The SMART regimen resulted in higher inhaled corticosteroid exposure ( @ g budesonide per day -LSB- @ -RSB- vs @ g budesonide per day -LSB- @ -RSB- , respectively ; ratio of means @ -LSB- @-@ -RSB- ; p = @ ) , but reduced oral corticosteroid exposure ( @ mg prednisone -LSB- @ -RSB- vs @ mg prednisone -LSB- @ -RSB- , respectively ; p = @ ) , with no significant difference in composite systemic corticosteroid exposure ( @ mg prednisone equivalent per year -LSB- @ -RSB- vs @ mg prednisone equivalent per year -LSB- @ -RSB- , respectively ; @ -LSB- @-@ -RSB- ; p = @ ) .


Participants in the SMART group had fewer severe asthma exacerbations ( @ -LSB- weighted mean rate per year @ -RSB- vs @ -LSB- @ -RSB- ; relative rate @ -LSB- @-@ -RSB- ; p = @ ) .


The SMART regimen has a favourable risk-to-benefit profile and can be recommended for use in adults at risk of severe asthma exacerbations .


To evaluate anti-depressive effects of acupuncture on selective serotonin reuptake inhibitors ( SSRIs ) .


Totally @ patients with depression were randomly assigned to the control group ( @ cases ) and the treatment group ( @ cases ) .


All patients took one kind of SSRIs .


Those in the treatment group were additionally treated by acupuncture .


All were treated for @ weeks .


Patients ' efficacies were evaluated with Hamilton Depression Scale ( HAMD ) , Self-rating Depression Scale ( SDS ) , and Eisenberg antidepressant side effects scale ( Asberg ) .


Compared with the control group after @ weeks of treatment , the cured-markedly effective rate was improved by @ % in the treatment group ( P < @ ) .


The HAMD was lower in the treatment group .


The tendency of interaction of sleep disorder factor and anxiety/somatization factor was different between at the end of @-week treatment and at the end of @-week treatment in the treatment group ( P < @ ) .


The SDS score decreased at the end of @-week treatment in the treatment group .


The reduction rate was elevated by @ % ( P < @ ) .


By the end of @-week treatment , the average score of Asberg decreased by @ score in average in the treatment group , while it decreased by @ score in average in the control group ( P < @ ) .


Acupuncture could effectively improve anti-depressive effects of SSRIs and reduce their adverse reactions .


The aim of this study was to assess the long-term prognosis , efficacy , and safety of combination therapy using ursodeoxycholic acid ( UDCA ) and bezafibrate ( BF ) for primary biliary cirrhosis ( PBC ) patients exhibiting dyslipidemia .


We performed a prospective , randomized , controlled , multicenter study to compare the long-term clinical results between combination therapy and UDCA monotherapy for patients refractory to UDCA monotherapy .


Twenty-seven consecutive PBC patients were enrolled .


The median treatment period in the UDCA and UDCA+BF groups was @ and @ months , respectively .


The serum alkaline phosphatase ( ALP ) levels and the Mayo risk score in the combination therapy group ( mean @IU/l and @ , respectively ) were significantly lower than those in the UDCA monotherapy group ( mean @IU/l and @ , respectively ) at @ years after the beginning of the study ( P < @ ) .


The serum creatinine levels in the combination therapy group ( mean @ mg/dl ) were significantly higher than those in the UDCA monotherapy group ( mean @ mg/dl ) at @ years after the beginning of the study ( P < @ ) .


However , the survival rate was not significantly different between the groups .


We observed dose reduction or discontinuation of the administration of BF , but not UDCA , due to renal dysfunction or muscle pain .


Long-term combination therapy significantly improved the serum ALP levels and the Mayo risk score .


In addition , long-term combination therapy significantly increased the serum creatinine levels .


We should pay close attention to adverse events during this long-term combination therapy .


To evaluate the effects of a dexmedetomidine constant rate infusion ( CRI ) and atropine on changes in global perfusion variables induced by hemorrhage and volume replacement ( VR ) in isoflurane-anesthetized dogs .


@ adult dogs .


Each dog was anesthetized twice , with a @-week interval between anesthetic sessions .


Anesthesia was maintained with @ times the minimum alveolar concentration of isoflurane with and without dexmedetomidine ( @ g/kg , IV bolus , followed by @ g/kg/h , CRI ) .


Dogs were mechanically ventilated and received an atracurium neuromuscular blockade during both sessions .


During anesthesia with isoflurane and dexmedetomidine , atropine was administered @ minutes before baseline measurements were obtained .


After baseline data were recorded , @ % of the total blood volume was progressively withdrawn and VR was achieved with an equal proportion of autologous blood .


Following hemorrhage , cardiac index , oxygen delivery index , and mixed-venous oxygen saturation were significantly decreased and the oxygen extraction ratio was significantly increased from baseline .


The anaerobic threshold was not achieved during either anesthetic session .


When dogs were anesthetized with isoflurane and dexmedetomidine , they had a significantly lower heart rate , cardiac index , and mixed-venous oxygen saturation during VR than they did when anesthetized with isoflurane alone .


Plasma lactate concentration , mixed venous-to-arterial carbon dioxide difference , base excess , and anion gap were unaltered by hemorrhage and VR and did not differ between anesthetic sessions .


Results indicated that the use of a dexmedetomidine CRI combined with atropine in isoflurane-anesthetized dogs that underwent volume-controlled hemorrhage followed by VR did not compromise global perfusion sufficiently to result in anaerobic metabolism .


Daily bathing of critically ill patients with the broad-spectrum , topical antimicrobial agent chlorhexidine is widely performed and may reduce health care-associated infections .


To determine if daily bathing of critically ill patients with chlorhexidine decreases the incidence of health care-associated infections .


A pragmatic cluster randomized , crossover study of @ patients admitted to @ adult intensive care units of a tertiary medical center in Nashville , Tennessee , from July @ through July @ .


Units performed once-daily bathing of all patients with disposable cloths impregnated with @ % chlorhexidine or nonantimicrobial cloths as a control .


Bathing treatments were performed for a @-week period followed by a @-week washout period during which patients were bathed with nonantimicrobial disposable cloths , before crossover to the alternate bathing treatment for @ weeks .


Each unit crossed over between bathing assignments @ times during the study .


The primary prespecified outcome was a composite of central line-associated bloodstream infections ( CLABSIs ) , catheter-associated urinary tract infections ( CAUTIs ) , ventilator-associated pneumonia ( VAP ) , and Clostridium difficile infections .


Secondary outcomes included rates of clinical cultures that tested positive for multidrug-resistant organisms , blood culture contamination , health care-associated bloodstream infections , and rates of the primary outcome by ICU .


During the chlorhexidine bathing period , @ infections occurred : @ CLABSI , @ CAUTI , @ VAP , and @ C difficile .


During the control bathing period , @ infections occurred : @ CLABSI , @ CAUTI , @ VAP , and @ C difficile .


The primary outcome rate was @ per @ patient-days during the chlorhexidine and @ per @ patient-days during the control bathing periods ( rate difference , -@ ; @ % CI , -@ to @ ; P = @ ) .


After adjusting for baseline variables , no difference between groups in the rate of the primary outcome was detected .


Chlorhexidine bathing did not change rates of infection-related secondary outcomes including hospital-acquired bloodstream infections , blood culture contamination , or clinical cultures yielding multidrug-resistant organisms .


In a prespecified subgroup analysis , no difference in the primary outcome was detected in any individual intensive care unit .


In this pragmatic trial , daily bathing with chlorhexidine did not reduce the incidence of health care-associated infections including CLABSIs , CAUTIs , VAP , or C difficile .


These findings do not support daily bathing of critically ill patients with chlorhexidine .


Get It & Forget It , an educational video about intrauterine devices ( IUDs ) , was developed and evaluated .


A feasibility study and a pre/post evaluation nested within a randomized trial were conducted to test change in knowledge about IUDs and intention to get an IUD after viewing a theory-driven dramatic video .


Participants ( n = @ ) completed surveys before and after watching the video .


Knowledge about IUD effectiveness increased significantly ( @ % to @ % , p < @ ) , as did intention to use an IUD ( @ % to @ % , p < @ ) postvideo .


An online theory-driven video intervention can reach young women seeking information about long-acting contraception .


Oxidative stress may contribute to heart failure ( HF ) progression .


Inhibiting xanthine oxidase in hyperuricemic HF patients may improve outcomes .


We randomly assigned @ patients with symptomatic HF , left ventricular ejection fraction @ % , and serum uric acid levels @ mg/dL to receive allopurinol ( target dose , @ mg daily ) or placebo in a double-blind , multicenter trial .


The primary composite end point at @ weeks was based on survival , worsening HF , and patient global assessment .


Secondary end points included change in quality of life , submaximal exercise capacity , and left ventricular ejection fraction .


Uric acid levels were significantly reduced with allopurinol in comparison with placebo ( treatment difference , -@ -LSB- -@ , -@ -RSB- mg/dL and -@ -LSB- -@ , -@ -RSB- mg/dL at @ and @ weeks , respectively , both P < @ ) .


At @ weeks , there was no significant difference in clinical status between the allopurinol - and placebo-treated patients ( worsened @ % versus @ % , unchanged @ % versus @ % , improved @ % versus @ % , respectively ; P = @ ) .


At @ and @ weeks , there was no significant difference in change in Kansas City Cardiomyopathy Questionnaire scores or @-minute walk distances between the @ groups .


At @ weeks , left ventricular ejection fraction did not change in either group or between groups .


Rash occurred more frequently with allopurinol ( @ % versus @ % , P = @ ) , but there was no difference in serious adverse event rates between the groups ( @ % versus @ % , P = @ ) .


In high-risk HF patients with reduced ejection fraction and elevated uric acid levels , xanthine oxidase inhibition with allopurinol failed to improve clinical status , exercise capacity , quality of life , or left ventricular ejection fraction at @ weeks .


Data on gastrointestinal ( GI ) side effects of bariatric surgery are limited because of incomplete reporting , cross-sectional samples , and nonstandardized assessments .


To report on GI side effects over the first @ months after Roux-en-Y gastric bypass ( RYGB ) and laparoscopic adjustable gastric banding ( LAGB ) .


Academic medical center , United States .


One hundred forty-four patients completed a standardized clinical interview @ months after operation , including questions on the occurrence and frequency of episodes of dumping syndrome , vomiting , and plugging for each of the past @ months ; monthly rates were stable , so results were averaged over the entire period .


Although data were collected as part of a randomized controlled trial , randomization group and the interaction of group by surgical procedure were not related to GI side effects .


Thus , results are reported by procedure only ( RYGB , n = @ ; LAGB , n = @ ) .


RYGB patients had a higher preoperative body mass index ( BMI ) than LAGB patients ( @ versus @ kg/m ( @ ) , respectively ; P = @ ) , were more likely to report dumping ( @ % versus @ % , P < @ ) , and were less likely to report plugging ( @ % versus @ % , P = @ ) .


Vomiting did not differ significantly by procedure ( @ % versus @ % , P = @ ) .


Most patients experienced each GI side effect less than once per week .


Although self-reported GI side effects were common over the first @ months after operation , the frequency of episodes was relatively low .


Longer-term follow-up is needed to determine whether symptoms worsen or improve over time .


Many people with intellectual disability present with challenging behaviour which often has serious consequences such as the prescription of long term medication , in-patient admissions and disruption of normal daily activities .


Small scale studies of Positive Behaviour Support ( PBS ) delivered by paid carers suggest that it reduces challenging behaviour and costs of care and improves quality of life .


This study aims to investigate whether professionals training in the delivery of PBS as part of routine practice is clinically and cost effective compared to treatment as usual in community intellectual disability services .


The study is a multi-centre cluster randomised controlled trial involving community intellectual disability services in England and service users with mild to severe intellectual disability and challenging behaviour .


The teams will be randomly allocated into one of two conditions , either training and support to deliver PBS or treatment as usual .


We will carry out assessments of challenging behaviour , use of services , quality of life , mental health , and family and paid carer burden at six and @ months .


We will monitor treatment fidelity and we will interview a sample of paid and family carers , service users , staff and managers about what they think of the treatment and how best we can deliver it in routine care .


The main outcome is reduction in challenging behaviour at one year after randomisation .


We will also carry out a health economic evaluation to examine the costs and consequences of staff training in PBS .


The study findings will have significant implications for the delivery of PBS in community based services with the potential for reducing inpatient admissions and out-of-area placements for adults with intellectual disability and challenging behaviour .


To investigate the effect of physical training combined with growth hormone ( GH ) on muscle thickness and its relationship with muscle strength and motor development in infants with Prader-Willi syndrome ( PWS ) .


In a randomized controlled trial , @ infants with PWS ( @ @ months ) were followed over @ years to compare a treatment group ( n = @ ) with a waiting-list control group ( n = @ ) .


Muscle thickness of @ muscle groups was measured by using ultrasound .


Muscle strength was evaluated by using the Infant Muscle Strength meter .


Motor performance was measured with the Gross Motor Function Measurement .


Analyses of variance were used to evaluate between-group effects of GH on muscle thickness at @ months and to compare pre - and posttreatment ( after @ months of GH ) values .


Multilevel analyses were used to evaluate effects of GH on muscle thickness over time , and multilevel bivariate analyses were used to test relationships between muscle thickness , muscle strength , and motor performance .


A significant positive effect of GH on muscle thickness ( P < @ ) was found .


Positive relationships were found between muscle thickness and muscle strength ( r = @ , P < @ ) , muscle thickness and motor performance ( r = @ , P < @ ) , and muscle strength and motor performance ( r = @ , P < @ ) .


GH increased muscle thickness , which was related to muscle strength and motor development in infants with PWS .


Catch-up growth was faster in muscles that are most frequently used in early development .


Because this effect was independent of GH , it suggests a training effect .


Vaginal infections are common , frequently recur , and may increase women 's risk for sexually transmitted infections ( STIs ) .


We tested the efficacy of a novel regimen to prevent recurrent vaginal infections .


Human immunodeficiency virus ( HIV ) - negative women @-@ years old with @ or more vaginal infections , including bacterial vaginosis ( BV ) , vulvovaginal candidiasis ( VVC ) , or Trichomonas vaginalis ( TV ) , were randomly assigned to receive vaginal suppositories containing metronidazole @ mg plus miconazole @ mg or matching placebo for @ consecutive nights each month for @ months .


Primary endpoints , evaluated every @ months , were BV ( Gram stain ) and VVC ( positive wet mount and culture ) .


Participants ( N = @ ) were randomly assigned to the intervention ( N = @ ) or placebo ( N = @ ) arm .


Two hundred seventeen ( @ % ) women completed an end-of-study evaluation .


The intervention reduced the proportion of visits with BV compared to placebo ( @ % vs @ % ; relative risk -LSB- RR -RSB- @ , @ % confidence interval -LSB- CI -RSB- @ -@ ) .


In contrast , the proportion of visits with VVC was similar in the intervention ( @ % ) versus placebo ( @ % ) arms ( RR @ , @ % CI @ -@ ) .


Monthly treatment with intravaginal metronidazole plus miconazole reduced the proportion of visits with BV during @ months of follow-up .


Further study will be important to determine whether this intervention can reduce women 's risk of STIs .


The aim of this clinical study was to evaluate the retention rate and caries-prevention effect of a flowable composite compared to a conventional resin-based sealant in a young population over a @-month period .


Thirty-four patients , ranging in age from @ to @ years , diagnosed with at least @ non-cavitated pit-and-fissure caries in the first and second molars were selected for this randomized split-mouth design trial .


A total of @ sealants , were placed in @ upper molars and @ lower molars .


The teeth were sealed with a flowable resin composite ( Tetric Evo Flow ) or a sealant material ( Helioseal F ) .


Each restoration was independently evaluated in terms of retention and the presence of caries at baseline and at @ , @ , @ , and @ months .


Data were analyzed using non-parametric Mann-Whitney U and Friedman @-way ANOVA tests at p < @ .


Tetric Evo Flow showed complete retention with @ % , @ % , @ % , and @ % at @ , @ , @ , and @-month evaluations , respectively , while Helioseal F retention rates were @ % , @ % , @ % , and @ % , respectively , for the same evaluation periods .


At the @-month recall , @ ( @ % ) total losses were observed in subjects treated with Tetric Evo Flow and @ total losses ( @ % ) for Helioseal F , respectively .


No significant differences were observed between the materials in retention rates or caries incidence for each evaluation period ( p > @ ) .


Placement of flowable composite as fissure sealants in the younger population seems to be as effective as conventional fluoride containing fissure sealants for the prevention of fissure caries .


The use of a flowable composite as a fissure sealant material , in conjunction with a total-etch , single bottle adhesive , yielded better retention than did the conventional fluoride containing resin-based fissure sealant over a @-month period in young patients .


Total knee arthroplasty ( TKA ) is associated with significant perioperative blood loss and need for transfusion .


This study aimed to evaluate the effectiveness and safety of tranexamic acid ( TXA ) to reduce perioperative blood loss in patients receiving TKA .


A total of @ patients who accepted unilateral TKA from May @ to May @ randomly received either @ mg/kg TXA in @ mL normal saline solution ( TXA group , n = @ ) or the same amount of normal saline solution ( placebo group , n = @ ) at @ min before the tourniquet was loosened .


The following data were recorded : intraoperative blood loss ; post-operative drainage at @ h ; total drainage amount ; hidden blood loss ; total blood loss ; transfusion volumes ; number of transfusions ; post-operative hemoglobin at @ , @ , and @ days ; D-dimer ; number of lower limb ecchymoses ; and deep vein thrombosis ( DVT ) .


A total of @ patients were available for analysis ( TXA group , n = @ ; placebo group , n = @ ) .


Post-operative@-h drainage , post-operative @-h D-dimer values , total drainage volume , hidden blood loss , total blood loss , and the rate of postoperative ecchymosis were lower in the TXA group than in the placebo group ( p < @ ) .


The post-operative @-day Hgb was higher in the TXA group than in the placebo group ( p = @ ) .


The rate of transfusion and DVT was similar in both groups ( n.s. ) .


Perioperative blood loss could be reduced after TKA by intravenously injecting @ mg/kg TXA at @ min before the tourniquet was loosened .


The application of TXA is not associated with increased risk of DVT .


A Knowledge Broker is one approach for facilitating the integration of evidence-informed decision making in public health practice .


In this paper , the findings from two studies investigating a Knowledge Broker intervention as a means of enhancing capacity for evidence-informed decision making are presented .


Contextual factors that facilitate this strategy are also identified .


This paper describes work done through a single mixed-methods study ( randomized controlled trial with a qualitative component ) and a case study .


The Health Evidence team conducted two studies examining Knowledge Broker impact in Canadian public health departments .


The effectiveness of knowledge translation strategies of varying intensities for promoting the use of research evidence in decisions related to child obesity prevention were explored via a randomized controlled trial with a fundamental descriptive component ( @-@ ) .


In a case study ( @-@ ) , the authors partnered with three health departments to develop and implement tailored strategies targeted at the organization .


Knowledge Brokers worked with designated staff in these studies via one-on-one consultations , small group meetings , and/or workshops and presentations .


The Knowledge Broker role was assessed by analysing data from close-ended surveys , interviews , organizational documents , and reflective journals .


In this paper , the authors focus on findings from the qualitative analysis of implementing the Knowledge Broker role in both studies and explore several contextual factors that impacted study outcomes .


Knowledge Brokers were shown to enhance individual capacity by improving knowledge and skill in searching for , critically appraising , and applying research evidence to practice-based issues .


Organizational capacity was also enhanced with strong management support and policies .


Effective Knowledge Broker attributes included both expertise in research methodology and public health , as well as intangible traits such as approachability and patience .


Finally , optimal positioning and ways of working were identified , including the importance of in-person meetings and neutrality of the Knowledge Broker .


Knowledge brokering is a potentially promising knowledge translation strategy for public health , though additional feasibility and cost-effectiveness data are still needed .


The research presented here further highlights the importance of context and adopting a tailored approach to implement a Knowledge Broker strategy .


Open tibial fractures are usually caused by high-energy trauma .


There is no consensus about the best treatment for these fractures .


Biomechanical studies show that fixing on two planes approaches the rigidity of the bone , whereas the use of interlocking intramedullary nailing is widely used and reported to produce better therapeutic results in fracture healing .


To compare bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing .


Prospective randomised study with @ patients undergoing two types of surgical treatment : biplanar external fixation or reamed locked intramedullary nailing .


Consolidation , complications ( infection , malunion and non-union ) and quality of life using the SF-@ Health Survey were assessed @ months after surgery .


Consolidation occurred in @ % of patients who underwent reamed intramedullary nailing , and in @ % of patients who were treated with biplanar external fixation .


In the intramedullary nailing group , there were two cases of non-union , three cases of malunion and two cases of infection .


In the patients treated with biplanar fixation , there were three cases of non-union , five cases of malunion and no cases of infection .


There were no statistically significant differences between the treatment groups for these results .


Patient quality of life was statistically equal for both methods .


Treatment with biplanar external fixation was associated with statistically similar results compared with intramedullary locking .


There are significant burdens associated with providing care for loved ones with cancer .


However , caregiver quality of life ( QOL ) is often overlooked .


With the increasing number of older adults with cancer , it is important to determine whether a patient 's age and QOL have any association with the caregiver 's QOL .


The objective of our study was to describe caregiver QOL and explore whether patient age and other psychosocial factors impact caregiver QOL .


Baseline information from patients with advanced cancer undergoing radiation and their caregivers , who were enrolled in a randomized , controlled clinical trial to test the effectiveness of a structured , multidisciplinary QOL intervention , was analyzed for this study .


Caregivers completed the Caregiver Quality of Life Index-Cancer ( CQOLC ) Scale .


Both patients and caregivers completed the Linear Analogue Self-Assessment ( LASA ) to measure QOL , and Profile of Mood States ( POMS ) to measure mood states .


Overall , @ patient-caregiver pairs participated in the study .


At baseline , caregivers of older adults ( @years ) had higher mental ( P = @ ) , emotional ( P = @ ) , spiritual ( P < @ ) , and social support ( P = @ ) LASA QOL scores .


Caregivers of older adults also had higher baseline QOL ( CQOLC , P = @ ) and mood ( POMS , P = @ ) than caregivers of younger adults .


Caregivers of patients with higher LASA QOL scores had higher overall ( P = @ ) , mental ( P = @ ) , physical ( P = @ ) , emotional ( P = @ ) , and spiritual LASA QOL scores ( P = @ ) .


Caregivers of older adults with advanced cancer demonstrated better QOL and fewer mood disturbances compared to caregivers of younger patients .


When patients have good QOL , caregivers also had good QOL .


Cranial nerve injury ( CNI ) is the most common neurologic complication of carotid endarterectomy ( CEA ) and can cause significant chronic disability .


Data from prior randomized trials are limited and provide no health-related quality of life ( HRQOL ) outcomes specific to CNI .


Incidence of CNIs and their outcomes for patients in the Carotid Revascularization Endarterectomy vs Stenting Trial ( CREST ) were examined to identify factors predictive of CNI and their impact on HRQOL .


Incidence of CNIs , baseline and procedural characteristics , outcomes , and HRQOL scores were evaluated in the @ patients randomized to CEA and undergoing surgery @ days .


Patients with CNI were identified and classified using case report forms , adverse event data , and clinical notes .


Baseline and procedural characteristics were compared using descriptive statistics .


Clinical outcomes at @ and @ months were analyzed .


All data were adjudicated by two neurologists and a vascular surgeon .


HRQOL was evaluated using the Medical Outcomes Short-Form @ ( SF-@ ) Health Survey to assess general health and Likert scales for disease-specific outcomes at @ weeks , @ weeks , and @ months after CEA .


The effect of CNI on SF-@ subscales was evaluated using random effects growth curve models , and Likert scale data were compared by ordinal logistic regression .


CNI was identified in @ patients ( @ % ) .


Cranial nerves injured were VII ( @ % ) , XII ( @ % ) , and IX/X ( @ % ) , and @ % had Horner syndrome .


CNI occurred in @ of @ patients ( @ % ) receiving general anesthesia and in one of @ patients ( @ % ) operated on under local anesthesia ( P = @ ) .


No other predictive baseline or procedural factors were identified .


Deficits resolved in @ patients ( @ % ) at @ month and in @ of @ patients ( @ % ) by @ year .


One patient died before the @-year follow-up visit .


The HRQOL evaluation showed no statistical difference between groups with and without CNI at any interval .


By Likert scale analysis , the group with CNI showed a significant difference in the difficulty eating/swallowing parameter at @ and @ weeks ( P < @ ) but not at @ year .


In CREST , CNI occurred in @ % of patients undergoing CEA , with @ % resolution at @ days and @ % at @ year .


The incidence of CNI was significantly higher in patients undergoing general anesthesia .


CNI had a small and transient effect on HRQOL , negatively affecting only difficulty eating/swallowing at @ and @ weeks but not at @ year .


On the basis of these findings , we conclude that CNI is not a trivial consequence of CEA but rarely results in significant long-term disability .


Changes in the levels of lipids are associated with breast cancer ( BC ) .


Disease-specific serum free fatty acids ( FFAs ) were quantified using chip-based direct-infusion nanoelectrospray ionization-Fourier transform ion cyclotron resonance mass spectrometry ( CBDInanoESI-FTICR MS ) in the negative ion mode .


Multiple point internal standard calibration curves between the concentration ratios of fatty acids ( i.e. , C@ :@ , C@ :@ , C@ :@ , C@ :@ , C@ :@ , and C@ :@ ) to internal standards ( C@ :@ for C@ :@ , C@ :@ , C@ :@ , and C@ :@ , C@ :@ for C@ :@ and C@ :@ ) and their corresponding intensity ratios were established with a correlation coefficient of greater than @ .


Data from @ serum samples including @ healthy controls and @ BC patients indicate that serum concentrations of FFAs in patients with BC were significantly decreased compared with those in healthy controls .


A panel of C@ :@ , C@ :@ , C@ :@ , C@ :@ , and C@ :@ showed an excellent diagnostic ability to differentiate the patients with early stage BC from healthy controls , with the area under the receiver operating characteristics ( ROC ) curve of @ , a sensitivity of @ % , and a specificity of @ % .


Our findings suggest that these FFAs may be a valuable biomarker panel for the early-stage detection of BC .


Inhaled glucocorticosteroids ( ICS ) are the mainstay of treatment in asthma .


Fluticasone furoate ( FF ) is a novel , once-daily ICS asthma therapy .


This study investigated the efficacy and safety of FF@mcg in patients with mild-to-moderate persistent asthma .


A @-week , multicenter , randomized , placebo-controlled and active-controlled , double-blind , double-dummy , parallel-group phase III study .


Three hundred and fifty-one patients ( aged @years ; uncontrolled by non-ICS therapy ) were randomized to treatment ( @:@:@ ) with once-daily FF@mcg dosed in the evening , twice-daily fluticasone propionate ( FP ) @mcg or placebo .


The primary endpoint was change from baseline in evening trough forced expiratory volume in @s ( FEV@ ) at Week@ .


Secondary endpoints were change from baseline in the percentage of rescue-free @-h periods ( powered endpoint ) , change from baseline in evening and morning peak expiratory flow , change from baseline in the percentage of symptom-free @-h periods and number of withdrawals due to lack of efficacy .


Evening trough FEV@ at Week @ was not statistically significantly increased with FF @mcg once-daily ( @ml -LSB- @ % CI : -@ , @ -RSB- ; P = @ ) , but was with FP @mcg twice daily ( @ml -LSB- @ , @ -RSB- ; P = @ ) , vs placebo .


No consistent trends were observed across other endpoints , including the powered secondary endpoint .


No safety concerns were raised for either active treatment .


FP @mcg twice daily improved evening trough FEV@ in patients with mild-to-moderate persistent asthma , but FF @mcg once daily did not demonstrate a significant effect .


Secondary endpoints showed variable results .


No safety concerns were identified for FF or FP .


A prophylactic antibiotic is recommended in open cholecystectomy surgeries , but in laparoscopic cholecystectomies such prophylaxis is controversial .


Recent reviews have not found conclusive evidence that routine prophylaxis , especially in low risk patients , is effective .


This clinical trial was undertaken to evaluate the efficacy of cefazolin in reducing surgical site infection SSI in laparoscopic cholecystectomies in a sample not screened for high or low risk patients .


A randomized double-blind controlled trial was conducted in a single university hospital .


Scheduled cholecystectomy patients without selection for patient risk factors were randomized into two groups .


Pre-operatively , group A patients received a placebo of @ml isotonic sodium chloride , and group B patients received @g of cefazolin as a prophylactic antibiotic .


All patients underwent a standard laparoscopic cholecystectomy , and were followed up for at least @days .


Two hundred ninety-nine patients were randomized ( @ in group A and @ in group B ) .


SSI occurred in seven patients ( @ % ) , five ( @ % ) in the placebo group , and two ( @ % ) in the prophylactic antibiotic group .


The difference was not statistically significant ( p value = @ ) , and no specific risk factors for post-operative infection were identified .


A single dose of preoperative prophylactic cefazolin has no significant benefit in reducing the incidence of SSI in laparoscopic cholecystectomy .


Whether or not to use a prophylactic depends on the individual patient , and the consideration of the attending surgeon .


The purpose of this study was to test the effectiveness of an online problem-based learning ( e-PBL ) program that offers multimedia scenarios to develop sexual health care competencies .


A pretestposttest control group design was used with two randomized groups in one Korean tertiary hospital .


The sample included @ RNs who cared for oncology patients .


The intervention group completed an e-PBL cycle consisting of eight tutorials .


Nurses in the intervention group scored significantly higher on knowledge than did those in the control group .


The intervention group exhibited no significant differences in attitude and practices following the intervention .


The results show the potential of e-PBL to enhance traditional PBL by offering multimedia scenarios in an interactive and flexible learning environment .


To determine whether children with type @ diabetes mellitus ( T@DM ) have evidence of increased aortic stiffness or early atherosclerosis as measured by magnetic resonance imaging ( MRI ) .


T@DM increases risk for cardiovascular disease in adults but whether this process starts in childhood is unknown .


A total of @ T@DM patients ( @ @ yr ) and @ age-matched controls ( @ @ yr ) participated .


MRI was performed to assess aortic arch pulse wave velocity ( PWV ) , strain , and distensibility of the ascending and descending thoracic aorta and measures of atherosclerosis .


Groups were well-matched for age , pulse pressure , and gender .


Low-density lipoprotein-cholesterol ( LDL-C ) was higher in T@DM ( @ @ vs. @ @ mg/dL , p < @ ) .


There was a trend toward decreased strain and distensibility in T@DM vs. controls in the ascending ( distensibility : T@DM @ @ kPa @ , control @ @ kPa @ , p = @ ) and descending aorta ( strain : T@DM @ @ % vs. control @ @ % , p = @ ) .


There was no difference in arch PWV .


Advancing age and male gender was negatively associated with aortic stiffness .


Hemoglobin A@c ( HbA@c ) was inversely related to descending aorta strain and distensibility ( p < @ ) .


Children with diabetes in the lowest two tertiles of insulin sensitivity demonstrated thoracic descending aortas with significantly lower strain ( p = @ ) and distensibility ( p = @ ) and increased measures of wall irregularity ( p = @ ) .


There were no differences in measurements of atherosclerosis between the two groups .


Adolescents with T@DM , especially those with lower insulin sensitivity , demonstrated a trend toward stiffer , less compliant thoracic aortas , which was inversely associated with diabetes control .


These data suggest large vessel aortopathy starts early in T@DM .


The homeostatic mechanisms of iron metabolism and erythropoiesis in infants are unclear .


Infants synthesize both fetal hemoglobin ( HbF ) and adult hemoglobin ( HbA ) , and it is not known how the hemoglobin switch is regulated .


We hypothesized that iron supplements to infants affect the disappearance of HbF .


We randomized @ low-birth-weight infants ( @,@-@ ,@ g ) into three intervention groups receiving @ , @ , or @mg/kg/d of iron supplements from @wk to @ mo of age .


In the present secondary analysis , we analyzed iron status , total hemoglobin ( Hb ) , and HbF fraction at @wk , @wk , and at @ mo and calculated absolute levels of HbF .


We observed dose-dependent increased levels of Hb in iron-supplemented groups at @ mo of age .


However , for absolute HbF concentration , there was no similar effect of intervention .


Mean ( SD ) HbF was @ ( @ ) , @ ( @ ) , and @ ( @ ) g/l at @wk , @wk , and @ mo , respectively , similar in all groups .


In linear regression analyses , postconceptional age turned out as the major predictor of HbF , independent of gestational age at birth .


Our hypothesis was rejected .


Instead , we confirmed a close correlation to postconceptional age , supporting a genetically programmed switch , insensitive to most environmental factors including birth .


Dose-dense sequential chemotherapy including anthracyclines and taxanes has been established in the adjuvant setting of high-risk operable breast cancer .


However , the preferable taxane and optimal schedule of administration in a dose-dense regimen have not been defined yet .


From July @ to November @ , @ patients ( @ eligible ) were randomized to receive , every @ weeks , @ cycles of epirubicin @ mg/m@ followed by @ cycles of paclitaxel @ mg/m@ followed by @ cycles of intensified CMF ( Arm A ; @ patients ) , or @ cycles of epirubicin followed by @ cycles of CMF , as in Arm A , followed @ weeks later by @ weekly cycles of docetaxel @ mg/m@ ( Arm B ; @ ) , or @ weekly cycles of paclitaxel @ mg/m@ ( Arm C ; @ ) .


Trastuzumab was administered for one year to HER@-positive patients post-radiation .


At a median follow-up of @ months , the @-year disease-free survival ( DFS ) rate was @ % , @ % and @ % , for Arms A , B and C , respectively , while the @-year overall survival ( OS ) rate was @ % in all arms .


No differences were found in DFS or OS between the combined B and C Arms versus Arm A ( DFS : HR = @ , @ % CI : @-@ @ , P = @ ; OS : HR = @ , @ % CI : @-@ @ , P = @ ) .


Among the @ patients who received trastuzumab , @ patients ( @ % ) completed @ year of treatment uneventfully .


In all arms , the most frequently reported severe adverse events were neutropenia ( @ % vs. @ % vs. @ % ) and leucopenia ( @ % vs. @ % vs. @ % ) , while febrile neutropenia occurred in fifty-one patients ( @ % vs. @ % vs. @ % ) .


Patients in Arm A experienced more often severe pain ( P = @ ) , neurological complications ( P = @ ) and allergic reactions ( P = @ ) , while patients in Arm B suffered more often from severe skin reactions ( P = @ ) .


No significant differences in survival between the regimens were found in the present phase III trial .


Taxane scheduling influenced the type of severe toxicities .


HER@-positive patients demonstrated comparable @-year DFS and OS rates with those reported in other similar studies .


Protein-rich supplements are used widely for the prevention and management of undernutrition in older people .


The use of protein supplements in older people could , however , be counterproductive by reducing appetite and overall energy intake .


The objective was to determine whether aging influences the effects of protein loads , administered directly into the small intestine , on energy intake , antropyloroduodenal motility , and appetite .


Intraduodenal infusions ( @ mL , @ min ) of saline ( @ kcal , control ) and protein ( hydrolyzed whey ) loads of @ , @ , and @ kcal were followed by an ad libitum buffet meal in @ young ( @-@ y ) and @ healthy older ( @-@ y ) men .


Suppression of energy intake ( kcal ) at the meal by protein infusion compared with control was calculated .


In young subjects , a dose-responsive suppression ( SEM ) of energy intake was found at the buffet meal by protein ( suppression at @ kcal : @ @ % , P = @ ; @ kcal : @ @ % , P = @ ; @ kcal : @ @ % , P = @ ) , whereas suppression was observed only after the @-kcal load in older subjects ( @ kcal : @ @ % increase , P = @ ; @ kcal : @ @ % increase , P = @ ; @ kcal : @ @ % suppression , P = @ ) .


Suppression of energy intake by protein was less in older than in young subjects ( P < @ ) .


In young subjects , total energy intake ( meal + infusion ) on the @-kcal protein-infusion day was lower than that on the control day ( P = @ ) , whereas in older subjects it was greater on the @-kcal ( P = @ ) and @-kcal ( P = @ ) infusion days .


Energy intake was inversely related to isolated pyloric pressure waves ( r = -@ , P = @ ) and positively related to antral ( r = @ , P = @ ) and duodenal ( r = @ , P = @ ) pressure waves .


Suppression of energy intake by protein was inversely related to the change in isolated pyloric pressure waves ( r = -@ , P = @ ) and positively related to duodenal pressure waves ( r = @ , P = @ ) .


Intraduodenal protein suppresses appetite and energy intake less in healthy older than in young adults .


In older subjects , intraduodenal protein at low doses increased overall energy intake , which supports the use of protein supplements in undernourished older people .


This trial was registered at www.anzctr.org.au as @ .


To determine whether internet-delivered cognitive behaviour therapy ( iCBT ) for depression and anxiety reduces self-reported absenteeism in employed individuals .


We reanalysed data from five randomised controlled trials of iCBT : two for depression ( conducted from September @ to February @ and from June @ to January @ ) , two for generalised anxiety disorder ( conducted from March @ to June @ and from July @ to January @ ) and one for social phobia ( conducted from May @ to July @ ) .


Participants across Australia were recruited via a website .


The inclusion criteria were : ( i ) meets criteria for the disorder of interest ; ( ii ) aged @ years or over ; ( iii ) no previous history of a psychotic disorder or drug or alcohol misuse ; ( iv ) not actively suicidal .


The iCBT courses each consisted of six online lessons ( to be completed within @ weeks ) , homework assignments , automatic emails and resource documents .


The number of days absent ( self-reported absenteeism ) in the previous week .


We included @ participants in our analysis .


When data for the three disorders were combined , participants who received iCBT had significant reductions in self-reported absenteeism compared with those in the control groups ( who were on a waitlist ) ( P = @ ) .


When data for the three disorders were analysed separately , reductions in self-reported absenteeism for participants who received iCBT were not significantly different to those for participants in the control groups .


Using data from five RCTs , we showed that iCBT was associated with reductions in self-reported absenteeism .


Future research should focus on replicating these findings in other contexts , such as other disorders and other iCBT courses .


To compare the combination spironolactone-norgestimate-ethinyl estradiol in hirsutism with other protocols including the same dose of estrogen .


In this open prospective study , @ women with hirsutism due to polycystic ovary syndrome ( PCOS ) were randomly assigned to the following treatment protocols : Group A ( n = @ ) : spironolactone @ mg-norgestimate @ mcg-ethinyl estradiol @ microg ; Group B ( n = @ ) : cyproterone acetate @ mg-ethinyl estradiol @ microg ; Group C ( n = @ ) : norgestimate @ microg-ethinyl estradiol @ microg .


The decrease in the hirsutism score was higher in group A than in the other groups ( p < @ ) and comparable in groups B and C.


The decrease in acne score , androgen and estradiol levels , and ovary volume was similar in groups A and B. C-reactive protein increase was similar in all groups , but the augmentation of fibrinogen ( p = @ ) , triglycerides ( p < @ ) , monocyte count ( p = @ ) , platelet number ( p < @ ) and mean volume ( p = @ ) was more pronounced in group B than in group A. Low-density lipoprotein/high-density lipoprotein cholesterol ratio decreased in groups A and C.


Spironolactone-norgestimate-ethinyl estradiol is an effective and well-tolerated combination for the treatment of hirsutism in PCOS , with a favorable influence on lipids and indices of low-grade inflammation .


Lowering dietary sodium and adhering to medication regimens are difficult for persons with heart failure ( HF ) .


Because these behaviors often occur within the family context , this study evaluated the effects of family education and partnership interventions on dietary sodium ( Na ) intake and medication adherence ( MA ) .


HF patient and family member ( FM ) dyads ( n = @ ) were randomized to : usual care ( UC ) , patient-FM education ( PFE ) , or family partnership intervention ( FPI ) .


Dietary Na ( @-day food record ) , urinary Na ( @-hour urine ) , and MA ( Medication Events Monitoring System ) were measured at baseline ( BL ) before randomization , and at @ and @ months .


FPI and PFE reduced urinary Na at @ months , and FPI differed from UC at @ months ( P = @ ) .


Dietary Na decreased from BL to @ months , with both PFE ( P = @ ) and FPI ( P = @ ) lower than UC .


The proportion of subjects adherent to Na intake ( @,@ mg/d ) was higher at @ months in PFE and FPI than in UC ( ( @ ) ( @ ) = @ ; P = @ ) .


MA did not differ among groups across time .


Both FPI and PFE groups increased HF knowledge immediately after intervention .


Dietary Na intake , but not MA , was improved by PFE and FPI compared with UC .


The UC group was less likely to be adherent with dietary Na .


Greater efforts to study and incorporate family-focused education and support interventions into HF care are warranted .


To evaluate preexposure prophylaxis ( PrEP ) efficacy for HIV-@ prevention among women using depot medroxyprogesterone acetate ( DMPA ) for contraception and men whose HIV-@-infected partners use DMPA .


Secondary analysis of data from a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among heterosexual Kenyan and Ugandan HIV-@ serodiscordant couples .


PrEP efficacy for HIV-@ prevention was compared among HIV-@-uninfected women using DMPA versus no hormonal contraception and among HIV-@ uninfected men whose HIV-@-infected female partners used DMPA versus no hormonal contraception .


Of @ HIV-@ serodiscordant couples , @ HIV-@-uninfected women used DMPA at some point during follow-up , @ HIV-@-uninfected women used no hormonal contraception , @ HIV-@-uninfected men had female partners who used DMPA , and @ men had female partners who used no hormonal contraception .


PrEP efficacy estimates for HIV-@ prevention , compared with placebo , were similar among women using DMPA and those using no hormonal contraception ( @ and @ % , adjusted interaction P = @ ) .


Similarly , for men whose female partners used DMPA , PrEP efficacy did not differ from men whose partners used no hormonal contraception ( @ versus @ % , adjusted interaction P = @ ) .


PrEP is efficacious for HIV-@ prevention among women using DMPA and men whose partners use DMPA , suggesting PrEP could mitigate the potential increased HIV-@ acquisition and transmission risks that have been associated with DMPA use .


Women at risk for HIV-@ choosing DMPA could maintain this contraceptive method and add PrEP to achieve prevention of unintended pregnancy and HIV-@ .


The Verband Deutscher Rentenversicherungstrger ( VDR ) required the intense focus on vocational rehabilitation of medical problems since the early @s .


By integrating elements of the working environment in the structures and processes of medical rehabilitation , vocational problems can be identified early in order to take appropriate countermeasures .


Posttreatment proposals off er a way to provide a reliable long-term success .


The intention of this study is the implementation and the investigation of effectiveness of an intensified vocational program that integrates besides the in-patient rehabilitation post-treatment proposals as well .


Cardiac rehabilitation patient occurring special vocational problems participe .


The recruited patients were randomized to either the vocational program or the common cardiac rehabilitation.Primary outcome was the vocational reintegration @ months after the end of rehabilitation.The database was collected through a query of the pension insurance accounts and questionnaires .


@ people were included to the study at the beginning of rehabilitation .


Rates of response :@ % of the survey to the end of rehabilitation ,@ % of the survey @ months and @ % of the survey @ months after the end of rehabilitation.The sample was characterized by great interferences of their professional involvement and a high demand for vocational treatments .


At the beginning of the rehabilitation @ % of study participants intended to make an application for reduction-pension .


Nevertheless , one year after the end of rehabilitation a surprisingly high rate of vocational reintegration by over @ % in both groups ( IG : @ % , KG : @ % , p < @ ) was indicated.The majority of the unemployed patients at the beginning of rehabilitation remained in the unemployment ( IG : @ % , KG : @ % , p < @ ) .


The participation rate at the post-treatment proposals was @ % .


The results show that vocational programs in rehabilitation need to be revised , including with regard to the question , whether and in what way post-treatment proposals must be changed .


Long-term tenofovir disoproxil fumarate ( TDF ) treatment for chronic hepatitis B ( CHB ) is associated with sustained viral suppression and regression of fibrosis and cirrhosis at year @ ( @ weeks ) and no TDF resistance through @ years ( @ weeks ) .


We assessed the efficacy , safety , and resistance of TDF for up to @ years ( @ weeks ) in HBeAg-positive and HBeAg-negative CHB patients .


Patients who completed @ year ( @ weeks ) of randomized treatment with TDF or adefovir dipivoxil were eligible to receive open-label TDF for a total duration of @ years ( @ weeks ) .


Of @ patients initially randomized , @ ( @ % ) entered the open-label phase ; @/@ ( @ % ) remained on study at year @ .


For patients on treatment at year @ , @ % maintained viral suppression ( HBV DNA < @ IU/mL ) , @ % achieved serum alanine aminotransferase normalization , and in HBeAg-positive patients , @/@ ( @ % ) and @/@ ( @ % ) achieved HBeAg and HBsAg loss , respectively .


One/@ ( @ % ) HBeAg-negative patients achieved HBsAg loss .


No resistance to TDF was detected through @ years .


During the open-label phase , grade @/@ drug-related adverse events were uncommon ( @ % ) ; ten ( @ % ) patients had elevation of serum creatinine @ mg/dL above baseline .


No significant change in bone mineral density was observed from year @ to year @ ( week @ to week @ ) .


Long-term TDF treatment was associated with sustained virologic , biochemical , and serologic responses , without resistance .


TDF treatment was well tolerated , with a low incidence of renal and bone events .


These data confirm the safety and efficacy of long-term TDF for CHB .


The aims of this analysis were to examine levels of unmet needs and depression among carers of people newly diagnosed with cancer and to identify groups who may be at higher risk , by examining relationships with demographic characteristics .


One hundred and fifty dyads of people newly diagnosed with cancer and their carers , aged @ years and older , were recruited from four Australian hospitals .


People with cancer receiving adjuvant cancer treatment with curative intent , were eligible to participate .


Carers completed the Supportive Care Needs Survey-Partners & Caregivers ( SCNS-P & C@ ) , and both carers and patients completed the Centre of Epidemiologic-Depression Scale ( CES-D ) .


Overall , @ % of carers reported at least one , @ % at least three , @ % at least five , and @ % at least @ unmet needs ; the most commonly endorsed unmet needs were in the domains of information and health care service needs .


Thirty percent of carers and @ % of patients were at risk of clinical depression .


A weak to moderate positive relationship was observed between unmet needs and carer depression ( r = @ , p < @ ) .


Carer levels of unmet needs were significantly associated with carer age , hospital type , treatment type , cancer type , living situation , relationship status ( in both uni - and multi-factor analysis ) ; person with cancer age and carer level of education ( in unifactor analysis only ) ; but not with carer gender or patient gender ( in both uni - and multi-factor analyses ) .


Findings highlight the importance of developing tailored programmes to systematically assist carers who are supporting patients through the early stages of cancer treatment .


To further our understanding of central sleep apnea ( CSA ) at high altitude during acclimatization , we tested the hypothesis that pharmacologically altering cerebral blood flow ( CBF ) would alter the severity of CSA at high altitude .


The study was a randomized , placebo-controlled single-blind study .


A field study at @,@ m in Nepal .


We studied @ normal volunteers .


Between days @ to @ at high altitude , CBF velocity ( CBFv ) was increased by intravenous ( IV ) acetazolamide ( @ mg/kg ) and reduced by oral indomethacin ( @ mg ) .


Arterial blood gases , hypoxic and hypercapnic ventilatory responses , and CBFv and its reactivity to carbon dioxide were measured awake .


Overnight polysomnography was performed .


The central apnea-hypopnea index was elevated following administration of indomethacin ( @ @ to @ @ events/h ; mean standard deviation ; P < @ ) and was reduced following IV acetazolamide ( @ @ to @ @ events/h ; P < @ ) .


Intravenous acetazolamide elevated CBFv at high altitude by @ % ( @ % confidence interval -LSB- CI -RSB- : @-@ % ) but did not affect ventilatory responses .


The elevation in CBFv was partly mediated via a selective rise in partial pressure of arterial carbon dioxide ( PaCO@ ) ( @ @ to @ @ mm Hg ) and an associated fall in pH ( P < @ ) .


Oral indomethacin reduced CBFv by @ % ( @ % CI : @-@ % ) , blunted CBFv reactivity , and increased the hypercapnic ventilatory response by @ % ( @ % CI : @-@ % ) but had no effect on PaCO@ or pH.


Our findings indicate an important role for cerebral blood flow regulation in the pathophysiology of central sleep apnea at high altitude .


Dipeptidyl-peptidase @ ( DPP@ ) inhibitors improve glycemic control in patients with diabetes mellitus by preventing the degradation of glucagon-like peptide-@ ( GLP-@ ) .


GLP-@ causes vasodilation in animal models but also increases sympathetic activity ; the effect of GLP-@ in the human vasculature and how it is altered by DPP@ inhibition is not known .


DPP@ also degrades the vasodilator brain natriuretic peptide ( BNP ) to a less potent metabolite .


This study tested the hypothesis that DPP@ inhibition potentiates the vasodilator responses to GLP-@ and BNP in the human forearm .


Seventeen healthy subjects participated in this randomized , double-blinded , placebo-controlled crossover study .


On each study day , subjects received DPP@ inhibitor ( sitagliptin @ mg by mouth ) or placebo .


Sitagliptin increased forearm blood flow and decreased forearm vascular resistance without affecting mean arterial pressure and pulse .


GLP-@ and BNP were infused in incremental doses via brachial artery .


Venous GLP-@ concentrations were significantly higher during sitagliptin use , yet there was no effect of GLP-@ on forearm blood flow in the presence or absence of sitagliptin .


BNP caused dose-dependent vasodilation ; however , sitagliptin did not affect this response .


GLP-@ and BNP had no effect on net norepinephrine release .


These data suggest that GLP-@ does not act as a direct vasodilator in humans and does not contribute to sympathetic activation .


Sitagliptin does not regulate vascular function in healthy humans by affecting the degradation of GLP-@ and BNP .


To observe the efficacy of thread-moxa in Zhuang folk medicine ( TM ) combined with acupuncture and external application drugs for AIDS patients with herpes zoster ( AHZ ) .


A randomized , controlled clinical trial was conducted in @ patients with AHZ .


They were randomly assigned to the treatment group ( treated with TM combined with acupuncture and Jingwanhong Scald Ointment ) and the control group ( treated with Famciclovir Tablet , nimesulide dispersible tablet , vitamin B@ , ribavirin ointment ) .


The treatment course was @ days for both groups.The clinical efficacy , significant efficiency visual analog scale score ( VAS ) , sleep quality score ( QS ) , the postherpetic neuralgia rate in @ year after treatment were observed .


The markedly effective rate was significantly higher in the treatment group than in the control group ( @ % vs. @ % , P < @ ) .


There was no statistical difference in the total effective rate between the two groups ( @ % vs. @ % , P > @ ) .


The post-treatment VAS , QS , the time for pain disappearance , skin repair , crusting , and @-year postherpetic neuralgia incidence rate were significantly lower in the treatment group than in the control group ( P < @ , P < @ ) .


TM combined with acupuncture and Jingwanhong Scald Ointment was effective for treating AHZ patients .


It relieved pain quickly , shortened their course of disease , and improved their quality of sleep .


To determine whether acupuncture is effective as an overactive bladder ( OAB ) treatment compared with solifenacin and placebo , and to investigate its relation with urine nerve growth factor ( NGF ) levels .


The study was conducted with methodological rigor based on the Consolidated Standards of Reporting Trials criteria .


@ female patients with OAB were included and randomly assigned to a solifenacin , acupuncture or placebo group .


The medicated group received solifenacin @ mg/day ; the acupuncture and placebo groups were treated twice a week for @ weeks .


Symptom scores , quality of life scores , frequency of micturition and urine NGF levels were used to assess treatment efficiency .


The study was completed with @ patients ( n = @ in the solifenacin group , n = @ in the acupuncture group and n = @ in the placebo group ) .


After treatment , comparison of the medical and acupuncture therapy groups with the placebo group showed significant differences between recovery concerning quality of life ( p < @ and p < @ , respectively ) and symptom scores ( p < @ and p < @ , respectively ) .


The decrease of NGF levels after treatment compared to before treatment was determined in each group ( solifenacin , acupuncture , placebo group ; p < @ , p < @ , p = @ , respectively ) .


Sufficient symptomatic improvement was not achieved in @ patients in the acupuncture group .


Therefore , comparisons were assessed twice with and without including these patients , and NGF levels in the acupuncture group were higher than at first comparison in which all patients in the acupuncture group were included .


In patients with OAB in whom anticholinergic treatment is contraindicated , acupuncture may be considered another treatment option .


To explore whether subjects harbouring A. actinomycetemcomitans , P. gingivalis or T. forsythia at baseline showed increased clinical benefits with the adjunctive use of systemic amoxicillin and metronidazole ( AMX-MET ) during non-surgical treatment of generalized aggressive periodontitis ( GAgP ) .


Forty one subjects were included in this @-month randomized placebo-controlled clinical trial using a @-day course of systemic AMX-MET or placebo as adjuncts to non-surgical periodontal therapy .


Clinical and microbiological parameters were collected at baseline , @ and @months after treatment .


Microbiological cultures were processed for pooled subgingival samples and identities of isolates were determined by PCR for A. actinomycetemcomitans , P. gingivalis and T. forsythia


At @months , the test treatment resulted in significant additional improvements in the primary outcome variable compared to placebo , and the effect of the adjunctive antimicrobials was not modified by the baseline microbiological status in the primary analysis .


However , secondary exploratory subgroup analyses showed improved clinical outcomes in subjects harbouring A. actinomycetemcomitans at baseline compared to subjects who did not harbour this pathogen .


All subjects benefited from the tested adjunctive antimicrobial regimen , although subjects who harboured A. actinomycetemcomitans at baseline may show greater clinical benefits .


Larger appropriately powered studies are needed to confirm whether adjunctive AMX-MET is more beneficial for GAgP patients who harbour A. actinomycetemcomitans , along with other key periodontal pathogens .


The authors investigated the effect of remifentanil administration on resting electroencephalography functional connectivity and its relationship to cognitive function and analgesia in healthy volunteers .


Twenty-one healthy male adult subjects were enrolled in this placebo-controlled double-blind cross-over study .


For each subject , @ min of multichannel electroencephalography recording , a cognitive test of sustained attention ( continuous reaction time ) , and experimental pain scores to bone-pressure and heat stimuli were collected before and after infusion of remifentanil or placebo .


A coherence matrix was calculated from the electroencephalogram , and three graph-theoretical measures ( characteristic path-length , mean clustering coefficient , and relative small-worldness ) were extracted to characterize the overall cortical network properties .


Compared to placebo , most graph-theoretical measures were significantly altered by remifentanil at the alpha and low beta range ( @ to @ Hz ; all P < @ ) .


Taken together , these alterations were characterized by an increase in the characteristic path-length ( alpha @ % and low beta range @ % ) and corresponding decrements in mean clustering coefficient ( low beta range -@ % ) and relative small-worldness ( alpha -@ % and low beta range -@ % ) .


Changes in characteristic path-lengths after remifentanil infusion were correlated to the continuous reaction time index ( r = -@ ; P = @ ) , while no significant correlations between graph-theoretical measures and experimental pain tests were seen .


Remifentanil disrupts the functional connectivity network properties of the electroencephalogram .


The findings give new insight into how opioids interfere with the normal brain functions and have the potential to be biomarkers for the sedative effects of opioids in different clinical settings .


Patients with several painful functional gastrointestinal disorders ( FGIDs ) are reported to have a high prevalence of psychosocial disturbance .


These aspects have not been studied extensively in patients with suspected Sphincter of Oddi dysfunction ( SOD ) .


A total of @ patients with post-cholecystectomy pain and suspected SOD were enrolled in seven US centers in a multicenter-randomized trial ( Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction ) .


Baseline assessments included pain descriptors and burden , structured psychosocial assessments of anxiety/depression , coping , trauma , and health-related quality of life .


Patients with high levels of depression , suicidal ideation , or psychosis were excluded .


The study population ( @ % female , mean age @ ) reported anxiety ( @ % ) , depression ( @ % ) , past sexual trauma ( @ % ) , and physical abuse ( @ % ) .


Of the total screened population ( n = @ ) , @ % of the patients were excluded because of the presence of defined severe psychological problems .


The mean medical outcomes study short-form-@ ( SF-@ ) physical and mental composite scores were @ ( s.d. = @ ) and @ ( s.d. = @ ) , respectively .


Most subjects reported symptoms of other FGIDs .


There were no correlations between the extent of the pain burden in the @ months before enrollment and the baseline anxiety scores or victimization history .


However , those with greater pain burden were significantly more depressed .


There were no meaningful differences in the psychosocial parameters in subjects with or without irritable bowel , and those who had cholecystectomy for stones or functional gallbladder disease .


Those declining randomization were comparable to those randomized .


Psychosocial comorbidity in SOD is high .


However , it does not appear to differ significantly from that reported in surveys of age - and gender-matched general populations , and may be lower than reported with other FGIDs .


Neonatal sepsis is a major cause of neonatal mortality .


In populations with limited access to health care , early identification of bacterial infections and initiation of antibiotics by community health workers ( CHWs ) could be lifesaving .


It is unknown whether this strategy would be feasible using traditional birth attendants ( TBAs ) , a cadre of CHWs who typically have limited training and educational backgrounds .


We analyzed data from the intervention arm of a cluster-randomized trial involving TBAs in Lufwanyama District , Zambia , from June @ to November @ .


TBAs followed neonates for signs of potential infection through @ days of life .


If any of @ criteria were met , TBAs administered oral amoxicillin and facilitated referral to a rural health center .


Our analysis included @,@ neonates with final vital status by day @ .


TBAs conducted a median of @ ( interquartile range @-@ ) home visits ( @ % in week @ and @ % in weeks @-@ ) and referred @ neonates ( @ % ) for suspected sepsis .


Of referred neonates , @/@ ( @ % ) completed their referral .


Among neonates given amoxicillin , @/@ ( @ % ) were referred ; among referred neonates , @/@ ( @ % ) received amoxicillin .


Referral and/or initiation of antibiotics were strongly associated with neonatal death ( for referral , relative risk -LSB- RR -RSB- = @ , @ % confidence interval -LSB- CI -RSB- = @-@ @ ; for amoxicillin administration , RR = @ , @ % CI = @-@ @ ) .


Neonates clinically judged to be `` extremely sick '' by the referring TBA were at greatest risk of death ( RR = @ , @ % CI = @-@ @ ) .


The strategy of administering a first dose of antibiotics and referring based solely on the clinical evaluation of a TBA is feasible and could be effective in reducing neonatal mortality in remote rural settings .


Two major antigenically heterogenous norovirus genogroups ( GI and GII ) commonly infect humans and are the leading cause of foodborne , viral gastrointestinal infections in adults .


We assessed B cell responses in participants in a double-blind , placebo-controlled , dose-escalation phase @ study of the safety and immunogenicity of an intramuscular bivalent norovirus virus-like particle ( VLP ) vaccine .


The vaccine contained a GI @ VLP ( Norwalk ) and a consensus GII @ VLP , representing the two major genotypes that cause human disease , and was administered on days @ and @ to healthy adults aged @-@ years .


Four separate cohorts received increasing doses of @ g , @ g , @ g , and @ g of each VLP adjuvanted in monophosphoryl lipid A and alum .


PBMCs were analyzed for B cell activation and mucosal homing markers ( flow cytometry ) and VLP-specific and total IgG and IgA Ab-secreting cells ( ASCs ) ; and serum titers of VLP-specific IgG , IgA , and Pan-Ig were determined .


The vaccine elicited CD@ + CD@ + plasmablasts and high frequencies of ASCs specific for both VLP antigens in the peripheral blood at @ days after the first dose .


The plasmablasts exhibited a mucosal-homing phenotype and included a high proportion of IgA ASCs .


Serum antibodies increased as early as @ days after the first immunization .


The data suggest that a single dose of the IM bivalent norovirus vaccine is effective in activating pre-existing B cell memory .


The rapid B cell response and the mucosal homing phenotype of induced ASCs are consistent with anamnestic responses in subjects primed by prior oral norovirus infection .


This study is registered at ClinicalTrials.gov Identifier NCT@ .


The study aimed to compare the efficacy and safety of nebulized steroid ( NS ) with systemic corticosteroids ( SC ) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization .


The study was a randomized , parallel design trial .


Eligible patients ( n = @ ) were randomly allocated to @ of the @ treatment groups : parenteral corticosteroid ( PS ) ( n = @ ) , @ mg ( NB ) ( n = @ ) , or @ mg NB ( n = @ ) .


Partial pressure of arterial oxygen ( PaO@ ) , carbon dioxide ( PaCO@ ) , pH , and oxygen saturation ( SaO@ ) were evaluated at baseline , @ h , @ h , and discharge .


Airway obstruction ( forced vital capacity -LSB- FVC -RSB- and forced expiratory volume @ s -LSB- FEV@ -RSB- ) was evaluated at admission and discharge .


There were no significant differences between the groups for all parameters at all time periods , except for higher FEV@ value in the @-mg NB group at baseline .


In groups , significant differences were determined for FVC , FEV@ , PaO@ , and SaO@ ( p < @ ) , but not for PaCO@ and pH , in comparison to their baseline values .


As adverse events , hyperglycemia and oral moniliasis were observed in the PS group ( n = @ ) and in the NB groups ( n = @ ) , respectively , and treatment change was required in @ patients ( @ patients in the PS group and @ patients in the NB groups ) ( p = @ ) .


Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects .


The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage .


However , there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the @ arms .


Placebo-controlled trials indicate that cytisine , a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation , almost doubles the chances of quitting at @ months .


We investigated whether cytisine was at least as effective as nicotine-replacement therapy in helping smokers to quit .


We conducted a pragmatic , open-label , noninferiority trial in New Zealand in which @ adult daily smokers who were motivated to quit and called the national quitline were randomly assigned in a @:@ ratio to receive cytisine for @ days or nicotine-replacement therapy for @ weeks .


Cytisine was provided by mail , free of charge , and nicotine-replacement therapy was provided through vouchers for low-cost patches along with gum or lozenges .


Low-intensity , telephone-delivered behavioral support was provided to both groups through the quitline .


The primary outcome was self-reported continuous abstinence at @ month .


At @ month , continuous abstinence from smoking was reported for @ % of participants receiving cytisine ( @ of @ ) and @ % of participants receiving nicotine-replacement therapy ( @ of @ ) , for a difference of @ percentage points ( @ % confidence interval , @ to @ ) .


The effectiveness of cytisine for continuous abstinence was superior to that of nicotine-replacement therapy at @ week , @ months , and @ months .


In a prespecified subgroup analysis of the primary outcome , cytisine was superior to nicotine-replacement therapy among women and noninferior among men .


Self-reported adverse events over @ months occurred more frequently in the cytisine group ( @ events among @ participants ) than in the group receiving nicotine-replacement therapy ( @ events among @ participants ) ; adverse events were primarily nausea and vomiting and sleep disorders .


When combined with brief behavioral support , cytisine was found to be superior to nicotine-replacement therapy in helping smokers quit smoking , but it was associated with a higher frequency of self-reported adverse events .


( Funded by the Health Research Council of New Zealand ; Australian New Zealand Clinical Trials Registry number , ACTRN@ . )


Chronic hepatitis B ( CHB ) can progress to cirrhosis , hepatocellular carcinoma ( HCC ) and ultimately liver-related death .


Although oral antiviral therapy for patients with CHB reduces the risk of such complications , once cirrhosis is established , the benefits of antiviral therapy are not robustly demonstrated .


According to traditional Chinese medicine ( TCM ) , some Chinese herbal medicines promote blood circulation and soften hard masses , and therefore they may block and reverse hepatic fibrosis .


The aim of this study is to evaluate the effects of TCM tablets of the compound biejia ruangan ( RGT ) administered for fibrosis , and entecavir ( ETV ) , on the development of HCC in patients with CHB or hepatitis B virus ( HBV ) - related compensated cirrhosis .


This multicenter , centrally randomized , double-blind , placebo-controlled , parallel-group study is planned to complete within @ years .


For the study , @,@ with CHB or HBV-related compensated cirrhosis are randomly assigned in a @:@ ratio to a treatment group ( @ mg ETV once daily ; @ g RGT three times daily ) or a control group ( @ mg ETV once daily ; @ g RGT dummy agent three times daily ) .


The primary end points are the development of HCC and liver-related death .


Secondary end points include disease progression and overall survival .


Although antiviral therapy can achieve sustained suppression of HBV replication , thereby preventing cirrhosis , patients with CHB treated with nucleos ( t ) ide analogs ( NUCs ) retain a higher risk for HCC compared with patients with inactive disease .


Although previous clinical trials with RGT have confirmed the efficacy of blocking and reversing hepatic fibrosis in patients with CHB or compensated cirrhosis , the long-term risk for HCC or disease progression in these patients treated with combination of RGT and NUCs compared with NUCs alone is unclear .


Therefore , it is necessary to investigate the effects of the RGT blockade and reversal of hepatic fibrosis on the development of HCC in patients with CHB or HBV-related compensated cirrhosis in large , prospective , multicenter , double-blind , randomized , controlled trials in China .


Pain is among the most cited negative effects of orthodontic treatment .


Non-steroidal anti-inflammatory drugs seem to be an effective option for minimizing this but can have adverse effects on tooth movement owing to their ability to block prostaglandin synthesis .


Acetaminophen has been suggested as the analgesic of choice during orthodontic treatment as it showed no effect on orthodontic tooth movement in previous animal studies .


The purpose of this study was to compare the effects of ibuprofen and acetaminophen on the prostaglandin E@ ( PGE@ ) levels of the gingival crevicular fluid ( GCF ) during orthodontic tooth movement in human subjects .


A total of @ patients ( mean age @ years ) were randomly divided into three equal groups : ibuprofen , acetaminophen , and control groups .


Maxillary canines were distalized with @ g of force delivered by NiTi coil springs .


GCF samples were obtained before ( baseline ) and after spring activation at @ , @ , and @ h.


The PGE@ content of the GCF was determined using enzyme-linked immunosorbent assay .


PGE@ levels in all groups increased significantly by @ and @ h of force application and decreased to baseline levels by @ h. No significant difference was found between the acetaminophen and control groups at any time point .


There was a significant decrease in PGE@ levels in the ibuprofen group at @ and @ h when compared to the other two groups .


Acetaminophen showed no significant effect on prostaglandin synthesis and may be the safe choice compared to ibuprofen for relieving pain associated with orthodontic tooth movement .


To examine the clinical and cost-effectiveness of brief advice for excessive alcohol consumption among people who attend sexual health clinics .


Two-arm , parallel group , assessor blind , pragmatic , randomised controlled trial .


@ people aged @ years or over who attended one of three sexual health clinics and were drinking excessively were randomised to either brief advice or control treatment .


Brief advice consisted of feedback on alcohol and health , written information and an offer of an appointment with an Alcohol Health Worker .


Control participants received a leaflet on health and lifestyle .


The primary outcome was mean weekly alcohol consumption during the previous @ days measured @ months after randomisation .


The main secondary outcome was unprotected sex during this period .


Among the @ randomised to brief advice , @ ( @ % ) received it .


The adjusted mean difference in alcohol consumption at @ months was -@ units per week ( @ % CI -@ to @ , p = @ ) among those in the active compared to the control arm of the trial .


Unprotected sex was reported by @ ( @ % ) of those who received brief advice , and @ ( @ % ) controls ( adjusted OR = @ , @ % CI @ to @ , p = @ ) .


There were no significant differences in costs between study groups at @ months .


Introduction of universal screening and brief advice for excessive alcohol use among people attending sexual health clinics does not result in clinically important reductions in alcohol consumption or provide a cost-effective use of resources .


Dietary nitrate supplementation with beetroot juice ( BR ) has received widespread attention as an ergogenic aid .


However , recent evidence in well-trained cyclists has not consistently reported improved cycling economy or performance .


The present study examined the effects of acute and chronic BR supplementation on VO@ during submaximal running and @-m time trial ( TT ) performance of elite distance runners .


Eight male @-m runners ( VO@peak , @ @ mLkgmin ; @-m personal best , @:@ @ s ) participated in this study .


In a randomized , double-blind , crossover design , subjects supplemented with BR or a nitrate-free BR placebo ( PL ) for @ d separated by at least @ wk .


On days @ ( acute ) and @ ( chronic ) , subjects ingested @ mL of BR ( @-mmol nitrate ) or PL and completed a submaximal treadmill run and @-m TT on an indoor @-m track .


Plasma nitrate increased from @ @ to @ @ M ( acute ) and @ @ M ( chronic ) after BR supplementation .


There were no VO@ differences between conditions at @ % , @ % , and @ % VO@peak ( acute PL , @ @ mLmin ; chronic PL , @ @ mLmin ; acute BR , @ @ mLmin ; chronic BR , @ @ mLmin ) .


The @-m TT was unaffected by acute or chronic BR supplementation ( acute PL , @:@ min : s @ s ; chronic PL , @:@ min : s @ s ; acute BR , @:@ min : s @ s ; chronic BR , @:@ min : s @ s ) .


However , two subjects improved their TT performance after acute ( @ and @ s ) and chronic BR supplementation ( @ and @ s ) .


Acute and chronic BR supplementation did not reduce running VO@ or improve @-m TT performance of a group of elite distance runners , but two responders to BR were identified .


To evaluate the effectiveness of transcranial direct current stimulation alone and in combination with cognitive behavioural management in patients with non-specific chronic low back pain .


Double blind parallel group randomised controlled trial with six months ' follow-up conducted May @-March @ .


Participants , physiotherapists , assessors , and analyses were blinded to group allocation .


Interdisciplinary chronic pain centre .


@ participants with non-specific chronic low back pain > @ weeks were recruited from @ patients assessed for eligibility .


Participants were randomised to receive anodal ( @ minutes to motor cortex at @ mA ) or sham transcranial direct current stimulation ( identical electrode position , stimulator switched off after @ seconds ) for five consecutive days immediately before cognitive behavioural management ( four week multidisciplinary programme of @ hours ) .


Two primary outcome measures of pain intensity ( @-@ visual analogue scale ) and disability ( Oswestry disability index ) were evaluated at two primary endpoints after stimulation and after cognitive behavioural management .


Analyses of covariance with baseline values ( pain or disability ) as covariates showed that transcranial direct current stimulation was ineffective for the reduction of pain ( difference between groups on visual analogue scale @ mm ( @ % confidence interval -@ mm to @ mm ; P = @ ) ) and disability ( difference between groups @ point ( -@ to @ ; P = @ ) ) and did not influence the outcome of cognitive behavioural management ( difference between group @ mm ( -@ mm to @ mm ) ; P = @ ; difference between groups on Oswestry disability index @ point ( -@ to @ ) ; P = @ ) .


The stimulation was well tolerated with minimal transitory side effects .


This results of this trial on the effectiveness of transcranial direct current stimulation for the reduction of pain and disability do not support its clinical use for managing non-specific chronic low back pain.Trial registration Current controlled trials ISRCTN@ .


The purposes of this study were to establish the physiological interpretation of the shape parameter of the dynamic contrast-enhanced ultrasound ( DCE-US ) lognormal perfusion model and to evaluate the clinical significance of the parameter in a sample of patients undergoing antiangiogenic therapy for metastatic renal cell carcinoma ( mRCC ) .


The physiological interpretation of the lognormal shape parameter was explored using computer simulations of disruption-replenishment in fractal models of the microcirculation generated by a piecewise iterative algorithm in MATLAB .


Architectural variety was accomplished by introducing random perturbations to the diameter , length , and branching angles to the growing vascular tree .


The shape parameter was extracted from the time-intensity curves and compared with the transit time distributions calculated directly from the simulations .


Dynamic contrast-enhanced ultrasound data were obtained from @ consenting patients with mRCC being treated with antiangiogenic therapy .


Lognormal parameters related to the blood volume , mean flow speed , and vascular morphology/heterogeneity extracted before , during , and after therapy were correlated with progression-free survival ( PFS ) .


Cox proportional hazard ratios were calculated alongside receiver operator characteristics for different combinations of the vascular parameters to determine their ability to distinguish patients who would progress early ( less than the median PFS ) versus late ( greater than the median PFS ) .


The lognormal shape parameter correlated strongly to the width of the transit time distribution calculated directly from the simulations , and by extension , to the morphology/heterogeneity of the microvascular network ( Spearman r = @ , P < @ , n = @ ) .


Shorter time to progression was predicted by higher baseline heterogeneity ( P = @ ) and a reduction in tumor blood volume less than @ % ( P = @ ) after @ weeks of treatment .


Combining baseline parameters with changes that occur shortly after starting treatment increased the sensitivity and specificity of DCE-US to identify which patients would progress/resist therapy early versus late compared with when the vascular parameters were considered in isolation .


The DCE-US shape parameter from the lognormal perfusion model is representative of microvascular morphology/heterogeneity and may be used to noninvasively characterize the vascular architecture of cancer lesions .


A more abnormal flow distribution at baseline predicts for poorer outcome for patients treated with antiangiogenic therapy for metastatic renal cell cancer .


Combining pretreatment and on-treatment measurements of vascularity can improve the performance of DCE-US to predict which patients will progress earlier versus later when on antiangiogenic therapy for mRCC .


There is considerable interindividual variability in pulmonary artery pressure among high-altitude ( HA ) dwellers , but the underlying mechanism is not known .


At low altitude , a patent foramen ovale ( PFO ) is present in about @ % of the general population .


Its prevalence is increased in clinical conditions associated with pulmonary hypertension and arterial hypoxemia , and it is thought to aggravate these problems .


We searched for a PFO ( transesophageal echocardiography ) in healthy HA dwellers ( n = @ ) and patients with chronic mountain sickness ( n = @ ) at @,@ m above sea level and studied its effects ( transthoracic echocardiography ) on right ventricular ( RV ) function , pulmonary artery pressure , and vascular resistance at rest and during mild exercise ( @ W ) , an intervention designed to further increase pulmonary artery pressure .


The prevalence of PFO ( @ % ) was similar to that reported in low-altitude populations and was not different in participants with and without chronic mountain sickness .


Its presence was associated with RV enlargement at rest and an exaggerated increase in right-ventricular-to-right-atrial pressure gradient ( @ @ mm Hg vs @ @ mm Hg , P < @ ) and a blunted increase in fractional area change of the right ventricle ( @ % -LSB- -@ % , @ % -RSB- vs @ % -LSB- @ % , @ % -RSB- , P = @ ) during mild exercise .


These findings show , we believe for the first time , that although the prevalence of PFO is not increased in HA dwellers , its presence appears to facilitate pulmonary vasoconstriction and RV dysfunction during a mild physical effort frequently associated with daily activity .


In most ocular procedures , a central position of the eye is necessary .


This can be achieved using a deep plane of anaesthesia , locoregional blocks or with neuromuscular blocking agents .


The aim of this study was to evaluate the influence of atracurium on cardiovascular parameters , and on recovery quality and duration in horses .


Thirty-four warmblood horses undergoing in total @ vitrectomies were divided into two groups .


Premedication , induction and maintenance were identical in all patients .


After @ minutes , horses of group A received atracurium ( @ mg/kg ) while in the control group ( group K ) the depth of anaesthesia was adapted to keep the bulbus in a central position .


Dobutamine and fluids were administered to maintain the mean arterial blood pressure ( MAP ) above @ mmHg .


Cardiac output ( CO ) , heart rate ( HR ) , MAP , respiratory rate , end-expiratory isoflurane concentration ( ETIso ) and dobutamine requirements were determined .


Position and movement of the globe during the surgical procedure were scored .


Time and quality of the recovery period was scored .


Horses of group K required significantly higher concentrations of isoflurane ( group A : @ @ % ; group K : @ @ % ) and had an overall lower MAP ( group A : @ @ mmHg ; group K : @ @ mmHg ) and CO ( group A : @ @ l/min ; group K : @ @ l/min ) but needed significantly more dobutamine ( group A : @ @ g/kg/min ; group K : @ @ g/kg/min ) compared to group A. Complete relaxation occurred @ @ minutes after atracurium bolus and lasted for @ @ minutes .


The score of the bulbus position and movement was significantly lower in group A , resulting in a better quality for the surgical procedure .


In group A , the recovery time to standing was significantly shorter ( group A : @ @ min ; group K : @ @ min ) , with no difference in quality .


The use of atracurium resulted in a better cardiovascular condition , probably because of the isoflurane-sparing effect .


The recovery time was shorter in these horses without negative effects on recovery quality .


No signs of residual atracurium effects were detected .


The present study was aimed at determining the role warm saline rinse in the prevention of alveolar osteitis following dental extractions .


Apparently patients aged @ and above who were referred to the Oral Surgery Clinic of our institution , with an indication for non-surgical extraction of pathologic teeth were prospectively and uniformly randomized into warm saline group and control .


The experimental group ( n = @ ) were instructed to gargle @ times daily with warm saline and no such instructions were given to the second group ( n = @ ) to serve as controls .


Information on demographic , indications for extraction , and development of alveolar osteitis were obtained and analyzed .


Comparative statistics were done using Pearson 's chi square or Fisher 's exact test as appropriate .


A p value of less than @ was considered significant .


The demographic and other baseline parameters such as indications for extractions were comparable among the study groups ( p > @ ) .


The overall prevalence of alveolar osteitis was @ % .


There was a statistical significant difference between the study groups with respect to development of alveolar osteitis ( X@ = @ , df = @ , p = @ ) .


The risk of development of alveolar osteitis was @ times higher in the control group ( OR = @ , P = @ ) .


Warm saline mouth rinse instruction is beneficial in the prevention of development of alveolar osteitis after dental extractions .


To evaluate the growth of geographic atrophy ( GA ) during anti-vascular endothelial growth factor ( VEGF ) therapy .


Cohort within a clinical trial .


Patients included in the Comparison of Age-related Macular Degeneration Treatments Trials ( CATT ) .


Participants were randomly assigned to injections of ranibizumab or bevacizumab and to a @-year dosing regimen of monthly or pro re nata ( PRN ) or to monthly for @ year and PRN the following year .


Digital color photographs and fluorescein angiograms at baseline and @ and @ years were evaluated for GA , and the total area of GA was measured by @ graders masked to treatment ; differences were adjudicated .


Multivariate linear mixed models of the annual change in the square root of the area included baseline demographic , treatment , and ocular characteristics on imaging as candidate risk factors .


Geographic atrophy growth rate .


Among @ participants , @ ( @ % ) had GA at baseline , @ ( @ % ) developed GA during year @ , and @ ( @ % ) developed GA during year @ .


Among @ eyes evaluable for growth , the rate was @ mm/yr ( standard error -LSB- SE -RSB- , @ mm/year ) .


In multivariate analysis , the growth rate was @ mm/year in eyes receiving bevacizumab and @ mm/year in eyes receiving ranibizumab ( difference , @ mm/yr ; @ % confidence interval -LSB- CI -RSB- , @-@ @ ; P = @ ) .


Growth rate did not differ between eyes treated monthly and PRN ( P = @ ) .


Eyes with subfoveal choroidal neovascularization ( CNV ) lesions had a lower growth rate than eyes with nonsubfoveal CNV lesions ( difference , @ ; @ % CI , @-@ @ ; P = @ ) .


Eyes with GA farther from the fovea had higher growth rates by @ ( @ % CI , @-@ ) mm/year for every millimeter farther from the fovea .


The growth rate was @ mm/year for eyes with predominantly classic lesions , @ mm/year for eyes with minimally classic lesions , and @ mm/year for eyes with occult only lesions ( P < @ ) .


The growth rate in eyes having a fellow eye with GA was higher by @ mm/year ( @ % CI , @-@ @ ; P = @ ) than in eyes without GA in the fellow eye .


Eyes with epiretinal membrane had a higher growth rate than eyes without epiretinal membrane ( difference , @ ; @ % CI , @-@ @ ; P = @ ) .


Geographic atrophy growth depends on several ocular factors .


Ranibizumab may accelerate GA growth .


Intravenous ( IV ) acetaminophen may be an effective component of multimodal postoperative pain management .


The primary objective of this study was to evaluate the impact of IV acetaminophen on total opioid use in postoperative patients .


The secondary objective was to evaluate the effect of IV acetaminophen on hospital length of stay .


This retrospective , case-control study evaluated the impact of IV acetaminophen on total opioid use in surgical patients .


Patients were included if they received at least one perioperative dose of IV acetaminophen and underwent a surgical knee procedure .


Controls were matched and randomly selected based on procedure type , age , and severity of illness .


Postoperative opioids were converted into oral morphine equivalents , and overall use was compared between groups .


One hundred patients were enrolled , with @ patients receiving IV acetaminophen and @ matched controls .


A total of @mg versus @ mg oral morphine equivalents were used in the IV acetaminophen group and control group , respectively ( p = @ ) .


There were @mg/day oral morphine equivalents used in the IV acetaminophen group versus @ mg in the control group ( p = @ ) .


The median hospital length of stay in both groups was @days ( p = @ ) .


IV acetaminophen did not significantly decrease postoperative opioid use in patients who underwent surgical knee procedures .


In addition , there was a nonsignificant trend toward increased opioid use in the IV acetaminophen group .


There was no significant difference in hospital length of stay between the IV acetaminophen group and the control group .


These findings require further study in larger patient populations and in other orthopedic procedures that typically require longer hospital stays .


To determine if repetitive sphenopalatine ganglion ( SPG ) blocks with @ % bupivacaine delivered through the Tx@ ( ) are superior in reducing pain associated with chronic migraine ( CM ) compared with saline .


The SPG is a small concentrated structure of neuronal tissue that resides within the pterygopalatine fossa ( PPF ) in close proximity to the sphenopalatine foramen and is innervated by the maxillary division of the trigeminal nerve .


From an anatomical and physiological perspective , SPG blockade may be an effective acute and preventative treatment for CM .


This was a double-blind , parallel-arm , placebo-controlled , randomized pilot study using a novel intervention for acute treatment in CM .


Up to @ subjects could be enrolled at @ headache specialty clinics in the US .


Eligible subjects were between @ and @ years of age and had a history of CM defined by the second edition of the International Classification of Headache Disorders appendix definition .


They were allowed a stable dose of migraine preventive medications that was maintained throughout the study .


Following a @-day baseline period , subjects were randomized by computer-generated lists of @:@ to receive @ % bupivacaine or saline , respectively .


The primary end-point was to compare numeric rating scale scores at pretreatment baseline vs @ minutes , @ minutes , and @ hours postprocedure for all @ treatments .


SPG blockade was accomplished with the Tx@ ( ) , which allows a small flexible soft plastic tube that is advanced below the middle turbinate just past the pterygopalatine fossa into the intranasal space .


A @ cc of anesthetic or saline was injected into the mucosa covering the SPG .


The procedure is performed similarly in each nostril .


The active phase of the study consisted of a series of @ SPG blocks with @ cc of @ % bupivacaine or saline provided @ times per week for @ weeks .


Subjects were re-evaluated at @ and @ months postfinal procedure .


The final dataset included @ subjects , @ in the bupivacaine group and @ in the saline group .


A repeated measures analysis of variance showed that subjects receiving treatment with bupivacaine experienced a significant reduction in the numeric rating scale scores compared with those receiving saline at baseline ( M = @ vs M = @ , P = @ ) , @ minutes ( M = @ vs M = @ , P < @ ) , @ minutes ( M = @ vs M = @ , P < @ ) , and @ hours after treatment ( M = @ vs M = @ , P < @ ) , respectively .


Headache Impact Test-@ scores were statistically significantly decreased in subjects receiving treatments with bupivacaine from before treatment to the final treatment ( Mdiff = -@ , P = @ ) , whereas no significant change was seen in the saline group ( Mdiff = -@ , P = @ ) .


SPG blockade with bupivacaine delivered repetitively for @ weeks with the Tx@ ( ) device demonstrates promise as an acute treatment of headache in some subjects with CM .


Statistically significant headache relief is noted at @ and @ minutes and sustained at @ hours for SPG blockade with bupivacaine vs saline .


The Tx@ ( ) device was simple to use and not associated with any significant or lasting adverse events .


Further research on sphenopalatine ganglion blockade is warranted .


The aim of this study was to investigate the efficacy of a single shot intercostal block for pain control in pediatric patients undergoing the Nuss procedure .


A double-blind , randomized , controlled study was performed .


Thirty patients received a single shot bilateral intercostal block with levobupivacaine ( L group ) and @ patients with @ % saline ( S group ) .


Standardized baseline analgesia was applied for all patients .


Morphine consumption , pain scores , respiratory depression , nausea and vomiting , and urinary retention were recorded every @h for @h after surgery .


The loading dose of morphine was lower ( p < @ ) in the L group .


There were significantly lower morphine doses up to @h after surgery and VAS scores up to @h after surgery in the L group ( p < @ and p = @ , respectively ) .


The incidence of nausea and vomiting was lower in the L group ( < @ ) .


The incidence of urinary retention was lower in the L group ( p = @ ) .


A single shot IB is an effective additional treatment for pediatric patients undergoing the Nuss procedure and results in the reduced consumption of morphine , less postoperative pain , and fewer opioid-related adverse effects .


To evaluate a slower ( compared with a standard ) infusion rate of the loading dose of magnesium sulphate for preterm fetal neuroprotection as a strategy to reduce maternal adverse effects .


Randomised controlled trial .


South Australian maternity hospital .


Fifty-one women at < @ weeks of gestation , where birth was planned or expected within @ hours .