The smaller laparoscope-hole and sole operating hole make this maneuver a safe , easy and mini-invasive procedure .


It is more suitable for clinical application and popularity in primary care .


To identify an optimal margin about the gross target volume ( GTV ) for stereotactic radiosurgery ( SRS ) of brain metastases , minimizing toxicity and local recurrence .


Adult patients with @ to @ brain metastases less than @ cm in greatest dimension , no previous brain radiation therapy , and Karnofsky performance status ( KPS ) above @ were eligible for this institutional review board-approved trial .


Individual lesions were randomized to @ - or @ - mm uniform expansion of the GTV defined on contrast-enhanced magnetic resonance imaging ( MRI ) .


The resulting planning target volume ( PTV ) was treated to @ , @ , or @ Gy marginal dose for maximum PTV diameters less than @ , @ to @ , and @ to @ cm , respectively , using a linear accelerator-based image-guided system .


The primary endpoint was local recurrence ( LR ) .


Secondary endpoints included neurocognition Mini-Mental State Examination , Trail Making Test Parts A and B , quality of life ( Functional Assessment of Cancer Therapy-Brain ) , radionecrosis ( RN ) , need for salvage radiation therapy , distant failure ( DF ) in the brain , and overall survival ( OS ) .


Between February @ and November @ , @ patients with @ brain metastases were treated .


The median age was @ years , the median KPS was @ , and the predominant histologies were non-small cell lung cancer ( @ patients ) and melanoma ( @ ) .


Fifty-five , @ , and @ lesions were treated to @ , @ , and @ Gy , respectively .


The PTV/GTV ratio , volume receiving @ Gy or more , and minimum dose to PTV were significantly higher in the @-mm group ( all P < @ ) , and GTV was similar ( P = @ ) .


At a median follow-up time of @ months , @ patients were alive , with median OS @ months .


LR was observed in only @ lesions ( @ in the @ mm group , P = @ ) , with @ % LR @ months after SRS .


Biopsy-proven RN alone was observed in @ lesions ( @ in the @-mm group , P = @ ) .


The @-month DF rate was @ % .


Three months after SRS , no significant change in neurocognition or quality of life was observed .


SRS was well tolerated , with low rates of LR and RN in both cohorts .


However , given the higher potential risk of RN with a @-mm margin , a @-mm GTV expansion is more appropriate .


Depression and anxiety disorders during adolescence can have detrimental consequences .


Both disorders are related to negative outcome in various areas during adolescence and are also predictive of depression and anxiety disorders later in life .


Especially parental psychopathology and being female are risk factors that increase the probability of developing one of these disorders during adolescence .


Research has shown that prevention programs have promising results , especially for adolescents who have these risk factors .


Therefore , in this study , we will focus on the effectiveness of a prevention program ' A jump forward ' that has been developed for adolescent girls with a familial risk of depression and/or anxiety .


We designed a randomized controlled trial to test the effectiveness of an indicated and selective prevention program aimed at depression and anxiety in adolescent girls .


Adolescents aged between @ and @ years old with depressive and/or anxiety symptoms and with parents who show indicators of parental psychopathology will be randomly assigned to the experimental ( N = @ ) or control groups ( N = @ ) .


Participants in the experimental group will follow a preventive intervention , consisting of six sessions of @ minutes each .


All participants will complete baseline , intervention phase @ ( after session @ ) , intervention phase @ ( after session @ ) , post-intervention , @ month follow-up , and @ month follow-up assessments .


Furthermore , parents will be asked to complete assessments at baseline , post-intervention , and @-month follow-up .


Primary outcome will be depressive symptoms .


Secondary outcomes will be anxiety symptoms , suicidal ideation , response style , negative cognitive errors , parental emotional support and parental control , parental psychopathology , parenting stress and adolescents ' depression and anxiety symptoms according to the parents .


This paper described the study designed to evaluate a program for preventing depression and/or anxiety in high-risk adolescents over a @-month follow-up period .


If the program showed to be effective in reducing symptoms of depression and anxiety and preventing adolescents from developing clinical levels of these disorders , our results would be relevant to practice .


Thus , the intervention could be used on a large scale .


Moreover , this study aims to contribute to the evidence-based prevention of depression and anxiety of adolescents .


The phosphotidylinositol-@ kinase/serine-threonine kinase ( AKT ) / mammalian target of rapamycin signaling pathway is frequently altered in non-small-cell lung cancer ( NSCLC ) .


PX-@ is an oral , irreversible , pan-isoform inhibitor of phosphotidylinositol-@ kinase .


Preclinical models revealed synergy with docetaxel and a phase @ trial demonstrated tolerability of this combination .


This randomized phase @ study evaluated PX-@ combined with docetaxel in patients with advanced , refractory NSCLC .


Patients with locally advanced , recurrent , or metastatic NSCLC who had received at least one and no more than two prior systemic treatment regimens were randomized ( @:@ ) to a combination of docetaxel ( @ mg/m intravenous every @ days ) with or without PX-@ ( @ mg orally daily ; arms A and B , respectively ) .


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


Secondary end points included objective response rate , overall survival ( OS ) , toxicity , and correlation of biomarker analyses with efficacy outcomes .


A total of @ patients were enrolled .


Median PFS was @ months in arm A and @ months in arm B ( p = @ ) .


Objective response rates were @ % and @ % in arms A and B , respectively ( p = @ ) .


There was no difference in OS between the two arms ( @ versus @ months ; p = @ ) .


Grade @ or higher adverse events were infrequent , but more common in the combination arm with respect to diarrhea ( @ % versus @ % ) , nausea ( @ % versus @ % ) , and vomiting ( @ % versus @ % ) .


PIK@CA mutations or PTEN loss were infrequently observed .


The addition of PX-@ to docetaxel did not improve PFS , response rate , or OS in patients with advanced , refractory NSCLC without molecular preselection .


Earlier studies on the management of metabolic syndrome ( MetS ) have mostly focused on very low carbohydrate diets , whereas long-term adherence to such diets is difficult for apparently healthy people .


The aim of this study was to examine the effects of moderate replacement of carbohydrates by dietary fats on insulin resistance and features of MetS among women .


This randomized crossover clinical trial was performed with @ overweight or obese ( body mass index -LSB- BMI -RSB- > @ kg/m ( @ ) ) women with MetS .


After a @-wk run-in period , participants were randomly assigned to consume either a calorie-restricted high-carbohydrate ( HC ) diet ( @ % -@ % of energy from carbohydrates and @ % -@ % from fats ) or a calorie-restricted moderately restricted carbohydrate ( MRC ) diet ( @ % -@ % of total calories as carbohydrate and @ % -@ % as dietary fats ) for @ wk .


Protein contents of both diets were @ % to @ % of total energy .


A @-wk washout period was applied following which participants were crossed over to the alternate treatment arm for an additional @ wk .


Anthropometric , blood pressure , and biochemical measurements were performed before and after each phase of intervention .


Mean age and BMI of study participants was @ y and @ kg/m ( @ ) , respectively .


A trend toward greater reduction in waist ( -@ versus -@ cm ; P = @ ) and hip circumferences ( -@ versus -@ cm ; P = @ ) as well as serum triglyceride ( TG ) levels ( -@ versus @ mg/dL ; P = @ ) was observed after consumption of an MRC diet compared with an HC diet .


The TG to high-density lipoprotein cholesterol ( HDL-C ) ratio had a tendency to improve with the MRC diet rather than the HC diet ( -@ versus -@ ; P = @ ) .


Consumption of the MRC diet resulted in a greater reduction of systolic blood pressure ( -@ versus -@ mm Hg ; P = @ ) and diastolic blood pressure ( -@ versus -@ mm Hg ; P = @ ) compared with the HC diet .


The prevalence of MetS was significantly decreased following the consumption of the MRC diet ( P = @ ) .


The two diets were not significantly different in terms of their effect on fasting plasma glucose , serum HDL-C , low-density lipoprotein cholesterol , and total cholesterol , insulin levels , and Homeostasis Model Assessment-Insulin Resistance .


Moderate replacement of carbohydrates by dietary fats was not associated with statistically different changes in fasting plasma glucose , insulin , or atherogenic dyslipidemia among individuals with the metabolic syndrome ; however , it resulted in decreased diastolic blood pressure and lower prevalence of the metabolic syndrome .


Lymphoceles are among the most common post-operative complications of pelvic lymphadenectomy , with a reported incidence of @ % to @ % in gynecology oncology .


Several studies evaluated the effectiveness of biological glues on reducing lymphoceles , but no data on gynecological patients are available .


We evaluated the effectiveness of cyanoacrylic glues ( n-butyl cyanoacrylate ) ( Glubran @ - GEM s.r.l. , Italy ) in preventing lymphocele on @ patients who underwent pelvic lymphadenectomy for endometrial or cervical cancer .


Single-blind prospective randomized study .


Patients were divided into @ groups : pelvic lymphadenectomy plus n-butyl cyanoacrylate ( treatment group : @ patients ) and pelvic lymphadenectomy without n-butyl cyanoacrylate ( control group : @ patients ) .


Primary endpoint was incidence of pelvic lymphocele in the two groups @ days after surgery , and evaluated with pelvic ultrasound and RMI examination .


Secondary endpoints evaluated drainage volume of lymphorrhea @ , @ , @ and @ h after surgery .


@ % in the treatment group and @ % in the control group had lymphocele @month after the procedure ( p < @ ; RR @ -LSB- @ % CI @-@ @ -RSB- ) .


Concerning the secondary outcome in group A the amount of lymphorrhea presented a constant significant decrease during evaluation ; on the contrary , in group B , after an initial decrease at @ h , the amount of lymphorrhea remained unchanged ; at all considered times the amount of lymphorrhea resulted significantly greater in controls .


Intraoperative application of n-butyl cyanoacrylate seems to reduce lymph production after pelvic lymphadenectomy , providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after pelvic lymphadenectomy .


To observe the clinical effect of electric stimulation of long-term retaining needle on analgesia after laparoscopic cholecystectomy ( LC ) and the impacts on the post-surgical flatus time .


Under static absorptive composite general anesthesia , @ cases of LC were randomized into three groups , @ cases in each one .


In the control group , the analgesia was not applied after LC .


In the analgesia-pumper group , the patient controlled intravenous analgesia ( PCIA ) was used .


In the needle-retaining group , the electric acupuncture stimulator was used .


The needles were inserted transversely at Riyue ( GB @ ) , Qichong ( ST @ ) and Yanglingquan ( GB @ ) and fixed with sterile sticker .


Separately , in @ h and @ h after surgery , the electric acupuncture stimulation with disperse-dense wave , @ Hz/@ Hz frequency was applied continuously for @ min .


Visual analogue scale ( VAS ) , adverse reactions such as vomiting and nausea and the postoperative flatus time in @ , @ , @ , @ , @ and @ h after surgery were observed and recorded in the three groups .


In @ , @ , @ , @ and @ h after surgery , VAS scores in the needle-retaining group and the analgesia-pumper group were all lower than those in the control group ( P < @ , P < @ ) .


The analgesia effect at the above time points in the needle-retaining group was better than that in the analgesia-pumper group ( all P < @ ) .


There was not adverse reaction in the needle-retaining group .


But there were @ cases of somnolence , @ cases of nausea and @ cases of vomiting in the analgesia-pumper group , and @ cases of nausea and @ case of vomiting in the control group .


The flatus time was quite earlier in the needle-retaining group as compared with the other two groups -LSB- ( @ + / - @ ) h vs ( @ + / - @ ) h , P < @ ; ( @ + / - @ ) h vs ( @ + / - @ ) h , P < @ -RSB- .


The electric stimulation of long-term retaining needle is safe and effective in analgesia after LC .


It avoids the adverse reactions of analgesics and promotes postoperative flatus .


Recently , we have shown advantages of a direct optical entry ( DOE ) using a bladeless trocar in comparison with the open Hasson technique ( OHT ) in older reproductive-age women with previous operations , as well as in comparison with Veress needle entry in reproductive-age and postmenopausal women .


A prospective multicenter randomized study to determine whether the DOE is feasible for establishing safe and rapid entry into the abdomen in comparison with those of the OHT in reproductive-age obese women .


Two types of surgical techniques were blindly applied in @ obese reproductive-age women with benign neoplastic diseases of ovary and uterus .


Namely , laparoscopic entry into the abdomen in @ patients was performed by DOE and in @ women by OHT .


Following parameters ( entry time in seconds needed to establish the intra-abdominal vision after pneumoperitoneum , blood loss , occurrence of vascular and/or bowel injuries ) were compared during surgery as main outcomes .


Main baseline characteristics of patients , including age ( @ @ vs @ @ ) , body mass index ( @ @ vs @ @ kg/m ( @ ) ) , and parity ( @ @ vs @ @ ) , were not significantly different between the DOE and OHT groups ( P > @ ) .


While intraoperative parameters such as the entry time ( @ @ vs @ @ seconds ) and blood loss value ( @ @ vs @ @ mL ) were significantly reduced in the DOE group in comparison with those of OHT group ( respectively , P < @ and < @ ) , there were also trends to slight decrease of the occurrence of the minor injuries , manifested as omental small vessels rupture ( @ of @ vs @ of @ ) and punctures and pinches of jejunal serosa ( @ of @ vs @ of @ ) in patients of the DOE group in comparison with those of OHT group ( respectively , P = @ and = @ ) .


DOE reduced entry time and blood loss with trends to slightly decrease of the occurrence of the minor vascular and bowel injuries , thus enabling a possible alternative to OHT in obese women ; however , further larger trials need to confirm the possible additional benefits of a DOE .


Family carers of people with dementia frequently become depressed or anxious .


In observational studies , more emotion-focused and less dysfunctional coping predict fewer psychological symptoms , but no randomised controlled trial ( RCT ) has directly investigated emotion-focused coping as mediator of effectiveness of a successful psychological intervention .


We hypothesised that emotion-focused coping would mediate the START psychological interventions effects in an RCT .


We tested whether mediated effects were moderated by severity of baseline symptoms .


@ family carers from NHS dementia services were randomised to START ( manualised coping skills intervention ) , or treatment-as-usual ( TAU ) .


Blinded raters administered the Hospital Anxiety and Depression Scale ( HADS-T ) and Brief COPE inventory at baseline , @ and @ months .


HADS-T improved in the intervention group when compared to TAU at all levels of psychological distress .


We tested whether coping was a mediator and for moderated mediation , and ( post-hoc ) subgroup treatment effects on coping .


Data were available for @ carers ( @ % ) for the mediation analysis .


The reduced HADS-T score in the intervention group was mediated by increased emotion-focused coping only among carers with higher ( @ + ) baseline HADS-T scores ( mediated effect = -@ -LSB- -@ , -@ -RSB- ; proportion of overall effect = @ % -LSB- @ % , @ % -RSB- ) .


We did not measure plausible psychosocial treatment mechanisms other than coping .


START benefited family carers both in preventing and treating psychological morbidity , through different mechanisms of action .


The most psychologically distressed carers increased their emotion-focused coping and did not decrease their dysfunctional coping , while others benefited but not through this mechanism .


To investigate the effect of @ commonly used mydriatics on choroidal thickness using enhanced depth imaging optical coherence tomography ( EDI-OCT ) .


In this prospective study , @ healthy subjects were enrolled .


The participants were randomly divided into @ groups based on the application of drops .


One eye of each subject received a drop of tropicamide @ % in the tropicamide group ( n = @ ) , a drop of phenylephrine @ % in the phenylephrine group ( n = @ ) , and a drop of artificial tear in the control group ( n = @ ) .


Drops were given thrice at @min intervals .


Subfoveal choroidal thickness ( SFCT ) was measured using EDI-OCT before and at @min after drop application in both the dilated eye and nondilated contralateral eye .


The SFCT was significantly decreased after drop instillation in both the dilated eye and contralateral eye in the tropicamide group ( P < @ and P = @ , respectively ) and in the phenylephrine group ( P < @ and P = @ , respectively ) .


However , the SFCT did not significantly differ after drop instillation in either the dropped eye or contralateral eye in the control group ( P = @ and P = @ , respectively ) .


The findings of the present study revealed that tropicamide and phenylephrine cause a decrease in choroidal thickness .


An inhaled gas absolute humidity of @ mg H@OL is the value most considered as the threshold necessary for preventing the deleterious effects of dry gas on the epithelium of the airways during anesthesia .


Because children have small minute ventilation , we hypothesized that the humidification of a circle breathing system is lower in children compared with adults .


The Primus anesthesia workstation ( Drger Medical , Lbeck , Germany ) has a built-in hotplate to heat the patient 's exhaled gases .


A heat and moisture exchanger ( HME ) is a device that can be used to further humidify and heat the inhaled gases during anesthesia .


To evaluate the humidifying properties of this circle breathing system during pediatric anesthesia , we compared the temperature and humidity of inhaled gases under low or high fresh gas flow ( FGF ) conditions and with or without an HME .


Forty children were randomly allocated into @ groups according to the ventilation of their lungs by a circle breathing system in a Drger Primus anesthesia workstation with low ( @ Lmin ) or high ( @ Lmin ) FGF without an HME ( @L and @L groups ) or with an HME ( Pall BB@FS , Pall Biomedical , East Hills , NY ; HME@L and HME@L groups ) .


The temperature and absolute humidity of inhaled gases were measured at @ , @ , @ , @ , and @ minutes after connecting the patient to the breathing circuit .


The mean inhaled gas temperature was higher in HME groups ( HME@L : @ C @ C ; HME@L : @ C @ C ) compared with no-HME groups ( @L : @ C @ C ; @L : @ C @ C ; P < @ ) .


The mean inhaled gas absolute humidity was higher in HME than no-HME groups and higher in low-flow than high-flow groups ( -LSB- HME@L : @ @ mg H@OL -RSB- > -LSB- HME@L : @ @ mg H@OL -RSB- > -LSB- @L : @ @ mg H@OL -RSB- > -LSB- @L : @ @ mg H@OL -RSB- ; P < @ ) .


In a pediatric circle breathing system , the use of neither high nor low FGF provides the minimum humidity level of the inhaled gases thought to reduce the risk of dehydration of airways .


Insertion of an HME increases the humidity and temperature of the inhaled gases , bringing them closer to physiological values .


The use of a low FGF enhances the HME efficiency and consequently increases the inhaled gas humidity values .


Therefore , the association of an HME with low FGF in the breathing circuit is the most efficient way to conserve the heat and the moisture of the inhaled gas during pediatric anesthesia .


De novo donor-specific anti-human leukocyte antigen antibodies develop in a high proportion of lung transplant recipients early after lung transplantation .


We recently showed that de novo donor-specific antibodies ( DSA ) occurrence is associated with significantly increased mortality .


Here , we studied the efficacy of a preemptive treatment protocol .


A retrospective observational study was conducted on all lung transplantations at Hanover Medical School between January @ and May @ .


Among the @ transplant recipients , early DSA developed in @ ( @ % ) .


Of these , @ patients ( @ % ; Group A ) received therapeutic plasma exchange , and @ patients ( @ % ; Group B ) did not .


Among Group A patients , @ also received rituximab .


Between groups , there was no statistically significant difference in mortality , incidence of pulsed steroid therapies , rejections diagnosed by biopsy specimen , incidence of bronchitis obliterans syndrome ( BOS ) , or infections requiring hospitalization at @ year and @ years .


Also , there were no statistically significant differences after matching @ Group A with @ Group B patients through propensity score analysis .


Significantly more Group A patients ( @ % ) than Group B patients ( @ % ) cleared DSA at hospital discharge ( p = @ ) .


At the last control after transplantation ( median , @ months ; interquartile range , @-@ months ) , @ Group A ( @ % ) and @ Group B patients ( @ % ) still showed DSA ( p = @ ) .


Preemptive treatment with therapeutic plasma exchange and rituximab led to improved elimination of DSA early after lung transplantation ( p = @ ) .


However , spontaneous elimination in untreated Group B patients also occurred frequently .


This treatment protocol was not associated with significantly improved outcome .


Low back pain is often accepted as a `` normal '' part of pregnancy .


Despite research suggesting that quality of life for women who are pregnant is adversely affected , most are advised to self-manage .


Although the use of acupuncture for the management of persistent nonspecific low back pain has been recommended in recent UK national guidelines , its use in the management of pregnancy-related low back pain remains limited .


This study aimed to explore the perceptions and experiences of physical therapists involved in treating women who are pregnant and have low back pain with the objective of informing the pretrial training program for a pilot randomized trial ( Evaluating Acupuncture and Standard care for pregnant womEn with Back pain -LSB- EASE Back -RSB- ) .


A qualitative phenomenological method with purposive sampling was used in the study .


Three focus groups and @ individual semistructured interviews were undertaken , and an iterative exploratory thematic analysis was performed .


To ensure transparency of the research process and the decisions made , an audit trail was created .


Twenty-one physical therapists participated , and emergent issues included : a lack of experience in treating pregnancy-related complaints , mixed messages from previous acupuncture education , a mistrust of the current evidence for acupuncture safety and effectiveness , and personal and professional fear of causing harm .


The findings suggest that UK physical therapists are reluctant to use acupuncture in the management of pregnancy-related low back pain .


The explanations for these findings include perceived lack of knowledge and confidence , as well as a pervasive professional culture of caution , particularly fears of inducing early labor and of litigation .


These findings have been key to informing the content of the training program for physical therapists delivering acupuncture within the pilot EASE Back trial .


Tiotropium , a once-daily long-acting anticholinergic bronchodilator , when administered via Respimat SoftMist inhaler ( tiotropium Respimat ) significantly reduces the risk of severe exacerbations and improves lung function in patients with severe persistent asthma that is not fully controlled despite using inhaled corticosteroids ( ICS ) and long-acting @-agonists .


To further explore the dose-response curve in asthma , we investigated the efficacy and safety of three different doses of tiotropium Respimat as add-on to ICS in symptomatic patients with moderate persistent asthma .


In this randomised , double-blind , placebo-controlled , four-way crossover study , patients were randomised to tiotropium Respimat @g , @ g or @ g or placebo Respimat , once daily in the evening .


Each treatment was administered for @weeks , without washout between treatment periods .


Eligibility criteria included @ % and @ % of predicted normal forced expiratory volume in @second ( FEV@ ) and seven-question Asthma Control Questionnaire mean score of @ .


Patients were required to continue maintenance treatment with stable medium-dose ICS for at least @weeks prior to and during the treatment period .


Long-acting @-agonists were not permitted during the treatment phase .


The primary efficacy end point was peak FEV@ measured within @hours after dosing ( peak FEV@ ( @-@h ) ) at the end of each @-week period , analysed as a response ( change from study baseline ) .


In total , @ patients were randomised and @ completed the study .


Statistically significant improvements in peak FEV@ ( @-@h ) response were observed with each tiotropium Respimat dose versus placebo ( all P < @ ) .


The largest difference from placebo was with tiotropium Respimat @g ( @mL ) .


Trough FEV@ and FEV@ area under the curve ( AUC ) ( @-@h ) responses were greater with each tiotropium Respimat dose than with placebo ( all P < @ ) , and both were greatest with @g .


Peak forced vital capacity ( FVC ) ( @-@h ) , trough FVC and FVC AUC ( @-@h ) responses , versus placebo , were greatest with tiotropium Respimat @g ( P < @ , P = @ and P < @ , respectively ) .


Incidence of adverse events was comparable between placebo and all tiotropium Respimat groups .


Once-daily tiotropium Respimat add-on to medium-dose ICS improves lung function in symptomatic patients with moderate asthma .


Overall , improvements were largest with tiotropium Respimat @g .


Evolocumab , a monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type @ ( PCSK@ ) , significantly reduced low-density lipoprotein ( LDL ) cholesterol levels in phase @ studies .


We conducted a phase @ trial to evaluate the safety and efficacy of @ weeks of treatment with evolocumab .


We stratified patients with hyperlipidemia according to the risk categories outlined by the Adult Treatment Panel III of the National Cholesterol Education Program .


On the basis of this classification , patients were started on background lipid-lowering therapy with diet alone or diet plus atorvastatin at a dose of @ mg daily , atorvastatin at a dose of @ mg daily , or atorvastatin at a dose of @ mg daily plus ezetimibe at a dose of @ mg daily , for a run-in period of @ to @ weeks .


Patients with an LDL cholesterol level of @ mg per deciliter ( @ mmol per liter ) or higher were then randomly assigned in a @:@ ratio to receive either evolocumab ( @ mg ) or placebo every @ weeks .


The primary end point was the percent change from baseline in LDL cholesterol , as measured by means of ultracentrifugation , at week @ .


Among the @ patients included in the primary analysis , the overall least-squares mean ( SE ) reduction in LDL cholesterol from baseline in the evolocumab group , taking into account the change in the placebo group , was @ % ( P < @ ) .


The mean reduction was @ % among patients who underwent background therapy with diet alone , @ % among those who received @ mg of atorvastatin , @ % among those who received @ mg of atorvastatin , and @ % among those who received a combination of @ mg of atorvastatin and @ mg of ezetimibe ( P < @ for all comparisons ) .


Evolocumab treatment also significantly reduced levels of apolipoprotein B , non-high-density lipoprotein cholesterol , lipoprotein ( a ) , and triglycerides .


The most common adverse events were nasopharyngitis , upper respiratory tract infection , influenza , and back pain .


At @ weeks , evolocumab added to diet alone , to low-dose atorvastatin , or to high-dose atorvastatin with or without ezetimibe significantly reduced LDL cholesterol levels in patients with a range of cardiovascular risks .


( Funded by Amgen ; DESCARTES ClinicalTrials.gov number , NCT@ . )


Endoscopic stents are placed for palliation of extrahepatic bile duct obstruction .


Although self-expandable metal stents ( SEMS ) remain patent longer than plastic stents , they are more expensive .


We aimed to evaluate which type of stent ( plastic , uncovered SEMS -LSB- uSEMS -RSB- , or partially covered SEMS -LSB- pcSEMS -RSB- ) is the most effective and we assessed costs .


We performed a multicenter randomized trial in @ patients at @ hospitals in The Netherlands from February @ through February @ .


Patients were assigned randomly for placement of a plastic stent ( n = @ ) , uSEMS ( n = @ ) , or pcSEMS ( n = @ ) during endoscopic retrograde cholangiopancreatography .


Patients were followed up for up to @ year .


Researchers were not blinded to groups .


The main study end points included functional stent time and costs .


The mean functional stent times were @ days for plastic stents , @ days for uSEMS , and @ days for pcSEMS ( P < @ for uSEMS and pcSEMS vs plastic ) .


The initial placement of plastic stents ( @ or $ @ ) cost significantly less than placement of SEMS ( @ or $ @ ) ( P = @ ) .


However , the total cost per patient at the end of the follow-up period did not differ significantly between plastic stents ( @ or $ @ ) and SEMS ( @ or $ @ ) ( P = @ ) .


Furthermore , in patients with short survival times ( @ mo ) or metastatic disease , the total cost per patient did not differ between plastic stents and SEMS .


No differences in costs were found between pcSEMS and uSEMS .


Although placement of SEMS ( uncovered or partially covered ) for palliation of extrahepatic bile duct obstruction initially is more expensive than placement of plastic stents , SEMS have longer functional time .


The total costs after @ year do not differ significantly with stent type .


Dutch Clinical Trial Registration no : NTR@ .


To determine whether ureteric stent extraction strings affect stent-related quality of life ( QoL ) or increase complications after ureteroscopy ( URS ) for stone disease .


In all , @ patients undergoing URS ( October @ to May @ ) for stone disease were randomised to receive a ureteric stent with or without an extraction string .


Patients completed the Ureteric Stent Symptom Questionnaire ( USSQ ) on postoperative days @ and @ , and @ weeks after stent removal .


Pain was assessed at stent removal .


Adverse events , including early stent removal , stent migration , retained stent , urinary tract infection ( UTI ) , emergency room ( ER ) visits and postoperative phone calls were monitored .


There was no difference in stent-related QoL as measured by the USSQ between those with and without a stent extraction string , pain at stent removal between those who pulled their stent independently vs those who underwent cystoscopy for stent removal , or in the rate of UTIs , ER visits or phone calls between groups .


Five patients ( four female , one male ) removed their stent early by inadvertently pulling the string ; none required replacement .


Patients without a string had a significantly longer period with the postoperative ureteric stent ( @ vs @ days , P < @ ) .


One patient without a stent string retained her ureteric stent for @ months , which was removed by cystoscopy without incident .


Ureteric stent extraction strings may offer several advantages without increasing stent-related urinary symptoms , complications , or postoperative morbidity .


Administration of a loading dose of a statin ( HMG-CoA reductase inhibitor ) prior to percutaneous coronary intervention ( PCI ) contributes to protection from myocardial ischemic-reperfusion injury .


This trial was designed to investigate the effect and mechanism of loading-dose rosuvastatin therapy before PCI in patients with acute coronary syndrome .


One hundred and forty-three patients with acute coronary syndrome were randomized to either the loading-dose ( rosuvastatin @mg given @h before PCI ) or conventional-dose ( rosuvastatin @mg given @h before PCI ) group .


Blood samples were collected before and @ , @ , and @h post-PCI for measurement of serum cardiac troponin-I ( cTnI ) , creatine kinase-MB ( CK-MB ) , superoxide dismutase ( SOD ) , reactive oxygen species ( ROS ) , and malondialdehyde ( MDA ) .


Echocardiography and the major adverse cardiac/cerebrovascular events ( MACCE ) rate were followed up for @months post-PCI .


Blood serum CK-MB and cTnI were significantly lower in the loading-dose group than in the conventional-dose group at @ and @h post-PCI -LSB- CK-MB : @ vs. @ IU/L , P = @ ; @ vs. @ IU/L , P = @ .


cTnI : @ vs. @ ng/mL , P = @ ; @ vs. @ ng/mL , P = @ -RSB- .


Echocardiography at @months after PCI revealed significant improvement in cardiac function in the loading-dose group compared with the conventional-dose group ( P < @ ) .


The MACCE rate at @months after PCI in the loading-dose group was lower than in the conventional-dose group ( P = @ ) .


The levels of MDA and ROS were decreased and the SOD level was significantly higher in the loading-dose group than in the conventional-dose group at @ , @ , and @h post-PCI ( P < @ ) .


Administration of loading-dose rosuvastatin in patients with acute coronary syndrome prior to PCI exerts myocardial protection by inhibition of oxidative stress .


The variability in habitual intakes of most components in the Philippine diet is unknown .


To perform a quantitative evaluation of the traditional Philippine diet using data collected over an extended period of time .


We sought to identify seasonal variations and within-subject components of variation in nutrient intake .


A quantitative evaluation of the Philippine diet was conducted in convents in metropolitan Manila as part of an efficacy trial to examine biofortified rice as an approach to improve iron nutritional status .


Weighed food intakes were conducted on @ days in each of more than @ religious sisters over @ months in @ convents .


The sisters consumed their habitual diets except for the substitution of one variety of rice for another .


More than @ % of calories were derived from rice , with protein from meat and fish comprising @ % of calories .


There were significant variations in macronutrient and micronutrient intakes across seasons of the year , with more rice consumed in the wet season and more fruits , eggs , milk , and beverages consumed in the dry season .


The day-to-day within-subject variation ( CV ) in median intake was @ % for energy , @ % for protein , @ % for iron , and @ % for vitamin A.


These novel data show that traditional Filipino dietary patterns have substantial individual variation and are inadequate in certain micronutrients .


This quantitative evaluation of diet can provide a reference point for dietary adequacy .


To study whether the reinforced feedback in virtual environment ( RFVE ) is more effective than traditional rehabilitation ( TR ) for the treatment of upper limb motor function after stroke , regardless of stroke etiology ( i.e. , ischemic , hemorrhagic ) .


Randomized controlled trial .


Participants .


Forty-four patients affected by stroke .


Intervention .


The patients were randomized into two groups : RFVE ( N = @ ) and TR ( N = @ ) , and stratified according to stroke etiology .


The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality , while in the TR treatment the same exercises were provided without augmented feedbacks .


Outcome Measures .


Fugl-Meyer upper extremity scale ( F-M UE ) , Functional Independence Measure scale ( FIM ) , and kinematics parameters ( speed , time , and peak ) .


The F-M UE ( P = @ ) , FIM ( P = @ ) , time ( P = @ ) , and peak ( P = @ ) , were significantly higher in the RFVE group after treatment , but not speed ( P = @ ) .


The patients affected by hemorrhagic stroke significantly improved FIM ( P = @ ) , time ( P = @ ) , and peak ( P = @ ) after treatment , whereas the patients affected by ischemic stroke improved significantly only speed ( P = @ ) when treated by RFVE .


These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function .


This trial is registered with NCT@ .


Differences in manifestation , treatment , and outcomes of acute heart failure between men and women have not been well studied .


The objective of this analysis was to characterize differences in clinical presentation , and in-hospital and post-discharge outcomes between sexes in acute heart failure patients .


Clinical profiles , treatment characteristics , and outcomes were compared between sexes in @ patients hospitalized for acute heart failure and impaired renal function .


Women comprised @ % of the study population and were older , had higher body mass index , LVEF , and systolic blood pressure , and a greater prevalence of diabetes .


At baseline , women showed signs and symptoms of congestion comparable with men , but more often had rales , orthopnoea , and worse renal function .


Women were less intensively diuresed , as indicated by lower oral and intravenous diuretic doses used , fewer dose increases , and less total weight loss during hospitalization .


Furthermore , hospitalization was slightly but significantly prolonged in women ( @ @ vs. @ @ days ; P = @ ) .


Age-adjusted @-day mortality was lower in women ( @ % vs. @ % , hazard ratio @ ; @ % confidence interval @-@ @ , P = @ ) , but multivariable risk-adjusted mortality was similar in both sexes , mainly attributable to lower blood urea nitrogen , higher LVEF , and higher systolic blood pressure in women compared with men .


Women with acute heart failure present with a clinical profile different from that of men , with more hypertension , diabetes , and depression , and a preserved LVEF .


During hospitalization , they were less intensively diuresed .


Nevertheless , risk-adjusted @-day outcome was similar between sexes .


The purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy ( PAT ) followed by standard anticoagulant therapy , with anticoagulation therapy alone , for the treatment of acute proximal lower extremity deep vein thrombosis .


In this randomised , prospective study , @ patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination , were separated into an interventional treatment group ( @ males , @ females , average age @years ) and a medical treatment group ( @ males , @ females , average age @years ) .


In the interventional group , PAT with large-lumen @-F diameter catheterisation was applied , after initiation of standard anticoagulant therapy .


Balloon angioplasty ( n @ ) and stent implementation ( n : @ ) were used to treat patients with residual stenosis ( > @ % ) after PAT .


Prophylactic IVC filters were placed in two patients .


The thrombus clearance status of the venous system was evaluated by venography .


In both the medical and interventional groups , venous patency rates and clinical symptom scores were evaluated at months @ , @ , and @ after treatment .


Deep venous systems became totally cleared of thrombi in @ patients treated with PAT .


The venous patency rates in month @ were @ and @ % in the interventional and medical treatment groups , respectively .


A statistically significant improvement was observed in clinical symptom scores of the interventional group ( PAT ) with or without stenting ( @ before treatment ; @ at month @ ) compared with the medical treatment group ( @ before treatment ; @ at month @ ) .


During follow-up , four patients in the medical treatment and one in the interventional group developed pulmonary embolisms .


For treatment of acute deep vein thrombosis , PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms .


PAT is a safe , inexpensive , and easily performed method of endovascular treatment with a low rate of major complications .


Our present findings and literature data suggest that PAT can be used as first-line treatment in proximal deep vein thrombosis patients , especially when thrombolytic treatment is contraindicated .


To explore a more optimal therapy for chronic prostatitis .


Ninty cases of chronic prostitis were randomized into a warming-promoting needling and target penetrating needling method group ( WT group ) , a conventional acupuncture group ( CA group ) and a medication group ( M group ) , @ cases in each one .


The warming-promoting needling method was applied at Zhongji ( CV @ ) , Guanyuan ( CV @ ) , Qihai ( CV @ ) , Daheng ( SP @ ) , Qichong ( ST @ ) in the WT group , the needling sensation was targeted towards the prostate , once daily ; in CA group , conventional acupuncture was applied at the same acupoints of WT group ; Qianliekang tablets was prescribed to the M group .


For the @ groups , @ treatment made one session and @ days as an interval , the efficacy was evaluated after @ sessions .


All of the @ methods were effective for chronic prostitis , the total effective rate in the WT group was @ % ( @/@ ) , which was superior to @ % ( @/@ , P < @ ) in the CA group and @ % ( @/@ , P < @ ) in the M group .


The curative rate in the WT group was @ % ( @/@ ) , which was superior to @ % ( @/@ ) in the CA group and @ % ( @/@ ) in the M group ( both P < @ ) .


The warming-promoting needling and target penetrating needling method achieve superior efficacy on chronic prostatitis as compared with conventional acupuncture and Qianliekang tablets .


In the American College of Surgeons National Surgical Quality Improvement Program ( ACS NSQIP ) , pancreatic fistula has not been monitored , although organ space infection ( OSI ) data are collected .


Therefore , the purpose of this analysis was to determine the relationship between ACS NSQIP organ space infection and pancreatic fistulas .


From @ to @ , @ pancreatic resection patients were monitored via ACS NSQIP at our institution .


From this database , @ patients were randomly chosen for further analysis .


Four patients were excluded because they underwent total pancreatectomy .


Data on OSI were gathered prospectively .


Data on pancreatic fistulas and other intra-abdominal complications were determined retrospectively .


Organ space infections ( OSIs ) were documented in @ patients ( @ % ) .


Grades B ( n = @ ) and C ( n = @ ) pancreatic fistulas occurred in @ patients ( @ % ) ; grade A fistulas were observed in @ patients ( @ % ) .


Bile leaks and gastrointestinal ( GI ) anastomotic leaks each developed in @ ( @ % ) patients .


Only @ of @ grade B and C pancreatic fistulas ( @ % ) , and none of @ grade A fistulas were classified as OSIs in ACS NSQIP .


In addition , only @ of @ bile leaks ( @ % ) and @ of @ GI anastomotic leaks ( @ % ) were OSIs .


Moreover , @ OSIs were due to bacterial peritonitis , a chyle leak , and an ischemic bowel .


This analysis suggests that the sensitivity ( @ % ) and specificity ( @ % ) of organ space infection ( OSI ) in ACS NSQIP are too low for OSI to be a surrogate for grade B and C pancreatic fistulas .


We concluded that procedure-specific variables will be required for ACS NSQIP to improve outcomes after pancreatectomy .


To evaluate feasibility , safety , and efficacy of overnight closed-loop insulin delivery in free-living youth with type @ diabetes .


Overnight closed loop was evaluated at home by @ pump-treated adolescents with type @ diabetes aged @-@ years .


Over a @-week period , overnight insulin delivery was directed by a closed-loop system , and on another @-week period sensor-augmented therapy was applied .


The order of interventions was random .


The primary end point was time when adjusted sensor glucose was between @ and @ mmol/L from @ to @ h.


Closed loop was constantly applied over at least @ h on @ nights ( @ % ) ; sensor data were collected over at least @ h on @ control nights ( @ % ) .


Closed loop increased time spent with glucose in target by a median @ % ( interquartile range -@ to @ ; P < @ ) .


Mean overnight glucose was reduced by a mean @ ( SD @ ) mg/dL ( P < @ ) .


Time when glucose was < @ mg/dL was low in both groups , but nights with glucose < @ mg/dL for at least @ min were less frequent during closed loop ( @ vs. @ % ; P = @ ) .


Despite lower total daily insulin doses by a median @ ( interquartile range -@ to @ ) units ( P = @ ) , overall @-h glucose was reduced by a mean @ ( SD @ ) mg/dL ( P = @ ) during closed loop .


Unsupervised home use of overnight closed loop in adolescents with type @ diabetes is safe and feasible .


Glucose control was improved during the day and night with fewer episodes of nocturnal hypoglycemia .


To evaluate the long-term outcomes of thin-flap laser in situ keratomileusis ( LASIK ) in eyes with thin corneas ( central corneal thickness -LSB- CCT -RSB- < @ m ) but normal topography .


Private center , Tokyo , Japan .


Retrospective randomized comparative study .


The efficacy , safety , predictability , and topography of LASIK were evaluated in eyes with a CCT of less than @ m but with normal topography ( thin-cornea group ) to @ years postoperatively .


The LASIK outcomes in the thin-cornea group were compared with those in eyes with a CCT of @ m or greater ( control group ) .


Analysis was performed to determine whether there were differences between the groups at the last checkup @ to @ years postoperatively .


In the thin-cornea group ( @ eyes ; @ patients ) , no significant differences were observed in LASIK outcomes when eyes were subdivided by the time of final checkup ( @ , @ , and @ years ) .


There was a significant difference in visual and refractive outcomes between @ months postoperatively and the last checkup in the thin-cornea group and the control group ( @ eyes ; @ patients ) .


No significant difference in visual , refractive , or topography outcomes was observed between the @ groups at the last checkup .


Laser in situ keratomileusis in eyes with thin corneas was as safe and effective as and showed similar long-term stability in eyes with a CCT of @ m or greater .


No eye in either group had a postoperative complication .


Skin-to-skin contact reduces pain response in preterm infants subjected to minor painful procedures , such as heel lance .


Diaper change is a procedure performed several times daily in hospitalized preterm infants .


Routine care giving tasks such as diaper change may be stressful for the infant .


The purpose of this study was to investigate whether diaper change induces stress and if skin-to-skin contact could reduce such stress , measured by changes in skin conductance .


This was a randomized crossover pilot study in @ preterm infants with gestational age between @ and @ weeks .


The diaper change procedure was done twice in each infant , once during skin-to-skin contact , and once in incubator or bed with the mother present .


During diaper change heart rate ( HR ) , peripheral oxygen saturation ( SpO@ ) , and changes in skin conductance ( SC ) peaks per sec , using the Skin Conductance Algesimeter ( SCA ) , were registered .


The mean SC peaks/sec increased/decreased significantly under/after change of diapers which thereby underpins that this is a stressful procedure for the preterm infant .


Skin-to-skin contact ( SSC ) entails significantly lower stress levels ( p < @ ) compared to diaper changed in an incubator/bed measured by the SCA .


Diaper change is a stressful procedure for preterm infants and may be ameliorated by skin-to-skin contact .


This was a randomized clinical trial to determine whether Nordic pole walking ( NPW ) is more effective in improving walking distance than a standard home exercise programme ( HEP ) in patients with intermittent claudication .


Fifty-two patients with stable claudication were allocated randomly to a standard HEP or NPW group , and asked to complete three @-min walks per week for @ weeks .


Claudication distance ( CD ) and maximum walking distance ( MWD ) were measured at @ ( baseline ) , @ , @ and @ weeks .


Patients in the NPW group were tested with ( NPW + ) and without ( NPW - ) poles .


For NPW + , CD increased immediately from a median ( range ) of @ ( @-@ ) m to @ ( @-@ ) m , and MWD from @ ( @-@ ) to @ ( @-@ ) m ( P = @ and P < @ respectively ) .


By @ weeks , CD had further increased to @ ( @-@ ) m and MWD had more than doubled to @ ( @-@ ) m ( P < @ and P = @ ) .


For NPW - , CD at @ weeks had increased significantly to @ ( @-@ ) m and MWD to @ ( @-@ ) m ( P < @ and P = @ respectively ) .


At @ weeks the changes in the standard HEP group were not significant , despite excellent compliance : CD from @ ( @-@ ) to @ ( @-@ ) m and MWD from @ ( @-@ ) to @ ( @-@ ) m ( P = @ and P = @ respectively ) .


A @-week exercise programme using Nordic poles significantly improved walking distance in claudicants compared with a standard HEP .


To evaluate whether an electronic health record ( EHR ) reminder improves rates of screening for type @ diabetes in women with prior gestational diabetes .


We randomly allocated primary care providers ( by clinic site ) to a reminder for type @ diabetes screening within the EHR or to usual care .


Women with previous gestational diabetes mellitus were identified through an automated search of laboratory results and the problem list .


We compared rates of screening during the study period ( @-@ ) in women at intervention sites with those at control sites .


With a sample size of @ participants , we had @ % power to detect a @ % difference in screening rates .


We included @ individuals seen at a participating clinic during the study period , of whom @ were at a reminder clinic and @ were at a control clinic .


A similar proportion of women were screened for type @ diabetes in both groups ( n = @ , @ % of the reminder group compared with n = @ , @ % of the control group , P = @ ; adjusted odds ratio -LSB- OR -RSB- @ , @ % confidence interval -LSB- CI -RSB- @-@ @ ) .


Patient characteristics associated with risk for diabetes including body mass index ( adjusted OR per kg/m @ , @ % CI @-@ @ ) and race ( adjusted OR for nonwhite race @ , @ % CI @-@ @ ) were significantly associated with screening .


A simple EHR reminder did not increase the rate of diabetes screening in women with prior gestational diabetes mellitus .


This is a prospective , randomized , single-blind study .


We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents .


Fifty intellectually disabled , American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study .


Patients were randomized to receive either @ g kg ( -@ ) remifentanil ( Group @ , n = @ ) or a combination of @ g kg ( -@ ) remifentanil and @ mg kg ( -@ ) lidocaine ( Group @ , n = @ ) .


To evaluate intubation conditions , Helbo-Hansen scoring system was used .


In patients who scored @ points or less in all scorings , intubation conditions were considered acceptable , however if any of the scores was greater than @ , intubation conditions were regarded unacceptable .


Mean arterial pressure , heart rate and peripheral oxygen saturation ( SpO@ ) were recorded at baseline , after opioid administration , before intubation , and at @ , @ , and @ min after intubation .


Acceptable intubation parameters were achieved in @ patients in Group @ ( @ % ) and in @ patients in Group @ ( @ % ) .


In intra-group comparisons , the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values ( p = @ ) CONCLUSION : By the addition of @ g/kg remifentanil during sevoflurane induction , successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction .


Also worth noting , the addition of @mg/kg lidocaine to @ g/kg remifentanil does not provide any additional improvement in the intubation parameters .


Global tuberculosis ( TB ) control may require mass vaccination with a new TB vaccine , such as a recombinant bacille Calmette Guerin ( BCG ) or attenuated Mycobacterium tuberculosis ( MTB ) .


The safety profile of live mycobacterial vaccines in latently infected adults with prior infant BCG vaccination is unknown .


Evaluate safety and reactogenicity of BCG revaccination , with or without isoniazid ( INH ) pretreatment , in adults with latent MTB infection ( LTBI ) .


Eighty-two healthy , HIV uninfected , South African adults , with a BCG scar and tuberculin skin test ( TST ) diameter @ mm , were randomized to receive @ months of INH , starting either before , or @ months after , intradermal revaccination with BCG Vaccine SSI ( Statens Serum Institut , Copenhagen ) .


Safety and reactogenicity data are reported through @ months post BCG revaccination .


Baseline characteristics were similar between treatment arms .


Mean baseline TST diameter was @ @ mm .


Seventy-two subjects received BCG revaccination .


Injection site erythema ( @ % ) and induration ( @ % ) peaked @ week after revaccination .


Ulceration ( @ % ) peaked at @ weeks , and resolved by @ months in all but @ subjects .


Diameter of ulceration was > @mm in only @ % , but a residual scar was common ( @ % ) .


No regional lymphadenitis or serious morbidity related to BCG was seen .


Reactogenicity was not affected by INH pretreatment .


BCG revaccination of MTB infected adults is safe , well tolerated , and reactogenicity is similar to that of primary BCG vaccination .


Clinical trials of live recombinant BCG or attenuated MTB vaccines may be considered in latently infected adults , with or without INH pretreatment ( ClinicalTrials.gov identifier : NCT@ ) .


Oral nonsteroidal antiinflammatory medications ( NSAIDs ) have been shown to reduce pain with first-trimester surgical abortion compared to placebo , but it is unclear if one NSAID is better than another .


Some providers administer intramuscular ketorolac , though data regarding its efficacy in abortion are limited .


This study was designed to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester surgical abortion .


This was a randomized , double-blind , controlled trial .


Women undergoing first-trimester surgical abortion with local anesthesia were randomized to preprocedural oral ibuprofen , @ mg given @-@ min preprocedure , or intramuscular ketorolac , @ mg given @-@ min preprocedure .


The primary outcome was pain with uterine aspiration on a @-point , @-@ , numerical rating scale .


Secondary outcomes included pain with cervical dilation , postoperative pain and patient satisfaction .


Ninety-four women were enrolled ; @ were randomized to ibuprofen and @ to ketorolac .


The groups did not differ with regards to demographics , reproductive history or Depression Anxiety Stress Scale scores .


Mean pain scores for suction curettage did not differ between groups ( @ vs. @ , p = @ ) .


There was also no difference in pain with cervical dilation ( @ vs. @ , p = @ ) or postoperative pain ( @ vs. @ p = @ ) , though patients in the ketorolac group experienced significantly greater arm pain than those who received a placebo injection ( @ vs. @ , p < @ ) .


Satisfaction with pain control did not differ significantly by group .


Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen for first-trimester surgical abortion .


Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during first-trimester surgical abortion , is more expensive and causes patients significant arm discomfort .


Its use should therefore be reserved for patients who can not tolerate oral NSAIDs .


To study the effect of urapidil combined with phentolamine in the management of hypertension during extracorporeal circulation .


Ninety patients undergoing aortic and mitral valve replacement were randomly divided into @ equal groups to receive treatment with phentolamine ( group A ) , urapidil ( group B ) , or both ( group C ) during extracorporeal circulation .


The mean arterial pressure ( MAP ) before and after drug administration , time interval of two administrations , spontaneous recovery of heart beat after aorta unclamping , ventricular arrhythmia , changes of ST-segment @ min after the recovery of heart beat , ante-parallel cycle time , aorta clamping time , post-parallel cycle time , dopamine dose after cardiac resuscitation , and perioperative changes of plasma TNF - and IL-@ levels were recorded .


There was no significant difference in MAP between the @ groups before or after hypotensive drug administration ( P > @ ) .


The time interval of two hypotensive drug administrations was longer in group C than in groups A and B ( P < @ ) .


The incidence of spontaneous recovery of heart beat after aorta unclamping , incidence of ventricular arrhythmia , changes of ST-segment @ min after the recovery of heart beat , ante-parallel cycle time , aorta clamping time , and post-parallel cycle time were all comparable between the @ groups .


The dose of dopamine administered after cardiac resuscitation was significantly larger in group B than in groups A or group C ( P < @ ) .


The plasma levels of TNF - and IL-@ were significantly increased after CPB and after the operation in all the groups , but were lowed in group C than in groups A and B at the end of CPB and at @ h and @ after the operation .


Urapidil combined with phentolamine can control hypertension during extracorporeal circulation without causing hypotension .


Eptifibatide is indicated during percutaneous coronary intervention ( PCI ) with continuation for @-@ hours post procedure but is associated with bleeding .


We examined the efficacy and safety of shorter post-PCI eptifibatide infusions in high-risk non-ST-segment elevation acute coronary syndrome ( NSTE ACS ) patients .


EARLY ACS patients treated with PCI and eptifibatide were grouped by post-procedure infusion duration : < @ , @-@ , @-@ , and @-@ ( per protocol ) hours .


Adjusted estimated event rates for @-hour death/myocardial infarction ( MI ) / recurrent ischaemia requiring urgent revascularization ( RIUR ) , @-day death/MI , post-PCI packed red blood cell ( PRBC ) transfusion , and GUSTO ( Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries ) moderate/severe bleeding were obtained using inverse-propensity weighting to account for informative censoring of infusions .


Among @ eptifibatide-treated PCI patients , there were @ @-hour death/MI/RIUR events , @ @-day death/MI events , @ PRBC transfusions , and @ GUSTO moderate/severe bleeds .


Compared with per protocol , patients receiving post-PCI infusions < @ hours had similar adjusted estimated rates of @-hour death/MI/RIUR ( absolute difference @ higher ; @ vs. @ , @ % CI -@ to @ ; p = @ ) and @-day death/MI ( @ higher ; @ vs. @ , @ % CI -@ to @ ; p = @ ) .


There were also no differences in ischaemic outcomes between infusions of @-@ hours and per-protocol infusions .


Adjusted estimated rates of PRBC transfusion were higher for the < @-hour infusion group compared with per protocol ( @ higher ; @ vs. @ , @ % CI @ to @ , p = @ ) but were similar for other groups .


Adjusted GUSTO moderate/severe bleeding rates were similar to per-protocol rates for all groups .


In high-risk NSTE ACS patients , post-PCI eptifibatide infusions < @ hours were not associated with worse ischaemic outcomes .


Shorter eptifibatide infusions in this population may be feasible .


Residual anastomoses after fetoscopic laser surgery for twin-to-twin transfusion syndrome ( TTTS ) may lead to severe postoperative complications , including recurrent TTTS and twin anemia-polycythemia sequence ( TAPS ) .


A novel technique ( Solomon technique ) using laser coagulation of the entire vascular equator was recently investigated in a randomized controlled trial ( Solomon trial ) and compared with the Standard selective laser technique .


The aim of this secondary analysis was to evaluate the occurrence and characteristics of residual anastomoses in placentas included in the Solomon trial .


International multicenter randomized controlled trial in TTTS , randomized @:@ ratio to either the Solomon laser technique or Standard laser technique .


At time of laser , surgeons recorded whether they considered the procedure to be complete .


Placental dye injection was performed after birth in the participating centers to evaluate the presence of residual anastomoses .


A total of @ placentas were included in the study .


The percentage of placentas with residual anastomoses in the Solomon group and Standard group was @ % ( @/@ ) and @ % ( @/@ ) , respectively ( P = @ ) .


The percentage of placentas with residual anastomoses in the subgroup of cases where the procedure was recorded as complete was @/@ ( @ % ) and @/@ ( @ % ) in the Solomon group and Standard group , respectively ( P < @ ) .


The Solomon laser technique reduces the risk of residual anastomoses .


However , careful follow-up remains essential also after the Solomon technique , as complete dichorionization is not always achieved .


Visual stimulation increases the blood flow in the posterior cerebral artery ( PCA ) , which supplies blood to the visual cortex by neurovascular coupling ( NVC ) .


Relative contributions of vasodilatation and pressor response on NVC during dynamic exercise are still unknown .


We measured the blood flow velocity in the PCA ( PCAv ) by transcranial Doppler ultrasound flowmetry during rest and exercise in @ healthy males while they performed @-min submaximal leg-cycle exercises at mild - , moderate - , and high-intensity , which corresponded to heart rates of @ , @ , and @ bpm , respectively .


NVC was estimated as the relative change in PCAv from @ s eye-closing to the peak response during @ s looking at a reversed checkerboard .


Conductance index was calculated for evaluating vasodilatation as pressure divided by blood flow .


In response to visual stimulation , a magnitude of vasodilatation was significantly decreased under the moderate-intensity , while pressor response was significantly suppressed under the high-intensity exercises , compared with the control condition .


Conversely , peak response to visual stimulation in PCAv was not affected by exercise intensity though relative and absolute responses were significantly lower in the moderate - and high-intensity exercises than the control .


It is suggested that the contributions of pressor response and vasodilatation were modified by exercise intensity , partly playing a role for stabilizing the peak response of PCAv with visual stimulation during dynamic exercise .


Chronic stable angina pectoris ( CSAP ) is a common cardiovascular condition that endangers a patient 's life quality and longevity .


As demonstrated in several clinical trials , acupuncture is attested to be effective for CSAP .


Current trials are not adequate enough to provide high-quality evidence for clinical decision making , as a result of inadequate methodology design and small sample size .


Notably , stark controversy toward acupoint specificity also exists in the clinical acupuncture trials for CSAP .


Therefore , we designed the present study as a randomized controlled trial primarily to investigate the effectiveness of acupuncture in addition to routine care among patients with CSAP .


Meanwhile , we examined whether acupoint on the disease-affected meridian ( DAM ) is superior to either acupoint on the non-affected meridian ( NAM ) or non-acupoint ( NA ) , to further investigate the meridian-based characteristics of acupoint specificity .


This study was a multicenter , assessor and statistician blinded , randomized controlled trial in China .


In this study , @ participants in sum will be randomly assigned to four groups through central randomization in a @:@:@:@ ratio .


The whole study period is @ weeks including a @-week baseline period , a @-week treatment period and a @-week follow-up .


Participants in the DAM group receive acupuncture stimulation at acupoints on the disease-affected meridian , and three different control groups will undergo acupuncture stimulation at the NAM , the non-acupoint and no intervention respectively , in addition to basic treatment .


Participants in the acupuncture groups will receive @ sessions of acupuncture treatment over @ weeks , while the wait-listed ( WL ) group would receive free acupuncture treatment after the completion of the study .


The outcome measures in this trial include the frequency of angina attack during @ weeks as the primary outcome and eight other secondary outcomes .


This trial will provide new and relatively high-quality evidence in acupuncture treatment for CSAP .


Moreover , this trial may further validate the meridian-based characteristics of acupoint specificity by comparing the strength of acupoints on the disease-affected meridian versus that of the non-affected meridian , to further inspire optimization of acupuncture therapy for CSAP .


A pragmatic , randomized , controlled , single-blinded trial in Dutch general practice .


Assessing the costs and cost-effectiveness of adding segmental epidural steroid injections to care as usual in radiculopathy in general practice .


Lumbosacral radicular syndrome ( radiculopathy ) is a benign , generally self-limiting but painful condition caused by a herniated lumbar intervertebral disc , which results in an inflammatory process around the nerve root .


Segmental epidural steroid injections could lessen pain .


Low back pain and sciatica form a large financial burden on national health care systems .


Improving pain treatment could lower costs to society by diminishing loss of productivity .


Patients with acute radiculopathy were included by general practitioners .


All patients received usual care .


Patients in the intervention group received one segmental epidural steroid injection containing @ mg of triamcinolone as well .


Follow-up was performed using postal questionnaires at @ , @ , @ , @ , @ , and @ weeks .


Main outcomes were pain , disability and costs .


Economic evaluation was performed from a societal perspective with a time horizon of @ year .


Sixty-three patients were included in the analysis .


Mean total costs were @ or $ @ in the intervention group and @ or $ @ in the control group .


This difference was mostly due to loss of productivity .


The point estimate for the incremental cost-effectiveness ratio was -@ or - $ @ ( @-point diminishment on the numerical rating scale back pain score in @ patient in the course of @ yr would save @ or $ @ ) .


Bootstrapping showed a @ % confidence interval of -@ to @ or - $ @ to $ @ .


The cost-effectiveness acceptability curve showed that without additional investment the probability that epidural steroids are cost-effective is more than @ % .


The effect on pain and disability of epidural steroids in lumbosacral radicular syndrome is small but significant , and at lower costs with no reported complications or adverse effects .


Segmental epidural steroid injections could be considered by policy makers as an additional treatment option .


We studied whether a @-month group-mediated cognitive behavioral ( GMCB ) intervention for peripheral artery disease ( PAD ) participants , which promoted home-based walking exercise , improved @-minute walk and other outcomes at @-month follow-up , @ months after completing the intervention , compared to a control group .


We randomized PAD participants to a GMCB intervention or a control group .


During phase I ( months @ to @ ) , the intervention used group support and self-regulatory skills during weekly on-site meetings to help participants adhere to home-based exercise .


The control group received weekly on-site lectures on topics unrelated to exercise .


Primary outcomes were measured at the end of phase I.


During phase II ( months @ to @ ) , each group received telephone contact .


Compared to controls , participants randomized to the intervention increased their @-minute walk distance from baseline to @-month follow-up , ( from @ to @ m in the intervention versus @ to @ m in the control group ; mean difference = +@ m ; @ % confidence interval -LSB- CI -RSB- = +@ , +@ ; P < @ ) and their Walking Impairment Questionnaire ( WIQ ) speed score ( from @ to @ in the intervention group versus @ to @ in the control group ; mean difference = +@ ; @ % CI = +@ , +@ ; P = @ ) .


Change in the WIQ distance score was not different between the @ groups at @-month follow-up ( P = @ ) .


A weekly on-site GMCB intervention that promoted home-based walking exercise intervention for people with PAD demonstrated continued benefit at @-month follow-up , @ months after the GMCB intervention was completed .


To evaluate the use of the Roux loop on the postoperative course in patients submitted for gastroenteroanastomosis ( GE ) .


Non-jaundiced patients ( n = @ ) operated on in the Department of General and Transplant Surgery in Lodz , between January @ and December @ were enrolled .


The tumor was considered unresectable when liver metastases or major vascular involvement were confirmed .


Patients were randomized to receive Roux ( n = @ ) or conventional GE ( n = @ ) on a prophylactic basis .


The mean time to nasogastric tube withdrawal in Roux GE group was shorter ( @ @ vs @ @ , P < @ ) .


Time to starting oral liquids , soft diet and regular diet were decreased ( @ @ vs @ @ ; P < @ ; @ @ vs @ @ , P < @ and @ @ vs @ @ , P = @ ; respectively ) .


The Roux GE group had a lower use of prokinetics ( @ mg thrice daily for @ @ d vs @ @ d , P = @ ; total @ @ mg vs @ @ mg , P = @ ) .


The mean hospitalization time following Roux GE was shorter ( @ d vs @ d , P = @ ) .


Delayed gastric emptying ( DGE ) was confirmed in @ % after conventional GE but in none of the patients following Roux GE .


Roux gastrojejunostomy during open abdomen exploration in patients with unresectable pancreatic cancer is easy to perform , decreases the incidence of DGE and lowers hospitalization time .


In the Mexican-American population , the prevalence of Type @ diabetes mellitus ( T@DM ) is as high as @ % of the population .


This randomized controlled clinical trial was designed to elucidate how treatment of periodontal disease affects HbA@c values in this population .


One hundred and fifty-four T@DM patients with periodontal disease were enrolled in the study .


The test group was treated with scaling and root planing ( SRP ) ; the control group received oral hygiene instructions .


At baseline and @-@ weeks after therapy , a complete periodontal examination was performed .


Blood was collected at baseline and @ months later for HbA@c levels .


One hundred and twenty-six individuals completed the study .


Baseline mean SD HbA@c for the test and control groups were @ @ % and @ @ % respectively .


Non-significant difference in HbA@c reductions ( @ @ % and @ @ % ) was found between test and control groups at @ months .


Comparisons of the periodontal clinical parameters between the test and control groups found significant differences with improved results in the test subjects .


No statistically significant differences were found in the changes of HbA@c levels between test and control groups .


Non-surgical periodontal therapy improved the magnitude of change in periodontal parameters as compared to the control subjects .


ClinicalTrials.gov Identifier : NCT@ .


The study aimed at comparing the fixed tapering dose and the symptom-triggered regimens of lorazepam for alcohol detoxification .


We carried out a prospective , randomized , double blind controlled trial involving @ consecutive consenting male patients admitted with diagnosis of uncomplicated alcohol withdrawal .


The patients were randomized into two groups based on the type of lorazepam dosage : symptom-triggered ( n = @ ) and fixed tapering dose regimens ( n = @ ) .


Alcohol withdrawal symptoms were rated on CIWA-Ar ( Clinical Institute Withdrawal Assessment - Alcohol revised ) .


The main outcome measures were the total amount and duration of lorazepam treatment and the incidence of adverse events or complications .


The mean lorazepam dose administered in the symptom-triggered group was significantly lower than in the fixed tapering dose group ( @ versus @ mg , P < @ ) and for a significantly shorter duration of time ( @ versus @ h , P < @ ) with more significant results for higher initial CIWA-Ar scores .


There were no significant differences between both the groups in terms of the incidence of complications like seizures or delirium tremens .


Symptom-triggered lorazepam treatment for alcohol withdrawal resulted in administration of lower total doses of medication for a shorter duration of treatment and was as safe as the fixed tapering dose .


Peripheral intravenous catheterization in children is challenging , and success rates vary greatly .


We conducted a pragmatic randomized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the standard approach in achieving successful catheter placement on the first attempt .


We enrolled a convenience sample of @ children in a pediatric emergency department who required peripheral intravenous catheterization between June @ to August @ .


We stratified them by age ( @ yr and > @ yr ) and randomly assigned them to undergo the procedure with the standard approach , or with the help of either ultrasound or near-infrared vascular imaging .


The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt .


The rate of successful first attempts did not differ significantly between either of the @ intervention groups and the standard approach group ( differences in proportions -@ % , @ % confidence interval -LSB- CI -RSB- -@ % to @ % , for ultrasound imaging ; -@ % , @ % CI -@ % to @ % , for near-infrared imaging ) .


Among children @ years and younger , the difference in success rates relative to standard care was also not significant for ultrasound imaging ( -@ % , @ % CI -@ % to @ % ) , but it was significantly worse for near-infrared imaging ( -@ % , @ % CI -@ % to -@ % ) .


Among children older than @ years , the differences in success rates relative to standard care were smaller but not significant ( -@ % , @ % CI -@ % to @ % , for ultrasound imaging ; -@ % , @ % CI -@ % to @ % , for near-infrared imaging ) .


None of the pairwise comparisons were statistically significant in any of the outcomes .


Neither technology improved first-attempt success rates of peripheral intravenous catheterization in children , even in the younger group .


These findings do not support investment in these technologies for routine peripheral intravenous catheterization in children .


The aim of this survey was to compare the effect of letrozole with medroxyprogesterone acetate ( MPA ) in treatment of simple endometrial hyperplasia to preserve fertility in young women .


Forty-five patients referred to Shahid Sadoughi gynecology clinics from @ until @ who suffered from abnormal vaginal bleeding or endometrial thickness , that underwent curettage with diagnosis of simple endometrial hyperplasia without atypia were enrolled .


The patients were divided randomly into two groups .


First group including @ women receive ten mg MPA , for ten days during a month for three months .


All cases were followed by interview , endometrial curetage , and vaginal sonography .


Serum level of estradiol was checked before and after treatment .


At the end of the study , biopsy was retaken in @ patients .


All the patients were under observation by two gynecologists .


Age range of patients was @ to @ years .


Mean body mass index ( BMI ) in the MPA and letrozole groups was @ + / - @ and @ + / - @ , respectively .


Fifty and @ percent of cases had history of obesity or polycystic ovarian syndrome ( PCOS ) in MPA and letrozole groups , respectively .


Forty-one selected cases ( @ of the MPA and @ of the letrozole groups ) continued the treatment for three months .


The endometrial thicknesses decreased in both groups .


Serum estradiol level also decreased in both groups .


The most common complication in the MPA and letrozole groups was headache ( @ % ) and flashing and dizziness , respectively .


The side-effects were reported less in the letrozole group and the most common ones in this group were dizziness and flashing .


In women suffering from simple endometrial hyperplasia without atypia , letrozole can lead to decrease of serum estradiol level and endometrial thickness like MPA .


In both groups , there was no simple hyperplasia report in curettage report following treatment .


It should be noted that there was an incomplete response to treat case with pathology of disordered proliferative type .


Letrozole is a good therapeutic option in simple endometrial hyperplasia without atypia : cases candidate for medical treatment .


To confirm the effect and safety of letrozole , more studies with larger samples are recommended .


Obstructive Sleep Apnea ( OSA ) is a common medical problem in adults that is becoming increasingly recognized in children .


It occurs in the pediatric age group , from newborns to teens .


More recently , many specialists have estimated OSA prevalence to be between @ and @ % .


However , in syndromic children , the prevalence of OSA can be from @ to @ % , having a significant effect on their Quality-of-Life .


As they are a challenging population for management , it is essential to evaluate them thoroughly before planning appropriate intervention .


To compare the efficacy of Adenotonsillectomy ( T&A ) and Continuous Positive Airway Pressure ( CPAP ) in syndromic children -LSB- Down syndrome ( DS ) and Mucopolysaccharidoses ( MPS ) -RSB- with Obstructive Sleep Apnea ( OSA ) .


In a prospective , randomized , cohort comparative study , @ syndromic children ( DS and MPS ) aged between @ and @ years were recruited from a private MPS support group and the Down Syndrome Society , Chennai .


A standard assessment was performed on all children who entered the study including a full overnight Polysomnogram ( PSG ) , Epworth Sleepiness Scale-Children ( ESS-C ) and Quality-of-Life ( QOL ) tool OSA-@ .


The children with positive PSG who consented for the study ( n = @ ) were randomly distributed to two groups , T&A group & CPAP group .


The children were followed up with repeat PSG , clinical evaluation , ESS-C and Quality-of-Life ( QOL ) tool OSA-@ for a period of @ year .


Follow-up was available for @ syndromic children .


Both the groups , T&A group and CPAP group , showed statistically significant ( p < @ ) improvement in Apnea-Hypoapnea Index ( AHI ) , ESS-C , QOL from the intervention .


In our study , T&A showed equal outcome compared to CPAP .


The contrasting feature between the two groups was that CPAP use gave immediate sustained improvement while T&A gave gradual progressive improvement of symptoms over a period of @ year .


On average , T&A gives equal outcomes as CPAP and it can be suggested as a first-line treatment in this group of syndromic children .


During laparoscopic cholecystectomy ( LCHE ) , the insufflation with warmed and humidified carbon dioxide ( CO@ ) may reduce postoperative pain .


The aim of the study was to evaluate the positive effects of heated and humidified carbon dioxide gas on patients with regard to postoperative pain after LCHE .


This is a prospective , randomized , double-blinded , controlled clinical trial .


@ patients ( female = @ , male = @ ) scheduled for elective LCHE were randomized into two groups : receiving either heated humidified carbon dioxide , or standard gas .


Intraoperative core temperature was measured .


The perioperative management was identical for both groups .


Postoperative pain intensity was assessed using a visual analog pain scale , and the amount of analgesic consumption was recorded .


The postoperative pain management was also standardized and equal for both groups .


@ out of @ received standard gas ( group A ) , and @ received warmed , humidified gas ( group B ) .


The groups were comparable demographically .


The amount of analgesic consumption was recorded .


Intraoperative core temperature was significant higher in group B than in group A. Pain was significantly less in group B ( p = @ ) @h postoperatively .


On the first postoperative day , no significant difference in pain between the two groups was detectable ( p = @ ) .


The use of warmed and humidified carbon dioxide during LCHE reduces postoperative pain at the day of operation .


Existing theories suggest that the mother-infant relationship has a potentially significant effect on long-term adult mental health , but there are few empirical data to support this view .


Even fewer prior studies have examined the specific dynamics of the mother-infant relationship and their association with adult mental health .


A total of @ inner-city infants born between @ and @ were followed prospectively as a part of the Collaborative Perinatal Project ( CPP ) and the Johns Hopkins Pathways to Adulthood Study .


Multiple observations of development and an extensive adult interview were performed .


Maternal behavior was observed and systematically rated at the infant 's @-month pediatric neurological evaluation and at @ months by a developmental psychologist .


Factor analysis was used to organize the maternal behavior variables into different types of dysfunctional mother-infant relationships .


Adult mental health was assessed at the follow-up interview , when the infant had reached the age of @-@ years , by the General Health Questionnaire ( GHQ ) and self-perception of current mental health .


There was a significant association between unsupportive maternal behavior at @ months and subsequent poor adult mental health ( Fisher 's exact test , p = @ ) .


There was no association between overly involved maternal behavior and poor mental health as an adult .


After adjustment for potential confounding variables , the elevated rates of poor adult mental health in children of mothers who exhibited unsupportive maternal behavior at @ months persisted ( OR = @ -LSB- @ % CI = @-@ @ -RSB- , p < @ ) .


Infants who experience unsupportive maternal behavior at @ months have an increased risk for developing psychological sequelae later in life .


Low back pain is a common , highly debilitating condition , whose severity is variable .


This study evaluated the efficacy of treatment with Ga-Al-As diode laser ( @nm ) with a large diameter spot ( @cm ( @ ) ) , in association with exercise therapy , in reducing pain .


The present study aimed to evaluate the pain reduction efficacy of treatment with the Ga-Al-As diode laser ( @nm ) in combination with exercise therapy , in patients with chronic low back pain ( CLBP ) .


This study evaluated @ patients with CLBP ( mean age @ years ) who were randomly assigned to two groups .


The laser plus exercises group ( Laser + EX : @ patients ) received low-level laser therapy ( LLLT ) with a diode laser , @nm , with a specific handpiece -LSB- @cm ( @ ) irradiation spot size , power @W in continuous wave ( CW ) , fluence @ J/cm ( @ ) , total energy per point @J -RSB- thrice weekly , and followed a daily exercise schedule for @ weeks ( @ days/week ) .


The exercises group ( EX : @ patients ) received placebo laser therapy plus daily exercises .


The outcome was evaluated on the visual analogue pain scale ( VAS ) , before and after treatment .


At the end of the @ week period , the Laser + EX group showed a significantly greater decrease in pain than did the EX group .


There was a significant difference between the two groups , with average VAS scores of @ ( Laser + EX group ) and @ ( EX group ) .


The Student 's t test demonstrated a statistically significant difference between the two groups , at p < @ .


This study demonstrated that the use of diode laser ( @nm ) with large diameter spot size , in association with exercise therapy , appears to be effective .


Such treatment might be considered a valid therapeutic option within rehabilitation programs for nonspecific CLBP .


Caffeine use is on the rise among children and adolescents .


Previous studies from our laboratory reported gender differences in the effects of caffeine in adolescents .


The purpose of this study was to test the hypotheses that gender differences in cardiovascular responses to caffeine emerge after puberty and that cardiovascular responses to caffeine differ across the phases of the menstrual cycle .


To test these hypotheses , we examined heart rate and blood pressure before and after administration of placebo and @ doses of caffeine ( @ and @ mg/kg ) in prepubertal ( @ - to @-year-olds ; n = @ ) and postpubertal ( @ - to @-year-olds ; n = @ ) boys ( n = @ ) and girls ( n = @ ) by using a double-blind , placebo-controlled , dose-response design .


There was an interaction between gender and caffeine dose , with boys having a greater response to caffeine than girls .


In addition , we found interactions between pubertal phase , gender , and caffeine dose , with gender differences present in postpubertal , but not in prepubertal , participants .


Finally , we found differences in responses to caffeine across the menstrual cycle in post-pubertal girls , with decreases in heart rate greater in the midluteal phase and blood pressure increases greater in the midfollicular phase of the menstrual cycle .


These data suggest that gender differences in response to caffeine emerge after puberty .


Future research will determine the extent to which these gender differences are mediated by physiological factors , such as steroid hormones , or psychosocial factors , such as more autonomy and control over beverage purchases .


To assess the efficacy and safety of oral azithromycin compared with oral doxycycline in patients with meibomian gland dysfunction ( MGD ) who had failed to respond to prior conservative management .


@ patients ( > @years old ) with MGD were randomly assigned to receive either oral @-day azithromycin ( @mg on day @ and then @mg/day ) or @-month doxycycline ( @mg/day ) .


They also continued eyelid warming/cleaning and artificial tears .


A score comprising five symptoms and seven signs ( primary outcome ) was recorded prior to treatment and at @week , and @ and @months after treatment .


Total score was the sum of both scores at each follow-up .


Side effects were recorded and overall clinical improvement was categorised as excellent , good , fair or poor based on the percentage of change in the total score .


Symptoms and signs improved significantly in both groups ( p = @ ) .


While improvement of symptoms was not different between the groups , bulbar conjunctival redness ( p = @ ) and ocular surface staining ( p = @ ) were significantly better in the azithromycin group .


The azithromycin group showed a significantly better overall clinical response ( p = @ ) .


Mild gastrointestinal side effects were not significantly different between the groups except for the second visit , when the doxycycline group had significantly more side effects ( p = @ ) .


Although both oral azithromycin and doxycycline improved the symptoms of MGD , @-day oral azithromycin is recommended for its better effect on improving the signs , better overall clinical response and shorter duration of treatment .


The novel arthritis-specific Work Productivity Survey ( WPS ) was developed to estimate patient productivity limitations associated with arthritis within and outside the home , which is an unmet need in psoriatic arthritis ( PsA ) .


The WPS has been validated in rheumatoid arthritis .


This report assesses the discriminant validity , responsiveness and reliability of the WPS in adult-onset PsA .


Psychometric properties were assessed using data from the RAPID-PsA trial ( NCT@ ) investigating certolizumab pegol ( CZP ) efficacy and safety in PsA .


WPS was completed at baseline and every @ weeks until Week @ .


Validity was evaluated at baseline via known-groups defined using first and third quartiles of patients ' Disease Activity Score @ based on C-reactive protein ( DAS@ ( CRP ) ) , Health Assessment Questionnaire-Disability Index ( HAQ-DI ) , Short Form-@ ( SF-@ ) items and PsA Quality of Life ( PsAQoL ) scores .


Responsiveness and reliability were assessed by comparing WPS mean changes at Week @ in American College of Rheumatology @ % improvement criteria ( ACR@ ) or HAQ-DI Minimal Clinically Important Difference ( MCID ) @ responders versus non-responders , as well as using standardized response means ( SRM ) .


All comparisons were conducted on the observed cases in the Randomized Set , regardless of the randomization group , using a non-parametric bootstrap-t method .


Compared with patients with a better health state , patients with a worse health state had on average @ to @ times more household work days lost , more days with reduced household productivity , more days missed of family/social/leisure activities , more days with outside help hired and a significantly higher interference of arthritis per month .


Among employed patients , those with a worse health state had @ to @ times more workplace days lost , more days with patient workplace productivity reduced , and a significantly higher interference of arthritis on patient workplace productivity versus patients with a better health state .


WPS was also responsive to clinical changes , with responders having significantly larger improvements at Week @ in WPS scores versus non-responders .


The effect sizes for changes in productivity in ACR@ or HAQ-DI MCID responders were moderate ( @ < SRM < @ ) or small .


These analyses demonstrate the validity , responsiveness and reliability of the WPS , as an instrument for the measurement of patient productivity within and outside the home in an adult-onset PsA population .


Insulin degludec/insulin aspart ( IDegAsp ) is a soluble co-formulation of IDeg and IAsp .


This pan-Asian , @-week trial investigated efficacy and safety of IDegAsp vs biphasic insulin aspart @ ( BIAsp @ ) in Asian adults with type @ diabetes ( T@DM ) , inadequately controlled on once - or twice-daily ( BID ) basal , premixed or self-mixed insulin .


Participants ( mean age @ years , HbA@c @ % , FPG @ mmol/L , BMI @ kg/m ( @ ) ) were randomised @:@ to BID IDegAsp ( n = @ ) or BIAsp @ ( n = @ ) and continued existing metformin treatment .


Insulins were administered with breakfast and main evening meal , titrated to a pre-breakfast and pre-main evening meal self-measured plasma glucose target of @-@ mmol/L .


IDegAsp achieved the primary endpoint of non-inferiority to BIAsp @ for mean change in HbAc ( estimated treatment difference -LSB- ETD -RSB- IDegAsp-BIAsp @ : @ % points -LSB- @ % CI -@ ; @ -RSB- ) .


IDegAsp was superior in lowering fasting plasma glucose ( FPG ) ( ETD -@ mmol/L , @ % CI -@ ; -@ , p < @ ) , and resulted in a lower final mean daily insulin dose ( @ U/kg vs @ U/kg , estimated rate ratio -LSB- RR -RSB- @ , @ % CI @ ; @ , p < @ ) .


Rates of overall confirmed and severe hypoglycaemia were similar between treatments , while rate of nocturnal confirmed hypoglycaemia was numerically ( p = ns ) lower with IDegAsp .


During the maintenance period there was a trend ( p = ns ) towards lower hypoglycaemia rates for IDegAsp .


In Asian adults with T@DM , IDegAsp BID effectively improves long-term glycaemic control , and compared to BIAsp @ , provides superior reductions in FPG with a lower dose , and numerically less nocturnal hypoglycaemia .


While neuromodulation through unihemispheric repetitive transcranial magnetic stimulation ( rTMS ) has shown promise for the motor recovery of stroke patients , the effectiveness of the coupling of different rTMS protocols remains unclear .


We aimed to test the long-term efficacy of this strategy with different applying sequences and to identify the electrophysiological correlates of motor improvements to the paretic hand .


In our sham-controlled , double-blinded parallel study , @ stroke patients ( @-@ months poststroke ) were randomly allocated to three groups .


Group A underwent @-session rTMS conditioning initiated with @-session @ Hz rTMS over the contralesional primary motor cortex ( M@ ) , followed by @-session intermittent theta burst stimulation ( iTBS ) consequently over the ipsilesional M@ ; Group B underwent the same two paradigms but in reverse ; and Group C received sham stimulation that was identical to Group A.


We tested cortical excitability and motor assessments at the baseline , postpriming rTMS , postconsequent rTMS , and at @-months follow-up .


Group A manifested greater improvement than Group B in Fugl-Meyer Assessment ( FMA ) , Wolf Motor Function testing ( WMFT ) score , and muscle strength ( P = @-@ @ ) post the priming rTMS .


After the consequent rTMS , Group A continued to present a superior outcome than Group B in FMA ( P = @ ) and WMFT score ( P = @ ) with significant behavior-electrophysiological correlation .


Conditioning the contralesional M@ prior to ipsilesional iTBS was found to be optimal for enhancing hand function , and this effect persisted for at least @ months .


Early modulation within @ months poststroke rebalances interhemispheric competition and appears to be a feasible time window for rTMS intervention .


To clarify the usefulness of protein-sparing modified formula diet in obese type @ diabetic patients , the effects of partial use of formula diet on weight reduction and changes in related metabolic variables , and the improving rates of risk factors per @ % body weight reduction , were compared with those of conventional subcaloric diet .


Obese patients -LSB- BMI > @ kg/m -RSB- with diabetic mellitus were randomly assigned to a low-caloric diet with partial use of formula diet group ( FD , n = @ ) and a conventional low-caloric diet group ( CD , n = @ ) .


Subjects in FD took one pack of formula diet ( MicroDiet , @ kcal/pack ) in place of one of three daily low-caloric meals for @ weeks .


Total daily calorie prescribed was same .


Weight reduction was greater in FD than in CD ( week @ : -@ vs -@ kg ; all p < @ ) .


Systolic blood pressure decreased significantly only in FD .


HbA@c reduction was greater in FD than in CD .


HDL-cholesterol increased significantly more in FD than in CD ( week @ : +@ vs. +@ mg/dl , p < @ ) .


Among several improving rates ( % ) of risk factors/@ % body weight reduction , those of HbA@c at weeks @ and @ , triglyceride at week @ and HDL-cholesterol at week @ , were significantly higher in FD than CD .


Doses of sulfonylurea and thiazolidinedione were significantly decreased in FD than in CD .


Partial use of formula diet was much more effective in reducing body weight , and also in improving coronary risk factors than conventional diet in part due to reduced body weight through decreased energy diet intake and due to dietary composition of the formula diet .


The management of patients with refractory immune thrombocytopenia ( ITP ) is challenging , as there is no standard treatment option .


The aim of this study was to investigate the efficacy of recombinant human thrombopoietin ( rhTPO ) in combination with cyclosporin A ( CsA ) for the management of patients with corticosteroid-resistant primary ITP .


Thirty-six patients with corticosteroid-resistant ITP were randomly divided into an observation group and control group .


In the observation group , @ patients received subcutaneous injection of rhTPO at a dose of @ g/kg ( @ U/kg ) once daily up to day @ .


Simultaneously they also received oral CsA at a dose of @-@ @ mg/kg twice daily for three months .


In the control group , rhTPO alone was administered subcutaneously at @ g/kg once daily in the other @ ITP patients for @ consecutive days and then the treatment was withdrawn .


There was no significant difference in the response rate at the end of the first week after treatment initiation between the observation group and the control group ( @ % vs. @ % , P > @ ) , neither was there at the end of the second week ( @ % vs. @ % , P > @ ) .


However , the relapse rate in the observation group was significantly lower than that in control group at the end of the first ( @ % vs. @ % , P < @ ) , second ( @ % vs. @ % , P < @ ) and the third month ( @ % vs. @ % , P < @ ) .


In addition , rhTPO plus CsA were well tolerated and adverse events recorded were mild .


Combination therapy with rhTPO and CsA was effective in the management of patients with corticosteroidresistant ITP , with a relatively short time to response and low recurrence rate .


It might be considered as a potential secondline treatment regimen for ITP .


To compare the efficacy of glycerin suppository versus no suppository in preterm very-low-birthweight neonates for improving feeding tolerance .


Randomized controlled trial .


Level III neonatal unit from Mumbai , India .


@ very-low-birthweight ( birth weight between @ to @ grams ) preterm ( gestational age between @ to @ weeks ) neonates randomized to glycerine suppository ( n = @ ) or no intervention ( n = @ ) .


Glycerin suppository ( @g ) once a day from day-@ to day-@ of life or no suppository , along with intermittent oral feeds and standardized care .


Time required to achieve full enteral feeds ( @ mL/kg/d ) .


Baseline characteristics of neonates like gestational age , birthweight , gender and age at the time of introduction of feeds were comparable in both groups .