In addition , many important lessons have been learned in preparation for this study .


Adoption of nonstandard vital signs monitors into critical care/trauma medicine may require a new paradigm of personnel education , training , and practice .


Therapeutic/care management , level IV .


Brief potentially ictal rhythmic discharges , termed B ( I ) RDs , have been described mainly in neonates , and their significance in adults remains unclear .


To describe the incidence of B ( I ) RDs in critically ill patients and investigate their association with seizures and outcome .


We reviewed the records of prospectively identified patients with B ( I ) RDs and patients serving as controls matched for age ( @ years ) and primary diagnosis .


The prevalence of seizures during continuous electroencephalography and functional outcome , as measured by the Glasgow Outcome Scale , were determined .


We identified B ( I ) RDs in @ patients ( @ % ) .


The pattern most often consisted of very brief ( @-@ seconds ) runs of sharply contoured theta activity without obvious evolution .


All patients with B ( I ) RDs had cerebral injury , and in cases with a single focal lesion ( @ -LSB- @ % -RSB- ) , B ( I ) RDs were localized in the same region in all but @ cases ( @ % ) .


Patients with B ( I ) RDs were more likely to have seizures during continuous electroencephalography than were patients without B ( I ) RDs ( @ of @ -LSB- @ % -RSB- vs @ of @ -LSB- @ % -RSB- ; P < @ ) , and @ patients with B ( I ) RDs ( @ % ) had only subclinical seizures .


Brief potentially ictal rhythmic discharges were identified before seizures in all but @ case ( @ % ) and ceased in all @ cases ( @ % ) in which seizures were controlled .


Patients with B ( I ) RDs tended to have a worse outcome than controls ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) ; however , this finding was not statistically significant .


Brief potentially ictal rhythmic discharges in critically ill patients are associated with a high prevalence ( @ % ) of electrographic seizures and might serve as an early predictor of seizures during subsequent monitoring .


A larger prospective study is needed to better understand their clinical and prognostic significance .


To investigate whether strength decline in post-polio syndrome ( PPS ) results from excessive distal axonal degeneration of enlarged motor units .


We assessed changes over @ years in isometric quadriceps strength , mean motor unit action potential ( MUAP ) size , root mean squared ( RMS ) amplitude , and level of interference ( LOI ) in @ patients with PPS and @ healthy controls , using high density surface EMG .


At baseline , all patients had symptomatic quadriceps dysfunction , evidenced by transmission defects on single-fibre EMG .


MU size and strength declined significantly by @ % and @ % , respectively in patients with PPS .


Those with the largest initial MU sizes exhibited the greatest losses of mean MU size ( @ % ) and proportional decreases in quadriceps strength ( @ % ) .


Initial strength , change in LOI and change in RMS amplitude together explained @ % of the variability in strength changes in patients .


MU size of controls did not change , although they lost @ % strength .


MU size and strength declined concomitantly in a homogeneous cohort of patients with PPS and quadriceps dysfunction .


This long term follow-up study provides evidence that size diminution of enlarged MUs combined with a reduced number of active MUs contributes to the gradual strength decline in PPS .


A high incidence of diabetes mellitus has been reported among patients diagnosed with lumbar degenerative spinal diseases .


Although epidural steroid injections are known to increase the postprocedure blood glucose level , it has not been investigated whether a lower steroid dose can reduce blood glucose excursions and still be effective in controlling patients ' subjective pain .


We compared the effects of @ common doses of triamcinolone administered via epidural steroid injections on blood glucose levels and pain control in patients with diabetes mellitus to determine an adequate epidural steroid dose .


A prospective observational study .


One hundred patients with diabetes mellitus were enrolled .


They received lumbar transforaminal , lumbar interlaminar , or caudal epidural triamcinolone for radiculopathy , spinal stenosis , or failed back surgery syndrome .


After the type of procedure was clinically determined , the doses of triamcinolone given were randomly chosen , either @ mg ( Group @ ) or @ mg ( Group @ ) .


The patients were asked to measure their finger stick blood glucose level twice daily ( fasting and postprandial ) for @ days before the injection , on the day of the injection , for @ days after the injection , and at @ days after the injection .


They also kept a blood glucose diary .


Employment status and clinical outcome were evaluated at @ weeks after the procedure .


There were significant increases in fasting blood glucose ( FBG ) level on postprocedure day ( PPD ) # @ to PPD # @ in Group @ , but on PPD # @ in Group @ .


Moreover , there was a significant difference in FBG between groups on PPD # @ and PPD # @ ( FBG on PPD # @ : @ -LSB- @ -RSB- ) mg/dL in Group @ versus @ -LSB- @ -RSB- mg/dL in Group @ , P < @ -RSB- .


Postprandial blood glucose ( PBG ) level was significantly elevated in both groups from PPD # @ to PPD # @ .


Notably , the increase in PBG was significantly greater in Group @ than Group @ on PPD # @ and # @ ( PBG on PPD # @ : @ -LSB- @ -RSB- mg/dL versus @ -LSB- @ -RSB- mg/dL in Groups @ and @ , respectively , P = @ ) .


The numeric rating scale for pain reported by the patients decreased for @ weeks after treatment with no difference between groups .


Employment status and clinical outcome was not different between groups .


The patients who chose to participate in this study may be a cohort of well-controlled patients with diabetes mellitus .


The type of procedure performed was determined by a clinical decision and not randomized .


The different routes of administration and diagnosis of failed back surgery syndrome can result in different levels of systemic absorption , thereby influencing the degree and duration of hyperglycemia .


In patients with FBSS , the epidural space may be destructed by surgery and adhesive changes in epidural space could be extensive .


Therefore , we thought that the absorption of epidural space in these patients would be incomplete or slow compared with those without FBSS .


Epidural steroid injections were associated with statistically significant elevations in PBG in patients with diabetes for up to @ days after the procedure .


The higher dose of triamcinolone increased FBG and PBG greater than a lower dose did without affecting pain control , employment status , or clinical outcome .


Thus , with respect to glucose and pain control , @ mg of triamcinolone appears to be recommended rather than @ mg in patients with diabetes .


Clinical Trials registration : NCT@ .


The CORONIS Trial was a @ non-regular , fractional , factorial trial of five pairs of alternative caesarean section surgical techniques on a range of short-term outcomes , the primary outcome being a composite of maternal death or infectious morbidity .


The consequences of different surgical techniques on longer term outcomes have not been well assessed in previous studies .


Such outcomes include those related to subsequent pregnancy : mode of delivery ; abnormal placentation ( e.g. accreta ) ; postpartum hysterectomy , as well as longer term pelvic problems : pain , urinary problems , infertility .


The Coronis Follow-up Study aims to measure and compare the incidence of these outcomes between the randomised groups at around three years after women participated in the CORONIS Trial .


This study will assess the following null hypotheses : In women who underwent delivery by caesarean section , no differences will be detected with respect to a range of long-term outcomes when comparing the following five pairs of alternative surgical techniques evaluated in the CORONIS Trial : @ .


Blunt versus sharp abdominal entry .


Exteriorisation of the uterus for repair versus intra-abdominal repair .


Single versus double layer closure of the uterus .


Closure versus non-closure of the peritoneum ( pelvic and parietal ) .


Chromic catgut versus Polyglactin-@ for uterine repair .


The outcomes will include ( @ ) women 's health : pelvic pain ; dysmenorrhoea ; deep dyspareunia ; urinary symptoms ; laparoscopy ; hysterectomy ; tubal/ovarian surgery ; abdominal hernias ; bowel obstruction ; infertility ; death .


( @ ) Outcomes of subsequent pregnancies : inter-pregnancy interval ; pregnancy outcome ; gestation at delivery ; mode of delivery ; pregnancy complications ; surgery during or following delivery .


The results of this follow-up study will have importance for all pregnant women and for health professionals who provide care for pregnant women .


Although the results will have been collected in seven countries with limited health care resources ( Argentina , Chile , Ghana , India , Kenya , Pakistan , Sudan ) any differences in outcomes associated with different surgical techniques are likely to be generalisable throughout the world .


Psychosocial interventions for bipolar disorder are frequently unavailable and resource intensive .


Mobile technology may improve access to evidence-based interventions and may increase their efficacy .


We evaluated the feasibility , acceptability and efficacy of an augmentative mobile ecological momentary intervention targeting self-management of mood symptoms .


This was a randomized single-blind controlled trial with @ consumers diagnosed with bipolar disorder who completed a four-session psychoeducational intervention and were assigned to @ weeks of either : @ ) mobile device delivered interactive intervention linking patient-reported mood states with personalized self-management strategies , or @ ) paper-and-pencil mood monitoring .


Participants were assessed at baseline , @ weeks ( mid-point ) , @ weeks ( post-treatment ) , and @ weeks ( follow up ) with clinician-rated depression and mania scales and self-reported functioning .


Retention at @ weeks was @ % and both conditions were associated with high satisfaction .


Compared to the paper-and-pencil condition , participants in the augmented mobile intervention condition showed significantly greater reductions in depressive symptoms at @ and @ weeks ( Cohens d for both were d = @ ) .


However , these effects were not maintained at @-weeks follow up .


Conditions did not differ significantly in the impact on manic symptoms or functional impairment .


This was not a definitive trial and was not powered to detect moderators and mediators .


Automated mobile-phone intervention is feasible , acceptable , and may enhance the impact of brief psychoeducation on depressive symptoms in bipolar disorder .


However , sustainment of gains from symptom self-management mobile interventions , once stopped , may be limited .


The incidence of end-stage renal disease ( ESRD ) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations .


In a high-risk cohort with frequent protocol-directed follow-up , we evaluated the influence of race on cardiovascular ( CV ) outcomes and incidence of ESRD .


TREAT was a randomized , double-blind , placebo-controlled study .


This secondary analysis focused on role of race on outcomes .


TREAT enrolled @,@ patients with type @ diabetes , chronic kidney disease ( estimated glomerular filtration rate @-@ mL/min per @ m ( @ ) ) , and anemia ( hemoglobin level @ g/dL ) treated with either darbepoetin alfa or placebo .


We compared self-described black and Hispanic patients to white patients with regard to baseline characteristics and outcomes , including mortality , CV outcomes ( myocardial infarction , stroke , heart failure , resuscitated sudden death , and coronary revascularization ) , and incident ESRD .


Multivariate adjusted Cox models were developed for these outcomes .


Black and Hispanic patients were younger , more likely women , had less prior CV disease , and higher blood pressure .


During a mean follow-up of @ years with comparable access to care , blacks and Hispanics had a greater risk of ESRD but a significant lower risk of myocardial infarction and coronary revascularization than whites .


After adjusting for confounders , blacks remained at significantly greater risk of ESRD than whites ( hazard ratio @ , @ % CI @-@ @ , P < @ ) , whereas this ESRD risk did not persist among Hispanics .


Despite similar access to care and lower CV event rates , the risk of ESRD was higher among blacks and Hispanics than whites .


For blacks , but not Hispanics , this increase was independent of known attributable risk factors .


Generic preference-based measures were criticized for being inappropriate in some conditions .


One solution is to include `` bolt-on '' dimensions describing additional specific health problems .


This study aimed to develop bolt-on dimensions to the EuroQol five-dimensional questionnaire ( EQ-@D ) and assess their impact on health state values .


Bolt-on dimensions were developed for vision problems , hearing problems , and tiredness .


Each bolt-on dimension had three severity levels to match the EQ-@D .


Three `` core '' EQ-@D states across a range of severity were selected , and each level of a bolt-on item was added , resulting in nine states in each condition .


Health states with and without the bolt-on dimensions were valued by @ members of the UK general public using time trade-off in face-to-face interviews , and mean health state values were compared using t tests .


Regression analysis examined the impact of the bolt-on variants and the level of the bolt-on items after controlling for sociodemographic characteristics .


Bolt-on dimensions had an impact on health state values of the EQ-@D ; however , the size , direction , and significance of the impact depend on the severity of the core EQ-@D state and of the bolt-on dimension .


Regression analysis demonstrated that after controlling for possible differences in sociodemographic characteristics between the groups , there were no significant differences in health state values between the three bolt-on dimensions but confirmed that the impact depended on the severity of the EQ-@D health state and the levels of bolt-on dimensions .


The impact of a bolt-on dimension on the EQ-@D depends on the core health state and the level of the bolt-on dimension .


Further research in this area is encouraged .


Studies suggest that giving newly born preterm infants sustained lung inflation ( SLI ) may decrease their need for mechanical ventilation ( MV ) and improve their respiratory outcomes .


We randomly assigned infants born at @ weeks @ days to @ weeks @ days of gestation to receive SLI ( @ cm H@O for @ seconds ) followed by nasal continuous positive airway pressure ( nCPAP ) or nCPAP alone in the delivery room .


SLI and nCPAP were delivered by using a neonatal mask and a T-piece ventilator .


The primary end point was the need for MV in the first @ hours of life .


The secondary end points included the need for respiratory supports and survival without bronchopulmonary dysplasia ( BPD ) .


A total of @ infants were enrolled in the SLI group and @ in the control group .


Significantly fewer infants were ventilated in the first @ hours of life in the SLI group ( @ of @ -LSB- @ % -RSB- ) than in the control group ( @ of @ -LSB- @ % -RSB- ) ; unadjusted odds ratio : @ -LSB- @ % confidence interval : @-@ @ -RSB- ; P = @ ) .


The need for respiratory support and survival without BPD did not differ between the groups .


Pneumothorax occurred in @ % ( n = @ ) of infants in the control group compared with @ % ( n = @ ) in the SLI group , with an unadjusted odds ratio of @ ( @ % confidence interval : @-@ @ ; P = @ ) .


SLI followed by nCPAP in the delivery room decreased the need for MV in the first @ hours of life in preterm infants at high risk of respiratory distress syndrome compared with nCPAP alone but did not decrease the need for respiratory support and the occurrence of BPD .


This study aimed to evaluate the efficacy of aprepitant , a neurokinin ( NK ) @ receptor antagonist , on chemotherapy-induced nausea and vomiting ( CINV ) .


A randomized , open-labeled , parallel-design study was undertaken in gynecologic-cancer ( GC ) patients at the Fukuoka University Hospital .


Twenty-three patients were divided into without ( group A ) or with aprepitant ( Group B ) in the first cycle of paclitaxel and carboplatin ( TC ) therapy .


From the second cycle onwards , all patients used aprepitant .


Statistical significance was assessed using McNemar and Chi-square tests .


In the first cycle , the prevalence of a complete response , no episodes of nausea or food intake in group B was significantly increased compared to group A. No significant difference in the prevalence of a complete response or food intake situation was found from the second cycle onwards .


Combination of aprepitant with standard anti-emetic therapy may contribute to prevention of CINV in TC therapy for GC patients .


Pemphigus is an autoimmune blistering mucocutaneous disorder .


Common treatments include corticosteroids and immunosuppressive drugs .


This study aimed to assess the therapeutic effects of oral prednisolone along with the common adjuvant therapy in pemphigus vulgaris .


Eighty-seven patients with pemphigus vulgaris from the first stage of a previously randomized clinical trial were enrolled in the present non-blinded clinical trial .


The patients were divided into four groups and treated accordingly with prednisolone alone ( P ; N = @ ) , prednisolone and azathioprine ( P/A ; N = @ ) , prednisolone and mycophenolate mofetil ( P/M ; N = @ ) , and prednisolone and cyclophosphamide ( P/C ; N = @ ) .


These patients were followed-up for an extended one-year period .


The primary localization of the recurrence occurred in the oral cavity of @ , @ , @ , and @ patients in the P , P/A , P/M , and P/C groups , respectively .


There was no significant difference between them ( P = @ ) .


The mean total dose of prednisolone administered in groups P , P/A , P/M , and P/C was accordingly @ , @ , @ , and @ mg/day .


Minor recurrence of the disease in the above-mentioned groups was observed in @ ( @ % ) , @ ( @ % ) , @ ( @ % ) , and @ ( @ % ) of the patients , respectively .


With regard to the minor recurrence of the disease , there was no significant difference among the four treatment groups ( P = @ ) .


Since in this follow-up study no therapeutic benefit of oral prednisolone and common adjuvant therapy was found in terms of the number of minor and major recurrences , the extent to which treatment of PV can be improved upon treatment with these agents remains to be elucidated .


The purpose of this study was to investigate the immediate effects of traditional Thai massage ( TTM ) on psychological stress and heart rate variability ( HRV ) .


Thirty healthy participants were randomly allocated in two groups , a TTM group ( n = @ ) who received a @-hour session with moderate pressure of whole body TTM or a control group ( n = @ ) who rested on the bedfor @ hour All ofthem were given a @-minute mental arithmetic test to induce psychological stress after which they received a @-hour session of TTM or bed rest .


Psychological stress and HR V were measured at baseline and immediately after mental arithmetic test , and immediately after TTM or bed rest .


The studyfound that psychological stress was signficantly increased ( p < @ ) after mental arithmetic test in both groups .


Comparison on these measures between immediately after mental arithmetic test and after TTM or bed rest revealed that psychological stress was significantly decreased ( p < @ ) and HR Vwas significantly increased ( p < @ ) in both groups .


Root mean square of successive differences ( RMSSD ) and low frequency were significantly increased ( p < @ ) only in the TTM group .


However ; all of these measures were found without significant difference when groups were compared .


TTM and bed rest could decrease psychological stress and HRV


More than a third of the approximately @ million women with histories of interpersonal violence in the United States develop posttraumatic stress disorder ( PTSD ) .


Currently available treatments for this population have a high rate of incomplete response , in part because problems in affect and impulse regulation are major obstacles to resolving PTSD .


This study explored the efficacy of yoga to increase affect tolerance and to decrease PTSD symptomatology .


Sixty-four women with chronic , treatment-resistant PTSD were randomly assigned to either trauma-informed yoga or supportive women 's health education , each as a weekly @-hour class for @ weeks .


Assessments were conducted at pretreatment , midtreatment , and posttreatment and included measures of DSM-IV PTSD , affect regulation , and depression .


The study ran from @ through @ .


The primary outcome measure was the Clinician-Administered PTSD Scale ( CAPS ) .


At the end of the study , @ of @ participants ( @ % ) in the yoga group no longer met criteria for PTSD compared to @ of @ ( @ % ) in the control group ( n = @ , = @ , P = @ ) .


Both groups exhibited significant decreases on the CAPS , with the decrease falling in the large effect size range for the yoga group ( d = @ ) and the medium to large effect size decrease for the control group ( d = @ ) .


Both the yoga ( b = -@ , t = -@ , P = @ , d = -@ ) and control ( b = -@ , t = -@ , P = @ , d = -@ ) groups exhibited significant decreases from pretreatment to the midtreatment assessment .


However , a significant group quadratic trend interaction ( d = -@ ) showed that the pattern of change in Davidson Trauma Scale significantly differed across groups .


The yoga group exhibited a significant medium effect size linear ( d = -@ ) trend .


In contrast , the control group exhibited only a significant medium effect size quadratic trend ( d = @ ) but did not exhibit a significant linear trend ( d = -@ ) .


Thus , both groups exhibited significant decreases in PTSD symptoms during the first half of treatment , but these improvements were maintained in the yoga group , while the control group relapsed after its initial improvement .


Yoga significantly reduced PTSD symptomatology , with effect sizes comparable to well-researched psychotherapeutic and psychopharmacologic approaches .


Yoga may improve the functioning of traumatized individuals by helping them to tolerate physical and sensory experiences associated with fear and helplessness and to increase emotional awareness and affect tolerance .


Nausea and vomiting ( NV ) related to DMSO affect patients undergoing auto-SCT despite antiemetic measures .


Orange flavoring may reduce gastrointestinal symptoms .


A multicenter , randomized , three-arm , open-label trial in four Italian large bone marrow transplant centers was conducted to assess the effectiveness of orange aroma in preventing NV related to DMSO .


Patients were randomized to orange ice lollies , non-citrus ice lollies , and routine treatment ( deep breaths ) during reinfusion .


Data on NV were collected up to @days after infusion ; @/@ patients were randomized : @ to orange , @ to non-citrus ice lollies , and @ to routine treatment .


Although @h after transplantation no differences were observed in controlled nausea ( Numerical Rating Scale ( NRS ) @-@ , @ ) or vomiting , significantly fewer patients had no episodes of vomiting , no antiemetic rescue therapy , and no nausea ( NRS < @ ) in the deep breath vs lollies groups ( P = @ ) .


The intensity of nausea over time differed significantly between ice lollies vs routine care ( P = @ ) groups , but not between the orange and non-citrus groups ( P = @ ) .


The vasoconstrictive action of ice may prevent NV related to DMSO in the acute phase and reduce the need for rescue antiemetic therapy .


Ice lollies offer a simple , noninvasive , and economic means for relieving nausea and vomiting related to this preservative .


To compare the efficacy of the vaginal and sublingual administration of the synthetic prostaglandin misoprostol with the currently used oral administration route in second-trimester medical abortion .


This was a prospective randomized trial of medical abortion with misoprostol after mifepristone priming at @-@ weeks of gestation .


From @ to @ , recruited women received @ mg mifepristone orally followed @-@ hours later by an @-microgram vaginal loading dose of misoprostol .


Women were then randomized to receive additional @-microgram misoprostol doses orally every @ hours , vaginally every @ hours , or sublingually every @ hours .


The main outcome was the duration of abortion with emphasis on the proportion of women undelivered @ hours after the misoprostol loading dose in the three groups .


A total of @ women were randomized : @ to oral , @ to vaginal , and @ to sublingual misoprostol .


The median gestation at recruitment was oral @ weeks ( interquartile range @-@ @ ) , vaginal @ weeks ( interquartile range @-@ @ ) , and sublingual @ weeks ( interquartile range @-@ @ ) .


The overall abortion duration was longer in women receiving oral misoprostol : oral @ hours ( @ % confidence interval -LSB- CI -RSB- @-@ @ ) , vaginal @ hours ( @ % CI @-@ @ ) , and sublingual @ hours ( @ % CI @-@ @ ) .


Overall , @ of @ ( @ % ) women were undelivered at @ hours , comprising @ % ( @ % CI @-@ @ ) oral , @ % ( @ % CI @-@ @ ) vaginal , and @ % ( @ % CI @-@ @ ) sublingual groups .


Vaginal or sublingual misoprostol administered after a vaginal loading dose in second-trimester medical abortion with mifepristone priming is associated with a shorter time to pregnancy termination compared with an oral regimen .


IPX@ , an investigational extended-release carbidopa-levodopa ( CD-LD ) preparation , has demonstrated a rapid attainment and prolonged maintenance of therapeutic LD plasma concentrations in advanced Parkinson 's disease ( PD ) .


This phase-@ crossover study assessed its efficacy and safety vs. CD-LD plus entacapone ( CL+E ) .


At baseline , all patients had motor fluctuations despite a stable regimen of CL+E or CD-LD-entacapone combination tablets ( CLE ) .


The study included a @-week conversion from CL+E or CLE to IPX@ , followed by two @-week , double-blind crossover treatment periods in randomized order , one on IPX@ ( and placebo CL+E ) , the other on CL+E ( and placebo IPX@ ) , separated by @-week open-label IPX@ treatment .


The primary efficacy measure was mean percent daily `` off '' time during waking hours ( from patient diaries ) .


Of @ randomized patients , @ completed the study .


Their median daily LD dosage was @mg from IPX@ and @mg from CL+E , corresponding , after correction for bioavailability , to an approximately @ % higher LD exposure on IPX@ .


Compared with CL+E , IPX@ demonstrated a lower percent `` off '' time ( @ % vs. @ % ; p < @ ) , lower `` off '' time ( @ vs. @ h/day ; p < @ ) , and higher `` on '' time without troublesome dyskinesia ( @ vs. @ h/day ; p < @ ) .


Other endpoints , including patient-reported treatment preference , also favored IPX@ ( p < @ ) .


During double-blind treatment , @ % and @ % of patients reported adverse events on IPX@ and CL+E , respectively .


The most common were dyskinesia ( @ patients ) , insomnia ( @ ) , and confusional state ( @ ) for IPX@ , and fall ( @ ) for CL+E .


In advanced PD , IPX@ showed improved efficacy , compared with CL+E , and appeared to be well tolerated .


To measure the psychosocial consequences in the Danish lung cancer screening trial ( DLCST ) and compare those between the computed tomography ( CT ) group and the control group .


This study was a single centre randomised controlled trial with five annual screening rounds .


Healthy current or former heavy smokers aged @-@ years ( men and women ) were randomised @:@ to a CT group and a control group .


Heavy smokers were defined by having smoked @ pack years and former smokers by being abstinent @ years .


Both groups were invited annually to the screening clinic to complete the validated lung-cancer-specific questionnaire consequences of screening lung cancer ( COS-LC ) .


The CT group was also offered a low dose CT scan of the lungs .


The COS-LC measures nine scales with psychosocial properties : Anxiety , Behaviour , Dejection , Negative impact on sleep , Self-blame , Focus on Airway Symptoms , Stigmatisation , Introvert , and Harm of Smoking .


@ participants were randomised to the DLCST and the COS-LC completion rates for the CT group and the control group were @ % and @ % , respectively .


There was a significant increase in negative psychosocial consequences from baseline through rounds @-@ for both the CT group and the control group ( mean increase > @ , p < @ for @ of @ possible scales ) .


During rounds @-@ the control group experienced significantly more negative psychosocial consequences in seven of nine scales compared with the CT group ( mean score > @ and p < @ ) .


Lung cancer CT-screening trials induced more negative psychosocial reactions in both the CT group and the control group compared with the baseline psychosocial profile .


The CT group experienced less negative psychosocial consequences compared with the control group , which might be explained by reassurance among those with normal screening results .


Maternal immunization with tetanus toxoid , reduced diphtheria toxoid , and acellular pertussis ( Tdap ) vaccine could prevent infant pertussis .


To evaluate the safety and immunogenicity of Tdap immunization during pregnancy and its effect on infant responses to diphtheria and tetanus toxoids and acellular pertussis ( DTaP ) vaccine .


Phase @-@ , randomized , double-blind , placebo-controlled , clinical trial conducted from @ to @ .


Forty-eight pregnant women aged @ to @ years received Tdap ( n = @ ) or placebo ( n = @ ) at @ to @ weeks ' gestation , with crossover immunization postpartum .


Tdap vaccination at @ to @ weeks ' gestation or postpartum .


Primary outcomes were maternal and infant adverse events , pertussis illness , and infant growth and development until age @ months .


Secondary outcomes were antibody concentrations in pregnant women before and @ weeks after Tdap immunization or placebo , at delivery and @ months ' postpartum , and in infants at birth , at @ months , and after the third and fourth doses of DTaP .


No Tdap-associated serious adverse events occurred in women or infants .


Injection site reactions after Tdap immunization were reported in @ ( @ % -LSB- @ % CI , @ % -@ % -RSB- ) and @ ( @ % -LSB- @ % CI , @ % -@ % -RSB- ) pregnant and postpartum women , respectively ( P > @ ) .


Systemic symptoms were reported in @ ( @ % -LSB- @ % CI , @ % -@ % -RSB- ) and @ ( @ % -LSB- @ % CI , @ % -@ % -RSB- ) pregnant and postpartum women , respectively ( P = @ ) .


Growth and development were similar in both infant groups .


No cases of pertussis occurred .


Significantly higher concentrations of pertussis antibodies were measured at delivery in women who received Tdap during pregnancy vs postpartum ( eg , pertussis toxin antibodies : @ EU/mL -LSB- @ % CI , @-@ @ -RSB- and @ EU/mL -LSB- @ % CI , @-@ @ -RSB- , respectively ; P < @ ) and in their infants at birth ( @ EU/mL -LSB- @ % CI , @-@ @ -RSB- and @ EU/mL -LSB- @ % CI , @-@ @ -RSB- , respectively ; P < @ ) and at age @ months ( @ EU/mL -LSB- @ % CI , @-@ @ -RSB- and @ EU/mL -LSB- @ % CI , @-@ @ -RSB- , respectively ; P < @ ) .


Antibody responses in infants born to women receiving Tdap during pregnancy were not different following the fourth dose of DTaP .


This preliminary assessment did not find an increased risk of adverse events among women who received Tdap vaccine during pregnancy or their infants .


For secondary outcomes , maternal immunization with Tdap resulted in high concentrations of pertussis antibodies in infants during the first @ months of life and did not substantially alter infant responses to DTaP .


Further research is needed to provide definitive evidence of the safety and efficacy of Tdap immunization during pregnancy .


To investigate the effects of Huangqi injection on the infection factors in children with acute lymphoblastic leukemia ( ALL ) during remission induction chemotherapy .


Ninety-one children with ALL were divided into treatment ( n = @ ) and control groups ( n = @ ) by a randomized double-blind method .


During remission induction chemotherapy , the treatment group was given Huangqi injection ( @ mL/kgd ) for @ days , while an equal volume of normal saline was used instead in the control group ; the other supportive care was the same for the two groups .


After remission induction chemotherapy , the incidence of infection , duration of infection , white blood cell and neutrophil counts , site of infection , and positive rate of pathogenic bacteria in secretion were compared between the two groups .


Four cases in the treatment group dropped out of the study due to allergic reaction .


After remission induction chemotherapy , compared with the control group , the treatment group had a significantly lower incidence of infection ( P < @ ) , a shorter duration of infection at any site ( P < @ ) , a higher neutrophil count after chemotherapy ( P < @ ) , and lower incidence rates of respiratory tract infection , urinary tract infection , blood infection , and skin and soft tissue infections ( P < @ ) .


Gram-negative bacteria were the main pathogens .


Among the infected children , the positive rate of pathogenic bacteria in secretion was significantly lower in the treatment group than in the control group ( P < @ ) .


Huangqi injection may reduce bone marrow suppression caused by chemotherapy drugs and increase neutrophil count during remission induction chemotherapy to reduce the incidence and duration of infection in children with ALL .


This study sought to determine whether outcomes for transfemoral ( TF ) transcatheter aortic valve replacement ( TAVR ) differ between the randomized controlled trial ( RCT ) and the subsequent NRCA ( Nonrandomized Continued Access ) registry of the PARTNER ( Placement of AoRTic TraNscathetER Valves ) trial .


The PARTNER RCT demonstrated that TAVR with the Edwards Sapien valve ( Edwards Lifesciences , Irvine , California ) is noninferior to surgery in high-risk patients and superior to standard therapy for inoperable patients .


The inclusion and exclusion criteria , data collection , monitoring , and core laboratories were the same for the RCT and NRCA registry .


Baseline characteristics , procedural results , and @-year outcomes were compared between patients undergoing TF-TAVR as part of the RCT and as part of the NRCA registry .


In the RCT , @ patients underwent TF-TAVR , whereas in the NRCA , @,@ patients did .


At @ days , death , cardiac death , stroke , and transient ischemic attacks were not different in the NRCA registry than in the RCT .


Major vascular complications ( @ % vs. @ % , p < @ ) and major bleeding ( @ % vs. @ % , p < @ ) were significantly lower in the NRCA registry .


At @ year , death rates were significantly lower in the NRCA cohort ( @ % vs. @ % , p = @ ) and cardiac death tended to be lower ( @ % vs. @ % , p = @ ) .


Stroke or transient ischemic attack ( @ % vs. @ % , p = @ ) and stroke alone ( @ % vs. @ % , p = @ ) also tended to be lower .


The large NRCA registry demonstrates further improvement in procedural and longer-term outcomes after TF-TAVR when compared with the favorable results from the PARTNER RCT .


( THE PARTNER TRIAL : Placement of AoRTic TraNscathetER Valve Trial ; NCT@ ) .


Three small retrospective studies have suggested that patients undergoing continuous androgen deprivation ( CAD ) have superior survival and time to progression if lower castrate levels of testosterone ( < @ nmol/L ) are achieved .


Evidence from prospective large studies has been lacking .


The PR-@ study randomly assigned patients experiencing biochemical failure after radiation therapy or surgery plus radiation therapy to CAD or intermittent androgen deprivation .


The relationship between testosterone levels in the first year and cause-specific survival ( CSS ) and time to androgen-independent progression in men in the CAD arm was evaluated using Cox regression .


There was a significant difference in CSS ( P = @ ) and time to hormone resistance ( P = @ ) among those who had first-year minimum nadir testosterone @ , > @ to @ , and @ nmol/L .


Patients with first-year nadir testosterone consistently > @ nmol/L had significantly higher risks of dying as a result of disease ( @ to @ nmol/L : hazard ratio -LSB- HR -RSB- , @ ; @ % CI , @ to @ ; > @ nmol/L : HR , @ ; @ % CI , @ to @ ) and developing hormone resistance ( @ to @ nmol/L : HR , @ ; @ % CI , @ to @ ; @ nmol/L : HR , @ ; @ % CI , @ to @ ) .


Maximum testosterone @ nmol/L predicted for a higher risk of dying as a result of disease ( P = @ ) .


Low nadir serum testosterone ( ie , < @ mmol/L ) within the first year of androgen-deprivation therapy correlates with improved CSS and duration of response to androgen deprivation in men being treated for biochemical failure undergoing CAD .


Despite vaccination , residents of long-term-care facilities ( LTCFs ) remain at high risk of influenza-related morbidity and mortality .


More-effective vaccine options for this population are needed .


We conducted a single-blinded , randomized , controlled trial comparing high-dose ( HD ) to standard-dose ( SD ) inactivated influenza vaccine ( IIV ) in @ frail , elderly residents of LTCFs during the @-@ and @-@ influenza seasons .


Hemagglutination inhibition ( HI ) antibody titers were measured at baseline and @ and @ days following vaccination .


A total of @ subjects ( @ % ) completed the study .


The mean age was @ years .


Geometric mean titers ( GMTs ) were significantly higher ( P < @ ) at day @ for HD recipients , compared with SD recipients , for all comparisons except influenza A ( H@N@ ) during @-@ ( the HD formulation was noninferior to the SD formulation for influenza A -LSB- H@N@ -RSB- during @-@ ) .


GMTs for HD and SD recipients during @-@ were as follows : influenza A ( H@N@ ) , @ ( @ % confidence interval -LSB- CI -RSB- , @-@ ) and @ ( @ % CI , @-@ ) , respectively ; influenza A ( H@N@ ) , @ ( @ % CI , @-@ ) and @ ( @ % CI , @-@ ) , respectively ; and influenza B , @ ( @ % CI , @-@ ) and @ ( @ % CI , @-@ ) , respectively .


During @-@ , GMTs for HD and SD recipients were as follows : influenza A ( H@N@ ) , @ ( @ % CI , @-@ ) and @ ( @ % CI , @-@ ) ; influenza A ( H@N@ ) , @ ( @ % CI , @-@ ) and @ ( @ % CI , @-@ ) , respectively ; and influenza B , @ ( @ % CI , @-@ ) and @ ( @ % CI , @-@ ) , respectively .


GMTs were significantly higher at day @ for HD recipients , compared with SD recipients , for influenza A ( H@N@ ) in both years ( P < @ ) .


Among frail , elderly residents of LTCFs , HD influenza vaccine produced superior responses for all strains except influenza A ( H@N@ ) in @-@ .


Preoperative radiotherapy ( RT ) is widely used to downstage rectal tumours , but the rate of recurrence varies significantly .


Therefore , new biomarkers are needed for better treatment and prognosis .


It has been shown that astrocyte elevated gene-@ ( AEG-@ ) is a key mediator of migration , invasion , and treatment resistance .


Our aim was to analyse the AEG-@ expression in relation to RT in rectal cancer patients and to test its radiosensitising properties .


The AEG-@ expression was examined by immunohistochemistry in @ patients from the Swedish clinical trial of RT. .


Furthermore , we inhibited the AEG-@ expression by siRNA in five colon cancer cell lines and measured the survival after irradiation by colony-forming assay .


The AEG-@ expression was increased in the primary tumours compared with the normal mucosa independently of the RT ( P < @ ) .


High AEG-@ expression in the primary tumour of the patients treated with RT correlated independently with higher risk of distant recurrence ( P = @ ) and worse disease-free survival ( P = @ ) .


Downregulation of AEG-@ revealed a decreased survival after radiation in radioresistant colon cancer cell lines .


The AEG-@ expression was independently related to distant recurrence and disease-free survival in rectal cancer patients with RT and could therefore be a marker to discriminate patients for distant relapse .


To evaluate the long-term effects of percutaneous tibial nerve stimulation ( PTNS ) on quality of life in women with chronic pelvic pain .


Thirty-three women with chronic pelvic pain were randomized into PTNS ( n = @ ) or control ( n = @ ) groups .


In PTNS group , weekly PTNS in @-min sessions for @ weeks was performed whereas the control group received no stimulation .


Present pain intensity-visual analog scale ( PPI-VAS ) , short-form McGill pain questionnaire ( SF-MPQ ) , and SF-@ were used at baseline , @-week , and @-month follow-up for the evaluation of pain intensity and quality of life .


Two women ( @ % ) were cured , @ ( @ % ) were much improved , @ ( @ % ) were the same and @ ( @ % ) was worse after PTNS .


Two women ( @ % ) were improved , @ ( @ % ) were the same , and @ ( @ % ) were worse in the control group .


Mean PPI-VAS of PTNS group at baseline , @ weeks , and @ months was @ @ , @ @ and @ @ , respectively .


There was a significant improvement in PPI-VAS scores of PTNS group whereas no change was observed in the control group .


There was a slight increase in the PPI-VAS scores of the PTNS group at @-month , but the difference was not statistically significant .


There was significant improvement in all domains of SF-MPQ and SF-@ in PTNS group with continuing effects at @ months whereas no significant change was observed in the control group .


PTNS is a minimally invasive treatment method that leads to decrease in pain severity and improvement in quality of life in women with chronic pelvic pain with effects continuing at @ months .


Antibiotics used to reduce nasal colonization by Staphylococcus aureus in patients before admission are inappropriate for carriage reduction on a regular basis within a hospital community .


Effective nonantibiotic alternatives for daily use in the nares will allow reduction of this bacterial source to be addressed .


Our study tested the effectiveness of a nonantibiotic , alcohol-based antiseptic in reducing nasal bacterial carriage in health care professionals ( HCPs ) at an urban hospital center .


HCPs testing positive for vestibular S aureus colonization were treated @ times during the day with topical antiseptic or control preparations .


Nasal S aureus and total bacterial colonization levels were determined before and at the end of a @-hour workday .


Seventy-eight of @ HCPs screened ( @ % ) tested positive for S aureus infection .


Of @ subjects who tested positive for S aureus infection who completed the study , @ received antiseptic and @ received placebo treatment .


Antiseptic treatment reduced S aureus colony forming units from baseline by @ % ( median ) and @ % ( mean ) ( P < @ ) .


Total bacterial colony forming units were reduced by @ % ( median ) and @ % ( mean ) ( P < @ ) .


Nasal application of a nonantibiotic , alcohol-based antiseptic was effective in reducing S aureus and total bacterial carriage , suggesting the usefulness of this approach as a safe , effective , and convenient alternative to antibiotic treatment .


The pharmacokinetics of nifedipine as a tocolytic agent has not been studied in great detail in pregnant women and has instead focused on immediate release tablets and gastrointestinal therapeutic system ( GITS ) tablets .


The aim of this study was to determine nifedipine slow-release half-life and distribution volume in pregnant women and to compare these with pharmacokinetic parameters of nifedipine in non-pregnant subjects described in the literature .


This is a study parallel to a trial studying women with threatened preterm labor between @ + @ and @ + @ weeks after initial tocolysis and a completed course of corticosteroids , who were randomly allocated to maintenance nifedipine ( slow-release tablets @ mg @ times daily ) or placebo .


Exclusion criteria for the pharmacokinetic study were contra-indications for nifedipine , impaired liver function , and concomitant intake of inhibitors or inducers of the cytochrome P@ @A@ isoenzyme .


Blood samples for measuring nifedipine plasma concentrations were drawn at t = @ , t = @ hours , t = @ hours , t = @ hours , t = @ hours , t = @ days , and t = @ days .


Pharmacokinetic parameters were estimated using iterative two-stage Bayesian population pharmacokinetic analysis by MWPharm software .


The study was designed to establish a correlation between body weight and nifedipine plasma level .


The pharmacokinetic parameters of nifedipine slow-release tablets were determined from the data of @ pregnant women .


Nifedipine slow-release had a half-life of @ - @ hours , a mean distribution volume of @ @ L/kg ( calculated while using a fixed biological availability of @ taken from the literature due to lack of intravenous data in this population ) compared to a half-life of @ - @ hours , and a distribution volume of @ - @ L/kg described in non-pregnant subjects in the literature .


None of the women delivered during study medication .


Study medication was continued for the duration of the pharmacokinetic study ( @ days ) in all women .


A correlation between nifedipine plasma levels and maternal body weight was not demonstrated .


This may have been caused by lack of power .


Pregnant subjects in this study , using nifedipine slow-release tablets , showed a larger volume of distribution and a shorter elimination half-life than for non-pregnant subjects as published in the literature .


Impairment of the mucosal barrier plays an important role in the pathophysiology of acute pancreatitis .


The myosin IXB ( MYO@B ) gene and the two tight-junction adaptor genes , PARD@ and MAGI@ , have been linked to gastrointestinal permeability .


Common variants of these genes are associated with celiac disease and inflammatory bowel disease , two other conditions in which intestinal permeability plays a role .


We investigated genetic variation in MYO@B , PARD@ and MAGI@ for association with acute pancreatitis .


Five single nucleotide polymorphisms ( SNPs ) in MYO@B , two SNPs in PARD@ , and three SNPs in MAGI@ were studied in a Dutch cohort of @ patients with acute pancreatitis and over @ controls , and in a German cohort of @ patients and @ controls .


Association to MYO@B and PARD@ was observed in the Dutch cohort , but only one SNP in MYO@B and one in MAGI@ showed association in the German cohort ( p < @ ) .


Joint analysis of the combined cohorts showed that , after correcting for multiple testing , only two SNPs in MYO@B remained associated ( rs@ , p = @ , odds ratio ( OR ) @ , @ % confidence interval ( @ % CI ) @-@ @ ; rs@ , p = @ , OR @ , @ % CI @-@ @ ) .


SNP rs@ is a non-synonymous SNP previously suspected to impact on ulcerative colitis .


None of the SNPs showed association to disease severity or etiology .


Variants in MYO@B may be involved in acute pancreatitis , but we found no evidence for involvement of PARD@ or MAGI@ .


More than @ % of patients with resistant hypertension have obstructive sleep apnea ( OSA ) .


However , there is little evidence about the effect of continuous positive airway pressure ( CPAP ) treatment on blood pressure in patients with resistant hypertension .


To assess the effect of CPAP treatment on blood pressure values and nocturnal blood pressure patterns in patients with resistant hypertension and OSA .


Open-label , randomized , multicenter clinical trial of parallel groups with blinded end point design conducted in @ teaching hospitals in Spain involving @ patients with resistant hypertension and an apnea-hypopnea index ( AHI ) of @ or higher .


Data were collected from June @ to October @ .


CPAP or no therapy while maintaining usual blood pressure control medication .


The primary end point was the change in @-hour mean blood pressure after @ weeks .


Secondary end points included changes in other blood pressure values and changes in nocturnal blood pressure patterns .


Both intention-to-treat ( ITT ) and per-protocol analyses were performed .


A total of @ patients were randomly assigned to receive CPAP ( n = @ ) or no CPAP ( control ; n = @ ) .


The mean AHI was @ ( SD , @ ) and an average of @ antihypertensive drugs were taken per patient .


Baseline @-hour mean blood pressure was @ mm Hg ; systolic blood pressure ( SBP ) , @ mm Hg ; and diastolic blood pressure ( DBP ) , @ mm Hg .


At baseline , @ % of patients displayed a dipper pattern ( a decrease of at least @ % in the average nighttime blood pressure compared with the average daytime blood pressure ) .


The percentage of patients using CPAP for @ or more hours per day was @ % .


When the changes in blood pressure over the study period were compared between groups by ITT , the CPAP group achieved a greater decrease in @-hour mean blood pressure ( @ mm Hg -LSB- @ % CI , @ to @ -RSB- ; P = @ ) and @-hour DBP ( @ mm Hg -LSB- @ % CI , @ to @ -RSB- ; P = @ ) , but not in @-hour SBP ( @ mm Hg -LSB- @ % CI , -@ to @ -RSB- ; P = @ ) compared with the control group .


Moreover , the percentage of patients displaying a nocturnal blood pressure dipper pattern at the @-week follow-up was greater in the CPAP group than in the control group ( @ % vs @ % ; adjusted odds ratio -LSB- OR -RSB- , @ -LSB- @ % CI , @ to @ -RSB- ; P = @ ) .


There was a significant positive correlation between hours of CPAP use and the decrease in @-hour mean blood pressure ( r = @ , P = @ ) , SBP ( r = @ ; P = @ ) , and DBP ( r = @ , P = @ ) .


Among patients with OSA and resistant hypertension , CPAP treatment for @ weeks compared with control resulted in a decrease in @-hour mean and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern .


Further research is warranted to assess longer-term health outcomes .


Tools to predict death or spontaneous survival are necessary to inform liver transplantation ( LTx ) decisions in pediatric acute liver failure ( PALF ) , but such tools are not available .


Recent data suggest that immune/inflammatory dysregulation occurs in the setting of acute liver failure .


We hypothesized that specific , dynamic , and measurable patterns of immune/inflammatory dysregulation will correlate with outcomes in PALF .


We assayed @ inflammatory mediators on stored serum samples obtained from a convenience sample of @ children in the PALF study group ( PALFSG ) collected within @ days after enrollment .


Outcomes were assessed within @ days of enrollment consisting of spontaneous survivors , non-survivors , and LTx recipients .


Data were subjected to statistical analysis , patient-specific Principal Component Analysis ( PCA ) , and Dynamic Bayesian Network ( DBN ) inference .


Raw inflammatory mediator levels assessed over time did not distinguish among PALF outcomes .


However , DBN analysis did reveal distinct interferon-gamma-related networks that distinguished spontaneous survivors from those who died .


The network identified in LTx patients pre-transplant was more like that seen in spontaneous survivors than in those who died , a finding supported by PCA .


The application of DBN analysis of inflammatory mediators in this small patient sample appears to differentiate survivors from non-survivors in PALF .


Patterns associated with LTx pre-transplant were more like those seen in spontaneous survivors than in those who died .


DBN-based analyses might lead to a better prediction of outcome in PALF , and could also have more general utility in other complex diseases with an inflammatory etiology .


Treatment of patients with prostate cancer has evolved considerably in the last decade , especially in terms of minimization of the negative impacts on erectile function and continence to ensure good quality of life for treated patients .


New surgical devices , such as dissectors and hemostatic scalpels , allow precise definition of the surgical field with finer dissection of the anatomic structures , with subsequent reductions in operative times and better oncologic and functional outcomes .


Although monopolar scissors ( MS ) are still widely used , radiofrequency ( RF ) and ultrasound ( US ) scalpels have been introduced recently in laparoscopic radical prostatectomy ( LRP ) .


Despite the widespread use of these scalpels , however , few studies have compared these devices in terms of oncologic and functional outcomes after radical prostatectomy .


The present study aimed to prospectively assess the impact of MS , RF , and US scalpels on margin status at apex , and recovery of urinary continence and erectile function in patients undergoing extraperitoneal LRP .


A total of @ men were prospectively enrolled between September @ and April @ and postoperatively evaluated for continence and clinical factors .


There were no differences in terms of operative times ( P = @ ) , blood loss ( P = @ ) , apical margin positivity ( P = @ ) or postoperative hospital stay ( P = @ ) among the groups .


Moreover , no differences in the functional outcome scores , as evaluated by the International Consultation on Incontinence self-administered Questionnaire , at @ , @ , and @ months postsurgery were observed .


Our study represents the first evaluation of continence recovery in LRP with respect to different devices used for prostatic apex dissection .


We found that the oncologic , functional , and operative outcomes were similar between these different devices during LRP , with no scalpel demonstrating superiority in continence recovery .


This study was to determine any significant difference between the incidence of infectious morbidity with the use of a @ hour antibiotics regimen compared to a @-day course of antibiotics following elective caesarean section using a cheap and easily available combination of Ampicillin/Cloxacillin and Metronidazole .


Two hundred patients planned to have elective caesarean section for various indications and who satisfied the inclusion criteria were enrolled in the study in two groups of @ patients each between the period of January to June @ .


Patients were randomized to receive either Ampiclox as @ intravenous doses of @g stat and @ mg each @ hourly and Metronidazole as @ intravenous doses of @ mg each @ hourly both for @ hours or same combination intravenously for @ hours and subsequent oral use for @ days .


The mean maternal age , parity , gestational age and indication for caesarean section were similar in the two groups of participants .


There was no statistical difference in the incidence of febrile morbidity ( @ % / @ % , p = @ ) , urinary tract infection ( @ % / @ % , p = @ ) , wound infection ( @ % / @ % , p = @ ) and endometritis ( @ % / @ % , p = @ ) .


The mean cost of antibiotics per patient ( N@ / $ @ ) in the short term prophylaxis group was half that of the long term prophylaxis group ( N@ , @ / $ @ ) .


There was no difference in the incidence of infection related morbidity when short term prophylactic antibiotics was used at elective caesarean section compared to long term prophylactic antibiotics .


Inferior scapular notching following reverse shoulder arthroplasty is due to mechanical impingement and , in some studies , has been associated with poorer functional scores , lower patient satisfaction , and more limited shoulder motion .


We aimed to test the hypothesis that inferior positioning of the center of rotation with eccentric glenosphere designs decreases the adduction deficit before impingement occurs and improves clinical outcome .


A randomized , controlled , double-blinded trial was performed .


According to the results of a power analysis , fifty patients undergoing reverse shoulder arthroplasty for the diagnosis of cuff tear arthropathy were randomized intraoperatively to receive either a concentric or eccentric glenosphere .


The glenoid baseplate was positioned flush to the inferior border of the glenoid before the glenosphere was then attached .


Notching was assessed using an anteroposterior radiograph , and clinical outcome was assessed using the visual analog pain scale score , shoulder function rating , American Shoulder and Elbow Surgeons score , and Oxford shoulder score .


Active forward elevation and external rotation were assessed .


The outcome assessor was blinded to the treatment group .


The mean follow-up period for the groups was forty-three and forty-seven months .


Patient demographics and preoperative scores were similar between the groups .


At the time of the final follow-up , four patients ( @ % ) in the concentric group had developed inferior scapular notching ( two with Nerot grade I and two with Nerot grade II ) , ranging in size from @ to @ mm , compared with one patient ( @ % ; Nerot grade I ) in the eccentric group ( p = @ ) .


No notching occurred in any patient with glenoid overhang of > @ mm .


No significant difference between the groups was seen with respect to functional outcome scores , patient satisfaction , or shoulder motion .


There were no differences in notching rates or clinical outcomes between concentric and eccentric glenospheres following reverse shoulder arthroplasty .


Inferior glenosphere overhang of > @ mm , however , prevented notching .


This may be achieved with a modified surgical technique , but eccentric glenospheres provide an additional option .


Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence .


Couples-based HIV counseling and testing ( CHCT ) is a proven strategy to reduce the risk of HIV transmission between partners , but uptake of CHCT is low .


We describe the study design of a randomized controlled trial ( RCT ) aimed to increase participation in CHCT and reduce sexual risk behavior for HIV among heterosexual couples in rural KwaZulu-Natal , South Africa .


We hypothesize that the rate of participation in CHCT will be higher and sexual risk behavior will be lower in the intervention group as compared to the control .


Heterosexual couples ( N = @ couples , @ individuals ) are being recruited to participate in a randomized trial of a couples-based intervention comprising two group sessions ( one mixed gender , one single gender ) and four couples ' counseling sessions .


Couples must have been in a relationship together for at least @ months .


Quantitative assessments are conducted via mobile phones by gender-matched interviewers at baseline , @ , @ , and @ months post-randomization .


Intervention content is aimed to improve relationship dynamics , and includes communication skills and setting goals regarding CHCT .


The Uthando Lwethu ( ` our love ' ) intervention is the first couples-based intervention to have CHCT as its outcome .


We are also targeting reductions in unprotected sex .


CHCT necessitates the testing and mutual disclosure of both partners , conditions that are essential for improving subsequent outcomes such as disclosure of HIV status , sexual risk reduction , and improving treatment outcomes .


Thus , improving rates of CHCT has the potential to improve health outcomes for heterosexual couples in a rural area of South Africa that is highly impacted by HIV .


The results of our ongoing clinical trial will provide much needed information regarding whether a relationship-focused approach is effective in increasing rates of participation in CHCT .


Our intervention represents an attempt to move away from individual-level conceptualizations , to a more integrated approach for HIV prevention .


In this post-hoc analysis , we determined the influence of single nucleotide polymorphisms in host candidate immune genes on the outcome of drug resistant malaria in Cameroon .


Human DNA from @ patients from a previous clinical trial was subjected to mass spectrometry-based single nucleotide polymorphism ( SNP ) genotyping .


Allele frequencies of candidate immune genes were calculated for @ SNPs on @ human chromosomes for their possible involvement in clearance of drug-resistant parasites with the triple mutations of pfcrt@T , pfmdr@Y , and pfmdr@Y ( TY ) and pfdhfr@I , pfdhfr@R , pfdhfr@N , and pfdhps@G ( IRNG ) which were determined by dotblot or PCR-restriction analysis .


Differences in SNP frequencies and association analysis were carried out by comparing Chi-square odds ratios ( ORs ) and stratified by Mantel-Haenzel statistics .


An adjusted P value ( OR ) < @ was considered significant .


Post-treatment drug failure rates were amodiaquine ( @ % ) ; sulpadoxine/pyrimethamine-amodiaquine combination ( @ % ) ; and sulphadoxine/pyrimethamine ( @ % ) .


SNPs in IL@ , IL-@R@ , and CD@ appeared to have been associated with clearance of resistant parasites -LSB- p = @ , OR ( C allele ) :@ , @ % CI ( OR ) : @-@ -RSB- ; -LSB- P = @ , OR = @ , @ % CI ( OR ) : @-@ -RSB- ; -LSB- P = @ ( -@ ) , OR = @ , @ % CI ( OR ) : @-@ -RSB- , respectively , with high fever ( > @C for @ hours ) -LSB- IL-@ , P = @ , OR = @ , @ % CI ( OR ) : @-@ -RSB- and also in high frequency among the Fulani participants -LSB- P = @ , OR = @ , @ % CI ( OR ) : @-@ ) -RSB- .


The CD@-@ null allele was completely absent in the northern population .


Independent association of SNPs in IL@ and IL-@ with clearance of amodiaquine - and sulphadoxine/pyrimethamine-resistant parasites did not reach statistical significance , but may suggest that not all drug-resistant mutants are adversely affected by the same immune-mediated mechanisms of clearance .


We validated the metabolic syndrome ( MetS ) score by confirmatory factor analysis ( CFA ) in children , middle-aged men , and older women and men and by investigating the relationships of the MetS score to incident type @ diabetes , myocardial infarction , and cardiovascular and overall death in middle-aged men .


We assessed the core features of MetS , calculated the MetS score using z scores for waist circumference , insulin , glucose , triacylglycerols , HDL-cholesterol and blood pressure , and carried out CFA to investigate whether MetS represents a single entity in population samples of @ children , @,@ middle-aged men , @ older women and @ older men from Finland .


We also followed-up incident type @ diabetes for @ years and other outcomes for @-@ years in middle-aged men .


We carried out second-order CFAs in which the MetS was represented by a second-order latent variable underlying four latent variables characterised by abdominal obesity , insulin resistance , dyslipidaemia and raised blood pressure in different age groups .


These second-order factors and factors derived from first-order CFA using previously proposed models were strongly associated with a composite MetS score in all age groups ( r = @-@ @ ) and similarly predicted type @ diabetes , cardiovascular outcomes and mortality in middle-aged men .


The risk of type @ diabetes , myocardial infarction , cardiovascular death and overall death increased @ - , @ - , @ - and @-fold , respectively , for a @ SD increase in the MetS score .


The MetS can be described as a single entity in all age groups .


The MetS score is a valid tool for research evaluating cardiometabolic risk in different age groups .


Further research is needed to define cut-off points for risk estimation in clinical practice .


Insufficient use of behavioral theory to understand health care workers ' ( HCWs ) hand hygiene compliance may result in suboptimal design of hand hygiene interventions and limit effectiveness .


Previous studies examined HCWs ' intended , rather than directly observed , compliance and/or focused on just @ behavioral model .


This study examined HCWs ' explanations of noncompliance in `` real time '' ( immediately after observation ) , using a behavioral theory framework , to inform future intervention design .


HCWs were directly observed and asked to explain episodes of noncompliance in `` real-time . ''


Explanations were recorded , coded into @ behavioral domains , using the Theory Domains Framework , and subdivided into themes .


Over two-thirds of @ recorded explanations were explained by @ domains .


These were `` Memory/Attention/Decision Making '' ( @ , @ % ) , subdivided into @ themes ( memory , loss of concentration , and distraction by interruptions ) , and `` Knowledge '' ( @ , @ % ) , with @ themes relating to specific hand hygiene indications .


No other domain accounted for more than @ ( @ % ) explanations .


An explanation of HCW 's `` real-time '' explanations for noncompliance identified `` Memory/Attention/Decision Making '' and `` Knowledge '' as the @ behavioral domains commonly linked to noncompliance .


This suggests that hand hygiene interventions should target both automatic associative learning processes and conscious decision making , in addition to ensuring good knowledge .


A theoretical framework to investigate HCW 's `` real-time '' explanations of noncompliance provides a coherent way to design hand hygiene interventions .


Western industrialised nations face a large increase in the number of older people .


People over the age of @ years account for almost half of the @ million hospital admissions in England from @ to @ .


During @-@ , respiratory infections accounted for approximately @ in @ hospital admissions and @ in @ of the @ million bed-days .


To determine the diagnostic accuracy and clinical effectiveness and cost-effectiveness of rapid molecular and near-patient diagnostic tests for influenza , respiratory syncytial virus ( RSV ) and Streptococcus pneumoniae infections in comparison with traditional laboratory culture .


We carried out a randomised controlled trial ( RCT ) to evaluate impact on prescribing and clinical outcomes of point-of-care tests ( POCTs ) for influenza A and B and pneumococcal infection , reverse transcriptase-polymerase chain reaction ( RT-PCR ) tests for influenza A and B and RSV A and B , and conventional culture for these pathogens .


We evaluated diagnostic accuracy of POCTs for influenza and pneumococcal infection , RT-PCR for influenza and sputum culture for S. pneumoniae using samples collected during the RCT .


We did a systematic review and meta-analysis of POCTs for influenza A and B.


We evaluated ease and speed of use of each test , process outcomes and cost-effectiveness .


There was no evidence of association between diagnostic group and prescribing or clinical outcomes .


Using PCR as ` gold standard ' , Quidel Influenza A+B POCT detected @ % -LSB- @ % confidence interval ( CI ) @ % to @ % -RSB- of influenza infections ( specificity @ % , @ % CI @ % to @ % ) ; viral culture detected @ % ( @ % CI @ % to @ % ; specificity @ % , @ % CI @ % to @ % ) .


Using blood culture as ` gold standard ' , BinaxNOW pneumococcal POCT detected @ % ( @ % CI @ % to @ % ) of pneumococcal infections ( specificity @ % ; @ % CI @ % to @ % ) ; sputum culture detected @ % ( @ % CI @ % to @ % ; specificity @ % , @ % CI @ % to @ % ) .


Overall , pooled estimates of sensitivity and specificity of POCTs for influenza from the literature were @ % ( @ % CI @ % to @ % ) and @ % ( @ % CI @ % to @ % ) , respectively .


Median intervals from specimen collection to test result were @ minutes -LSB- interquartile range ( IQR ) @-@ minutes ) for Quidel Influenza A+B POCT , @ minutes ( IQR @-@ minutes ) for BinaxNOW pneumococcal POCT , @ hours ( IQR @-@ @ hours ) for semi-nested conventional PCR , @ hours ( IQR @-@ @ hours ) for real-time PCR , @ hours ( IQR @-@ @ hours ) for culture of influenza and @ hours ( IQR @-@ @ hours ) and @ hours ( IQR @-@ @ hours ) for culture of S. pneumoniae in blood and sputum , respectively .


Both POCTs were rated straightforward and undemanding ; blood culture was moderately complex and all other tests were complex .


Costs and quality-adjusted life-years ( QALYs ) of each diagnostic strategy were similar .


Incrementally , PCR was most cost-effective ( @ % probability at a willingness to pay of @,@ / QALY ) .


Few patients were admitted within a timescale conducive to treatment with a neuraminidase inhibitor according to National Institute for Health and Care Excellence guidance .


The accuracy study was limited by inadequate gold standards .


All tests had limitations .


We found no evidence that POCTs for influenza or S. pneumoniae , or PCR for influenza or RSV influenced antimicrobial prescribing or clinical outcomes .


The total costs and QALYs of each diagnostic strategy were similar , although , incrementally , PCR was the most cost-effective strategy .


The analysis does not support routine use of POCTs for either influenza or pneumococcal antigen for adults presenting with acute cardiopulmonary conditions , but suggests that conventional viral culture for clinical diagnosis should be replaced by PCR .


Elastic resistance bands ( ERB ) combined with proprioceptive neuromuscular facilitation ( PNF ) are often used in resistance muscle training programs , which have potential effects on peripheral muscle strength .


However , the effects of the combination of ERB and PNF on respiratory muscle strength warrant further investigation .


The assessment of the effects of PNF combined with ERB on respiratory muscle strength .


Twenty healthy , right-handed females were included .


Subjects were randomized to either the resistance training program group ( TG , n = @ ) or the control group ( CG , n = @ ) .


Maximal expiratory pressure ( MEP ) and inspiratory pressure ( MIP ) were measured before and after four weeks of an upper extremity resistance training program .


The training protocol consisted of upper extremity PNF combined with ERB , with resistance selected from @ repetition maximum protocol .


PNF combined with ERB showed significant increases in MIP and MEP ( p < @ ) .


In addition , there were significant differences between the TG and CG regarding MIP ( p = @ ) and MEP ( p = @ ) .


PNF combined with ERB can have a positive impact on respiratory muscle strength .


These results may be useful with respect to cardiopulmonary chronic diseases that are associated with reduced respiratory muscle strength .


To examine the performance of T@-weighted ( T@W ) and diffusion-weighted ( DW ) magnetic resonance imaging ( MRI ) for detecting the index tumour in patients with prostate cancer and to examine the agreement between MRI and histology when assessing tumour volume ( TV ) and overall tumour burden .


The study included @ consecutive patients with biopsy confirmed prostate cancer randomised to MRI before radical prostatectomy from December @ to July @ .


MRI-detected tumours ( MRTs ) were ranked from @ to @ according to decreasing volume and were compared with histologically detected tumours ( HTs ) ranked from @ to @ , with HT @ = index tumour .


Whole-mount section histology was used as a reference standard .


The TVs of true-positive MRTs ( MRTVs @-@ ) were compared with the TVs found by histology ( HTVs @-@ ) .


All tumours were registered on a @-sector map and by classifying each sector as positive/negative , the rate of true-positive and - negative sectors was calculated .


The detection rate for the HT @ ( index tumour ) was @ % ; HT @ , @ % ; and HT @ , @ % .


The MRTV @-@ vs the HTV @-@ were @ mL vs @ mL ( index tumour , P < @ ) , @ mL vs @ mL ( tumour @ , P = @ ) , and @ mL vs @ mL ( tumour @ , P = @ ) .


The rate of true-positive and - negative sectors was @ % and @ % , = @ .


A combination of T@W and DW MRI detects the index tumour in @ % of cases , although MRI underestimates both TV and tumour burden compared with histology .


Heart rate variability ( HRV ) is a marker of autonomic dysfunction severity .


The effects of physical training on HRV indexes in Chagas heart disease ( CHD ) are not well established .


To evaluate the changes in HRV indexes in response to physical training in CHD .


Patients with CHD and left ventricular ( LV ) dysfunction , physically inactive , were randomized either to the intervention ( IG , N = @ ) or control group ( CG , N = @ ) .


The IG participated in a @-week exercise program consisting of @ sessions/week .


Mean age was @ @ years , @ % males , mean LVEF was @ @ % .


Baseline HRV indexes were similar between groups .


From baseline to follow-up , total power ( TP ) : @ ( IQ @ - @ ) to @ ( @ - @ ) ms , p = @ ) and very low frequency power : @ ( @ - @ ) to @ ( @ - @ ) ms , p = @ ) increased in the IG , but not in the CG .


The delta ( post - pre ) HRV indexes were similar : SDNN @ @ vs. @ @ ms. p = @ ; rMSSD @ ( @ - @ ) vs. @ ( @ - @ ) ms. p = @ ; TP @ ( @ - @ ) vs. @ ( @ - @ ) Hz .


p = @ ; low frequency power ( LFP ) @ ( @ - @ ) vs. @ ( @ - @ ) Hz .


p = @ ; except for high frequency power , which tended to increase in the IG : @ ( @ - @ ) vs. @ ( @ - @ ) Hz .


p = @ ) .


In the studied population , the variation of HRV indexes was similar between the active and inactive groups .


Clinical improvement with physical activity seems to be independent from autonomic dysfunction markers in CHD .


There is co-morbidity between parental depression and childhood conduct disorder .


The Incredible Years ( IY ) parenting programmes reduce both conduct disorder in children and depression in their parents .


Recent U.K. and Ireland trials of the effectiveness and cost-effectiveness of IY parenting programmes have assessed children 's health and social care service use , but little is known about the programme 's impact on parental service use .


This paper explores whether an above clinical cut-off score on the Beck Depression Inventory II ( BDI II ) is associated with high or low parental health and social care service use in high-risk families receiving the IY Basic Programme .


This is a secondary analysis of a subsample ( N = @ ) from the first U.K. community-based randomised controlled trial of the @-week IY Basic Programme ( N = @ ) .


Parents with children at risk of developing conduct disorder were randomised to receive the programme or to a waiting-list control group .


BDI II total and BDI II clinical depression cut-off scores were compared to frequencies and costs of parents ' service use , at baseline , six , twelve and eighteen months post-baseline for the intervention group and at baseline and six months post-baseline for the control group .


Intervention group parents who scored above the clinical cut-off on the BDI II at baseline used more health and social care services than those who scored below at baseline , six and eighteen months .


Significant reductions in service use frequencies were found for the intervention group only .


Parents with higher levels or depression used more health and social care service and parenting programmes have been shown to reduce parental depression and also health and social service use .


However , further exploration of depressed parents ' service use and the cost implications for publically funded health and social care services is needed .


In the late @s , the use of high-dose chemotherapy ( HDCT ) and stem-cell rescue held promise for patients with advanced and poor prognosis germ-cell tumors ( GCT ) .


We started a randomized phase II trial to assess the efficacy of sequential HDCT compared with cisplatin , etoposide , and bleomycin ( PEB ) .


Patients were randomly assigned to receive four cycles of PEB every @ weeks or two cycles of PEB followed by a high-dose sequence ( HDS ) comprising HD-cyclophosphamide ( @ g/m ( @ ) ) , @ courses of cisplatin and HD-etoposide ( @ g/m ( @ ) ) with stem-cell support , and a single course of HD-carboplatin -LSB- area under the curve ( AUC ) @ mg/ml min -RSB- with autologous stem-cell transplant .


Postchemotherapy surgery was planned on responding residual disease in both arms .


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


The study was designed to detect a @ % improvement of @-year PFS ( from @ % to @ % ) , with @ % power and two-sided at @ % .


From December @ to March @ , @ patients were randomized : @ in PEB and @ in HDS arm .


Median follow-up was @ months -LSB- interquartile range ( IQR ) : @-@ @ -RSB- .


Complete or partial response with normal markers ( PRm - ) were obtained in @ ( @ % ) and @ ( @ % ) patients , respectively .


Five-year PFS was @ % -LSB- @ % confidence interval ( CI ) @-@ @ -RSB- and @ % ( @ % CI @ % -@ % ) in PEB and HDS arm , respectively ( log-rank test P = @ ) .


Five-year overall survival was @ % ( @ % CI @-@ @ ) and @ % ( @ % CI @-@ @ ) .


One toxic death ( PEB arm ) was recorded .


The study failed to meet the primary end point .


Furthermore , survival estimates of conventional-dose chemotherapy higher than expected should be accounted for and will likely limit further improvements in the first-line setting .


CLINICALTRIALS.GOV : NCT@ .


Osteochondral lesions of the talus ( OLT ) frequently occur after ankle sprains in young patients participating in sports activities .


These injuries may lead to chronic pain , joint swelling , and finally osteoarthritis , therefore , surgical repair is frequently needed .


A collagen scaffold seeded with bone marrow-derived cells ( BMDCs ) harvested from patient 's iliac crest and implanted into the OLT through a single arthroscopic procedure has been recently proposed as an effective treatment option .


Nevertheless , BMDCs , embedded in an inflammatory environment , tend to differentiate toward a fibroblast phenotype with a consequential loss of mechanical characteristics .


Biophysical stimulation with pulsed electromagnetic fields ( PEMFs ) has been shown to promote anabolic chondrocyte activity , stimulate proteoglycan synthesis , and reduce the release of the most relevant pro-inflammatory cytokines .


The aim of this randomized controlled trial was to evaluate the effects of PEMFs on clinical outcome in patients who underwent BMDCs transplantation for OLT .


Thirty patients affected by grade III and IV Outerbridge OLT underwent BMDCs transplantation .


After surgery , patients were randomly assigned to either experimental group ( PEMFs @ hours per day for @ days starting within @ days after operation ) or control group .


Clinical outcome was evaluated with ( American Orthopaedic Foot and Ankle Society ) AOFAS score , Visual Analog Scale ( VAS ) , and Short Form-@ ( SF-@ ) .


Significantly higher AOFAS score was recorded in the experimental group both at @ or @ months follow-up .


At @ days and @ and @ months follow-up , significant lower pain was observed in the experimental group .


No significant difference was found in SF-@ between groups .


A superior clinical outcome was found in the experimental group with more than @ points higher AOFAS score at final follow-up .


Biophysical stimulation started soon after surgery aided patient recovery leading to pain control and a better clinical outcome with these improvements lasting more than @ year after surgery .


Level II , prospective comparative study .


Asparaginase is a critical agent used to treat acute lymphoblastic leukemia ( ALL ) .


Pegaspargase ( SS-PEG ) , a pegylated form of Escherichia coli L-asparaginase with a succinimidyl succinate ( SS ) linker , is the first-line asparaginase product used in Children 's Oncology Group ( COG ) ALL trials .


Calaspargase pegol ( SC-PEG ) replaces the SS linker in SS-PEG with a succinimidyl carbamate linker , creating a more stable molecule .


COG AALL@P@ was designed to determine the pharmacokinetic and pharmacodynamic comparability of SC-PEG to SS-PEG in patients with newly diagnosed high-risk ( HR ) B-cell ALL .


A total of @ evaluable patients were randomly assigned at a @:@ ratio to receive SC-PEG at @,@ ( SC-PEG@ ; n = @ ) or @,@ IU/m ( @ ) ( SC-PEG@ ; n = @ ) versus SS-PEG @,@ IU/m ( @ ) ( SS-PEG@ ; n = @ ) as part of an otherwise identical chemotherapy regimen .


The groups were similar demographically , except more female patients received SC-PEG@ .


The mean half-life of plasma asparaginase activity for both SC-PEG doses was approximately @ longer than that of SS-PEG@ .


The total systemic exposure , as defined by induction area under the curve from time @ to @ days , was greater with SC-PEG@ than with SS-PEG@ or SC-PEG@ .


The proportion of patients with plasma asparaginase activity @ mIU/mL and @ mIU/mL was higher in patients who received SC-PEG as compared with SS-PEG@ .


After one dose of pegylated asparaginase on induction day @ , plasma asparagine was undetectable for @ days for SS-PEG@ and @ days for both SC-PEG groups .


SC-PEG@ achieves a significantly longer period of asparaginase activity above defined thresholds and asparagine depletion compared with SS-PEG@ and has a comparable toxicity profile in children with HR B-cell ALL .


The aim of this study was to confirm the cardioprotective effects of hypothermia using a combination of cold salineand endovascular cooling .


Hypothermia has been reported to reduce infarct size ( IS ) in patients with ST-segment elevation myocardial infarctions .


In a multicenter study , @ patients with ST-segment elevation myocardial infarctions ( < @ h ) scheduled to undergopercutaneous coronary intervention were randomized to hypothermia induced by the rapid infusion of@to @,@ ml cold saline and endovascular cooling or standard of care .


Hypothermia was initiated before percutaneous coronary intervention and continued for @ h after reperfusion .


The primary end point was IS as apercent of myocardium at risk ( MaR ) , assessed by cardiac magnetic resonance imaging at @ @ days .


Mean times from symptom onset to randomization were @ @ min in patients receiving hypothermia and @ @min in controls .


Patients randomized to hypothermia achieved a core body temperature of @ C before reperfusion , with a @-min longer door-to-balloon time .


Median IS/MaR was not significantly reduced ( hypothermia : @ % -LSB- interquartile range : @ % to @ % ; control : @ % -LSB- interquartile range : @ % to @ % -RSB- ; relative reduction @ % ; p = @ ) .


The incidence of heart failure was lower with hypothermia at @ @ days ( @ % vs. @ % , p < @ ) , with no mortality .


Exploratory analysis of early anterior infarctions ( @ to @ h ) found a reduction in IS/MaR of @ % ( p < @ ) and an absolute reduction of IS/left ventricular volume of @ % ( p = @ ) .


Hypothermia induced by cold saline and endovascular cooling was feasible and safe , and it rapidly reduced coretemperature with minor reperfusion delay .


The primary end point of IS/MaR was not significantly reduced .


Lower incidence of heart failure and a possible effect in patients with early anterior ST-segment elevation myocardial infarctions need confirmation .


( Efficacy of Endovascular Catheter Cooling Combined With Cold Saline for the Treatment of Acute Myocardial Infarction -LSB- CHILL-MI -RSB- ; NCT@ ) .


Physicians have a major influence on parental vaccine decisions .


We tested a physician-targeted communication intervention designed to ( @ ) reduce vaccine hesitancy in mothers of infants seen by trained physicians and ( @ ) increase physician confidence in communicating about vaccines .


We conducted a community-based , clinic-level , @-arm cluster randomized trial in Washington State .


Intervention clinics received physician-targeted communications training .


We enrolled mothers of healthy newborns from these clinics at the hospital of birth .


Mothers and physicians were surveyed at baseline and @ months .


The primary outcome was maternal vaccine hesitancy measured by Parental Attitudes on Childhood Vaccines score ; secondary outcome was physician self-efficacy in communicating with parents by using @ vaccine communication domains .


We enrolled @ clinics and @ mothers .


We conducted intervention trainings at @ clinics , reaching @ % of eligible physicians ; @ clinics were randomized to the control group .


Maternal vaccine hesitancy at baseline and follow-up changed from @ % to @ % in the intervention group and @ % to @ % in the control group .


At baseline , groups were similar on all variables except maternal race and ethnicity .


The intervention had no detectable effect on maternal vaccine hesitancy ( adjusted odds ratio @ , @ % confidence interval @-@ @ ) .


At follow-up , physician self-efficacy in communicating with parents was not significantly different between intervention and control groups .


This physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy .


Research is needed to identify physician communication strategies effective at reducing parental vaccine hesitancy in the primary care setting .


Physical therapy influences chronic pain by means of the specific ingredient of an intervention as well as contextual factors including the setting and therapeutic alliance ( TA ) between provider and patient .


The purpose of this study was to compare the effect of enhanced versus limited TA on pain intensity and muscle pain sensitivity in patients with chronic low back pain ( CLBP ) receiving either active or sham interferential current therapy ( IFC ) .


An experimental controlled study with repeated measures was conducted .


Participants were randomly divided into @ groups : ( @ ) AL ( n = @ ) , which included the application of active IFC combined with a limited TA ; ( @ ) SL ( n = @ ) , which received sham IFC combined with a limited TA ; ( @ ) AE ( n = @ ) , which received active IFC combined with an enhanced TA ; and ( @ ) SE ( n = @ ) , which received sham IFC combined with an enhanced TA .


One hundred seventeen individuals with CLBP received a single session of active or sham IFC .


Measurements included pain intensity as assessed with a numerical rating scale ( PI-NRS ) and muscle pain sensitivity as assessed via pressure pain threshold ( PPT ) .


Mean differences on the PI-NRS were @ cm ( @ % CI = @-@ @ ) , @ cm ( @ % CI = @-@ @ ) , @ cm ( @ % CI = @-@ @ ) , and @ cm ( @ % CI = @-@ @ ) for the AL , SL , AE , and SE groups , respectively .


Mean differences on PPTs were @ kg ( @ % CI = @-@ @ ) , @ kg ( @ % CI = @-@ @ ) , @ kg ( @ % CI = @-@ @ ) , and @ kg ( @ % CI = @-@ @ ) , for the AL , SL , AE , and SE groups , respectively .


The study protocol aimed to test the immediate effect of the TA within a clinical laboratory setting .


The context in which physical therapy interventions are offered has the potential to dramatically improve therapeutic effects .


Enhanced TA combined with active IFC appears to lead to clinically meaningful improvements in outcomes when treating patients with CLBP .


Statins have multiple antiatherosclerotic effects , but can reduce blood plasma concentrations of minerals , including zinc .


As zinc possesses antiinflammatory and antioxidant effects , low zinc status can promote injuries or inadequate tissue repair in endothelial cells .


Metallothionein ( MT ) expression might modulate responses induced by statins in patients with atherosclerosis .


However , research regarding mineral status and the use of statins is scarce .


This study evaluated the effects of zinc supplementation on zinc status and expression of the zinc-dependent MT@F and MT@A genes in patients with atherosclerosis treated with rosuvastatin .


A double-blind , randomized clinical trial was performed with @ participants treated with @mg rosuvastatin for @ months with or without zinc supplementation ( @mg/day ) .


Diet , lipid profile , high-sensitivity reactive protein C ( hs-CRP ) , plasma and erythrocyte zinc concentrations , erythrocyte superoxide dismutase ( SOD ) activity , and MT@F and MT@A genes expression were analyzed before and after intervention .


Rosuvastatin therapy was effective in reducing low - and non-high-density lipoprotein , total cholesterol , triglycerides , and hs-CRP levels , independent of zinc supplementation .


Additionally , zinc treatment had no effect on SOD enzyme activity ( P = @ ) , plasma ( P > @ ) and erythrocyte ( P > @ ) zinc concentrations , or the pattern of MT@F and MT@A genes expression ( P = @ and P = @ , respectively ) .


The effectiveness of rosuvastatin treatment is independent of the effects of zinc supplementation .


Moreover , rosuvastatin treatment did not have a significant impact on zinc status or MT@F and MT@A genes expression in patients with atherosclerosis .


A reduction of gynaecological adverse events has been reported in trials comparing aromatase inhibitors with tamoxifen as adjuvant treatment in postmenopausal women with early breast cancer , but there is a paucity of randomised studies specifically investigating their effects on the uterus .


We report here the results of a prospective phase III trial comparing the effects of tamoxifen and exemestane by transvaginal ultrasound ( TVUS ) .


Postmenopausal patients with ER + early breast cancer were randomised to receive tamoxifen @ mg once daily or exemestane @ mg once daily as adjuvant hormone therapy .


TVUS was performed at baseline and at @ and @ months to measure endometrial thickness ( ET ) and uterine volume ( UV ) .


A total of @ women were randomised to tamoxifen ( n = @ ) or exemestane ( n = @ ) .


A significantly higher proportion of patients in the tamoxifen group had increased ET at @ and @ months from randomisation compared with the exemestane group ( @ % and @ % versus @ % and @ % , respectively ; P < @ ) .


Mean ET and UV also significantly increased with tamoxifen compared to exemestane at both time points ( P < @ for all comparisons ) .


Tamoxifen is associated with endometrial thickening and increased uterine volume in a significant proportion of postmenopausal women with early breast cancer .


Our study confirms the lack of endometrial effects of exemestane , which may be of interest to patients and clinicians when choosing among adjuvant endocrine options for breast cancer .


To evaluate the efficacy of furazolidone-based triple and quadruple therapy in eradicating Helicobacter pylori ( H. pylori ) in a multi-center randomized controlled trial .


A total of @ H. pylori positive patients with duodenal ulcer disease were enrolled at @ different hospitals in Jiangxi province in China .


The patients were randomly assigned to four treatment groups as follows : patients in Groups @ and @ received rabeprazole ( @ mg ) , amoxicillin ( @ mg ) and furazolidone ( @ mg ) twice daily for @ and @ d , respectively ; patients in Groups @ and @ received rabeprazole ( @ mg ) , bismuth ( @ mg ) , amoxicillin ( @ mg ) and furazolidone ( @ mg ) twice daily for @ and @ d , respectively .


The primary outcome measure was H. pylori eradication rate @ wk after treatment by intention-to-treat and per protocol analysis , while the secondary outcome measures were symptom and sign changes at the end of treatment and @ wk after the end of treatment , as well as the proportion of patients who developed adverse events .


The demographic data of the four groups were not significantly different .


Overall , @ patients completed the scheme and were re-assessed with the ( @ ) C-urea breath test .


The intention-to-treat analysis of the H. pylori eradication rates in Groups @ , @ , @ and @ were @ % , @ % , @ % and @ % , respectively .


The H. pylori eradication rate in Group @ was significantly higher than that in Group @ .


According to the per protocol analysis , the H. pylori eradication rates in Groups @ , @ , @ and @ were @ % , @ % , @ % and @ % , respectively .


The number of adverse events was @ ( @ % ) , @ ( @ % ) , @ ( @ % ) and @ ( @ % ) in Groups @ , @ , @ and @ , respectively , including dizziness , vomiting , diarrhea , nausea , skin rash , itchy skin , and malaise .


The symptoms were relieved without special treatment in all of the patients .


Both @ - and @-d quadruple furazolidone-based therapies achieve satisfactory H. pylori eradication rates .


Heart failure with preserved left ventricular ejection fraction ( HFpEF ) currently affects more than seven million Europeans and is the only cardiovascular disease increasing in prevalence and incidence .


No pharmacological agent has yet been shown to improve symptoms or prognosis .


The most promising way to improve pathophysiology and deprived exercise-tolerance in HFpEF patients seems to be exercise training , but the optimal approach and dose of exercise is still unknown .


The major objective of the optimising exercise training in prevention and treatment of diastolic heart failure study ( OptimEx-CLIN ) is to define the optimal dose of exercise training in patients with HFpEF .


In order to optimise adherence , supervision and economic aspects of exercise training a novel telemedical approach will be introduced and investigated .


In a prospective randomised multi-centre study , @ patients with stable symptomatic HFpEF will be randomised ( @:@:@ ) to moderate intensity continuous training , high intensity interval training , or a control group .


The training intervention includes three months supervised followed by nine months of telemedically monitored home-based training .


The primary endpoint is change in exercise capacity , defined as change in peak oxygen uptake ( VO@peak ) after three months , assessed by cardiopulmonary exercise testing .


Secondary endpoints include diastolic filling pressure ( E/e ' ) and further echocardiographic and cardiopulmonary exercise testing ( CPX ) parameters , biomarkers , quality of life and endothelial function .


Training sessions and physical activity will be monitored and documented throughout the study with accelerometers and heart rate monitors developed on a telemedical platform for the OptimEx-CLIN study .


Inclusion of patients started in July @ , first results are expected in @ .


The authors hypothesized that a muscle relaxant would have no meaningful difference in intubation conditions during nasal intubation under remifentanil and propofol anesthesia .


This parallel-group , double-blinded , randomized controlled trial included @ patients who received saline ( S group ; n = @ ) or rocuronium ( R group ; n = @ ) .


In addition to remifentanil @ g/kg per minute and propofol @ mg/kg per hour , propofol @ mg/kg was administered until loss of consciousness .


Nasal intubation was performed @ minutes after administration of R or S @ mg/kg .


Significant differences in intubation conditions and salivary amylase levels before and after intubation were tested ( P < @ ) .


Vocal cord status ( P = @ ) and response to intubation or cuff filling ( P = @ ) were significantly different , but intubation conditions were not .


Salivary amylase level was significantly lower with R administration ( P = @ ) .


No patient complained of postoperative throat pain and hoarseness .


Muscle relaxants during nasal intubation performed after bolus administration of propofol @ mg/kg in addition to @ minutes of remifentanil @ g/kg per minute plus propofol @ mg/kg per hour are unnecessary .


The aims of this study were to establish whether , in patients with gout , MPO is released from neutrophils and urate is oxidized to allantoin and if these effects are attenuated by allopurinol .


MPO , urate , allantoin and oxypurinol were measured in plasma from @ patients with gout and @ healthy controls .


Twenty-three patients had acute gout , @ of whom were receiving allopurinol , and @ had intercritical gout , @ of whom were receiving allopurinol .


Ten additional gout patients had samples collected before and after @ weeks of allopurinol .


Plasma MPO and its specific activity were higher ( P < @ ) in patients with acute gout not receiving allopurinol compared with controls .


MPO protein in patients ' plasma was related to urate concentration ( r = @ , P < @ ) .


Plasma allantoin was higher ( P < @ ) in all patient groups compared with controls .


In controls and patients not receiving allopurinol , allantoin was associated with plasma urate ( r = @ , P < @ ) and MPO activity ( r = @ , P < @ ) .


When @ patients were treated with allopurinol , it lowered their plasma urate and allantoin ( P = @ ) .


In all patients receiving allopurinol , plasma allantoin was related to oxypurinol ( r = @ , P < @ ) .


Oxypurinol was a substrate for purified MPO that enhanced the oxidation of urate .


Increased concentrations of urate in gout lead to the release of MPO from neutrophils and the oxidation of urate .


Products of MPO and reactive metabolites of urate may contribute to the pathology of gout and hyperuricaemia .


At low concentrations , oxypurinol should reduce inflammation , but high concentrations may contribute to oxidative stress .


To propose a simple correction of body-mass index ( BMI ) based on self-reported weight and height ( reported BMI ) using gender , body shape perception and socioeconomic status in an adolescent population .


@ boys and girls aged @-@ years were randomly selected from a representative sample of @ French adolescents living in Paris surveyed in @ .


After an anonymous self-administered pen-and-paper questionnaire asking for height , weight , body shape perception ( feeling too thin , about the right weight or too fat ) and socioeconomic status , subjects were measured and weighed .


BMI categories were computed according to Cole 's cut-offs .


Reported BMIs were corrected using linear regressions and ROC analyses and checked with cross-validation and multiple imputations to handle missing values .


Agreement between actual and corrected BMI values was estimated with Kappa indexes and Intraclass correlation coefficients ( ICC ) .


On average , BMIs were underreported , especially among girls .


Kappa indexes between actual and reported BMI were low , especially for girls : @ @ % CI = -LSB- @-@ @ -RSB- for boys and @ @ % CI = -LSB- @-@ @ -RSB- for girls .


The regression of reported BMI by gender and body shape perception gave the most balanced results for both genders : the Kappa and ICC obtained were @ @ % CI = -LSB- @-@ @ -RSB- and @ , @ % CI = -LSB- @-@ @ -RSB- for boys ; @ @ % CI = -LSB- @-@ @ -RSB- and @ , @ % CI = -LSB- @-@ @ -RSB- for girls .


The regression of reported BMI by gender and socioeconomic status led to similar corrections while the ROC analyses were inaccurate .


Using body shape perception , or socioeconomic status and gender is a promising way of correcting BMI in self-administered questionnaires , especially for girls .


Souvenaid is a nutraceutical compound thought to positively enhance synaptic function .


In line with this mechanism of action , Souvenaid has been shown to improve cognitive function in subjects with mild Alzheimer 's disease in randomized clinical trials .