Over @ months , in the micronutrient group , hemoglobin increased by @ g/dL , retinol by @ g/dL , ferritin by @ g/L , body iron stores by @ mg and the decrease in the prevalence of retinol deficiency was from @ % to @ % , anaemia from @ % to @ % , iron deficiency from @ % to @ % and iron deficiency anaemia from @ % to @ % , while the prevalence of all these deficiencies increased or the changes were not significant in the other two groups .


Multiple micronutrient fortified salt was able to improve iron and vitamin A status , whereas this was not seen in the nutrition education group .


Home wireless device monitoring could play an important role in improving the health of patients with poorly controlled chronic diseases , but daily engagement rates among these patients may be low .


To test the effectiveness of two different magnitudes of financial incentives for improving adherence to remote-monitoring regimens among patients with poorly controlled diabetes .


Randomized , controlled trial .


( Clinicaltrials.gov Identifier : NCT@ ) .


Seventy-five patients with a hemoglobin A@c greater than or equal to @ % recruited from a Primary Care Medical Home practice at the University of Pennsylvania Health System .


Twelve weeks of daily home-monitoring of blood glucose , blood pressure , and weight ( control group ; n = @ ) ; a lottery incentive with expected daily value of $ @ ( n = @ ) for daily monitoring ; and a lottery incentive with expected daily value of $ @ ( n = @ ) for daily monitoring .


Daily use of three home-monitoring devices during the three-month intervention ( primary outcome ) and during the three-month follow-up period and change in A@c over the intervention period ( secondary outcomes ) .


Incentive arm participants used devices on a higher proportion of days relative to control ( @ % low incentive vs. @ % , P = @ ; @ % high incentive vs. @ % , P = @ ) during the three-month intervention period .


There was no difference in adherence between the two incentive arms ( P = @ ) .


When incentives were removed , adherence in the high incentive arm declined while remaining relatively high in the low incentive arm .


In month @ , the low incentive arm had an adherence rate of @ % compared to @ % in the high incentive arm ( P = @ ) and @ % in the control group ( P = @ ) .


A daily lottery incentive worth $ @ per day improved monitoring rates relative to control and had significantly better efficacy once incentives were removed than a higher incentive .


Urolithins are bioactive metabolites produced by the gut microbiota from ellagitannins ( ETs ) and ellagic acid ( EA ) .


We investigated whether urolithins could be detected in colon tissues from colorectal cancer ( CRC ) patients after pomegranate extract ( PE ) intake .


CRC patients ( n = @ ) were divided into controls and PEs consumers ( @ mg/day for @ days ) before surgical resection .


PEs with low ( PE-@ ) and high ( PE-@ ) punicalagin : EA ratio were administered .


Twenty-three metabolites , but no ellagitannins , were detected in urine , plasma , normal ( NT ) or malignant ( MT ) colon tissues using UPLC-ESI-QTOF-MS / MS ( UPLC , ultra performance liquid chromatography ; QTOF , quadrupole TOF ) .


Free EA , five EA conjugates , gallic acid and @ urolithin derivatives were found in colon tissues .


Individual and total metabolites levels were higher in NT than in MT , independently of the PE consumed .


The maximal mean concentration ( @ @ ng/g ) was found in NT after consumption of PE-@ and the lowest concentration ( @ @ ng/g ) in MT with PE-@ .


Urolithin A or isourolithin A were the main urolithins produced ( @ and @ % patients with urolithin A or isourolithin A phenotype , respectively ) .


High punicalagin content ( PE-@ ) hampered urolithins formation .


Significant levels of EA derivatives and urolithins are found in human colon tissues from CRC patients after consumption of pomegranate .


Further studies are warranted to elucidate their biological activity .


Chronic kidney disease is a common disease .


Most chronic kidney diseases evolve from primary glomerulonephritis .


Proteinuria is an independent risk factor for the progression of chronic kidney disease .


The general consensus is that therapy administered to decrease proteinuria should include steroids and/or immunosuppressants , angiotensin-converting enzyme inhibitors , and angiotensin II receptor blockers .


However , the side effects of , and adverse reactions to , these agents reduce the benefits to patients .


In addition , the cost of these drugs is relatively high .


Therefore , identification of inexpensive and effective drugs to decrease proteinuria is urgently needed .


Shenyankangfu tablets have been a widely applied Chinese patent medicine for many years to decrease proteinuria .


However , there is a lack of research-derived data regarding the clinical use .


Therefore , we designed the present randomized controlled clinical trial to compare the efficacy and safety of Shenyankangfu tablets versus losartan potassium for control of proteinuria in patients with primary glomerulonephritis .


This study will be a multicenter , prospective , double-blind , double-dummy , randomized controlled clinical trial .


We will enroll @ patients diagnosed with primary glomerulonephritis .


The eligible patients will be randomly divided into the following groups at a @:@:@:@:@ ratio : Shenyankangfu tablets group , losartan potassium @ mg group , losartan potassium @ mg group , Shenyankangfu tablets + losartan potassium @ mg group , and Shenyankangfu tablets + losartan potassium @ mg group .


All groups will be followed up for @ weeks ; follow-up visits will be performed , at weeks @ , @ , @ , @ , @ , @ , and @ .


The primary efficacy outcome will be the post-treatment change in the @-hour proteinuria level , and the secondary efficacy outcomes will be the post-treatment changes in the serum creatinine level , estimated glomerular filtration rate , traditional Chinese medicine syndrome score , and serum albumin level .


The results of this trial will provide solid data for use in evidence-based medicine with respect to the efficacy and safety of Shenyankangfu tablets for control of proteinuria in patients with primary glomerulonephritis compared to those of losartan potassium .


Moreover , we infer that therapy comprising Shenyankangfu tablets + losartan potassium can decrease proteinuria to a larger extent than Shenyankangfu tablets or losartan potassium can alone .


Sufficient pain treatment remains a challenge after total knee arthroplasty ( TKA ) , especially in high pain catastrophizing patients .


Serotonergic signaling may be involved in pain processing , but the effect of selective serotonin reuptake inhibitors on well-defined postoperative pain has not previously been investigated .


The authors hypothesized that perioperative escitalopram would reduce pain after TKA in high pain catastrophizing patients .


A total of @ pain catastrophizing patients ( selected using the pain catastrophizing scale as preoperative screening tool ) scheduled for TKA were randomized in a double-blind manner to either @ mg escitalopram or placebo daily from preanesthesia to postoperative day @ in addition to a standardized analgesic regime .


The primary outcome was pain upon ambulation @ h after surgery .


Secondary outcomes were overall pain during well-defined mobilizations and at rest from @ to @ h and from days @ to @ , morphine equivalents , anxiety , depression , and side effects .


Pain upon ambulation ( mean -LSB- @ % CI -RSB- ) @ h after surgery in the escitalopram versus placebo group was @ ( @ to @ ) versus @ ( @ to @ ) , the mean difference being -@ ( -@ to @ ) , P = @ .


Overall pain upon ambulation and at rest from days @ to @ was lower in the escitalopram versus placebo group , as was depression score at day @ ( all P @ in analyses uncorrected for multiple tests ) .


Side effects were nonsignificant except for reduced tendency to sweat and prolonged sleep in the escitalopram group .


No other between-group differences were observed .


Escitalopram did not reduce pain upon ambulation @ h after TKA in high pain catastrophizing patients .


Future studies on optimal timing , dose , and duration of selective serotonin reuptake inhibitor treatment might be warranted .


To evaluate the effects of almost continuous skin-to-skin contact ( SSC ) on salivary cortisol , parental stress , parental depression , and breastfeeding .


This is a randomised study engaging families of late preterm infants ( @-@ weeks gestation ) .


Salivary cortisol reactivity was measured in infants during a nappy change at one month corrected age , and in infants and mothers during still-face at four month corrected age .


Both parents completed the Swedish Parenthood Stress Questionnaire ( SPSQ ) at one month and the Edinburgh Postnatal Depression Scale ( EPDS ) at one and four months .


Ainsworth 's sensitivity scale was used to control for parental sensitivity .


Thirty-seven families from two different neonatal care units in Sweden , randomised to either almost continuous SSC or standard care ( SC ) .


Infants randomised to SSC had a lower salivary cortisol reactivity at one month ( p = @ ) .


There was a correlation between the mothers ' and the preterm infants ' salivary cortisol levels at four months in the SSC group ( = @ , p = @ ) , but not in the SC group ( = @ , p = @ ) .


Fathers in SSC scored lower on the SPSQ sub-scale spouse relationship problems compared to fathers in SC ( p < @ ) .


Almost continuous SSC decreases infants ' cortisol reactivity in response to handling , improves the concordance between mothers ' and infants ' salivary cortisol levels , and decreases fathers ' experiences of spouse relationship problems .


The purpose of this study was to evaluate the influence of the guanine nucleotide-binding proteins ( G-proteins ) , beta-@ subunit ( GNB@ ) genotype on the effectiveness of a fixed-dose combination of isosorbide dinitrate and hydralazine ( FDC I/H ) in A-HeFT ( African American Heart Failure Trial ) .


GNB@ plays a role in alpha@-adrenergic signaling .


A polymorphism ( C@T ) exists , and the T allele is linked to enhanced alpha-adrenergic tone and is more prevalent in African Americans .


A total of @ subjects enrolled in the genetic substudy ( GRAHF -LSB- Genetic Risk Assessment of Heart Failure in African Americans -RSB- ) were genotyped for the C@T polymorphism .


The impact of FDC I/H on a composite score ( CS ) that incorporated death , hospital stay for heart failure , and change in quality of life ( QoL ) and on event-free survival were assessed in GNB@ genotype subsets .


The GRAHF cohort was @ % male , @ % ischemic , @ % New York Heart Association functional class III , age @ @ years , with a mean qualifying left ventricular ejection fraction of @ @ .


For GNB@ genotype , @ subjects were TT ( @ % ) , @ ( @ % ) CT , and @ ( @ % ) were CC .


In GNB@ TT subjects , FDC I/H improved the CS ( FDC I/H = @ @ ; placebo = -@ @ , p = @ ) , QoL ( FDC I/H = @ @ ; placebo = @ @ , p = @ ) , and event-free survival ( hazard ratio : @ , p = @ ) , but not in subjects with the C allele ( for CS , FDC I/H = -@ @ ; placebo = -@ @ , p = @ ; for QoL , FDC I/H = @ @ ; placebo = @ @ , p = @ ; and for event-free survival , p = @ ) .


The GNB@ TT genotype was associated with greater therapeutic effect of FDC I/H in A-HeFT .


The role of the GNB@ genotype for targeting therapy with FDC I/H deserves further study .


Chronic media otitis is a common cause of reference to ear , nose and throat clinics and the treatment is one of the health problems among ENT specialists .


Ciprofloxacin drop that is of fluoroquinolone drug class due to good treatment effect is now widely used in the treatment of chronic media otitis .


Due to the widespread use , it seems proper research on the human population has not been taken to ensure its non-toxicity in the inner ear , therefore comparison of local ciprofloxacin ototoxicity with systemic in chronic media otitis is investigated in this study .


This study was conducted as a randomized clinical trial .


Prospective methods were considered and the number of samples in the study group was @ patients that were treated with ciprofloxacin drops .


And in the control group @ patients with chronic media otitis who were treated with ciprofloxacin tablets .


The collected data was analyzed using SPSS software .


Statistical indicators of different frequencies in air conduction ( AC ) in both groups showed , there was significant improvement in hearing thresholds at frequencies of @ , @ , @ in air conduction for the group receiving drops compared to the group receiving tablet .


Based on statistical indicators in different frequencies of bone conduction in the two treated groups , there was significant difference in the two groups receiving tablets and drops only at a frequency of @ Hz that drop impact improves hearing threshold and in contrast in the group receiving tablet hearing loss was seen in the frequency of @ .


Topical ciprofloxacin is a safe and uncomplicated ototoxic drug that is an effective antibiotic used in the treatment of refractory chronic otitis those dregs such as pseudomonas aerogenusa and staphylococci resistant to methicillin are responsible for it , which in the usual doses has not harmful effects on hearing hairy cells .


The preoperative period ( prehabilitation ) may represent a more appropriate time than the postoperative period to implement an intervention .


The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer .


A parallel-arm single-blind superiority randomized controlled trial was conducted .


Seventy-seven patients were randomized to receive either prehabilitation ( n = @ ) or rehabilitation ( n = @ ) .


Both groups received a home-based intervention of moderate aerobic and resistance exercises , nutritional counseling with protein supplementation , and relaxation exercises initiated either @ weeks before surgery ( prehabilitation ) or immediately after surgery ( rehabilitation ) , and continued for @ weeks after surgery .


Patients were managed with an enhanced recovery pathway .


Primary outcome was functional exercise capacity measured using the validated @-min walk test .


Median duration of prehabilitation was @ days .


While awaiting surgery , functional walking capacity increased ( @ m ) in a higher proportion of the prehabilitation group compared with the rehabilitation group ( @ vs. @ % , adjusted P = @ ) .


Complication rates and duration of hospital stay were similar .


The difference between baseline and @-week @-min walking test was significantly higher in the prehabilitation compared with the rehabilitation group ( +@ m -LSB- SD , @ -RSB- vs. -@ m -LSB- SD , @ -RSB- ; mean difference @ m -LSB- @ % CI , @ to @ -RSB- ) .


A higher proportion of the prehabilitation group were also recovered to or above baseline exercise capacity at @ weeks compared with the rehabilitation group ( @ vs. @ % , adjusted P = @ ) .


Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program .


In low-income settings , many women and girls face activity restrictions during menses , owing to lack of affordable menstrual products .


The menstrual cup ( MC ) is a nonabsorbent reusable cup that collects menstrual blood .


We assessed the acceptability and performance of the MPower MC compared to pads or tampons among women in a low-resource setting .


We conducted a randomized two-period crossover trial at one site in Durban , South Africa , between January and November @ .


Participants aged @-@ years with regular menstrual cycles were eligible for inclusion if they had no intention of becoming pregnant , were using an effective contraceptive method , had water from the municipal system as their primary water source , and had no sexually transmitted infections .


We used a computer-generated randomization sequence to assign participants to one of two sequences of menstrual product use , with allocation concealed only from the study investigators .


Participants used each method over three menstrual cycles ( total @ months ) and were interviewed at baseline and monthly follow-up visits .


The product acceptability outcome compared product satisfaction question scores using an ordinal logistic regression model with individual random effects .


This study is registered on the South African Clinical Trials database : number DOH-@-@ .


Of @ women assessed , @ were eligible and randomly assigned to selected menstrual products .


One hundred and five women completed all follow-up visits .


By comparison to pads/tampons ( usual product used ) , the MC was rated significantly better for comfort , quality , menstrual blood collection , appearance , and preference .


Both of these comparative outcome measures , along with likelihood of continued use , recommending the product , and future purchase , increased for the MC over time .


MC acceptance in a population of novice users , many with limited experience with tampons , indicates that there is a pool of potential users in low-resource settings .


Trials of endovascular therapy for ischemic stroke have produced variable results .


We conducted this study to test whether more advanced imaging selection , recently developed devices , and earlier intervention improve outcomes .


We randomly assigned patients with ischemic stroke who were receiving @ mg of alteplase per kilogram of body weight less than @ hours after the onset of ischemic stroke either to undergo endovascular thrombectomy with the Solitaire FR ( Flow Restoration ) stent retriever or to continue receiving alteplase alone .


All the patients had occlusion of the internal carotid or middle cerebral artery and evidence of salvageable brain tissue and ischemic core of less than @ ml on computed tomographic ( CT ) perfusion imaging .


The coprimary outcomes were reperfusion at @ hours and early neurologic improvement ( @-point reduction on the National Institutes of Health Stroke Scale or a score of @ or @ at day @ ) .


Secondary outcomes included the functional score on the modified Rankin scale at @ days .


The trial was stopped early because of efficacy after @ patients had undergone randomization ( @ patients in each group ) .


The percentage of ischemic territory that had undergone reperfusion at @ hours was greater in the endovascular-therapy group than in the alteplase-only group ( median , @ % vs. @ % ; P < @ ) .


Endovascular therapy , initiated at a median of @ minutes after the onset of stroke , increased early neurologic improvement at @ days ( @ % vs. @ % , P = @ ) and improved the functional outcome at @ days , with more patients achieving functional independence ( score of @ to @ on the modified Rankin scale , @ % vs. @ % ; P = @ ) .


There were no significant differences in rates of death or symptomatic intracerebral hemorrhage .


In patients with ischemic stroke with a proximal cerebral arterial occlusion and salvageable tissue on CT perfusion imaging , early thrombectomy with the Solitaire FR stent retriever , as compared with alteplase alone , improved reperfusion , early neurologic recovery , and functional outcome .


( Funded by the Australian National Health and Medical Research Council and others ; EXTEND-IA ClinicalTrials.gov number , NCT@ , and Australian New Zealand Clinical Trials Registry number , ACTRN@ . )


The benefits of aerobic training for the main features of asthma , such as bronchial hyperresponsiveness ( BHR ) and inflammation , are poorly understood .


We investigated the effects of aerobic training on BHR ( primary outcome ) , serum inflammatory cytokines ( secondary outcome ) , clinical control and asthma quality of life ( Asthma Quality of Life Questionnaire ( AQLQ ) ) ( tertiary outcomes ) .


Fifty-eight patients were randomly assigned to either the control group ( CG ) or the aerobic training group ( TG ) .


Patients in the CG ( educational programme + breathing exercises ( sham ) ) and the TG ( same as the CG + aerobic training ) were followed for @months .


BHR , serum cytokine , clinical control , AQLQ , induced sputum and fractional exhaled nitric oxide ( FeNO ) were evaluated before and after the intervention .


After @weeks , @ patients ( @ CG/@ TG ) completed the study and were analysed .


The TG improved in BHR by @ doubling dose ( dd ) ( @ % CI @ to @ dd ) , and they experienced reduced interleukin @ ( IL-@ ) and monocyte chemoattractant protein @ ( MCP-@ ) and improved AQLQ and asthma exacerbation ( p < @ ) .


No effects were seen for IL-@ , IL-@ , IL-@ , sputum cellularity , FeNO or Asthma Control Questionnaire @ ( ACQ-@ ; p > @ ) .


A within-group difference was found in the ACQ-@ for patients with non-well-controlled asthma and in sputum eosinophil and FeNO in patients in the TG who had worse airway inflammation .


Aerobic training reduced BHR and serum proinflammatory cytokines and improved quality of life and asthma exacerbation in patients with moderate or severe asthma .


These results suggest that adding exercise as an adjunct therapy to pharmacological treatment could improve the main features of asthma .


Biochemical failure ( BF ) after radiation therapy is defined on the basis of a rising prostate-specific antigen ( PSA ) level ( A@ failure ) or any event that prompts the initiation of salvage androgen-deprivation therapy without PSA failure ( A@ ) .


It was hypothesized that A@ failure may have a different prognosis .


Data for @ eligible patients from Radiation Therapy Oncology Group ( RTOG ) @ and RTOG @ were analyzed .


BF was defined according to the @ American Society for Therapeutic Radiology and Oncology consensus definition as A@ for PSA failure or as A@ for the start of salvage hormone therapy before @ consecutive PSA rises .


Rates of all-cause mortality ( hazard ratio -LSB- HR -RSB- , @ ; @ % confidence interval -LSB- CI -RSB- , @-@ @ ; P < @ ) and distant metastasis ( DM ; HR , @ ; @ % CI , @-@ @ ; P < @ ) were greater with A@ failure .


The @-year overall survival ( OS ) rates were @ % and @ % for A@ and A@ , respectively ( P < @ ) , and the DM rates were @ % and @ % , respectively ( P < @ ) .


The DM rate was greater at @ years for A@ patients with DM as the first sign of failure versus patients with other A@ failures ( @ % vs @ % , P < @ ) , and this also correlated with worse OS at @ years : @ % for A@ failure without DM and @ % with DM ( P < @ ) .


After the removal of patients with DM , the difference between A@ and A@ BF persisted for OS ( P = @ ) but not for DM ( P = @ ) CONCLUSIONS : These results suggest that patients with rising PSA levels alone have less risk than those with A@ failures ; although DM was the largest contributor of adverse risk to A@ failure , it did not account for all excess risk in A@ failure .


The purpose of this study was to evaluate the efficacy of personalized normative feedback ( PNF ) on college student alcohol-related risky sexual behavior ( RSB ) .


In a randomized controlled trial , @ ( @ % female ) sexually active college students were stratified by gender and level of drinking and randomly assigned to an alcohol-only intervention , an alcohol-related RSB-only intervention , a combined alcohol and alcohol-related RSB intervention , or control .


All assessment and intervention procedures were Web-based .


Results indicated a significant reduction in drinking outcomes for the alcohol only and the combined alcohol and alcohol-related RSB interventions relative to control .


Findings further demonstrated a significant reduction in alcohol-related RSB outcomes for the alcohol-related RSB only and the combined alcohol and alcohol-related RSB interventions relative to control .


There were no significant intervention effects on alcohol-related negative consequences .


These findings demonstrate that the combined alcohol and alcohol-related RSB intervention was the only intervention successful at reducing both drinking and alcohol-related RSB outcomes relative to control .


There were no significant differences when comparing the combined alcohol and alcohol-related RSB intervention to the alcohol-only intervention or the alcohol-related RSB-only intervention .


Finally , results suggested that the intervention effects on high-risk behaviors were mediated by reductions in descriptive normative perceptions .


These findings demonstrate that PNF specific to drinking in sexual situations was needed to reduce alcohol-related RSB .


Furthermore , this study highlights the potential utility of a brief intervention that can be delivered via the Internet to reduce high-risk drinking and alcohol-related RSB among college students .


There is increasing interest in the earlier detection of , and intervention in , patients at highest risk of developing chronic obstructive pulmonary disease ( COPD ) .


The objective of this research was to develop and validate a risk prediction model for general practitioner ( GP ) - recorded diagnosis of COPD .


We used data from @ Scottish GP practices ; two-thirds were randomly allocated to a derivation cohort and the other third to a validation cohort .


We included patients aged @-@ years at the cohort entry date , and excluded patients with a recorded diagnosis of COPD prior to the entry date and with missing data on smoking status .


There were @,@ patients in the derivation cohort and @,@ in the validation cohort .


The incidence of COPD in the total cohort was @ / @,@ patient-years of follow-up ( @ % confidence interval ( CI ) , @-@ @ ) .


In the derivation cohort , the COPD risk for ever - versus never-smokers was substantially higher in women ( hazard ratio ( HR ) = @ , @ % CI , @-@ @ ) than in men ( HR = @ , @ % CI , @-@ @ ) .


Other risk factors for both sexes were level of deprivation and a previously recorded asthma diagnosis .


In the validation cohort , the model discriminated well between patients who did and those who did not develop COPD : area under the receiver operating characteristics curve = @ ( @ % CI , @-@ @ ) for females and @ ( @ % CI , @-@ @ ) for males .


We have developed and validated the first risk prediction model for COPD , which has the major advantage of being populated entirely by routinely collected data and consequently may be used for clinical practice .


Bacillus Calmette-Gurin ( BCG ) seems to have beneficial nonspecific effects ; early BCG vaccination of low-birth-weight ( LBW ) newborns reduces neonatal mortality by > @ % due to prevention of primarily septicemia and pneumonia .


Within a randomized trial in LBW infants in Guinea-Bissau of early BCG vs the usual postponed BCG , a subgroup was bled @ weeks after randomization .


Levels of interleukin ( IL ) -@ , IL-@ , IL-@ , IL-@ , IL-@ , interferon ( IFN ) - and tumor necrosis factor ( TNF ) - were measured from whole-blood assays stimulated with innate agonists to Toll-like receptor ( TLR ) -@ , -@ or -@ / @ , or purified protein derivative ( PPD ) .


Among @ infants , BCG significantly increased the in vitro cytokine responses to purified protein derivative of Mycobacterium tuberculosis ( PPD ) , as expected .


BCG was also associated with increased responses to heterologous innate stimulation , particularly of the cytokines IL-@ , IL-@ , TNF - , and IFN - .


Four weeks after immunization , BCG-vaccinated infants have a significantly increased production of cytokines upon heterologous challenge , particularly T helper cell type @ polarizing and typically monocyte-derived pro-inflammatory cytokines .


BCG may accelerate the development of the neonatal immune system , mediating comprehensive protection against infections and mortality .


The aim of the prospective Homburg Cream and Sugar study was to analyze the role of fasting and postprandial serum triglycerides ( TG ) as risk modifiers in patients with coronary artery disease ( CAD ) .


A sequential oral triglyceride and glucose tolerance test was developed to obtain standardized measurements of postprandial TG kinetics and glucose in @ consecutive patients with stable CAD confirmed by angiography ( @ % were treated with a statin ) .


Fasting and postprandial TG predicted the primary outcome measure of cardiovascular death and hospitalizations after @ months follow-up ( fasting TG > @ vs. < @ mg/dl : Hazard ratio ( HR ) @ , @ % confidence interval ( CI ) @-@ @ , p = @ ; area under the curve > @ vs. < @ mg/dl/@ hr : HR @ , @ % CI @-@ @ , p = @ ) .


Parameters of the postprandial TG increase did not improve risk prediction compared to fasting TG .


The number of cardiovascular deaths and myocardial infarctions was higher in the upper tertile of fasting TG ( HR @ , @ % - CI @-@ @ , p = @ ) .


Risk prediction by TG was independent of traditional risk factors , medication , glucose metabolism , LDL - and HDL-cholesterol .


Total cholesterol , LDL - and HDL-cholesterol concentrations were not associated with the primary outcome .


Fasting serum triglycerides > @ mg/dl independently predict cardiovascular events in patients with coronary artery disease on guideline-recommended medication .


Assessment of postprandial TG does not improve risk prediction compared to fasting TG in these patients .


We have examined the effects of gabapentin ( GBP ) on stress-related changes of cortisol and catecholamines in patients who underwent hysterectomy because of uterine fibrinoids .


Additionally , we have observed the effect of GBP on the immune status in the acute stress response to surgery .


Sixty patients scheduled for an abdominal hysterectomy were randomly assigned to the GBP administration @h before surgery ( n = @ pts ) , or to the placebo group ( n = @ pts ) .


Blood samples were collected before and @h after the surgery .


The intensity of pain was assessed by a visual analogue scale ( VAS ) every @h at rest .


Immunomodulatory effects of GBP were determined by flow cytometry .


We followed the total proportion of CD@ ( + ) lymphocytes , CD@ ( + ) CD@ ( + ) , CD@ ( + ) CD@ ( + ) , CD@ ( + ) B lymphocytes , CD@ ( + ) CD@ ( + ) CD@ ( - ) NK cells and CD@ ( + ) CD@ ( + ) CD@ ( + ) NKT cells before and @h after hysterectomy .


The plasma cortisol and catecholamines concentration was used to estimate the level of the stress response .


VAS pain score at rest was significantly lower in the GBP group than in the placebo group ( P = @ ) .


Application of GBP significantly decreased the plasma cortisol level @h after the operation in comparison to the placebo group ( P < @,@ ) .


We found significant positive correlation between the VAS pain score and concentration of cortisol in all patients ( P = @ ) .


GBP reduced the concentration of catecholamines ( p < @ ) .


The proportion of CD@ ( + ) ( P = @ ) and CD@ ( + ) CD@ ( + ) cells ( P = @ ) was significantly lower in the GBP group @h after operation , while the contribution of CD@ ( + ) ( P = @ ) was significantly higher .


Preoperative administration of GBP reduced the pain scores at rest in patients at @ , @ and @h after abdominal hysterectomy .


Additionally , GBP reduced the stress response and changed immune parameters in the reaction to surgery .


The aim of the current study was to directly investigate whether active gas suction reduces intraperitoneal residual carbon dioxide and to analyze the effect of active gas suction on postoperative pain after laparoscopic cholecystectomy .


This prospective , randomized clinical study included patients between @ and @ years of age with gallbladder disease who were eligible for elective laparoscopic cholecystectomy .


Patients were allocated into either the natural evacuation group ( NE group ) or the active suction group ( AS group ) .


In the AS group , active suction was applied by inserting the laparoscopic suction irrigation device through a @-mm trocar for @ seconds at the end of surgery .


A chest X-ray was taken at postoperative Day @ , and the residual intraabdominal gas volume was measured .


Perioperative data including pain score and analgesic requirement were collected .


Thirty-nine patients were allocated to the NE group , and @ were allocated to the AS group .


There was no statistically significant difference between the two groups in terms of demographic data and operative findings .


However , a significant difference was observed in the residual intraperitoneal gas volume , with @ mL in the NE group and @ mL in the AS group ( P < @ ) .


Significant differences were also observed in the pain scores measured @ hours after surgery , on postoperative Day @ , and on postoperative Day @ .


Active gas suction is a very simple procedure that is safe and feasible .


Performing this procedure significantly decreases the residual intraperitoneal gas volume and postoperative pain after laparoscopic surgery .


The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery ( SYNTAX ) trial demonstrated that in patients with @-vessel or left main coronary artery disease , coronary artery bypass graft surgery ( CABG ) was associated with a lower rate of cardiovascular death , myocardial infarction , stroke , or repeat revascularization compared with percutaneous coronary revascularization with drug-eluting stents ( DES-PCI ) ) .


The long-term cost-effectiveness of these strategies is unknown .


Between @ and @ , @ patients with left main or @-vessel coronary artery disease were randomized to CABG ( n = @ ) or DES-PCI ( n = @ ) .


Costs were assessed from a US perspective , and health state utilities were evaluated with the EuroQOL questionnaire .


A patient-level microsimulation model based on the @-year in-trial data was used to extrapolate costs , life expectancy , and quality-adjusted life expectancy over a lifetime horizon .


Although initial procedural costs were $ @ per patient lower with CABG , total hospitalization costs were $ @ @ per patient higher .


Over the next @ years , follow-up costs were higher with DES-PCI as a result of more frequent hospitalizations , revascularization procedures , and higher medication costs .


Over a lifetime horizon , CABG remained more costly than DES-PCI , but the incremental cost-effectiveness ratio was favorable ( $ @ @ per quality-adjusted life-year gained ) and remained < $ @ @ per quality-adjusted life-year in most bootstrap replicates .


Results were consistent across a wide range of assumptions about the long-term effect of CABG versus DES-PCI on events and costs .


In patients with left main disease or a SYNTAX score @ , however , DES-PCI was economically dominant compared with CABG , although these findings were less certain .


For most patients with @-vessel or left main coronary artery disease , CABG is a clinically and economically attractive revascularization strategy compared with DES-PCI .


However , among patients with less complex disease , DES-PCI may be preferred on both clinical and economic grounds .


Circulating endothelial progenitor cells ( EPCs ) reflect endothelial repair capacity and may be a significant marker for the clinical outcomes of cardiovascular disease .


While some high-dose statin treatments may improve endothelial function , it is not known whether different statins may have similar effects on EPCs.This study aimed to investigate the potential class effects of different statin treatment including pitavastatin and atorvastatin on circulating EPCs in clinical setting .


A pilot prospective , double-blind , randomized study was conducted to evaluate the ordinary dose of pitavastatin ( @mg daily ) or atorvastatin ( @mg daily ) treatment for @weeks on circulating EPCs in patients with cardiovascular risk such as hypercholesterolemia and type @ diabetes mellitus ( T@DM ) .


Additional in vitro study was conducted to clarify the direct effects of both statins on EPCs from the patients .


A total of @ patients ( @ with T@DM ) completed the study .


While the lipid-lowering effects were similar in both treatments , the counts of circulating CD@ + KDR+EPC s were significantly increased ( from @ to @ % of gated mononuclear cells , P < @ ) only by pitavastatin treatment .


Besides , plasma asymmetric dimethylarginine level was reduced ( from @ to @ mol/L , P < @ ) by atorvastatin , and plasma vascular endothelial growth factor ( VEGF ) level was increased ( from @ to @ pg/mL , P < @ ) by pitavastatin .


In the in vitro study , while both statins increased endothelial nitric oxide synthase ( eNOS ) expression , only pitavastatin increased the phosphorylation of eNOS in EPCs .


Pitavastatin but not atorvastatin ameliorated the adhesion ability of early EPCs and the migration and tube formation capacities of late EPCs .


While both statins similarly reduced plasma lipids , only pitavastatin increased plasma VEGF level and circulating EPCs in high-risk patients , which is probably related to the differential pleiotropic effects of different statins .


Heart rate variability ( HRV ) has been used as a measure of stress and mental strain in surgeons .


Low HRV has been associated with death and increased risk of cardiac events in the general population .


The aim of this study was to clarify the effect of a @-hour night shift on surgeons ' HRV .


Surgeons were monitored prospectively with an ambulatory electrocardiography device for @ consecutive hours , beginning on a precall day and continuing through an on-call ( @-h shift ) day .


We measured HRV by frequency domain parameters .


We included @ surgeons in our analysis .


The median pulse rate was decreased precall ( median @ , interquartile range -LSB- IQR -RSB- @-@ beats per minute -LSB- bpm -RSB- ) compared with on call ( median @ , IQR @-@ bpm , p < @ ) .


Increased high-frequency ( HF ) activity was found precall ( median @ , IQR @-@ ms@ ) compared with on call ( median @ , IQR @-@ ms@ , p < @ ) .


The low-frequency : high-frequency ( LF : HF ) ratio was lower precall ( median @ , IQR @-@ @ ) than on call ( median @ , IQR @-@ @ , p < @ ) .


We found no correlation between the LF : HF ratio and performance in laparoscopic simulation .


Surgeons working night shifts had a significant decrease in HRV and a significant increase in pulse rate , representing sympathetic dominance in the autonomic nervous system .


Adenosine is the first-line medication in patients with paroxysmal supraventricular tachycardia .


Because it is cleared so rapidly from the circulation , recurrence of paroxysmal supraventricular tachycardia after initial successful conversion may occur .


This study was conducted to evaluate the role of oral verapamil administration to control early recurrences of paroxysmal supraventricular tachycardia after adenosine infusion .


Patients with acute paroxysmal supraventricular tachycardia and no contraindications for adenosine or verapamil treatment were included in study .


All patients received an adenosine protocol ( @ mg rapid bolus intravenous injection followed by two repeated doses of @ mg if necessary ) .


Patients in the adenosine-only group did not received any other medications but patients in the adenosine/verapamil group received @ mg verapamil orally immediately after converting the rhythm to sinus rhythm .


All patients were followed up for @ h in the acute care area of the emergency department under continuous cardiac monitoring .


A total of @ patients were assessed for eligibility and @ patients were randomized into two groups ( adenosine only versus adenosine/verapamil ) .


There was no statistically significant difference in paroxysmal supraventricular tachycardia recurrence rate between the two groups in the first @ min after treatment .


Recurrence rate was statistically significantly lower in the adenosine/verapamil group than in the adenosine-only group between @ and @ min after treatment and thereafter .


Two patients in the adenosine-only group experienced flushing and one patient in the adenosine/verapamil group experienced decreased systolic blood pressure .


Oral verapamil can decrease paroxysmal supraventricular tachycardia recurrence after successful control with intravenous adenosine .


In Parkinson 's Disease ( PD ) , cognitive dysfunctions which can reduce patients ' quality of life occur frequently .


Data on non-pharmacological intervention effects on cognitive functions in patients with PD are rare .


The aim of this study was to examine the effects of different cognitive group trainings ( structured vs. unstructured ) on cognition , depression , and quality of life in non-demented PD patients .


In this randomized controlled trial , @ non-demented patients with PD according to UK Brain Bank criteria ( Hoehn & Yahr I-III ) were allocated to one of two cognitive multi-component treatments ( `` NEUROvitalis '' , a structured training , or the unstructured training `` Mentally fit '' with randomly assembled cognitive tasks , each including @ group-sessions @min over @ weeks ) or a waiting list control group ( CG ) .


A neuropsychological test battery was performed before and after the training .


Compared to the CG , patients from the `` NEUROvitalis '' group improved in short-term memory ( word list learning `` Memo '' : p < @ ) and working memory ( digit span reverse from `` DemTect '' : p < @ ) , whereas depression scores where reduced in the `` Mentally fit '' group ( Beck Depression Inventory-II : p < @ ) .


The `` NEUROvitalis '' group improved significantly more in working memory than the `` Mentally fit '' group ( DemTect : p < @ ) .


Cognitive and affective functions can be improved by cognitive trainings in PD patients .


Specific effects ( e.g. on memory and working memory versus depression ) seem to be dependent on the type of training .


Further research is needed to define long-term effects and the efficacy in PD patients with different extent of cognitive and neuropsychiatric symptoms .


Stem cell therapy ( SCT ) is used for immunosuppression minimization in renal transplantation ( RT ) .


We carried out a prospective study to evaluate the benefits of co-infusion of donor adipose-derived mesenchymal stem cells ( AD-MSC ) + hematopoietic stem cells ( HSC ) in living donor RT ( LDRT ) under non-myeloablative conditioning .


In a demographically balanced three-armed LDRT trial with @ patients in each arm , group-@ received portal co-infusion of AD-MSC + HSC , group-@ received HSC and group-@ received no SCT .


Lymphoid irradiation and anti-thyroglobulin were used for conditioning .


SCT was safe .


At @ and @ years post-transplant , patient survival was @ % and @ % in group-@ , @ % and @ % in group-@ , and @ % and @ % in group-@ , death-censored graft survival was @ % and @ % in group-@ , @ % and @ % in group-@ , and @ % and @ % in group-@ with mean serum creatinine ( mg/dL ) of @ and @ in group-@ , @ and @ in group-@ , and @ and @ and in group-@ .


Rejection episodes and immunosuppression requirement were lesser in SCT groups versus controls with best results noted in group-@ .


Coinfusion of donor AD-MSC + HSC in portal circulation pre-transplant under non-myeloablative conditioning is safe and effective for immunosuppression minimization in LDRT .


We examined the effects of doxazosin , finasteride and combined therapy in men with lower urinary tract symptoms associated with benign prostatic hyperplasia on sexual function , as assessed by the Brief Male Sexual Function Inventory during @ years .


The MTOPS ( Medical Therapy of Prostatic Symptoms ) study was a multicenter , randomized , double-blind , placebo controlled clinical trial with a primary outcome of time to benign prostatic hyperplasia progression .


Change in sexual function was a secondary outcome .


We analyzed the records of@ ,@ men enrolled in the study who completed the inventory at baseline and atleast once during followup .


In men enrolled in MTOPS sexual function decreased with time .


Men assigned to finasteride and combined therapy experienced overall statistically significant but slight worsening of ejaculatory function compared with men on placebo .


Men assigned to combined therapy also experienced significant worsening in erectile function and sexual problem assessment .


There was no significant difference in changes in any inventory domain in men assigned to doxazosin alone compared to placebo .


This study significantly extends understanding of the effects of long-term treatment with these drugs on sexual function in men with lower urinary tract symptoms associated with benign prostatic hyperplasia .


Treatment with finasteride or combined therapy was associated with worsening sexual function while treatment with doxazosin alone was associated with minimal negative impact , if any .


Physicians should discuss with their patients the possible long-term effects of these drugs for lower urinary tract symptoms associated with benign prostatic hyperplasia on sexual function .


We developed a unique remote monitoring and control diabetes management system ( MDRS ) supporting the use of an artificial pancreas ( AP ) at home .


In this study , we aimed at assessing the efficacy and safety of the MDRS and its ability to prevent or shorten nocturnal hypoglycemia episodes without the use of an AP , as well as evaluating parental attitudes toward the use of such a system in the future .


This was a prospective , case control , randomized study .


Eighteen patients treated nightly over a @-week period by the MDRS were compared with @ patients treated with sensor-augmented pump ( SAP ) therapy .


We analyzed the performance of the MDRS , the number and duration of hypo - or hyperglycemia episodes , and the efficacy of the MDRS in detecting them .


Parents of the study participants completed the hypoglycemia fear survey , attitude , and satisfaction questionnaires .


The MDRS allows continuous monitoring of the patients using it .


Without the use of an AP , the MDRS did not significantly prevent nocturnal hypoglycemia episodes .


The patients and their parents found the system reliable and user-friendly .


The overall impression of the MDRS users was favorable , with a keen interest of the patients and their caregivers to use such a system in the future .


The MDRS is reliable and safe remote monitoring system for AP at-home systems .


Remote monitoring of type @ diabetes patients treated with SAP therapy is a promising and feasible task that is highly anticipated by patients and their caregivers .


To assess the efficacy of animated biofeedback and pelvic floor muscle ( PFM ) exercise in managing children with non-neuropathic underactive bladder ( UB ) .


A total of @ children with UB without underlying neuropathic disease , aged @-@ years , were included in this study .


They were randomly divided into @ equal treatment groups comprising standard urotherapy ( hydration , scheduled voiding , toilet training , and diet ) with ( group A ) or without ( group B ) animated biofeedback and PFM exercise .


The follow-up period for each participant was @ year .


A complete voiding and bowel habit diary was recorded by participants ' parents before and after @ evaluations .


In addition , uroflowmetry with electromyography and bladder ultrasound were performed before , @ months , and @ year after treatment .


Results were compared between the @ cohorts .


Mean number of voiding episodes was significantly increased in group A after biofeedback therapy compared with group B with only standard urotherapy ( @ @ vs @ @ times a day ; P < @ ) .


Urinary tract infection did not relapse in @ of @ ( @ % ) and @ of @ ( @ % ) patients in groups A and B , respectively ( P < @ ) .


Postvoid residual volume and voiding time decreased considerably , whereas maximum urine flow increased significantly in group A compared with group B ( @ @ vs @ @ mL/s ; P < @ ) .


Combination of animated biofeedback and PFM exercise effectively improves sensation of bladder fullness and contractility in children with UB due to voiding dysfunction .


To compare retention rates of Super Flex ( Eagle Vision , Memphis , Tennessee , USA ; Softplug-Oasis Medical Inc , Glendora , California , USA ) vs Parasol ( Odyssey Medical , Memphis , Tennessee , USA ; Beaver Visitec International , Waltham , Massachusetts , USA ) punctal plugs .


Randomized , double-masked , interventional controlled clinical trial .


Institutional study at Hotel Dieu Hospital ( Queen 's University ) of @ eyes , from patients with moderate to severe dry eye .


Each eye from eligible patients was separately randomized to receive Super Flex or Parasol punctal plugs .


The main outcome measure was plug retention at @ months .


Secondary outcome measures included objective tests of Schirmer I ( mm ) , tear meniscus height ( mm ) , tear break-up time ( s ) , inferior fluorescein corneal staining ( National Eye Institute -LSB- NEI -RSB- scale ) , and average lissamine green conjunctival staining ( NEI scale ) .


Punctal plug retention was significantly different at @ months ( P = @ ) .


Sixty-eight percent of Parasol plugs were retained compared to @ % of Super Flex plugs .


Parasol plugs required less frequent artificial tear use at @ months ( P = @ ) .


There was a statistically significant improvement in all secondary outcome measures ( Schirmer , tear meniscus height , tear break-up time , fluorescein corneal staining ) at @ months within plug groups except conjunctival staining .


There were no additional significant differences between groups and no plug complications reported .


Punctal plugs improve symptoms of moderate to severe dry eye ; however , retention rates differ significantly .


These data will allow us to guide patient decision making for the safe and effective treatment of punctal plugs for moderate to severe dry eye .


Little is known about adolescent relationship abuse ( ARA ) and related sexual and reproductive health among females who either identify as lesbian or bisexual or engage in sexual behavior with female partners ( i.e. , sexual minority girls -LSB- SMGs -RSB- ) .


Baseline data were collected from @ sexually active girls ages @-@ years seeking care at eight California school-based health centers participating in a randomized controlled trial .


Associations between ARA , sexual minority status and study outcomes ( vaginal , oral , and anal sex , number and age of sex partners , contraceptive nonuse , reproductive coercion , sexually transmitted infection -LSB- STI -RSB- and pregnancy testing ) were assessed via logistic regression models for clustered survey data .


SMGs comprised @ % ( n = @ ) of the sample .


Controlling for exposure to ARA , SMGs were less likely to report recent vaginal sex ( adjusted odds ratio -LSB- AOR -RSB- , @ ; @ % confidence interval -LSB- CI -RSB- , @ -@ ) and more likely to report recent oral sex ( AOR , @ ; @ % CI , @-@ @ ) and anal sex ( AOR , @ ; @ % CI , @-@ @ ) compared with heterosexual girls .


Heterosexual girls with ARA exposure ( AOR , @ ; @ % CI , @-@ @ ) and SMGs without ARA exposure ( AOR , @ ; @ % CI , @-@ @ ) were more likely than nonabused heterosexual girls be seeking care for STI testing or treatment than heterosexual girls without recent victimization .


Findings suggest the need for attention to STI risk among all girls , but SMGs in particular .


Clinicians should be trained to assess youth for sexual contacts and sexual identity and counsel all youth on healthy relationships , consensual sex , and safer sex practices relevant to their sexual experiences .


Vancomycin is the standard first-line treatment for methicillin-resistant Staphylococcus aureus bacteremia .


However , recent consensus guidelines recommend that clinicians consider using alternative agents such as daptomycin when the vancomycin minimum inhibitory concentration is greater than @ ug/ml .


To date however , there have been no head-to-head randomized trials comparing the safety and efficacy of daptomycin and vancomycin in the treatment of such infections .


The primary aim of our study is to compare the efficacy of daptomycin versus vancomycin in the treatment of bloodstream infections due to methicillin-resistant Staphylococcus aureus isolates with high vancomycin minimum inhibitory concentrations ( greater than or equal to @ ug/ml ) in terms of reducing all-cause @-day mortality .


The study is designed as a multicenter prospective open label phase IIB pilot randomized controlled trial .


Eligible participants will be inpatients over @-years-old with a positive blood culture for methicillin-resistant Staphylococcus aureus with vancomycin minimum inhibitory concentration of greater than or equal to @ ug/ml .


Randomization into intervention or active control arms will be performed with a @:@ allocation ratio .


We aim to recruit @ participants over a period of two years .


Participants randomized to the active control arm will receive vancomycin dose-while those randomized to the intervention arm will receive daptomycin .


Participants will receive a minimum of @ days study treatment.The primary analysis will be conducted on the intention-to-treat principle .


The Fisher 's exact test will be used to compare the @-day mortality rate from index blood cultures ( primary endpoint ) between the two treatment arms , and the exact two-sided @ % confidence interval will be calculated using the Clopper and Pearson method .


Primary analysis will be conducted using a two sided alpha of @ .


If results from this pilot study suggest that daptomycin shows significant efficacy in the treatment of bloodstream infections due to methicillin-resistant Staphylococcus aureus isolates with high vancomycin minimum inhibitory concentrations , we aim to proceed with a larger scale confirmatory study .


This would help guide clinicians and inform practice guidelines on the optimal treatment for such infections .


Amyotrophic lateral sclerosis is a fatal neurodegenerative disease with few therapeutic options .


Mild obesity is associated with greater survival in patients with the disease , and calorie-dense diets increased survival in a mouse model .


We aimed to assess the safety and tolerability of two hypercaloric diets in patients with amyotrophic lateral sclerosis receiving enteral nutrition .


In this double-blind , placebo-controlled , randomised phase @ clinical trial , we enrolled adults with amyotrophic lateral sclerosis from participating centres in the USA .


Eligible participants were aged @ years or older with no history of diabetes or liver or cardiovascular disease , and who were already receiving percutaneous enteral nutrition .


We randomly assigned participants ( @:@:@ ) using a computer-generated list of random numbers to one of three dietary interventions : replacement calories using an isocaloric tube-fed diet ( control ) , a high-carbohydrate hypercaloric tube-fed diet ( HC/HC ) , or a high-fat hypercaloric tube-fed diet ( HF/HC ) .


Participants received the intervention diets for @ months and were followed up for @ months .


The primary outcomes were safety and tolerability , analysed in all patients who began their study diet .


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


Between Dec @ , @ , and Nov @ , @ , we enrolled @ participants , of whom @ started their study diet ( six in the control group , eight in the HC/HC group , and six in the HF/HC group ) .


One patient in the control group , one in the HC/HC group , and two in the HF/HC group withdrew consent before receiving the intervention .


Participants who received the HC/HC diet had a smaller total number of adverse events than did those in the other groups ( @ in the HC/HC group vs @ in the control group vs @ in the HF/HC group ; overall , p = @ ; HC/HC vs control , p = @ ) and significantly fewer serious adverse events than did those on the control diet ( none vs nine ; p = @ ) .


Fewer patients in the HC/HC group discontinued their study diet due to adverse events ( none -LSB- @ % -RSB- of eight in the HC/HC group vs three -LSB- @ % -RSB- of six in the control group ) .


During the @ month follow-up , no deaths occurred in the nine patients assigned to the HC/HC diet compared with three deaths ( @ % ) in the seven patients assigned to the control diet ( log-rank p = @ ) .


Adverse events , tolerability , deaths , and disease progression did not differ significantly between the HF/HC group and the control group .


Our results provide preliminary evidence that hypercaloric enteral nutrition is safe and tolerable in patients with amyotrophic lateral sclerosis , and support the study of nutritional interventions in larger randomised controlled trials at earlier stages of the disease .


Various laser treatments are currently available for melasma but their use remains challenging because of potential side effects .


The aim of this randomized controlled study was to compare the efficacy and safety of low-fluence Q-switch @,@ nm Nd : YAG and low-power fractional CO@ laser using a split-face design .


A total of @ female patients with symmetric melasma were enrolled to the study and each side of their face was randomly allocated to either low-fluence Q-switch @,@ nm Nd : YAG or low-power fractional CO@ laser .


They were treated every @ weeks for five consecutive sessions and followed for @ months after the last treatment session .


Response to treatment was assessed using the Melanin Index ( MI ) score , modified Melasma Area and Severity Index ( mMASI ) score , and a subjective self-assessment method .


At the @-month follow-up visit , both sides of the face had statistically significant reductions in the MI and mMASI scores compared with the first visit ( p < @ ) .


The differences between the mean MI and mMASI scores at baseline and at @-month follow-up were compared between the two treatments and results showed that the reduction of MI and mMASI score in the fractional CO@ laser-treated side was significantly more than on the Q-switch @,@ nm Nd : YAG laser-treated side ( p < @ ) .


There were no significant adverse effects with either of the laser treatments .


The present study shows that low-power fractional CO@ laser is safe and effective and can be considered as a valuable approach in the treatment of melasma .


To observe the clinical therapeutic effect of OM-@ BV ( OM-@ Broncho-Vaxom ) in children with asthma and recurrent respiratory tract infection , and the effect of OM-@ BV on human - defensins @ ( hBD-@ ) and immunoglobulin levels .


Sixty-two children with asthma and recurrent respiratory infection treated between @ January and December were divided into two groups by the randomized , double blind method : a treatment group and a control group .


With inhaling corticosteroids , the treatment group was given OM-@ BV , and the control group was given a placebo .


Clinical curative effects and adverse reactions were observed .


Serum levels of hBD-@ , IgA , IgG , IgM and urea and alanine aminotransferase ( ALT ) were measured before treatment and @ months and @ months after treatment .


Compared with the control group and before treatment , the frequency of respiratory tract infection was reduced in the treatment group @ months and @ months after treatment ( P < @ ) , and serum levels of hBD-@ , IgA and IgG in the treatment group increased significantly ( P < @ ) .


There was no significant difference in serum levels of urea , ALT and IgM between the control and treatment groups ( P > @ ) .


Mild adverse reactions occurred in @ cases in the two groups , @ cases of abdominal pain and @ cases of constipation .


OM-@ BV can improve serum levels of hBD-@ , IgA and IgG , reduce the occurrence of acute respiratory tract infection and cause mild adverse reactions , suggesting its satisfactory therapeutic effect and safety in the treatment of asthma combined with recurrent respiratory tract infection in children .


Supplementary immunisation activities with oral poliovirus vaccines ( OPVs ) are usually separated by @ week intervals ; however , shorter intervals have been used in security-compromised areas and for rapid outbreak responses .


We assessed the immunogenicity of monovalent type-@ oral poliovirus vaccine ( mOPV@ ) given at shorter than usual intervals in Karachi , Pakistan .


This was a multicentre , randomised , controlled , four-arm , open-label , non-inferiority trial done at five primary health-care centres in low-income communities in and around Karachi , Pakistan .


Eligible participants were healthy newborn babies with a birthweight of at least @ kg , for whom informed consent was provided by their parent or guardian , and lived less than @ km from the study clinic .


After receiving a birth dose of trivalent OPV , we enrolled and randomly assigned newborn babies ( @:@:@:@ ) to receive two doses of mOPV@ with an interval of @ week ( mOPV@-@ week ) , @ weeks ( mOPV@-@ weeks ) , or @ weeks ( mOPV@-@ weeks ) between doses , or two doses of bivalent OPV ( bOPV ) with an interval of @ weeks between doses ( bOPV-@ weeks ) .


We gave the first study dose of OPV at age @ weeks .


We did the randomisation with a centrally generated , computerised allocation sequence with blocks of @ ; participants ' families and study physicians could not feasibly be masked to the allocations .


Trial participants were excluded from local supplementary immunisation activities during the study period .


The primary outcome was non-inferiority ( within a @ % margin ) between groups in seroconversion to type-@ poliovirus .


The primary and safety analyses were done in the per-protocol population of infants who received all three doses of vaccine .


This trial is registered with ClinicalTrials.gov , number NCT@ , and is closed to new participants .


Between March @ , @ , and May @ , @ , we enrolled @ newborn babies , and randomly assigned @ ( @ % ) to treatment .


@ ( @ % ) of the @ babies were included in the per-protocol analysis .


Proportions of seroconversion to type-@ poliovirus were @/@ ( @ % , @ % CI @-@ ) with mOPV@-@ week , @/@ ( @ % , @-@ ) with mOPV@-@ weeks , @/@ ( @ % , @-@ ) with mOPV@-@ weeks , and @/@ ( @ % , @-@ ) with bOPV-@ weeks .


Non-inferiority was shown between groups and no significant differences were noted .


Ten participants died during the trial .


Seven of these deaths occurred during the lead-in period before randomisation ( two from diarrhoea , five from unknown causes ) .


Three infants died from sepsis after random assignment .


No deaths were attributed to the procedures or vaccines .


Additionally , we noted no events of vaccine-associated paralysis .


We identified no significant differences in responses to mOPV@ given with shorter intervals between doses than with the standard @ week intervals .


The short-interval strategy could be particularly beneficial when temporary windows of opportunity for safe access can be granted in areas of conflict -- eg , during cease-fire periods .


In such situations , we recommend shortening the interval between OPV doses to @ days .


To evaluate the cardioprotection of remote ischemic postconditioning ( RIPostC ) in patients with acute ST-segment elevation myocardial infarction ( STEMI ) who underwent primary percutaneous coronary intervention ( PCI ) .


Forty-six STEMI patients undergoing primary PCI at Peking University Third Hospital from January to April @ were randomized to RIPostC group ( n = @ ) and control group ( n = @ ) .


The RIPostC protocol was started within @ min after reflow by thrombus aspiration or balloon inflation and consisted of @ cycles of @ min/@ min ischemia/reperfusion by cuff inflation/deflation of the lower left limb .


The enzymatic infarct size , rate of complete ST segment resolution , corrected thrombolysis in myocardial infarction ( TIMI ) frame count ( CTFC ) in infarct-related artery ( IRA ) and plasma levels of malondialdehyde ( MDA ) , endothelin-@ ( ET-@ ) , tumor necrosis factor ( TNF ) of the two groups were compared .


There was no significant difference in enzymatic infarct size between the two groups ( P > @ ) .


The rate of complete ST-segment resolution was significantly higher in RIPostC group than in control group ( @ % vs. @ % , P = @ ) .


There was a trend toward lower CTFC in RIPostC group than that in control group , but the difference was not statistically significant ( @ @ vs. @ @ , P = @ ) .


However , in the subgroup of anterior wall myocardial infarction CTFC in RIPostC group was significantly lower , compared with control group ( @ vs. @ , P = @ ) .


There were lower plasma levels of MDA,ET-@ , TNF in RIPostC group than in control group at different time points after primary PCI ( P < @ ) .


In STEMI patients undergoing primary PCI , RIPostC may improve myocardial perfusion and attenuate ischemia reperfusion injury with the underlying mechanisms involving reduction of oxidative stress , protection of endothelial function and inhibition of inflammatory response .


Long-term therapy of hypertension may influence mineral status in patients .


However , drug-micronutrient interactions are largely unexplored in practice .


This study intended to evaluate the effect of hypotensive monotherapy on iron , zinc , and copper levels , as well as on selected biochemical parameters , in newly diagnosed patients with hypertension , and to assess the influence of diet with optimal mineral levels on the mineral balance in these subjects .


Forty-five patients , aged @-@ years with diagnosed essential hypertension , beginning monotherapy treatment with diuretics , calcium antagonists , angiotensin-converting enzyme inhibitors , and - blockers , were employed .


Over three months , the patients underwent monotherapy ( stage II ) .


Next , patients were randomly divided into a diet group ( of @ subjects ) and a control group ( of @ subjects ) .


In this stage , which lasted one month , patients were given the same drug but also followed an optimal mineral-content diet ( for the diet group ) , or else continued drug use without any change in diet ( for control group ) ( stage III ) .


Lipids , glucose , ceruloplasmin , and ferritin -- along with superoxide dismutase and catalase activities -- were assayed in serum .


Iron , zinc , and copper concentrations in serum , erythrocytes , and urine were determined using flame atomic absorption spectrometry .


Blood pressure was measured .


Diet intake was monitored at each stage .


It was found that the zinc level in serum significantly decreased following treatment , and that the use of the optimal-mineral diet during antihypertensive treatment markedly increased zinc serum concentration .


After treatment , a significant increase in zinc excretion in the urine was observed .


Glucose levels in the serum of patients in stage II were significantly higher than in the baseline .


In patients in the diet group , glucose levels markedly decreased .


Moreover , a negative correlation was found between serum glucose and zinc levels in patients .


Antihypertensive treatments should include monitoring of mineral status .


It seems that the zinc balance of patients on long-term therapy with hypotensive drugs may benefit from an optimal-mineral diet .


Aim of the present study was to compare the effects of highly branched cyclic dextrin ( HBCD ) drink with a glucose-based control drink on immunoendocrine responses to endurance exercise .


Using a randomized , double-blind placebo-controlled cross-over design , seven male triathletes participated in two duathlon races separated by one month , consisting of @ km of running , @ km of cycling and @ km of running .


In the first race , four athletes consumed the HBCD-based drink and three athletes consumed the glucose-based drink .


In the second race , three athletes consumed the HBCD-based drink and four athletes consumed the glucose-based drink .


We collected blood and urine samples before and after the races to analyze leukocyte count and concentrations of hormones and cytokines .


Lymphocyte and neutrophil counts increased significantly after exercise in both trials ( P < @ ) , but were not significantly different between the trials .


Plasma noradrenalin concentration increased significantly ( P < @ ) during exercise in the glucose trial , but not in the HBCD trial .


Plasma concentrations of interleukin ( IL ) -@ and IL-@ increased significantly during exercise in both trials ( P < @ ) but were not significantly different between the trials .


Post-race urinary IL-@ , IL-@ and IL-@p@ concentrations were significantly lower in the HBCD trial compared with the glucose trial ( P < @ ) , although the plasma concentrations of these cytokines were not significantly different between both trials .


These results suggest that the HBCD-based drink may attenuate the stress hormone response , and reduce the urinary cytokine levels following exhaustive exercise .


To promote well-being and health behaviors among adolescents , @ interventions were implemented at @ secondary schools .


Adolescents in the E-health@Uth group received Web-based tailored messages focused on their health behaviors and well-being .


Adolescents in the E-health@Uth and consultation group received the same tailored messages , but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems .


This study evaluated the effect of E-health@Uth and E-health@Uth and consultation on well-being ( ie , mental health status and health-related quality of life ) and health behaviors ( ie , alcohol and drug use , smoking , safe sex ) .


A cluster randomized controlled trial was conducted among third - and fourth-year secondary school students ( mean age @ , SD @ ) .


School classes ( clusters ) were randomly assigned to ( @ ) E-health@Uth group , ( @ ) E-health@Uth and consultation group , or ( @ ) control group ( ie , care as usual ) .


Adolescents completed a questionnaire at baseline and at @-month follow-up assessing alcohol consumption , smoking , drug use , condom use , mental health via the Strengths and Difficulties Questionnaire ( SDQ ) and the Youth Self Report ( YSR ; only measured at follow-up ) , and health-related quality of life .


Multilevel logistic , ordinal , and linear regression analyses were used to reveal differences in health behavior and well-being between the intervention groups and the control group at follow-up .


Subsequently , it was explored whether demographics moderated the effects .


Data from @ adolescents were analyzed .


Compared to the control intervention , the E-health@Uth intervention , as a standalone intervention , showed minor positive results in health-related quality of life ( B = @ , @ % CI @-@ @ ) and condom use during intercourse among adolescents of Dutch ethnicity ( OR @ , @ % CI @-@ @ ) not replicated in the E-health@Uth and consultation group .


The E-health@Uth and consultation intervention showed minor positive results in the mental health status of adolescents ( SDQ : B = -@ , @ % CI -@ to -@ ) , but a negative effect on drug use among boys ( OR @ , @ % CI @-@ @ ) .


In the subgroup of adolescents who were at risk of mental health problems at baseline ( and referred for a consultation with the nurse ) , the E-health@Uth and consultation group showed minor to moderate positive results in mental health status ( SDQ : B = -@ , @ % CI -@ to -@ ; YSR : B = -@ , @ % CI -@ to -@ ) and health-related quality of life ( B = @ , @ % CI @-@ @ ) at follow-up compared to adolescents in the control group who were at risk of mental health problems at baseline .


Findings from this study support the use of the E-health@Uth and consultation intervention in promoting the well-being of adolescents at risk of mental health problems .


Future research is needed to further evaluate the effects of the consultation as a standalone intervention , and the dual approach of further tailored eHealth messages and a consultation .


Examine psychological and behavioral predictors of @-year weight loss maintenance in women .


Participants were @ women in a @-year randomized controlled trial on weight management with a @-year follow-up .


Signal detection analyses identified behavioral and psychological variables that best predicted @ % and @ % weight loss at @ years .


Women with better body image were more likely to have lost @ % weight at @ years ( P < @ ) .


Exercise intrinsic motivation had a partial compensatory effect , in that women with poor body image but higher motivation were more likely to maintain weight loss than women with poor body image and lower motivation ( P < @ ) .


Women with high exercise autonomous motivation were three times more likely to have lost @ % weight than were those with lower autonomous motivation ( P < @ ) .


Among women with lower autonomous motivation , perceiving fewer exercise barriers was somewhat compensatory : these women were more likely to maintain weight loss than women with lower autonomy but more perceived barriers ( P < @ ) .


In overweight women , improving body image and increasing autonomous and intrinsic motivation for exercise likely promotes clinically significant long-term weight loss maintenance .


Decreasing perceived exercise barriers is another promising intervention target .


The purpose of this study was to investigate the effectiveness of an orientated tour in reduction of children 's anxiety before elective surgeries .


Anxiety is a common emotional reaction following surgical experience among children that can result in increasing postoperative pain , increasing analgesic use .


The study was a blinded clinical trial ; @ children were randomized into two groups ( intervention and control ) .


All children received standard preoperative care , while those in the intervention group also received an orientated tour with their mother of the operation room the night before the surgery was carried out .


The children 's anxiety was assessed by the `` Child Drawing : Hospital '' instrument and vital signs measured before and after intervention in both groups .


Data were analyzed with SPSS ver .


@ software .


Anxiety decreased in the intervention group following implementation of the orientated tour ( P = @ ) .


Following the orientated tour in the intervention group , respiration rate ( P < @ ) and blood pressure ( P < @ systolic and diastolic ) were significantly reduced , while heart rate and body temperature were not significantly different to pre-intervention .


Comparison changes of vital signs following the orientated tour between the two groups was not significant .


Implementation of an orientated tour of the preoperative room can decrease anxiety levels in children before elective surgeries , but it has no clinical effect on vital signs .


To compare the outcome of cross-arch prostheses supported either by supershort ( @ mm ) or long ( @ mm ) implants , placed flapless and immediately restored with metal-resin screw-retained cross-arch prostheses .


Thirty patients with edentulous ( or to be rendered edentulous ) mandibles and @ with edentulous maxillas , who had sufficient bone to allow the placement of four and six implants respectively , which were at least @ mm-long , were randomised according to a parallel group design into @ equal groups , where they received either @ mm or @ mm-long implants at one centre .


Implants with a diameter of @ mm , were to be placed flapless with an insertion torque of at least @ Ncm .


Mandibles received four implants between the mental foramina .


Implants were to be immediately loaded with metal-resin-definitive prostheses on the same day of implant placement .


Patients were followed up to @ year after loading and the outcome measures were : prosthesis and implant failures , complications , and peri-implant marginal bone level changes .


No patients dropped-out .


Two prostheses were remade , one on short maxillary implants and one on long mandibular implants .


Two @ mm maxillary implants which did not achieve @ Ncm torque in soft bone of one patient , but were immediately loaded anyway , failed after @ weeks compared to one mandibular @ mm-long implant that failed after @ days .


Two complications occurred in each group .


There were no statistically significant differences for prosthesis failures , implant failures and complications .


Patients with mandibular short implants lost on average @ mm of peri-implant bone at @ year and patients with long mandibular implants lost @ mm .


Patients with short maxillary implants lost on average @ mm of peri-implant bone at @ year and patients with long maxillary implants lost @ mm .


Short implants showed less bone loss when compared to long implants and the differences up to @ year were statistically significant both in maxillae ( mean difference = @ mm , @ % CI @ to @ , P = @ ) and in mandibles ( mean difference = @ mm , @ % CI @ to @ , P = @ ) .


Flapless-placed @ mm-long implants achieved similar results as @ mm-long implants when supporting immediately loaded cross-arch prostheses both in maxillae and mandibles up to @ year after loading .


These preliminary results must be confirmed by other trials , and @ - to @-year post-loading data is necessary before making reliable recommendations .


Intense focused ultrasound ( IFUS ) has been used successfully for skin tightening .


To investigate the efficacy of IFUS in treating enlarged pores and to evaluate changes in skin elasticity and sebum production following IFUS .


Twenty-two subjects with enlarged pores were randomized to receive a single treatment with IFUS using @-mm transducer on one side of the face , and @-mm transducer on the other .


OBJECTIVE clinical assessments were made by blinded photographic evaluation .


Subjective satisfaction and adverse effects were evaluated .


Measurements of elasticity and sebum were performed at baseline , @ and @ weeks post-treatment .


Physicians ' evaluation showed clinical pore improvements in @ % and @ % of the IFUS-treated sites using @-mm and @-mm transducer , respectively .


The mean improvement scores were @ and @ for @-mm and @-mm transducer , respectively , with no statistical differences .


Cutometer measurement demonstrated a significant improvement in skin elasticity .


Sebum level showed a reduction without statistical significance .


There was a positive correlation between improvement in elasticity and pore improvement grades .


All treatments were well tolerated without significant side effects .


IFUS using @-mm or @-mm transducer was safe and effective for reducing enlarged pores in Asian skin with an improvement in skin elasticity .


To evaluate a thermal pulsation treatment compared to a warming eyelid device for the management of meibomian gland dysfunction .


Thirty patients were randomized into two groups : the first had a treatment with MeiboPatch ( ) on a daily basis for three months while the second had a single treatment with LipiFlow ( ) .


The evaluation focused on a classical approach but also on a modern approach of the ocular surface ( interferometry lipid layer LipiView ( ) ) , analysis of the tear film by Oquas ( ) ( osmolarity by TearLab ( ) ) before treatment , then a month and three months later .


Both treatments proved to be effective with almost three times more functional meibomian glands at @ months in the LipiFlow group and almost twice more in the MeiboPatch group ( P < @ ) but the LipiFlow allows a more rapid improvement at the first month of treatment .


Functional scores and classic exploration of the ocular surface except the Schirmer test also undergo a significant improvement in both groups after three months of treatment .


The combination of heat applied to the inner eyelid surface , together with simultaneous expression of the glands , during a single @-minute treatment shows to be highly effective in treating cases of meibomian gland disease .


Whilst results were excellent , and continued lid hygiene remains advised , the benefit of being able to simultaneous address potential compliance issues relating to ongoing treatment is significant .


The convenience of a single @-minute treatment versus an ongoing daily heating regime was shown to be highly desirable and a welcome relief in our patients ' busy lifestyles .


Type @ diabetes demands a complicated disease self-management by child and parents .


The overwhelming task of combining every day parenting tasks with demands of taking care of a child with diabetes can have a profound impact on parents , often resulting in increased parenting stress .


Tailored disease information , easy accessible communication with healthcare professionals and peer support are found to support parents to adequately cope with the disease and the disease self-management in everyday life .


Internet can help facilitate these important factors in usual pediatric diabetes care .


Therefore , we will develop a web-based patient portal in addition to usual pediatric diabetes care and subsequently evaluate its efficacy and feasibility .


The web-based patient portal , called Sugarsquare , provides online disease information , and facilitates online parent-professional communication and online peer support .


We hypothesize that parenting stress in parents of a child with type @ diabetes will decrease by using Sugarsquare and that Sugarsquare will be feasible in this population .


We will test the hypotheses using a multicenter randomized controlled trial .


Eligible participants are parents of a child with type @ diabetes under the age of @ .


Parents are excluded when they have no access to the internet at home or limited comprehension of the Dutch language .


Participants are recruited offline from seven clinics in the Netherlands .


Participants are randomly allocated to an intervention and a control group .


The intervention group will receive access to the intervention during the twelve-month study-period ; the control group will receive access in the last six months of the study-period .


Self-reported parenting stress is the primary outcome in the present study .


Data will be gathered at baseline ( T@ ) and at six ( T@ ) and twelve ( T@ ) months following baseline , using online questionnaires .


User statistics will be gathered throughout the twelve-month study-period for feasibility .


Dependent on its feasibility and efficacy , the intervention will be implemented into usual pediatric diabetes care .


Strengths and limitations of the study are discussed .


To investigate computer-assisted surgery ( CAS ) for dorsal insertion of percutaneous scaphoid screws and to compare operative time , accuracy , and fluoroscopy time with the traditional mini C-arm method .


We hypothesized that CAS techniques would improve accuracy , reduce actual K-wire insertion time , and decrease fluoroscopy time .


Ten fresh cadaveric upper limbs were randomized to either CAS or traditional dorsal percutaneous scaphoid screw placement by a single surgeon .


Custom orthoses were applied to the CAS arms followed by intraoperative computed tomography ( CT ) scan and navigation calibration .


Time was recorded for the portion of setup that required surgeon input , ideal guide wire placement , and fluoroscopy .


Postoperative CT scans of the CAS arms were obtained to confirm accuracy .


Two-tailed unpaired Student t test was used to analyze the outcome variables .


The CAS group required on average @ @ minutes longer for setup .


The time forplacement of the guidewire in the ideal position was @ @ minutes in the CAS group compared with @ @ minutes in the control group .


Fluoroscopy time was @ @ seconds for the CAS group and @ @ seconds for the control group .


Postoperative CT scans demonstrated @ @ mm maximum deviation from the planned ideal screw .


No significant differences were found in the accuracy between methods , the number of guidewire attempts , or the total surgical time .


Computer-assisted surgery navigation of dorsal percutaneous scaphoid screw placement takes on average @ minutes longer to set up , but leads to significantly reduced guidewire placement time and no differences in overall procedural time .


This CAS method was as accurate as the traditional method and resulted in an approximate @-fold reduction in fluoroscopy time .


This is an effective imaging alternative to the mini C-arm for scaphoid fixation using existing intraoperative CT scanners and navigation software .


Sodium drink is used as a countermeasure against body fluid loss .


However , high concentrations of sodium may cause gastrointestinal upset ( e.g. , diarrhea ) .


We sought to determine the sodium concentration that induces hypervolemia with a minimal risk of gastrointestinal disturbance .


Eight healthy active males rested in a chair and ingested a given amount ( @-@ ml kg body mass ( -@ ) ) of water ( W ) or solution containing @ , @ or @ mmol l ( -@ ) Na ( + ) ( @ , @ and @Na trials ) in @ equal portions at @ min intervals .


To standardize their hydration status , subjects consumed the same meal and water @ h before each trial .


Drink trials were performed on separate days , and the order was randomized .


The change in plasma volume ( PV ) from pre-drink status was estimated from the hemoglobin concentration and hematocrit every @ min for @ min after initiation of drinking .


Subjects began trials in a euhydrated state , as reflected by their plasma osmolality ( in mmol l ( -@ ) : W , @ @ ; @Na , @ @ ; @Na , @ @ ; @Na , @ @ ) .


At @ min , PV had not increased from the pre-drink value in the W ( -@ @ % ) or @Na ( @ @ % ) trials , but it increased to similar degrees in the @Na ( @ @ % ) and @Na ( @ @ % ) trials .


No diarrhea was reported in the W or @Na trials , but it was reported in the @Na ( n = @ ) and @Na ( n = @ ) trials .


Beverages containing @ mmol l ( -@ ) Na ( + ) induce hypervolemia with a minimum incidence of gastrointestinal problems .


It is unclear whether radial compared with femoral access improves outcomes in unselected patients with acute coronary syndromes undergoing invasive management .


We did a randomised , multicentre , superiority trial comparing transradial against transfemoral access in patients with acute coronary syndrome with or without ST-segment elevation myocardial infarction who were about to undergo coronary angiography and percutaneous coronary intervention .


Patients were randomly allocated ( @:@ ) to radial or femoral access with a web-based system .


The randomisation sequence was computer generated , blocked , and stratified by use of ticagrelor or prasugrel , type of acute coronary syndrome ( ST-segment elevation myocardial infarction , troponin positive or negative , non-ST-segment elevation acute coronary syndrome ) , and anticipated use of immediate percutaneous coronary intervention .


Outcome assessors were masked to treatment allocation .


The @-day coprimary outcomes were major adverse cardiovascular events , defined as death , myocardial infarction , or stroke , and net adverse clinical events , defined as major adverse cardiovascular events or Bleeding Academic Research Consortium ( BARC ) major bleeding unrelated to coronary artery bypass graft surgery .


The analysis was by intention to treat .


The two-sided was prespecified at @ .


The trial is registered at ClinicalTrials.gov , number NCT@ .


We randomly assigned @ patients with acute coronary syndrome , with or without ST-segment elevation , to radial ( @ ) or femoral ( @ ) access for coronary angiography and percutaneous coronary intervention .


@ ( @ % ) patients with radial access had major adverse cardiovascular events , compared with @ ( @ % ) patients with femoral access ( rate ratio -LSB- RR -RSB- @ , @ % CI @-@ ; p = @ ) , non-significant at of @ ( @ % ) patients with radial access had net adverse clinical events compared with @ ( @ % ) patients with femoral access ( @ , @ % CI @-@ ; p = @ ) .


The difference was driven by BARC major bleeding unrelated to coronary artery bypass graft surgery ( @ % vs @ % , RR @ , @ % CI @-@ ; p = @ ) and all-cause mortality ( @ % vs @ % , RR @ , @ % CI @-@ ; p = @ ) .


In patients with acute coronary syndrome undergoing invasive management , radial as compared with femoral access reduces net adverse clinical events , through a reduction in major bleeding and all-cause mortality .


This study investigated whether a tailored approach to heparin and protamine management improved thromboelastometric parameters after cardiopulmonary bypass and reduced postoperative blood loss compared with activated coagulation time ( ACT ) - based fixed target heparin and protamine management .


Randomized controlled study .


Tertiary university hospital .


Patients undergoing elective valve surgery ( n = @ ) .


Heparin and protamine management were based either on the ACT ( n = @ ) or hemostasis management system ( HMS ) measurements ( n = @ ; HMS Plus ; Medtronic , Minneapolis , MN ) .


The target ACT for initiation of cardiopulmonary bypass was @ seconds .


Study variables included rotational thromboelastometry EXTEM ( extrinsic coagulation ) , HEPTEM ( intrinsic coagulation with heparinase ) , and FIBTEM ( fibrin part of clot formation ) tests and @-hour blood loss .


The use of HMS reduced the median protamine-to-heparin ratio from @ ( @-@ @ ) to @ ( @-@ @ ; p < @ ) .


The ACT group showed a prolonged postbypass clotting time for both EXTEM ( @ @ seconds v @ @ seconds ; p = @ ) and HEPTEM ( @ @ seconds v @ @ seconds ; p = @ ) tests .


There was a moderate correlation between protamine dosing with the EXTEM and HEPTEM clotting time ( r = @ ; p = @ and r = @ ; p = @ , respectively ) .


The number of patients with more than @ mL/@ hours was higher in the ACT than in the HMS group ( @ % v @ % ; p = @ ) .


Individualized heparin and protamine management decreased the protamine-to-heparin ratio , improved postbypass thromboelastometric hemostatic parameters , and reduced the incidence of severe blood loss compared with an ACT-based strategy , supporting the added value of this approach for hemostatic optimization during cardiac surgery .


Radiopharmaceutical use may improve the survival time of patients with castrate-resistant prostate cancer and bone metastases .


Whether androgen-deprivation therapy ( ADT ) combined with bone-targeted therapy provides a clinical benefit to patients with advanced castrate-sensitive prostate cancer has not been investigated .


Eighty male patients were enrolled , and @ were randomized : @ to the control arm and @ to the strontium-@ ( Sr-@ ) arm .


After randomization , patients in both study arms received ADT , doxorubicin , and zoledronic acid .


Kaplan-Meier methodology was used to evaluate the progression-free survival ( PFS ) time .


Multivariate Cox proportional hazards regression was used to evaluate the effects of Sr-@ after controlling for the number of bone metastases .


The median follow-up time for the @ patients alive at the last follow-up was @ months ( range , @-@ @ months ) .


The median PFS time was @ months ( @ % confidence interval , @-@ @ months ) for the control arm and @ months ( @ % confidence interval , @-@ @ months ) for the Sr-@ arm ( P = @ ) .


No patient developed myelodysplastic syndrome or a hematologic malignancy .


An unplanned subgroup analysis suggested increased efficacy of bone-targeted therapy with a greater extent of bone involvement ( ie , > @ bone metastases vs @ bone metastases on the bone scan ) .


The data showed that bone-targeted therapy using @ dose of Sr-@ combined with chemohormonal ablation therapy did not favorably affect the PFS of patients with castrate-sensitive prostate cancer .


The combined therapy was feasible and safe .


Whether such bone-targeted therapy provides a favorable outcome for those patients with a greater tumor burden in the bone warrants further investigation .


Perioperative hemorrhage is an important concern during orthognathic surgery .


The purpose of this study was to assess the effect of tranexamic acid ( TXA ) irrigation on perioperative hemorrhage during orthognathic surgery .


In this double-blind , randomized controlled clinical trial , @ participants who underwent orthognathic surgery were divided into @ groups .


The patients in the first group received TXA irrigation with normal saline ( @ mg/mL ) , and the patients in the second group had normal saline for irrigation during orthognathic surgery .


Age , gender , operation duration , the amount of irrigation solution used , and preoperative hemoglobin , hematocrit , and weight were the variables that were studied .


The use of TXA solution for irrigation was the predictive factor of the study .


Each group consisted of @ patients .


Group @ consisted of @ male patients ( @ % ) and @ female patients ( @ % ) and group @ consisted of @ male patients ( @ % ) and @ female patients ( @ % ) .


There was no difference in the distributions of the variables between the @ groups , except for the duration of the operation .


The mean duration of the operation was @ @ hours in group @ and @ @ hours in group @ , and the difference in this respect between the @ groups was statistically significant ( P < @ ) .


The mean intraoperative blood loss was @ @ mL in group @ and @ @ mL in group @ ( P < @ ) .


The mean volume of irrigation was @,@ @ mL in group @ and @ @ mL in group @ ( P > @ ) .


TXA is effective in reducing intraoperative blood loss in patients for whom substantial blood loss is anticipated .


This experimental study examined whether listening to self-chosen music after stress exposure improves mood , decreases subjective arousal and rumination , and facilitates cardiovascular recovery .


Participants ( N = @ ) were exposed to a mental arithmetic task with harassment to induce stress .


Afterward , participants were randomly assigned to one of four `` recovery '' conditions where they ( @ ) listened to self-chosen relaxing music , ( @ ) listened to self-chosen happy music , ( @ ) listened to an audio book , or ( @ ) sat in silence .


After this @-minute `` recovery manipulation period , '' participants sat in silence for another @ minutes .


Systolic blood pressure , diastolic blood pressure , and heart rate were continuously measured .


The recovery conditions caused differences in positive affect ( F ( @,@ ) = @ , p < @ ) and negative affect ( F ( @,@ ) = @ , p = @ ) .


As expected , mood improved while listening to either relaxing music or happy music .


The conditions showed no differences in subjective arousal ( F ( @,@ ) = @ , p = @ ) and rumination ( F ( @,@ ) = @ , p = @ ) .


Systolic blood pressure recovery , however , differed between the conditions ( linear time trend : F ( @,@ ) = @ , p = @ ; quadratic time trend : F ( @,@ ) = @ , p = @ ) .


Listening to both relaxing and happy music delayed systolic blood pressure recovery when compared with both control conditions .


Listening to self-selected music is an effective mood enhancer , but it delays blood pressure recovery .


We aimed to evaluate angiotensin receptor blocker add-on therapy in patients with low cardiac output during decompensated heart failure .


We selected patients with decompensated heart failure , low cardiac output , dobutamine dependence , and an ejection fraction < @ who were receiving an angiotensin-converting enzyme inhibitor .


The patients were randomized to losartan or placebo and underwent invasive hemodynamic and B-type natriuretic peptide measurements at baseline and on the seventh day after intervention .


ClinicalTrials.gov : NCT@ .


We studied @ patients in the losartan group and @ patients in the placebo group .


The patient characteristics were as follows : age @ years , ejection fraction @ % , dobutamine infusion @ mcg/kg .


min , indexed systemic vascular resistance @ dynes.sec / cm ( @ ) .


m ( @ ) , cardiac index @ L/min .


m ( @ ) , and B-type natriuretic peptide @,@ pg/mL .


After @ days of intervention , there was a @ % reduction in the B-type natriuretic peptide levels in the losartan group compared with an @ % increase in the placebo group ( mean difference , -@ % ; @ % confidence interval : -@ to -@ % , p = @ ) .


No significant difference was observed in the hemodynamic measurements .


Short-term add-on therapy with losartan reduced B-type natriuretic peptide levels in patients hospitalized for decompensated severe heart failure and low cardiac output with inotrope dependence .


The resumption of menses is an important indicator of recovery in anorexia nervosa ( AN ) .


Patients with early-onset AN are at particularly great risk of suffering from the long-term physical and psychological consequences of persistent gonadal dysfunction .


However , the clinical variables that predict the recovery of menstrual function during weight gain in AN remain poorly understood .


The aim of this study was to investigate the impact of several clinical parameters on the resumption of menses in first-onset adolescent AN in a large , well-characterized , homogenous sample that was followed-up for @ months .


A total of @ female adolescent patients with first-onset AN according to DSM-IV criteria were recruited for inclusion in a randomized , multi-center , German clinical trial .


Menstrual status and clinical variables ( i.e. , premorbid body mass index ( BMI ) , age at onset , duration of illness , duration of hospital treatment , achievement of target weight at discharge , and BMI ) were assessed at the time of admission to or discharge from hospital treatment and at a @-month follow-up .


Based on German reference data , we calculated the percentage of expected body weight ( % EBW ) , BMI percentile , and BMI standard deviation score ( BMI-SDS ) for all time points to investigate the relationship between different weight measurements and resumption of menses .


Forty-seven percent of the patients spontaneously began menstruating during the follow-up period .


% EBW at the @-month follow-up was strongly correlated with the resumption of menses .


The absence of menarche before admission , a higher premorbid BMI , discharge below target weight , and a longer duration of hospital treatment were the most relevant prognostic factors for continued amenorrhea .


The recovery of menstrual function in adolescent patients with AN should be a major treatment goal to prevent severe long-term physical and psychological sequelae .


Patients with premenarchal onset of AN are at particular risk for protracted amenorrhea despite weight rehabilitation .


Reaching and maintaining a target weight between the @th and @th BMI percentile is favorable for the resumption of menses within @ months .


Whether patients with a higher premorbid BMI may benefit from a higher target weight needs to be investigated in further studies .


Social skills training ( SST ) is a common intervention for children with autism spectrum disorders ( ASDs ) to improve their social and communication skills .


Despite the fact that SSTs are often applied in clinical practice , the evidence for the effectiveness of these trainings for children with ASD is inconclusive .