of @ counselors selected to maximize differences in several of their characteristics ( gender , professional status , clinical experience , and motivational interviewing -LSB- MI -RSB- experience ) or ( ii ) a control group receiving assessment only .


Drinking at @-month follow-up was first compared between the BMI and control groups to assess efficacy .


Then , the influence of counselors ' characteristics ( i.e. , gender , professional status , clinical experience , MI experience , BMI attitudes , and expectancies ) and within-session behaviors ( i.e. , measured by the Motivational Interviewing Skill Code ) on outcome was tested in regression analyses .


There was a significant ( p = @ ) decrease in alcohol use among the BMI group compared to the control group .


Counselors that were male , more experienced , that had more favorable BMI attitudes and expectancies , higher MI skills , but surprisingly less MI-consistent behaviors , had significantly better outcomes than the control group while their counterparts did not .


The current study demonstrated BMI efficacy on alcohol use reduction within a sample of non-treatment-seeking young adult males .


Moreover , BMI effect was related to interindividual differences among counselors , and results therefore provide recommendations for BMI training and implementation with similar populations .


Second-generation antipsychotics ( SGAs ) are among the first-line treatments for bipolar disorder and schizophrenia , but have a tendency to generate metabolic disturbances .


These features resemble a metabolic syndrome for which a central autonomic imbalance has been proposed that may originate from the hypothalamic suprachiasmatic nuclei .


In a clinical trial , we hypothesized that melatonin , a hormone that regulates the suprachiasmatic nucleus , could attenuate SGA-induced adverse metabolic effects .


In an eight-week , double-blind , randomized , placebo-controlled , parallel-group clinical trial , we evaluated the metabolic effect of melatonin in SGA-treated patients in terms of weight , blood pressure , lipid , glucose , body composition , and anthropometric measures .


A total of @ patients treated with SGAs , @ with bipolar disorder and @ with schizophrenia , randomly received placebo ( n = @ ) or melatonin @ mg ( n = @ ) .


The melatonin group showed a decrease in diastolic blood pressure ( @ versus @ mmHg for placebo , p = @ ) and attenuated weight gain ( @ versus @ kg for placebo , F = @ , p = @ ) compared to the placebo group .


The strong beneficial metabolic effects of melatonin in comparison to placebo on fat mass ( @ versus @ kg , respectively , p = @ ) and diastolic blood pressure ( @ versus @ mmHg , respectively , p = @ ) were observed in the bipolar disorder and not in the schizophrenia group .


No adverse events were reported .


Our results show that melatonin is effective in attenuating SGAs ' adverse metabolic effects , particularly in bipolar disorder .


The clinical findings allow us to propose that SGAs may disturb a centrally mediated metabolic balance that causes adverse metabolic effects and that nightly administration of melatonin helps to restore .


Melatonin could become a safe and cost-effective therapeutic option to attenuate or prevent SGA metabolic effects .


EP@ is a first-in-class , synthetic , parenteral , anticoagulant combining in a single molecule a direct thrombin inhibitor and an indirect factor Xa ( FXa ) inhibitor .


To investigate the safety , pharmacokinetics , and pharmacodynamics of EP@ and its interaction with aspirin , clopidogrel , and unfractionated heparin ( UFH ) .


In study @ , healthy male subjects were administered intravenously single-ascending doses ( @-@ mg ) of EP@ or placebo .


In study @ , healthy male subjects were administered intravenously a single dose of @ mg EP@ on day @ followed by oral administration of aspirin ( @ mg ) and clopidogrel ( @ mg ) once daily from day @ to @ .


On day @ , a second dose of @ mg EP@ was administered , and subjects were then randomized to receive a single dose of UFH ( @ or @ IU kg ( -@ ) ) or placebo .


Mild bleedings were the only drug-related adverse events .


EP@ pharmacokinetics were dose-proportional and characterized by a low clearance , a small volume of distribution , a long terminal half-life .


EP@ pharmacodynamics were characterized by a long-lasting , dose-dependent increase in activated clotting time , ecarin clotting time , thrombin time , anti-FXa activity , activated partial thromboplastin time , prothrombin time , and a decrease in endogenous thrombin potential , measured by a thrombin generation test .


Dose-dependent additive effects were seen with UFH on coagulation tests .


EP@ had no additive effect on the inhibition of platelet aggregation induced by aspirin and clopidogrel .


These results warrant further clinical development of this new class of anticoagulant .


Perinatal hypoxia-induced free radical formation is an important cause of hypoxic-ischaemic encephalopathy and subsequent neurodevelopmental disabilities .


Allopurinol reduces the formation of free radicals , which potentially limits hypoxia-induced brain damage .


We investigated placental transfer and safety of allopurinol after maternal allopurinol treatment during labour to evaluate its potential role as a neuroprotective agent in suspected fetal hypoxia .


We used data from a randomised , double-blind multicentre trial comparing maternal allopurinol versus placebo in case of imminent fetal hypoxia ( NCT@ ) .


We studied @ women in labour at term , with suspected fetal hypoxia prompting immediate delivery , in the intervention arm of the study .


Delivery rooms of @ Dutch hospitals .


@ mg allopurinol , intravenously to the mother , immediately prior to delivery .


Drug disposition ( maternal plasma concentrations , cord blood concentrations ) and drug safety ( maternal and fetal adverse events ) .


Within @ min after the end of maternal allopurinol infusion , target plasma concentrations of allopurinol of @ mg/L were present in cord blood .


Of all analysed cord blood samples , @ % ( @/@ ) had a target allopurinol plasma concentration at the moment of delivery .


No adverse events were observed in the neonates .


Two mothers had a red and/or painful arm during infusion .


A dose of @ mg intravenous allopurinol rapidly crosses the placenta and provides target concentrations in @ % of the fetuses at the moment of delivery , which makes it potentially useful as a neuroprotective agent in perinatology with very little side effects .


A limited number of adrenaline auto-injectors are currently available .


Epipen and Anapen are available in Australia , New Zealand , UK and parts of Europe and Asia .


Few studies have compared the performance of these devices .


To compare the intuitiveness of use of these devices .


A secondary aim was to compare the ability to recall the use of each device after a period of @months .


A random sample of @ subjects nave to both the EpiPen and Anapen were recruited from staff and families attending Royal Children 's Hospital , Melbourne Australia .


Subjects were randomized to Anapen ( n = @ ) or EpiPen ( n = @ ) and asked to demonstrate use of a ` trainer ' device ( i ) prior to and ( ii ) after receiving training in its correct use .


A subset ( n = @ ) participated in a follow-up study to evaluate ( iii ) the ability to recall correct use of each device .


Most subjects correctly demonstrated all steps in use of the EpiPen and Anapen both prior to ( @ % vs. @ % , p = @ ) and after training on use ( @ % vs. @ % ) .


However , after @months , significantly more participants correctly demonstrated use of EpiPen ( @ % ) compared to Anapen ( @ % ) ( p = @ ) and critical errors that would likely result in failure to administer adrenaline were more common with Anapen ( @ % vs. @ % , p = @ ) .


Most study participants correctly demonstrated the use of both devices without prior training .


There was greater attrition in correct use of Anapen compared to EpiPen over time .


Critical errors in administration were more likely with Anapen than EpiPen .


Pelvic organ prolapse is a common health problem : the lifetime risk of undergoing surgery for pelvic organ prolapse by the age of @ years is @ % .


Pelvic organ prolapse has significant negative effects on a woman 's quality of life .


Worldwide , vaginal hysterectomy is the leading treatment method for patients with symptomatic uterovaginal prolapse .


Several studies have shown that vaginal sacrospinous hysteropexy and laparoscopic sacrohysteropexy are safe and effective alternatives in treating uterine descent .


To date , it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction .


Therefore , we conducted the LAVA trial .


The LAVA trial is a randomized controlled multicenter non-inferiority trial .


The study compares laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy in women with uterine prolapse stage @ or higher .


The primary outcome of this study is surgical success of the apical compartment at @ and @ years follow-up .


Secondary outcomes are subjective improvement on urogenital symptoms and quality of life ( assessed by disease-specific and general quality of life questionnaires ) , complications following surgery , hospital stay , post-operative recovery , sexual functioning and costs-effectiveness .


Evaluation will take place pre-operatively , and @ weeks , @ months , @ months and annually till @ months after surgery .


Validated questionnaires will be used.Analysis will be performed according to the intention to treat principle .


Based on comparable recurrence rates of @ % and a non-inferiority margin of @ % , @ patients are needed in each arm to prove the hypothesis with a @ % confidence interval .


The LAVA trial is a randomized controlled multicenter non-inferiority trial that will provide evidence whether the efficacy of laparoscopic sacrohysteropexy is non-inferior to vaginal sacrospinous hysteropexy in women with symptomatic uterine prolapse stage @ or higher .


Since its introduction in @ , the use of @-plates has gained great popularity for the correction of diverse deformities in skeletally immature patients .


In this study , we evaluate @ different techniques of implant placement .


A consecutive series of patients with indication of guided growth around the knee ( femur or tibia ) were included in the study .


Patients were randomly divided in @ groups , with @-plate inserted using technique as described by Stevens ( group A ) versus technique modified from Paley ( group B ) .


We analyzed operative time , radiation exposure , incision size , and intraoperative complications .


Comparisons between groups were performed with a Mann-Whitney test .


A @-tailed P-value < @ was considered significant .


We evaluated a total of @ procedures in @ patients ( @ in group A and @ in group B ) .


Age and sex was similar in both groups ( P = @ and @ ) .


Operative time and radiation exposure was significantly lower in group B : @ minutes ( range , @ to @ min ) versus @ minutes ( range , @ to @ min ) ( P @ ) , and @ Gy ( range , @ to @ Gy ) versus @ Gy ( range , @ to @ Gy ) ( P = @ ) , respectively .


The incision size was also smaller in group B : @ mm ( range , @ to @ mm ) versus @ mm ( range , @ to @ mm ) ( P = @ ) .


There were no intraoperative complications in any of the @ groups .


Modified technique for @-plate placement seems to reduce operative time , radiation exposure , and incision size for guided growth around the knee .


Level of evidence II-prospective randomized study .


Fast-track program has been applied in several surgical fields .


However , currently many surgical patients are elderly over @ years of age , and discussion about the application of such protocols for elderly patients is inadequate .


The present study was designed to consider the safety and feasibility of application of a fast-track program after colorectal surgery in elderly patients .


A total of @ elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care program ( n = @ ) or the conventional perioperative care protocol ( control group , n = @ ) .


The fast track protocol included no preoperative mechanical bowel irrigation , immediate oral alimentation and earlier postoperative ambulation exercise .


The length of postoperative hospital stay , the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups .


The length of time to regain bowel function , including the passage of flatus -LSB- @ ( @-@ ) h vs @ ( @-@ ) h -RSB- , and to start a liquid diet ( @ -LSB- @-@ -RSB- h v/s @ -LSB- @-@ -RSB- h ) were significantly shorter in patients receiving the fast track care protocol compared with those receiving the conventional care protocol .


A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care -LSB- @ ( @-@ ) days v/s @ ( @-@ ) days -RSB- .


A reduced percentage of patients who developed general complications was also observed in the fast-track group ( @ % v/s @ % ) .


Fast-track after laparoscopic colorectal surgery can be safely applied in carefully selected elderly patients older than age @ years .


The fast-track recovery program resulted in a more rapid postoperative recovery , earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol .


To test the hypothesis that inhaled nitric oxide ( iNO ) would lead to improved oxygenation and a decrease in duration of mechanical ventilation in pediatric patients with acute respiratory distress syndrome .


A total of @ children with acute respiratory distress syndrome were enrolled from @ centers .


Patients were randomized to iNO or placebo and remained on the study drug until death , they were free of ventilator support , or day @ after the initiation of therapy .


Mean baseline oxygenation indexes ( OIs ) were @ @ and @ @ ( iNO and placebo groups , respectively , P = @ ) .


There was a trend toward an improved OI in the iNO group compared with the placebo group at @ hours that became significant at @ hours .


There was no difference in the OI between groups at @ hours .


Days alive and ventilator free at @ days was greater in the iNO group , @ @ and @ @ days ( iNO and placebo groups , respectively , P = @ ) .


Although overall survival at @ days failed to reach statistical significance , @ % ( @ of @ ) in the iNO group and @ % ( @ of @ ) in the placebo group ( P = @ ) , the rate of extracorporeal membrane oxygenation-free survival was significantly greater in those randomized to iNO @ % ( @ of @ ) vs @ % ( @ of @ ) for those receiving placebo ( P < @ ) .


The use of iNO was associated with a significantly reduced duration of mechanical ventilation and significantly greater rate of extracorporeal membrane oxygenation-free survival .


To compare the clinical outcomes of sorafenib plus either erlotinib or placebo in patients with advanced hepatocellular carcinoma ( HCC ) in a multicenter , multinational , randomized , phase III trial .


Patients with advanced HCC and underlying Child-Pugh class A cirrhosis , who were naive to systemic treatment ( N = @ ) , were randomly assigned to sorafenib plus either erlotinib ( n = @ ) or placebo ( n = @ ) .


The primary end point was overall survival ( OS ) .


Median OS was similar in the sorafenib plus erlotinib and sorafenib plus placebo groups ( @ v @ months , respectively ; hazard ratio -LSB- HR -RSB- , @ ; P = @ ) , as was median time to progression ( @ v @ months , respectively ; HR , @ ; P = @ ) .


In the sorafenib/erlotinib arm versus the sorafenib/placebo arm , the overall response rate trended higher ( @ % v @ % , respectively ; P = @ ) , whereas the disease control rate was significantly lower ( @ % v @ % , respectively ; P = @ ) .


The median durations of treatment with sorafenib were @ days in the sorafenib/erlotinib arm and @ days in the sorafenib/placebo arm .


In the sorafenib/erlotinib and sorafenib/placebo arms , the rates of treatment-emergent serious AEs ( @ % v @ % , respectively ) and drug-related serious AEs ( @ % v @ % , respectively ) were similar .


AEs matched the known safety profiles of both agents , but rates of rash/desquamation , anorexia , and diarrhea were higher in the sorafenib/erlotinib arm , whereas rates of alopecia and hand-foot skin reaction were higher in the sorafenib/placebo arm .


Withdrawal rates for AEs during cycles @ to @ were higher in the sorafenib/erlotinib arm .


Adding erlotinib to sorafenib did not improve survival in patients with advanced HCC .


Human 's life as well as medical professions consist of many moral dilemmas .


The aim of our study was to evaluate moral competences of midwifery students during their whole university education ( @ year course ) based on their moral competences C-index .


We performed randomized single blinded @-year follow-up trial of @ midwifery students .


Standard Moral Judgment Test ( MJT ) By Georg Lind was used accompanied by own questionnaire .


Moral competences were calculated ( C-index ) according to Lind 's methodology .


Subjects were also divided into active and passive ethics training to search for differences .


C-index varied during studies insignificant ( p = @ ) .


Randomized groups were equal at the beginning point , no significant differences were noticed .


Active ethics teaching did not increase C-index compared to controls in all measuring points ( P@-P@ , respectively p = @,@ and p = @,@ ) .


During @ year studies at medical university moral competences measured by C-index varied insignificantly , but simultaneously the change in C-index was dependent on its value at the beginning of the trial .


There was not statistically significant influence of active ethic 's teaching compared to controls .


Among social factors parents have strongest influence on students ' morality , but growing role of Medical University in this hierarchy raises hopes for improvement in effectiveness of training in ethics .


The aim of this study was to examine whether EndoPredict ( EP ) , a novel genomic expression test , is effective in predicting local recurrence ( LR ) - free survival ( LRFS ) following surgery for breast cancer in postmenopausal women .


In addition , we examined whether EP may help tailor local therapy in these patients .


From January @ to June @ , @ postmenopausal patients were randomly assigned to either tamoxifen or tamoxifen followed by anastrozole within the prospective ABCSG @ trial .


Using assay scores from EP , we classified breast tumour blocks as either low or high risk for recurrence .


Data were gathered from @ patients .


The median follow-up was @ months and the cumulative incidence of LR was @ % ( @ % per year ) .


The risk of LR over a @-year period among patients with high-risk lesions ( n = @ ) was significantly higher ( LRFS = @ % ) when compared with patients with low-risk lesions ( n = @ ) ( @-year LRFS = @ % ) ( HR : @ ( @-@ @ ) P < @ ) .


The groups that received breast conservation surgery ( BCT ) and mastectomy ( MX ) had similar LR rates ( P = @ ) .


Radiotherapy ( RT ) after BCT significantly improved LRFS in the cohorts predicted by EP to be low-risk for LR ( received RT : n = @ , @-year LRFS @ % ; did not receive RT : n = @ , @-year LRFS @ % , P < @ ) .


EndoPredict is an effective prognostic tool for predicting LRFS .


Among postmenopausal , low-risk patients , EP does not appear to be useful for tailoring local therapy .


Somatostatin ( SST ) receptors ( SSTRs ) are expressed in a number of tissues , including the adrenal cortex , but their role in cortisol secretion has not been well characterized .


The objective of the study was to investigate the expression of SSTRs in the adrenal cortex and cultured adrenocortical cells from primary pigmented nodular adrenocortical disease ( PPNAD ) tissues and to test the effect of a single injection of @ g of the SST analog octreotide on cortisol secretion in patients with PPNAD .


The study was conducted at an academic research laboratory and clinical research center .


Expression of SSTRs was examined in @ PPNAD tissues and the immortalized PPNAD cell line CAR@ .


Ten subjects with PPNAD underwent a randomized , single-blind , crossover study of their cortisol secretion every @ minutes over @ hours ( @:@ pm to @:@ am ) before and after the midnight administration of octreotide @ g sc .


SSTRs expression was investigated by quantitative PCR and immunohistochemistry .


The CAR@ and primary cell lines were studied in vitro .


The data of the @ patients were analyzed before and after the administration of octreotide .


All SSTRs , especially SSTR@-@ , were expressed in PPNAD at significantly higher levels than in normal adrenal .


SST was found to differentially regulate expression of its own receptors in the CAR@ cell line .


However , the administration of octreotide to patients with PPNAD did not significantly affect cortisol secretion .


SSTRs are overexpressed in PPNAD tissues in comparison with normal adrenal cortex .


Octreotide did not exert any significant effect on cortisol secretion in a short clinical pilot study in a small number of patients with PPNAD , but long-acting SST analogs targeting multiple SSTRs may be worth investigating in this condition .


By the age of sixteen , one in five children will sustain a mild traumatic brain injury also known as concussion .


Our research found that one in seven school children with mild traumatic brain injury suffer post-concussion syndrome symptoms for three months or longer .


Post-concussion syndrome is associated with significant disability in the child and his/her family and yet there are no evidence-based medical treatments available .


Melatonin has several potential mechanisms of action that could be useful following mild traumatic brain injury , including neuroprotective effects .


The aim of this study is to determine if treatment with melatonin improves post-concussion syndrome in youths following mild traumatic brain injury .


Our hypothesis is that treatment of post-concussion syndrome following mild traumatic brain injury with @ or @ mg of sublingual melatonin for @ days will result in a decrease in post-concussion syndrome symptoms compared with placebo .


Ninety-nine youths with mild traumatic brain injury , aged between @ and @ years , who are symptomatic at @ days post-injury will be recruited .


This study will be conducted as a randomized , double blind , placebo-controlled superiority trial of melatonin .


Three parallel treatment groups will be examined with a @:@:@ allocation : sublingual melatonin @ mg , sublingual melatonin @ mg , and sublingual placebo .


Participants will receive treatment for @ days .


The primary outcome is a change on the Post-Concussion Symptom Inventory ( Parent and Youth ) .


The secondary outcomes will include neurobehavioral function , health-related quality of life and sleep .


Neurophysiological and structural markers of change , using magnetic resonance imaging techniques and transcranial magnetic stimulation , will also be investigated .


Melatonin is a safe and well-tolerated agent that has many biological properties that may be useful following a traumatic brain injury .


This study will determine whether it is a useful treatment for children with post-concussion syndrome .


Recruitment commenced on @ December @ .


Glucagon-like peptide-@ ( GLP-@ ) analogs have recently been promoted as antihyperglycemic agents in critically ill patients with systemic inflammation , but the effects of TNF - on glucose metabolism during GLP-@ administration are unknown .


The objective of the study was to determine whether the infusion of TNF - at high physiological levels impairs GLP-@ 's effects on glucose metabolism .


This was a randomized , controlled , cross-over trial .


The study was conducted at a hospital clinical research laboratory .


Twelve healthy males ( aged @ @ y ; body mass index @ @ kg/m ( @ ) ) .


After an overnight fast , either saline ( @ % ) or recombinant human TNF - ( @ ng/m ( @ ) h ) was infused from t = @-@ hours .


At t = @ hours , GLP-@ infusion ( @ pmol/kg min ) began .


From t = @-@ hours , the GLP-@ infusion rate was increased to @ pmol/kg min .


Plasma glucose was clamped at @ mmol/L throughout via a variable rate @ % dextrose infusion .


Trials were @-@ days apart .


Endogenous glucose production ( EGP ) was measured by the -LSB- @,@ - ( @ ) H@ -RSB- glucose isotope tracer dilution method .


GLP-@ infusion suppressed plasma glucagon ( P < @ ) , elevated plasma insulin , and C-peptide ( P < @ ) and suppressed EGP ( P < @ ) during the saline infusion .


In contrast , the infusion of TNF - increased plasma TNF - and IL-@ , elevated body temperature , and blunted the GLP-@-induced suppression of EGP during high-dose GLP-@ infusion ( all P < @ , TNF - vs saline ) .


However , TNF - infusion lowered plasma GLP-@ during high-dose GLP-@ infusion ( P < @ ) .


TNF - induces systemic inflammation and reduces plasma GLP-@ , thereby reducing the suppression of EGP during GLP-@ infusion .


This may have clinical relevance if GLP-@ analog drugs are used for the treatment of hyperglycemia in critically ill patients .


To determine the efficacy and safety of azithromycin @ % eye drops in a paediatric population with purulent bacterial conjunctivitis .


This was a multicentre , international , randomised , investigator-masked study in @ children with purulent discharge and bulbar conjunctival injection .


Patients received either azithromycin @ % eye drops ( twice daily for @days ) or tobramycin @ % eye drops ( every @h for @days , then four times daily for @days ) .


Clinical signs were evaluated on day ( D ) @ , @ and @ , and cultures on D@ and D@ .


The primary variable was the clinical cure ( absence of bulbar conjunctival injection and discharge ) on D@ in the worse eye for patients with positive cultures on D@ .


@ patients ( mean age @ years ; range @day-@years ) were included ; @ had positive cultures on D@ .


Azithromycin was superior to tobramycin in clinical cure rate on D@ ( @ % vs @ % , p = @ ) and was non-inferior to tobramycin on D@ ( @ % vs @ % , respectively ) .


Azithromycin treatment eradicated causative pathogens , including resistant species , with a similar resolution rate to tobramycin ( @ % vs @ % , respectively ) .


These results were confirmed in a subgroup of patients younger than @months old .


Azithromycin @ % eye drops provided a more rapid clinical cure than tobramycin @ % eye drops in the treatment of purulent bacterial conjunctivitis in children , with a more convenient twice-a-day dosing regimen .


Mothers and children living in adverse contexts are at risk of premature death .


To determine the effect of prenatal and infant/toddler nurse home visiting on maternal and child mortality during a @-decade period ( @-@ ) .


A randomized clinical trial was designed originally to assess the home visiting program 's effect on pregnancy outcomes and maternal and child health through child age @ years .


The study was conducted in a public system of obstetric and pediatric care in Memphis , Tennessee .


Participants included primarily African American women and their first live-born children living in highly disadvantaged urban neighborhoods , who were assigned to @ of @ treatment groups : treatment @ ( transportation for prenatal care -LSB- n = @ -RSB- ) , treatment @ ( transportation plus developmental screening for infants and toddlers -LSB- n = @ -RSB- ) , treatment @ ( transportation plus prenatal/postpartum home visiting -LSB- n = @ -RSB- ) , and treatment @ ( transportation , screening , and prenatal , postpartum , and infant/toddler home visiting -LSB- n = @ -RSB- ) .


Treatments @ and @ were included originally to increase statistical power for testing pregnancy outcomes .


For determining mortality , background information was available for all @ mothers assigned to all @ treatments and all but @ live-born children in treatments @ and @ ( n = @ ) .


Inclusion of children in treatments @ and @ was not possible because background information was missing on too many children .


Nurses sought to improve the outcomes of pregnancy , children 's health and development , and mothers ' health and life-course with home visits beginning during pregnancy and continuing through child age @ years .


All-cause mortality in mothers and preventable-cause mortality in children ( sudden infant death syndrome , unintentional injury , and homicide ) derived from the National Death Index .


The mean ( SE ) @-year maternal all-cause mortality rate was @ % ( @ % ) in the combined control group ( treatments @ and @ ) , @ % ( @ % ) in treatment @ , and @ % ( @ % ) in treatment @ .


The survival contrast of treatments @ and @ combined with treatment @ was significant ( P = @ ) ; the contrast of treatments @ and @ combined with treatment @ was not significant ( P = @ ) , and the contrast of treatments @ and @ combined with treatments @ and @ combined was significant ( post hoc P = @ ) .


At child age @ years , the preventable-cause child mortality rate was @ % ( @ % ) in treatment @ and @ % ( SE not calculable ) in treatment @ ; the survival contrast was significant ( P = @ ) .


Prenatal and infant/toddler home visitation by nurses is a promising means of reducing all-cause mortality among mothers and preventable-cause mortality in their first-born children living in highly disadvantaged settings .


Radial artery ( RA ) was the second arterial graft introduced in clinical practice for myocardial revascularization .


The skeletonization technique of the left internal thoracic artery ( LITA ) may actually change the graft 's flow capacity with potential advantages .


This leads to the assumption that the behavior of the RA , as a coronary graft , is similar to that of the LITA , when skeletonized .


This study evaluated ` free ' aortic-coronary radial artery ( RA ) grafts , whether skeletonized or with adjacent tissues .


A prospective randomized study comparing @ patients distributed into two groups was conducted .


In group I , we used skeletonized radial arteries ( @ patients ) , and in group II , we used radial arteries with adjacent tissues ( @ patients ) .


After the surgical procedure , patients underwent flow velocity measurements .


The main surgical variables were : RA internal diameter , RA length , and free blood flow in the radial artery .


The mean RA graft diameters as calculated using quantitative angiography in the immediate postoperative period were similar , as well as the flow velocity measurement variables .


On the other hand , coronary cineangiography showed the presence of occlusion in one RA graft and stenosis in five RA grafts in GII , while GI presented stenosis in only one RA graft ( p = @ ) .


These results show that the morphological and pathological features , as well as the hemodynamic performance of the free radial artery grafts , whether prepared in a skeletonized manner or with adjacent tissues , are similar .


However , a larger number of non-obstructive lesions may be observed when RA is prepared with adjacent tissues .


Skeletal muscle from sedentary older adults exhibits reduced mitochondrial abundance and oxidative capacity .


The primary objective was to determine whether @ weeks of combined training ( CT ) has a more robust effect than endurance training ( ET ) or resistance training ( RT ) on mitochondrial physiology in healthy young ( @-@ years ) and older ( @ years ) adults .


Thirty-four young and @ older adults were randomly assigned to @ weeks of ET , RT , and control/CT .


Control subjects completed @ weeks of no exercise ( control ) followed by @ weeks of CT. .


Body composition , skeletal muscle strength , and peak oxygen uptake were measured before and after the intervention .


Vastus lateralis muscle biopsy samples were obtained before and @ hours after the intervention .


Mitochondrial physiology was evaluated by high-resolution respirometry and expression of mitochondrial proteins and transcription factors by quantitative PCR and immunoblotting .


ET and CT significantly increased oxidative capacity and expression of mitochondrial proteins and transcription factors .


All training modalities improved body composition , cardiorespiratory fitness , and skeletal muscle strength .


CT induced the most robust improvements in mitochondria-related outcomes and physical characteristics despite lower training volumes for the ET and RT components .


Importantly , most of the adaptations to training occurred independent of age .


Collectively , these results demonstrate that both ET and CT increase muscle mitochondrial abundance and capacity although CT induced the most robust improvements in the outcomes measured .


In conclusion , CT provides a robust exercise regimen to improve muscle mitochondrial outcomes and physical characteristics independent of age .


The efficacy of posttraumatic stress disorder ( PTSD ) treatments in psychosis has not been examined in a randomized clinical trial to our knowledge .


Psychosis is an exclusion criterion in most PTSD trials .


To examine the efficacy and safety of prolonged exposure ( PE ) therapy and eye movement desensitization and reprocessing ( EMDR ) therapy in patients with psychotic disorders and comorbid PTSD .


A single-blind randomized clinical trial with @ arms ( N = @ ) , including PE therapy , EMDR therapy , and waiting list ( WL ) of @ outpatient mental health services among patients with a lifetime psychotic disorder and current chronic PTSD .


Baseline , posttreatment , and @-month follow-up assessments were made .


Participants were randomized to receive @ weekly @-minute sessions of PE ( n = @ ) , EMDR ( n = @ ) , or WL ( n = @ ) .


Standard protocols were used , and treatment was not preceded by stabilizing psychotherapeutic interventions .


Clinician-rated severity of PTSD symptoms , PTSD diagnosis , and full remission ( on the Clinician-Administered PTSD Scale ) were primary outcomes .


Self-reported PTSD symptoms and posttraumatic cognitions were secondary outcomes .


Data were analyzed as intent to treat with linear mixed models and generalized estimating equations .


Participants in the PE and EMDR conditions showed a greater reduction of PTSD symptoms than those in the WL condition .


Between-group effect sizes were @ ( P < @ ) in PE and @ ( P = @ ) in EMDR .


Participants in the PE condition ( @ % ; odds ratio -LSB- OR -RSB- , @ ; P = @ ) or the EMDR condition ( @ % ; OR , @ ; P < @ ) were significantly more likely to achieve loss of diagnosis during treatment than those in the WL condition ( @ % ) .


Participants in the PE condition ( @ % ; OR , @ ; P = @ ) , but not those in the EMDR condition ( @ % ; OR , @ ; P = @ ) , were more likely to gain full remission than those in the WL condition ( @ % ) .


Treatment effects were maintained at the @-month follow-up in PE and EMDR .


Similar results were obtained regarding secondary outcomes .


There were no differences in severe adverse events between conditions ( @ in PE , @ in EMDR , and @ in WL ) .


The PE therapy and EMDR therapy showed no difference in any of the outcomes and no difference in participant dropout ( @ % in PE and @ % in EMDR , P = @ ) .


Standard PE and EMDR protocols are effective , safe , and feasible in patients with PTSD and severe psychotic disorders , including current symptoms .


A priori exclusion of individuals with psychosis from evidence-based PTSD treatments may not be justifiable .


Until recently , non-specific low back pain ( NSLBP ) in adolescents was considered a rare phenomenon unlike in adults .


The last two decades has shown an increasing amount of research highlighting the prevalence in this age group .


Recent studies estimate lifetime prevalence at @ % -@ % , point prevalence at @ % -@ % , and prevalence of recurrent NSLBP at @ % -@ % .


In Zimbabwe , there is dearth of literature on the magnitude of the problem in adolescents .


Therefore , the aims of the study were to determine the prevalence ( lifetime , point , recurrent ) and the nature of recurrent NSLBP reported by adolescents in secondary schools .


A cross-sectional study was conducted using a questionnaire .


A cluster sample of @ adolescents ( age @-@ years ) randomly derived from government schools participated in the study .


Lifetime prevalence , point prevalence and prevalence of recurrent NSLBP were presented as percentages of the total population .


Exact @ % confidence intervals were given .


Chi-square test was used to evaluate the effect of gender and age on prevalence .


The students ' response rate was @ % .


The lifetime prevalence was @ % -LSB- @ % confidence interval = @-@ @ -RSB- with no significant difference between sexes -LSB- @ ( @ ) = @ , p = @ -RSB- .


However , NSLBP peaked earlier in female students ( @ years ) than in male students ( @ years ) -LSB- t ( @ ) = @ , p < @ -RSB- .


About @ % of the adolescents reported having an episode of NSLBP on the day of the survey .


However , female students ( @ % ) were more affected on the day -LSB- @ ( @ ) = @ , p < @ -RSB- .


Twenty-nine percent of the adolescents experienced recurrent NSLBP with @ % experiencing at least three episodes in the last @ months .


On average , recurrent NSLBP reported was mild in intensity ( @ @ ) on the visual analogue scale ( VAS ) and short in duration .


Recurrent NSLBP was associated with sciatica in @ % of adolescents .


NSLBP is a common occurrence among Zimbabwean adolescents in secondary schools .


It increases with chronological age and is recurrent in the minority of adolescents .


Although much of the symptomatology may be considered benign , the existence of recurrent NSLBP in adolescents before their work-life begins should be a concern to health professionals , teachers and parents .


We evaluated the efficacy of low-molecular-weight heparin ( LMWH ) relative to aspirin in preventing early neurologic deterioration ( END ) , venous thromboembolism ( VTE ) , and outcomes at @months .


Patients were randomly assigned to receive either subcutaneous enoxaparin @ anti-factor Xa IU/@ @ mL twice daily or oral aspirin @mg daily for @days .


After day @ , all subjects received aspirin @mg once daily for @months .


We assessed whether LMWH was superior to aspirin in preventing END and VTE within the first @days after index stroke and evaluated @-month outcomes .


Of the total @ patients , @ % suffered from END , and @ % suffered from deep-vein thrombosis during the first @days , with a significance difference between the LMWH group and aspirin group ( @ % , @ % versus @ % , @ % , respectively ) .


At @months , there was a significant difference in the frequency of good outcomes among patients over the median age of @years ( LMWH @ % versus aspirin @ % ) .


The benefit of LMWH was also significant in patients with symptomatic stenosis of the posterior circulation and basilar artery ( @ % and @ % for LMWH versus @ % and @ % for aspirin , respectively ) .


For patients with acute ischemic stroke , treatment with LMWH within @hours of stroke until @days later may reduce END and deep-vein thrombosis during the first @days .


LMWH appears to have advantages over aspirin in certain subgroups , such as elderly patients and patients with posterior circulation and basilar artery stenosis .


Using simulation-based mastery learning , residents can be trained to achieve a predefined performance standard in resuscitation .


After mastery is achieved , performance degradation occurs over time .


Prior investigations have shown performance retention of @-@ months following intensive simulation-based mastery learning sessions .


We sought to investigate the duration of mastery-level resuscitation performance retention after a single @ - to @-hour simulation-based mastery learning session .


Randomized , prospective trial .


Medical simulation laboratory .


Convenience sample of @ pediatric residents .


Baseline resuscitation performance was determined on four standardized simulation scenarios .


After determination of baseline performance , each resident repeated each scenario , as needed , until mastery-level performance was achieved .


Residents were then randomized and retested @ , @ , or @ months later .


Statistical analysis on scores at baseline and retesting were used to determine performances changes from baseline and performance retention over time .


Forty-two residents participated in the study ( @ in @ mo group , @ in @ mo group , and @ in @ mo group ) .


At baseline , postgraduate year-@ residents performed better than postgraduate year-@ residents ( p = @ ) .


Overall performance on each of the four scenarios improved at retesting .


The percent of residents maintaining mastery-level performance showed a significant linear decline ( p = @ ) , with a drop at each retesting interval ; @ % retained mastery at @ months , @ % at @ months , and @ % at @ months .


There was no difference in retention between postgraduate year-@ , postgraduate year-@ , and postgraduate year-@ residents ( p = @ ) .


Residents displayed significant improvements in resuscitation performance after a single simulation-based mastery learning session , but performance declined over time , with less than @ % retaining mastery-level performance at @ months .


Our results suggest that relatively frequent refresher training is needed after a single simulation-based mastery learning session .


Additional research is needed to determine the duration of performance retention following any specific simulation-based mastery learning intervention .


Diabetic retinopathy ( DR ) is associated with a higher risk of renal and cardiovascular events .


We sought to compare the risk for renal versus cardiovascular ( CV ) outcomes , stratified by retinopathy severity .


ACCORD was a randomized trial of people with type @ diabetes , at high-risk for CV disease .


A subgroup ( n = @,@ from @ clinics ) had stereoscopic fundus photographs graded centrally .


Participants were stratified at baseline to moderate/severe DR or no/mild DR and were monitored for renal and CV outcomes at follow-up visits over @ years .


The composite renal outcome was composed of serum creatinine doubling , macroalbuminuria , or end-stage renal disease .


The composite CV outcome was the ACCORD trial primary outcome .


Competing risk techniques were used to estimate the relative risk ( RR ) of renal versus CV composite outcomes within each DR stratum .


The hazards ratio for doubling of serum creatinine and incident CV event in the moderate/severe DR versus no/mild DR strata were : @ ( @ % CI : @-@ @ ) and @ ( @ % CI : @-@ @ ) , respectively .


The RR of the two composite outcomes was highly similar in the no/mild DR stratum ( adjusted RR at @ years for CV versus renal events = @ , @ % CI : @-@ @ ) and the moderate/severe DR stratum ( adjusted RR = @ , @ % CI : @-@ @ ) .


Thus , in people with type @ diabetes at high risk for cardiovascular disease , incident CV versus renal events was similar , irrespective of the severity of the DR. Further evaluation of the specificity of DR for microvascular versus macrovascular events in other populations is warranted .


We propose a new hybrid brain-computer interface ( BCI ) system that integrates two different EEG tasks : tactile selective attention ( TSA ) using a vibro-tactile stimulator on the left/right finger and motor imagery ( MI ) of left/right hand movement .


Event-related desynchronization ( ERD ) from the MI task and steady-state somatosensory evoked potential ( SSSEP ) from the TSA task are retrieved and combined into two hybrid senses .


One hybrid approach is to measure two tasks simultaneously ; the features of each task are combined for testing .


Another hybrid approach is to measure two tasks consecutively ( TSA first and MI next ) using only MI features .


For comparison with the hybrid approaches , the TSA and MI tasks are measured independently .


Using a total of @ subject datasets , we analyzed the BCI classification performance for MI , TSA and two hybrid approaches in a comparative manner ; we found that the consecutive hybrid approach outperformed the others , yielding about a @ % improvement in classification accuracy relative to MI alone .


It is understood that TSA may play a crucial role as a prestimulus in that it helps to generate earlier ERD prior to MI and thus sustains ERD longer and to a stronger degree ; this ERD may give more discriminative information than ERD in MI alone .


Overall , our proposed consecutive hybrid approach is very promising for the development of advanced BCI systems .


Despite the extraordinary scale up of HIV prevention , care and treatment services in sub-Saharan Africa ( SSA ) over the past decade , the overall effectiveness of HIV programs has been significantly hindered by high levels of attrition across the HIV care continuum .


Data from `` real-life '' settings are needed on the effectiveness of an easy to deliver package of services that can improve overall performance of the HIV care continuum .


We are conducting an implementation science study using a two-arm cluster site-randomized design to determine the effectiveness of a combination intervention strategy ( CIS ) using feasible , evidence-based , and practical interventions-including ( @ ) point-of-care ( POC ) CD@ count testing , ( @ ) accelerated antiretroviral therapy initiation for eligible individuals , and ( @ ) SMS reminders for linkage to and retention in care-as compared to the standard of care ( SOC ) in Mozambique in improving linkage and retention among adults following HIV diagnosis .


A pre-post intervention two-sample design is nested within the CIS arm to assess the incremental effectiveness of the CIS plus financial incentives ( CIS + FI ) compared to the CIS without FI on study outcomes .


Randomization is done at the level of the study site , defined as a primary health facility .


Five sites are included from the City of Maputo and five from Inhambane Province .


Target enrollment is a total of @,@ adults : @ in the SOC arm , @ in the CIS cohort of the intervention arm and @ in the CIS + FI cohort of the intervention arm ( average of @ participants per site ) .


Participants are followed for @ months from time of HIV testing to ascertain a combined endpoint of linkage to care within @ month after testing and retention in care @ months from HIV test .


Cost-effectiveness analyses of CIS compared to SOC and CIS + FI compared to CIS will also be conducted .


Study findings will provide evidence on the effectiveness of a CIS and the incremental effectiveness of a CIS + FI in a `` real-life '' service delivery system in a SSA country severely impacted by HIV .


High calcium intakes enhance fat loss under restricted energy intake .


Mechanisms explaining this may involve reduced dietary fat absorption , enhanced lipid utilization and ( or ) reductions in appetite .


This study aimed to assess the impact of @ weeks of calcium supplementation on substrate utilization during exercise and appetite sensations at rest .


Thirteen physically active males completed two @-d supplemental periods , in a double-blind , randomized crossover design separated by a @-week washout period .


During supplementation , a test-drink was consumed daily containing @ and @mg of calcium during control ( CON ) and high-calcium ( CAL ) periods , respectively .


Cycling-based exercise tests were conducted before and after each supplemental period to determine substrate utilization rates and circulating metabolic markers ( non-esterified fatty acid , glycerol , glucose and lactate concentrations ) across a range of exercise intensities .


Visual analog scales were completed in the fasting , rested state to determine subjective appetite sensations .


No significant differences between supplements were observed in lipid or carbohydrate utilization rates , nor in circulating metabolic markers ( both P > @ ) .


Maximum rates of lipid utilization were @ and @ g/min for CON and CAL , respectively , prior to supplementation and @ and @ g/min , respectively , post-supplementation ( main effects of time , supplement and time x supplement interaction effect all P > @ ) .


Furthermore , no significant differences were detected in any subjective appetite sensations ( all P > @ ) .


Two weeks of calcium supplementation does not influence substrate utilization during exercise in physically active males .


The objective of the study was to evaluate the efficacy of @ alpha-hydroxyprogesterone caproate ( @OHP-C ) in prolonging gestation in patients with a short cervix and other risk factors for preterm delivery , such as previous preterm birth , cervical surgery , uterine anomalies , or prenatal diethylstilbestrol ( DES ) exposure .


This open-label , multicenter , randomized controlled trial included asymptomatic singleton pregnancies from @ ( +@ ) through @ ( +@ ) weeks of gestation with a cervical length less than @ mm and a history of preterm delivery or cervical surgery or uterine malformation or prenatal DES exposure .


Randomization assigned them to receive ( or not ) @ mg of intramuscular @OHP-C weekly until @ weeks .


The primary outcome was time from randomization to delivery .


After enrolling @ patients , an interim analysis demonstrated the lack of efficacy of @OHP-C in prolonging pregnancy .


The study was discontinued because of futility .


The groups were similar for maternal age , body mass index , parity , gestational age at inclusion , history of uterine anomalies , DES syndrome , previous preterm delivery or midtrimester abortion , and cervical length at randomization .


The enrollment-to-delivery interval did not differ between patients allocated to @OHP-C ( n = @ ) and those allocated to the control group ( n = @ ) ( median -LSB- interquartile range -RSB- time to delivery : @ -LSB- @-@ -RSB- and @ -LSB- @-@ -RSB- days , respectively ) .


The rate of preterm delivery less than @ ( @ % vs @ % , P > @ ) , less than @ ( @ % vs @ % , P = @ ) , or less than @ ( @ % vs @ % , P = @ ) weeks was similar in patients allocated to @OHP-C and those in the control group .


@OHP-C did not prolong pregnancy in women with singleton gestations , a sonographic short cervix , and other risk factors of preterm delivery ( prior history , uterine malformations , cervical surgery , or prenatal DES exposure ) .


The objectives of this trial were to investigate short-term changes in product usage , tobacco-related biomarkers of exposure , and subjective effects in smokers who switched to dissolvable tobacco ( Camel Orbs ) use .


Participants were randomized into @ of @ groups ( continued smoking , switched to consuming Orbs , switched to dual use of cigarettes and Orbs , and tobacco abstinent ) and confined for @ days with dietary restrictions .


Most measurements were at baseline and days @ , @ , and @ of intervention .


Mouth-level tar and nicotine exposures were estimated by filter tip analysis .


Twenty biomarkers were quantified in @-hr urine ; @ were quantified in blood/plasma ( carboxyhemoglobin , nicotine , cotinine , and thiocyanate ) .


Ratings for nicotine dependence and withdrawal symptoms were scored .


After @ days , substantial and statistically significant reductions ( ~ @ % -@ % ) in all biomarkers were observed in the Orbs and abstinent groups compared to baseline .


Numerous smaller reductions ( ~ @ % -@ % ) were also noted in the continued smoking and dual-use groups ( generally similar in magnitude for both groups ) .


Subjective questionnaire findings indicated greater withdrawal discomfort levels throughout the intervention period for the nonsmoking groups .


For subjects that continued smoking , clinical confinement conditions did not significantly alter product use behavior and toxicant exposure profile compared to baseline .


Substantial reductions in toxicant exposure occurred for participants that did not smoke .


Cigarette smokers that switched to Orbs use showed reductions in all biomarkers , similar to abstinent group .


Changes in toxicant exposure for the dual-use group were similar to the continued-smoking group , consistent with minimal changes observed in that group 's product use behavior ( small reduction in cigarettes per day and small increase in Orbs use ) .


Our aim was to identify whether particular subgroups of patients had an unacceptably high risk of symptomatic intracranial hemorrhage or low chance of benefit when treated with alteplase ( recombinant tissue-type plasminogen activator ) .


Third International Stroke Trial was an international randomized trial of the intravenous ( IV ) recombinant plasminogen activator alteplase ( @ mg/kg ) versus control in @ ( @ versus @ ) patients .


We analyzed the effect of recombinant tissue-type plasminogen activator on @-month functional outcome , early death , and symptomatic intracranial hemorrhage ( both @ days ) .


We tested for any differences in treatment effect between subgroups by a test of interaction .


Our @ protocol prespecified subgroups were time to randomization , age , sex , stroke subtype , atrial fibrillation , early ischemic change ( clinician and expert panel ) , prior antiplatelet use , stroke severity , diastolic and systolic blood pressure at randomization , center 's thrombolysis experience , and trial phase .


Analyses were adjusted for key baseline prognostic factors .


There were no significant interactions in the subgroups analyzed that were consistent across all @ outcomes .


Treatment with recombinant tissue-type plasminogen activator increased the odds of symptomatic intracranial hemorrhage by a greater amount in patients taking prior antiplatelets than those who were not ( P = @ for test of interaction ) , but had no clear detrimental effect on functional outcome at @ months in this group ( P = @ for test of interaction ) .


Among the types of patient in the Third International Stroke Trial , this secondary analysis did not identify any subgroups for whom treatment should be avoided .


Given the limitations of the analysis , we found no clear evidence to avoid treatment in patients with prior ischemic stroke , diabetes mellitus , or hypertension .


Exercise training induces several beneficial effects in patients with chronic heart failure ( CHF ) .


This study investigated the effects of high-intensity aerobic interval training ( AIT ) compared with combined AIT and strength training ( COM ) on early ventilatory and metabolic recovery pattern after symptom-limited cardiopulmonary exercise testing ( CPET ) in CHF patients .


Stable CHF patients ( N = @ ; @ @ years -LSB- mean SD -RSB- , @ males ) participated in an exercise training program for @ weeks , @ times per week .


Participants were randomly assigned to either AIT ( n = @ ) or COM group ( n = @ ) .


Cardiopulmonary exercise testing was performed before and after completion of the program .


Primary measurements included absolute and percentage difference of oxygen uptake , carbon dioxide output , minute ventilation ( ( Equation is included in full-text article . )


E ) , tidal volume ( VT ) , respiratory rate , and the first-degree slope of oxygen uptake ( ( Equation is included in full-text article . )


O@/t slope ) and carbon dioxide output ( ( Equation is included in full-text article . )