The literacy testing found that @ % of patients in the community practice and @ % in the tertiary care academic centre had `` marginal '' or `` inadequate '' literacy skills , but there was no significant difference between sites ( p = @ ) .


Comprehension of the educational material was higher in the intervention group versus the control group ( p = @ ) , with a mean cloze score of @ % in the intervention group and @ % in the control group .


The intervention group spent significantly less time reading the pamphlets ( p < @ ) , with an average of @ minutes compared with @ minutes .


The feedback survey indicated that patients found the pamphlet with the lower reading level easier to read ( p = @ ) , which was reflected in their comments as well .


In both academic and community practice settings , about @ % of patients with glaucoma have marginal or inadequate literacy skills .


However , regardless of practice , all patients better comprehend , and were more receptive to , educational material written at grade @ reading level with illustrations , regardless of initial literacy level .


Patients are classically at risk of delayed cerebral ischemia ( DCI ) after aneurysmal subarachnoid hemorrhage .


We validated a grading scale-the VASOGRADE-for prediction of DCI .


We used data of @ phase II randomized clinical trials and a single hospital series to assess the relationship between the VASOGRADE and DCI .


The VASOGRADE derived from previously published risk charts and consists of @ categories : VASOGRADE-Green ( modified Fisher scale @ or @ and World Federation of Neurosurgical Societies scale -LSB- WFNS -RSB- @ or @ ) ; VASOGRADE-Yellow ( modified Fisher @ or @ and WFNS @-@ ) ; and VASOGRADE-Red ( WFNS @ or @ , irrespective of modified Fisher grade ) .


The relation between the VASOGRADE and DCI was assessed by logistic regression models .


The predictive accuracy of the VASOGRADE was assessed by receiver operating characteristics curve and calibration plots .


In a cohort of @ patients , the VASOGRADE significantly predicted DCI ( P < @ ) .


The VASOGRADE-Yellow had a tendency for increased risk for DCI ( odds ratio -LSB- OR -RSB- , @ ; @ % CI , @-@ @ ) when compared with VASOGRADE-Green ; those with VASOGRADE-Red had a @-fold higher risk of DCI ( OR , @ ; @ % CI , @-@ @ ) .


Studies were not a significant confounding factor between the VASOGRADE and DCI .


The VASOGRADE had an adequate discrimination for prediction of DCI ( area under the receiver operating characteristics curve = @ ) and good calibration .


The VASOGRADE results validated previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients , which allows DCI risk stratification on presentation after subarachnoid hemorrhage .


It could help to select patients at high risk of DCI , as well as standardize treatment protocols and research studies .


To determine the effect of suppression of vascular endothelial growth factor ( VEGF ) by monthly injection of ranibizumab on posterior retinal nonperfusion ( RNP ) in patients with diabetic macular edema ( DME ) .


Unplanned retrospective analysis of prospectively collected data from @ randomized , sham injection-controlled , double-masked , multicenter clinical trials .


Six hundred sixty-six patients with DME .


An independent reading center measured the area of RNP on fluorescein angiograms obtained in the phase @ RISE and RIDE trials .


The percentage of patients with no posterior RNP .


The percentage of patients with no posterior RNP decreased in the sham group between baseline and month @ , but remained relatively stable in the @ ranibizumab groups .


After month @ , the sham group crossed over to receive monthly injections of ranibizumab @ mg , and the differences between the sham and ranibizumab groups were reduced .


The percentage of patients who showed an increase in posterior RNP from baseline increased over time in all @ groups , but at a faster rate in the sham group , resulting in statistically significant differences at every time point between months @ ( @ % vs. @ % ; P = @ ) and @ ( @ % vs. @ % ; P < @ ) for ranibizumab @ mg versus sham and from months @ ( @ % vs. @ % ; P = @ ) through @ ( @ % vs. @ % ; P < @ ) for ranibizumab @ mg .


Initiation of ranibizumab in the sham group at month @ was followed by reduction in the percentage of patients with an increase in posterior RNP from baseline at months @ and @ , whereas the @ ranibizumab groups continued their gradual rise .


Just as high VEGF levels contribute to progression of retinal nonperfusion in retinal vein occlusion , the same is true in patients with DME , suggesting that regardless of the underlying disease process , high levels of VEGF can cause closure of retinal vessels .


However , our data also suggest that VEGF-induced worsening of retinal perfusion in DME is superimposed on another cause of more gradually worsening perfusion , possibly glucotoxicity .


Thus , monthly injections of ranibizumab can slow , but not completely prevent , retinal capillary closure in patients with DME .


To assess the efficacy of combined use of scorpion antivenom ( SAV ) with prazosin , compared with prazosin alone in children with Mesobuthus tamulus scorpion envenomation .


Randomised controlled trial .


A tertiary care hospital in south India .


@ children with definite history and/or systemic manifestations of scorpion envenomation were recruited from the paediatric emergency or outpatient department from February @ to July @ .


The children were randomised into two groups .


In @ children , SAV was administrated as a slow intravenous bolus combined with prazosin ( group A ) .


Others received prazosin alone ( group B ) .


Results were analysed by Student t test and ( @ ) test .


Time required for resolution of autonomic symptoms , total dose of prazosin , adverse events .


Children in group A recovered earlier than those in group B ( mean difference @ h , @ % CI @ to @ ) .


@ children ( @ % ) in group A were clear of autonomic symptoms within @h , compared with @ children ( @ % ) in group B ( mean difference @ % , @ % CI @ % to @ % ) .


The proportion of children deteriorating to clinical grade @ or @ was @ % in group A as against @ % in group B ( p < @ ) .


The mean dose of prazosin required was @g/kg versus @ g/kg in group A and B , respectively ( p < @ ) .


SAV was not associated with severe adverse reactions .


Usage of SAV led to faster recovery and reduced the incidence of myocardial dysfunction .


Combined therapy with SAV and prazosin is beneficial for children with M tamulus scorpion envenomation .


Continuous feedback on patient improvement and the therapeutic alliance may reduce the number of dropouts and increase patient outcome .


There are , however , only three published randomized trials on the effect of feedback on the treatment of eating disorders , showing inconclusive results , and there are no randomized trials on the effect of feedback in group therapy .


Accordingly the current randomized clinical trial , initiated in September @ at the outpatient clinic for eating disorders at Stolpegaard Psychotherapy Centre , aims to investigate the impact of continuous feedback on attendance and outcome in group psychotherapy .


The hypothesis is that continuous feedback to both patient and therapist on treatment progress and alliance will increase attendance and treatment outcome .


The trial is set up using a randomized design with a minimum of @ patients allocated to either an experimental or control group at a ratio of @:@ .


The experimental group will receive standard treatment ( systemic and narrative group psychotherapy ) with feedback intervention , whereas the control group will receive standard treatment only .


The participants are diagnosed with bulimia nervosa , binge eating disorder , or an eating disorder not otherwise specified , according to the DSM-IV .


In the experimental group feedback to the participants , based on the Outcome Rating Scale ( ORS ) and the Group Session Rating Scale ( GSRS ) , is actively added to standard treatment .


The ORS assesses areas of life functioning known to change as a result of therapeutic intervention .


The GSRS assesses key dimensions of effective therapeutic relationships .


In the control group , the patients fill out the Outcome Rating Scale only , and feedback is not provided.The primary outcome is the rate of attendance to treatment sessions .


The secondary outcome is the severity of eating disorder symptoms .


Exploratory outcomes are the level of psychological and social functioning , and suicide or self-harm .


This is measured with the ORS , Symptom Check List , WHO-Five Wellbeing Index , Sheehan Disability Scale and a modified version of the Self-Harm Inventory .


If the results will confirm the hypothesis , this trial will support feedback as a way to improve group treatment attendance for outpatients with eating disorders .


Hepatitis B virus ( HBV ) infection is endemic in South Africa however , there is limited data on the degree of liver disease and geographic variation in HIV/HBV coinfected individuals .


In this study , we analysed data from the CIPRA-SA ` Safeguard the household study ' in order to assess baseline HBV characteristics in HIV/HBV co-infection participants prior to antiretroviral therapy ( ART ) initiation .


@ participants from two South African townships Soweto and Masiphumelele were enrolled in a randomized trial of ART ( CIPRA-SA ) .


Participants were tested for hepatitis B surface antigen ( HBsAg ) , hepatitis B e antigen ( HBeAg ) , and HBV DNA .


FIB-@ scores were calculated at baseline .


Forty-eight ( @ % ) were HBsAg positive , of whom @ ( @ % ) were HBeAg positive .


Of those with HBV , @ % had an HBV DNA < @ IU/ml and ALT < @ IU/ml ; @ % had a FIB-@ score < @ , consistent with absent or minimal liver disease .


HBV prevalence was @ % in Masiphumelele compared to @ % in Soweto ( relative risk @ ; @ % CI : @-@ @ ) .


More participants in Masiphumelele had HBeAg-negative disease ( @ % vs. @ % , p = @ ) and HBV DNA levels @ IU/ml , ( @ % vs. @ % p < @ ) .


One third of HIV/HBV co-infected subjects had low HBV DNA levels and ALT while the majority had indicators of only mild liver disease .


There were substantial regional differences in HBsAg and HbeAg prevalence in HIV/HBV co-infection between two regions in South Africa .


This study highlights the absence of severe liver disease and the marked regional differences in HIV/HBV co-infection in South Africa and will inform treatment decisions in these populations .


The aim of this research is to explore the coupling patterns of brain dynamics during an auditory oddball task in schizophrenia ( SCH ) .


Event-related electroencephalographic ( ERP ) activity was recorded from @ SCH patients and @ healthy controls .


The coupling changes between auditory response and pre-stimulus baseline were calculated in conventional EEG frequency bands ( theta , alpha , beta-@ , beta-@ and gamma ) , using three coupling measures : coherence , phase-locking value and Euclidean distance .


Our results showed a statistically significant increase from baseline to response in theta coupling and a statistically significant decrease in beta-@ coupling in controls .


No statistically significant changes were observed in SCH patients .


Our findings support the aberrant salience hypothesis , since SCH patients failed to change their coupling dynamics between stimulus response and baseline when performing an auditory cognitive task .


This result may reflect an impaired communication among neural areas , which may be related to abnormal cognitive functions .


To determine whether a health-promotion intervention increases South African men 's adherence to physical-activity guidelines .


We utilized a cluster-randomized controlled trial design .


Eligible clusters , residential neighborhoods near East London , South Africa , were matched in pairs .


Within randomly selected pairs , neighborhoods were randomized to theory-based , culturally congruent health-promotion intervention encouraging physical activity or attention-matched HIV/STI risk-reduction control intervention .


Men residing in the neighborhoods and reporting coitus in the previous @ months were eligible .


Primary outcome was self-reported individual-level adherence to physical-activity guidelines averaged over @-month and @-month post-intervention assessments .


Data were collected in @-@ .


Data collectors , but not facilitators or participants , were blind to group assignment .


Primary outcome intention-to-treat analysis included @ of @ clusters and @ of @ men in the health-promotion intervention and @ of @ clusters and @ of @ men in the attention-control intervention .


Model-estimated probability of meeting physical-activity guidelines was @ % in the health-promotion intervention and @ % in attention-matched control ( OR = @ ; @ % CI , @-@ @ ) , adjusting for baseline prevalence and clustering from @ neighborhoods .


A theory-based culturally congruent intervention increased South African men 's self-reported physical activity , a key contributor to deaths from non-communicable diseases in South Africa .


The aim of the current study was to determine any relationship between the timing of clamping of the umbilical cord and the lipid levels circulating in umbilical artery and vein .


We studied a clinical trial with systematic assignment in @ single-fetus full-term deliveries with normal gestational course and spontaneous delivery ; out of these , @ were subjected to early clamping ( EC , within @ s of delivery ) and @ to late clamping ( LC , at @ min ) .


In all cases , total cholesterol ( TC ) , triglycerides ( TG ) , and phospholipids were measured in sera from umbilical artery and vein .


TC and TG values were significantly higher in the EC group than in the LC group in both umbilical artery and vein .


Comparing values between umbilical artery and vein in the two clamping groups , in the EC group , all studied lipids TC , TG and phospholipids were significantly higher in vein than in artery .


In the LC group , only TC was higher in vein .


Umbilical cord lipid levels are related to the timing of umbilical cord clamping , finding which is noteworthy , because they are essential component of postnatal development .


Our study confirms that delivery acts as an important modifier of fetal lipid levels .


Attrition is common in the treatment of anorexia nervosa and its causes are complex and incompletely understood .


In particular , its relationship with adaptive function and motivational stage of change has been little studied .


This study aimed to ( @ ) investigate and ( @ ) compare the strength of associations between adaptive function , stage of change and other previously found factors such as illness sub-type and treatment attrition in women with severe and enduring anorexia nervosa ( SE-AN ) .


Participants were @ adult women with SE-AN of at least @ years duration who were enrolled in a multi-site randomized controlled trial conducted from July @ through June @ .


Treatment comprised @ outpatient visits over @ months of either Cognitive Behaviour Therapy for Anorexia Nervosa ( CBT-AN ) or Specialist Supportive Clinical Management ( SSCM ) both of which were modified for severe and enduring illness .


Assessments were done at baseline , end of treatment , and @ and @ month post treatment follow-up .


Demographic variables , duration of illness , specific and generic health related quality of life ( QoL ) , eating disorder ( ED ) and mood disorder symptoms , social adjustment , body mass index ( BMI ) , and motivation for change were assessed with interview and self-report questionnaires .


Treatment attrition was defined as leaving therapy after either premature termination according to trial protocol or self-instigated discharge .


Binary logistic regression was used to investigate relative strength of associations .


Those who did not complete treatment were significantly more likely to have the purging sub-type of anorexia nervosa and poorer ED related QoL .


There were no significant differences between attrition and which therapy was received , educational level , and global ED psychopathology , stage of change , BMI , social adjustment , duration of illness or level of depression .


The strongest predictors on multivariable analysis were ED QoL and AN-purging subtype .


This study supported previous findings of associations between attrition and purging subtype .


Furthermore , we found associations between a potentially important cycle of attrition , and poorer EDQoL , which has not been previously reported .


Contrary to expectations we did not find an association with BMI , severity of ED symptoms , low level of motivation to change ED features , or level of education .


Recent evidence supports the use of normal saline flushes in place of heparin to maintain the patency of peripheral intravenous locks ( IVLs ) ; however , there are no data regarding the recommended flush frequency .


This was an open , non-inferiority , randomised controlled trial .


Children with IVLs , aged @-@ years , were randomly assigned to receive saline flushing every @ h ( group A ) or every @ h ( group B ) .


The main outcome was the maintenance of catheter patency .


Four hundred patients were randomised ; @ subjects were analysed in the @ h group and @ in the @ h group ( three patients were lost at follow-up ) .


Occlusion occurred in @ children ( @ % ) in group A versus @ ( @ % ) in group B ( p = @ ) .


The difference in catheter patency was +@ % in favour of the @ h group ( @ % CI -@ % to @ % ) , showing the non-inferiority of the @ h procedure ( the non-inferiority margin was set at -@ % ) .


Catheter-related complications were not different between the two groups ( @ % in group A vs @ % in group B ; p = @ ) .


A flushing procedure with one flush per day allows maintenance of catheter patency without an increase in catheter-related complications .


We propose a simplification of the flushing procedure with only one flush per day , thereby reducing costs ( materials use and nursing time ) , labour and unnecessary manipulation of the catheters which can cause distress in younger children and their parents .


The benefits of chemoradiotherapy ( CRT ) for cervical cancer compared with radiation ( RT ) alone seem to diminish in later-stage disease .


However , these modalities have not been directly compared for disease-free interval ( DFI ) and overall survival ( OS ) of women with stage IIIB cervical cancer .


We conducted a randomized controlled clinical trial comparing DFI and OS of @ women with stage IIIB squamous cervical cancer who received either cisplatin plus RT ( CRT ) or RT alone ( @ patients in the CRT group and @ patients in the RT-only group ) .


The CRT group had significantly better DFI ( hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ; P = @ ) .


However , patients in the CRT group did not have significantly better OS than those in the RT-only group ( HR , @ ; @ % CI , @ to @ ; P = @ ) .


Toxicity was graded according to criteria of the Radiation Therapy Oncology Group .


The organs affected ( excluding hematologic effects ) did not differ significantly between groups .


Also , late toxicity events and organs affected were not significantly disproportionate between the study groups .


For stage IIIB cervical cancer , the addition of cisplatin offers a small but significant benefit in DFI , with acceptable toxicity .


Attention-based coping strategies for pain are widely used in pediatric populations .


The purpose of this study was to test a novel mindful attention manipulation on adolescent 's experimental pain responses .


Furthermore , the relationship between state mindfulness and experimental pain was examined .


A total of @ adolescents were randomly assigned to a mindful attention manipulation or control group prior to an experimental pain task .


Participants completed measures of state mindfulness immediately prior to the pain task , and situational catastrophizing and pain intensity following the task .


Overall the manipulation had no effect on pain .


Secondary analysis showed that meditation experience moderated the effect of the manipulation .


State mindfulness predicted pain outcomes , with reductions in situational catastrophizing mediating this relationship .


The mindful attention manipulation was effective among adolescents with a regular meditation practice .


State mindfulness was related to ameliorated pain responses , and these effects were mediated by reduced catastrophizing .


To evaluate the astigmatic effects of @-mm and @-mm cataract incisions .


A randomized prospective study of @ eyes of @ patients undergoing superior clear corneal incision ( SCCI ) was divided into three groups : @ eyes with a control @-mm SCCI ; @ eyes with a @-mm SCCI ; and @ eyes with a @-mm SCCI .


The corneal astigmatism was measured with an autokeratometer preoperatively and @month after surgery .


The with-the-wound ( WTW ) , against the-wound ( ATW ) , and WTW-ATW changes were calculated using the Holladay-Cravy-Koch formula .


The WTW , ATW , and WTW-ATW changes were significantly higher for the control @-mm SCCI than for the @ - and @-mm SCCI ( all p < @ ) , and no difference was found between the @ - and @-mm SCCI incision groups .


In our study , the astigmatic effects were the same for the @ mm and @ mm incisions and as expected , were significantly lower than the control @ mm incision group .


Vegetarian diets have been associated with reduced mortality .


Because a pure vegetarian diet might not easily be embraced by many individuals , consuming preferentially plant-derived foods would be a more easily understood message .


A provegetarian food pattern ( FP ) emphasizing preference for plant-derived foods might reduce all-cause mortality .


The objective was to identify the association between an a priori-defined provegetarian FP and all-cause mortality .


We followed @ participants ( @ % women ; mean age : @ y ) at high cardiovascular risk for a median of @ y.


A validated @-item semiquantitative food-frequency questionnaire was administered at baseline and yearly thereafter .


Fruit , vegetables , nuts , cereals , legumes , olive oil , and potatoes were positively weighted .


Added animal fats , eggs , fish , dairy products , and meats or meat products were negatively weighted .


Energy-adjusted quintiles were used to assign points to build the provegetarian FP ( range : @-@ points ) .


Deaths were confirmed by review of medical records and the National Death Index .


There were @ deaths during the follow-up period ( @ from cardiovascular causes , @ from cancer , @ for noncancer , noncardiovascular causes ) .


Higher baseline conformity with the provegetarian FP was associated with lower mortality ( multivariable-adjusted HR for @ compared with < @ points : @ ; @ % CI : @ , @ ) .


Similar results were found with the use of updated information on diet ( RR : @ ; @ % CI : @ , @ ) .


Among omnivorous subjects at high cardiovascular risk , better conformity with an FP that emphasized plant-derived foods was associated with a reduced risk of all-cause mortality .


This trial was registered at www.controlled-trials.com as ISRCTN@ .


This study aims to compare the effects of a mandibular advancement device ( MAD ) with continuous positive airway pressure ( CPAP ) treatment for obstructive sleep apnea ( OSA ) on blood pressure ( BP ) , oxidative stress , and heart rate variability ( HRV ) in a randomized , crossed-over , single-blind , and controlled trial .


Twenty-nine moderate-to-severe adult OSA patients underwent MAD , CPAP , and placebo oral appliance treatment .


Polysomnography , Epworth sleepiness scale , @-h ambulatory BP monitoring , oxidative stress parameters ( malondialdehyde , catalase , superoxide dismutase , vitamins C , E , B@ , B@ , folate , homocysteine , uric acid ) , and HRV were assessed at baseline and after @month of each treatment .


Diaries were used to evaluate compliance for devices and a pressure-time meter for CPAP .


Both active treatments resulted in decreases in apnea and hypopnea index and Epworth sleepiness scale ; CPAP showed a greater effect .


Frequency of diastolic BP dipping was higher in the MAD group compared with the CPAP group .


A significant drop from baseline levels for catalase activity was observed after MAD .


For HRV , there was a significant decrease in total power at night with CPAP and MAD compared with POA , and a decrease in index of sleep autonomic variation with MAD compared with baseline levels .


Compliance rates were higher with MAD rather than CPAP .


Even though CPAP proved to be more effective at attenuating OSA , better compliance with MAD favored the reduction of one of the enzymes which participates in oxidative stress and better autonomic modulation during sleep .


People using long-term indwelling urinary catheters experience multiple recurrent catheter problems .


Self-management approaches are needed to avoid catheter-related problems .


The aim was to determine effectiveness of a self-management intervention in prevention of adverse outcomes ( catheter-related urinary tract infection , blockage , and accidental dislodgement ) .


Healthcare treatment associated with the adverse outcomes and catheter-related quality of life was also studied .


A randomized clinical trial was conducted .


The intervention involved learning catheter-related self-monitoring and self-management skills during home visits by a study nurse ( twice during the first month and at @ months-with a phone call at @ months ) .


The control group received usual care .


Data were collected during an initial face-to-face home interview followed by bimonthly phone interviews .


A total of @ adult long-term urinary catheter users participated .


Participants were randomized to treatment or control groups following collection of baseline data .


Generalized estimating equations were used for the analysis of treatment effect .


In the intervention group , there was a significant decrease in reported blockage in the first @ months ( p = @ ) , but the effect did not persist .


There were no significant effects for catheter-related urinary tract infection or dislodgment .


Comparison of baseline rates of adverse outcomes with subsequent periods suggested that both groups improved over @ months .


A simple-to-use catheter problems calendar and the bimonthly interviews might have functioned as a modest self-monitoring intervention for persons in both groups .


A simplified intervention using a self-monitoring calendar is suggested-with optimal and consistent fluid intake likely to add value .


A @-month phase @ study of fingolimod demonstrated efficacy and safety in Japanese patients with relapsing-remitting multiple sclerosis ( MS ) .


Here we report a @-month observational extension that evaluated efficacy and safety in patients who received fingolimod continuously for @ months or who switched from placebo to fingolimod .


Of @ patients who completed the @-month core study , @ entered the extension .


Those originally randomized to placebo were re-randomized to fingolimod @ mg or @ mg .


During the extension , all patients were switched to open-label fingolimod @ mg .


Magnetic resonance imaging ( MRI ) and relapse outcomes were maintained or improved in patients treated with fingolimod for @ months versus those treated for @ months .


No new safety events were reported over @ months of treatment .


Infections occurred in similar proportions of continuously treated and switched patients , while cardiac and liver adverse events occurred in fewer continuously treated than switched patients .


Four patients were aquaporin-@ ( AQP@ ) antibody-positive , three of whom showed rapid disease exacerbations within @ days of fingolimod initiation .


Continuous fingolimod treatment for up to @ months was associated with maintained or improved efficacy and a manageable safety profile , consistent with that previously seen .


Results in a small number of patients suggest lack of benefit in AQP@ antibody-positive patients .


Meaningful statistical interpretation was limited by the small sample size in each treatment group , owing to the number of patients who completed the core study .


Monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome are typically treated with fetoscopic laser coagulation .


Postoperative complications can occur due to residual vascular anastomoses on the placenta .


We aimed to assess the efficacy and safety of a novel surgery technique that uses laser coagulation of the entire vascular equator ( Solomon technique ) .


We undertook an open-label , international , multicentre , randomised controlled trial at five European tertiary referral centres .


Women with twin-to-twin transfusion syndrome were randomly assigned by online randomisation ( @:@ ) with permuted blocks to the Solomon technique or standard laser coagulation .


The primary outcome was a composite of incidence of twin anaemia polycythaemia sequence , recurrence of twin-to-twin transfusion syndrome , perinatal mortality , or severe neonatal morbidity .


Analyses were by intention to treat , with results expressed as odds ratios ( ORs ) and @ % CIs .


This trial is registered with the Dutch Trial Registry , number NTR@ .


Between March @ , @ , and July @ , @ , @ women were randomly assigned to either the Solomon group ( n = @ ) or the standard treatment group ( n = @ ) .


The primary outcome occurred in @ ( @ % ) of @ fetuses in the Solomon group versus @ ( @ % ) of @ in the standard treatment group ( OR @ ; @ % CI @-@ ) .


The Solomon technique was associated with a reduction in twin anaemia polycythaemia sequence ( @ % vs @ % for the standard treatment ; OR @ , @ % CI @-@ ) and recurrence of twin-to-twin transfusion syndrome ( @ % vs @ % ; @ , @-@ ) .


Perinatal mortality and severe neonatal morbidity did not differ significantly between the two groups .


Outside of the common and well-known complications of twin-to-twin transfusion syndrome and its treatment , no serious adverse events occurred .


Fetoscopic laser coagulation of the entire vascular equator reduces postoperative fetal morbidity in severe twin-to-twin transfusion syndrome .


We recommend that fetoscopic surgeons consider adopting this strategy for treatment of women with twin-to-twin transfusion syndrome .


Many smokers find the cost of smoking cessation medications a barrier .


Financial coverage for these medications increases utilization of pharmacotherapies .


This study assesses whether financial coverage increases the proportion of successful quitters .


A pragmatic , open-label , randomized , controlled trial was conducted in @ Canadian sites between March @ and September @ .


Smokers ( @ cigarettes/day ) without insurance coverage who were motivated to quit within @days were randomized ( @:@ ) in a blinded manner to receive either full coverage eligibility for @weeks or no coverage .


Pharmacotherapies covered were varenicline , bupropion , or nicotine patches/gum .


Investigators/subjects were unblinded to study group assignment after randomization and prior to choosing a smoking cessation method ( s ) .


All subjects received brief smoking cessation counseling .


The primary outcome measure was self-reported @-day point prevalence of abstinence ( PPA ) at week @ .


Of the @ randomized subjects ( coverage , @ ; no coverage , @ ) , @ ( @ % ) and @ ( @ % ) , respectively , were dispensed at least one smoking cessation medication dose .


The @-day PPA at week @ was higher in the full coverage versus no coverage group : @ % ( n = @ ) and @ % ( n = @ ) , respectively ; odds ratio ( OR ) = @ , @ % confidence interval ( CI ) @-@ @ ; p = @ .


Urine cotinine-confirmed @-day PPA at week @ was @ % ( n = @ ) and @ % ( n = @ ) , respectively ; OR = @ , @ % CI @-@ @ ; p = @ .


After pharmacotherapy , coverage eligibility was withdrawn from the full coverage group , continuous abstinence between weeks @ and @ was @ % ( n = @ ) and @ % ( n = @ ) , in the full coverage and no coverage groups , respectively ; OR = @ , @ % CI @-@ @ ; p = @ .


In this study , the adoption of a smoking cessation medication coverage drug policy was an effective intervention to improve @-week quit rates in Canada .


The advantages were lost once coverage was discontinued .


Further study is required on the duration of coverage to prevent relapse to smoking .


( clinicaltrials.gov identifier : NCT@ ; the study was sponsored by Pfizer Inc. ) .


To analyze bereaved next of kin 's suggestions for improving end-of-life ( EOL ) care in Veterans Affairs ( VA ) Medical Centers ( VAMCs ) .


Qualitative .


This study was part of a larger study testing the effectiveness of a multimodal intervention strategy to improve processes of EOL care in six southeast U.S. VAMCs ( Best Practices for End-of-Life Care for Our Nation 's Veterans-BEACON Trial ) .


Bereaved next of kin ( n = @ ) of veterans who died between @ and @ .


Data addressing praise , criticism , and recommendations for enhancing EOL care were abstracted from semistructured interviews of next of kin and aggregated into a code labeled `` Suggestions . ''


Content analysis proceeded iteratively through data review , comparison , and negotiation of emergent themes and integration of all coauthors ' insights and interpretations into the evolving interpretive scheme .


Next of kin provided examples that resonated with their conceptions of quality EOL care .


They also described distressing situations and perceptions of deficits in care .


Major themes derived were compassionate care , good communication , support for family visits and privacy , and the need for death preparation and postdeath guidance .


The fifth theme , unique to this study , was the salience of the relationship between the veterans and their families and the VA and the expectations this engendered in terms of dignity and honor .


Interventions that support staff 's ability to convey compassion , communicate information to families and other staff , listen to patients and families , prepare families for the individual 's death , and provide consistent , coordinated information regarding after-death activities may optimize EOL hospital care for veterans .


Trials in castration-resistant prostate cancer ( CRPC ) need new clinical end points that are valid surrogates for survival .


We evaluated circulating tumor cell ( CTC ) enumeration as a surrogate outcome measure .


Examining CTCs alone and in combination with other biomarkers as a surrogate for overall survival was a secondary objective of COU-AA-@ , a multinational , randomized , double-blind phase III trial of abiraterone acetate plus prednisone versus prednisone alone in patients with metastatic CRPC previously treated with docetaxel .


The biomarkers were measured at baseline and @ , @ , and @ weeks , with @ weeks being the primary measure of interest .


The Prentice criteria were applied to test candidate biomarkers as surrogates for overall survival at the individual-patient level .


A biomarker panel using CTC count and lactate dehydrogenase ( LDH ) level was shown to satisfy the four Prentice criteria for individual-level surrogacy .


Twelve-week surrogate biomarker data were available for @ patients .


The abiraterone acetate plus prednisone and prednisone-alone groups demonstrated a significant survival difference ( P = @ ) ; surrogate distribution at @ weeks differed by treatment ( P < @ ) ; the discriminatory power of the surrogate to predict mortality was high ( weighted c-index , @ ) ; and adding the surrogate to the model eliminated the treatment effect on survival .


Overall , @-year survival of patients with CTCs < @ ( low risk ) versus patients with CTCs @ cells/@ @ mL of blood and LDH > @ U/L ( high risk ) at @ weeks was @ % and @ % , respectively .


A biomarker panel containing CTC number and LDH level was shown to be a surrogate for survival at the individual-patient level in this trial of abiraterone acetate plus prednisone versus prednisone alone for patients with metastatic CRPC .


Additional trials are ongoing to validate the findings .


Pulmonary edema may alter alveolar bacterial clearance and infectivity .


Manipulation of fluid balance aimed at reducing fluid overload may , therefore , influence ventilator-associated pneumonia ( VAP ) occurrence in intubated patients .


The objective of the present study was to assess the impact of a depletive fluid-management strategy on ventilator-associated complication ( VAC ) and VAP occurrence during weaning from mechanical ventilation .


We used data from the B-type Natriuretic Peptide for the Fluid Management of Weaning ( BMW ) randomized controlled trial performed in nine ICUs across Europe and America .


We compared the cumulative incidence of VAC and VAP between the biomarker-driven , depletive fluid-management group and the usual-care group during the @ days following randomization , using specific competing-risk methods ( the Fine and Gray model ) .


Among the @ patients analyzed , @ experienced VAP , including @ ( @ % ) in the usual-care group vs @ ( @ % ) in the interventional group ( P = @ ) .


From the Fine and Gray model , the probabilities of VAC and VAP occurrence were both significantly reduced with the interventional strategy while adjusting for weaning outcome as a competing event ( subhazard ratios -LSB- @th-@th percentiles -RSB- , @ -LSB- @-@ @ -RSB- , P = @ and @ -LSB- @-@ @ -RSB- , P = @ , respectively ) .


Using proper competing risk analyses , we found that a depletive fluid-management strategy , when initiating the weaning process , has the potential for lowering VAP risk in patients who are mechanically ventilated .


Despite the potential benefits of long-chain n-@ polyunsaturated fatty acids ( LC n-@ PUFAs ) , intake is often low because of low consumption of oily seafood .


Microencapsulated fish oil powder can improve tolerance and acceptance of LC n-@ PUFAs .


Bioavailability is important to achieve efficacy .


We investigated the bioavailability of LC n-@ PUFAs from microencapsulated powder in comparison with meals enriched with liquid fish oil .


Participants ( N = @ , age@ years ) of this @-week double-blinded dietary intervention were randomized into three groups .


Group @ ( n = @ ) received @ g/d eicosapentaenoic acid ( EPA ) and docosahexaenoic acid ( DHA ) as ready-to-eat meals enriched with liquid fish oil ; group @ ( n = @ ) received the same amount of these LC n-@ PUFAs as microencapsulated fish oil powder and regular meals ; and group @ ( n = @ ) was the control group , which received placebo powder and regular meals .


Blood samples were taken from fingertips at baseline and at the end point .


Seventy-seven subjects ( @ % ) completed the study .


The amount of EPA in blood doubled in both groups that received LC n-@ PUFAs ( P < @ ) , but it did not change in the control group .


The changes in DHA were less but still significant in both intervention groups .


According to multivariate analysis , both intervention groups had higher end-point LC n-@ PUFA concentrations compared with placebo , but differences between intervention groups were not significant .


Bioavailability of LC n-@ PUFAs in encapsulated powder is very similar to the bioavailability of LC n-@ PUFAs in ready-to-eat meals enriched with liquid fish oil .


Thus , encapsulated powder can be considered useful to increase LC n-@ PUFA concentrations in blood .


Short sleep duration is associated with an increased risk of type @ diabetes .


Subchronic sleep restriction ( SR ) causes insulin resistance , but the mechanisms and roles of specific tissues are unclear .


The purpose of this article was to determine whether subchronic SR altered ( @ ) hepatic insulin sensitivity , ( @ ) peripheral insulin sensitivity , and ( @ ) substrate utilization .


This was a randomized crossover study in which @ subjects underwent @ admissions separated by a washout period .


Each admission had @ acclimatization nights followed by @ nights of either SR ( @ hours time in bed ) or normal sleep ( @ hours time in bed ) .


MAIN OUTCOME MEASURE/METHODS : Insulin sensitivity ( measured by hyperinsulinemic-euglycemic clamp ) and hepatic insulin sensitivity ( measured by stable isotope techniques ) were measured .


In addition , we assayed stress hormone ( @-hour urine free cortisol , metanephrine , and normetanephrine ) , nonesterified fatty acid ( NEFA ) , and - hydroxybutyrate ( - OH butyrate ) levels .


Resting energy expenditure ( REE ) and respiratory quotient ( RQ ) were measured by indirect calorimetry .


Compared to normal sleep , whole-body insulin sensitivity decreased by @ % ( P = @ ) with SR and peripheral insulin sensitivity decreased by @ % ( P = @ ) .


Whereas hepatic insulin sensitivity ( endogenous glucose production ) did not change significantly , percent gluconeogenesis increased ( P = @ ) .


Stress hormones increased modestly ( cortisol by @ % , P = @ ; metanephrine by @ % , P = @ ; normetanephrine by @ % , P = @ ) .


Fasting NEFA and - OH butyrate levels increased substantially ( @ % and @ % , respectively ) .


REE did not change ( P = @ ) , but RQ decreased ( @ @ vs @ @ , P = @ ) .


Subchronic SR causes unique metabolic disturbances characterized by peripheral , but not hepatic , insulin resistance ; this was associated with a robust increase in fasting NEFA levels ( indicative of increased lipolysis ) , decreased RQ , and increased - OH butyrate levels ( indicative of whole-body and hepatic fat oxidation , respectively ) .


We postulate that elevated NEFA levels are partially responsible for the decrease in peripheral sensitivity and modulation of hepatic metabolism ( ie , increase in gluconeogenesis without increase in endogenous glucose production ) .


Elevated cortisol and metanephrine levels may contribute to insulin resistance by increasing lipolysis and NEFA levels .


Measurement of central blood pressure provides prognostic information beyond conventional peripheral blood pressure ( BP ) .


However , few studies have directly compared the effects of antihypertensives on central hemodynamics .


This study investigated the effects of a low-dose combination of nifedipine Gastrointestinal Therapeutic System ( GITS ) and valsartan versus high-dose monotherapy with either agent in reducing central BP in essential hypertension inadequately controlled by low-dose monotherapy .


In this prospective , open-label , randomized , active-controlled , multicenter @-week study , patients not meeting the target BP after @ weeks of treatment with low-dose monotherapy were randomized to receive nifedipine GITS @mg plus valsartan @mg ( N@ + V@ ) , nifedipine GITS @mg ( N@ ) , or valsartan @mg ( V@ ) for a further @ weeks .


Central hemodynamics were measured by applanation tonometry .


A total of @ patients were enrolled .


Reduction in central systolic BP from baseline to week @ , the primary efficacy variable , was significantly greater in the N@ + V@ group ( -@ mmHg ) and the N@ group ( -@ mmHg ) compared with V@ group ( -@ mmHg ) .


Decrease in the augmentation index in the N@ group was significantly greater compared with V@ alone , without differences between combination therapy and either high-dose monotherapy .


Decreases in brachial systolic BP were significantly greater in the N@ + V@ and N@ groups than in the V@ group .


By multiple regression analysis , most differences in drug effects on central hemodynamics disappeared after controlling for changes in peripheral BP .


A low rate of adverse events occurred in all treatment groups .


A low-dose combination of nifedipine GITS plus valsartan or high-dose nifedipine was more effective in improving central hemodynamics than high-dose valsartan in patients with hypertension , mostly because of the improvement in peripheral ( brachial ) hemodynamics .


To develop and examine the effectiveness of a home-based self-help psychoeducation programme on health-related quality of life , stress level , anxiety and depression symptoms , self-efficacy , cardiac risk factors and health service use of outpatients with coronary heart disease .


Hospital-based cardiac rehabilitation programmes have been shown to improve , effectively , the quality of life of patients with coronary heart disease .


However , a majority of these patients do not participate in these programmes , while those who do enrol in these programmes fail to complete the programmes .


Randomized controlled trial with repeated measures .


This study was approved and received the grant in July @ .


A convenience sample of @ coronary heart disease outpatients will be recruited from a tertiary hospital in Singapore .


Participants are randomly assigned to the @-week experimental group and will participate in the programme or the control group who will not participate in the programme .


The outcome measures include the : @-item Short Form Health Survey , Perceived Stress Scale , Hospital Anxiety and Depression Scale and General Self-Efficacy Scale .


Data will be collected at baseline , then @ and @ weeks from baseline .


At the end , a process evaluation will be conducted to assess the acceptability , strengths and weaknesses of our programme based on the participants ' perspectives .


Our programme offers coronary heart disease patients an additional option to the existing cardiac rehabilitative services in Singapore hospitals .


It aims to help them manage their disease effectively by reducing cardiac risk factors and improve their health-related quality of life and psychological well-being .


To investigate the guiding role of narrow-band imaging endoscopy in laryngeal malignant lesion biopsy .


From February @ to January @ , @ patients suspected of laryngeal malignant lesions after electronic nasopharyngolaryngoscope screening were included in the study .


The patients were randomly divided into two groups , @ cases in group A underwent laryngeal tumor biopsies in the white light mode and @ cases in group B did in NBI mode .


The patients were applied with corresponding surgery treatment according to the biopsy results .


Postoperative pathologic examination result was as a gold standard for identifing the laryngeal diseases .


The positive rate of malignant lesions in group A ( @ % , @/@ ) was significantly lower than that in group B ( @ % , @/@ ) ( = @ , P < @ ) ; the accurate rate of biopsy in group A ( @ % , @/@ ) was significantly lower than that in group B ( @ % , @/@ , = @ , P < @ ) .


Narrow-band imaging endoscopy can obviously improve in the detection of laryngeal malignant lesion by biopsy .


Universal interventions may widen or narrow inequalities if disproportionately effective among higher or lower socio-economic groups .


The present paper examines impacts of the Primary School Free Breakfast Initiative in Wales on inequalities in children 's dietary behaviours and cognitive functioning .


Cluster-randomised controlled trial .


Responses were linked to free school meal ( FSM ) entitlement via the Secure Anonymised Information Linkage databank .


Impacts on inequalities were evaluated using weighted school-level regression models with interaction terms for intervention whole-school percentage FSM entitlement and intervention aggregated individual FSM entitlement .


Individual-level regression models included interaction terms for intervention individual FSM entitlement .


Fifty-five intervention and fifty-six wait-list control primary schools .


Approximately @ children completed measures of dietary behaviours and cognitive tests at baseline and @-month follow-up .


School-level models indicated that children in intervention schools ate a greater number of healthy items for breakfast than children in control schools ( b = @ ; @ % CI @ , @ ) , with larger increases observed in more deprived schools ( interaction term b = @ ; @ % CI @ , @ ) .


An interaction between intervention and household-level deprivation was not significant .


Despite no main effects on breakfast skipping , a significant interaction was observed , indicating declines in breakfast skipping in more deprived schools ( interaction term b = -@ ; @ % CI -@ , -@ ) and households ( OR = @ ; @ % CI @ , @ ) .


No significant influence on inequality was observed for the remaining outcomes .


Universal breakfast provision may reduce socio-economic inequalities in consumption of healthy breakfast items and breakfast skipping .


There was no evidence of intervention-generated inequalities in any outcomes .


Evolving primary care models require methods to help practices achieve quality standards .


This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of @ pediatric preventive services .


In this cluster-randomized trial , a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling , lead screening , and dental fluoride varnish application .


Thirty practices were randomized to Early or Late Intervention , and outcomes assessed for @ well-child visits .


A multidisciplinary team characterized facilitation processes by using comparative case study methods .


Baseline performance was as follows : for Obesity : @ % successful performance in Early and @ % in Late practices , P = @ ; Lead : @ % and @ % success , respectively , P = @ ; and Fluoride : < @ % success for all practices .


Four months after randomization , performance rose in Early practices , to @ % for Obesity , @ % for Lead , and @ % for Fluoride , all P < @ for improvement compared with Late practices ' control time .


During the full @-month intervention , care improved versus baseline in all practices , for Obesity for Early practices to @ % , and for Late practices @ % ; for Lead for Early practices to @ % and Late practices @ % ; and for Fluoride , for Early practices to @ % and Late practices @ % , all P < @ compared with baseline .


Improvements were sustained @ months after intervention .


Successful facilitation involved multidisciplinary support , rapid-cycle problem solving feedback , and ongoing relationship-building , allowing individualizing facilitation approach and intensity based on @ levels of practice need .


Practice-tailored Facilitation Intervention can lead to substantial , simultaneous , and sustained improvements in @ domains , and holds promise as a broad-based method to advance pediatric preventive care .


The Stent-In @ trial randomized patients with malignant colonic obstruction to emergency surgery or stent placement as a bridge to elective surgery .


The aim of this study was to compare the oncological outcomes .


Disease recurrence , and disease-free , disease-specific and overall survival were evaluated , including a subgroup analysis of patients with a stent - or guidewire-related perforation .


Of @ patients included in the original Stent-In @ trial , patients with benign ( @ ) or incurable ( @ ) disease were excluded from this study , along with a patient who had withdrawn from the trial .


Of the remaining @ patients , @ were randomized to emergency surgery ( @ resection , @ stoma only ) and @ to stenting .


Unsuccessful stenting required emergency surgery in six patients owing to wire or stent perforation .


Locoregional or distant disease recurrence developed in nine of @ patients in the emergency surgery group and @ of @ in the stent group .


Disease-free survival was worse in the subgroup with stent - or guidewire-related perforation .


Five of six patients in this subgroup developed a recurrence , compared with nine of @ in the emergency surgery group and eight of @ who had unperforated stenting .


Stent placement for malignant colonic obstruction was associated with a risk of recurrence in this trial , but the numbers are small .


There is not enough evidence to refute the approach strongly .


Previous studies have found that family-focused treatment is an effective adjunct to pharmacotherapy in stabilizing symptoms in adult bipolar disorder .


The authors examined whether pharmacotherapy and family-focused treatment for adolescents with bipolar disorder was more effective than pharmacotherapy and brief psychoeducation ( enhanced care ) in decreasing time to recovery from a mood episode , increasing time to recurrence , and reducing symptom severity over @ years .


A total of @ adolescents ( mean age , @ years ) with bipolar I or II disorder and a DSM-IV-TR manic , hypomanic , depressive , or mixed episode in the previous @ months were randomly assigned , with family members , either to pharmacotherapy and family-focused treatment , consisting of psychoeducation ( i.e. , recognition and early intervention with prodromal symptoms ) , communication enhancement training , and problem-solving skills training , delivered in @ sessions over @ months ; or to pharmacotherapy and three weekly sessions of enhanced care ( family psychoeducation ) .


Independent evaluators assessed participants at baseline , every @ months during year @ , and every @ months during year @ , using weekly ratings of mood .


Twenty-two participants ( @ % ) withdrew shortly after randomization .


Time to recovery or recurrence and proportion of weeks ill did not differ between the two treatment groups .


Secondary analyses revealed that participants in family-focused treatment had less severe manic symptoms during year @ than did those in enhanced care .


After an illness episode , intensive psychotherapy combined with best-practice pharmacotherapy does not appear to confer advantages over brief psychotherapy and pharmacotherapy in hastening recovery or delaying recurrence among adolescents with bipolar disorder .


Malaria and HIV are two major causes of morbidity and mortality among pregnant women in sub-Saharan Africa .


Foetal and neonatal outcomes of this co-infection have been extensively studied .


However , little is known about maternal morbidity due to clinical malaria in pregnancy , especially malaria-related fever , in the era of generalized access to antiretroviral therapy and anti-malarial preventive strategies .


A cohort study was conducted in order to estimate the incidence rate and to determine the factors associated with malaria-related fever , as well as the maternal morbidity attributable to malaria in a high-transmission setting of South Benin among HIV-infected pregnant women .


Four-hundred and thirty-two women who participated in a randomized trial testing strategies to prevent malaria in pregnancy were included and followed until delivery , with at least three scheduled visits during pregnancy .


Confirmed malaria-related fever was defined as axillary temperature > @ C and a concomitant , positive , thick blood smear or rapid diagnostic test for Plasmodium falciparum .


Suspected malaria-related fever was defined as an axillary temperature > @ C and the concomitant administration of an anti-malarial treatment in the absence of parasitological investigation .


Incidence rate for confirmed malaria-related fever was of @ per @,@ person-year ( PY ) ( @ % confidence interval ( CI ) : @-@ @ ) .


In multivariate analysis , CD@ lymphocytes ( Relative Risk ( RR ) for a @ cells/mm@ variation = @ ; CI : @-@ @ ) , antiretroviral treatment started before inclusion ( RR = @ ; CI : @-@ @ ) and history of symptomatic malaria in early pregnancy ( RR = @ ; CI : @-@ @ ) were associated with the incidence of confirmed or suspected malaria-related fever .


More than a half of participants with parasitaemia were symptomatic , with fever being the most common symptom .


The crude fraction of febrile episodes attributable to malaria was estimated at @ % .


This work highlights that malaria is responsible for a substantial morbidity in HIV-infected pregnant women , with cellular immunodepression as a major determinant , and establishes the possible advantage offered by the early initiation of antiretroviral treatment .


The aims of this study were ( @ ) to explore the effectiveness of dyad practice compared with individual practice on a simulator for learning a complex clinical skill and ( @ ) to explore medical students ' perceptions of how and why dyad practice on a simulator contributes to learning a complex skill .


In @ , the authors randomly assigned @ medical students to either the dyad or the individual practice group to learn coronary angiography skills using instruction videos and a simulator .


Two weeks later , participants each performed two video-recorded coronary angiographies on the simulator .


Two raters used a rating scale to assess the participants ' video-recorded performance .


The authors then interviewed the participants in the dyad practice group .


Seventy-two ( @ % ) participants completed the study .


The authors found no significant difference between the performance scores of the two groups ( meanstandard deviation , @ % @ % for individual versus @ % @ % for dyad practice ; P = @ ) .


Dyad practice participants noted that several key factors contributed to their learning : being equal-level novices , the quality of the cooperation between partners , observational learning and overt communication , social aspects and motivation , and meta-cognition .


Dyad practice is more efficient and thus more cost-effective than individual practice and can be used for costly virtual reality simulator training .


However , dyad practice may not apply to clinical training involving real patients because learning from errors and overt communication , both keys to dyad practice , do not transfer to clinical practice .


Iron deficiency is the most widespread nutritional deficiency in the world .


The objective of this randomized efficacy trial was to determine the effects of iron-biofortified pearl millet ( Fe-PM ) on iron status compared with control pearl millet ( Control-PM ) .


A randomized trial of biofortified pearl millet ( Pennisetum glaucum ) , bred to enhance iron content , was conducted in @ children ( @-@ y ) for @ mo in Maharashtra , India .


Iron status -LSB- hemoglobin , serum ferritin ( SF ) , soluble transferrin receptor ( sTfR ) , and total body iron ( TBI ) -RSB- , inflammation ( C-reactive protein and -@ acid glycoprotein ) , and anthropometric indices were evaluated at enrollment and after @ and @ mo. .


Hodges-Lehmann-Sen @ % CIs were used to examine the effect of the Fe-PM on iron status compared with commercially available Control-PM .


Linear and binomial regression models were used to evaluate the effects of Fe-PM on iron status and incidence of anemia and iron deficiency , compared with Control-PM .


At baseline , @ % of children were iron deficient ( SF < @ g/L ) and @ % were anemic ( hemoglobin < @ g/dL ) .


Fe-PM significantly increased SF concentrations and TBI after @ mo compared with Control-PM .


Among children who were iron deficient at baseline , those who received Fe-PM were @ times more likely to become iron replete by @ mo than were those receiving Control-PM ( RR : @ , @ % CI : @ , @ , P = @ ) .


The effects of Fe-PM on iron status were greater among children who were iron deficient at baseline than among children who were not iron deficient at baseline .


Fe-PM significantly improved iron status in children by @ mo compared with Control-PM .


This study demonstrated that feeding Fe-PM is an efficacious approach to improve iron status in school-age children and it should be further evaluated for effectiveness in a broader population context .


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


To investigate whether basic laparoscopic skills acquired via structured spaced training on a box trainer persist after @ months .


In a prospective study undertaken at the Ege University School of Medicine ( Izmir , Turkey ) between January @ , @ , and June @ , @ , @ gynecology residents without previous laparoscopy experience were randomly assigned ( @:@ ) to receive training with a box trainer ( @ hour per week for @ weeks ) or to a control group .


At baseline and at @ weeks , residents ' performance was assessed via the salpingectomy module of LapSim .


The box trainer group was reassessed for skills retention @ months later .


The box trainer group performed significantly better than the control group in time ( P = @ ) and economy of movement ( P = @ ) at the final test .


Error scores did not differ significantly .


Deterioration between final and retention tests in the box trainer group were recorded in time ( P = @ ) , instrument path length ( P = @ ) , and instrument angular path ( P = @ ) .


However , time and economy of movement scores were better at the retention assessment than at baseline ( P = @ and P = @ , respectively ) .


Structured training with a box trainer improved laparoscopic skills , but deterioration was evident within @ months .


This deterioration should be considered when planning laparoscopic training programs .


Anthracycline-induced cardiotoxicity is ( partly ) mediated by free radical overload .


A randomized study was performed in breast cancer patients to investigate whether free radical scavenger super oxide dismutase ( SOD ) protects against anthracycline-induced cardiotoxicity as measured by changes in echo , electrocardiography and an array of biomarkers .


Eighty female , chemotherapy-nave breast cancer patients ( median age @ , range @-@ years ) scheduled for four or five courses of adjuvant @ weekly doxorubicin plus cyclophosphamide ( AC ) chemotherapy , were randomly assigned to receive @mg PC-SOD ( human recombinant SOD bound to lecithin ) or placebo , administered intravenously ( i.v. ) immediately prior to each AC course .


The primary end point was protection against cardiac damage evaluated using echocardiography , QT assessments and a set of biochemical markers for myocardial function , oxidative stress and inflammation .


Assessments were performed before and during each course of chemotherapy , and at @ , @ and @ months after completion of the chemotherapy regimen .


In all patients cardiac effects such as increases in NT-proBNP concentration and prolongation of the QTc interval were noticed .


There were no differences between the PC-SOD and placebo-treated patients in systolic or diastolic cardiac function or for any other of the biomarkers used to assess the cardiac effects of anthracyclines .


PC-SOD at a dose of @mg i.v. is not cardioprotective in patients with breast carcinoma treated with anthracyclines .


Diuresis is a major therapy for the reduction of congestive symptoms in acute decompensated heart failure ( ADHF ) patients .


We previously reported the efficacy and safety of tolvaptan compared to carperitide in hospitalized patients with ADHF .


There were some reports of cardio - and renal-protective effects in carperitide ; therefore , the purpose of this study was to compare the long-term effects of tolvaptan and carperitide on cardiorenal function and prognosis .


One hundred and five ADHF patients treated with either tolvaptan or carperitide were followed after hospital discharge .


Levels of plasma B-type natriuretic peptide , serum sodium , potassium , creatinine , and estimated glomerular filtration rate were measured before administration of tolvaptan or carperitide at baseline , the time of discharge , and one year after discharge .


These data between tolvaptan and carperitide groups were not different one year after discharge .


Kaplan-Meier survival curves demonstrated that the event-free rate regarding all events , cardiac events , all cause deaths , and rehospitalization due to worsening heart failure was not significantly different between tolvaptan and carperitide groups .


We demonstrated that tolvaptan had similar effects on cardiac and renal function and led to a similar prognosis in the long term , compared to carperitide .


To explore the clinical efficacy of high-frequency oscillatory ventilation ( HFOV ) combined with pulmonary surfactant ( PS ) in the treatment of neonatal pulmonary hemorrhage ( NPH ) .


A total of @ neonates diagnosed with NPH between January @ and June @ were enrolled .


After being stratified by gestational age , the neonates were randomly divided into treatment ( HFOV+PS ) and control ( HFOV alone ) groups ( n = @ each ) .


Both groups were treated with HFOV after the onset of NPH .


After @-@ hours of HFOV treatment , the treatment group received PS via intratracheal injections , followed by continuous use of HFOV .


Dynamic changes in the blood gas , oxygenation index ( OI ) , and PaO@/FiO@ ( P/F ) values of the neonates were determined before HFOV treatment and after @ , @ , and @ hours of HFOV treatment .


The time to hemostasis , duration of ventilation , incidence of complications , and cure rate were compared between groups .


After @ , @ , and @ hours of HFOV treatment , the treatment group had significantly improved PaO@ , PaCO@ , O/I , and P/F values compared with the control group ( P < @ ) .


The time to hemostasis and the duration of ventilation were significantly shorter in the treatment group than in the control group ( P < @ ) , and the incidence of complications was lower in the former than in the latter ( P < @ ) .


There was no significant difference in the cure rate between the treatment ( @ % ) and control ( @ % ) groups ( P > @ ) .


HFOV combined with PS is an effective treatment to improve oxygenation , shorten the time to hemostasis and the duration of ventilation , and reduce the incidence of complications in neonates with NPH .


However , the dual therapy is unable to reduce the mortality of neonates compared with HFOV monotherapy .


Our objective was to evaluate the effect of intensive care treatment on the protein binding of sufentanil and hydromorphone in cardiac surgery patients during postoperative analgesia using a target-controlled infusion ( TCI ) and patient-controlled analgesia ( PCA ) .


Fifty adult patients were enrolled in this prospective randomized study ; of which , @ completed the study ( age range @-@ yr ) .


Sufentanil was administered as an analgesic intraoperatively , and hydromorphone was dosed after operation with TCI and PCA until @ a.m. on the first postoperative day .


Arterial plasma samples were collected for drug and protein concentration measurements up to @ h after cardiac surgery .


Corresponding patient data were collected from the electronic patient data system .


After explorative data analysis with principal component analysis , multivariate regression analysis and non-linear mixed effects modelling was used to study the effect of treatment on protein binding .


Data of @ patients were analysed .


The median protein binding of sufentanil and hydromorphone was @ % ( IQ range @-@ @ % ) and @ % ( IQ range @-@ @ % ) , respectively .


Free fraction of sufentanil increased towards the end of the study period , whereas hydromorphone free fraction remained nearly constant .


The total sufentanil concentration and volume balance were identified as significant covariates for the protein binding of sufentanil .


For the protein binding of hydromorphone , no significant covariate effects were found .


Sufentanil protein binding was significantly dependent on changes in the total drug concentration and volume balance addressing the importance of adequate dosing and fluid-guided therapy .


Hydromorphone protein binding was nearly constant throughout the study period .


To determine whether self-expanding plastic stent ( SEPS ) placement significantly improves quality of life and maintains optimal nutrition while allowing full-dose neoadjuvant therapy ( NAT ) in patients with esophageal cancer .


A prospective , dual-institution , single-arm , phase II ( http://ClinicalTrials.gov: NCT@ ) evaluation of esophageal cancer patients undergoing NAT prior to resection .


All patients had a self-expanding polymer stent placed prior to NAT .


The European Organisation for Research and Treatment of Cancer QLQ-C@ and QLQ-OG@ , Functional Assessment of Cancer Therapy-Anorexia , and Functional Assessment of Cancer Therapy-General surveys were administered prior to stenting , within @ week post-stent placement , and at the completion of neoadjuvant therapy .


Fifty-two patients were enrolled ; @ ( @ % ) had stent migrations requiring replacement .


There were no instances of esophageal erosion or perforation .


All patients received some form of neoadjuvant therapy .


Thirty-six ( @ % ) received chemoradiation ; @ ( @ % ) of these patients received the planned dose of chemotherapy , and @ ( @ % ) received the full planned dose of radiotherapy .


There were @ ( @ % ) patients receiving chemotherapy alone ; @ ( @ % ) of patients in the chemotherapy-alone group completed the planned dose of therapy .


Placement of SEPS appears to provide significant improvement in quality of life related to dysphagia and eating restriction in patients with esophageal cancer undergoing neoadjuvant therapy .


Consideration of SEPS instead of percutaneous feeding tube should be initiated as a first line in dysphagia palliation and NAT nutritional support .


Creatine supplementation has emerged as a promising non-pharmacological therapeutic strategy to counteract muscle dysfunction and low lean mass in a variety of conditions , including in pediatric and rheumatic diseases .


The objective of this study was to examine the efficacy and safety of creatine supplementation in childhood systemic lupus erythematosus ( C-SLE ) .


C-SLE patients with mild disease activity ( n = @ ) received placebo or creatine supplementation in a randomized fashion using a crossover , double-blind , repeated-measures design .


The participants were assessed at baseline and after @ weeks in each arm , interspersed by an eight-week washout period .


The primary outcomes were muscle function , as assessed by a battery of tests including one-maximum repetition ( @-RM ) tests , the timed-up-and-go test , the timed-stands test , and the handgrip test .


Secondary outcomes included body composition , biochemical markers of bone remodeling , aerobic conditioning , quality of life , and physical capacity .


Possible differences in dietary intake were assessed by three @-hour dietary recalls .


Muscle phosphorylcreatine content was measured through phosphorus magnetic resonance spectroscopy ( @ P-MRS ) .


The safety of the intervention was assessed by laboratory parameters , and kidney function was measured by ( @ ) Cr-EDTA clearance .


Additionally , self-reported adverse events were recorded throughout the trial .


Intramuscular phosphorylcreatine content was not significantly different between creatine and placebo before or after the intervention ( creatine-Pre : @ @ , Post : @ @ , placebo-Pre : @ @ ; Post : @ @ mmol/kg wet muscle ; p = @ for interaction between conditions ) .


In addition , probably as a consequence of the lack of change in intramuscular phosphorylcreatine content , there were no significant changes between placebo and creatine for any muscle function and aerobic conditioning parameters , lean mass , fat mass , bone mass , and quality of life scores ( p > @ ) .


The ( @ ) Cr-EDTA clearance was not altered by creatine supplementation and no side effects were noticed .


A @-week creatine supplementation protocol at @ g/kg/d is well tolerated and free of adverse effects but did not affect intramuscular phosphorylcreatine , muscle function , free-fat mass or quality of life in non-active C-SLE patients .


Inhibition of brain aminopeptidase A ( APA ) , which converts angiotensin II into angiotensin III , has emerged as a novel antihypertensive treatment , as demonstrated in several experimental animal models .


QGC@ ( originally named RB@ ) is a prodrug of the specific and selective APA inhibitor EC@ , and as such it is the prototype of a new class of centrally acting antihypertensive agents .


Given by the oral route in hypertensive rats , it enters the brain and generates EC@ , which blocks the brain renin-angiotensin system activity and normalises blood pressure .


The aim of the present study was to evaluate the safety , pharmacokinetics and pharmacodynamic effects of QGC@ in humans .


Fifty-six healthy male volunteers were randomly assigned to receive in double-blind and fasted conditions single oral doses of @ , @ , @ , @ , @ , @ , @,@ and @,@ mg of QGC@ ( n = @/dose ) or placebo ( n = @/dose ) .


We measured plasma and urine concentrations of both QGC@ and EC@ by liquid chromatography-tandem mass spectrometry , plasma renin concentrations ( PRC ) , plasma and free urine aldosterone ( PAldo and UAldo ) , plasma copeptine ( PCop ) , and plasma and urine cortisol ( PCort and UCort ) concentrations , and supine systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) and heart rate ( HR ) at various time points .


All doses of QGC@ were clinically and biologically well-tolerated .


Peak plasma concentrations ( Cmax ) of QGC@ and EC@ increased linearly with the dose , with a median time to reach Cmax ( tmax ) of @ h for QGC@ and @ h for EC@ .


The median plasma elimination half-life of QGC@ was @ h consistently throughout doses .


Urinary excretion of QGC@ and EC@ was below @ % of the administered dose .


When compared with placebo , QGC@ did not significantly change PRC , PAldo , UAldo , PCop , PCort or UCort .


No significant change was observed for supine HR , SBP and DBP in any treatment group .


Single oral administration of QGC@ up to @,@ mg in healthy volunteers was well-tolerated .


Following oral administration , QGC@ is absorbed via the gastrointestinal tract and converted partially into its active metabolite EC@ in plasma .


As in animal experiments , in normotensive subjects QGC@ had no effect on the systemic renin-angiotensin-aldosterone parameters and on PCop concentrations , a marker of vasopressin release .


In normotensive subjects , a single dose of QCG@ had no effect on SBP , DBP or HR .


These data support further evaluation of multiple oral doses of QGC@ in human volunteers and its clinical efficacy in hypertensive patients .


Interleukin @A is a proinflammatory cytokine that is implicated in the pathogenesis of psoriatic arthritis .


We assessed the efficacy and safety of subcutaneous secukinumab , a human anti-interleukin-@A monoclonal antibody , in patients with psoriatic arthritis .


In this phase @ , double-blind , placebo-controlled study undertaken at @ centres in Asia , Australia , Canada , Europe , and the USA , adults ( aged @ years old ) with active psoriatic arthritis were randomly allocated in a @:@:@:@ ratio with computer-generated blocks to receive subcutaneous placebo or secukinumab @ mg , @ mg , or @ mg once a week from baseline and then every @ weeks from week @ .


Patients and investigators were masked to treatment assignment .


The primary endpoint was the proportion of patients achieving at least @ % improvement in the American College of Rheumatology response criteria ( ACR@ ) at week @ .


Analysis was by intention to treat .


This study is registered with ClinicalTrials.gov , number NCT@ .


Between April @ , and Nov @ , @ , @ patients were randomly assigned to receive secukinumab @ mg ( n = @ ) , @ mg ( n = @ ) , @ mg ( n = @ ) , or placebo ( n = @ ) .


A significantly higher proportion of patients achieved an ACR@ at week @ with secukinumab @ mg ( @ -LSB- @ % -RSB- patients ; odds ratio versus placebo @ , @ % CI @-@ ; p < @ ) , @ mg ( @ -LSB- @ % -RSB- patients ; @ , @-@ ; p < @ ) , and @ mg ( @ -LSB- @ % -RSB- patients ; @ , @-@ ; p = @ ) versus placebo ( @ -LSB- @ % -RSB- patients ) .


Up to week @ , the most common adverse events were upper respiratory tract infections ( four -LSB- @ % -RSB- , eight -LSB- @ % -RSB- , ten -LSB- @ % -RSB- , and seven -LSB- @ % -RSB- with secukinumab @ mg , @ mg , @ mg , and placebo , respectively ) and nasopharyngitis ( six -LSB- @ % -RSB- , four -LSB- @ % -RSB- , six -LSB- @ % -RSB- , and eight -LSB- @ % -RSB- , respectively ) .


Serious adverse events were reported by five ( @ % ) , one ( @ % ) , and four ( @ % ) patients in the secukinumab @ mg , @ mg , and @ mg groups , respectively , compared with two ( @ % ) in the placebo group .


No deaths were reported .


Subcutaneous secukinumab @ mg and @ mg improved the signs and symptoms of psoriatic arthritis , suggesting that secukinumab is a potential future treatment option for patients with this disorder .


Remifentanil , an ultra-short-acting opioid , is widely used for pain control during surgery .


However , regular dose ( RD ) remifentanil exacerbates postoperative pain in a dose-dependent manner .


Recent studies suggest that high-dose ( HD ) remifentanil offers sustained analgesia in experimental studies .


We thus hypothesized that intraoperative administration of high-dose remifentanil may attenuate postoperative pain .


In this prospective , randomized , double blind , controlled clinical study , sixty patients undergoing thyroidectomy ( @-@ years-of-age ) received an intraoperative infusion of @ ( RD group ) or @ g kg ( -@ ) min ( -@ ) ( HD group ) remifentanil during thyroidectomy .


A visual analogue scale ( VAS ) was used to measure pain intensity .


Mechanical pain threshold on the forearm was assessed using von Frey filaments before surgery ( baseline ) , @ h postoperatively and @-@ h postoperatively .


The primary outcome was to compare the difference of VAS score at different time points after operation and morphine consumption @ h postoperatively between RD and HD groups .


The second outcome was to compare the difference of mechanical pain thresholds in the forearm postoperatively between RD and the HD groups .


VAS scores were lower @ min postoperatively in the HD group ( @ @ , @ % CI @-@ @ ) compared with the RD group ( @ @ , @ % CI @-@ @ ) ( t = @ , p = @ , RD group vs. HD group ) .


Postoperative morphine consumption was much lower in the HD group compared with the RD group ( @ @ mg vs. @ @ mg , p = @ ) .


In both groups , mechanical pain threshold was decreased @-@ h postoperatively ( @ @ Ln ( g ) vs. @ @ Ln ( g ) , p = @ in RD group ; @ @ Ln ( g ) vs. @ @ Ln ( g ) , p = @ in HD group , @-@ h postoperatively vs baseline ) .


Intraoperative administration of high-dose remifentanil decreased VAS scores and morphine consumption postoperatively .


Thus , modulation of intraoperative opiates may be a simple and effective method of postoperative pain management .


The aim of the present study was to determine whether an increased supply of energy , protein , essential fatty acids , and vitamin A reduces postnatal growth failure in very-low-birth-weight infants .


Fifty infants with birth weight < @ g were randomized to an intervention ( n = @ ) or a control ( n = @ ) feeding protocol within @ hours after birth .


Forty-four infants were included in the final analysis .


This study was discontinued because of an increased occurrence of septicemia in the intervention group .


The intervention group had a lower mean birth weight ( P = @ ) and a higher proportion of infants small-for-gestational age ( P = @ ) than the control group .


Other baseline characteristics were similar .


The median ( interquartile range ) energy and protein supplies during the first @ weeks of life were higher in the intervention group : @ ( @-@ ) versus @ ( @-@ ) kcal kg day ( P < @ ) and @ ( @-@ @ ) versus @ ( @-@ @ ) g kg day ( P < @ ) .


The infants in the intervention group regained birth weight faster ( P = @ ) and maintained their z scores for weight and head circumference from birth to @ weeks ' postmenstrual age ( both P < @ ) .


The median ( interquartile range ) growth velocity was @ ( @-@ @ ) g kg day in the intervention group and @ ( @-@ @ ) g kg day in the control group ( P < @ ) .


In line with the improved growth in the intervention group , the proportion of growth-restricted infants was @ of @ both at birth and at @ weeks ' postmenstrual age , whereas this proportion increased among the controls from @ of @ to @ of @ ( P = @ ) .


Enhanced supply of energy , protein , essential fatty acids , and vitamin A caused postnatal growth along the birth percentiles for both weight and head circumference .


The link between physical activity ( PA ) and prevention of disease , maintenance of independence , and improved quality of life in older adults is supported by strong evidence .


However , there is a lack of data on population levels in this regard , where PA level has been measured objectively .


The main aims were therefore to assess the level of accelerometer-determined PA and to examine its associations with self-reported health in a population of Norwegian older adults ( @-@ years ) .


This was a part of a national multicenter study .


Participants for the initial study were randomly selected from the national population registry , and the current study included those of the initial sample aged @-@ years .


The ActiGraph GT@M accelerometer was used to measure PA for seven consecutive days .


A questionnaire was used to register self-reported health .


Univariate analysis of variance with Bonferroni adjustments were used for comparisons between multiple groups .


A total of @ participants had valid activity registrations .


Mean age ( SD ) was @ ( @ ) years for women ( n = @ ) and @ ( @ ) years for men ( n = @ ) .


Overall PA level ( cpm ) differed considerably between the age groups where the oldest ( @-@ y ) displayed a @ % lower activity level compared to the youngest ( @-@ y ) .


No sex differences were observed in overall PA within each age group .


Significantly more men spent time being sedentary ( @-@ and @-@ years ) and achieved more minutes of moderate to vigorous PA ( MVPA ) ( @-@ years ) compared to women .


Significantly more women ( except for the oldest ) , spent more minutes of low-intensity PA compared to men .


PA differed across levels of self-reported health and a @ % higher overall PA level was registered in those , with `` very good health '' compared to those with `` poor/very poor health '' .


Norwegian older adults PA levels differed by age .


Overall , the elderly spent @ % of their time being sedentary and only @ % in MVPA .


Twenty one percent of the participants fulfilled the current Norwegian PA recommendations .


Overall PA levels were associated with self-reported health .


Obesity is one of the main determinants of avoidable disease burden.To implement a program by university students acting as `` health promoting agents '' ( HPAs ) and to evaluate the effects on obesity prevalence of the primary-school-based program that promotes healthy lifestyle , including dietary and physical activity recommendations over @ months .


Two school clusters were randomly assigned to intervention ( @ schools , @,@ pupils ) or control ( @ schools , @ pupils ) ; @ % of pupils were Western European .


Mean age ( SD ) was @ years ( @ % females ) at baseline .


Generalized linear mixed models were used to analyze differences in primary outcome between both groups .


Data collected included body mass index ( BMI ) every year .


Dietary habits and lifestyle questionnaires were filled in by the parents at baseline and at the end of the study .


The interventions focused on eight lifestyle topics covered in @ activities ( @ hour/activity/session ) implemented by HPAs over @ school academic years .


At @ months , obesity prevalence in boys was decreased -@ % in the intervention group ( from @ % to @ % ) and increased @ % ( from @ % to @ % ) in the control group ; the difference was @ % ( @ % CI @ to @ ; P = @ ) .


The boys in the intervention group had an effective reduction of -@ units in the change of BMI z-score ( from @ to -@ ) , compared to control ( from -@ to @ ) ; @ % more intervention pupils undertook physical activity > @ hours/week than control pupils ( P = @ ) .


Fish consumption was a protector ( odds ratio @ ; @ % CI @ to @ ) while `` fast-food '' consumption was a risk factor for childhood obesity ( odds ratio : @ ; @ % CI @ to @ ) .


Our school-based program , conducted by HPA students , successfully reduced childhood obesity prevalence in boys .


Effective physician communication at the end-of-life is a cornerstone to providing patient-centered palliative care .


Educational programs in physician communication often rely on self-assessments of physician knowledge and attitudes and seldom provide patients ' reports .


Thus , it is unclear whether physician self-assessments are associated with patient perspectives .


To determine whether physician trainees ' self-assessments of their communication skills in religious/spiritual discussions were associated with assessments obtained from patients under their care .


Prospective , observational , survey-based study of internal medicine trainees ' self-assessments matched with their patients ' reports .


Data were obtained from preintervention surveys prior to the trainees participating in a communication educational intervention .


The study took place at two internal medicine training programs , one in the southeastern United States and one in the northwestern United States .


Our subjects were @ physician trainees in internal medicine and @ patients with advanced medical illnesses under their care .


The outcomes were patient reports of the occurrence of religious/spiritual communication and patient ratings of the quality of this communication .


The primary predictor of interest was trainees ' preintervention self-assessments of their competency in religious/spiritual communication .


Using multiple variable and path analysis we found that trainees ' self-assessments of their communication skills in religious/spiritual communication was significantly and positively associated with their patients ' reports of the occurrence and ratings of religious/spiritual communication .


Physician trainee self-assessments may be a valid surrogate for patient ratings of quality with respect to religious/spiritual communication .


This specific domain of physician-patient communication should receive further investigation as our finding contrasts with reports of more general measures of physician-patient end-of-life communication .


Adolescents consume more sugar-sweetened beverages than do individuals in any other age group , but it is unknown how the type of sugar-sweetened beverage affects metabolic health in this population .


The objective was to compare the metabolic health effects of short-term ( @-wk ) consumption of high-fructose ( HF ) and high-glucose ( HG ) - sweetened beverages in adolescents ( @-@ y of age ) .


In a counterbalanced , single-blind fashion , @ male and female adolescents completed two @-wk trials that included @ ) an HF trial in which they consumed @ mL of a sugar-sweetened beverage/d ( equivalent to @ g fructose/d and @ g glucose/d ) for @ wk and @ ) an HG trial in which they consumed @ mL of a sugar-sweetened beverage/d ( equivalent to @ g glucose/d and @ g fructose/d ) for @ wk in addition to their normal ad libitum diet .


In addition , the participants maintained similar physical activity levels during each trial .


The day after each trial , insulin sensitivity and resistance -LSB- assessed via Quantitative Insulin Sensitivity Check Index ( QUICKI ) and homeostatic model assessment of insulin resistance ( HOMA-IR ) index -RSB- and fasting and postprandial glucose , lactate , lipid , cholesterol , insulin , C-peptide , insulin secretion , and clearance responses to HF or HG mixed meals were assessed .


Body weight , QUICKI ( whole-body insulin sensitivity ) , HOMA-IR ( hepatic insulin resistance ) , and fasting lipids , cholesterol , glucose , lactate , and insulin secretion or clearance were not different between trials .


Fasting HDL - and HDL-cholesterol concentrations were @-@ % greater ( P < @ ) in female adolescents than in male adolescents .


Postprandial triacylglycerol , HDL-cholesterol , HDL-cholesterol , and glucose concentrations were not different between HF and HG trials .


The lactate incremental area under the curve was @-fold greater during the HF trial ( P < @ ) , whereas insulin secretion was @ % greater during the HG trial ( P < @ ) .


Moderate amounts of HF - or HG-sweetened beverages for @ wk did not have differential effects on fasting or postprandial cholesterol , triacylglycerol , glucose , or hepatic insulin clearance in weight-stable , physically active adolescents .


This study investigates consequences of chronic neck pain on muscle function and the rehabilitating effects of contrasting interventions .


Women with trapezius myalgia ( MYA , n = @ ) and healthy controls ( CON , n = @ ) participated in a case-control study .


Subsequently MYA were randomized to @ weeks of specific strength training ( SST , n = @ ) , general fitness training ( GFT , n = @ ) , or a reference group without physical training ( REF , n = @ ) .


Participants performed tests of @ consecutive cycles of @s isometric maximal voluntary contractions ( MVC ) of shoulder elevation followed by @s relaxation at baseline and @-week follow-up .


In the case-control study , peak force , rate of force development , and rate of force relaxation as well as EMG amplitude were lower in MYA than CON throughout all @ MVC .


Muscle fiber capillarization was not significantly different between MYA and CON .


In the intervention study , SST improved all force parameters significantly more than the two other groups , to levels comparable to that of CON .


This was seen along with muscle fiber hypertrophy and increased capillarization .


Women with trapezius myalgia have lower strength capacity during repetitive MVC of the trapezius muscle than healthy controls .


High-intensity strength training effectively improves strength capacity during repetitive MVC of the painful trapezius muscle .


Childbirth is a demanding event in a woman 's life .


The aim of this study was to explore whether a brief intervention in the form of an antenatal course in self-hypnosis to ease childbirth could improve the childbirth experience .


In a randomized , controlled , single-blinded trial , @,@ healthy nulliparous women were allocated to one of three groups during pregnancy : A hypnosis group participating in three @-hour sessions teaching self-hypnosis to ease childbirth , a relaxation group receiving three @-hour lessons in various relaxation methods and Mindfulness , and a usual care group receiving ordinary antenatal care only .


Wijmas Delivery Expectancy/Experience Questionnaire ( W-DEQ ) was used to measure the childbirth experience @weeks postpartum .


The intention-to-treat analysis indicated that women in the hypnosis group experienced their childbirth as better compared with the other two groups ( mean W-DEQ score of @ in the Hypnosis group , @ in the Relaxation group , and @ in the Care as usual group ( p = @ ) ) .


The tendency toward a better childbirth experience in the hypnosis group was also seen in subgroup analyses for mode of delivery and for levels of fear .


In this large randomized controlled trial , a brief course in self-hypnosis improved the women 's childbirth experience .


To assess the impact of ASIR ( adaptive statistical iterative reconstruction ) and lower tube potential on dose reduction and image quality in chest computed tomography angiographies ( CTAs ) of patients with pulmonary embolism .


CT data from @ patients with pulmonary embolism were acquired using different protocols-Group A : @ kV , filtered back projection , n = @ ; Group B : @ kV , @ % ASIR , n = @ ; Group C : @ kV , @ % ASIR , n = @ and Group D : @ kV , @ % ASIR , n = @ .


Normalised effective dose was calculated ; image quality was assessed quantitatively and qualitatively .


Normalised effective dose in Group B was @ % lower than in Group A ( p = @ ) and @ % lower in Group C than in Group A ( p < @ ) .


Group A , B and C did not show significant differences in qualitative or quantitative analysis of image quality .


Group D showed significantly higher noise levels in qualitative and quantitative analysis , significantly more artefacts and decreased overall diagnosability .


Best results , considering dose reduction and image quality , were achieved in Group C.


The combination of ASIR and lower tube potential is an option to reduce radiation without significant worsening of image quality in the diagnosis of pulmonary embolism .


Iterative algorithms and lowering of tube potential reduce radiation without compromising interpretability @ % ASIR and @ kV tube potential led to a @ % dose reduction @ % ASIR and @ kV tube potential led to significantly worse image quality .


We evaluated the effects of carbohydrate ( CHO ) supplementation on markers of bone turnover in elite runners .


Twenty-four male runners were randomly assigned to two groups -- a CHO and a control ( CON ) group -- using a double-blind design .


The participants were submitted to an overload training program ( days @-@ ) , followed by a high-intensity intermittent running protocol ( @ m ) on day @ .


They received a maltodextrin solution ( CHO group ) or a placebo solution as the CON equivalent , before , during , and after these protocols .


After @ days of intensive training , baseline levels of osteocalcin ( OC ) decreased in both CHO and CON groups ( before : @ and @ ng/ml , after : @ and @ ng/ml , respectively , p < @ ) .


On day @ , at @ min of the recovery period , carboxy-terminal of telopeptide type I collagen ( CTX ) serum concentration was suppressed in the CHO group ( @ ng/ml ) vs. @ ng/ml for the CON group ( p < @ ) .


CHO supplementation was effective in decreasing CTX levels from baseline to recovery ( @ ng/mL to @ ng/mL , p < @ ) , while an increase from @ ng/mL to @ ng/mL ( p < @ ) was observed in the CON group .


CHO beverage ingestion attenuated the exercise-induced increase in CTX concentration , suggesting that CHO supplementation is a potential strategy to prevent bone damage in athletes .


To evaluate effects of quaternary benzo ( c ) phenanthridine alkaloids ( QBAs ) against Salmonella spp and determine effects on growth performance , organism shedding , and gastrointestinal tract integrity in pigs inoculated with Salmonella enterica serovar Typhimurium .


@ Salmonella isolates and twenty @-week-old pigs .


Minimum inhibitory concentration of QBAs against the Salmonella isolates was determined .


Pigs were allocated to @ groups and inoculated with Salmonella organisms .


Pigs received diets supplemented with @ g of QBAs/@ ,@ kg of feed , @ g of QBAs/@ ,@ kg of feed , or @ g of chlortetracycline/@ ,@ kg of feed or a nonsupplemented ( control ) diet .


Pigs were weighed on day @ and then weekly for @ days .


Fecal samples were collected to quantify Salmonella organisms .


Gastrointestinal tract integrity was evaluated by measuring transepithelial resistance .


In vitro , @ of @ ( @ % ) Salmonella isolates were inhibited at @ g of QBAs/mL ; all @ were inhibited at @ g of QBAs/mL .


Diets containing QBAs significantly decreased Salmonella spp shedding ; shedding was lower @ days after inoculation for pigs fed diets containing QBAs or chlortetracycline than for pigs fed the control diet .


Growth performance was similar for pigs fed diets containing QBA or chlortetracycline .


Gastrointestinal tract integrity was improved in pigs fed the diet containing @ g of QBAs/@ ,@ kg of feed .


QBAs and chlortetracycline decreased Salmonella spp shedding but did not differ with regard to growth performance .


Gastrointestinal tract integrity was better , albeit not significantly , in pigs fed diets containing QBAs .


Further investigation into the role of QBAs and their mechanism as an immunomodulator is necessary .


Carbon dioxide ( CO@ ) insufflation has previously been shown to have advantages over air insufflation in terms of procedure-related pain and oral insertion depth during double-balloon enteroscopy .


The aim of this prospective study was to evaluate the performance of CO@ vs. air insufflation during single-balloon enteroscopy .


This study was a randomized European multicenter trial ( ClinicalTrials.gov : NCT@ ) .


Patients and endoscopists were blinded to the type of insufflation gas used .


Patient discomfort during and after the procedure was scored using a visual analog scale .


A total of @ patients were enrolled in the study ( @ in the CO@ group and @ in the air group ) .


Patient characteristics were comparable in both groups .


The mean ( SD ) oral intubation depth was not significantly deeper in the CO@ group vs. the air group ( @ vs. @ cm ; P = @ ) .


However , in patients with previous abdominal surgery , oral intubation depth was significantly higher in the CO@ group compared with the air group ( @ vs. @ cm ; P < @ ) .


In patients undergoing SBE via the anal approach , CO@ showed no significant difference in intubation depth compared with air insufflation ( @ vs. @ cm ; P = @ ) .


The diagnostic yield was comparable ( CO@ @ % ; air @ % ) .


Procedure times , dosage of sedation , and therapeutic interventions did not differ between the two groups .


Patients in the CO@ group reported less pain than those in the air group .


This study demonstrated an advantage of using CO@ insufflation during single-balloon enteroscopy in patients with a history of previous abdominal surgery .


Overall , single-balloon enteroscopy was a well-tolerated procedure that may benefit from the use of CO@ insufflation to reduce post-procedural pain .


In platinum-resistant ovarian cancer ( OC ) , single-agent chemotherapy is standard .


Bevacizumab is active alone and in combination .


AURELIA is the first randomized phase III trial to our knowledge combining bevacizumab with chemotherapy in platinum-resistant OC .


Eligible patients had measurable/assessable OC that had progressed < @ months after completing platinum-based therapy .


Patients with refractory disease , history of bowel obstruction , or > two prior anticancer regimens were ineligible .


After investigators selected chemotherapy ( pegylated liposomal doxorubicin , weekly paclitaxel , or topotecan ) , patients were randomly assigned to single-agent chemotherapy alone or with bevacizumab ( @ mg/kg every @ weeks or @ mg/kg every @ weeks ) until progression , unacceptable toxicity , or consent withdrawal .


Crossover to single-agent bevacizumab was permitted after progression with chemotherapy alone .


The primary end point was progression-free survival ( PFS ) by RECIST .


Secondary end points included objective response rate ( ORR ) , overall survival ( OS ) , safety , and patient-reported outcomes .


The PFS hazard ratio ( HR ) after PFS events in @ of @ patients was @ ( @ % CI , @ to @ ; unstratified log-rank P < @ ) .


Median PFS was @ months with chemotherapy alone versus @ months with bevacizumab-containing therapy .


RECIST ORR was @ % versus @ % , respectively ( P = @ ) .