Proctitis symptoms were highest scored in the placebo group in both the second ( @ -LSB- @-@ -RSB- ) and third ( @ -LSB- @-@ -RSB- ) weeks than in the synbiotic group ( week @ : @ -LSB- @-@ -RSB- , P < @ ; week @ : @ -LSB- @-@ -RSB- , P < @ ) .


In both scores the placebo group had a significantly higher result ( P < @ ) than the synbiotic group ( repeated-measures analysis of variance ) .


Synbiotics reduce proctitis symptoms and improve quality of life in radiation-induced acute proctitis during radiation therapy for prostate cancer .


To evaluate the safety of two commercially available formulations of bimatoprost eye drops : @ and @ % ophthalmic solutions .


This was a randomized , prospective , parallel-group , open-label , cohort study .


A total of @ glaucoma patients ( @ eyes ) under bimatoprost @ % monotherapy since at least @ year were enrolled .


Selected patients were randomized to receive a single drop of bimatoprost @ % ( n = @ ) or bimatoprost @ % ( n = @ ) ophthalmic solutions for @ months .


Statistical analysis was performed using paired t-test and repeated measures ANOVA test .


Global clinical score ( the sum of pruritus , stinging/burning , blurred vision , sticky eye sensation , eye dryness sensation , and foreign body sensation ) significantly decreased in the bimatoprost @ % group from baseline @ @ to @ @ ( P < @ ) and @ @ ( P < @ ) at @-month and @-month follow-ups , respectively .


Comparison between groups showed differences at both follow-up visits ( P = @ and P < @ , respectively ) .


In vivo confocal microscopy revealed a significant increase in goblet cell density in the bimatoprost @ % group compared with the bimatoprost @ % group ( P < @ at both follow-up visits ) .


All functional parameters and conjunctival hyperemia improved in the bimatoprost @ % group at each follow-up visit ( P < @ ) and in comparison with bimatoprost @ % ( P < @ ) .


The results of this trial suggest that bimatoprost @ % eye drops seem to decrease the ocular discomfort with respect to bimatoprost @ % eye drops .


Type @ diabetes mellitus ( T@DM ) is caused by insulin deficiency resulting from progressive destruction of cells .


The histological hallmark of the diabetic islet is mononuclear cell infiltration .


Thiazolidinediones ( TZDs ) activate PPARg and enhance the actions of insulin .


Studies in non-obese diabetic and streptocotozin-treated mouse models demonstrated that pretreatment with TZDs prevented the development of T@DM .


The purpose of this study was to examine whether pioglitazone , given with insulin , preserved cell function in patients with new-onset T@DM .


This was a randomized , double-blind , placebo-controlled @-week study .


Subjects received pioglitazone or placebo .


Blood sugar , glycated hemoglobin ( HbA@c ) , C-peptide , and liver enzymes were measured at baseline .


Boost stimulated C-peptide responses were measured at baseline and at @ weeks .


Blood sugar , insulin dose , height , weight , and liver enzymes were monitored at each visit .


HbA@c was performed every @ weeks .


Of the @ patients , @ received pioglitazone , and @ - placebo .


There was no clinical improvement in HbA@c between or within groups at the completion of the study .


Mean peak C-peptide values were similar between groups at baseline .


Mean peak C-peptide level was slightly higher at @ weeks in the pioglitazone group compared to the placebo ( @ vs. @ ng/mL ) which was considered as clinically insignificant .


The interaction of HbA@c and insulin dose ( HbA@c * insulin/kg/day ) , which combines degree of diabetic control and dose of insulin required to achieve this control , showed transient improvement in the pioglitazone group at @ weeks but was not sustained at @ weeks .


In this pilot study , pioglitazone did not preserve cell function when compared to placebo .


Based on a radiobiological assumption of a low alpha/beta ( / ) ratio for prostate cancer , hypofractionated radiotherapy has increasingly gained traction in the clinical practice and recent guidelines have confirmed the non-inferiority of this approach .


Nevertheless , the largest studies that have used hypofractionation so far , employed image-guided radiation therapy/intensity modulated radiation therapy ( IGRT/IMRT ) facilities that might have overcome the radiobiological advantages , which remain to be fully confirmed .


The aim of this trial was to evaluate the feasibility of a hypofractionated schedule delivered with @D-Conformal Radiotherapy to prostate and seminal vesicles in combination with hormonal therapy .


The study included @ consecutive patients with localized prostate cancer ( PCa ) , irrespective of risk class , treated with a schedule of @ Gy in @ fractions over @ weeks ( @ fractions of @ Gy each per week ) .


According to National Comprehensive Cancer Network ( NCCN ) prognostic classification , patients were divided into a favourable group ( @ % ) , intermediate group ( @ % ) and unfavourable group ( @ % ) .


Early and late toxicities were scored using the radiation toxicity grading/European Organisation for Research and Treatment of Cancer ( RTOG/EORTC ) criteria .


Additionally , the international prostate symptom index ( IPSS ) for benign prostate hypertrophy was used to evaluate obstructive urinary symptoms .


Biochemical outcome was reported according to the Phoenix definition for biochemical failure .


Hormonal therapy ( HT ) was administrated in @ % of patients .


After a median follow-up of @ months ( range = @-@ ) , maximum G@ late genitourinary ( GU ) and gastrointestinal ( GI ) toxicities occurred in @ % and @ % patients , respectively .


The corresponding figures for acute toxicities were @ % and @ % .


Patients with higher IPSS score before enrolment had significantly worse urinary function after treatment .


Only @ % of patients died from PCa .


Biochemical non-evidence of disease ( bNED ) was @ % for all patients .


Our study confirms that @D conformal radiotherapy ( @DCRT ) remains a safe and effective method to deliver a dose-escalated hypofractionated regimen for PCa patients in all risk classes with acceptable toxicity rates and optimal biochemical control .


The optimal intensity and duration of the intervention to achieve sustained risk reduction in patients at high and very high cardiovascular ( CV ) risk still need to be established .


The aim of this study was to evaluate the impact of general practitioner 's ( GP 's ) systematic and planned intervention on total CV risk reduction and a change in individual CV risk factors .


This was a cluster-randomized trial ( ISRCTN@ ) including @ practices and @ patients aged @ .


The participating GPs and their examinees were randomized into an intervention or to a control group ( standard care ) .


Intervention group practitioners followed up their examinees during @ , @ , @ , @ , and @ months .


The main outcome measures were change in proportion of patients with low , moderate , high , and very high CV risk , and change in individual CV risk factors from the first to the second registration .


The proportion of patients with very high CV risk was lower in the intervention group , the same as of patients with high blood pressure , total and LDL cholesterol , and increased intake of alcohol .


The mean systolic ( -@ mmHg ) and diastolic ( -@ mmHg ) blood pressure , triglycerides ( -@ mmol/L ) , body mass index ( -@ ) , and waist ( -@ cm ) and hip circumference ( -@ cm ) was reduced significantly in the intervention group .


There was no additional impact in the intervention group of other tested CV risk factors .


Systematic and planned GP 's intervention in CVD prevention reduces the number of patients with very high total CV risk and influences a change in lifestyle habits .


The study aimed to determine the effect of preference-based tailored navigation on colorectal cancer ( CRC ) screening adherence and related outcomes among African Americans ( AAs ) .


We conducted a randomized controlled trial that included @ AA patients who were age @ to @ years , were eligible for CRC screening , and had received care through primary care practices in Philadelphia .


Consented patients completed a baseline telephone survey and were randomized to either a Standard Intervention ( SI ) group ( n = @ ) or a Tailored Navigation Intervention ( TNI ) group ( n = @ ) .


The SI group received a mailed stool blood test kit plus colonoscopy instructions , and a reminder .


The TNI group received tailored navigation ( a mailed stool blood test kit or colonoscopy instructions based on preference , plus telephone navigation ) and a reminder .


A six-month survey and a @-month medical records review were completed to assess screening adherence , change in overall screening preference , and perceptions about screening .


Multivariable analyses were performed to assess intervention impact on outcomes .


At six months , adherence in the TNI group was statistically significantly higher than in the SI group ( OR = @ , @ % CI = @ to @ ) .


Positive change in overall screening preference was also statistically significantly greater in the TNI group compared with the SI group ( OR = @ , @ % CI = @ to @ ) .


There were no statistically significant differences in perceptions about screening between the study groups .


Tailored navigation in primary care is a promising approach for increasing CRC screening among AAs .


Research is needed to determine how to maximize intervention effects and to test intervention impact on race-related disparities in mortality and survival .


To investigate the safety/tolerability and efficacy of long-term adjunctive zonisamide and its impact on growth and development in children ( @-@years ) with partial epilepsy .


Open-label extension of a phase III , placebo-controlled trial .


Started with double-blind transition period ( @-@weeks ) , during which patients on zonisamide continued at the same dose and those on placebo switched to zonisamide @mg/kg/day , up-titrated to @mg/kg/day ( maximum @mg/day ) .


During the subsequent open-label period ( @-@weeks ) , zonisamide dosing could be adjusted according to tolerability/response .


Safety assessments included treatment-emergent adverse events ( TEAEs ) , clinical laboratory parameters , and vital signs .


Efficacy assessments included responder rate ( primary assessment ) and seizure freedom rate during the open-label period .


Growth and development assessments comprised Tanner stages , hand x-rays , Child Behavior Checklist ( CBCL @/@ ) , School Performance questionnaire , Physician and Parent/Guardian Global Impression of Change , and Controlled Oral Word Association Test ( COWAT ) .


One hundred forty-four children entered the study ; @ ( @ % ) of @ children completed it , and @ ( @ % ) of @ received zonisamide for @year .


TEAEs occurred in @ ( @ % ) of @ patients .


There were low incidences of serious TEAEs ( @ % ) and TEAEs leading to discontinuation ( @ % ) .


Bicarbonate level decreases > @ mm occurred in @ patients ( @ % ) , and @ patients ( @ % ) had a weight decrease of @ % from baseline .


During the open-label period , @ ( @ % ) of @ patients were responders and @ ( @ % ) of @ achieved seizure freedom .


Tanner staging and skeletal development were as expected for the study population .


Changes were minimal for CBCL @/@ and School Performance scores .


Most patients were `` much improved '' / `` very much improved '' on Physician ( @ % ) and Parent/Guardian ( @ % ) Global Impressions of Change .


Median changes in COWAT Category and Letter Fluency scores were @ and @ , respectively .


Adjunctive zonisamide was well tolerated and efficacious over a period of at least @year in children with partial epilepsy , with no unexpected safety concerns and no consistent detrimental effects on growth and development .


A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .


An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis .


To compare antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis confirmed by computed tomography ( CT ) .


The Appendicitis Acuta ( APPAC ) multicenter , open-label , noninferiority randomized clinical trial was conducted from November @ until June @ in Finland .


The trial enrolled @ patients aged @ to @ years with uncomplicated acute appendicitis confirmed by a CT scan .


Patients were randomly assigned to early appendectomy or antibiotic treatment with a @-year follow-up period .


Patients randomized to antibiotic therapy received intravenous ertapenem ( @ g/d ) for @ days followed by @ days of oral levofloxacin ( @ mg once daily ) and metronidazole ( @ mg @ times per day ) .


Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy .


The primary end point for the surgical intervention was the successful completion of an appendectomy .


The primary end point for antibiotic-treated patients was discharge from the hospital without the need for surgery and no recurrent appendicitis during a @-year follow-up period .


There were @ patients in the surgical group and @ in the antibiotic group .


Of @ patients in the surgical group , all but @ underwent successful appendectomy , resulting in a success rate of @ % ( @ % CI , @ % to @ % ) .


In the antibiotic group , @ patients ( @ % ; @ % CI , @ % to @ % ) underwent appendectomy within @ year of initial presentation for appendicitis .


Of the @ patients available for follow-up in the antibiotic group , @ ( @ % ; @ % CI , @ % to @ % ) did not require surgery .


The intention-to-treat analysis yielded a difference in treatment efficacy between groups of -@ % ( @ % CI , -@ % to ) ( P = @ ) .


Given the prespecified noninferiority margin of @ % , we were unable to demonstrate noninferiority of antibiotic treatment relative to surgery .


Of the @ patients randomized to antibiotic treatment who subsequently underwent appendectomy , @ ( @ % ; @ % CI , @ % to @ % ) had uncomplicated appendicitis , @ ( @ % ; @ % CI , @ % to @ % ) had complicated acute appendicitis , and @ ( @ % ; @ % CI , @ % to @ % ) did not have appendicitis but received appendectomy for suspected recurrence .


There were no intra-abdominal abscesses or other major complications associated with delayed appendectomy in patients randomized to antibiotic treatment .


Among patients with CT-proven , uncomplicated appendicitis , antibiotic treatment did not meet the prespecified criterion for noninferiority compared with appendectomy .


Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the @-year follow-up period , and those who required appendectomy did not experience significant complications .


Safety and efficacy of a once daily controlled-released ( CR ) formulation of pregabalin was evaluated in patients with fibromyalgia using a placebo-controlled , randomized withdrawal design .


This multicenter study included @ week single-blind pregabalin CR treatment followed by @ week double-blind treatment with placebo or pregabalin CR .


The starting dose of @mg/day was escalated during the first @ weeks , up to @mg/day based on efficacy and tolerability .


Patients with @ % reduction in average daily pain score at the end of the single-blind phase were randomized to continue pregabalin CR at the optimized dose ( @-@mg / day ) or to placebo .


The primary endpoint was time to loss of therapeutic response ( LTR ) , defined as < @ % pain reduction relative to single-blind baseline or discontinuation owing to lack of efficacy or adverse event ( AE ) .


Secondary endpoints included measures of pain severity , global assessment , functional status , tiredness/fatigue , and sleep .


ClinicalTrials.gov NCT@ .


A total of @ patients entered the single-blind phase , and @ were randomized to pregabalin CR and @ to placebo .


The median time to LTR ( Kaplan-Meier analysis ) was significantly longer in the pregabalin CR group than placebo ( @ vs. @ days , p = @ ) .


By trial end , @/@ ( @ % ) pregabalin CR and @/@ ( @ % ) placebo patients experienced LTR .


Significantly more patients reported ` benefit from treatment ' ( Benefit , Satisfaction , and Willingness to Continue Scale ) in the pregabalin CR group ; no other secondary endpoints were statistically significant .


Most AEs were mild to moderate in severity ( most frequent : dizziness , somnolence ) .


The percentage of pregabalin CR patients discontinuing because of AEs was @ % and @ % in the single-blind and double-blind phases , respectively ( placebo , @ % ) .


Time to LTR was significantly longer with pregabalin CR versus placebo in fibromyalgia patients who initially showed improvement with pregabalin CR , indicating maintenance of response .


Pregabalin CR was well tolerated in most patients .


Generalizability may be limited by study duration and selective population .


A key component of palliative care is support for family caregivers .


Although some family caregivers identify positive aspects , the impact is typically burdensome ; they are prone to physical and psychological morbidity , financial disadvantage and social isolation .


Outcomes of systematic reviews have highlighted the importance of investment in family caregiver intervention research .


To provide an overview of the development , evaluation and outcomes arising from of a programme of research ( The Melbourne Family Support Program ( FSP ) ) , which focused on reducing the psychosocial burden of family caregivers .


Developmental work involved a systematic literature review ; focus groups with family caregivers and health professionals ; and identification of a conceptual framework .


Following a pilot randomised controlled trial ( RCT ) , a programme of psychoeducational intervention studies was developed and tested ; one via RCT , the others via prepost test .


Four psychoeducational interventions , incorporating one-to-one and group format delivery , conducted in both the home and inpatient hospital/hospice were evaluated .


Statistically significant outcomes included improvements in family caregivers ' preparedness , competence , positive emotions , more favourable levels of psychological wellbeing and a reduction in unmet needs .


Internationally endorsed guidelines for the psychosocial support of family caregivers were produced and several resources were constructed .


Fifteen publications in international peer-reviewed journals have arisen from this programme .


The interventions and resources from the Melbourne FSP provide several evidenced-based and clinically relevant approaches that focus on reducing the psychosocial burden of the caregiving role .


In several instances , however , more rigorous methodological testing is advocated .


The authors prospectively compared single dose ( @ mmol/kg bodyweight ) gadobenate dimeglumine with double dose ( @ mmol/kg bodyweight ) gadopentetate dimeglumine for contrast-enhanced magnetic resonance angiography ( CE-MRA ) in patients with suspected or known steno-occlusive disease of the carotid , renal or peripheral vasculature using an intra-individual crossover study design .


Twenty-eight patients with suspected or known steno-occlusive disease of the carotid ( n = @ ) , renal ( n = @ ) or peripheral arteries ( n = @ ) were randomised to receive either @ mmol/kg gadobenate dimeglumine or @ mmol/kg gadopentetate dimeglumine for a first CE-MRA procedure .


After @-@ days all patients underwent a second identical CE-MRA procedure with the other contrast agent .


Three blinded readers assessed images for vessel anatomical delineation , disease detection/exclusion , and global preference .


Diagnostic performance for detection of @ % stenosis was determined for @/@ patients who also underwent digital subtraction angiography ( DSA ) .


Non-inferiority was assessed using the Wilcoxon signed rank , McNemar and Wald tests .


Quantitative ( signal-to-noise and contrast-to-noise ratio ) enhancement based on @D maximum intensity projection reconstructions was compared .


No differences were noted for any qualitative parameter .


Equivalence was reported for all diagnostic preference end-points .


Superiority for gadobenate dimeglumine was reported by all readers for sensitivity for disease detection ( @-@ @ vs. @-@ @ % ) .


Quantitative enhancement was similar for single dose gadobenate dimeglumine and double dose gadopentetate dimeglumine .


Under identical examination conditions a single @ mmol/kg body weight dose of gadobenate dimeglumine can fully replace a double @ mmol/kg body weight dose of gadopentetate dimeglumine for routine CE-MRA procedures .


As a result of increased resistance to antibiotics , Helicobacter pylori eradication rates using standard triple therapy have been declining .


To validate the efficacy and tolerability of a concomitant regimen as a first-line treatment for H. pylori infection .


A total of @ nave H. pylori-infected patients from six hospitals in Korea were randomly assigned to concomitant therapy and standard triple therapy groups .


The concomitant regimen consisted of @ mg of lansoprazole , @g of amoxicillin , @ mg of clarithromycin , and @ mg of metronidazole , twice daily for @ days .


The standard triple regimen consisted of @ mg of lansoprazole , @g of amoxicillin , and @ mg of clarithromycin , twice daily for @ days .


Concomitant and standard eradication rates were @ % ( @/@ ) vs. @ % ( @/@ ) by intention-to-treat ( p = @ ) and @ % ( @/@ ) vs. @ % ( @/@ ) by per-protocol ( p = @ ) , respectively .


The two groups were similar with regard to the incidence of adverse events .


Although @-day concomitant therapy was validated as a suboptimal treatment option for the treatment of H. pylori infection , this regimen is expected to be a promising starting point in the development of an optimal treatment regimen for H. pylori infection .


Eosinophilic esophagitis is usually triggered by foods , by unclear mechanisms .


We evaluated the roles of IgE and IgG@ in the development of eosinophilic esophagitis .


We performed a prospective , randomized , double-blind , placebo-controlled trial of adults with eosinophilic esophagitis given an antibody against IgE ( omalizumab , n = @ ) or placebo ( n = @ ) every @-@ weeks for @ weeks , based on weight and serum level of IgE .


Endoscopy was performed , esophageal biopsy specimens were collected , and symptoms were assessed at baseline and at @ weeks .


Maximum numbers of eosinophils/high-power field were determined .


Homogenates of esophageal biopsy specimens from @ subjects with eosinophilic esophagitis and @ without ( controls ) were assessed for IgM , IgA , and IgG subclasses .


In a retrospective analysis , we performed immunofluorescence analysis of IgG@ in fixed esophageal tissues from @ patients with eosinophilic esophagitis who underwent esophagectomy and @ consecutive autopsies ( controls ) .


We also performed immunofluorescence analysis of IgG@ in esophageal mucosal biopsy specimens from @ subjects with eosinophilic esophagitis and @ without ( controls ) .


Finally , sera were collected from @ subjects with eosinophilic esophagitis and from @ without ( controls ) , and assayed for total and food-reactive IgG@ .


Omalizumab did not alter symptoms of eosinophilic esophagitis or eosinophil counts in biopsy samples compared with placebo .


Homogenates of esophageal tissues from patients with eosinophilic esophagitis had a @-fold increase in IgG@ compared with controls ( P < @ @ ( -@ ) ) , but no significant increases in other IgG subclasses , IgM , or IgA .


Sparse stromal deposits resembling immune complexes were found in @ of @ eosinophilic esophagitis biopsy specimens based on ultrastructural analysis .


Esophagectomy samples from @ patients with eosinophilic esophagitis contained @ and @ IgG@ plasma cells/maximal high-power field , mainly in the deep lamina propria ; these levels were greater than in tissues from controls .


Fibrosis essentially was exclusive to the lamina propria .


Granular extracellular IgG@ was detected in biopsy specimens from @ of @ patients with eosinophilic esophagitis , butin none of the specimens from @ controls ( P = @ @ ( -@ ) ) .


The total serum level of IgG@ increased only slightly in patients with eosinophilic esophagitis , compared with controls .


Subjects witheosinophilic esophagitis had increased serum levels of IgG@ that reacted with milk , wheat , egg , and nuts-the @ foods thatmost commonly trigger this condition ( P @ @ ( -@ ) for each food ) .


In a prospective trial , omalizumab did not reduce symptoms of eosinophilic esophagitis or tissue eosinophil counts compared with placebo .


This finding , along with observed granular deposits of IgG@ , abundant IgG@-containing plasma cells , and serum levels of IgG@ reactive to specific foods , indicate that , in adults , eosinophilic esophagitis is IgG@-associated , and not an IgE-induced allergy .


ClinicalTrials.gov number : NCT@ .


The aim of this study is to compare the efficacy , safety and cost-effectiveness of topical Whitfield 's ointment plus oral fluconazole with topical @ % butenafine in tinea infections of the skin .


Patients were randomly allocated to the two treatment groups and advised to apply either agent topically twice-a-day for @ weeks on the lesions and fluconazole ( @ mg ) was administered once a week for @ weeks in the study group applying Whitfield 's ointment .


Patients were followed-up at an interval of @ days for clinical score and global evaluation response was assessed at baseline and during each follow-up .


Out of @ patients enrolled in the study @ completed the study .


Patients treated with Whitfield 's ointment and oral fluconazole reduced mean sign and symptom score from @ @ to @ @ while butenafine treated patients reduced it from @ @ to @ @ at the end of the treatment .


Nearly , @ % patients were completely cleared of the lesion on the @ ( rd ) follow-up with both treatments .


Whitfield 's ointment with oral fluconazole is as efficacious , safe and cost-effective as compared with @ % butenafine in tinea infections of the skin .


Sacral nerve stimulation ( SNS ) has been demonstrated to alleviate symptoms and improve quality of life in selected patients with irritable bowel syndrome ( IBS ) .


The mechanisms of action , however , remain unknown .


The aim of the study was to evaluate the effects of SNS on rectal sensitivity and biomechanical properties in patients with IBS .


Twenty patients with diarrhea-predominant ( n = @ ) or mixed ( n = @ ) IBS were treated with SNS in a controlled , randomized crossover trial .


They were randomized to either @ month of SNS ( ON ) or placebo ( OFF ) with the opposite setting for the next month .


Sensory and biomechanical parameters were assessed by multimodal rectal stimulation at the end of each period .


IBS-specific symptoms were evaluated at baseline and at the end of each treatment period .


Cold stimuli were better tolerated in the ON period ( @ C -LSB- @ -RSB- ) compared to the OFF period ( @ C -LSB- @ -RSB- ; p = @ ) .


Significantly lower cross-sectional areas were needed to elicit sensory responses in the ON period ( @ mm ( @ ) -LSB- @ -RSB- ) compared to the OFF period ( @ mm ( @ ) -LSB- @ -RSB- ; p = @ ) .


The association between reduced sensory threshold and improvement of constipation was of borderline significance ( p = @ ) .


Wall stiffness was significantly lower in the ON period ( @ mmHg -LSB- @ -RSB- ) compared to the OFF period ( @ mmHg -LSB- @ -RSB- ; p = @ ) .


Reduced wall stiffness was significantly associated with improved overall GSRS-IBS symptom score ( p = @ ) .


Reduced sensory threshold to stretch ( p = @ ) and reduced wall stiffness ( p < @ ) were predictors of the GSRS-IBS symptom score .


SNS for diarrhea-predominant and mixed IBS relaxes the rectal wall , while making it more sensitive to stretch and less sensitive to cold .


Reduced wall stiffness and increased sensitivity to stretch are associated with improved GSRS-IBS symptom score .


Restoration of biomechanics is a major goal in THA .


Imageless navigation enables intraoperative control of leg length equalization and offset reconstruction .


However , the effect of navigation compared with intraoperative fluoroscopy is unclear .


We asked whether intraoperative use of imageless navigation ( @ ) improves the relative accuracy of leg length and global and femoral offset restoration ; ( @ ) increases the absolute precision of leg length and global and femoral offset equalization ; and ( @ ) reduces outliers in a reconstruction zone of @ mm for leg length and global and femoral offset restoration compared with intraoperative fluoroscopy during minimally invasive ( MIS ) THA with the patient in a lateral decubitus position .


In this prospective study a consecutive series of @ patients were randomized to either navigation-guided or fluoroscopy-controlled THA using sealed , opaque envelopes .


All patients received the same cementless prosthetic components through an anterolateral MIS approach while they were in a lateral decubitus position .


Leg length , global or total offset ( representing the combination of femoral and acetabular offset ) , and femoral offset differences were restored using either navigation or fluoroscopy .


Postoperatively , residual leg length and global and femoral offset discrepancies were analyzed on magnification-corrected radiographs of the pelvis by an independent and blinded examiner using digital planning software .


Accuracy was defined as the relative postoperative difference between the surgically treated and the unaffected contralateral side for leg length and offset , respectively ; precision was defined as the absolute postoperative deviation of leg length and global and femoral offset regardless of lengthening or shortening of leg length and offset throughout the THA .


All analyses were performed per intention-to-treat .


Analyzing the relative accuracy of leg length restoration we found a mean difference of @ mm ( @ % CI , -@ to +@ mm ; p = @ ) between fluoroscopy and navigation , @ mm ( @ % CI , -@ to +@ mm ; p = @ ) for global offset and @ mm ( @ % CI , +@ to +@ mm ; p = @ ) for femoral offset .


For the absolute precision of leg length and global and femoral offset equalization , there was a mean difference of @ @ mm ( p < @ ) between fluoroscopy and navigation .


The biomechanical reconstruction with a residual leg length and global and femoral offset discrepancy less than @ mm and less than @ mm , respectively , succeeded in @ % and @ % , respectively , in the navigation group and in @ % and @ % , respectively , in the fluoroscopy group .


Intraoperative fluoroscopy and imageless navigation seem equivalent in accuracy and precision to reconstruct leg length and global and femoral offset during MIS THA with the patient in the lateral decubitus position .


Cardiac muscle perfusion , as determined by single-photon emission computed tomography ( SPECT ) , decreases after breast and/or chest wall ( BCW ) irradiation .


The active breathing coordinator ( ABC ) enables radiation delivery when the BCW is farther from the heart , thereby decreasing cardiac exposure .


We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC .


Stages I to III left breast cancer patients requiring adjuvant radiation therapy ( XRT ) were randomized to ABC or No-ABC .


Myocardial perfusion was evaluated by SPECT scans ( before and @ months after BCW radiation ) using @ methods : ( @ ) fully automated quantitative polar mapping ; and ( @ ) semiquantitative visual assessment .


The left ventricle was divided into @ segments for the polar map and @ segments for the visual method .


Segments were grouped by anatomical rings ( apical , mid , basal ) or by coronary artery distribution .


For the visual method , @ nuclear medicine physicians , blinded to treatment groups , scored each segment 's perfusion .


Scores were analyzed with nonparametric tests and linear regression .


Between @ and @ , @ patients were enrolled and @ were available for analysis .


The cohorts were well matched .


The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts .


In unadjusted and adjusted analyses , controlling for pretreatment perfusion score , age , and chemotherapy , ABC was not significantly associated with prevention of perfusion deficits .


In this randomized controlled trial , ABC does not appear to prevent radiation-induced cardiac perfusion deficits .


Atopic asthma is characterized by Th@ cytokine-driven inflammation of the airway mucosa , which is signaled by the fraction of exhaled nitric oxide ( FENO ) .


We tested whether an FENO-guided anti-inflammatory treatment algorithm could improve asthma-related quality of life and asthma symptom control , and reduce exacerbations in atopic asthmatics within primary care .


Altogether , @ patients with asthma and who were nonsmokers ( age range , @-@ years ) with perennial allergy and who were on regular inhaled corticosteroid treatment were recruited at @ primary health care centers , randomly assigned to @ groups and followed up for @ year .


For the controls ( n = @ ) , FENO measurement was blinded to both operator and patient , and anti-inflammatory treatment was adjusted according to usual care .


In the active group ( n = @ ) , treatment was adjusted according to FENO .


Questionnaires on asthma-related quality of life ( Mini Asthma Quality of Life Questionnaire ) and asthma control ( Asthma Control Questionnaire ) were completed , and asthma events were noted .


The Asthma Control Questionnaire score change over @ year improved significantly more in the FENO-guided group ( -@ -LSB- interquartile range -LCB- IQR -RCB- , -@ to @ -RSB- vs @ -LSB- -@ to @ -RSB- ; P = @ ) , whereas the Mini Asthma Quality of Life Questionnaire score did not ( @ -LSB- IQR , @-@ @ -RSB- vs @ -LSB- IQR , -@ to @ -RSB- ; P = @ ) .


The change in Asthma Control Questionnaire was clinically important in subpopulations with poor control at baseline ( P = @ ) .


Furthermore , the exacerbation rate ( exacerbations/patient/y ) was reduced by almost @ % in the FENO-guided group ( @ -LSB- CI , @-@ @ -RSB- vs @ -LSB- CI , @-@ @ -RSB- ; P = @ ) .


Mean overall inhaled corticosteroid use was similar in both groups ( P = @ ) .


Use of FENO to guide anti-inflammatory treatment within primary care significantly reduced the exacerbation rate and improved asthma symptom control without increasing overall inhaled corticosteroid use .


It is needed to evaluate the spreadability , coverage , and adhesion of facial base makeup products .


Using the oscillation applicator or hand application , @ volunteers spread the liquid foundation on their faces and forearms .


To assess the spreadability , coverage , and adhesion , we analyzed digital images of volunteers ' faces to measure spreadability and coverage , and we measured the adhesion effect on the forearm by tape-stripping .


In terms of spreadability , coverage , and adhesion , the results of group who used the ` oscillation applicator ' were significantly twice as high as the other group who applied by hand .


In this study , we demonstrated a method for quantitative assessing the effect of spreadability , coverage , and adhesion of the liquid foundation used in base makeup .


Also , we discovered a distinction between using an oscillation applicator and using hand application .


It is expected that image analysis assessment and tape-stripping would be useful parameters for the evaluation of the facial base makeup .


Epidural route is preferable for postoperative pain relief in thoraco-abdominal and lower limb surgeries .


We aimed to compare epidural butorphanol versus morphine for postoperative analgesia up to @ hours in open nephrectomy surgery .


@ ASA physical status I and II adult patients were selected for this randomized double blind prospective study .


A standard balanced general anesthesia technique was applied for all patients .


Epidural catheter was placed in lower thoracic inter-vertebral space before the start of surgery .


Injection butorphanol @ mg/kg in group B ( n = @ ) or morphine @ mg/kg in group M ( n = @ ) was given in a double blind manner after completion of surgery and before extubation through the epidural catheter .


Patients were observed for pain relief by Visual Analogue Scale ( VAS ) for the next @ hours .


Dose was repeated when VAS was > @ .


The onset and peak effect of pain relief , duration of analgesia of @st dose , frequency of drug administration and side effects if any were observed .


The average onset of analgesia was @ + / - @ minutes with butorphanol and @ + / - @ minutes with morphine group which was statistically significant ( p < @ ) .


The mean peak effect of pain relief following @st dose was @ + / - @ minutes with butorphanol and @ + / - @ minutes with morphine group .


The duration of pain relief after @st dose was statistically significant and was @ + / - @ minutes in group B and @ + / - @ minutes in group M which was gradually increased on repeated dosing in group B while it was almost same in Group M. Number of doses required in @ hours was significantly higher ( p < @ ) in butorphanol group than morphine group .


Somnolence was the main side effect in group B while pruritus was the main side effect with group M.


Epidural butorphanol appears to provide safer and faster postoperative analgesia without much untoward effects but its analgesic action is short so more repeated doses are required than morphine via epidural catheter up to @ hours .


The Panitumumab Randomized trial In combination with chemotherapy for Metastatic colorectal cancer to determine Efficacy ( PRIME ) demonstrated that panitumumab-FOLFOX@ significantly improved progression-free survival ( PFS ) versus FOLFOX@ as first-line treatment of wild-type ( WT ) KRAS metastatic colorectal cancer ( mCRC ) , the primary end point of the study .


Patients were randomized @:@ to panitumumab @ mg/kg every @ weeks + FOLFOX@ ( arm @ ) or FOLFOX@ ( arm @ ) .


This prespecified final descriptive analysis of efficacy and safety was planned for @ months after the last patient was enrolled .


A total of @ patients were randomized .


Median PFS for WT KRAS mCRC was @ months -LSB- @ % confidence interval ( CI ) @-@ @ months -RSB- for arm @ and @ months ( @ % CI @-@ @ months ) for arm @ ; hazard ratio ( HR ) = @ ; @ % CI @-@ @ ; P = @ .


Median overall survival ( OS ) for WT KRAS mCRC was @ months ( @ % CI @-@ @ months ) for arm @ and @ months ( @ % CI @-@ @ months ) for arm @ ; HR = @ ; @ % CI @-@ @ ; P = @ ( @ % OS events ) .


An exploratory analysis of updated survival ( > @ % OS events ) was carried out which demonstrated improvement in OS ; HR = @ ; @ % CI @-@ @ ; P = @ for WT KRAS mCRC .


The adverse event profile was consistent with the primary analysis .


In WT KRAS mCRC , PFS was improved , objective response was higher , and there was a trend toward improved OS with panitumumab-FOLFOX@ , with significant improvement in OS observed in an updated analysis of survival in patients with WT KRAS mCRC treated with panitumumab + FOLFOX@ versus FOLFOX@ alone ( P = @ ) .


These data support a positive benefit-risk profile for panitumumab-FOLFOX@ for patients with previously untreated WT KRAS mCRC .


KRAS testing is critical to select appropriate patients for treatment with panitumumab .


Studies on protein requirements in vulnerable groups such as older adults are few , and results are conflicting .


The main objective of this study was to determine the protein requirements of free-living women > @ y by measuring the oxidation of l - -LSB- @ - ( @ ) C -RSB- phenylalanine to ( @ ) CO@ in response to graded intakes of protein .


Twelve subjects participated in the study , with protein intakes ranging from @ to @ g kg ( -@ ) d ( -@ ) for a total of @ studies .


The diets provided energy at @ times each subject 's resting energy expenditure and were isocaloric .


Protein was given as an amino acid mixture on the basis of the egg protein pattern , except for phenylalanine and tyrosine , which were maintained constant across the protein intake amounts .


All subjects were adapted for @ d before the study day to a protein intake of @ g kg ( -@ ) d ( -@ ) .


The mean protein requirement was determined by applying a mixed-effects change-point regression analysis to F ( @ ) CO@ ( label tracer oxidation in ( @ ) CO@ breath ) , which identified a breakpoint in the F ( @ ) CO@ in response to graded amounts of protein .


The mean estimated average requirement ( EAR ) and upper @ % CI ( approximating the RDA ) protein requirement of women > @ y were @ and @ g kg ( -@ ) d ( -@ ) , respectively .


These estimates of protein requirements for older women are higher than the current EAR and RDA based on nitrogen balance data , which are @ and @ g kg ( -@ ) d ( -@ ) , respectively .


This trial was registered at clinicaltrials.gov as NCT@ .


Initial medication response has been shown to predict treatment outcome across a variety of substance use disorders , but no studies have examined the predictive power of initial response to buprenorphine-naloxone in the treatment of prescription opioid dependence .


We therefore conducted a secondary analysis of data from the Prescription Opioid Addiction Treatment Study to determine whether initial response to buprenorphine-naloxone predicted @-week treatment outcome in a prescription opioid-dependent population .


Using data from a multisite , randomized controlled trial of buprenorphine-naloxone plus counseling for DSM-IV prescription opioid dependence ( June @-July @ ) , we conducted a secondary analysis to investigate the relationship between initial medication response and @-week treatment outcome to establish how soon the efficacy of buprenorphine-naloxone could be predicted ( N = @ ) .


Outcomes were determined from the Substance Use Report , a self-report measure of substance use , and confirmatory urinalysis .


Predictive values were calculated to determine the importance of abstinence versus use at various time points within the first month of treatment ( week @ , weeks @-@ , @-@ , or @-@ ) in predicting successful versus unsuccessful treatment outcome ( based on abstinence or near-abstinence from opioids ) in the last @ weeks of buprenorphine-naloxone treatment ( weeks @-@ ) .


Outcome was best predicted by medication response after @ weeks of treatment .


Two weeks of initial abstinence was moderately predictive of treatment success ( positive predictive value = @ % ) , while opioid use in both of the first @ weeks was strongly predictive of unsuccessful treatment outcome ( negative predictive value -LSB- NPV -RSB- = @ % ) , especially when successful outcome was defined as total abstinence from opioids in weeks @-@ ( NPV = @ % ) .


Evaluating prescription opioid-dependent patients after @ weeks of buprenorphine-naloxone treatment may help determine the likelihood of successful outcome at completion of the current treatment regimen .


To investigate whether there is an association between diameter of bacille Calmette-Gurin ( BCG ) scars and effect of purified protein derivative ( PPD ) reaction and to determine whether vitamin A ( VA ) combined vitamin D ( VD ) supplementation influences the immune response to BCG revaccinated in Chinese infants .


A cross-section and @-month community-randomised trial was conducted .


A total of @ @ infants at @ , @ and @ months of age in Junan County of China were examined for BCG scar formation .


Then , @ revaccinated infants were randomly assigned to supplementation ( n = @ ) and control ( n = @ ) groups .


The supplementation group were daily assigned to @ @ IU VA and @ IU VD for @ months .


Then all infants were subjected to skin test with PPD .


The diameter of BCG scars was positively correlated with diameter of skin indurations of PPD ( r = @ , P < @ ) in the @ @ infants .


The rate of positive response to PPD was higher in the supplementation group than in the control group ( @ % versus @ % , P < @ , prevalence ratio @ , @ % CI @-@ @ ) .


The prevalence ratio of PPD response for the supplementation group compared with that for the control group was @ ( @ % CI @-@ @ ) for the males and @ ( @ % CI @-@ @ ) for the females .


For the supplementation group , the males got larger tuberculin induration than the females -LSB- ( @ ) cm versus ( @ ) cm , P < @ ) after intervention .


The diameter of BCG scars was effectively correlated with PPD response , which indicates BCG scar formation may be an useful tool to evaluate the effect of tuberculosis prevention .


VA combined VD supplementation may play an immuno-regulatory role in BCG revaccination .


This may contribute to the prevention of childhood tuberculosis .


Barbed sutures were developed to reduce operative time and improve security of wound closure .


The authors compare absorbable barbed sutures ( V-Loc , Covidien , Mansfield , Massachusetts ) with conventional ( smooth ) absorbable sutures for soft tissue approximation .


A prospective multicenter randomized study comparing barbed sutures with smooth sutures was undertaken between August @ , @ , and January @ , @ , in @ patients undergoing abdominoplasty , mastopexy , and reduction mammaplasty .


Each patient received barbed sutures on @ side of the body , with deep dermal sutures eliminated or reduced .


Smooth sutures with deep dermal and subcuticular closure were used on the other side as a control .


The primary endpoint was dermal closure time .


Safety was assessed through adverse event reporting through a @-week follow-up .


A total of @ patients were ultimately treated ( @ with slow-absorbing polymer and @ with rapid-absorbing polymer ) .


Mean dermal closure time was significantly quicker with the barbed suture compared with the smooth suture ( @ vs @ minutes ; P < @ ) , primarily due to the need for fewer deep dermal sutures .


The rapid-absorbing barbed suture showed a complication profile equivalent to the smooth suture , while the slow-absorbing barbed suture had a higher incidence of minor suture extrusion .


Barbed sutures enabled faster dermal closure quicker than smooth sutures , with a comparable complication profile .


Low T levels have been associated with ejaculatory dysfunction ( EjD ) in cross-sectional studies ; however , the efficacy of T replacement in improving EjD has not been studied in a randomized controlled trial .


To evaluate the efficacy of T replacement in androgen-deficient men with EjD .


A multicenter , double-blind , randomized , placebo-controlled , @-week trial with T solution @ % versus placebo .


Medical centers in the United States , Canada , and Mexico .


Seventy-six men with one or more EjD symptoms , including delayed ejaculation , anejaculation , reduced ejaculate volume , and/or reduced force of ejaculation , and two total T levels < @ ng/dL ( < @ nmol/L ) measured with liquid chromatography tandem mass spectrometry .


Sixty milligrams of T solution @ % or placebo applied to the axillae for @ weeks .


The primary outcome was a change in the score of the three-item Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form ( MSHQ-EjD-SF ) ; secondary outcomes included measured ejaculate volume , scores of the bother/satisfaction item of the MSHQ-EjD-SF , the orgasmic function domain of the International Index of Erectile Function Questionnaire , and the sexual activity log .


Seventy-six participants were randomized ; @ completed the study .


Baseline demographic and clinical characteristics were comparable between the treatment arms .


T replacement improved the MSHQ-EjD-SF score ( mean score change , +@ ) ; however , this effect was not statistically different from placebo ( mean score change , +@ ; P = @ ) .


No differences were seen in any of the secondary outcomes or frequency of adverse events .


T replacement was not associated with significant improvement in EjD in androgen-deficient men .


To evaluate the effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and materials received by patients undergoing cardiac catheterisation .


Cardiac catheterisation is one of the most anxiety-provoking invasive procedures for patients .


However , informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored .


A randomised experimental design with three-cohort prospective comparisons .


In total , @ consecutive patients were randomly assigned to one of three groups : regular education ; ( group @ ) , accessibility-enhanced multimedia informational education ( group @ ) and instructional digital videodisc education ( group @ ) .


Anxiety was measured with Spielberger 's State Anxiety Inventory , which was administered at four time intervals : before education ( T@ ) , immediately after education ( T@ ) , before cardiac catheterisation ( T@ ) and one day after cardiac catheterisation ( T@ ) .


A satisfaction questionnaire was administrated one day after cardiac catheterisation .


Data were collected from May @-September @ and analysed using descriptive statistics , chi-squared tests , one-way analysis of variance , Scheffe 's post hoc test and generalised estimating equations .


All patients experienced moderate anxiety at T@ to low anxiety at T@ .


Accessibility-enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and materials received compared with patients in groups @ and @ .


A statistically significant difference in anxiety levels was only found at T@ among the three groups ( p = @ ) .


The findings demonstrate that the accessibility-enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation , to reduce anxiety and improve satisfaction with the information and materials received compared with the regular education and instructional digital videodisc education .


As the accessibility-enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and materials received , it can be adapted to complement patient education in future regular cardiac care .


The present study addressed the question whether neurophysiological signals exhibit characteristic modulations preceding a miss in a covert vigilant attention task which mimics a natural environment in which critical stimuli may appear in the periphery of the visual field .


Subjective , behavioural and encephalographic ( EEG ) data of @ participants performing a modified Mackworth Clock task were obtained and analysed offline .


The stimulus consisted of a pointer performing regular ticks in a clockwise sequence across @ dots arranged in a circle .


Participants were requested to covertly attend to the pointer and press a response button as quickly as possible in the event of a jump , a rare and random event .


Significant increases in response latencies and decreases in the detection rates were found as a function of time-on-task , a characteristic effect of sustained attention tasks known as the vigilance decrement .


Subjective sleepiness showed a significant increase over the duration of the experiment .


Increased activity in the - frequency range ( @-@ Hz ) was observed emerging and gradually accumulating @ s before a missed target .


Additionally , a significant gradual attenuation of the P@ event-related component was found to antecede misses by @ s.


The results corroborate recent findings that behavioural errors are presaged by specific neurophysiological activity and demonstrate that lapses of attention can be predicted in a covert setting up to @ s in advance reinforcing the prospective use of brain-computer interface ( BCI ) technology for the detection of waning vigilance in real-world scenarios .


Combining these findings with real-time single-trial analysis from BCI may pave the way for cognitive states monitoring systems able to determine the current , and predict the near-future development of the brain 's attentional processes .


A better understanding of drivers of treatment costs may help identify effective cost containment strategies and prioritize resources .


We aimed to develop a method for estimating inpatient costs for pediatric patients with acute myeloid leukemia ( AML ) enrolled on NCI-funded Phase III trials , compare costs between AAML@ treatment arms ( standard chemotherapy gemtuzumab ozogamicin ( GMTZ ) ) , and evaluate primary drivers of costs for newly diagnosed pediatric AML .


Patients from the AAML@ trial were matched on hospital , sex , and dates of birth and diagnosis to the Pediatric Health Information Systems ( PHIS ) database to obtain daily billing data .


Inpatient treatment costs were calculated as adjusted charges multiplied by hospital-specific cost-to-charge ratios .


Generalized linear models were used to compare costs between treatment arms and courses , and by patient characteristics .


Inpatient costs did not differ by randomized treatment arm .


Costs varied by course with stem cell transplant being most expensive , followed by Intensification II ( cytarabine/mitoxantrone ) and Induction I ( cytarabine/daunorubicin/etoposide ) .


Room/board and pharmacy were the largest contributors to inpatient treatment cost , representing @ % of the total cost .


Higher AML risk group ( P = @ ) and older age ( P < @ ) were associated with significantly higher daily inpatient cost .


Costs from external data sources can be successfully integrated into NCI-funded Phase III clinical trials .


Inpatient treatment costs did not differ by GMTZ exposure but varied by chemotherapy course .


Variation in cost by course was driven by differences in duration of hospitalization through room/board charges as well as increased clinical and pharmacy charges in specific courses .


The Institute of Medicine has called on the US health care system to identify and reduce medical errors .


Unfortunately , medication dosing errors remain commonplace and may result in potentially life-threatening outcomes , particularly for pediatric patients when dosing requires weight-based calculations .


Novel medication delivery systems that may reduce dosing errors resonate with national health care priorities .


Our goal was to evaluate novel , prefilled medication syringes labeled with color-coded volumes corresponding to the weight-based dosing of the Broselow Tape , compared with conventional medication administration , in simulated pediatric emergency department ( ED ) resuscitation scenarios .


We performed a prospective , block-randomized , crossover study in which @ emergency physician and nurse teams managed @ simulated pediatric arrest scenarios in situ , using either prefilled , color-coded syringes ( intervention ) or conventional drug administration methods ( control ) .


The ED resuscitation room and the intravenous medication port were video recorded during the simulations .


Data were extracted from video review by blinded , independent reviewers .


Median time to delivery of all doses for the conventional and color-coded delivery groups was @ seconds ( @ % confidence interval -LSB- CI -RSB- @ to @ seconds ) and @ seconds ( @ % CI @ to @ seconds ) , respectively ( difference = @ seconds ; @ % CI @ to @ seconds ) .


With the conventional method , @ doses were administered , with @ critical dosing errors ( @ % ) ; with the color-coded method , @ doses were administered , with @ critical dosing errors ( difference = @ % ; @ % CI @ % to @ % ) .


A novel color-coded , prefilled syringe decreased time to medication administration and significantly reduced critical dosing errors by emergency physician and nurse teams during simulated pediatric ED resuscitations .


Prosthetic grafts continue to be required for hemodialysis access when the options for native fistulas have been exhausted .


The inferior long-term patency of grafts makes the possibility of preventing occlusion with heparin-bonded grafts an attractive alternative .


We carried out a prospective randomized study to compare the patency of standard grafts with heparin-bonded grafts .


Patients with end-stage renal failure requiring a prosthetic access were randomized to receive either a standard expanded polytetrafluorethylene ( ePTFE ) graft or a heparin-bonded ePTFE graft .


Patients were enrolled from June @ until November @ and were followed up until July @ , when the study concluded .


In this study , @ patients were randomized and followed up for a median of @ months .


No patient was lost to follow-up .


Primary patency was @ % and @ % for heparin-bonded grafts and @ % and @ % for standard ePTFE grafts at @ and @ months , respectively ( P = @ ) .


Assisted primary patency was @ % , @ % , and @ % for heparin-bonded grafts and @ % , @ % , and @ % for standard grafts at @ , @ , and @ months , respectively ( P = @ ) .


Secondary patency was @ % , @ % , and @ % for heparin-bonded grafts and @ % , @ % , and @ % for standard grafts at @ , @ , and @ months , respectively ( P = @ ) .


There were significantly fewer thromboses in heparin-bonded grafts during the first @ months ( P = @ ) .


Of @ standard grafts , @ were eventually abandoned vs @ heparin-bonded grafts ( P = @ ) .


Bleeding complications , infections , and intervention rates were similar in both groups .


Heparin-bonded grafts demonstrated a trend to improved patency , but the difference was not statistically significant .


Heparin-bonded grafts had a significantly lower early thrombosis rate that was sustained only for the first @ months of follow-up .


Cellulitis ( erysipelas ) is a recurring and debilitating bacterial infection of the skin and underlying tissue .


We assessed the cost-effectiveness of prophylactic antibiotic treatment to prevent the recurrence of cellulitis using low dose penicillin V in patients following a first episode ( @ months prophylaxis ) and more recurrent cellulitis ( @ months prophylaxis , or @ months in those declining @ months ) .


Within-trial cost-effectiveness analysis was conducted using the findings of two randomised placebo-controlled multicentre trials ( PATCH I and PATCH II ) , in which patients recruited in the UK and Ireland were followed-up for up to @ years .


Incremental cost , reduction in recurrence , cost per recurrence prevented and cost/QALY were estimated .


National unit and reference costs for England in @ were applied to resource use , exploring NHS and societal perspectives .


A total of @ patients from the two trials contributed to the analysis .


There was a @ % reduction in the number of recurrences occurring within the trial ( IRR : @ @ % CI : @ to @ , p = @ ) , corresponding to an absolute reduction of recurrence of @ recurrences/patient ( @ % CI : @ to @ , p = @ ) .


Incremental costs of prophylaxis suggested a small cost saving but were not statistically significant , comparing the two groups .


If a decision-maker is willing to pay up to @,@ / QALY then there is a @ % probability of antibiotic prophylaxis being cost-effective from an NHS perspective , rising to @ % probability from a secondary , societal perspective .


Following first episode or recurrent cellulitis of the leg , prophylactic low dose penicillin is a very low cost intervention which , on balance , is effective and cost-effective at preventing subsequent attacks .


Antibiotic prophylaxis reduces cellulitis recurrence by nearly a third but is not associated with a significant increase in costs .


Cardiac rehabilitation ( CR ) is pivotal in preventing recurring events of myocardial infarction ( MI ) .


This study aims to investigate the effect of a smartphone-based home service delivery ( Care Assessment Platform ) of CR ( CAP-CR ) on CR use and health outcomes compared with a traditional , centre-based programme ( TCR ) in post-MI patients .


In this unblinded randomised controlled trial , post-MI patients were randomised to TCR ( n = @ ; @ years ) and CAP-CR ( n = @ ; @ years ) for a @-week CR and @-month self-maintenance period .


CAP-CR , delivered in participants ' homes , included health and exercise monitoring , motivational and educational material delivery , and weekly mentoring consultations .


CAP-CR uptake , adherence and completion rates were compared with TCR using intention-to-treat analyses .


Changes in clinical outcomes ( modifiable lifestyle factors , biomedical risk factors and health-related quality of life ) across baseline , @weeks and @months were compared within , and between , groups using linear mixed model regression .


CAP-CR had significantly higher uptake ( @ % vs @ % ) , adherence ( @ % vs @ % ) and completion ( @ % vs @ % ) rates than TCR ( p < @ ) .


Both groups showed significant improvements in @-minute walk test from baseline to @weeks ( TCR : @-@m ; CAP-CR : @-@m ) , which was maintained at @months .


CAP-CR showed slight weight reduction ( @-@kg ) and also demonstrated significant improvements in emotional state ( K@ : median ( IQR ) @ ( @-@ @ ) to @ ( @-@ @ ) ) , and quality of life ( EQ@D-Index : median ( IQR ) @ ( @-@ @ ) to @ ( @-@ @ ) ) at @weeks .


This smartphone-based home care CR programme improved post-MI CR uptake , adherence and completion .


The home-based CR programme was as effective in improving physiological and psychological health outcomes as traditional CR .


CAP-CR is a viable option towards optimising use of CR services .


To compare the clinical efficacy differences between fire needling technique of filiform needle at high stress points and regular acupuncture on chrondromalacia patellae so as to provide the better therapy for the treatment of this disease .


Sixty cases of chrondromalacia patellae were randomized into a fire needling group ( @ cases ) and a routine acupuncture group ( @ cases ) .


In the fire needling group , @ to @ high stress points were localized according to the symptoms , palpation and imaging condition and were stimulated with fire needling technique of filiform needle .


The treatment was given once every two days , @ treatments made one session .


In the routine acupuncture group , the regular acupuncture was applied at Dubi ( ST @ ) , Xiguan ( LR @ ) , Yanglingquan ( GB @ ) , Yinlingquan ( SP @ ) , Zusanli ( ST @ ) , etc. .


The treatment was given once every day , @ treatments made one session .


Lysholm score , VSA score , patella title angle ( PTA ) and lateral patella angle ( LPA ) of the affected knees before and after treatment , as well as the clinical efficacy after treatment were observed in the two groups .


After treatment , Lysholm score , VSA score , PTA and LPA were all improved apparently in the two groups ( all P < @ ) .


After the treatments , the improvements in Lysholm score , VSA score , PTA and LPA in the fire needling group were more obvious than those in the routine acupuncture group ( all P < @ ) .


The effective rate was @ % ( @/@ ) in the fire needling group , better than @ % ( @/@ ) in the routine acupuncture group ( P < @ ) .


The fire needling technique of filiform needle at the high stress points relieves the clinical symptoms of chrondromalacia patellae and recovers the biodynamical structure of patellae .


The double-blind , placebo-controlled Sildenafil in Treatment-Naive Children , Aged @ to @ Years , With Pulmonary Arterial Hypertension ( STARTS-@ ) study assessed sildenafil in pediatric patients with pulmonary arterial hypertension ; improved hemodynamics and exercise capacity occurred in medium - and high-dose groups .


STARTS-@ was the extension study .


In STARTS-@ , @ children @ kg were randomly assigned to low - , medium - , or high-dose sildenafil or placebo orally thrice daily ; within-group dose depended on weight .


In STARTS-@ , sildenafil-treated patients continued STARTS-@ dosing ; placebo-treated patients were randomized to @ of the @ sildenafil dose groups .


Patients requiring additional pulmonary arterial hypertension-specific therapy discontinued study treatment ; survival follow-up was attempted .


As of August @ , all children received @ years of treatment ( unless discontinued ) from STARTS-@ baseline ; @ deaths were reported ( @ on study treatment ) , @ of which occurred within the first year of treatment .


Most patients who died ( @/@ ) had idiopathic/heritable pulmonary arterial hypertension ( @ % versus @ % overall ) and baseline functional class III/IV disease ( @ % versus @ % overall ) ; patients who died had worse baseline hemodynamics .


Kaplan-Meier estimated @-year survival rates from start of sildenafil were @ % , @ % , and @ % for patients randomized to low - , medium - , and high-dose sildenafil , respectively ; @ % , @ % , and @ % were known to be alive at @ years .


Hazard ratios for mortality were @ ( @ % confidence interval , @-@ @ ) for high versus low and @ ( @ % confidence interval , @-@ @ ) for medium versus low dose ; however , multiple analyses raised uncertainty about the survival/dose relationship .


Although children randomized to higher compared with lower sildenafil doses had an unexplained increased mortality , all sildenafil dose groups displayed favorable survival for children with pulmonary arterial hypertension .


Abiraterone acetate ( AA ) was recently approved for castration-resistant prostate cancer in Japan .


Two phase @ studies were conducted to assess the pharmacokinetics of abiraterone after single-dose administration in Japanese healthy men and to evaluate the effects of food timing on abiraterone pharmacokinetics after single-dose administration of AA in Japanese and Caucasian healthy men .


In the dose-proportionality study , subjects ( n = @ Japanese ) were randomly assigned to receive single doses of @ , @ , and @,@ mg AA , and in the food-timing study , subjects ( n = @ Japanese and n = @ Caucasian ) randomly received single doses of @,@ mg AA under fasted ( overnight ) and three different modified fasting conditions .


Mean C ( max ) and AUC ( ) for abiraterone increased dose-dependently in Japanese healthy men ; however , @ % confidential interval ( CI ) was outside the predefined dose-proportionality criteria .


Based on geometric mean ratios and @ % CIs ( versus overnight fasting condition ) , abiraterone exposure ( AUC ) increased significantly with dosing @ h premeal , @ h postmeal , or in between two meals @ h apart by @ % , @ % , and @ % , respectively .


No clinically meaningful difference was observed in the pharmacokinetics of abiraterone between Caucasian and Japanese subjects .


The aim of this study was to determine whether biomarkers of myocardial stress and fibrosis improve prediction of the mode of death in patients with chronic heart failure .


The @ most common modes of death in patients with chronic heart failure are pump failure and sudden cardiac death .


Prediction of the mode of death may facilitate treatment decisions .


The relationship between amino-terminal pro-brain natriuretic peptide ( NT-proBNP ) , galectin-@ , and ST@ , biomarkers that reflect different pathogenic pathways in heart failure ( myocardial stress and fibrosis ) , and mode of death is unknown .


HF-ACTION ( Heart Failure : A Controlled Trial Investigating Outcomes of Exercise Training ) was a randomized controlled trial of exercise training versus usual care in patients with chronic heart failure due to left ventricular systolic dysfunction ( left ventricular ejection fraction@ % ) .


An independent clinical events committee prospectively adjudicated mode of death .


NT-proBNP , galectin-@ , and ST@ levels were assessed at baseline in @ subjects .


Associations between biomarkers and mode of death were assessed using cause-specific Cox proportional hazards modeling , and interaction testing was used to measure differential associations between biomarkers and pump failure versus sudden cardiac death .


Discrimination and risk reclassification metrics were used to assess the added value of galectin-@ and ST@ in predicting mode of death risk beyond a clinical model that included NT-proBNP .


After a median follow-up period of @ years , there were @ deaths : @ from pump failure , @ from sudden cardiac death , and @ from other causes .


Elevations in all biomarkers were associated with increased risk for both pump failure and sudden cardiac death in both adjusted and unadjusted analyses .


In each case , increases in the biomarker had a stronger association with pump failure than sudden cardiac death , but this relationship was attenuated after adjustment for clinical risk factors .


Clinical variables along with NT-proBNP levels were stronger predictors of pump failure ( C statistic : @ ) than sudden cardiac death ( C statistic : @ ) .


Addition of ST@ and galectin-@ led to improved net risk classification of @ % for sudden cardiac death , but not pump failure .


Clinical predictors along with NT-proBNP levels were strong predictors of pump failure risk , with insignificant incremental contributions of ST@ and galectin-@ .


Predictability of sudden cardiac death risk was less robust and enhanced by information provided by novel biomarkers .


Lack of adherence to recommended treatment for obstructive sleep apnea remains an ongoing public health challenge .


Despite evidence that continuous positive airway pressure ( CPAP ) is effective and improves overall quality of life , adherence with the use of CPAP in certain racial/ethnic groups , especially blacks , is suboptimal .


Evidence indicates that the incidence and prevalence of obstructive sleep apnea are higher among blacks , relative to whites , and blacks are less likely to adhere to recommended treatment compared with other racial/ethnic groups .


Using a two-arm randomized controlled design , this study will evaluate the effectiveness of a culturally and linguistically tailored telephone-delivered intervention to promote adherence to physician-recommended sleep apnea assessment and treatment among blacks with metabolic syndrome , versus an attention-control arm .


The intervention is designed to foster adherence to recommended sleep apnea care using the stages-of-change model .


The intervention will be delivered entirely over the telephone .


Participants in the intervention arm will receive @ phone calls to address challenges and barriers to recommended care .


Outcomes will be assessed at baseline , and at @ - and @-months post-randomization .


This tailored behavioral intervention will improve adherence to sleep apnea assessment and treatment among blacks with metabolic syndrome .


We expect to demonstrate that this intervention modality is feasible in terms of time and cost and can be replicated in populations with similar racial/ethnic backgrounds .


Previous studies have shown that oxytocin ( OXT ) enhances social cognitive processes .


It has also been demonstrated that OXT does not uniformly facilitate social cognition .


The effects of OXT administration strongly depend on the exposure to stressful experiences in early life .


Emotional facial recognition is crucial for social cognition .


However , no study has yet examined how the effects of OXT on the ability to identify emotional faces are altered by early life stress ( ELS ) experiences .


Given the role of OXT in modulating social motivational processes , we specifically aimed to investigate its effects on the recognition of approach - and avoidance-related facial emotions .


In a double-blind , between-subjects , placebo-controlled design , @ male participants performed an emotion recognition task with faces taken from the `` Karolinska Directed Emotional Faces '' set .


We clustered the six basic emotions along the dimensions approach ( happy , surprise , anger ) and avoidance ( fear , sadness , disgust ) .


ELS was assessed with the Childhood Trauma Questionnaire ( CTQ ) .


Our results showed that OXT improved the ability to recognize avoidance-related emotional faces as compared to approach-related emotional faces .


Whereas the performance for avoidance-related emotions in participants with higher ELS scores was comparable in both OXT and placebo condition , OXT enhanced emotion recognition in participants with lower ELS scores .


Independent of OXT administration , we observed increased emotion recognition for avoidance-related faces in participants with high ELS scores .


Our findings suggest that the investigation of OXT on social recognition requires a broad approach that takes ELS experiences as well as motivational processes into account .


Low-birth-weight children are known to be at risk of both anemia and cognitive/language deficits in their early years .


The aim of the current study was to examine the effects of a @-element multiple micronutrient powder ( MNP ) on the cognitive and language development of full-term low-birth-weight ( LBW-T ) children in Bangladesh .


The current study was a follow-up of children who were enrolled in a randomized cluster trial at @-@ mo of age .


Children in @ intervention clusters ( communities ) were administered a daily @-element MNP sachet with their food for @ mo , and both intervention and control groups ( also @ clusters ) received nutrition , health , and hygiene education .


The current study involved the assessment of children at @-@ mo of age ( @-element MNP group : n = @ ; control group : n = @ ) on @ subtests of the Bayley Scales of Infant and Toddler Development III test to measure cognitive , receptive language , and expressive language development .


There was a significant effect of the @-element MNP on children 's expressive language scores ( d = @ ) , and stunting moderated the effect on receptive language scores ; there was no effect on cognitive development ( d = @ ) .


An MNP may thus offer one feasible solution to improve language development of LBW-T children in low-resource community settings .


This trial was registered at clinicaltrials.gov as NCT@ .


We aimed to develop and establish the reliability and validity of a measure of Fear of Recurrence , measuring cognitive appraisals of relapse rather than standard early signs of relapse .


We also aimed to establish the sensitivity and specificity to relapse .


Participants diagnosed with schizophrenia or a related disorder were randomized to one of two early signs monitoring conditions , using either the Early Signs Scale or the Fear of Recurrence Scale ( FoRSe ) .


Participants were followed up for @-months or until relapse .


A total of @ participants were randomized to Standard ( n = @ ) or FoRSe ( n = @ ) monitoring .


We found good evidence supporting reliability and validity of the FoRSe .


In addition , a cut-off point of @ was associated with an optimal sensitivity in both Standard ( n = @:@ % , @ % CI = @-@ ) and FoRSe ( n = @:@ % , @ % CI = @-@ ) monitoring .


However , this degree of sensitivity was associated with a lower specificity in Standard ( n = @:@ % , @ % CI = @-@ ) and FoRSe ( n = @:@ % , @ % CI = @-@ ) .


Finally , Fear of Relapse was a significant predictor of time to relapse -LSB- Exp ( ) = @ , @ % CI = @-@ @ , p < @ -RSB- .


The study provides evidence that Fear of Recurrence may be an important clinical construct linked to increased risk of relapse and poorer emotional recovery in people diagnosed with schizophrenia .


Monitoring Fear of Recurrence is as sensitive to relapse detection as monitoring early signs alone .


Greater Fear of Relapse was associated with shorter duration to actual relapse .


Fear of recurrence may be an important clinical feature linked to poorer emotional recovery and increased risk of relapse .


Fear of Recurrence may be an important focus of psychological therapy to promote emotional recovery and prevention of relapse .


Compare the long-term effects of an energy-restricted very low-carbohydrate , high-fat ( LC ) diet with an isocaloric high-carbohydrate , low-fat ( HC ) diet on exercise tolerance and capacity in overweight and obese adults .


Seventy-six adults ( @ males ; age @ @ years ; BMI @ @ kg/m ( @ ) ) were randomized to either a hypocaloric ( @-@ MJ/day ) LC diet ( @ % protein , @ % carbohydrate , @ % fat ) or isocaloric HC diet ( @ % protein , @ % carbohydrate , @ % fat ) for @ weeks .


Pre - and postintervention , participants ' body weight and composition , handgrip , and isometric knee extensor strength were assessed and participants performed an incremental exercise test to exhaustion .


Forty-three participants completed the study ( LC = @ ; HC = @ ) .


Overall , peak relative oxygen uptake increased ( +@ % ) and reductions occurred in body weight ( -@ % ) , body fat percentage ( -@ % -LSB- absolute -RSB- ) , isometric knee extensor strength ( -@ % ) , handgrip strength ( -@ % ) , and absolute peak oxygen uptake ( -@ % ; p @ time for all ) with no diet effect ( p @ ) .


During submaximal exercise , rating of perceived exertion did not change in either group ( p = @ time , p = @ Time Group ) .


Compared to the HC diet , the LC diet had greater reductions in respiratory exchange ratio ( LC -@ @ , HC -@ @ ; p = @ ) , and increased fat oxidation ( LC @ @ % -LSB- of energy expenditure -RSB- , HC @ @ % ; p = @ ) .


In overweight and obese patients , an LC diet promoted greater fat utilization during submaximal exercise .


Both an LC diet and an HC diet had similar effects on aerobic capacity and muscle strength , suggesting that long-term consumption of an LC weight loss diet does not adversely affect physical function or the ability to perform exercise .


To test if nucleolar channel system ( NCS ) prevalence matches the accuracy of the endometrial receptivity array ( ERA ) for identification of the window of endometrial receptivity .


Comparative retrospective study , May @-May @ .


University-affiliated infertility clinic .


Forty-nine healthy oocyte donors , regularly cycling , aged @-@ years with a body mass index of @-@ kg/m@ .


Endometrial biopsies were collected throughout the menstrual cycle .


All samples underwent transcriptomic signature identification by ERA testing ( performed in a prior study ) and quantification of NCS prevalence by using indirect immunofluorescence ( performed in the present study ) .


Concordance of ERA results determining the window of implantation with NCS prevalence was statistically analyzed using the kappa index .


Based on dating according to the luteinizing hormone surge , specimens were dichotomized into receptive ( n = @ ) and nonreceptive ( n = @ ) .


The NCS prevalence was expressed as percentage of NCSs per endometrial epithelial cells in each endometrial biopsy .


Concordance of ERA and NCS dating vs. luteinizing hormone yielded comparable kappa indices of @ and @ , respectively .


Direct comparison of ERA and NCS dating resulted in a kappa index of @ .


Prevalence of NCS identifies the window of endometrial receptivity previously identified by their transcriptomic signature using the ERA .


Continuous lumbar plexus blocks provide excellent analgesia for total hip arthroplasty ( THA ) , but their utility has been questioned as they may increase motor weakness .


The aim of this study was to compare the efficacy of two different concentrations of ropivacaine on both postoperative analgesia and motor function .


Thirty patients were examined in this prospective , single center , double-blinded , parallel group , comparative , randomized controlled trial in patients undergoing primary THA .


Lumbar plexus catheters were inserted preoperatively .


After surgery , patients were randomly assigned to receive an infusion of ropivacaine at a concentration of either @ % ( group @ % ) or @ % ( group @ % ) at a standardized volume of @mL per hour for @ hours .


Patients were also given free access to patient-controlled analgesia hydromorphone for @ hours , supplemental intravenous ( IV ) opiates , and boluses of their assigned local anesthetic concentration via the lumbar plexus catheter .


The primary endpoint was total hydromorphone consumption in @ hours .


Secondary endpoints included pain scores , sensory and motor function , and patient satisfaction .


There was no significant difference in hydromorphone consumption in the first @ hours postoperatively ( mean -LSB- @ % confidence interval -RSB- ) between group @ % ( @ mg -LSB- @-@ @ -RSB- ) and group @ % ( @ mg -LSB- @-@ @ -RSB- , P = @ ) .


The volume of local anesthetic received , pain scores , sensory and motor function , and patient satisfaction did not vary between groups .


Following primary THA , lumbar plexus perineural infusion of @ % ropivacaine provided similar benefits for postoperative analgesia and functional recovery as @ % ropivacaine .


The aim of this study was to determine the effects of synbiotic food consumption on glycemic status and serum high sensitivity C-reactive protein ( hs-CRP ) levels of Iranian pregnant women .


This randomized placebo-controlled clinical trial was performed among @ pregnant women , primigravida , aged @-@ year old , in their third trimester .


After a @-wk run-in period , subjects were randomly assigned to consume either a synbiotic ( n = @ ) or control food ( n = @ ) for @ weeks .


The synbiotic food consisted of a probiotic Lactobacillus sporogenes ( @ CFU ) , @ g inulin as prebiotic with @ g isomalt , @ g sorbitol and @ g stevia as sweetener per @ g. Control food ( the same substance without probiotic bacteria and inulin ) was packed in identical @-gram packages .


Patients were asked to consume the synbiotic and control foods two times a day .


Fasting blood samples were taken at baseline and after a @-wk intervention for quantification of related factors .


Consumption of a synbiotic food did not show any significant change regarding the impact of insulin actions in the synbiotic group ; nonetheless , compared to the control food , it resulted in a significant decrease in serum insulin levels ( -@ vs. @ IU/mL , P = @ ) and HOMA-IR ( -@ vs. @ , P = @ ) , a significant difference in HOMA-B ( @ vs. @ , P = @ ) and a significant rise in QUICKI score ( @ vs. -@ , P = @ ) .


Consumption of a synbiotic food for @ weeks by pregnant women had beneficial effects on insulin actions compared to the control food , but did not affect FPG and serum hs-CRP concentrations .


Macitentan is a novel dual endothelin receptor antagonist recently approved for the treatment of pulmonary arterial hypertension ( PAH ) .


Warfarin , an anticoagulant often prescribed to patients with PAH , has a narrow therapeutic index and is prone to potential interactions with drugs .


This study assessed the effects of macitentan on the pharmacokinetics and pharmacodynamics of single-dose warfarin in healthy subjects .


This was a randomised , open-label , single-centre , two-way crossover ( treatment A followed by treatment B , or vice versa ) , phase I study in @ healthy male subjects .


Treatment A was a loading dose of macitentan @ mg on Day @ followed by @ mg once daily for @ days , with a single @ mg dose of warfarin on Day @ .


Treatment B was a single dose of warfarin on Day @ .


Blood samples were assessed for warfarin pharmacokinetics ( R - and S-warfarin ) and pharmacodynamics -LSB- international normalised ratio ( INR ) and factor VII -RSB- .


Plasma trough concentrations of macitentan and its active metabolite ( ACT-@ ) and the safety and tolerability of each treatment were also assessed .


Plasma concentrations of R - and S-warfarin were similar in both treatment periods .


Warfarin did not affect the mean trough plasma concentrations of macitentan or ACT-@ .


Macitentan did not affect the pharmacodynamics of warfarin ; the mean INR and factor VII activity versus time profiles were similar with and without macitentan .


The absence of effect of macitentan on the pharmacokinetics and pharmacodynamics of a single dose of warfarin suggests that both drugs can be concomitantly administered without need for dose adjustment .


The protective effect of breast-feeding against later obesity may be explained by the lower protein content compared with formula milk .


However , the metabolic mechanisms remain unknown .


We studied the metabolic response to a higher or lower protein supply in infancy .


The Childhood Obesity Project study is a double-blind , randomized , multicenter intervention trial .


Infants were randomized to receive a higher ( HP ) or lower protein ( LP ) content infant formula or were breast-fed .


Plasma samples of @ infants who received formula milk with different protein content ( HP , @ g per @ mL ; LP , @ g per @ mL ) or were breast-fed were collected .


Changes in plasma amino acid and acylcarnitine concentrations of @-month-old infants according to different dietary protein supply were determined by liquid chromatography coupled to tandem mass spectrometry .


Twenty-nine metabolites differed significantly between the formula groups .


Branched-chain amino acids ( BCAAs ) were the most discriminant metabolites .


Their degradation products , the short-chain acylcarnitines C@ , C@ , and C@ , were also significantly elevated in the HP group .


A breakpoint analysis confirmed that with increasing BCAAs , the ratio between acylcarnitines and BCAAs decreases .


Long-chain acylcarnitines were decreased in HP infants .


BCAAs seem to play a pivotal role in the effect of a high-protein diet on - oxidation and fat storage .


We provide new evidence for a possible saturation of the BCAA degradation pathway that may represent the mechanism by which high-protein intake affects the metabolic regulation .


Moreover , it appears to inhibit the initial step of the - oxidation , thus leading to high early weight gain and body fat deposition .


This study was conducted to investigate the effects of reinsertion of the stylet after a spinal anesthesia procedure on the Post Dural Puncture Headache ( PDPH ) METHODS : We have enrolled into this study @ patients who were undergoing elective operations with spinal anesthesia and randomized them to Group A ( stylet replacement before needle removal ) and Group B ( needle removal without stylet replacement ) .


These patients were observed for the duration of @ hours in the hospital and they were checked for PDPH on the @ ( rd ) and the @ ( th ) day of the study .


Overall , the PDPH incidence was at @ % ( @ patients ) .


Thirty-three of these patients ( @ % ) who were in Group A ( stylet replacement before needle removal ) and the other @ patients ( @ % ) who were in Group B ( needle removal without stylet replacement ) experienced PDPH .


There was no significant difference between the two groups with respect to the PDPH .


In contrary to the diagnostic lumbar puncture , reinsertion of the stylet after spinal anesthesia with @-gauge Quincke needles does not reduce the incidence of PDPH .


Increased sympathetic activation and reduced parasympathetic tone are important pathophysiological contributors to the progression of heart failure , and are associated with poor outcome in patients .


The aim of this study is to determine if vagal nerve stimulation ( VNS ) is a promising approach to modulate autonomic function and slow cardiac remodelling and the progression of heart failure .


The NECTAR-HF ( NEural Cardiac TherApy foR Heart Failure ) trial is designed to evaluate whether the Boston Scientific VNS device is safe and may attenuate cardiac remodelling , improve cardiac function and increase exercise capacity , in symptomatic heart failure patients ( New York Heart Association Class II-III ) with left ventricular systolic dysfunction ( ejection fraction @ % ) and receiving optimal medical therapy .


Patients will be randomized in a @:@ ratio to receive standard optimal medical treatment plus VNS system in an active mode vs. optimal medical treatment plus VNS system in an inactive mode , for a @month period .


After the @month control period , inactive VNS systems will be activated and all patients will receive VNS .


The study is powered to detect differences in the primary efficacy endpoint of change in left ventricular end systolic diameter .


Secondary endpoints include ejection fraction , left ventricular volumes , quality of life scores , functional capacity , and changes in biomarkers .


This Phase II , randomized clinical trial conducted with vagal stimulation for heart failure will provide important new information on the potential of this novel and promising technique .


Proton pump inhibitors ( PPIs ) are affected by cytochrome P@ @C@ ( CYP@C@ ) polymorphisms .


This study compared the effect of two PPIs on early symptom relief in Japanese patients with reflux esophagitis , classified by the CYP@C@ phenotype .


Patients with reflux esophagitis were randomised to treatment with omeprazole @ mg or rabeprazole @ mg once daily .


The CYP@C@ phenotype -LSB- homozygous extensive metaboliser ( homoEM ) , heterozygous extensive metaboliser ( heteroEM ) or poor metaboliser ( PM ) -RSB- of each patient was determined .


The primary efficacy endpoint was early , sufficient ( Global Overall Symptom scale score @ or @ ) , sustained ( maintained for @ days ) reflux symptom relief .


Of the @ patients included in this analysis , the proportion achieving sufficient , sustained reflux symptom relief was higher with omeprazole than with rabeprazole on day @ ( @ vs. @ % ; p = @ ) and day @ ( @ vs. @ % ; p = @ ) ; there was no significant difference between the two groups on days @-@ .


Among patients with the CYP@C@ PM phenotype , sufficient , sustained reflux symptom relief was higher with omeprazole than with rabeprazole on days @-@ ( @-@ @ vs. @ % ; p @ ) ; differences were not significant on days @-@ , or among those with the homoEM or heteroEM phenotypes on days @-@ .


In Japanese patients with reflux esophagitis , omeprazole @ mg is more effective than rabeprazole @ mg at achieving early , sufficient , sustained reflux symptom relief in individuals with the CYP@C@ PM phenotype , and is similarly effective to rabeprazole @ mg in those with heteroEM or homoEM phenotypes .


Negative affect , alcohol consumption , and presence of others smoking have consistently been implicated as risk factors for smoking lapse and relapse .


What is not known , however , is how these factors work together to affect smoking outcomes .


This paper uses ecological momentary assessment ( EMA ) collected during the first @ days of a smoking cessation attempt to test the individual and combined effects of high-risk triggers on smoking urge and lapse .


Participants were @ female smokers who enrolled in a study that tested an individually tailored smoking cessation treatment .


Participants completed EMA , which recorded negative affect , alcohol consumption , presence of others smoking , smoking urge , and smoking lapse , for @ days starting on their quit date .


Alcohol consumption , presence of others smoking , and negative affect were , independently and in combination , associated with increase in smoking urge and lapse .


The results also found that the relationship between presence of others smoking and lapse and the relationship between negative affect and lapse were moderated by smoking urge .


The current study found significant individual effects of alcohol consumption , presence of other smoking , and negative affect on smoking urge and lapse .


Combing the triggers increased smoking urge and the risk for lapse to varying degrees , and the presence of all @ triggers resulted in the highest urge and lapse risk .


To evaluate whether adding functional exercise training to standard physiotherapy during residential slow-stream rehabilitation ( SSR ) improves discharge outcomes and functional ability .


Randomized controlled trial .


A regional hospital .


Older people ( N = @ ) admitted to SSR .


All participants received standard physiotherapy .


An individualized functional incidental training ( FIT ) program was implemented for intervention participants consisting of @ extra episodes of functional exercise daily for the period of SSR .


Research assistants visited twice weekly to practice and progress FIT programs .


Outcome measures included discharge destination , participant-expected discharge destination , and functional tests of the Berg Balance Scale ( BBS ) , de Morton Mobility Index ( DEMMI ) , and @ times sit-to-stand test ( FTSTS ) at admission and discharge .


Fifty-two participants completed the study .


At baseline , the SSR group achieved higher scores on the BBS , DEMMI , and FTSTS .


There was no significant difference in discharge destination between groups ( P = @ ) .


The difference in functional change between groups from admission to discharge on the BBS , DEMMI , and FTSTS was not significant .


Participant-expected discharge destination was significantly associated with eventual discharge destination ( @ ( @ ) = @ , P = @ ) .


Adding FIT to standard physiotherapy did not improve discharge outcomes and did not have a statistically significant effect on function , but may have a small effect on balance .


Patient expected and actual discharge destinations were associated .


The aim of this study was to investigate the site-specific effects of repetitive transcranial magnetic stimulation ( rTMS ) on freezing of gait ( FOG ) in patients with parkinsonism .


Twenty patients with parkinsonism and FOG were included .


A single session of @ Hz rTMS was applied over three different cortical regions of the dominant hemisphere : the primary motor cortex of the lower leg ( M@-LL ) , the supplementary motor area ( SMA ) , and the dorsolateral prefrontal cortex ( DLPFC ) .


We also performed sham stimulation as a control .


The Timed Up and Go ( TUG ) test , Turn Steps and Turn Time in @ turning , Unified Parkinson 's Disease Rating Scale ( UPDRS ) part III , FOG Questionnaire ( FOG-Q ) , and motor evoked potential ( MEP ) studies were performed before and after each intervention .


There were significant improvements in TUG test times after rTMS over the M@-LL and the DLPFC .


Improvement was significantly greater after the M@-LL stimulation than sham condition .


The M@-LL and DLPFC stimulation also resulted in significant improvements in both the number of Turn Steps and Turn Time .


UPDRS-III scores were significantly decreased after the M@-LL and DLPFC stimulation .


Use of @ Hz rTMS on the M@-LL and DLPFC is therapeutically effective for FOG in patients with parkinsonism .


Although transnasal endoscopy ( TNE ) is generally a comfortable and safe procedure , it has some disadvantages , such as complicated preprocessing and occasional repulsion reaction during catheterization .


In an attempt to simplify the preprocessing method , the efficacy of a catheter-free method in which a catheter is not inserted into the nasal cavity was assessed .


The present study was a prospective , open-label , single-center , randomized controlled study with parallel assignment allocation @:@ .


Between March @ and August @ , a total of @ TNE-nave patients were enrolled and randomized .


Patients were prospectively randomized into two groups ( catheter-free vs catheter-insertion method ) .


Patients who prepared according to the catheter-free method and who were unsuccessful underwent the catheter-insertion method .


Clinical characteristics , success rate , complications , vital signs , acceptability , and tolerability were assessed and compared .


Success rates of the catheter-free and catheter-insertion methods were @ % ( n = @ ) and @ % ( n = @ ) ( P > @ ) , respectively .


Causes of failure in the catheter-free method included severe rhinalgia ( n = @ , @ % ) and narrowing of the nasal cavity ( n = @ , @ % ) .


Causes of failure in the catheter-insertion method included narrowing of the nasal cavity ( n = @ , @ % ) .


Six patients whose TNE failed with the catheter-free method also experienced failed TNE with the catheter-insertion method .


There were no statistical differences in vital signs , acceptability , and tolerability .


The catheter-free method is sufficient for preparation for TNE .


The success rate of TNE depends more on the structure of the nasal cavity than the preprocessing method .


Subclinical diabetic cardiomyopathy ( DCM ) is frequent in asymptomatic subjects with type @ diabetes ( T@DM ) .


We sought the response of functional and fibrosis markers to therapy in a trial of aldosterone antagonism for treatment of DCM .


Biochemical , anthropometric , and echocardiographic data were measured in @ subjects with T@DM .


Myocardial function was evaluated with standard echocardiography and myocardial deformation ; ischaemia was excluded by exercise echocardiography .


Calibrated integrated backscatter and post-contrast T@ mapping from cardiac magnetic resonance imaging were used to assess myocardial structure .


Amino-terminal propeptides of pro-collagen type I ( PINP ) and III ( PIIINP ) , the carboxy-terminal propeptide of pro-collagen type I ( PICP ) and transforming growth factor beta-@ were measured from peripheral blood or urine to assess myocardial collagen turnover .


Diastolic dysfunction was identified in @ individuals , of whom @ ( @ male , age @ @ years ) were randomized to spironolactone @ mg/day or placebo therapy for @ months .


Groups were well-matched at baseline .


Spironolactone therapy was associated with improvements in diastolic filling profile ( peak E wave velocity -@ @ vs. @ @ ms , P = @ ; E/A ratio -@ @ vs. @ @ , P < @ ) and cIB values ( -@ @ dB vs. -@ @ dB , P = @ ; cIB -@ @ vs. -@ @ , P = @ ) .


cIB was independently associated with spironolactone therapy ( = @ , P = @ ) but not blood pressure .


With intervention , pro-collagen biomarkers ( PINP P = @ , PICP P = @ , PIIINP P = @ , and TGF-@ P = @ ) and T@ values ( P = @ ) remained similar between groups .


Spironolactone-induced changes in myocardial structure and diastolic properties in DCM are small , and are unassociated with changes in collagen biomarkers or T@ values .


The burden of acute gastroenteritis on children and their families continues to be enormous .


Probiotics , defined as viable microbial preparations that have a beneficial effect on the health of the host , represent a rapidly expanding field .


Although clinical trials in children with gastroenteritis have been performed , most have significant flaws , and guidelines do not consistently endorse their use .


PROGUT is a randomized , placebo-controlled , double-blind , five-center , Canadian , emergency department trial .