The intervention resulted in a statistically significant reduction in restraint use measured in the early mornings ( P = @ ) , and this trend continued after adjusting for unit and month ( P = @ ) .


Similarly , the rate of restraint use trended down at all other measured time periods but was not statistically significant .


A limited number of individuals had an order for physical restraint within their electronic medical record ( @ % before , @ % after the intervention ) .


The median number of monthly fall reports did not change ( three before , three after ; P = @ ) .


A multicomponent team-focused quality improvement intervention has the potential to decrease the use of physical restraints in older hospitalized adults .


To evaluate the effect of neck coordination exercise on sensorimotor function in women with neck pain compared with best-available treatment and sham treatment .


Observer-blinded randomized controlled trial with short-term and @-month follow-ups .


Women with chronic non-specific neck pain were randomized to @ groups : neck coordination exercise with a novel training device ; strength training for the neck and shoulders ; or massage .


Each group had @ participants .


The intervention period was @ weeks with @ individually supervised sessions .


Primary outcomes were postural sway measures and precision of goal-directed arm movements .


Secondary outcomes were range of motion for the neck , peak speed of axial rotation , and neck pain .


A repeated measures multivariate analysis of variance ( MANOVA ) was conducted separately on the primary outcomes for the short-term and @-month evaluations and on the sensorimotor secondary outcomes for the @-month effect .


The @-month effect on pain was analysed with a repeated measures analysis of variance ( ANOVA ) .


No significant treatment effects in favour of neck coordination exercise were found for short-term or @-month evaluations .


Neck coordination exercise is no better than strength training and massage in improving sensorimotor function .


Further research should investigate the use of cut-offs for sensorimotor dysfunctions prior to proprioceptive or coordinative training .


Opioids improve pain from knee and hip osteoarthritis ( OA ) and decrease the functional impairment of patients .


However , there is a possibility that opioids induce analgesia and suppress the physiological pain of OA in patients , thereby inducing the progression of OA changes in these patients .


The purpose of the current study was to investigate the possibility of progressive changes in OA among patients using opioids .


Two hundred knee or hip OA patients were evaluated in the current prospective , randomized , active-controlled study .


Patients were randomized @:@:@ into three parallel treatment groups : loxoprofen , tramadol/acetaminophen , and transdermal fentanyl groups .


Medication was administered for @ weeks .


Pain scores and progressive OA changes on X-ray films were evaluated .


Overall , pain relief was obtained by all three groups .


Most patients did not show progressive OA changes ; however , @ patients in the transdermal fentanyl group showed progressive OA changes during the @ weeks of treatment .


These @ patients used significantly higher doses than others in the transdermal fentanyl group .


Additionally , the average pain score for these @ patients was significantly lower than the average pain score for the other patients in the transdermal fentanyl group .


Fentanyl may induce progressive changes in knee or hip OA during a relatively short period , compared with oral Non-Steroidal Anti-Inflammatory Drugs or tramadol .


Probiotics are live microorganisms that may confer health benefits on the host .


Recent trials of probiotic use among healthy pregnant women demonstrate potential for improved glycemic control .


The aim of this study was to investigate the effects of a probiotic capsule intervention on maternal metabolic parameters and pregnancy outcome among women with gestational diabetes .


This double-blind placebo-controlled randomized trialrecruited pregnant women with a new diagnosis of gestational diabetes or impaired glucose tolerance following a @-hour @-g glucose tolerance test .


Women were randomized to a daily probiotic ( Lactobacillus salivarius UCC@ ) or placebo capsule from diagnosis until delivery .


Fasting blood samples were collected at baseline and @-@ weeks after capsule commencement for analysis of glucose , insulin , c-peptide , and lipids .


The primary outcome was difference in fasting glucose postintervention , first analyzed on an intention-to-treat basis and followed by per-protocol analysis that excluded women commenced on pharmacological therapy ( insulin or metformin ) .


Secondary outcomes were changes in insulin , c-peptide , homeostasis model assessment and lipids , requirement for pharmacological therapy , and neonatal anthropometry .


Of @ women recruited and randomized , there were nodifferences between the probiotic and placebo groups in postintervention fasting glucose ( @ @ vs @ @ mmol/L ; P = @ ) , requirement for pharmacological therapy ( @ % vs @ % ; P = @ ) , or birthweight ( @ @ vs @ @ kg ; P = @ ) .


Among @ women managed with diet and exercise alone , fastingplasma glucose decreased significantly within both the probiotic ( @ @ to @ @ mmol/L ; P < @ ) and placebo ( @ @ to @ @ mmol/L ; P < @ ) groups , but the levels between groups did not differ ( P = @ ) .


The late gestation-related rise in totaland low-density lipoprotein ( LDL ) cholesterol was attenuated in theprobiotic vs the placebo group ( +@ @ vs +@ @ mmol/L total cholesterol , P = @ ; +@ @ vs +@ @ mmol/L LDL cholesterol , P = @ ) .


No differences were notedbetween groups in other metabolic parameters or pregnancy outcome .


A probiotic capsule intervention among women with abnormal glucose tolerance had no impact on glycemic control .


The observed attenuation of the normal pregnancy-induced rise in total and LDL cholesterol following probiotic treatment requires further investigation , particularly in this obstetric group at risk of future metabolic syndrome .


Various designs of braces including hinged and nonhinged models are used to provide external support of the ankle .


Hinged ankle braces supposedly allow almost free dorsiflexion and plantar flexion of the foot in the sagittal plane .


It is unclear , however , whether this additional degree of freedom affects the stabilizing effect of the brace in the other planes of motion .


To investigate the dynamic and passive stabilizing effects of @ ankle braces , @ hinged models that provide free plantar flexion-dorsiflexion in the sagittal plane and @ ankle brace without a hinge .


Crossover study .


University Movement Analysis Laboratory .


Seventeen healthy volunteers ( @ women , @ men ; age = @ @ years ; height = @ @ cm ; body mass = @ @ kg ) .


We dynamically induced foot inversion on a tilting platform and passively induced foot movements in @ directions via a custom-built apparatus in @ brace conditions and a control condition ( no brace ) .


Maximum inversion was determined dynamically using an in-shoe electrogoniometer .


Passively induced maximal joint angles were measured using a torque and angle sensor .


We analyzed differences among the @ ankle-brace conditions ( @ braces , @ control ) for each of the dependent variables with Friedman and post hoc tests ( P < @ ) .


Each ankle brace restricted dynamic foot-inversion movements on the tilting platform as compared with the control condition , whereas only the @ hinged ankle braces differed from each other , with greater movement restriction caused by the Ankle X model .


Passive foot inversion was reduced with all ankle braces .


Passive plantar flexion was greater in the hinged models as compared with the nonhinged brace .


All ankle braces showed stabilizing effects against dynamic and passive foot inversion .


Differences between the hinged braces and the nonhinged brace did not appear to be clinically relevant .


Untreated postoperative urinary retention can result in permanent lower urinary tract dysfunction and can be prevented by timely bladder catheterization .


The author hypothesized that the incidence of postoperative bladder catheterization can be decreased by using the patient 's own maximum bladder capacity ( MBC ) instead of a fixed bladder volume of @ ml as a threshold for catheterization .


Randomized parallel-arm and single-blinded comparative effectiveness trial conducted in @,@ surgical patients , operated under general or spinal anesthesia without an indwelling urinary catheter .


Patients were randomized to either use their individual MBC ( index ) or a fixed bladder volume of @ ml ( control ) as a threshold for postoperative bladder catheterization .


Preoperatively , the MBC was determined at home by voiding in a calibrated bowl .


All other bladder volumes were measured by ultrasound .


Postoperatively , bladder catheterization was performed when spontaneous voiding was impossible , and the ultrasound measurement exceeded the threshold for the group in which the patient was randomized ( @ or MBC ) .


The primary outcome was the incidence of bladder catheterization .


The average MBC in the control group was @ ml ( @ ml ) and in the index group @ ml ( @ ml ) .


The incidence of catheterization decreased from @ % ( @ of @ patients ) in the control group to @ % ( @ of @ ) in the index group ( relative risk @ , @ % CI @ to @ , P = @ ) .


There were no adverse events in either group .


In patients undergoing surgery under general or spinal anesthesia using the MBC rather than a fixed @ ml threshold for bladder catheterization is a safe approach that significantly reduces the incidence of postoperative bladder catheterizations .


To improve the therapeutic index of whole-brain radiation therapy ( WBRT ) in the treatment of brain metastases ( BM ) from breast cancer , we investigated the efficacy and safety of WBRT combined with temozolomide ( TMZ ) in this population .


This phase II multicenter prospective randomized study included patients with newly diagnosed intraparenchymal BMs from breast cancer , unsuitable for surgery or radiosurgery .


All patients received conformal WBRT ( @ Gy @-@ Gy ) , with or without concomitant TMZ administered at a dosage of @ mg/m ( @ ) / day during the irradiation period .


The primary end point was objective response rate ( ORR ) @ weeks after the end of treatment , defined as a partial or complete response on systematic brain MRI ( modified WHO criteria ) .


Secondary end points were progression-free survival ( PFS ) and overall survival ( OS ) , neurologic symptoms , and tolerability .


Between February @ and November @ , @ patients were enrolled in the study ( @ in the WBRT + TMZ arm , @ in the WBRT arm ) .


Median age was @ years ( @-@ ) .


Median follow-up was @ months -LSB- @-@ @ -RSB- .


ORRs at @ weeks were @ % in the WBRT arm and @ % in the WBRT + TMZ arm ( NS ) .


In the WBRT arm , median PFS was @ months and median OS was @ months .


In the WBRT + TMZ arm , median PFS was @ months and median OS was @ months .


Treatment was well tolerated in this arm : the most common grade @ acute toxicity was reversible lymphopenia .


WBRT combined with TMZ did not significantly improve local control and survival in patients with BMs from breast cancer .


CLINICALTRIALS.GOV : NCT@ .


The aim was to evaluate the agreement between and the reproducibility of transperineal and transvaginal ultrasound cervical length measurements performed by the duty obstetrical team in case of preterm labor .


The acceptability of transperineal ultrasonography was also assessed .


Pregnant patients between @ and @weeks of gestation with contractions and a clinically modified cervix were included .


Order of ultrasonography examination ( transperineal or transvaginal first ) and rank of operator ( resident or senior ) were allocated randomly .


Agreement was assessed using the intraclass correlation coefficient ( ICC ) and the Bland and Altman plot .


The patient 's discomfort and preference for either method were assessed with a questionnaire .


@ patients admitted for preterm labor between @ and @weeks of gestation were included .


Six seniors and nine residents took part in the study .


Among the @ patients with an interpretable transperineal ultrasound scan , median cervical length measurements with the transperineal and the transvaginal technique were , respectively , @mm ( @-@ ) and @mm ( @-@ ) .


Concordance was good with an ICC of @ -LSB- IC @ % = ( @-@ @ ) -RSB- .


Transperineal ultrasonography was preferred in @ % of cases .


In case of preterm labor , cervical length measurement with transperineal ultrasonography seems reproducible and can be performed by the obstetric team on duty .


To determine if intervention school students who received skills-based breast self-exam ( BSE ) / testicular self-exam ( TSE ) training were more likely than control school students to report higher intentions to perform BSE/TSE , greater BSE/TSE self-efficacy , and actual performance of BSE/TSE .


BSE/TSE behaviors , intentions , and self-efficacy were assessed in a high school-based trial ( N = @ schools ; @ schools randomized/condition ) using self-reported data at @ time points ( N = @ , @ th grade students ) .


At follow-up , intervention students had greater BSE/TSE intentions and self-efficacy than control students .


Intervention students were more likely than control students to report monthly BSE ( @ % vs @ % , p = @ ) and TSE ( @ % vs @ % , p = @ ) .


Skills-based interventions with goal setting affect teenagers ' self-examination behaviors , intentions , and self-efficacy .


Teaching self-screening may empower teenagers to become more engaged in their preventive health , which may lead to improved health as they age .


Knowing how commonly used drugs affect performance monitoring is of great importance , because drug use is often associated with compromised behavioral control .


Two of the most commonly used recreational drugs in the western world , @,@-methylenedioxymethamphetamine ( MDMA or `` ecstasy '' ) and ethanol ( alcohol ) , are also often used in combination .


The error-related negativity ( ERN ) , correct-related negativity ( CRN ) , and N@ are electrophysiological indices of performance monitoring .


The present study aimed to investigate how ethanol , MDMA , and their co-administration affect performance monitoring as indexed by the electrophysiological correlates .


Behavioral and EEG data were obtained from @ healthy volunteers during execution of a speeded choice-reaction-time task after administration of ethanol , MDMA , and combined ethanol and MDMA , in a double-blind , placebo-controlled , randomized crossover design .


Ethanol significantly reduced ERN amplitudes , while administration of MDMA did not affect the ERN .


Co-administration of MDMA and ethanol did not further impair nor ameliorate the effect of ethanol alone .


No drug effects on CRN nor N@ were observed .


A decreased ERN following ethanol administration is in line with previous work and offers further support for the impairing effects of alcohol intoxication on performance monitoring .


This impairment may underlie maladaptive behavior in people who are under influence .


Moreover , these data demonstrate for the first time that MDMA does not affect performance monitoring nor does it interact with ethanol in this process .


These findings corroborate the notion that MDMA leaves central executive functions relatively unaffected .


We examined the effect of two interventions on both the reliability and validity of regulatory judgments : adjusting the regulatory instrument and attending a consensus meeting .


We adjusted the regulatory instrument .


With a randomized controlled trial ( RCT ) we examined the effect of the adjustments we made to the instrument .


In the consensus meeting inspectors discussed cases and had to reach consensus about the order of the cases .


We used a before and after case study to assess the effect of the consensus meeting .


We compared the judgments assigned in the RCT with the unadjusted instrument with the judgments assigned with the unadjusted instrument after the consensus meeting .


Moreover we explored the effect of increasing the number of inspectors per regulatory visit based on the estimates of the two interventions .


The consensus meeting improved the agreement between inspectors ; the variance between inspectors was smallest ( @ ) and the reliability coefficient was highest ( @ ) .


Validity is assessed by examining the relation between the assigned judgments and the corporate standard and expressed by a correlation coefficient .


This coefficient was highest after the consensus meeting ( @ ) .


Adjustment of the instrument did not increase reliability and validity coefficients .


Participating in a consensus meeting improved reliability and validity .


Increasing the number of inspectors resulted in both higher reliability and validity values .


Organizing consensus meetings and increasing the number of inspectors per regulatory visit seem to be valuable interventions for improving regulatory judgments .


Falls are a major problem in hospitals and nursing homes .


The consequences of falls can be severe , both for the individual and for the caring institution .


The aim of the work presented here is to reduce the number of falls on a geriatric ward by monitoring patients more closely .


To achieve this goal , a bed-exit alarm that reliably detects an attempt to get up has been constructed .


A requirements analysis revealed the nurses ' and physicians ' needs and preferences .


Based on the gathered information , an incremental design process generated different prototypes .


These were tested for the reliability of their ability to detect attempts to get up in both laboratory settings and with geriatric patients .


Based on the result of these tests , a scalable technical solution has been developed and proven its reliability in a @-year , randomized controlled pilot clinical trial on a geriatric ward .


The developed system is unobtrusive and easy to deploy .


It has been tested in laboratory settings , usability tests and a @-year randomized clinical trial with @ patients .


This paper focuses on the technical development of the system .


We present different prototypes , the experiments and the pilot study used to evaluate their performance .


Last but not least , we discuss the lessons learned so far .


The developed bed-exit alarm is able to reliably detect patients ' attempts to get up .


The results of the clinical trial show that the system is able to reduce the number of falls on a geriatric ward .


Next steps are the design of a specialized sensor node that is easier to use and can be applied on an even larger scale due to its reduced cost .


A multicenter trial with a larger number of patients is required to confirm the results of this pilot study .


To determine the effects of Yishenjiangzhuo granules ( YJG ) on bone metabolism and to explore the changes in levels of bone Gla protein ( BGP ) , tartrate-resistant acid phosphatase ( TRAP ) , as well as their relationships with levels of B cells , regulatory T cells ( Treg ) and interleukin ( IL ) -@ in patients with stage @-@ chronic kidney disease ( CKD ) before and after treatment .


Fifty-three stage @-@ CKD patients were divided randomly into two groups : YJG treatment and control .


Peripheral blood was taken from two groups of CKD patients and @ healthy subjects in the normal group .


The parameters determined were the levels of CD@ + , CD@ + , CD@ + CD@ + , CD@ + av , Treg ( CD@ + CD@ + CD@lo ) , BGP , TRAP , IL-@ , calcium , phosphate , blood urea nitrogen , serum creatinine ( SCr ) , hemoglobin ( Hb ) in peripheral blood , and urinary creatinine .


Calcium-phosphate products and endogenous creatinine clearance rate ( CCr ) were calculated according to standard protocols .


In YJG and control groups , SCr levels were lowered ( P < @ ) after treatment , whereas CCr ( P < @ ) as well as Hb and albumin levels ( P < @ ) were increased .


The changes in levels of CCr and SCr in the YJG group were more significant .


After treatment , CD@ + CD@ + and Treg levels in the two groups varied ( P < @ ) compared with those of the normal group ; the level of CD@ + increased but the levels of CD@ + and CD@ + AV decreased ( P < @ ) in both groups .


Compared with the control group , the changes of CD@ + and CD@ + AV in the YJG group were more apparent ( P < @ ) .


Compared with the normal group , levels of IL-@ in both groups increased significantly ( P < @ ) , and the difference in the control group was more significant ( P < @ ) .


After treatment , the TRAP level increased ( P < @ ) , but the difference in BGP level ( P > @ ) was not significant .


In stage @-@ CKD patients , B cells and IL-@ participated in the induction of osteoclast activation .


YJG could also elevate the level of B cells and decrease their apoptosis , but showed no significant effects on active B cells , IL-@ or osteoclast activity .


To investigate whether uterus preserving vaginal sacrospinous hysteropexy is non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments in the surgical treatment of uterine prolapse .


Multicentre randomised controlled non-blinded non-inferiority trial .


@ non-university teaching hospitals , the Netherlands .


@ healthy women with uterine prolapse stage @ or higher requiring surgery and no history of pelvic floor surgery .


Treatment with sacrospinous hysteropexy or vaginal hysterectomy with suspension of the uterosacral ligaments .


The predefined non-inferiority margin was an increase in surgical failure rate of @ % .


Primary outcome was recurrent prolapse stage @ or higher of the uterus or vaginal vault ( apical compartment ) evaluated by the pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at @ months ' follow-up .


Secondary outcomes were overall anatomical recurrences , including recurrent anterior compartment ( bladder ) and/or posterior compartment ( bowel ) prolapse , functional outcome , complications , hospital stay , postoperative recovery , and sexual functioning .


Sacrospinous hysteropexy was non-inferior for anatomical recurrence of the apical compartment with bothersome bulge symptoms or repeat surgery ( n = @ , @ % ) compared with vaginal hysterectomy with suspension of the uterosacral ligaments ( n = @ , @ % , difference -@ % , @ % confidence interval for difference -@ % to @ % ) .


At @ months , overall anatomical recurrences , functional outcome , quality of life , complications , hospital stay , measures on postoperative recovery , and sexual functioning did not differ between the two groups .


Five serious adverse events were reported during hospital stay .


None was considered to be related to the type of surgery .


Uterus preservation by sacrospinous hysteropexy was non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments for surgical failure of the apical compartment at @ months ' follow-up .


Lifestyle interventions affect patients ' risk factors for metabolic syndrome ( MeSy ) , a pre-stage to cardiovascular diseases , diabetes and related complications .


An effective lifestyle intervention is the Swedish Bjrkns intervention , a @-year randomized controlled trial in primary care for MeSy patients .


To include future disease-related cost and health consequences in a cost-effectiveness analysis , a simulation model was used to estimate the short-term ( @-year ) and long-term ( lifelong ) cost-effectiveness of the Bjrkns study .


A Markov micro-simulation model was used to predict the cost and quality-adjusted life years ( QALYs ) for MeSy-related diseases based on ten risk factors .


Model inputs were levels of individual risk factors at baseline and at the third year .


The model estimated short-term and long-term costs and QALYs for the intervention and control groups .


The cost-effectiveness of the intervention was assessed using differences-in-differences approach to compare the changes between the groups in the health care and societal perspectives , using a @ % discount rate .


A @ % confidence interval ( CI ) , based on bootstrapping , and sensitivity analyses describe the uncertainty in the estimates .


In the short-term , costs are predicted to increase over time in both groups , but less in the intervention group , resulting in an average cost saving/reduction of US$ -@ ( in @ , US$ @ = six point five seven SEK ) and US$ -@ , in the societal and health care perspectives .


The long-term estimate also predicts increased costs , but considerably less in the intervention group : US$ -@,@ ( @ % CI : US$ -@,@ to US$ -@,@ ) in the societal , and US$ -@,@ ( @ % CI : US$ -@,@ to US$ @,@ ) in the health care perspective .


As intervention costs were US$ @ per participant , the intervention would result in cost saving .


Furthermore , in the long-term an estimated @ QALYs ( @ % CI : @ to @ ) per participant would be gained .


The Swedish Bjrkns study appears to reduce demands on societal and health care resources and increase health-related quality of life .


The number of routine antenatal visits provided to low risk nulliparous women has been reduced in the UK , acknowledging this change in care may result in women being less satisfied with their care and having poorer psychosocial outcomes .


The primary aim of the study was to investigate whether the provision of proactive telephone support intervention ( TSI ) with and without uterine artery Doppler screening ( UADS ) would reduce the total number of antenatal visits required .


A secondary aim was to investigate whether the interventions affected psychological outcomes .


A three-arm randomised controlled trial involving @ low risk nulliparous women was conducted at a large maternity unit in North East England .


All women received antenatal care in line with current UK guidance .


Women in the TSI group ( T ) received calls from a midwife at @ , @ and @ weeks and women in the telephone and Doppler group ( T + D ) received the TSI and additional UADS at @ weeks ' gestation .


The main outcome measure was the total number of scheduled and unscheduled antenatal visits received after @ weeks ' gestation .


The median number of unscheduled ( n = @ ) , scheduled visits ( n = @ ) and mean number of total visits ( n = @ ) were similar in the three groups .


The majority ( @ % ) of additional antenatal visits were made to a Maternity Assessment Unit because of commonly occurring pregnancy complications .


Additional TSI + / - UADS was not associated with differences in clinical outcomes , levels of anxiety , social support or satisfaction with care .


There were challenges to the successful delivery of the telephone support intervention ; @ % of women were contacted at @ and @ weeks gestation reducing to @ % of women at @ weeks .


Provision of additional telephone support ( with or without UADS ) in low risk nulliparous women did not reduce the number of unscheduled antenatal visits or reduce anxiety .


This study provides a useful insight into the reasons why this client group attend for unscheduled visits .


To assess whether adding clopidogrel to acetylsalicylic acid ( ASA ) has a long-term protective vascular effect in patients with lacunar stroke while taking ASA .


Post hoc analysis of @ patients with ASA failure and recent lacunar stroke from the Secondary Prevention of Small Subcortical Strokes Trial ( SPS@ ) cohort randomly allocated to aspirin ( @ mg/day ) and clopidogrel ( @ mg/day ) or placebo .


Primary efficacy outcome was stroke recurrence ( ischemic and intracranial hemorrhage ) and main safety outcome was major extracranial hemorrhage .


Patients were followed for a mean period of @ years .


The ASA failure group had a significantly higher risk of vascular events including ischemic stroke when compared with the non-ASA failure group ( n = @,@ ) in SPS@ ( p = @ ) .


Mean age was @ years and @ % were men .


The risk of recurrent stroke was not reduced in the dual antiplatelet group , @ % per year , compared to the aspirin-only group , @ % per year ( hazard ratio -LSB- HR -RSB- @ ; @ % confidence interval -LSB- CI -RSB- @-@ @ ) .


There was also no difference between groups for ischemic stroke ( HR @ ; @ % CI @-@ @ ) .


The risk of gastrointestinal bleeding was higher in the dual antiplatelet group ( HR @ ; @ % CI @-@ @ ) ; however , the risk of intracranial hemorrhage was not different .


In patients with a recent lacunar stroke while taking ASA , the addition of clopidogrel did not result in reduction of vascular events vs continuing ASA only .


This study provides Class I evidence that for patients with recent lacunar stroke while taking ASA , adding clopidogrel as compared to continuing ASA alone does not reduce the risk of recurrent stroke .


To describe the perinatal and infant and early childhood morbidity associated with preterm premature rupture of membranes ( PROM ) in a cohort of twin pregnancies evaluated prospectively with neonatal follow-up to @ years of age .


This was a secondary analysis of a randomized controlled trial of magnesium sulfate for prevention of cerebral palsy .


Inclusion criteria were twin gestation with preterm PROM diagnosed between @@/@ and @@/@ weeks of gestation and planned expectant management .


Latency ( time from membrane rupture to delivery ) and perinatal outcomes were evaluated by gestational age at membrane rupture .


Long-term neonatal outcomes were also analyzed .


Among @ women who met inclusion criteria , the median gestational age at preterm PROM was @ weeks ( range @-@ @ weeks ) .


Approximately one-third of women achieved a latency of at least @ week .


Gestational age at preterm PROM ( odds ratio -LSB- OR -RSB- @ , @ % confidence interval -LSB- CI -RSB- @-@ @ for each week after @ weeks of gestation ) and cervical dilation at admission ( OR @ , @ % CI @-@ @ for each centimeter of dilation ) were inversely associated with a latency period of at least @ week .


There were no stillbirths ( @ % CI @-@ % ) , but the rate of neonatal mortality was @ per @,@ newborns ( @ % CI @-@ ) with a @ % cerebral palsy rate among survivors ( @ % CI @-@ @ % ) .


In twin pregnancies , preterm PROM from @ to @ weeks of gestation is associated with a neonatal mortality rate of @ % and an overall cerebral palsy rate of @ % .


A longer latency period is associated with less advanced cervical dilation and later gestational age at PROM .


LEVEL OF EVIEDENCE : II .


In the EINSTEIN DVT and EINSTEIN PE studies , the majority of patients received heparins to bridge the period during venous thromboembolism ( VTE ) diagnosis confirmation and the start of the study .


In contrast to vitaminK antagonists ( VKAs ) , rivaroxaban may not require initial heparin treatment .


To evaluate the effect of prestudy heparin on the efficacy and safety of rivaroxaban relative to enoxaparin/VKA , the @-month incidence of recurrent VTE , and the @-day incidence of major and nonmajor clinically relevant bleeding were compared in patients who did and did not receive prestudy heparin .


Of the @,@ patients randomized , @,@ ( @ % ) received prestudy heparin ( mean SD duration = rivaroxaban : @ -LSB- @ -RSB- days ; enoxaparin @ -LSB- @ -RSB- days ) , and @,@ ( @ % ) did not .


In patients who did not receive prestudy heparin , the incidences of recurrent VTE were similar in rivaroxaban ( @ of @ , @ % ) and enoxaparin/VKA ( @ of @ , @ % ) patients ( adjusted hazard ratio -LSB- HR -RSB- = @ ; @ % confidence interval -LSB- CI -RSB- = @ to @ ) .


The incidences of recurrent VTE were also similar in rivaroxaban ( @ of @,@ , @ % ) and enoxaparin/VKA ( @ of @,@ , @ % ) patients who did receive prestudy heparin ( adjusted HR = @ ; @ % CI = @ to @ ; pinteraction = @ ) .


The incidences of major or nonmajor clinically relevant bleeding with rivaroxaban were not significantly different from those with enoxaparin/VKA , either with ( @ of @,@ , @ % vs. @ of @,@ , @ % ; adjusted HR = @ ; @ % CI = @ to @ ) or without ( @ of @ , @ % vs. @ of @,@ % ; adjusted HR = @ ; @ % CI = @ to @ ; pinteraction = @ ) prestudy heparin .


Although the majority of patients in the EINSTEIN studies received prestudy heparin , there were no notable differences in treatment effect of rivaroxaban versus enoxaparin/VKA in those who did and did not receive it .


To compare , in an unselected population of nulliparous pregnant women , the postnatal effect of prenatal supervised pelvic floor muscle training with written instructions on postpartum urinary incontinence ( UI ) .


In a randomized controlled trial in two parallel groups , @ women were recruited from five university teaching hospitals in France and randomized during the second trimester of pregnancy .


The physiotherapy group received prenatal individually supervised exercises .


Both groups received written instructions about how to perform exercises at home .


Women were blindly assessed at baseline , end of pregnancy , and @ and @ months postpartum .


The primary outcome measured was UI severity , assessed with an International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score ( range @-@ ; @-@ is slight UI ) at @ months postpartum ; other outcomes were UI prevalence and pelvic floor troubles assessed using self-administered questionnaires .


To give a @-point difference in UI severity score , we needed @ women in each group ( standard deviation @ , = @ , = @ , and bilateral analysis ) .


Between February @ and June @ , @ women were randomized in the physiotherapy group and @ in the control group .


No difference was observed between the two groups in UI severity , prevalence , or pelvic floor troubles at baseline , end of pregnancy , and at @ and @ months postpartum .


At @ months postpartum , the primary outcome was available for @ women ( @ % ) ; mean UI severity was @ in the physiotherapy group compared with @ in the control group ( P = @ ) .


Prenatal supervised pelvic floor training was not superior to written instructions in reducing postnatal UI .


Human epidermal growth factor receptor @ ( HER@ ) amplification is present in a subgroup of gastroo-esophageal cancers ( GCs ) .


HER@ inhibition with trastuzumab has shown to improve outcomes in advanced disease .


Lapatinib ditosylate ( LAP ) , a dual anti-epidermal growth factor receptor ( EGFR ) and anti-HER@ tyrosine kinase inhibitor with preclinical activity against GC , has been approved in HER@-positive breast cancer .


We aimed to study the activity of LAP in HER@-amplified GC .


Patients ( pts ) with HER@-positive ( gene amplification or increased copy numbers based on predefined criteria ) advanced GC were randomly allocated @:@ to receive LAP @mg per day @-@ plus capecitabine ( CAP ) @mg/m ( @ ) on days @-@ of a @-day cycle or LAP @mg monotherapy day @-@ after having failed on a platinum-based first-line therapy .


HER@ status was assessed centrally .


The primary end-point was the objective response rate ( ORR ) as assessed by the investigator using Response Evaluation Criteria in Solid Tumors ( RECIST , version @ ) .


We aimed to include @ pts per arm to show an interesting response rate of @ % in either of the two arms .


@ pts were enrolled ( @ to LAP+CAP , @ to LAP ) .


Pts had received a median of three prior treatment lines .


@ pts in the LAP+CAP group ( @ % ) and @ pts in the LAP group ( @ % ) had received prior trastuzumab .


Only two pts ( @ % ; @ % confidence interval ( CI ) : @-@ @ ) , both in the LAP+CAP arm , achieved an objective response .


The study was closed prematurely for futility .


Median time to progression was @ ( @ % CI : @-@ ) days in the LAP group and @ ( @ % CI : @-@ ) days in the LAP+CAP group .


Other secondary efficacy end-points ( progression-free and overall survival ) were comparable in the two treatment groups .


Rates of diarrhoea were higher with LAP+CAP ( @ % ; @ % CI : @-@ ) compared to @ % ( @ % CI @-@ ) with LAP mono , whereas other adverse events were mostly similar between the groups ( @ -LSB- @ % -RSB- versus @ -LSB- @ % -RSB- ) .


Lapatinib showed insufficient activity in HER@-amplified pretreated advanced GC .


The safety profile of LAP or LAP+CAP was as expected with some more toxicity in the combination arm .


( ClinicalTrials.gov Identifier , NCT@ ) .


To determine if infrared laser acupuncture ( LA ) may have a specific effect in reducing pain and disability in treatment of chronic low back pain ( LBP ) .


This was a double-blind sham laser controlled trial performed in general practices in Perth , Western Australia .


The participants were @ adults with chronic non-specific LBP .


They were randomised to receive eight once-weekly treatments .


Laser machines ( @ mW , @ nm diode , power density @ W/cm ( @ ) ) stimulated points in three treatment groups : sham ( @ joules/point ) , low dose ( @ J/point ) and high dose ( @ joules/point ) .


Participants were followed-up at @ and @ weeks , and @ and @ months post treatment .


Primary outcomes were pain ( Numerical Pain Rating Scale ( NPRS ) ) and disability ( Oswestry Disability Inventory ( ODI ) ) at @ weeks post treatment .


Secondary outcomes included numerical rating scale for limitation of activity , global assessment of improvement , analgesic usage and adverse effects after treatment .


The analysis showed no difference between sham and the laser groups at @ weeks for pain or disability .


There was a significant reduction in mean pain and disability in all groups at @ weeks ( p < @ ) ; NPRS : sham ( -@ ( @ % CI -@ to -@ ) ) , low dose ( -@ ( -@ to -@ ) ) , high dose ( -@ ( -@ to -@ ) ) .


ODI : sham ( -@ ( -@ to -@ ) ) , low dose ( -@ , ( -@ to -@ ) ) , high dose ( -@ ( -@ to @ ) ) .


All secondary outcomes also showed clinical improvement over time but with no differences between groups .


LA using energy density range ( @-@ J/cm ( @ ) ) for the treatment of chronic non-specific LBP resulted in clinical improvement unrelated to laser stimulation .


Pelvic floor physical therapy ( PFPT ) is often used as a treatment of pelvic floor disorders and may improve function after pelvic reconstructive surgery .


However , the long-term impact of this modality is not understood .


This randomized controlled trial compared PFPT to the standard care in women undergoing vaginal reconstruction .


The intervention group received PFPT biweekly until @ weeks postoperatively , in conjunction with a physician assessment .


Control subjects underwent a physician assessment alone at all postoperative intervals .


The final follow-up was at @ weeks .


Physical examinations ( pelvic organ prolapse quantification assessment ) , intravaginal electromyography , voiding diaries , and validated questionnaires were completed by all subjects .


The primary outcome was change in the World Health Organization Quality of Life-BREF .


Forty-nine women completed the study , @ in the PFPT group and @ in the control group .


Although electromyography measures showed better muscular function in PFPT subjects after @ weeks , at @ months after surgery , this was no longer noted .


However , quality of life parameters improved for the entire sample at @ weeks , with no difference between groups .


Positive change from @ to @ weeks was also documented in scores on the Pelvic Floor Distress Inventory-@ ( P = @ ) and Pelvic Floor Impact Questionnaire-@ ( P = @ ) , corresponding with continued improvement in bladder symptoms .


Finally , Prolapse and Incontinence Sexual Questionnaire-@ and Female Sexual Function Index scores improved between @ and @ weeks , suggesting better sexual function overall with time elapsed from surgery .


Quality of life improves in all subjects after vaginal reconstructive surgery , with ongoing benefit between @ and @ months .


Nevertheless , standardized PFPT was not associated with differences at @ weeks in this cohort of women .


Prospective , randomized , controlled single-blind intervention trial .


Shock-absorbing insoles ( SAIs ) , compared with usual insoles , were hypothesized to result in larger increases in pressure pain threshold ( PPT ) after @ weeks of use .


Shock-absorbing insoles can decrease self-reported pain among young soccer players training on artificial turf .


However , nothing is known about the underlying changes in pain sensitivity assessed by PPT .


Methods Seventy-five players were included from the youth teams of under @ , under @ , and under @ years of age , playing for the Aalborg Boldspilklub ( AaB ) professional sports club .


After a randomization stratified by team and age , players were divided into @ groups , one that received SAIs and a control group that used their usual insoles .


Assessments were made in both groups after @ weeks of training on artificial turf ( baseline ) and @ weeks later ( follow-up ) .


The primary outcome was change in PPTs from baseline to follow-up , with PPTs measured over @ locations on the plantar surface of the foot , leg , and low back of the nonpreferred kicking leg .


A significantly larger increase was found in PPTs from baseline to follow-up for the SAI group compared with the control group ( mean difference , @ kPa ; @ % confidence interval -LSB- CI -RSB- : @ , @ kPa ) .


The PPTs increased significantly more among the SAI group compared with the control group ( P < @ ) for the abductor digiti minimi ( mean difference , @ kPa ; @ % CI : @ , @ kPa ) , tibialis anterior ( mean difference , @ kPa ; @ % CI : @ , @ kPa ) , medial gastrocnemius ( mean difference , @ kPa ; @ % CI : -@ , @ kPa ) , and erector spinae ( mean difference , @ kPa ; @ % CI : -@ , @ kPa ) .


The use of SAIs resulted in increased PPTs after @ weeks of training on artificial turf compared with controls , suggesting a protective role of SAIs in pressure sensitivity and pain perception .


The effectiveness of risk stratification for low back pain ( LBP ) management has not been demonstrated in outpatient physical therapy settings .


The purposes of this study were : ( @ ) to assess implementation of a stratified care approach for LBP management by evaluating short-term treatment effects and ( @ ) to determine feasibility of conducting a larger-scale study .


This was a @-phase , preliminary study .


In phase @ , clinicians were randomly assigned to receive standard ( n = @ ) or stratified care ( n = @ ) training .


Stratified care training included @ hours of content focusing on psychologically informed practice .


Changes in LBP attitudes and beliefs were assessed using the Pain Attitudes and Beliefs Scale for Physiotherapists ( PABS-PT ) and the Health Care Providers Pain and Impairment Relationship Scale ( HC-PAIRS ) .


In phase @ , clinicians receiving the stratified care training were instructed to incorporate those strategies in their practice and @-week patient outcomes were collected using a numerical pain rating scale ( NPRS ) , and the Oswestry Disability Index ( ODI ) .


Study feasibility was assessed to identify potential barriers for completion of a larger-scale study .


In phase @ , minimal changes were observed for PABS-PT and HC-PAIRS scores for standard care clinicians ( Cohen d = @-@ @ ) .


Decreased biomedical ( -@ points , d = @ ) and increased biopsychosocial ( +@ points , d = @ ) treatment orientations were observed for stratified care clinicians , with these changes sustained @ months later on the PABS-PT .


In phase @ , patients receiving stratified care ( n = @ ) had greater between-group improvements in NPRS ( @ points ; @ % confidence interval = @ , @ ; d = @ ) and ODI ( @ % points ; @ % confidence interval = @ , @ ; d = @ ) scores compared with patients receiving standard physical therapy care ( n = @ ) .


In phase @ , treatment was not randomly assigned , and therapist adherence to treatment recommendations was not monitored .


This study was not adequately powered to conduct subgroup analyses .


In physical therapy settings , biomedical orientation can be modified , and risk-stratified care for LBP can be effectively implemented .


Findings from this study can be used for planning of larger studies .


The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft ( SAVE RITA ) trial was designed to evaluate the noninferiority of the saphenous vein ( SV ) compared with the right internal thoracic artery ( -LSB- R -RSB- ITA ) used as a Y-composite graft .


A total of @ patients who had undergone off-pump revascularization for multivessel coronary artery disease using the SV or RITA as a Y-composite graft based on the in situ left ITA were assigned randomly to the SV Y-composite graft ( SV group , n = @ ) or free RITA Y-composite graft ( RITA group , n = @ ) .


The primary endpoint was the @-year angiographic patency rate of the second limb conduits ( SV or RITA ) .


Postoperative @-year coronary angiograms were performed in @ patients ( SV group , @ ; RITA group , @ ) .


The overall graft patency rate was @ % ( @ of @ ) at @ year ( @ % in the SV group vs @ % in the RITA group , P = @ ) .


The primary endpoint of the study , the @-year patency rate of the SV composite grafts , was @ % ( @ of @ ) and was noninferior to that of the RITA composite grafts ( @ % -LSB- @ of @ -RSB- ) with a @ % lower confidence limit of -@ % ( P < @ for noninferiority ) .


The graft qualities , evaluated using the FitzGibbon patency grades , were also similar between the @ groups ( P = @ ) .


No statistically significant differences were found in the overall survival rates between the @ groups at @ and @ years ( P = @ ) .


Also , no statistically significant differences were found between the @ groups in the freedom from major adverse cardiac and cerebrovascular event rates at @ and @ years ( P = @ ) .


The SV composite grafts were noninferior to the RITA composite grafts in terms of the @-year angiographic patency rates .


The control of bleeding after tooth extraction is a major concern in patients taking warfarin .


Light-emitting diode ( LED ) irradiation with hemostatic gelatin sponge application was investigated .


Patients who took warfarin and required tooth extraction were divided randomly into @ groups .


The first group was irradiated with blue-violet LED after tooth extraction .


The second group was treated with a hemostatic gelatin sponge and LED irradiation .


The third group was treated with only hemostatic gelatin sponges .


Hemostasis was evaluated at @ seconds after treatment .


Less than @ % of the patients achieved hemostasis within @ seconds in the hemostatic sponge group ; approximately @ % of the patients in the simple LED irradiation group achieved hemostasis within @ seconds ; and @ % of the patients in the LED and hemostatic sponge combined group achieved hemostasis within @ seconds , indicating that combined treatment with LED and hemostatic sponges provided a significantly higher hemostasis than in the hemostatic sponge group ( P < @ ) .


Blue-violet LED irradiation combined with hemostatic gelatin sponge treatment yielded hemostasis of the extraction socket within @ seconds without suture in most cases .


It is unknown whether diets with a high dietary total antioxidant capacity ( TAC ) can modify oxidative stress , low-grade inflammation , or liver dysfunction , all of which are risk factors for multiple sclerosis disease .


This study assesses alanine amino-transferase ( ALT ) , aspartate-aminotransferase ( AST ) and gamma-glutamyl transferase ( GGT ) activities in MS patients treated with co-supplemented hemp seed and evening primrose oils as well as Hot-nature diet and the therapeutic potential this intervention .


In this double blind , randomized trial , @ MS patients with EDSS < @ were allocated into @ groups : `` group A '' , who received co-supplemented hemp seed and evening primrose oils with advised Hot-nature diet ; `` group B '' , who received olive oil ; and `` group C '' , who received the co-supplemented oils .


Clinically , EDSS as well as serum level of liver enzymes ( GGT , AST , and ALT ) were assessed at baseline and after @ months .


Mean follow-up was @ SD days ( N = @ , @ M and @ F aged @ years with disease duration of @ years ) .


There was no significant difference in the study parameters at baseline .


Serum levels of liver enzymes ( GGT , AST , and ALT ) were serially monitored .


Intervention was associated with liver function alteration in three groups .


Significance decreased in EDSS score and the levels of liver enzymes were found in groups A and C , whereas elevated serum liver enzymes and EDSS score were observed in group B after the intervention .


Selecting foods according to their Total antioxidant capacity such as co-supplemented hemp seed and evening primrose oils with Hot-nature diet affects antioxidant intake and can have beneficial effects on improving EDSS score and activity of liver enzymes in RRMS patients .


Soy isoflavone supplements are used to treat several chronic diseases , although the data supporting their use are limited .


Some data suggest that supplementation with soy isoflavone may be an effective treatment for patients with poor asthma control .


To determine whether a soy isoflavone supplement improves asthma control in adolescent and adult patients with poorly controlled disease .


Multicenter , randomized , double-blind , placebo-controlled trial conducted between May @ and August @ at @ adult and pediatric pulmonary and allergy centers in the American Lung Association Asthma Clinical Research Centers network .


Three hundred eighty-six adults and children aged @ years or older with symptomatic asthma while taking a controller medicine and low dietary soy intake were randomized , and @ ( @ % ) completed spirometry at week @ .


Participants were randomly assigned to receive soy isoflavone supplement containing @ mg of total isoflavones ( n = @ ) or matching placebo ( n = @ ) in @ divided doses administered daily for @ weeks .


The primary outcome measure was change in forced expiratory volume in the first second ( FEV@ ) at @ weeks .


Secondary outcome measures were symptoms , episodes of poor asthma control , Asthma Control Test score ( range , @-@ ; higher scores indicate better control ) , and systemic and airway biomarkers of inflammation .


Mean changes in prebronchodilator FEV@ over @ weeks were @ L ( @ % CI , -@ to @ L ) in the placebo group and @ L ( @ % CI , -@ to @ L ) in the soy isoflavone group , which were not significantly different ( P = @ ) .


Mean changes in symptom scores on the Asthma Control Test ( placebo , @ -LSB- @ % CI , @-@ @ -RSB- vs soy isoflavones , @ -LSB- @ % CI , @-@ @ -RSB- ; positive values indicate a reduction in symptoms ) , number of episodes of poor asthma control ( placebo , @ -LSB- @ % CI , @-@ @ -RSB- vs soy isoflavones , @ -LSB- @ % CI , @-@ @ -RSB- ) , and changes in exhaled nitric oxide ( placebo , -@ ppb -LSB- @ % CI , -@ to -@ ppb -RSB- vs soy isoflavones , @ ppb -LSB- @ % CI , -@ to @ ppb -RSB- ) did not significantly improve more with the soy isoflavone supplement than with placebo .


Mean plasma genistein level increased from @ ng/mL to @ ng/mL ( P < @ ) in participants receiving the supplement .


Among adults and children aged @ years or older with poorly controlled asthma while taking a controller medication , use of a soy isoflavone supplement , compared with placebo , did not result in improved lung function or clinical outcomes .


These findings suggest that this supplement should not be used for patients with poorly controlled asthma .


The increasing investment in malaria rapid diagnostic tests ( RDTs ) to differentiate malarial and non-malarial fevers , and an awareness of the need to improve case management of non-malarial fever , indicates an urgent need for high quality evidence on how best to improve prescribers ' practices .


A three-arm stratified cluster-randomised trial was conducted in @ primary healthcare facilities from September @ to March @ within two rural districts in northeast Tanzania where malaria transmission has been declining .


Interventions were guided by formative mixed-methods research and were introduced in phases .


Prescribing staff from all facilities received standard Ministry of Health RDT training .


Prescribers from facilities in the health worker ( HW ) and health worker-patient ( HWP ) arms further participated in small interactive peer-group training sessions with the HWP additionally receiving clinic posters and patient leaflets .


Performance feedback and motivational mobile-phone text messaging ( SMS ) were added to the HW and HWP arms in later phases .


The primary outcome was the proportion of patients with a non-severe , non-malarial illness incorrectly prescribed a ( recommended ) antimalarial .


Secondary outcomes investigated RDT uptake , adherence to results , and antibiotic prescribing .


Standard RDT training reduced pre-trial levels of antimalarial prescribing , which was sustained throughout the trial .


Both interventions significantly lowered incorrect prescribing of recommended antimalarials from @ % ( @/@ ,@ ) in the standard training arm to @ % ( @/@ ,@ ) in the HW arm ( adjusted RD ( aRD ) @ % ; @ % confidence interval ( CI ) @ % to @ % ; P = @ ) and @ % ( @/@ ,@ ) in the HWP arm ( aRD @ % ; @ % CI @ % to @ % ; P = @ ) .


Small group training and SMS were incrementally effective .


There was also a significant reduction in the prescribing of antimalarials to RDT-negatives but no effect on RDT-positives receiving an ACT .


Antibiotic prescribing was significantly lower in the HWP arm but had increased in all arms compared with pre-trial levels .


Small group training with SMS was associated with an incremental and sustained improvement in prescriber adherence to RDT results and reducing over-prescribing of antimalarials to close to zero .


These interventions may become increasingly important to cope with the wider range of diagnostic and treatment options for patients with acute febrile illness in Africa .


To observe and evaluate the clinical effect of acupuncture at `` Siguan '' combined with the Gallbladder Meridian acupoints on migraine .


With randomized controlled trial design , @ patients were randomly divided into an observation group ( @ cases ) and a control group ( @ cases ) .


The observation group was treated with acupuncture at `` Siguan '' including Hegu ( LI @ ) and Taichong ( LR @ ) , combined with the Gallbladder Meridian acupoints including Fengchi ( GB @ ) , Shuaigu ( GB @ ) , Qiuxu ( GB @ ) and Zulinqi ( GB @ ) , while the control group was treated with acupuncture at the Gallbladder Meridian acupoints , including Fengchi ( GB @ ) , Shuaigu ( GB @ ) , Qiuxu ( GB @ ) , Zulinqi ( GB @ ) , Yanglingquan ( GB @ ) and Hanyan ( GB @ ) .


The treatment was given every other day in two groups , @ times per week for totally @ weeks .


The migraine intensity , migraine frequency and lasting time of each migraine were observed before and after treatment , and @-month follow-up was performed after treatment .


The clinical efficacy in two groups was evaluated .


Compared with those before treatment , the migraine intensity , frequency and lasting time were all reduced significantly after treatment in the two groups ( all P < @ ) , which were more obvious in the observation group ( all P < @ ) .


At the end of the treatment , the total effective rate was @ % ( @/@ ) in the observation group and @ % ( @/@ ) in the control group , which had statistical difference ( P < @ ) .


After @-month follow-up , the total effective rate was @ % ( @/@ ) in the observation group and @ % ( @/@ ) in the control group , which had no statistical difference ( P > @ ) .


The `` Siguan '' combined with the Gallbladder Meridian acupoints could significantly relieve the migraine intensity , frequency and lasting time , and its improvement of symptoms and short-term efficacy are superior to those of the Gallbladder Meridian acupoints alone .


Inflammation , insulin resistance and vascular dysfunction characterize obesity and predict development of cardiovascular disease ( CVD ) .


Although women experience CVD events at an older age , vascular dysfunction is evident @years prior to coronary artery disease .


Questions remain whether replacing SFA entirely with MUFA or PUFA is the optimal approach for cardiometabolic benefits .


This study tested the hypotheses that : a ) body composition , inflammation and vascular function would improve with a high fat diet ( HFD ) when type of fat is balanced as @/@ SFA , @/@ MUFA and @/@ PUFA ; and b ) body composition , inflammation and vascular function would improve more when balanced HFD is supplemented with @C fatty acids , in proportion to the degree of @C unsaturation .


Obese premenopausal women were stabilized on balanced HFD and randomized to consume @g/d of encapsulated stearate ( @:@ ) , oleate ( @:@ ) , linoleate ( @:@ ) or placebo .


Significant improvements occurred in fat oxidation rate ( @ % ) , body composition ( % fat : @ % ; % lean : @ % ) , inflammation ( IL-@ , IL-@ , @L-@ , Il-@ , IFN , TNF , TNF ) and vascular function ( BP , PAI-@ , tPA activity ) .


When compared to HFD + placebo , HFD + stearate had the greatest effect on reducing IFN ( @ % ) and HFD + linoleate had the greatest effect on reducing PAI-@ ( @ % ) .


Balancing the type of dietary fat consumed ( SFA/MUFA/PUFA ) is a feasible strategy to positively affect markers of CVD risk .


Moreover , reductions in inflammatory molecules involved in vascular function might be enhanced when intake of certain @C fatty acids is supplemented .


Long term effects need to be determined for this approach .


The effects of cholesteryl ester transfer protein ( CETP ) inhibition on lipids , inflammation , and markers of high-density lipoprotein ( HDL ) function , following an acute coronary syndrome ( ACS ) , are unknown .


The dal-ACUTE study randomized @ patients ( @ : @ ) to dalcetrapib @ mg/day or placebo within @ week of an ACS .


The primary endpoint was per cent change in HDL-cholesterol ( HDL-C ) after @ weeks .


Secondary endpoints included apolipoprotein levels , markers of HDL function , and inflammation .


Dalcetrapib treatment increased HDL-C and apolipoprotein A@ by @ and @ % , respectively ( both P < @ ) and total cholesterol efflux by @ % ( P = @ ) after @ weeks , principally via an increase in non-ATP-binding cassette transporter ( ABC ) A@-mediated efflux , without statistically significant changes in pre-@-HDL levels .


The increase in total efflux with dalcetrapib correlated most strongly with increases in apolipoprotein A@ and HDL-C ( r = @ and @ , respectively ) rather than the increase in pre-@-HDL ( r = @ ) .


Baseline and on-treatment ABCA@-mediated efflux correlated most strongly with pre-@-HDL levels ; in contrast , non-ABCA@-mediated efflux correlated better with apolipoprotein A@ and HDL-C levels .


High-density lipoprotein raised through CETP inhibition with dalcetrapib improves cholesterol efflux , principally via a non-ABCA@-mediated pathway .


While HDL-C was increased by one-third , apolipoprotein A@ and total efflux were increased only by one-tenth , supporting the concept of dissociation between improvements in HDL function and HDL-C levels , which may be of relevance to ongoing trials and the development of therapeutic interventions targeting HDL .


This study was designed to compare the effects of metformin and repaglinide on the fasting plasma glucose ( FPG ) and glycated haemoglobin ( HbA@c ) in newly diagnosed type @ diabetes in China .


A total of @ newly diagnosed type @ diabetic patients ( @ women and @ men ) participated in the study .


All patients received @-month treatment of metformin or repaglinide .


Fasting blood glucose and HbA@c were determined at baseline and at the end of the @-month of treatment .


FPG and HbA@c decreased in both metformin and repaglinide groups after @ months treatment ( P < @ ) .


The reduction of HbA@c was significantly greater in the repaglinide group ( P < @ ) .


Metformin decreases fasting insulin concentration and HOMA-IR ( P < @ ) , and repaglinide improves HOMA - ( P < @ ) .


Triglycerides ( TG ) were reduced in both groups ( P < @ in metformin group ; P < @ in repaglinide group ) , but total cholesterol ( TC ) and low-density lipoprotein ( LDL ) were decreased only after metformin treatment ( P < @ ) .


Both repaglinide and metformin were effective in glycaemic control in new onset patients with type @ diabetes in China .


Repaglinide had no effect on insulin sensitivity , but it improved - cell function .


The potential effect of onartuzumab , when administered with or without bevacizumab in combination with weekly paclitaxel , on the corrected QT interval ( QTc ) and other electrocardiogram ( ECG ) parameters , was investigated in a randomized , phase @ study OAM@g of first - or second-line therapy in patients with locally recurrent or metastatic triple-negative breast cancer .


Triplicate @-lead ECGs were recorded at screening , pre - and post-dose on day @ of cycles @ , @ , and @ , and at the study drug discontinuation visit ( SDDV ) .


Onartuzumab serum samples were collected pre - and post-dose on day @ of cycles @-@ and at the SDDV .


Fridericia 's correction was applied to QT recordings ( QTcF ) , and change from baseline ( QTcF ) was calculated .


Post-baseline measurements were reported as baseline-adjusted control arm ( placebo plus bevacizumab plus paclitaxel ) - corrected values ( QTcF ) .


Categorical ECG findings were noted .


Linear mixed effects modeling evaluated a potential concentration-QTcF relationship .


Out of @ enrolled patients , @ patients had ECG-evaluable data for analyses .


Similar QTcF and QTcF values were observed across all treatment arms , with mean increase < @ and < @ ms , respectively , across all time points .


Similar changes in heart rate , PR interval , and QRS duration were noted across all treatment arms .


Incidences of abnormal ECG findings of clinical interest were comparable in the onartuzumab-containing arms and the control arm .


No concentration-QTcF relationship was evident at onartuzumab serum concentrations up to @,@ g/ml .


These data suggest that onartuzumab , at the dose and exposures studied in this clinical trial , does not meaningfully affect the QTcF interval .


Patients with acute ischemic stroke benefit from rapid evaluation and treatment , and timely brain imaging is a necessary component .


We determined the effect of a targeted behavioral intervention on door-to-imaging time ( DIT ) among patients with ischemic stroke treated with tissue-type plasminogen activator .


Second , we examined the variation in DIT accounted for by patient-level and hospital-level factors .


The Increasing Stroke Treatment through Interventional behavioral Change Tactics ( INSTINCT ) trial was a cluster-randomized , controlled trial involving @ Michigan hospitals .


The intervention aimed to increase tissue-type plasminogen activator utilization .


Detailed chart abstractions collected data for @ patients with ischemic stroke .


We used a series of hierarchical linear mixed-effects models to evaluate the effect of the intervention on DIT ( difference-in-differences analysis ) and used patient-level and hospital-level explanatory variables to decompose variation in DIT .


DIT improved over time , without a difference between intervention and control hospitals ( intervention : @-@ @ minutes , control : @-@ @ minutes ; P = @ ) .


Adjusted DIT was faster in patients who arrived by ambulance ( @ minutes ; @ % confidence interval , @-@ @ ) , had severe strokes ( @ minute per +@ - point National Institutes of Health Stroke Scale ; @ % confidence interval , @-@ @ ) , and presented in the postintervention period ( @ minutes ; @ % confidence interval , @-@ @ ) .


After accounting for these factors , @ % of variation in DIT was attributable to hospital .


Neither hospital stroke volume nor stroke center status was associated with DIT .


Performance on DIT improved similarly in intervention and control hospitals , suggesting that nonintervention factors explain the improvement .


Hospital-level factors explain a modest proportion of variation in DIT , but further research is needed to identify the hospital-level factors responsible .


Establishing or providing occlusion that successfully permits efficient masticatory function is basic to dentistry .


To maintain harmony of the occlusal condition , the posterior teeth must pass close to but not contact their opposing teeth during mandibular movement .


Anterior guidance is essential to a harmonious functional relationship in the masticatory system .


The objective of this study was to find out the frequency of pattern of occlusal contacts in lateral position and to compare the accuracy of shim-stock and articulating paper .


This study was conducted in the Department of Prosthodontics , Kathmandu University School of Medical Sciences .


The study consisted of @ healthy subjects between the age group of @-@ years .


They were selected randomly from undergraduate students and dental hygienist of college of dental science and written consent was taken .


This age was selected because of minimal occlusal wear .


In the present study with @ participants the majority of the contact patterns with shimstock on the working side were group function ( @ % ) , the canine protected occlusal patterns were found to be @ % and the unclassifiable pattern were found to be @ % .


On the otherhand , the data with articulating paper were group function type ( @ % ) , the canine protected occlusal patterns as @ % and the unclassifiable pattern were found to be @ % .


In this study , with shim stock , the majority of the contact patterns were group function being @ % whereas with the articulating paper it was @ % .


When shim stock occlusal strip ( @ m thick ) was compared to commonly used articulating paper ( @ m ) , the excessive thickness of articulating paper that exceed the maximum recommended thickness of occlusal recording strips markedly must have given much more false contacts .


It was concluded that the majority of the contact pattern were group function being @ % with shim stock and @ % with articulating paper .


Also shim stock exhibits superior accuracy and reliability .


Several pilot studies have evoked interest in robot-assisted therapy ( RAT ) in children with cerebral palsy ( CP ) .


To assess the effectiveness of RAT in children with CP through a single-blind randomized controlled trial .


Sixteen children with CP were randomized into @ groups .


Eight children performed @ conventional therapy sessions per week over @ weeks ( control group ) .


Eight children completed @ conventional therapy sessions and @ robot-assisted sessions per week over @ weeks ( robotic group ) .


For both groups , each therapy session lasted @ minutes .


Throughout each RAT session , the patient attempted to reach several targets consecutively with the REAPlan .


The REAPlan is a distal effector robot that allows for displacements of the upper limb in the horizontal plane .


A blinded assessment was performed before and after the intervention with respect to the International Classification of Functioning framework : body structure and function ( upper limb kinematics , Box and Block test , Quality of Upper Extremity Skills Test , strength , and spasticity ) , activities ( Abilhand-Kids , Pediatric Evaluation of Disability Inventory ) , and participation ( Life Habits ) .


During each RAT session , patients performed @ movements on average with the REAPlan .


Among the variables assessed , the smoothness of movement ( P < @ ) and manual dexterity assessed by the Box and Block test ( P = @ ) improved significantly more in the robotic group than in the control group .


This single-blind randomized controlled trial provides the first evidence that RAT is effective in children with CP .


Future studies should investigate the long-term effects of this therapy .


Youth mental health is a significant public health concern due to the high prevalence of mental health problems in this population and the low rate of those affected seeking help .


While it is increasingly recognized that prevention is better than cure , most youth prevention programs have utilized interventions based on clinical treatments ( eg , cognitive behavioral therapy ) with inconsistent results .


This study explores the feasibility of the online delivery of a youth positive psychology program , Bite Back , to improve the well-being and mental health outcomes of Australian youth .


Further aims were to examine rates of adherence and attrition , and to investigate the program 's acceptability .


Participants ( N = @ ) aged @-@ years were randomly assigned to either of two conditions : Bite Back ( n = @ ) or control websites ( n = @ ) .


The Bite Back website comprised interactive exercises and information across a variety of positive psychology domains ; the control condition was assigned to neutral entertainment-based websites that contained no psychology information .


Participants in both groups were instructed to use their allocated website for @ consecutive weeks .


Participants were assessed pre - and postintervention on the Depression Anxiety Stress Scale-Short form ( DASS-@ ) and the Short Warwick-Edinburgh Mental Well-Being Scale ( SWEMWBS ) .


Of the @ randomized participants , @ ( @ % ) completed baseline and post measures after @ weeks .


Completers and dropouts were equivalent in demographics , the SWEMWBS , and the depression and anxiety subscales of the DASS-@ , but dropouts reported significantly higher levels of stress than completers .


There were no differences between the Bite Back and control conditions at baseline on demographic variables , DASS-@ , or SWEMWBS scores .


Qualitative data indicated that @ of @ Bite Back users ( @ % ) reported positive experiences using the website and @ ( @ % ) agreed they would continue to use it after study completion .


Compared to the control condition , participants in the Bite Back condition with high levels of adherence ( usage of the website for @ minutes or more per week ) reported significant decreases in depression and stress and improvements in well-being .


Bite Back users who visited the site more frequently ( @ times per week ) reported significant decreases in depression and anxiety and improvements in well-being .


No significant improvements were found among Bite Back users who demonstrated low levels of adherence or who used the website less frequently .


Results suggest that using an online positive psychology program can decrease symptoms of psychopathology and increase well-being in young people , especially for those who use the website for @ minutes or longer per week or more frequently ( @ times per week ) .


Acceptability of the Bite Back website was high .


These findings are encouraging and suggest that the online delivery of positive psychology programs may be an alternate way to address mental health issues and improve youth well-being nationally .


This open-label , prospective , observational study aimed to evaluate treatment response , efficacy therapy and safety to IFN -@ b for the essential thrombocythemia ( ET ) and polycythemia vera ( PV ) with JAK@V@F positive mutation .


A total of @ ET patients received IFN-@b therapy with JAK@V@F positive or negative mutation ; and @ PV patients with JAK@V@F ( + ) received IFN-@b or hydroxyurea ( HU ) therapy according to random number assignment ( ages @-@ years old ) .


ET patients receiving IFN -@ b with JAK@V@F ( + ) had a greater advantage in overall hematologic response ( OHR ) than JAK@V@F ( - ) ( @ % versus @ % , P < @ ) .


For PV patients with JAK@V@F ( + ) , IFN had no OHR superiority to HU ( @ % versus @ % , P > @ ) , but which gained a greater satisfactory molecular response than HU ( @ % versus @ % , P < @ ) .


IFN significantly decreased the phlebotomy rate , which was better than HU for MPDs patients with OHR than HU ( @ % versus @ % , P < @ ) .


Furthermore , ET patients with JAK@V@F ( + ) demonstrated a definite advantage over JAK@V@F ( - ) in five-year PFS ( @ % versus @ % , P < @ ) .


For PV patients with JAK@V@F ( + ) , IFN -@ b was superior to HU in five-year PFS ( @ % versus @ % , P < @ ) .


Moreover , IFN -@ b also contributed to improved vasomotor symptoms in MPDs , and especially significantly decreased the incidence of distal paresthesias ( @ % versus @ % ) and erythromelalgia ( @ % versus @ % ) better than HU ( P < @ ) .


Meanwhile , IFN did not observe the severe hematological adverse events in patients with PV or ET .


The data confirmed that IFN -@ b benefited the patients with ET or PV , particularly for JAK@V@F ( + ) mutation .


The inflammatory response in patients with seasonal allergic rhinitis ( SAR ) is partly mediated by the prostaglandin D@ receptor chemoattractant receptor homologous molecule on T ( H ) @ cells ( CRTH@ ) .


We sought to investigate the efficacy and safety of the oral CRTH@ antagonist BI @ ( @ , @ , and @ mg twice daily ) , fluticasone propionate nasal spray ( @ g once daily ) , or oral montelukast ( @ mg once daily ) administered for @ weeks in patients with SAR .


In this randomized , double-blind , placebo-controlled , partial-crossover study , participants aged @ to @ years with a positive skin prick test to Dactylis glomerata pollen were exposed to out-of-season allergen in the environmental challenge chamber for @ hours .


The primary efficacy variable was the total nasal symptom score assessed as the area under the curve ( AUC ) ( @-@h ) .


In total , @ patients ( @ % male ; mean age , @ years ) were randomized .


The adjusted mean total nasal symptom score AUC ( @-@h ) was significantly reduced versus placebo with @ mg of BI @ ( absolute difference , -@ ; percentage difference , -@ % ; P = @ ) , montelukast ( absolute difference , -@ ; percentage difference , -@ % ; P = @ ) , and fluticasone propionate ( absolute difference , -@ ; percentage difference , -@ % ; P < @ ) .


Compared with placebo , BI @ significantly reduced nasal eosinophil values ( P < @ for all doses ) , significantly inhibited nasal inflammatory cytokine levels ( IL-@ and eotaxin , P < @ ; @ mg twice daily ) , and induced a dose-related reduction in ex vivo prostaglandin D@-mediated eosinophil shape change .


Two hundred milligrams of BI @ twice daily demonstrated efficacy in treating SAR symptoms induced by environmental challenge chamber allergen exposure and had a favorable safety profile .


The effects of an oral hygienic care program ( OHCP ) have been reported in several diseases .


However , no study exists investigating the influence of an OHCP on stroke patients or patients in the intensive care unit ( ICU ) has been reported , thus we sought to investigate the potential effect of an OHCP .


Fifty-six consecutive stroke patients who were admitted to the ICU were randomly assigned to two groups : the intervention ( @ patients ) and control groups ( @ patients ) .


The OHCP included tooth brushing with an inter-dental brush and tongue cleaner and cleaning with chlorhexidine was administered to patients by one dentist once per day during admission in the ICU ( mean , @ weeks ) .


The plague index , gingival index , clinical attachment loss , and colonization degree of candida albicans were assessed .


After OHCP , the plaque index , gingival index , and colonization degree of candida albicans in saliva showed a significant decrease in the intervention group compared to those of the control group ( p < @ ) .


However , no significant difference was observed in clinical attachment loss and the colonization degree of candida albicans on the tongue ( p > @ ) .


Our OHCP was effective in improving the oral hygienic status and periodontal health of stroke patients during their stay in the ICU .


Therefore , we recommend administration of the OHCP for stroke patients during their stay in the ICU .


There are limited data on the performance of narrow band imaging ( NBI ) and Fujinon intelligent color enhancement ( FICE ) for differentiating polyp histologies .


The aim of this study was to compare the diagnostic performances of NBI and FICE in differentiating neoplastic from non-neoplastic colorectal polyps < @ mm during screening colonoscopy .


A total of @ average-risk adults undergoing screening colonoscopies were randomly allocated to NBI or FICE groups .


Four board-certified staff endoscopists without prior experience using NBI or FICE participated .


The main outcomes of this study were overall accuracy , sensitivity , and specificity of FICE and NBI in identifying neoplastic polyps .


There was no significant difference in the number of subjects with adenoma between the NBI ( @/@ , @ % ) and FICE groups ( @/@ , @ % ) ( after excluding adenoma @ cm ) ( P > @ ) .


The overall accuracy of NBI was @ % , compared with @ % for FICE ( P = @ ) .


The overall sensitivity and specificity of NBI and FICE were @ and @ % ( P = @ ) ; @ and @ % ( P = @ ) , respectively .


For polyps measuring @ mm , the accuracy was @ % for NBI and @ % for FICE ( P = @ ; sensitivity @ vs. @ % , P = @ ; specificity @ vs. @ % , P = @ ) .


The overall accuracy of NBI and FICE was similar for differentiating small polyp histologies during screening colonoscopy .


However , better results should be achieved before using NBI or FICE as real-time optical biopsy of colorectal polyps in screening colonoscopy .


The Placement of Aortic Transcatheter Valves ( PARTNER ) trial demonstrated similar survival after transcatheter and surgical aortic valve replacement ( TAVR and SAVR , respectively ) in high-risk patients with symptomatic , severe aortic stenosis .


The aim of this study was to evaluate the effect of left ventricular ( LV ) dysfunction on clinical outcomes after TAVR and SAVR and the impact of aortic valve replacement technique on LV function .


The PARTNER trial randomized high-risk patients with severe aortic stenosis to TAVR or SAVR .


Patients were stratified by the presence of LV ejection fraction ( LVEF ) < @ % .


All-cause mortality was similar for TAVR and SAVR at @-days and @ year regardless of baseline LV function and valve replacement technique .


In patients with LV dysfunction , mean LVEF increased from @ % to @ % ( P < @ ) @ year after TAVR and from @ % to @ % after SAVR ( P < @ ) .


Higher baseline LVEF ( odds ratio , @ -LSB- @ % confidence interval , @ , @ -RSB- ; P < @ ) and previous permanent pacemaker ( odds ratio , @ -LSB- @ % confidence interval , @ , @ -RSB- ) were independently associated with reduced likelihood of @ % absolute LVEF improvement by @ days ; higher mean aortic valve gradient was associated with increased odds of LVEF improvement ( odds ratio , @ per @ mm Hg -LSB- @ % confidence interval , @ , @ -RSB- ) .


Failure to improve LVEF by @ days was associated with adverse @-year outcomes after TAVR but not SAVR .


In high-risk patients with severe aortic stenosis and LV dysfunction , mortality rates and LV functional recovery were comparable between valve replacement techniques .


TAVR is a feasible alternative for patients with symptomatic severe aortic stenosis and LV dysfunction who are at high risk for SAVR .


To investigate the effects of nursing care based on the Theory of Human Caring on distress caused by infertility , perceived self-efficacy and adjustment levels .


Infertility leads to individual , familial and social problems .


Nursing care standards for women affected by infertility have yet to emerge .


A randomized controlled trial .


This study was conducted from May @-February @ , with @ Turkish women with infertility ( intervention group : @ , control group : @ ) .


We collected data using the Infertility Distress Scale , the Turkish-Infertility Self Efficacy Scale Short Form and the Turkish-Fertility Adjustment Scale .


The intervention group received nursing care based on the Theory of Human Caring .


Data were analysed using t-tests , chi-square tests and intention-to-treat analyses .


The intervention and control groups significantly differed with regard to infertility distress , self-efficacy and adjustment levels .


The intervention group 's mean self-efficacy score increased by seven points and adjustment score decreased by seven points ( in a positive direction ) .


In addition , there was a significant reduction in infertility distress scores in the intervention group , but there was no change in the control group .


Nursing care based on the Theory of Human Caring decreased the negative impact of infertility in women receiving infertility treatment and increased self-efficacy and adjustment .


Allergic rhinitis ( AR ) affects up to @ % of the adult population and symptomatic patients continue to engage in daily life activities , including car driving .


Previous studies have shown that AR can impair cognitive functions , especially during longer-lasting tasks .


Other reports suggest negative effects on psychomotor functions such as driving , but no clear evidence has been presented yet .


Primary objective was to determine the effect of AR per se on actual driving performance and compare it with the effects of treated AR .


Nineteen patients with documented AR history underwent a unique and validated @-h on-the-road driving test outside the pollen season .


In a @-leg repeated measures design , patients underwent a nasal provocation test with either pollen or inactive control prior to the driving test .


In the three conditions with pollen provocation , patients were pretreated with either cetirizine @mg , fluticasone furoate @ g , or placebo to alleviate the provoked AR symptoms .


The driving performance of patients when symptomatic and not treated was significantly impaired compared to the placebo condition .


When engaging in a secondary memory task during driving , their performance deteriorated further .


The magnitude of impairment was relevant and comparable to that seen at a blood alcohol level of @ % , the legal limit in many countries .


Treatment of AR symptoms partially counteracted the effect of AR on driving .


Untreated AR can impair driving ability and put patients at risk .


Drug therapy reduces this impairment , and AR patients should therefore be advised to always treat their condition .


Depression is common in primary care and is often unrecognized and untreated .


Studies are needed to demonstrate the feasibility of implementing evidence-based depression care provided by primary health care workers ( PHCWs ) in sub-Saharan Africa .


We carried out a pilot two-parallel arm cluster randomized controlled trial of a package of care for depression in primary care .


Six primary health care centers ( PHCC ) in two Local Government Areas of Oyo State , South West Nigeria were randomized into @ intervention and @ control clinics .


Three PHCWs were selected for training from each of the participating clinics .


The PHCWs from the intervention clinics were trained to deliver a manualized multicomponent stepped care intervention package for depression consisting of psychoeducation , activity scheduling , problem solving treatment and medication for severe depression .


Providers from the control clinics delivered care as usual , enhanced by a refresher training on depression diagnosis and management .


Outcome measures Patient 's Health Questionnaire ( PHQ-@ ) , WHO quality of Life instrument ( WHOQOL-Bref ) and the WHO disability assessment schedule ( WHODAS ) were administered in the participants ' home at baseline , @ and @months .


About @ % of the consecutive attendees to the clinics agreed to have the screening interview .


Of those screened , @ ( @ % ) were positive ( PHQ-@ score@ ) and @ gave consent for inclusion in the study : @ from intervention and @ from control clinics .


The rates of eligible and consenting participants were similar in the control and intervention arms .


In all @ % ( @ % in intervention and @ % in control ) of the participants were successfully administered outcome assessments at @months .


The PHCWs had little difficulty in delivering the intervention package .


At @months follow up , depression symptoms had improved in @ % from the intervention arm compared to @ % control .


Compared to the mean scores at baseline , there was improvement in the mean scores on all outcome measures in both arms at six months .


The results provide support for the feasibility of conducting a fully-powered randomized study in this setting and suggest that the instruments used may have the potential to detect differences between the arms .


To compare the effectiveness and safety of two cervical ripening methods in term primiparous women with unfavorable cervices and oligohydramnios .


Women ( @ cases ) with oligohydramnios -LSB- amniotic fluid index ( AFI ) @cm -RSB- and a low Bishop Score ( @ ) were assigned randomly to use double balloon catheter ( mechanical method group , @ cases ) or dinoprostone @mg controlled-release vaginal insert ( pharmacological method group , @ cases ) for induction of labor .


The study 's primary outcome was caesarean section rate ( CSR ) .


The secondary outcome measures included maternal and neonatal morbidity , an incremental changes in Bishop Score , and intrapartum interventions .


There was no significant difference between the mechanical method group and the pharmacological method group in CSR and change in Bishop Score .


Tacysystole , non-reassuring fetal heart patterns , and cases of newborn umbilical-cord arterial blood pH < @ were significantly lower with the mechanical method compared with the pharmacological method ( p < @ ) .


More patients needed additional intervention in the mechanical method group .


Both methods resulted in a similar CSR .


Double balloon catheter resulted in fewer labor complications , but more frequent use of oxytocin and amniotomy .


Compared with dinoprostone vaginal insert , double balloon catheter use may be less problematic in women with oligohydramnios .


To determine if sarcopenia modulates the response to a physical activity intervention in functionally limited older adults .


Secondary analysis of a randomized controlled trial .


Three academic centers .


Elders aged @ to @ years at risk for mobility disability who underwent dual-energy x-ray absorptiometry ( DXA ) for body composition at enrollment and follow-up at twelve months ( N = @ ) .


Subjects participated in a physical activity program ( PA ) featuring aerobic , strength , balance , and flexibility training , or a successful aging ( SA ) educational program about healthy aging .


Sarcopenia as determined by measuring appendicular lean mass and adjusting for height and total body fat mass ( residuals method ) , Short Physical Performance Battery score ( SPPB ) , and gait speed determined on @ meter course .


At twelve months , sarcopenic and non-sarcopenic subjects in PA tended to have higher mean SPPB scores ( @ and @ points ) compared to sarcopenic and non-sarcopenic subjects in SA ( @ and @ points , p = @ and @ ) , although the differences were not statistically significant .


At twelve months , faster mean gait speeds were observed in PA : @ and @ meters/second in sarcopenic and non-sarcopenic PA subjects , and @ and @ meters/second in sarcopenic and non-sarcopenic SA subjects ( p = @ and @ ) , although not statistically significant .


There was no difference between the sarcopenic and non-sarcopenic groups in intervention adherence or number of adverse events .


These data suggest that older adults with sarcopenia , who represent a vulnerable segment of the elder population , are capable of improvements in physical performance after a physical activity intervention .


Selegiline ( l-deprenyl ) is a selective monoamine oxidase type B inhibitor that has been shown to have neurotrophic and anti-apoptotic properties and to protect neurons in different experimental models of cerebral ischaemia .


The aim of this explorative study was to investigate whether selegiline could enhance cognitive and functional recovery in stroke survivors .


This was a randomized controlled study in which patients enrolled within two weeks of stroke underwent a clinical and functional evaluation and a neuropsychological assessment .


The patients were given selegiline ( @mg/day ) or matched placebo once a day for six weeks in addition to standard rehabilitation care .


Of @ stroke survivors , @ patients met the inclusion criteria and were randomly assigned to the Study Group ( n = @ ) or the Control Group ( n = @ ) .


The statistical analysis showed a significant improvement in most neuropsychological tests after two and six weeks in the study group ; these improvements were not replicated in the control group .


The between-group analysis revealed that the domains of attention and executive functions benefited most from the drug treatment .


With regard to functional status , comparison of clinical scores at admission and discharge showed a statistically significant enhancement in both groups without statistically significant differences between the groups .


These preliminary results suggest that selegiline administered in the subacute phase can promote cognitive functioning in stroke patients .


Further studies will elucidate whether and how this enhancement can impact on functional recovery in the short and in the long term .


Covalent immobilization of antimicrobial peptide melimine onto contact lenses can produce broad-spectrum antimicrobial lenses .


The purpose of this study was to investigate the performance of melimine-coated contact lenses in an animal model and human clinical trial .


Melimine was covalently attached onto the surface of contact lenses via EDC ( @-ethyl-@ - -LSB- @-dimethylaminopropyl -RSB- carbodiimide hydrochloride ) coupling .


A rabbit model of daily contralateral wear of lenses for @ days was conducted to assess the lens safety .


A prospective , randomized , double-masked , one-day human clinical trial was used to evaluate subjective responses and ocular physiology during contralateral wear of melimine-coated ( test ) and uncoated ( control ) lenses .


Delayed reactions were monitored during follow-up visits after @ and @ weeks .


Ex vivo retention of antimicrobial activity of worn lenses was assessed by reduction in numbers of viable Pseudomonas aeruginosa and Staphylococcus aureus .


Melimine-coated lenses produced no ocular signs or symptoms that would indicate cytotoxicity during the lens wear of rabbits .


No histological changes were found in rabbit corneas .


During the human trial , no differences were observed in wettability , surface deposition , lens-fitting centration , movement , tightness , and corneal coverage between test and control lenses ( p > @ ) .


There were no significant differences in bulbar , limbal , or palpebral redness or conjunctival staining ( p > @ ) .


Mean corneal ( extent , depth , and type ) staining was higher for test lenses compared with that for control lenses ( p < @ ) .


There was no significant difference in subjective responses for lens comfort , dryness , and awareness ( p > @ ) .


No delayed reactions were associated with the test lenses .


Worn test lenses retained more than @ log inhibition against both bacterial types .


Melimine-coated contact lenses were worn safely by humans .


However , they were associated with higher corneal staining .


The melimine-coated lenses retained high antibacterial activity after wear .


Postoperative sore throat ( POST ) is a frequent complication caused by mucosal trauma to the pharyngeal , laryngeal , and tracheal airway after endotracheal intubation .


We compared the effectiveness of Siccoral , Strefen , and Stomatovis treatments in alleviating POST .


This prospective , randomized , single-blinded , controlled trial compares the incidence of POST with Strefen lozenges , Siccoral spray , or Stomatovis gargle .


Three hundred and twenty American Society of Anesthesiologists class I-III patients undergoing elective genitourinary surgery under general orotracheal anesthesia were randomly allocated to four groups of @ patients each .


In the postoperative awakening unit and during related services , POST was evaluated by a blinded anesthesiologist at @ , @ , @ , and @ h post extubation .


The highest incidence of POST occured at @ and @ h post extubation in all groups ( P = @ @ ( -@ ) , P = @ @ ( -@ ) , respectively ) .


A significantly lower incidence of POST was observed in Strefen and Siccoral groups at @ and @ h compared to Control group ( Strefen : P = @ @ ( -@ ) , P = @ @ ( -@ ) ; Siccoral : P = @ @ ( -@ ) , P = @ @ ( -@ ) , respectively ) .


A significantly lower incidence of POST was observed with Siccoral treatment at @ h post extubation ( P = @ vs. Strefen treatment ) .


Although POST incidence was not significantly different between the Stomatovis and Control groups , it was lower in the Stomatovis group at @ and @ h ( P = @ and @ , respectively ) .


The incidence of POST was similar in all groups at @ and @ h post extubation ( P = @ and @ , respectively ) .


Siccoral and Strefen can be effective in relieving POST in the early hours after extubation .


Etomidate causes pain when injected intravenously .


In this study we sought to determine if pretreatment by ondansetron reduces the pain on injection of etomidate .


In this randomized , double blinded , placebo-controlled clinical trial , @ patients of both sexes aged between @ and @ years of American Society of Anesthesiologists ( ASA ) physical status class I or II , whom were candidates for various elective surgical procedures and need more than one intravenous access were enrolled in the study .


On arrival to the operating room two @ gauge cannulas were inserted into veins on the dorsum of both hands .


Following the infusion of @mL normal saline into both intravenous lines , using an elastic band , venous drainage of hands was occluded at midarm .


The patients were administered @ mg ( @ mL ) of ondansetron into one hand and @ mL of @ % saline into the other hand at the same time .


The elastic band was removed after @ min and @mg ( @ mL ) of etomidate was administered at the same rate simultaneously into intravenous lines .


The patients were asked to give a score of pain based on a verbal analog scale ( VAS ) to each hand .


A total number of @ patients were studied ( male = @ % , female = @ % ) .


The mean age of the participants was @ @ years old and the mean weight was @ @ kg .


The mean VAS for injection pain of etomidate after pre-administration of intravenous ondansetron was @ @ which was lower compared to pre-administration of placebo ( @ @ , p < @ ) .


This study illustrates that pre-treatment with intravenous ondansetron significantly reduces the pain on injection of etomidate .


This study sought to determine pharmacodynamic effects during transition from intravenous cangrelor to oral ticagrelor and from oral ticagrelor to intravenous cangrelor .


Cangrelor is an intravenous antagonist of P@Y@ and its use will require transition to and from oral agents .


Patients ( n = @ ) with stable coronary artery disease who were taking aspirin @ mg daily were recruited .


On study day @ , they received a bolus plus @-h infusion of cangrelor plus a @-mg dose of ticagrelor at either @ h ( n = @ ) or @ h ( n = @ ) .


Pharmacodynamic effects ( light transmission platelet aggregation in response to @ and @ mol/l adenosine diphosphate , VerifyNow , P@Y@ assay ( Accumetrics , San Diego , California ) , vasodilator-stimulated phosphoprotein index , and flow cytometry ) were assessed during and after the cangrelor infusion .


Patients took @ mg of ticagrelor twice daily for either @ ( n = @ ) or @ ( n = @ ) doses .


On study day @ , pharmacodynamic effects were assessed before and during a bolus plus @-h infusion of cangrelor .


During cangrelor infusion , extensive inhibition of platelet function reflected by limited residual platelet reactivity was apparent .


After cangrelor was stopped , the antiplatelet effects of ticagrelor were preserved despite a modest increase in platelet reactivity .


Ticagrelor given before or during infusion of cangrelor did not attenuate the pharmacodynamic effects of cangrelor .


The pharmacodynamic effects of ticagrelor were preserved when ticagrelor was given during infusion of cangrelor .


Consistent with the reversible binding of ticagrelor , this oral P@Y@ antagonist can be administered before , during , or after treatment with cangrelor .


Several studies conducted in Northeast Tanzania have documented declines in malaria transmission even before interventions were scaled up .


One explanation for these reductions may be the changes in socio-environmental conditions associated with economic development , and in particular improvements in housing construction .


This analysis seeks to identify ( @ ) risk factors for malaria incidence among young children and ( @ ) household and environmental factors associated with mosquito vector numbers collected in the child 's sleeping area .


Both analyses focus on housing construction quality as a key determinant .


For @ children enrolled in a larger trial of intermittent preventive treatment for malaria in infants in the Korogwe District in Tanga , Northeastern Tanzania , detailed information on their dwelling characteristics were collected in the last year of the trial .


Principal components analysis was used to construct an index of housing structure quality and converted to quintile units for regression analysis .


Univariate and multivariate random effects negative binomial regressions were used to predict risk factors for child malaria incidence and the mean total number of indoor female Anopheles gambiae and funestus mosquitoes collected per household across three occasions .


Building materials have substantially improved in Korogwe over time .


Multivariate regressions showed that residing in rural areas ( versus urban ) increased malaria incidence rates by over three-fold and mean indoor female A. gambiae and funestus numbers by nearly two-fold .


Compared to those residing in the lowest quality houses , children residing in the highest quality houses had one-third lower malaria incidence rates , even when wealth and rural residence were controlled for .


Living in the highest quality houses reduced vector numbers while having cattle near the house significantly increased them .


Results corroborate findings from other studies that show associations between malaria incidence and housing quality ; associations were concentrated amongst the highest quality houses .


Weight loss of @ % to @ % can improve type @ diabetes and related comorbidities .


Few safe , effective weight-management drugs are currently available .