Identification of effective intervention elements to promote children 's mental health in early school years is crucial for optimal later development .


Resuscitation is a life-saving measure usually instructed in simulation sessions .


Small-group teaching is effective .


However , feasible group sizes for resuscitation classes are unknown .


We investigated the impact of different group sizes on the outcome of resuscitation training .


Medical students ( n = @ ) were randomized to courses with three , five or eight participants per tutor .


The course duration was adjusted according to the group size , so that there was a time slot of @ minutes hands-on time for every student .


All participants performed an objective structured clinical examination before and after training .


The teaching sessions were videotaped and resuscitation quality was scored using a checklist while we measured the chest compression parameters with a manikin .


In addition , we recorded hands-on-time , questions to the tutor and unrelated conversation .


Results are displayed as median ( IQR ) .


Checklist pass rates and scores were comparable between the groups of three , five and eight students per tutor in the post-test ( @ % , @ % and @ % ) .


Groups of eight students asked fewer questions ( @ ( @ - @ ) vs. @ ( @ - @ ) , p < @ ) , had less hands-on time ( @:@ min ( @:@ - @:@ min ) vs. @:@ min ( @:@ - @:@ min ) , p = @ ) , conducted more unrelated conversations ( @ and @ , p < @ ) and had lower self-assessments than groups of three students per tutor ( @ ( @ - @ ) and @ ( @ - @ ) , p = @ ) .


Resuscitation checklist scores and pass rates after training were comparable in groups of three , five or eight medical students , although smaller groups had advantages in teaching interventions and hands-on time .


Our results suggest that teaching BLS skills is effective in groups up to eight medical students , but smaller groups yielded more intense teaching conditions , which might be crucial for more complex skills or less advanced students .


Urinary tract infection is a key issue for long-term intermittent catheterization users .


Various catheter designs and methods have evolved to decrease the risk but the evidence remains unclear regarding whether product type improves outcomes .


We determined whether single use hydrophilic coated catheters reduced urinary tract infections compared to multiple use polyvinylchloride catheters for children with neurogenic bladder due to spina bifida .


This was a randomized crossover @-center trial with @ treatment periods of @ weeks each , consisting of single use hydrophilic coated catheter and multiple use polyvinylchloride catheter ( washed with soap and water , and air dried after each use ) .


Each week participants recorded symptoms and urine results ( Multistix @SG reagent strip ) .


Primary outcome was person-weeks of urinary tract infection , defined as positive leukocytes plus fever , flank pain , increased incontinence , malaise , or cloudy or odorous urine requiring antibiotic treatment .


Individuals were included if they were a child or young adult with spina bifida and used intermittent catheterization as the primary method of bladder emptying .


Calculated sample size was @ .


More than @ patients were screened , of whom @ were randomized and @ completed both trial arms .


Mean age was @ years .


Of the patients @ were male and @ were female .


Mean SD person-weeks of urinary tract infection was @ @ in the single use hydrophilic coated catheter group and @ @ in the multiple use polyvinylchloride catheter group ( p < @ ) .


There were no statistical differences in weeks of febrile urinary tract infection or antibiotic use .


Results are consistent with the Cochrane Review in that single use hydrophilic coated catheters may not decrease the incidence of symptomatic urinary tract infection in community dwelling chronic intermittent catheterization users when compared to clean multiple use polyvinylchloride catheters .


Due to the negative impact of radiation on the patient and the surgical team during percutaneous nephrolithotomy ( PCNL ) , we aimed to evaluate success rate and complications of blind access for PCNL using lumbar notch landmark and compare with conventional fluoroscopy-guided access .


In a clinical trial , @ patients who were candidate for PCNL , were randomly assigned into blind group ( @ ) and fluoroscopy-guided group ( @ ) .


In group @ the lumbar notch was used to guide percutaneous access and in group @ fluoroscopy performed after needle insertion , Amplatz placement and at the end of surgery .


If the access failed , we would repeat puncturing up to @ times .


In group @ , access was achieved using full fluoroscopy guidance .


All patients underwent postoperative assessment including kidney-ureter-bladder X-ray and ultrasonography .


Both mean access time and mean operation time were statically similar in group @ and group @ ( @ @ vs. @ @ min and @ @ vs. @ @ min , respectively ) .


A successful puncture was achieved in @ % and @ % of the patients in groups @ and @ , respectively ( P = @ ) .


Total success rate of procedure was @ % and @ % of the patients in groups @ and @ , respectively ( P = @ ) .


According to this study , it seems that blind access is a safe and effective PCNL method , and we recommend employment of this technique by skilled endourologist in urology centers especially for patient with large hydronephrotic kidney .


To evaluate the effectiveness of the computerized CBT ( cCBT ) programme , MoodGYM , for the reduction in symptoms of general psychological distress ( the primary outcome ) , depression , anxiety , stress , and impaired daily functioning .


A randomized controlled trial , with a waiting list control condition , in a routine clinical setting .


Participants were @ public mental health service users ( aged @-@ -LSB- M = @ years ; SD = @ -RSB- ) waiting for interventions .


Self-report outcome measures were administered online at baseline and post-intervention ( i.e. , after @ days ) .


After high dropout rates , a post-intervention completers analysis examined @ MoodGYM participants and @ waiting list control participants .


MoodGYM was significantly more effective than the waiting list control for the reduction of symptoms of general psychological distress ( F -LSB- @ , @ -RSB- = @ ; p < @ ) and stress ( F -LSB- @ , @ -RSB- = @ ; p < @ ) but not depression , anxiety , or impaired daily functioning .


Due to their high associated dropout rates , self-help cCBT programmes such as MoodGYM should not be provided as front-line treatments .


However , as it is likely to be agreeable and beneficial to some service users , perhaps self-help cCBT should be provided as an additional treatment option .


Single-centre series of the management of patients with ruptured abdominal aortic aneurysm ( AAA ) are usually too small to identify clinical factors that could improve patient outcomes .


IMPROVE is a pragmatic , multicentre randomized clinical trial in which eligible patients with a clinical diagnosis of ruptured aneurysm were allocated to a strategy of endovascular aneurysm repair ( EVAR ) or to open repair .


The influences of time and manner of hospital presentation , fluid volume status , type of anaesthesia , type of endovascular repair and time to aneurysm repair on @-day mortality were investigated according to a prespecified plan , for the subgroup of patients with a proven diagnosis of ruptured or symptomatic AAA .


Adjustment was made for potential confounding factors .


Some @ of @ randomized patients had a symptomatic or ruptured aneurysm : diagnostic accuracy was @ per cent .


Patients randomized outside routine working hours had higher operative mortality ( adjusted odds ratio ( OR ) @ , @ per cent confidence interval @ to @ ) .


Mortality rates after primary and secondary presentation were similar .


Lowest systolic blood pressure was strongly and independently associated with @-day mortality ( @ per cent among those with pressure below @ mmHg ) .


Patients who received EVAR under local anaesthesia alone had greatly reduced @-day mortality compared with those who had general anaesthesia ( adjusted OR @ , @ to @ ) .


These findings suggest that the outcome of ruptured AAA might be improved by wider use of local anaesthesia for EVAR and that a minimum blood pressure of @ mmHg is too low a threshold for permissive hypotension .


Conventional glucocorticoid replacement therapy fails to mimic the physiological cortisol rhythm , which may have implications for morbidity and mortality in patients with Addison 's disease .


The objective of the study was to compare the effects of continuous sc hydrocortisone infusion ( CSHI ) with conventional oral hydrocortisone ( OHC ) replacement therapy .


This was a prospective crossover , randomized , multicenter clinical trial comparing @ months of treatment with thrice-daily OHC vs CSHI .


From Norway and Sweden , @ patients were enrolled from registries and clinics .


All patients were assessed at baseline and after @ and @ weeks in each treatment arm .


The morning ACTH level was the primary outcome measure .


Secondary outcome measures were effects on metabolism , health-related quality of life ( HRQoL ) , sleep , and safety .


CSHI yielded normalization of morning ACTH and cortisol levels , and @-hour salivary cortisol curves resembled the normal circadian variation .


Urinary concentrations of glucocorticoid metabolites displayed a normal pattern with CSHI but were clearly altered with OHC .


Several HRQoL indices in the vitality domain improved over time with CSHI .


No benefit was found for either treatments for any subjective ( Pittsburgh Sleep Quality Index questionnaire ) or objective ( actigraphy ) sleep parameters .


CSHI safely brought ACTH and cortisol toward normal circadian levels without adversely affecting glucocorticoid metabolism in the way that OHC did .


Positive effects on HRQoL were noted with CSHI , indicating that physiological glucocorticoid replacement therapy may be beneficial and that CSHI might become a treatment option for patients poorly controlled on conventional therapy .


Studies have suggested a link between diet and behavior in children with autism spectrum disorders ( ASDs ) .


Parental reports of behavioral changes upon exposure to gluten and/or casein are common in clinical practice .


An association between diet type , intestinal permeability ( IP ) ( ` leaky gut ' ) , and behavior has been long proposed but not substantiated .


We explored this possible association in this trial .


This randomized double-blind , placebo-controlled study explored the effects of gluten and milk on IP and behavior in children with ASDs over a period of @ weeks .


IP assessed by lactulose : mannitol ( L/M ) sugar permeability test and behavior assessed by the Aberrant Behavior Checklist and Conners Parent Rating were measured .


Gastrointestinal symptoms in both groups were also monitored .


Neither the L/M ratio nor behavioral scores were different between groups exposed to gluten/dairy or placebo .


The changes observed were noted to be small and not clinically significant .


Our study although underpowered to show small differences does not support an association between dietary gluten/milk , IP , and behavioral changes in subjects with ASD .


Optimization of systolic blood pressure and lipid levels are essential for secondary prevention after ischemic stroke , but there are substantial gaps in care , which could be addressed by nurse - or pharmacist-led care .


We compared @ types of case management ( active prescribing by pharmacists or nurse-led screening and feedback to primary care physicians ) in addition to usual care .


We performed a prospective randomized controlled trial involving adults with recent minor ischemic stroke or transient ischemic attack whose systolic blood pressure or lipid levels were above guideline targets .


Participants in both groups had a monthly visit for @ months with either a nurse or pharmacist .


Nurses measured cardiovascular risk factors , counselled patients and faxed results to primary care physicians ( active control ) .


Pharmacists did all of the above as well as prescribed according to treatment algorithms ( intervention ) .


Most of the @ study participants ( mean age @ yr , mean systolic blood pressure @ mm Hg , mean low-density lipoprotein -LSB- LDL -RSB- cholesterol @ mmol/L ) were already receiving treatment at baseline ( antihypertensives : @ % ; statins : @ % ) , but none met guideline targets ( systolic blood pressure @ mm Hg , fasting LDL cholesterol @ mmol/L ) .


Substantial improvements were observed in both groups after @ months : @ % of participants in the pharmacist case manager group met both systolic blood pressure and LDL guideline targets compared with @ % in the nurse-led group ( @ % absolute difference ; number needed to treat = @ , p = @ ) .


Compared with nurse-led case management ( risk factor evaluation , counselling and feedback to primary care providers ) , active case management by pharmacists substantially improved risk factor control at @ months among patients who had experienced a stroke .


The antibiotic rifaximin is used to treat non-constipated irritable bowel syndrome ( IBS ) .


Methane production is associated with constipation and its severity in constipation-predominant IBS ( C-IBS ) .


A previous retrospective study suggested that rifaximin and neomycin was superior to neomycin alone in improving symptoms in methane-positive subjects .


To determine the effectiveness of neomycin alone or with rifaximin in improving symptoms in methane-positive C-IBS subjects .


A double-blind , randomized , placebo-controlled trial was performed from @ to @ at three tertiary care centers .


Subjects aged @-@ with C-IBS ( Rome II criteria ) and breath methane ( > @ppm ) meeting the inclusion and exclusion criteria were recruited .


Subjects completed a baseline symptom questionnaire rating the severity of abdominal and bowel symptoms on a visual analog scale and were randomized to receive neomycin and placebo or neomycin and rifaximin for @ days .


Symptom severity was assessed by weekly questionnaire for @weeks of therapy and @ additional weeks of follow-up .


Thirty-one subjects ( @ neomycin and placebo , @ neomycin and rifaximin ) were included in the intention-to-treat analysis .


Constipation severity was significantly lower in the neomycin and rifaximin group ( @ ) compared to neomycin alone ( @ ) ( P = @ ) , with greater improvement in constipation ( P = @ ) , straining ( P = @ ) and bloating ( P = @ ) , but not abdominal pain .


In the neomycin and rifaximin group , subjects with methane < @ppm after treatment reported significantly lower constipation severity ( @ ) than subjects with persistent methane ( @ ) ( P = @ ) .


Rifaximin plus neomycin is superior to neomycin alone in improving multiple C-IBS symptoms .


This effect is predicted by a reduction in breath methane .


Stellate ganglion block ( SGB ) is effective for treatment of Bell 's palsy in patients with diabetes mellitus .


Corticosteroids are widely used for treatment of Bell 's palsy in patients with diabetes mellitus but may induce complications like hyperglycemia , which calls for an alternative therapy .


This study aimed to ascertain the effect of SGB on Bell 's palsy in patients with diabetes mellitus .


This randomized and single-blinded clinical trial involved @ diabetic patients with Bell 's palsy that were randomly divided into a control group ( n = @ ) and a treatment group ( SGB group , n = @ ) .


The House-Brackmann scale and facial disability index ( FDI , including FDIP and FDIS ) were observed before treatment and at @ and @ months after treatment for assessment of the outcome .


No statistically significant difference was found between the two groups before treatment as regards the House-Brackmann scale and FDI .


There was a statistically significant difference in FDIP score in the two groups after treatment in comparison with before treatment .


The FDIS score showed a statistical difference between the two groups after treatment .


Glucose fluctuation often remains to be corrected under basal-supported oral therapy .


We investigated the efficacy of adding once-daily rapid-acting insulin in Japanese diabetes patients treated with basal-supported oral therapy .


In this @-week , parallel-group , randomized , open-label trial , @ Japanese adults with type @ diabetes treated with insulin glargine and @ mg of sitagliptin were randomized into the following two arms : the single-bolus group , in which once-daily insulin glulisine was initiated at a main meal at a fifth ( i.e. , @ % ) the dose of insulin glargine , and the control group , in which the dose of sitagliptin was maximized to @ mg .


The primary end point was the change of glycemic fluctuation assessed with the M-value .


Baseline hemoglobin A@c levels , mean blood glucose profiles , and M-value were @ @ % , @ @ mmol/L , and @ @ units , respectively .


At the end of the study , the single-bolus group had a greater reduction of M-value than the control group ( P = @ ) ; the difference was @ units ( @ % confidence interval , @-@ @ units ) .


The single-bolus group also had a greater reduction of mean blood glucose levels ( P = @ ) .


There were no significant differences in the incidence of hypoglycemia or the weight change between the two groups ( P > @ ) .


Adding once-daily insulin glulisine was more effective in controlling the glycemic fluctuation in Japanese type @ diabetes patients treated with insulin glargine together with sitagliptin .


Although D@ lymphadenectomy has been shown to improve outcomes in gastric cancer , it may increase postoperative morbidity , mainly owing to splenopancreatic complications .


In addition , the effects of nodal dissection along the proper hepatic artery have not been extensively elucidated .


We hypothesized that modified D@ ( ie , D@ + ) lymphadenectomy may decrease surgical risks without impairing oncologic adequacy .


Patients with node-positive gastric cancer undergoing curative total gastrectomy were intraoperatively randomized to D@ + ( group @ , @ patients ) or standard D@ lymphadenectomy ( group @ , @ patients ) , the latter including splenectomy and nodal group @a .


The index of estimated benefit was used to assess the efficacy of dissection of each nodal station .


The primary endpoint for oncologic adequacy was the disease-free survival ( DFS ) rate .


Surgical complications were significantly more common in group @ , which also included @ postoperative deaths .


Overall , @ patients ( @ % ) experienced tumor recurrence .


The primary site of tumor relapse and the @-year DFS rate were not different between the @ groups .


Involvement of the second nodal level was associated with a worse DFS rate ; however , patients undergoing more extensive lymphadenectomy did not show a better DFS rate .


The incidence of involvement of nodal stations @ , @d , and @a was @ % , and the @-year DFS rate was zero .


Consequently , the benefit to dissect such lymph nodes was null .


These findings suggest that modified D@ lymphadenectomy confers the same oncologic adequacy as standard D@ lymphadenectomy , with a significant reduction of postoperative morbidity .


To demonstrate the safety and effectiveness of responsive stimulation at the seizure focus as an adjunctive therapy to reduce the frequency of seizures in adults with medically intractable partial onset seizures arising from one or two seizure foci .


Randomized multicenter double-blinded controlled trial of responsive focal cortical stimulation ( RNS System ) .


Subjects with medically intractable partial onset seizures from one or two foci were implanted , and @month postimplant were randomized @:@ to active or sham stimulation .


After the fifth postimplant month , all subjects received responsive stimulation in an open label period ( OLP ) to complete @years of postimplant follow-up .


All @ subjects were randomized .


The percent change in seizures at the end of the blinded period was -@ % in the active and -@ % in the sham stimulation group ( p = @ , Generalized Estimating Equations ) .


The median percent reduction in seizures in the OLP was @ % at @year and @ % at @years , which represents a progressive and significant improvement with time ( p < @ ) .


The serious adverse event rate was not different between subjects receiving active and sham stimulation .


Adverse events were consistent with the known risks of an implanted medical device , seizures , and of other epilepsy treatments .


There were no adverse effects on neuropsychological function or mood .


Responsive stimulation to the seizure focus reduced the frequency of partial-onset seizures acutely , showed improving seizure reduction over time , was well tolerated , and was acceptably safe .


The RNS System provides an additional treatment option for patients with medically intractable partial-onset seizures .


Cognitive impairment develops with pre-diabetes and dementia is a complication of diabetes .


Natural products like turmeric and cinnamon may ameliorate the underlying pathogenesis .


People @ years ( n = @ ) with newly-recognised untreated pre-diabetes were randomised to a double-blind metabolic study of placebo , turmeric ( @ g ) , cinnamon ( @ g ) or both ( @ g & @ g respectively ) , ingested at a white bread ( @ g ) breakfast .


Observations were made over @ hours for pre - and post-working memory ( WM ) , glycaemic and insulin responses and biomarkers of Alzheimer 's disease ( AD ) ( @ , @ , @ and @ hours ) : amyloid precursor protein ( APP ) , - secretase subunits presenilin-@ ( PS@ ) , presenilin-@ ( PS@ ) , and glycogen synthase kinase ( GSK-@ ) .


Differences between natural product users and non-users were determined by Students t and chi square tests ; and between pre-test and post-test WM by Wilcoxon signed rank tests .


Interaction between turmeric and cinnamon was tested by @-way ANOVA .


Multivariable linear regression ( MLR ) took account of BMI , glycaemia , insulin and AD biomarkers in the WM responses to turmeric and cinnamon .


No interaction between turmeric and cinnamon was detected .


WM increased from @ to @ out of @ ( p = @ ) with turmeric , but was unchanged with cinnamon .


WM improvement was inversely associated with insulin resistance ( r = -@ , p < @ ) , but not with AD biomarkers .


With MLR , the WM responses to turmeric were best predicted with an R@ of @ % ; and with significant turmeric , BMI and insulin/glucose AUC beta-coefficients .


Co-ingestion of turmeric with white bread increases working memory independent of body fatness , glycaemia , insulin , or AD biomarkers .


To compare the bowel cleansing efficacy of same day ingestion of @-L sulfa-free polyethylene glycol ( @-L SF-PEG ) vs @-L polyethylene glycol solution with ascorbic acid ( @-L PEG + Asc ) in patients undergoing afternoon colonoscopy .


@ patients ( mean age @ years , @ % male ) undergoing outpatient screening or surveillance colonoscopies were prospectively randomized to receive either @-L SF-PEG ( n = @ ) or @-L PEG + Asc solution ( n = @ ) .


Colonoscopies were performed by two blinded endoscopists .


Bowel preparation was graded using the Ottawa scale .


Each participant completed a satisfaction and side effect survey .


There was no difference in patient demographics amongst groups .


@-L SF-PEG resulted in better Ottawa scores compared to @-L PEG + Asc , @ vs @ ( P = @ ) ; left colon : @ vs @ respectively ( P = @ ) , right colon : @ vs @ respectively ( P = @ ) .


No difference in Ottawa scores was found for the mid colon or amount of fluid .


Patient satisfaction was similar for both arms but those assigned to @-L SF-PEG reported less bloating : @ % vs @ % ( P = @ ) .


Overall polyp detection , adenomatous polyp and advanced adenoma detection rates were similar between the two groups .


Morning only @-L SF-PEG provided superior cleansing with less bloating as compared to @-L PEG + Asc bowel preparation for afternoon colonoscopy .


Thus , future studies evaluating efficacy of morning only preparation for afternoon colonoscopy should use @-L SF-PEG as the standard comparator .


Type B influenza virus is a major epidemic strain responsible for considerable mortality and morbidity .


A colloidal gold immunochromatographic strip for the rapid detection of human influenza B virus was developed .


This test is based on membrane chromatography and uses colloidal gold conjugated with influenza B virus anti-NP monoclonal antibody as the tracer .


The assembled test strip was housed in a plastic case .


The colloid gold strip ( CGS ) specifically detected all influenza B viruses tested and did not react with other respiratory viruses .


Compared with SYBR Green real-time PCR , the sensitivity and specificity of the CGS test was @ % and @ % , respectively , and the consistency ratio between CGS and real-time PCR was @ % in detecting influenza B virus in @ nasopharyngeal swabs from patients with influenza-like illness in the hospital .


The CGS array developed in this study enabled typing of influenza B viruses in human clinical specimens .


Thus , together with the advantages of rapid detection and easy operation without requiring specialized personnel and equipment , this technique is a convenient and relatively inexpensive diagnostic tool for large-scale screening of clinical samples .


Minimally invasive techniques commonly are applied to mitral valve surgery ; however , there has been little research investigating the optimal methods of cardiopulmonary bypass for the right minithoracotomy approach .


Controversy exists as to whether a percutaneous superior vena cava drainage cannula ( PSVC ) is necessary during these operations .


The authors , therefore , sought to determine the effect of using a percutaneous superior vena cava catheter on brain near-infrared spectroscopy , blood lactate levels , hemodynamics and surgical parameters .


Randomized , blinded , crossover trial .


Tertiary care university hospital .


Patients undergoing minimally invasive mitral valve surgery via a right minithoracotomy .


Twenty minutes of either clamped or unclamped percutaneous superior vena cava neck catheter drainage , during mitral valve repair .


For the primary outcome of brain near-infrared spectroscopy , there were no differences between the two groups ( percutaneous superior vena cava clamped @ % @ % versus unclamped @ % @ % ) ( p = @ ) .


For the secondary outcomes pH ( clamped @ versus unclamped @ p = @ ) , surgical score ( clamped @ versus unclamped @ p = @ ) and CVP ( clamped @ mmHg@ @ mmHg versus unclamped @ mmHg@ @ mmHg p < @ ) were significantly different .


The use of a percutaneous superior vena cava drainage improved surgical visualization and lowered CVP , but had no effect on brain near infrared spectroscopy during minimally invasive mitral valve surgery .


( ClinicalTrials.gov Identifier : NCT@ ) .


A new gel formulation containing loteprednol etabonate ( LE ) , a C-@ ester corticosteroid used to treat ocular inflammation , was developed to provide increased retention on the ocular surface for improved drug delivery to intraocular tissues .


This investigation evaluated concentrations of LE in tear fluid following topical instillation of LE gel to humans and the ocular and systemic pharmacokinetics of LE following administration to rabbits .


LE ophthalmic gel @ % was administered as a single topical dose to human volunteers ( n = @ ) and Dutch Belted rabbits ( n = @ ) .


In the human study , tear sampling was performed at @ , @ , @ , and @h after instillation .


In the rabbit study , tears and ocular tissues were collected from @min through @h postdose .


Serial blood samples were collected from one cohort of rabbits for plasma analysis .


Concentrations of LE were determined by high performance liquid chromatography tandem mass spectrometry .


In humans , LE was detected in tears at all the time points assessed with mean concentrations of @g/g at @h declining to @ g/g at @h postdose .


In rabbits , LE was detected in all ocular tissues within @min after dosing .


Maximum concentrations of LE were achieved within @ h and were highest in tear fluid ( @g/g ) , followed by bulbar conjunctiva ( @ g/g ) , cornea , ( @ g/g ) , iris/ciliary body ( @ g/g ) , and aqueous humor ( @ g/mL ) .


LE remained measurable in all ocular tissues through @h with the exception of aqueous humor .


In contrast , plasma levels of LE were low with no detectable levels after @h .


The gel formulation of LE provided prolonged exposure to LE on the ocular surface , with measurable levels in tears through @h in both humans and rabbits , for delivery of LE to anterior segment tissues , as evidenced by sustained levels of LE in rabbit conjunctiva , cornea , and iris/ciliary body .


Long Acting Reversible Contraception ( LARC ) methods are highly effective in reducing the incidence of unwanted pregnancy .


Recent data indicates that the rate of abortion in Grampian , North East of Scotland is above the Scottish average and LARC uptake among young women low .


This study sought to explore young women 's perceptions of LARC , with the aim of developing a strategy to increase LARC uptake .


Qualitative study .


Sixty five women aged @-@ were randomly recruited to this qualitative study from community centres and shopping areas .


Recruitment and interviews were conducted in friendship pairs , triads or one-to-one basis .


Participants were asked about current and past contraception use , views of contraception methods including LARC ; and sources of information about contraception .


Data were analysed using thematic content analysis .


Women interviewed were aware of some of the delivery systems used for long acting contraception ( intrauterine devices , implants and injections ) but did not recognise them as ` LARC ' .


` Long acting ' was equated with permanency and the term ` reversible ' appeared to have the opposite effect to its intention .


Intrauterine devices were commonly referred to as ` coil ' .


The women often relied on verbal testimonies from those who had experienced using LARC , many of which were negative and inaccurate .


A lack of in-depth knowledge about LARC and the opinion that LARC methods were for older women were also cited as barriers to use .


This study shows that negative testimonies and the belief that LARC are not appropriate for young women may discourage LARC uptake .


Epidural injections are performed to manage lumbar central spinal stenosis pain utilizing caudal , interlaminar , and transforaminal approaches .


The literature on the efficacy of epidural injections in managing lumbar central spinal stenosis pain is sparse ; lacking multiple , high quality randomized trials with long-term follow-up .


Two randomized controlled trials of the caudal and lumbar interlaminar approaches that assessed @ patients with lumbar central spinal stenosis were analyzed .


The analysis found efficacy for both caudal and interlaminar approaches in managing chronic pain and disability from central spinal stenosis was demonstrated .


In the patients responsive to treatment , those with at least @ weeks of improvement with the first @ procedures , @ % reported significant improvement with caudal epidural injections , whereas it was @ % with local anesthetic only with interlaminar epidurals , @ % with caudal and @ % with lumbar interlaminar with local anesthetic with steroid .


The response rate was @ % with caudal and @ % with lumbar interlaminar with local anesthetic only and @ % with caudal and @ % with lumbar interlaminar with local anesthetic with steroid when all patients were considered .


In the interlaminar approach , results were superior for pain relief and functional status with fewer nonresponsive patients compared to the caudal approach .


The data was derived from @ previously published randomized , controlled trials rather than comparing @ techniques in one randomized controlled trial .


Further , the randomized controlled trials were active control trials without a placebo .


The results of this assessment showed significant improvement in patients suffering with chronic lumbar spinal stenosis with caudal and interlaminar epidural approaches with local anesthetic only , or with steroids in a long-term follow-up of up to @ years , in contemporary interventional pain management setting , with the interlaminar approach providing significantly better results .


Scope of practice in audiology encompasses proficiency in visual inspection of ear canal and tympanic membrane ( TM ) as well as otoscopy interpretation skills to determine normal versus abnormal conditions of outer and middle ear .


Audiology students can develop skills in otoscopy through education and supervised training .


Studies have shown that additional otoscopy training increased skills in medical students and general practitioners .


However , educational and supervised practices targeting otoscopy competency during audiology graduate coursework are lacking .


Also , no studies have attempted to determine otoscopy skills among audiology students .


To determine the effectiveness of the otoscopy training model on clinical competency and confidence level of audiology students in performing and interpreting otoscopy .


A combination of experimental treatment design with random assignment of treatment and control groups and delayed treatment for control group .


Thirty-two first - and second-year audiology graduate students who were enrolled in a pediatric audiology class participated in this study .


Students were randomly assigned to the control ( n = @ , @ females ) or experimental ( n = @ , @ females ) group .


Participants in the experimental group received supplementary otoscopy training including didactic otoscopy lectures as well as clinical training using manikin ears .


The control group received the same pretest and posttest and then completed a third assessment ( posttest @ ) after receiving the same training .


An evaluation of knowledge and skills regarding otoscopy between groups and time was conducted at three times : ( a ) pretraining , ( b ) upon completion of training for the experimental group , ( c ) upon completion of training by the control group .


The evaluation consisted of a written exam , a clinical exam , and a self-perception rating of confidence .


Both written exam scores and clinical exam scores ( otoscopy manikin ) were analyzed via two-way analyses of variance ( ANOVAs ) , whereas chi-square ( ) statistic was conducted to evaluate the effects of training on the confidence level of students of both groups .


Experimental and control groups demonstrated significant increased overall competency in otoscopy following the otoscopy training model with didactic and laboratory components .


Posttest confidence ratings showed increases in all groups , and there were no significant differences between groups .


The need for supplementary otoscopy training was warranted by low knowledge and clinical competency in otoscopy skills of audiology students as measured by pretest mean scores .


After completing the training , both experimental and control groups showed significant improvement in knowledge and competency .


Results also suggest that perceived confidence ratings may be misleading in determining students ' clinical otoscopy skills .


Acceptance of healthcare-associated pneumonia ( HCAP ) as an entity and the associated risk of infection by potentially multidrug-resistant ( MDR ) organisms such as methicillin-resistant Staphylococcus aureus ( MRSA ) , Pseudomonas and Acinetobacter have been debated .


We therefore compared patients with HCAP , hospital-acquired pneumonia ( HAP ) , and ventilator-associated pneumonia ( VAP ) enrolled in a trial comparing linezolid with vancomycin for treatment of pneumonia .


The analysis included all patients who received study drug .


HCAP was defined as pneumonia occurring < @hours into hospitalization and acquired in a long-term care , subacute , or intermediate health care facility ; following recent hospitalization ; or after chronic dialysis .


Data from @ patients ( HCAP = @ , HAP = @ , VAP = @ ) were analyzed .


Compared with HAP and VAP patients , those with HCAP were older , had slightly higher severity scores , and were more likely to have comorbidities .


Pseudomonas aeruginosa was the most common gram-negative organism isolated in all pneumonia classes -LSB- HCAP , @/@ ( @ % ) ; HAP , @/@ ( @ % ) ; VAP , @/@ ( @ % ) ; p = @ -RSB- .


Acinetobacter spp .


were also found with similar frequencies across pneumonia groups .


To address potential enrollment bias toward patients with MRSA pneumonia , we grouped patients by presence or absence of MRSA and found little difference in frequencies of Pseudomonas and Acinetobacter .


In this population of pneumonia patients , the frequencies of MDR gram-negative pathogens were similar among patients with HCAP , HAP , or VAP .


Our data support inclusion of HCAP within nosocomial pneumonia guidelines and the recommendation that empiric antibiotic regimens for HCAP should be similar to those for HAP and VAP .


The higher risk of adverse outcomes after transapical ( TA ) versus transfemoral ( TF ) transcatheter aortic valve replacement ( TAVR ) could be attributable to TA-TAVR being an open surgical procedure or to clinical differences between TA - and TF-TAVR patients .


We compared outcomes after neutralizing patient differences using propensity score matching .


From April @ to February @ , @ Placement of Aortic Transcatheter Valves ( PARTNER ) - I patients underwent TA-TAVR and @ underwent TF-TAVR with Edwards SAPIEN balloon-expandable bioprostheses .


Propensity matching based on @ preprocedural variables , exclusive of femoral access morphology , identified @ well-matched patient pairs ( @ % of possible matches ) , @ % of whom had peripheral arterial disease .


Matched TA-TAVR patients experienced more adverse procedural events , longer length of stay ( @ versus @ days ; P < @ ) , and slower recovery ( New York Heart Association class I , @ % versus @ % at @ days , equalizing by @ months at @ % versus @ % ) ; stroke risk was similar ( @ % versus @ % at @ days and @ % versus @ % at @ years ) ; mortality was elevated for the first @ postprocedural months ( @ % versus @ % ; P = @ ) ; but aortic regurgitation was less ( @ % versus @ % mild and @ % versus @ % moderate to severe at discharge , P = @ ; @ % versus @ % mild and @ % versus @ % moderate to severe at @ months , P < @ ) .


The likelihood of adverse periprocedural events and prolonged recovery is greater after TA-TAVR than TF-TAVR in vasculopathic patients after accounting for differences in cardiovascular risk factors , although stroke risk is equivalent and aortic regurgitation is less .


As smaller delivery systems permit TF-TAVR in many of these patients , we recommend a TF-first access strategy for TAVR when anatomically feasible .


The most dreaded hemorrhagic complication in endoscopic endonasal surgery is injury to the internal carotid artery ( ICA ) .


Although a number of treatment protocols are currently used , none have been formally investigated .


This study aims to compare the efficacy of the muscle patch , bipolar diathermy , and aneurysm clip on hemostasis , pseudoaneurysm formation , and long-term vessel patency for different injury types in a sheep model of carotid bleeding .


Twenty-seven sheep underwent ICA dissection/isolation followed by the artery placement within a modified `` sinus model otorhino neuro trainer '' ( SIMONT ) model .


Standardized linear , punch , and stellate injuries were made .


Randomization of sheep to receive @ of @ hemostatic techniques was performed ( muscle , bipolar , clip ) .


Specific outcome measures included attainment of primary hemostasis , time to hemostasis , blood loss , pseudoaneurysm formation , and carotid patency on follow-up magnetic resonance imaging ( MRI ) .


Bipolar achieved primary hemostasis in @ of @ cases and @ cases of secondary hemorrhage .


It had no associated pseudoaneurysm formation .


Carotid patency was variable on follow-up MRI .


Muscle patch achieved @ % primary hemostasis with @ cases of secondary hemorrhage .


There were @ cases of pseudoaneurysm and @ % patency rate on follow-up MRI .


Aneurysm clip achieved @ % primary hemostasis with @ case of secondary hemorrhage .


No pseudoaneurysm formation and a @ % rate of carotid insufficiency on MRI .


This study shows that the crushed muscle patch and aneurysm clip can be viable options in the management of ICA injury with short-term and long-term benefits .


Complications associated with these techniques were comparable if not reduced when compared to the published literature .


The hemostatic and inflammatory systems may activate each other .


Endometriosis is a chronic inflammatory disease affecting @ % of women .


The objective of this study was to compare the hemostatic effects of two treatments widely prescribed to women with endometriosis : the levonorgestrel intrauterine system ( LNG-IUS ) and the gonadotropin-releasing hormone analog ( GnRHa ) leuprolide acetate .


In this randomized open-label controlled trial , @ women with endometriosis were randomly allocated to one of two groups : @ women were assigned to use LNG-IUS and @ to use GnRHa .


The assessed variables were D-dimers , fibrinogen , prothrombin time , activated partial thromboplastin time , coagulation factors ( F ) II , V , VII , VIII , IX , X , and XI , antithrombin ( AT ) , protein C , free protein S , tissue plasminogen activator ( t-PA ) , @-antiplasmin , thrombin-antithrombin complex , and prothrombin fragment @ +@ .


All variables were assessed before treatment and six months after treatment onset .


In the LNG-IUS group , FVIII decreased @ % after six months of use .


In the GnRHa group , there was a @ % increase in AT , @ % reduction in D-dimers , and @ % increase in t-PA .


The LNG-IUS users exhibited a significantly greater reduction of FVIII than the GnRHa users ( LNG-IUS : -@ @ % vs. GnRHa : @ @ % , p = @ ) .


The women in the GnRHa group exhibited a greater increase of AT than the LNG-IUS users ( LNG-IUS : -@ @ % vs. GnRHa : @ @ % , p = @ ) .


Both hormonal treatments for endometriosis exhibited no association with a procoagulant profile .


Elderly patients with ST-segment elevation myocardial infarction ( STEMI ) have worse outcomes and a greater risk of intracranial bleeding than nonelderly patients .


Baseline characteristics , clinical outcomes , and the relationship of the tenecteplase ( TNK ) dose reduction to the efficacy , safety , and electrocardiographic indicators of reperfusion efficacy were evaluated in STEMI patients @ years .


The STREAM trial evaluated early presenting STEMI patients who could not undergo primary percutaneous coronary intervention within @ hour of first medical contact .


Because of excess intracranial hemorrhage ( ICH ) in patients @ years , the dose of TNK was reduced by @ % .


Before dose amendment , there were @ ( @ % ) of @ elderly patients with ICH ; @ of these were fatal , whereas no ICH occurred in the @ elderly patients who received half-dose TNK postamendment .


The median extent of ST-segment elevation resolution ( @ % ) and proportion of patients with @ mm in the electrocardiogram lead with greatest ST-segment elevation was comparable in elderly patients preamendment and postamendment ( @ % vs @ % and @ % vs @ % , respectively ) .


Patients requiring rescue coronary intervention after TNK was also similar ( @ % vs @ % ) .


The primary composite end point ( @-day all-cause death , cardiogenic shock , congestive heart failure , and reinfarction ) was @ % before versus @ % postamendment .


Our data , from a modest-sized population of elderly STEMI patients , indicate that half-dose TNK reduces the likelihood of ICH without compromising reperfusion efficacy .


These observations are hypothesis generating and warrant further confirmation in randomized clinical trials in the elderly .


The aim of this study was to compare the efficacy , safety , antiplaque and antigingivitis properties of a herbal mouthwash with chlorhexidine mouthwash .


A double-blinded randomized clinical trial was conducted among @ undergraduate students with age group @-@ years .


They were randomly divided into three mouthwash group with @ participants in each group .


Group A ( herbal ) , Group B ( chlorhexidine ) and Group C ( normal saline ) .


The Turesky et al. @ plaque index and Loe and Silness @ gingival index was recorded .


Student 's t-test and one-way ANOVA were used to test the significance .


A statistically highly significant difference was obtained between mouthwash B and C ( p = @ ) and a significant difference between mouthwash A and C ( p = @ ) , showing that chlorhexidine was superior to herbal mouthwash and saline .


However , there was a nonsignificant difference between mouthwash A and B ( p = @ ) showing that herbal and chlorhexidine mouthwash was equally effective in reducing plaque and gingivitis .


The efficacy of herbal mouthwash was equally effective in reducing plaque and gingivitis as compared to chlorhexidine mouthwash and may be considered as a good alternative .


The chlorhexidine mouthwash was reported with many side effects which limits its acceptability and long-term use , whereas the presently tested herbal mouthwash had no side effects apart from mild burning sensation .


Exposure to trauma reminders has been considered imperative in psychotherapy for posttraumatic stress disorder ( PTSD ) .


The authors tested interpersonal psychotherapy ( IPT ) , which has demonstrated antidepressant efficacy and shown promise in pilot PTSD research as a non-exposure-based non-cognitive-behavioral PTSD treatment .


The authors conducted a randomized @-week trial comparing IPT , prolonged exposure ( an exposure-based exemplar ) , and relaxation therapy ( an active control psychotherapy ) in @ unmedicated patients who had chronic PTSD and a score > @ on the Clinician-Administered PTSD Scale ( CAPS ) .


Randomization stratified for comorbid major depression .


The authors hypothesized that IPT would be no more than minimally inferior ( a difference < @ points in CAPS score ) to prolonged exposure .


All therapies had large within-group effect sizes ( d values , @-@ @ ) .


Rates of response , defined as an improvement of > @ % in CAPS score , were @ % for IPT , @ % for prolonged exposure , and @ % for relaxation therapy ( not significantly different between groups ) .


CAPS outcomes for IPT and prolonged exposure differed by @ points ( not significant ) , and the null hypothesis of more than minimal IPT inferiority was rejected ( p = @ ) .


Patients with comorbid major depression were nine times more likely than nondepressed patients to drop out of prolonged exposure therapy .


IPT and prolonged exposure improved quality of life and social functioning more than relaxation therapy .


This study demonstrated noninferiority of individual IPT for PTSD compared with the gold-standard treatment .


IPT had ( nonsignificantly ) lower attrition and higher response rates than prolonged exposure .


Contrary to widespread clinical belief , PTSD treatment may not require cognitive-behavioral exposure to trauma reminders .


Moreover , patients with comorbid major depression may fare better with IPT than with prolonged exposure .


To investigate the impact of cyclooxygenase-@ ( COX-@ ) inhibitor with - adrenoceptor blocker ( - blocker ) for men with benign prostatic hyperplasia ( BPH ) and lower urinary tract symptoms ( LUTS ) for detecting prostate cancer in men with elevated prostate specific antigen ( PSA ) .


Male patients with clinical BPH , elevated serum PSA ( > @ng/ml ) , and significant LUTS ( International Prostate Symptom Score -LSB- IPSS -RSB- @ ) were randomly assigned to receive doxazosin @mg daily plus celecoxib @mg daily ( study group ) or doxazosin @mg daily alone ( control group ) for @months .


Patients were investigated for the changes in IPSS , maximum flow rate ( Qmax ) , voided volume , postvoid residual ( PVR ) volume and serum PSA from baseline to @months after treatment .


After the @-month therapy , prostate biopsy was performed in the patients whose PSA were still higher than @ng/ml .


A total of @ patients completed the study .


The improvement in IPSS-voiding was significantly greater in the study group than control group ( p = @ ) .


In the study group , patients with prostatic hyperplasia or inflammation on the prostate biopsy had a significantly better result than in patients with prostatic adenocarcinoma , typically in the changes of Qmax and voided volume ( p = @ and p = @ , respectively ) .


The PSA level in the study group showed significant improvement after treatment ( p < @ ) .


However , prostate cancer detection rate failed to show any significant difference between the patients whose PSA levels decreased or not ( @/@ = @ % vs. @/@ = @ % , respectively , p = @ ) .


Treatment with COX-@ inhibitor and - blocker for @months could not improve prostatic cancer detection rate .


But it could increase therapeutic effectiveness of LUTS in men with BPH and elevated PSA levels .


The changes in Qmax and voided volume after combination treatment were significantly greater in patients with prostatic hyperplasia or inflammation than adenocarcinoma .


A variety of analgesic agents are available , and which one can be used in dogs and cats is a highly controversial issue , existing however a fear in the use of opiates due to possible adverse effects that these drugs can cause .


The aim of this study was to compare the analgesic effect provided by the administration of tramadol or pethidine on early postoperative pain of cats undergoing ovariohysterectomy in a double-blind prospective study .


Fourty-two animals were randomly assigned into three groups .


Pet received pethidine ( @ mg/kg ) , Tra @ received tramadol ( @ mg/kg ) and Tra @ received tramadol ( @ mg/kg ) ; all intramuscularly and associated with acepromazine ( @ mg/kg ) .


The efficacy of each analgesic regimen was evaluated prior to surgery ( baseline - TBL ) , during surgery and @ , @ and @ hours after extubation with subjective pain scale , physiologic parameters , serum concentrations of glucose , cortisol and IL-@ .


Changes in cardiovascular system were not clinically relevant .


There were no significant differences in pain scores ( P > @ ) during the study , although the number of rescue analgesia was significantly higher ( P < @ ) at Pet group ( @/@ ) than Tra @ group ( @/@ ) , whereas in Tra @ , two animals ( @/@ ) required additional analgesia .


The serum cortisol values of Pet group were significantly higher at T@h T@h ( P < @ ) and T@h ( P < @ ) when compared to baseline ( induction ) , also it was noticed a significant difference among the groups at T@h ( Pet values were higher than Tra @ and Tra @ ; P < @ ) .


Tramadol provided adequate analgesia and it was more effective than pethidine to at least six hours for the studied animals .


At the higher dose ( @ mg/kg ) tramadol is probably more effective , since rescue analgesia was not necessary .


No significant changes were observed physiological parameter that could contraindicate the use of these opioid in described doses , for the feline species .


CD@ + cells confer angiogenic potential and may be beneficial for the treatment of critical limb ischemia ( CLI ) .


However , patient selection , blinding methods and end points for clinical trials are challenging .


We hypothesized that bilateral intramuscular administration of cytokine-mobilized CD@ + cells in ambulatory patients with refractory CLI would be feasible and safe .


In this double-blind , randomized sham-controlled trial , subjects received subcutaneous injections of granulocyte colony-stimulating factor ( @ g/kg per day ) for @ days , followed by leukapheresis , and intramuscular administration of @-@ million sorted CD@ + cells delivered into both legs .


Control subjects received normal saline injections , sham leukapheresis and intramuscular injection of placebo buffered solution .


Subjects were followed for @ year .


An aliquot of CD@ + cells was collected from each subject to test for genes associated with cell senescence .


Seventy subjects were screened , of whom @ were eligible .


Subject enrollment was suspended because of a high rate of mobilization failure in subjects randomly assigned to treatment .


Of @ subjects enrolled ( @ randomly assigned to treatment , @ randomly assigned to control ) , there were no differences in serious adverse events at @ months , and blinding was preserved .


There were non-significant trends toward improved amputation-free survival , @-minute walk distance , walking impairment questionnaire and quality of life in subjects randomly assigned to treatment .


Successful CD@ + mobilizers expressed fewer senescence-associated genes compared with poor mobilizers .


Bilateral administration of autologous CD@ + cells in ambulatory CLI subjects was safe , and blinding was preserved .


However , poor mobilization efficiency combined with high CD@ + senescence suggests futility in this approach .


Severe borderline personality disorder is associated with a very high psychosocial and economic burden .


Current treatment guidelines suggest that several manualized treatments , including day hospital Mentalization-Based Treatment ( MBT-DH ) , are effective in these patients .


However , only two randomized controlled trials have compared manualized MBT-DH with treatment as usual .


Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH , the possible influence of researcher allegiance in one of the trials , and potential problems with the generalization of findings to mental health systems in other countries , this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands .


The trial is being conducted at two sites in The Netherlands .


Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of@ on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual .


The MBT-DH program consists of a maximum of @months ' intensive treatment , followed by a maximum of @months of maintenance therapy .


Specialist treatment as usual is provided by the City Crisis Service in Amsterdam , a service that specializes in treating patients with personality disorders , offering manualized , non-MBT interventions including family interventions , Linehan training , social skills training , and pharmacotherapy , without a maximum time limit .


Patients are assessed at baseline and subsequently every @months up to @months after the start of treatment .


The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index .


Secondary outcome measures include parasuicidal behaviour , symptomatic distress , social and interpersonal functioning , personality functioning , attachment , capacity for mentalizing and quality of life .


Cost-effectiveness is assessed in terms of the cost per quality-adjusted life year .


Outcomes will be analyzed using multilevel analyses based on intention-to-treat principles .


Severe borderline personality disorder is a serious psychological disorder that is associated with high burden .


This multi-site randomized trial will provide further data concerning the efficacy and cost-effectiveness of MBT-DH for these patients .


The objective of the study was to determine whether vitamin D ( vitD ) supplementation during pregnancy affects obstetric and neonatal outcomes .


The study was conducted at a university hospital in Karachi , Pakistan .


The study was a single-center , open-label , randomized , controlled trial of routine care ( group A , @ mg ferrous sulfate and @ mg calcium daily ) vs vitD supplementation ( group B , @ IU vitamin D@ daily ) , started at @ weeks and continued till delivery .


Maternal serum samples of @-hydroxyvitamin D ( @OHD ) were collected at baseline and delivery .


Neonatal vitD status was assessed in cord blood or in neonatal serum samples within @ hours of birth .


Obstetric outcomes included gestational hypertension , gestational diabetes , and preterm labor , and neonatal well-being included small for gestational age , birth weight , length , head circumference , and @ - and @-minute Apgar scores .


Of @ gravidae enrolled , @ completed the trial .


Maternal age , vitD status , and gestational age at enrollment were comparable between the two groups .


At delivery , maternal @OHD was increased in group B ( @ @ ng/dL vs @ @ ng/dL ( P = @ ) compared with group A ( @ @ ng/dL vs @ @ ng/dL , P = @ ) .


The obstetric outcomes were comparable between the two groups ( P > @ ) .


Neonatal @OHD levels were significantly higher in group B compared with group A ( @ @ ng/dL vs @ @ ng/dL ) .


There was positive correlation between maternal and neonatal @OHD levels ( r = @ , P = @ ) .


One - and @-minute Apgar scores were significantly higher in group B ( @ @ vs @ @ , P = @ , and @ @ vs @ @ , P = @ , respectively ) .


Neonatal anthropometric parameters were comparable between the two groups ( P > @ ) .


Maternal vitD supplementation improved maternal and neonatal vitD status .


Although caloric restriction is a widely used intervention to reduce body weight and insulin resistance , many patients are unable to comply with such dietary therapy for long periods .


The clinical effectiveness of low-carbohydrate diets was recently described in a position statement of Diabetes UK and a scientific review conducted by the American Diabetes Association .


However , randomised trials of dietary interventions in Japanese patients with type @ diabetes are scarce .


Therefore , the aim of this study was to examine the effects of a non-calorie-restricted , low-carbohydrate diet in Japanese patients unable to adhere to a calorie-restricted diet .


The enrolled patients were randomly allocated to receive a conventional calorie-restricted diet or low-carbohydrate diet .


The patients received consultations every two months from a registered dietician for six months .


We compared the effects of the two dietary interventions on glycaemic control and metabolic profiles .


The HbA@c levels decreased significantly from baseline to six months in the low-carbohydrate diet group ( baseline @ % , six months @ % , p = @ ) but not in the calorie-restricted group ( baseline @ % , six months @ % , n.s. ) , ( between-group comparison , p = @ ) .


The patients in the former group also experienced improvements in their triglyceride levels , without experiencing any major adverse effects or a decline in the quality of life .


Our findings suggest that a low-carbohydrate diet is effective in lowering the HbA@c and triglyceride levels in patients with type @ diabetes who are unable to adhere to a calorie-restricted diet .


A randomized controlled clinical trial was implemented to evaluate the effectiveness of combined mild hyperthermia therapy ( body core temperature @ C ) and multimodal inpatient rehabilitation for patients suffering from chronic low back pain when compared to multimodal pain therapy alone .


A total of @patients were randomly assigned to the combined or single therapeutic schemes according to a block randomization scheme .


According to the trial inclusion criteria all patients suffered from chronic low back pain and showed morphological degeneration .


All patients underwent a @-day inpatient multimodal pain therapy , which was complemented with a @-session schedule of mild hyperthermia therapy for the intervention group ( @h at @ C ) .


On admission and @months after treatment the study patients were asked to complete an interview assessment with the Oswestry low back pain disability questionnaire ( Oswestry disability index ) .


The change in the Oswestry disability index total score ( % ) @months after versus before therapy was defined as the primary clinical endpoint of the investigation .


The patients in the control group and in the intervention group had a median age of @years .


In the intervention group @ % of the patients were female and @ % reported having half to full time employment compared to @ % and @ % in the control group , respectively .


On admission the control patients reported a median Oswestry disability index of @ % and on recall the same of @ % .


The intervention group showed median Oswestry disability index estimates of @ % and @ % , respectively .


The changes in the overall Oswestry disability index after @months differed significantly with an estimated @ % for the intervention group versus @ % for the control group ( Wilcoxon p = @ ) .


When combined with a multimodal inpatient lower back pain functional therapy in patients showing morphological degeneration , the mild hyperthermia therapy demonstrated statistically significant , although not clinically relevant benefits in comparison to the multimodal treatment alone .


However , regarding the moderate overall patient-related benefits as measured in terms of the Oswestry disability index , the benefit of the underlying multimodal therapy concept implementation must be critically discussed irrespective of its combination with mild hyperthermia therapy .


Probiotics have treatment efficacy in irritable bowel syndrome ( IBS ) , but the exact mechanism remains obscure .


One hypothesis is the mediation of melatonin levels , leading to changes in IBS symptoms .


The purpose of this study was to evaluate the effects of a probiotic , VSL # @ , on symptoms , psychological and sleep parameters , and pain sensitivity in IBS , and relate these parameters to in vivo melatonin levels .


Forty-two IBS patients were randomly assigned to receive VSL # @ or placebo for @ weeks .


Subjects completed bowel and psychological questionnaires , underwent rectal sensitivity testing and saliva melatonin assays .


Abdominal pain duration and distension intensity decreased significantly in the probiotic group , along with an increase in rectal distension pain thresholds .


A correlation between increase in pain tolerance and improvement in abdominal pain scores ( r = @ , p = @ ) was seen with probiotic .


There was an increase in salivary morning melatonin levels in males treated with VSL # @ , which correlated ( r = @ ) with improved satisfaction in bowel habits .


When grouped based on baseline diurnal melatonin levels , patients with normal diurnal fluctuations showed an increase in morning melatonin levels with VSL # @ treatment , which significantly correlated with improved satisfaction in bowel habits ( r = @ ) .


They also had reduced symptom severity scores and abdominal pain duration when treated with VSL # @ , as well as satisfaction with bowel movements and quality-of-life .


VSL # @ improved symptoms and increased rectal pain thresholds .


Symptom improvement correlated with a rise in morning melatonin , significant in males and subjects with normal circadian rhythm .


This suggests that probiotics may act by influencing melatonin production , hence modulating IBS symptoms , in individuals with a normal circadian rhythm .


Charcot-Marie-Tooth type @A disease ( CMT@A ) is a rare orphan inherited neuropathy caused by an autosomal dominant duplication of a gene encoding for the structural myelin protein PMP@ , which induces abnormal Schwann cell differentiation and dysmyelination , eventually leading to axonal suffering then loss and muscle wasting .


We favour the idea that diseases can be more efficiently treated when targeting multiple disease-relevant pathways .


In CMT@A patients , we therefore tested the potential of PXT@ , a low-dose combination of three already approved compounds ( baclofen , naltrexone and sorbitol ) .


Our study conceptually builds on preclinical experiments highlighting a pleiotropic mechanism of action that includes downregulation of PMP@ .


The primary objective was to assess safety and tolerability of PXT@ .


The secondary objective aimed at an exploratory analysis of efficacy of PXT@ in CMT@A , to be used for designing next clinical development stages ( Phase @b/@ ) .


@ adult patients with mild-to-moderate CMT@A received in double-blind for @ year Placebo or one of the three increasing doses of PXT@ tested , in four equal groups .


Safety and tolerability were assessed with the incidence of related adverse events .


Efficacy was assessed using the Charcot-Marie-Tooth Neuropathy Score ( CMTNS ) and the Overall Neuropathy Limitations Scale ( ONLS ) as main endpoints , as well as various clinical and electrophysiological outcomes .


This trial confirmed the safety and tolerability of PXT@ .


The highest dose ( HD ) showed consistent evidence of improvement beyond stabilization .


CMTNS and ONLS , with a significant improvement of respectively of @ % ( @ % - @ % ) and @ % ( @ % - @ % ) in the HD group versus the pool of all other groups , appear to be the most sensitive clinical endpoints to treatment despite their quasi-stability over one year under Placebo .


Patients who did not deteriorate over one year were significantly more frequent in the HD group .


These results confirm that PXT@ deserves further investigation in adults and could greatly benefit CMT@A-diagnosed children , usually less affected than adults .


NaCl @ % / @ % hydroxyethyl starch ( HES ) @/@ @ ( HSH ) has shown its beneficial effects in cardiac surgery and immunomodulatory values in experiment and human studies .


However , there is concern regarding detrimental renal effects of chloride and HES in the intensive care setting .


The objective of this study was to evaluate the influence of HSH on kidney integrity and the level of inflammatory mediators in on-pump coronary artery bypass surgery patients .


This was a single-center , prospective , randomized , single-blind pilot study .


This work was performed at a tertiary cardiothoracic referral center during the period from February to August @ .


Forty patients scheduled for on-pump coronary artery bypass surgery were included .


PATIENTS were randomized to receive once either @ % NaCl/@ % HES @/@ @ ( HSH group , n = @ ) or placebo ( @ % NaCl ; control group , n = @ ) at a dose of @ mLkg for @ min after anesthesia induction .


The primary end point was the incidence of acute kidney injury ( AKI ) defined according to the Kidney Disease : Improving Global Outcomes .


Secondary end points were peak serum cystatin C , peak urine neutrophil gelatinase-associated lipocalin , plasma levels of interleukin @ ( IL-@ ) , IL-@ , intercellular adhesion molecule @ , and endothelial-leukocyte adhesion molecule ( E-selectin ) .


The incidence of AKI within @ h was similar between the groups ( HSH : four patients -LSB- @ % -RSB- ; control : six patients -LSB- @ % -RSB- ) .


There was a significantly lower peak value for serum cystatin C in the HSH group ( @ -LSB- @-@ @ -RSB- mgL ) compared with the control group ( @ -LSB- @-@ @ -RSB- mgL ; P = @ ) .


PATIENTS in both groups had similar peak postoperative urine neutrophil gelatinase-associated lipocalin concentrations .


NaCl @ % / @ % hydroxyethyl starch @/@ @ significantly reduces levels of IL-@ and IL-@ at @ h after cardiopulmonary bypass and intercellular adhesion molecule @ and E-selectin at @ h after cardiopulmonary bypass and on postoperative day @ ( P < @ for all ) .


NaCl @ % / @ % hydroxyethyl starch @/@ @ does not lead to the increase in AKI incidence when used for the volume therapy in on-pump coronary artery bypass surgery patients .


NaCl @ % / @ % hydroxyethyl starch @/@ @ usage enhanced neither tubular injury nor alteration of glomerular filtration .


In addition , HSH can reduce the level of the inflammatory mediators after surgery .


To compare ondansetron with metoclopramide in the treatment of hyperemesis gravidarum .


We enrolled @ women with hyperemesis gravidarum in a double-blind randomized trial .


Participants were randomized to intravenous @ mg ondansetron or @ mg metoclopramide every @ hours for @ hours .


Participants kept an emesis diary for @ hours ; at @ hours , they expressed their well-being using a @-point visual numeric rating scale and answered an adverse effects questionnaire .


Nausea intensity was evaluated using a @-point visual numeric rating scale at enrollment and at @ , @ , and @ hours .


Primary analysis was on an intention-to-treat basis .


Eighty women each were randomized to ondansetron or metoclopramide .


Median well-being visual numeric rating scale scores were @ ( range , @-@ ) compared with @ ( range , @-@ ) ( P = @ ) and vomiting episodes in the first @ hours were @ ( range , @-@ ) compared with @ ( range , @-@ ) ( P = @ ) for ondansetron compared with metoclopramide , respectively .


Repeat-measures analysis of variance of nausea visual numeric rating scale showed no difference between study drugs ( P = @ ) .


Reported rates of drowsiness ( @ % compared with @ % ; P = @ ; number needed to treat to benefit , @ ) , xerostomia ( @ % compared with @ % ; P < @ ; number needed to treat to benefit , @ ) , and persistent ketonuria at @ hours ( @ % compared with @ % ; P = @ ; number needed to treat to benefit , @ ) were less frequent with ondansetron .


Length of hospital stay was similar .


Ondansetron and metoclopramide demonstrated similar antiemetic and antinauseant effects in hyperemesis gravidarum .


However , the overall profile , particularly regarding adverse effects , was better with ondansetron .


In our setting , metoclopramide was significantly less expensive than ondansetron and remained a reasonable antiemetic choice .


To evaluate once-daily nepafenac @ % to prevent and treat ocular pain and inflammation after cataract surgery .


Sixty-five centers in the United States and Europe .


Randomized double-masked vehicle - and active-controlled phase @ study .


Patients received nepafenac @ % once daily , nepafenac @ % @ times daily , or their respective vehicles from day -@ to day @ after cataract extraction .


An additional drop of study drug was administered @ to @ minutes preoperatively .


The primary endpoint was the percentage of patients with a cure for inflammation ( score of @ for both aqueous cells and flare ) at day @ .


Of randomized patients , @ received nepafenac @ % , @ received nepafenac @ % , and @ and @ received the respective vehicles .


Significantly more nepafenac @ % patients had no inflammation ( @ % versus @ % ) and were pain free ( @ % versus @ % ) at day @ than vehicle patients ( both P < @ ) .


Nepafenac @ % was noninferior to nepafenac @ % for inflammation ( @ % confidence interval -LSB- CI -RSB- , -@ % to @ % ) and pain-free rates ( @ % CI , -@ % to @ % ) .


At all postoperative visits , fewer treatment failures ( P. @ ) and more clinical successes ( P @ ) were observed with nepafenac @ % versus vehicle .


Nepafenac @ % was well tolerated and had a safety profile comparable to that of nepafenac @ % .


Once-daily nepafenac @ % was noninferior to nepafenac @ % @ times daily for prevention and treatment of ocular inflammation and pain following cataract surgery .


The safety of nepafenac @ % was comparable to that of nepafenac @ % , with the added convenience of once-daily dosing .


Many inpatients receive little or no rehabilitation on weekends .


Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence , quality of life and length of stay compared to @ days per week of rehabilitation .


This was a multicenter , single-blind ( assessors ) randomized controlled trial with concealed allocation and @-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne , Australia .


Patients were eligible if they were adults ( aged @ years ) admitted for rehabilitation for any orthopedic , neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management .


Participants were randomly allocated to usual care Monday to Friday rehabilitation ( control ) or to Monday to Saturday rehabilitation ( intervention ) .


The additional Saturday rehabilitation comprised physiotherapy and occupational therapy .


The primary outcomes were functional independence ( functional independence measure ( FIM ) ; measured on an @ to @ point scale ) , health-related quality of life ( EQ-@D utility index ; measured on a @ to @ scale , and EQ-@D visual analog scale ; measured on a @ to @ scale ) , and patient length of stay .


Outcome measures were assessed on admission , discharge ( primary endpoint ) , and at @ and @ months post discharge .


We randomly assigned @ adults ( mean ( SD ) age @ ( @ ) years ) to Monday to Saturday rehabilitation ( n = @ ) or usual care Monday to Friday rehabilitation ( n = @ ) .


Relative to admission scores , intervention group participants had higher functional independence ( mean difference ( MD ) @ , @ % confidence interval ( CI ) @ to @ , P = @ ) and health-related quality of life ( MD @ , @ % CI @ to @ , P = @ ) on discharge and may have had a shorter length of stay by @ days ( @ % CI @ to @ , P = @ ) when compared to control group participants .


Intervention group participants were @ % more likely to have achieved a clinically significant change in functional independence of @ FIM points or more ( risk ratio ( RR ) @ , @ % CI @ to @ ) and @ % more likely to have achieved a clinically significant change in health-related quality of life ( RR @ , @ % CI @ to @ ) on discharge compared to the control group .


There was some maintenance of effect for functional independence and health-related quality of life at @-month follow-up but not at @-month follow-up .


There was no difference in the number of adverse events between the groups ( incidence rate ratio = @ , @ % CI @ to @ ) .


Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation .


The Resourceful Adolescent Program ( RAP ) is a universal , school-based intervention that has been found to produce small to medium effects in the reduction of adolescent depressive symptoms .


In the present study , we evaluated the effectiveness of a friendship-building skills program -- the Peer Interpersonal Relatedness ( PIR ) program -- in producing larger effects when used in conjunction with RAP .


A cluster-randomized controlled trial was used to assign whole classrooms of adolescent participants recruited from Sydney secondary schools to @ of @ conditions : ( a ) RAP-PIR , ( b ) RAP-placebo , or ( c ) assessment-only waiting-list control .


Hierarchical linear modeling ( HLM ) was used to analyze the data .


Across the intervention period , RAP did not significantly reduce depressive symptoms relative to those students not receiving this intervention .


RAP followed by PIR did significantly reduce depressive symptoms relative to those students not receiving PIR .


Across the @-month follow-up , the between-group reductions in depressive symptoms were no longer significant .


At follow-up , participants in the RAP-PIR condition had achieved significant increases in their school-related life satisfaction and significant increases in social functioning with peers relative to their peers in the other conditions .


The study provides preliminary support for the effectiveness of the PIR program in reducing depressive symptoms when used alongside RAP in the short term and in improving social adjustment and school-related life satisfaction in the longer term .


Given the importance of social adjustment in adolescent mental well-being , the PIR program represents a potentially important addition to the prevention of depression in youth .


It has been proposed that in the same way that conflict between vestibular and visual inputs leads to motion sickness , conflict between motor commands and sensory information associated with these commands may contribute to some chronic pain states .


Attempts to test this hypothesis by artificially inducing a state of sensorimotor incongruence and assessing self-reported pain have yielded equivocal results .


To help clarify the effect sensorimotor incongruence has on pain we investigated the effect of moving in an environment of induced incongruence on pressure pain thresholds ( PPT ) and the pain experienced immediately on completion of PPT testing .


Thirty-five healthy subjects performed synchronous and asynchronous upper-limb movements with and without mirror visual feedback in random order .


We measured PPT over the elbow and the pain evoked by testing .


Generalised linear mixed-models were performed for each outcome .


Condition ( four levels ) and baseline values for each outcome were within-subject factors .


There was no effect of condition on PPT ( p = @ ) or pressure-evoked pain ( p = @ ) .


A sensitivity analysis using only the first PPT measure after each condition confirmed the result ( p = @ ) .


Inducing a state of movement related sensorimotor incongruence in the upper-limb of healthy volunteers does not influence PPT , nor the pain evoked by testing .


We found no evidence that sensorimotor incongruence upregulates the nociceptive system in healthy volunteers .


The aim of this study was to evaluate the safety and efficacy of retropubic ( RP ) or transobturator ( TO ) midurethral slings ( MUS ) in a prospective randomized cohort of Turkish women .


A total of @ women with urodynamic stress urinary incontinence ( SUI ) were randomized to undergo either RP or TO MUS between August @ and February @ in a tertiary referral center by a single surgeon .


All patients had history , physical examination , urodynamic evaluation and quality of life assessments .


The validated Turkish versions of the SEAPI , ICIQ-SF and OAB-V@ questionnaires were used .


The Advantage RP and the Obtryx TO MUS Systems were used for all RP and TO procedures .


Twenty-seven patients were randomized to each group .


The median follow-up was @ @ months .


The median hospital stay was @ @ h and median operative time was @ @ min .


The overall objective and subjective cure rates were @ and @ % , respectively .


The quality of life of all patients significantly increased after the operation compared to their preoperative status .


Patients with a poorer subjective cure rate were those with mixed urinary incontinence , whose preoperative SEAPI and OAB-V@ scores were significantly higher .


MUS surgery is highly effective and could safely be performed in a cohort of Turkish women with SUI in subspecialty centers by experienced surgeons .


There is no significant difference between RP or TO applications in terms of safety and efficacy .


Further studies with long-term follow-up data are required .


Pharmacokinetics and bioequivalence of @ mg irbesartan tablets were studied in @ healthy Thai male volunteers .


A single oral dose of one @ mg tablet of the test product and the reference product was given to each volunteer according to a randomized two-way crossover design with @-week wash out period .


Blood samples were collected at predetermined time intervals until @ hours post dose and irbesartan concentration was quantified with a validated HPLC method .


Individual plasma irbesartan concentration-time profile was analyzed for pharmacokinetic parameters .


Maximum plasma concentrations ( Cmax ) of @,@ and @,@ ng/mL for test and reference , respectively , were achieved .


Areas under the plasma concentration-time curve ; AUC@-t and AUC@ - were @,@ and @,@ ngh/mL for test and @,@ and @,@ ngh/mL for reference .


The median tmax was @ hours and @ hours for test and reference , respectively .


Plasma elimination half-lives ( t@/@ ) were @ hours and @ hours for test and reference , respectively .


Primary pharmacokinetic parameters Cmax , AUC@-t , and AUC@ - were tested parametrically by analysis of variance ( ANOVA ) , and it revealed no statistically significant difference ( defined as p < @ ) between the corresponding Cmax , AUC@-t , and AUC@ - with respect to sequence , volunteers , period and formulation .


The @ % confidence intervals for the ratio of test and reference product of the parameters Cmax , AUC@-t , and AUC@ - were within @ - @ % ( @ - @ % for Cmax , @ - @ % for AUC@-t and @ - @ % for AUC@ - ) .


The two products were bioequivalent in terms of both rate and extent of drug absorption into systemic circulation .


To evaluate the efficacy of maintenance therapy with oral micronized progesterone ( OMP ) for prolongation of pregnancy in cases of arrested preterm labor .


Ninety women at @-@weeks of singleton pregnancy with intact membranes and arrested preterm labor were randomly allocated to receive OMP ( n = @ ) or placebo ( n = @ ) daily until @weeks or delivery , whichever was earlier .


Outcome parameters were compared using Student t test , ( @ ) test , Fisher exact test , and log-rank ( @ ) test .


OMP significantly prolonged the latency period ( @ vs @ days ; P = @ ) .


Log-rank analysis revealed a significant difference in mean time to delivery between the @ groups ( P = @ ) .


There were significantly fewer preterm births ( @ % vs @ % ; P = @ ) and low birth weight neonates ( @ % vs @ % ; P = @ ) , and significantly higher mean birth weight ( @ vs @ kg ; P = @ ) in the OMP group .


Perinatal outcomes and adverse effects were similar in the @ groups .


Maintenance tocolysis with OMP significantly prolonged pregnancy and decreased the number of preterm births .


Clinical Trial Registry of India : CTRI/@/@ / @ .


Propofol is commonly used in pediatric sedation , which may cause hypotension during induction .


Our goal was to determine the effect of a preinduction @-mL/kg isotonic fluid bolus on propofol-induced hypotension , assess clinical signs of hypoperfusion during hypotension , and evaluate for age-related propofol dosing differences .


This prospective , randomized , controlled , nonblinded study was conducted at Children 's Hospital of Illinois .


Patients were children @ to @ months of age who needed sedation for MRI or auditory brainstem-evoked response testing .


The treatment group received a preinduction @-mL/kg isotonic saline bolus before procedure initiation .


Patients were continuously monitored via cardiorespiratory monitor with pulse oximetry and end-tidal carbon dioxide measurements .


Cardiovascular indices and clinical signs of hypoperfusion were compared between groups , and propofol dosing differences were compared between age groups .


One hundred twenty-six patients were randomly assigned to treatment ( n = @ ) or control ( n = @ ) conditions .


Twelve patients in the treatment group and @ patients in the control group experienced postinduction hypotension , as defined by the Pediatric Advanced Life Support guidelines .


One patient in each group was given volume resuscitation when blood pressure did not improve after a reduction in the propofol infusion rate .


No hypotensive patients had physical signs of hypoperfusion , and patients@ year of age needed significantly more propofol .


A @-mL/kg preinduction isotonic saline bolus does not prevent propofol-induced hypotension .


No clinical signs of hypoperfusion were noted with induced hypotension , and infants@ months old need significantly more propofol per kilogram for procedures .


We examined contraceptive use and dual protection in the postpartum period in a Prevention of Mother to Child Transmission population and whether it varied by HIV status .


Data are from a prospective study , the South Africa HIV Antenatal Post-test Support Study .


Pregnant participants were recruited from a government clinic in an urban township , and the analytic sample was @ .


Following enrollment , participants were tested for HIV and administered a questionnaire at baseline and @ weeks postpartum .


We used generalized linear regression models to examine HIV status and use of modern contraceptives at @ weeks .


The risk ratio of condom use at @ weeks postpartum was @ -LSB- @ % confidence interval ( CI ) : @-@ @ -RSB- for HIV-positive compared to HIV-negative women .


The risk ratio for dual protection ( use of a condom and a hormonal method ) was @ ( @ % CI : @-@ @ ) at @ weeks for HIV-positive compared to HIV-negative women .


HIV positive status may be a motivating factor for women to use condoms and dual protection .


In this setting where HIV is highly prevalent , it is ever more important that women control the timing and limiting of births so as to preserve the health of the mother and child .


HIV status may be an important motivating behavioral factor for women to use contraceptives and dual protection in the postpartum period .


The INSPIRON-I trial is a first-in-man evaluation of the safety and efficacy of the Inspiron drug-eluting stent , a sirolimus-eluting stent with abluminal biodegradable polymer coating and thin cobalt-chromium alloy .


This is a randomised , multicentre comparison between Inspiron and a stent with the same metallic structure but without polymer coating or drug elution ( Cronus ) .


The primary objective was to evaluate the in-segment late loss ( LLL ) at six months .


Secondary endpoints included percent in-stent obstruction as measured by intravascular ultrasound ( IVUS ) at six months and major adverse cardiac events ( MACE ) .


Fifty-eight patients were enrolled ( @ lesions ) , @ for Inspiron and @ for Cronus .


Baseline clinical and angiographic characteristics of both groups were similar .


At six months , the in-segment LLL was reduced in the Inspiron group compared to the control group ( @ mm vs. @ mm , respectively ; p < @ ) , as well as the percent neointimal obstruction ( @ % vs. @ % ; p < @ ) .


At two-year follow-up , incidence of MACE was similar between groups ( @ vs. @ % , respectively ; p = @ ) , with lower target lesion revascularisation for Inspiron ( @ vs. @ % , respectively ; p = @ ) and no stent thrombosis .


Sirolimus eluted from an abluminal biodegradable polymer on a cobalt-chromium alloy proved effective in reducing restenosis at six months .


Chronic liver disease leads to fibrosis and cirrhosis of the liver .


This may , in turn , result in chronic liver failure or the development of hepatocellular carcinoma ( HCC ) .


Main risk factors for chronic liver disease are viral hepatitis and alcoholism .


The present study assessed a randomly selected population in southern Germany for risk factors for chronic liver disease such as fatty liver disease , viral hepatis infection and life-style factors .


In addition , the potential association with elevated liver enzymes was investigated .


A total of @ subjects ( @ females , @ males ) , aged @ - @ years , participated in the study .


Each subject underwent a standardized ultrasound examination , and anthropometric and biochemical assessments .


Test subjects were randomly selected from the general population of a town in southwestern Germany .


Data were acquired from November to December @ without further follow-up .


Several factors were found to be associated with chronic liver disease in the study population .


Alcohol consumption > @ g/d was seen in @ % ( n = @ ) .


Metabolic syndrome was diagnosed in @ % ( n = @ ) .


The number of people with a BMI greater than @ kg/m ( @ ) was @ % ( n = @ ) .


The prevalence of subjects with chronic hepatitis B was @ % ( n = @ ) , that of anti-HCV positive patients , @ % ( n = @ ) .


Elevated gGT was seen in @ % ( n = @ ) of the patients .


Prevalence of hepatic steatosis was @ % ( n = @ ) .


Many cases of chronic liver disease could be prevented by healthy nutrition , optimized medical treatment of associated disorders , and prevention strategies such as routine vaccination , in particular , against hepatitis B virus ( HBV ) .


Helicobacter pylori infection is an emerging health concern to some northern Canadian Aboriginal communities and their clinicians .


Clinicians in the north perceive H. pylori infection to be a major clinical problem because they find H. pylori infection in many patients evaluated for common stomach complaints , leading to frequent demand for treatment , which often fails .


Moreover , public health authorities identified the need for information to develop locally appropriate H. pylori control strategies .


We described adherence and identified barriers to completing treatment among H. pylori-positive participants in a community-based project inspired by local concerns about H. pylori infection risks .


In @ , @ H. pylori-positive participants ( diagnosed by a breath test , histopathology and/or culture ) of the Aklavik H. pylori project were randomised to standard-of-care or sequential treatment .


We ascertained adherence by interviewing participants using a structured questionnaire .


We estimated adherence frequencies as the proportion of participants who reported taking either @ % of doses ( perfect adherence ) or @ % of doses ( good adherence ) .


To compare the proportion with perfect or good adherence in subgroups , we report proportion differences and @ % confidence intervals ( CI ) .


Of @ participants who were interviewed , @ % reported perfect adherence and @ % reported good adherence .


We observed more frequent perfect adherence for : standard therapy ( @ % ) versus sequential ( @ % ) ; males ( @ % ) versus females ( @ % ) ; participants @-@ years ( @ % ) versus @-@ ( @ % ) .


Proportion differences were @ % ( CI : -@ , @ ) for standard versus sequential therapy ; @ % ( CI : @ , @ ) for male versus female ; and @ % ( CI : @ , @ ) for @-@ versus @-@ years for perfect adherence .


Of the @ participants who reported poor adherence ( < @ % of doses taken ) , the following barriers to treatment were reported : changed mind about taking treatment ( @ % ) , consumption of alcoholic beverages ( @ % ) , nausea ( @ % ) , forgetfulness ( @ % ) , stomach pain ( @ % ) , difficulty in swallowing pills ( @ % ) , no reason ( @ % ) or bad taste of the pills ( @ % ) .


This analysis suggests that adherence to treatment for eliminating H. pyori infection may vary by regimen and may be influenced by socio-demographic factors .


These findings add to the small body of evidence pertaining to adherence to H. pylori treatment in Arctic Aboriginal communities .


On-going research in additional northern Canadian communities will accumulate data for developing recommendations to improve adherence for treatment to eliminate H. pylori infection .


Clinical indications for hydroxyethyl starches ( HES ) in horses include rapid plasma volume expansion and oncotic support during periods of hypoproteinaemia .


Side effects such as coagulopathies associated with HES administration pose limitations to their use in veterinary medicine .


In man , tetrastarch ( @/@ @ ) has demonstrated less profound effects on coagulation compared with first - and second-generation HES .


To evaluate the haemostatic and oncotic effects of tetrastarch ( @/@ @ ) administered at @ , @ and @ml/kg bwt in healthy horses .


Randomised crossover experiment .


Tetrastarch ( @/@ @ ) was administered to @ healthy pony mares at @ , @ and @ml/kg bwt with a @-week washout period .


Packed cell volume , plasma total solids , colloid osmotic pressure ( COP ) , platelet count and thromboelastography ( TEG ) were measured at baseline , immediately after infusion ( @h ) , and @ , @ , @ , @ , @ and @h after tetrastarch infusion .


All TEG variables remained within normal reference ranges in all @ treatment groups .


Administration of tetrastarch at @ml/kg bwt resulted in a prolonged K-time ( P = @ ) at @h post infusion , and decreased maximum amplitude at @ ( P < @ ) , @ ( P = @ ) , @ ( P = @ ) , @ ( P < @ ) and @h ( P = @ ) post infusion compared with baseline .


Administration of tetrastarch increased mean COP values above baseline in all @ treatment groups , persisting to @ , @ and @h for the @ , @ and @ml/kg bwt doses , respectively .


Although still within established reference ranges , compared with lower dosages , the administration of @ml/kg bwt tetrastarch ( @/@ @ ) is more likely to induce changes in coagulation as measured by TEG .


Tetrastarch increased COP at all dosages evaluated in healthy horses .


Tetrastarch ( @/@ @ ) at @ and @ml/kg bwt has potential as a synthetic colloid for resuscitation and provision of oncotic support in horses .


To evaluate the @-month clinical performance of a nanofilled-resin composite with or without glass-fiber layering in restorations of large cavities in posterior teeth of children .


A total of @ restorations were placed in permanent molar teeth of @ children ( mean age @ years ) with ( FRC ; n = @ ) or without ( RC ; n = @ ) fiber layering .


One operator placed all restorations .


Restorations were evaluated according to the USPHS modified-Ryge criteria at baseline , @ , @ , @ , @ , and @ months .


The data were analyzed using Fisher 's exact and chi-square tests and outcomes were compared using the Cochran-Q test ( p < @ ) .


The @-month survival rates of the restorations were @ % and @ % in the RC and FRC groups , respectively .


Nanofilled-resin restorations with or without glass fiber-layering showed similarly high clinical performance .


No differences were detected between the evaluated criteria when comparing baseline with any of the evaluation periods ( p < @ ) .


After @ months there were no secondary caries , change in anatomical form or postoperative sensitivity .


Only minor changes for marginal adaptation , marginal discoloration , color match and surface texture were observed .


It was concluded that nanofilled-resin composite applied with or without glass-fiber layering showed similar and good results in large cavities of posterior permanent teeth in children over a @-month period .


Sitting time ( ST ) , a form of sedentary behavior , has been identified as a highly prevalent risk factor for multiple sclerosis ( MS ) - related morbidity .


There is limited information on the efficacy of behavioral interventions for reducing ST in persons with MS.


To examine the efficacy of a behavioral intervention for reducing ST in persons with MS in a pilot RCT .


Seventy MS patients were randomly assigned to intervention and waitlist control conditions .


The behavioral intervention was delivered April-September @ via the Internet and consisted of a dedicated website and one-on-one Skype video chats that taught participants the skills , techniques , and strategies for reducing sedentary behavior based on social cognitive theory .


ST was measured by questions on the abbreviated International Physical Activity Questionnaire ( IPAQ ) before and after the @-month RCT .


Data were analyzed in SPSS , version @ in March @ .


ANCOVA was performed on post-intervention scores controlling for pre-intervention values using an intent-to-treat analysis .


The group main effect was statistically significant ( F -LSB- @ , @ -RSB- = @ , p < @ , = @ ) and yielded a parameter estimate of @ ( SE = @ , t = @ , p < @ ) .


The adjusted mean scores for intervention and control groups were @ ( @ ) and @ ( @ ) minutes of ST , respectively ( d = @ ) .


We provide the first data on the efficacy of a behavioral intervention for reducing ST in MS patients .


This highlights the importance of designing and testing the effect of behavioral interventions that reduce ST on secondary outcomes such as function , symptoms , quality of life , and health status in persons with MS.


The parallel-group randomized active-controlled clinical study was conducted to compare the effectiveness of two in-hospital range of motion ( ROM ) exercise programs following total knee arthroplasty ( TKA ) .


Continuous passive motion ( CPM ) is frequently used to increase ROM and improve postoperative recovery despite little conclusive scientific evidence .


In contrast , a new active sling-based ROM therapy requires the activation of the knee joint muscles and dynamic joint stabilization .


It was hypothesized that higher demands on muscle strength and muscle coordination during sling exercise training ( ST ) might be advantageous for early recovery following TKA .


A total of @ patients undergoing primary TKA were assessed for eligibility .


Thirty-eight patients were randomly assigned to receive ST or CPM ( control intervention ) during hospital stay .


Patients were assessed before TKA for baseline measurement ( pretest ) , @day before discharge ( posttest ) and @months after TKA ( follow-up ) .


The passive knee flexion range of motion ( pFL ) was the primary outcome measure .


Secondary outcome measures included active knee flexion range of motion , active and passive knee extension ROM , static postural control , physical activity , pain , length of hospital stay as well as clinical , functional and quality-of-life outcomes ( SF-@ , HSS and WOMAC scores ) .


Data were analyzed according to the intention-to-treat principle .


Differences between the groups were tested for significance by the unpaired Student 's t test or an analysis of covariance ( ANCOVA ) adjusted for baseline , weight , sex , age , pain and physical activity .


A between-group difference could be determined at posttest .


The pFL was significantly higher by @ ( @ % CI @ to @ ; P = @ ) in the ST group .


No difference between groups in pFL was documented at follow-up .


Furthermore , no significant differences could be observed for any secondary outcome measure at posttest and follow-up .


ST seems to have a clinically relevant beneficial short-term effect on pFL compared to CPM .


The results support the implementation of ST in rehabilitation programs following TKA .


Therapy , level @b .


Small increases in mean serum creatinine ( SCr ) were observed in studies of rheumatoid arthritis patients during tofacitinib treatment .


These SCr changes were investigated and potential mechanisms explored .


SCr values and renal adverse event data were pooled from five Phase @ and two long-term extension ( LTE ) studies .


Dose-response relationships and association with inflammation ( C-reactive protein ( CRP ) ) were explored using Phase @ data and confirmed with Phase @ data .


In Phase @ , least squares mean SCr differences from placebo at Month @ were @ and @ mg/dl for tofacitinib @ and @ mg twice daily ( BID ) ( P < @ ) , respectively .


During Months @ to @ , confirmed SCr @ % increases over baseline were reported in @ ( @ % ; @ mg BID ) and @ ( @ % ; @ mg BID ) patients .