Secondary endpoints are time to full recovery within three months after index surgery , post-operative complications , recurrences , mortality and quality of life.Our hypothesis is that laparoscopic incisional hernia repair comes with a significant shorter hospital stay compared to open incisional hernia repair .


A difference of two days is considered significant .


One-hunderd-and-thirty-five patients are enrolled in each treatment arm .


The economic evaluation will be performed from a societal perspective .


Primary outcomes are costs per patient related to time-to-recovery and quality of life.The main goal of the trial is to establish whether laparoscopic incisional hernia repair is superior to conventional open incisional hernia repair in terms of cost-effectiveness .


This is measured through length of hospital stay and quality of life .


Secondary endpoints are re-operation rate due to post-operative complications or recurrences , mortality and quality of life .


The difference in time to full recovery between the two treatment strategies is thought to be in favor of laparoscopic incisional hernia repair .


Laparoscopic incisional hernia repair is therefore expected to be a more cost-effective approach .


Oxygen consumption may be impaired in critically ill patients .


To evaluate the effect of intravenous thiamine on oxygen consumption ( -LSB- Formula : see text -RSB- o@ ) in critically ill patients .


This was a small , exploratory open-label pilot study conducted in the intensive care units at a tertiary care medical center .


Critically ill adults requiring mechanical ventilation were screened for enrollment .


Oxygen consumption ( -LSB- Formula : see text -RSB- o@ ) and cardiac index ( CI ) were recorded continuously for @ hours .


After @ hours of baseline data collection , @ mg of intravenous thiamine was administered .


The outcome was change in -LSB- Formula : see text -RSB- o@ after thiamine administration .


Twenty patients were enrolled and @ were excluded because of incomplete -LSB- Formula : see text -RSB- o@ data , leaving @ patients for analysis .


There was a trend toward increase in -LSB- Formula : see text -RSB- o@ after thiamine administration ( @ ml/min , SE @ ; P = @ ) .


After preplanned adjustment for changes in CI in case of a delivery-dependent state in some patients ( with exclusion of one additional patient because of missing CI data ) , this became statistically significant ( @ ml/min , SE @ ; P = @ ) .


In patients with average CI greater than our cohort 's mean value of @ L/min/m ( @ ) , -LSB- Formula : see text -RSB- o@ increased by @ ml/min ( @ ; P < @ ) after thiamine .


Thiamine had no effect in patients with reduced CI ( < @ L/min/m ( @ ) ) .


There was no association between initial thiamine level and change in -LSB- Formula : see text -RSB- o@ after thiamine administration .


The administration of a single dose of thiamine was associated with a trend toward increase in -LSB- Formula : see text -RSB- o@ in critically ill patients .


There was a significant increase in -LSB- Formula : see text -RSB- o@ in those patients with preserved or elevated CI .


Further study is needed to better characterize the role of thiamine in oxygen extraction .


Clinical trial registered with www.clinicaltrials.gov ( NCT@ ) .


To assess the efficacy of aromatic essential oils on neck pain .


Sixty participants with a history of neck pain and Neck Disability Index ( NDI ) score > @ % were selected and randomly divided into control and experimental groups .


Motion analysis laboratory at Hungkuang University .


For the experimental group , the intervention included @ % concentration cream composed of four essential oils : marjoram , black pepper , lavender , and peppermint .


For the control group , only an unscented cream was provided .


For @ weeks , all patients applied @g cream directly to the affected area daily after showering or bathing .


Assessment was performed by using a visual analogue scale ( VAS ) , NDI , pressure pain threshold ( PPT ) evaluated with a pressure meter , and neck-joint range evaluated with Motion Analysis System ( MAS ) .


A t-test statistical analysis by SPSS statistical software indicated that VAS scores improved significantly for both groups ( p < @ ) .


In addition , the experimental group had improved pain tolerance in the left upper trapezius ( meanstandard deviation , @ ) and right upper trapezius ( @ ) as measured by the PPT .


According to the NDI , the experimental group also showed significant improvement ( p = @ ) .


Comparison of MAS values before and after the intervention showed significant improvement in the @ motion areas in the experimental group .


This finding suggests that the experimental group had better results than the control group .


The essential oil cream developed in this study can be used to improve neck pain .


This study appears to be the first to quantify this by using PPT and MAS .


Few studies have evaluated interventions to improve quality of life ( QOL ) for Latina breast cancer survivors and caregivers .


Following best practices in community-based participatory research ( CBPR ) , we established a multi-level partnership among Latina survivors , caregivers , community-based organizations ( CBOs ) , clinicians , and researchers to evaluate a survivor-caregiver QOL intervention .


A CBO in the mid-Atlantic region , Nueva Vida , developed a patient-caregiver program called Cuidando a mis Cuidadores ( Caring for My Caregivers ) , to improve outcomes important to Latina cancer survivors and their families .


Together with an academic partner , Nueva Vida and three CBOs established a multi-level team of researchers , clinicians , Latina cancer survivors , and caregivers to conduct a national randomized trial to compare the patient-caregiver program to usual care .


Incorporating team feedback and programmatic considerations , we adapted the prior patient-caregiver program into an @-session patient - and caregiver-centered intervention that includes skill-building workshops such as managing stress , communication , self-care , social well-being , and impact of cancer on sexual intimacy .


We will measure QOL domains with the patient-reported outcomes measurement information system , dyadic communication between the survivor and caregiver , and survivors ' adherence to recommended cancer care .


To integrate the intervention within each CBO , we conducted interactive training on the protection of human subjects , qualitative interviewing , and intervention delivery .


The development and engagement process for our QOL intervention study is innovative because it is both informed by and directly impacts underserved Latina survivors and caregivers .


The CBPR-based process demonstrates successful multi-level patient engagement through collaboration among researchers , clinicians , community partners , survivors , and caregivers .


This study evaluated change in health-related quality of life ( HRQOL ) associated with ongoing weight change among patients with type @ diabetes mellitus ( T@DM ) treated with dapagliflozin , a highly selective sodium-glucose cotransporter @ ( SGLT@ ) inhibitor that lowers blood glucose by increasing urinary glucose excretion and is associated with body weight reductions .


Patients with T@DM who had inadequate glycaemic control on metformin ( MET ) alone were enrolled in a @-week , double-blind , randomized , placebo-controlled study with a @-week extension to evaluate the effect of dapagliflozin + MET on body weight .


Patients also completed the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes Weight Questionnaire-@ ( SHIELD-WQ-@ ) , a weight change-related HRQOL survey .


Difference in proportions of patients treated with dapagliflozin @mg + MET ( n = @ ) or placebo + MET ( n = @ ) who reported improvement in HRQOL was analysed with Fisher 's exact test .


Dapagliflozin patients had significantly greater weight loss than placebo patients over @weeks ( p < @ ) .


This corresponded to a numerically greater proportion of dapagliflozin-treated patients reporting ongoing weight loss and associated improvements in most HRQOL domains at three different evaluation points ( weeks @ , @ and @ ) than placebo-treated patients .


In a post-hoc analysis among patients who reported ongoing weight loss regardless of treatment arm , a significantly greater proportion of patients reporting weight loss versus weight gain reported improvements in physical health , self-esteem and overall HRQOL at weeks @ , @ and @ .


Dapagliflozin-induced weight loss was associated with improvement in overall HRQOL .


Overall , ongoing weight loss was associated with improvements in several HRQOL domains compared with weight gain .


Care services for older people are provided with the expectation of supporting carers in their caregiving role .


The aim of the study is to investigate the association between the utilisation of care services by older people and the caregiving experience .


Cross-sectional design , involving a cohort of family carers ( n = @ ) of frail older people ( @ years ) enrolled in a clinical trial of frailty treatment in metropolitan Sydney from @ to @ .


The caregiving experience was measured in five domains : health , daily schedule , finance , family support and self-esteem ( Caregiver Reaction Assessment tool ) .


Multivariate regression analysis demonstrated an association between the utilisation of residential respite care and financial strain ( = -@ , P = @ ) , after controlling for functional ability , co-residence and age .


There is a need to consider carers ' financial barriers and concerns in regards to the utilisation of respite care services .


We examine improvement and worsening in quality of life ( QOL ) in terms of proportions achieving minimum clinically important change ( MCID ) , and factors related to MCID , in patients with temporal lobe epilepsy randomized to medical or surgical treatment .


Eighty patients with temporal lobe epilepsy randomized to surgical ( n ( @ ) = @ ) or medical ( n ( @ ) = @ ) therapy were followed for @ months , reporting QOL at baseline , and at @ and @ months .


Previously established thresholds for MCID across various general and epilepsy-specific QOL instruments were used to determine meaningful improvement ( positive MCID ) or worsening ( negative MCID ) .


Generalized linear mixed-effects models were used to compare MCID in both groups .


At @ months , @ % of patients in the surgical group achieved positive MCID on the Quality of Life in Epilepsy ( QOLIE ) -@ , as compared to @ % of those in the medical group ( p < @ ) .


On the QOLIE-@ , @ % of the surgical group and @ % of the medical group achieved positive MCID ( p < @ ) .


Substantially more medically treated patients exhibited clinically significant worsening in QOL , as compared with those surgically treated .


The respective medical versus surgical proportions with worsening were @ % versus @ % in QOLIE@ , @ % versus @ % in Health Utility Index-III ( HUI-III ) , and @ % versus @ % in Short Form-@ ( SF-@ ) Mental Composite Score ( MCS ) .


The number of patients who need to undergo surgery for one additional person to have a meaningful improvement in the QOLIE-@ is two ( number needed to treat = @ ) .


The results also favored surgery using the generic HUI-III instrument , but not with the mental of physical function subscales of the SF-@ .


Significantly more patients in the surgical group achieved meaningful improvement in epilepsy-specific measures of QOL at @ and @ months compared to those in the medical group .


Substantially more patients in the medical therapy group exhibited clinically significant worsening in their QOL assessed with epilepsy-specific and generic instruments .


A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .


To evaluate feasibility and potential effectiveness of a patient decision aid ( PtDA ) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement .


A prospective two-arm pilot randomized controlled trial .


Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic .


Patients were randomized to the PtDA intervention or usual education .


The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients ' clinical and decisional data for their surgeon .


The main feasibility outcomes were rates of recruitment and questionnaire completion ; the preliminary effectiveness outcomes were wait times and decision quality .


Of @ patients eligible for surgical consultation , @ ( @ % ) were recruited and randomized to the PtDA intervention ( n = @ ) or usual education ( n = @ ) .


Data collection yielded a @ % questionnaire completion rate with less than @ % missing items .


After one year , @ % of patients remained on the surgical wait list .


The median time from referral to being off the wait list ( censored using survival analysis techniques ) was @ weeks for the PtDA group ( n = @ , @ % CI : @ , @ ) and @ weeks for usual education ( n = @ , @ % CI : @ , @ ) .


Patients exposed to the PtDA had higher decision quality based on knowledge ( @ % versus @ % ; p < @ ) and quality decision being an informed choice that is consistent with their values for option outcomes ( @ % versus @ % ; p < @ ) .


Recruitment of patients with osteoarthritis considering surgery and data collection were feasible .


As some patients remained on the surgical waiting list after one year , follow-up should be extended to two years .


Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery .


While surgery and perioperative smoking cessation interventions may motivate patients to quit smoking in the short term , it is unknown how often this translates into permanent cessation .


In this study , we sought to determine the rates of long-term smoking cessation after a perioperative smoking cessation intervention and predictors of successful cessation at @ year .


We previously reported short-term results from a perioperative randomized controlled trial comparing usual care with an intervention involving ( @ ) brief counseling by the preadmission nurse , ( @ ) smoking cessation brochures , ( @ ) referral to a telephone quitline , and ( @ ) a free @-week supply of transdermal nicotine replacement .


We now report our @-year follow-up outcomes .


Between October @ and April @ , @ patients were randomized .


At @ year , @ patients ( @ % ) were available for follow-up telephone interview .


Smoking cessation occurred in @ % of control patients compared with @ % of patients in the intervention group ( relative risk , @ ; @ % confidence interval -LSB- CI -RSB- , @-@ @ ; P = @ ) .


The number needed-to-treat to achieve smoking cessation for @ patient at @ year postoperatively was @ ( @ % CI , @-@ @ ) .


Multivariable logistic regression modeling found that the intervention ( P = @ ) and lower nicotine dependency at baseline ( P < @ ) were predictive of success at smoking cessation at @ year .


Poisson regression showed that adjusted for nicotine dependency , those randomized to the intervention group were @ times ( @ % CI , @-@ @ ; P = @ ) more likely to achieve long-term cessation than those in the control group .


Adjusted for randomization group , a low level of nicotine dependency resulted in a relative risk of quitting of @ ( @ % CI , @-@ @ ; P = @ ) .


This study demonstrates that an intervention designed for a busy preadmission clinic results in decreased smoking rates not only around the time of surgery but also continued benefit in smoking cessation at @ year .


Perioperative care providers have a unique opportunity to assist patients in smoking cessation and achieve long-lasting results .


The aim of this study was to investigate whether more sickness absence is reported in countries with higher income inequality than elsewhere , and whether the level of income inequality moderates the association between psycho-social job demands and sickness absence .


Our analysis is based on the Fifth European Working Conditions Survey that compared @ European countries .


We performed multi-level regression analysis .


On the macro-level of analysis we included the Gini-Index as measure of inequality .


On the micro-level of analysis we followed the Karasek-Theorell model and included three scales for psychological job demands , physical job demands , and decision latitude in the model .


The model was stratified by sex .


We found that , in countries with high income inequality , workers report significantly more sickness absence than workers in countries with low income inequality .


In addition we found that the level of income inequality moderates the relationship between psychological job demands and sickness absence .


High psychological job demands are significantly more strongly related to more days of sickness absence in countries with low income inequality than in countries with high income inequality .


As the nature and causal pathways of cross-level interaction effects still can not be fully explained , we argue that future research should aim to explore such causal pathways .


In accordance with WHO recommendations we argue that inequalities should be reduced .


In addition we state that , particularly in countries with low levels of income inequality , policies should aim to reduce psychological job demands .


This study sought to assess the @-year outcomes of the population included in the EXAMINATION ( Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction ) trial beyond the @-year prescription period of dual antiplatelet therapy .


The EXAMINATION trial compared the performance of everolimus-eluting stents ( EES ) versus bare-metal stents ( BMS ) in an all-comer ST-segment elevation myocardial infarction ( STEMI ) population .


This was a multicenter , multinational , prospective , randomized , single-blind , controlled trial in patients with STEMI .


The primary endpoint , which was the combined endpoint of all-cause death , any recurrent myocardial infarction , and any revascularization , and the endpoints target lesion revascularization and stent thrombosis were assessed at @ years .


Between December @ , @ , and May @ , @ , @,@ patients were randomized to receive EES ( n = @ ) or BMS ( n = @ ) .


Compliance with dual antiplatelet regimen was reduced at @ years to a similar degree ( @ % vs. @ % , p = @ ) .


At @ years , the primary endpoint occurred in @ ( @ % ) patients of the EES group and in @ ( @ % ) patients of the BMS group ( p = @ ) .


Rate of target lesion revascularization was significantly lower in the EES group than in the BMS group ( @ % vs. @ % ; p = @ ) .


Rates of definite and definite or probable stent thrombosis were also significantly reduced in the EES group ( @ % vs. @ % ; p = @ , and @ % vs. @ % ; p = @ , respectively ) .


The @-year follow-up of the EXAMINATION trial confirms the safety and efficacy of the EES compared with BMS in the setting of STEMI .


Specifically , both rates of target lesion revascularization and stent thrombosis were reduced in recipients of EES without any signs of late attrition for either of these endpoints .


( A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction : EXAMINATION Study ; NCT@ ) .


The purpose of this study was to evaluate prevalence , progression , treatment , and outcome of silent coronary artery disease ( CAD ) in asymptomatic patients with diabetes ( DM ) at high coronary risk .


Despite the close association of diabetes and CAD , general CAD screening in asymptomatic patients with DM is discouraged even though outcome data in patients at high coronary risk are lacking .


Prospective multicenter outcome study-with a pilot randomized treatment substudy .


The study comprised @ asymptomatic patients with DM ( type @ ) without history or symptoms of CAD at high CAD risk .


They underwent clinical evaluation and myocardial perfusion single-photon emission computed tomography ( MPS ) at baseline and after @ years .


Patients with normal MPS received usual care ; those with abnormal MPS received medical or combined invasive and medical management .


An abnormal MPS was found in @ of @ patients ( @ % ) .


In patients with normal MPS , MACE occurred in @ % and ischemia or new scar in @ % .


Patients with abnormal MPS had more MACE ( @ % ; hazard ratio : @ ; @ % confidence interval -LSB- CI -RSB- : @ to @ ; p = @ ) and ischemia or new scar ( @ % ; odds ratio : @ ; @ % CI : @ to @ ; p < @ ) despite therapy , resulting in `` overt or silent CAD progression '' of @ % versus @ % ( odds ratio : @ ; @ % CI : @ to @ ; p < @ ) .


Patients with abnormal MPS randomized to medical versus invasive-medical strategies had similar event rates ( p = @ ) , but more ischemic or new scar findings ( @ % vs. @ % ; p < @ ) .


High-risk asymptomatic patients with DM and normal MPS ( @ % ) have a low rate of first manifestations of CAD .


Patients with abnormal MPS at baseline ( @ % ) have a @-fold higher rate of progression to `` overt or silent CAD , '' despite therapy .


Randomized patients ' outcomes suggest that a combined invasive and medical strategy for silent CAD may reduce scintigraphic but not symptomatic CAD progression versus medical therapy alone .


( Trial of Invasive versus Medical therapy of Early coronary artery disease in Diabetes Mellitus ISRCTN@ ) .


Chronic obstructive pulmonary disease ( COPD ) is associated with eosinophilic airway inflammation in @-@ % of patients .


Benralizumab , an anti-interleukin-@ receptor monoclonal antibody , depletes blood and sputum eosinophils .


We aimed to establish whether benralizumab reduces acute exacerbations of COPD in patients with eosinophilia and COPD .


We did this randomised , double-blind , placebo-controlled , phase @a study between Nov @ , @ , and July @ , @ , at @ sites in the UK , Poland , Germany , Canada , the USA , Denmark , and Spain .


Adults aged @-@ years , with moderate-to-severe COPD , at least one acute exacerbation of COPD , and a sputum eosinophil count of @ % or more within the previous year , were randomly assigned ( @:@ ) via computer-generated permuted block randomisation ( block size of four ) , with an interactive voice or web-response system , to receive placebo or @ mg benralizumab subcutaneously , every @ weeks ( three doses ) , then every @ weeks ( five doses ) over @ weeks .


Study site personnel included in study assessments , participants , and data analysts , were masked to treatment allocation .


The primary endpoint was the annualised rate of acute exacerbations of COPD at week @ , defined as the number of acute exacerbations divided by total duration of person-year follow-up .


Secondary and exploratory endpoints included COPD-specific Saint George 's Respiratory Questionnaire ( SGRQ-C ) , Chronic Respiratory Questionnaire self-administered standardised format ( CRQ-SAS ) , pre-bronchodilator forced expiratory volume in @ second ( FEV@ ) , and safety .


We did a prespecified subgroup analysis by baseline blood eosinophil count .


Analyses were by intention to treat and per-protocol .


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


We randomly assigned @ patients to receive placebo ( n = @ ) or benralizumab ( n = @ ) , of whom @ ( @ % ) patients completed the study .


Six patients who completed the study were excluded from the per-protocol population because of major protocol violations ; the per-protocol population thus included @ patients .


Benralizumab did not reduce the annualised rate of acute exacerbations of COPD compared with placebo in the per-protocol population , with rates of @ ( @-@ ; n = @ ) versus @ ( @-@ ; n = @ ) .


Mean pre-bronchodilator FEV@ change from baseline to week @ was -@ L ( SD @ ) with placebo , and @ L ( @ ) with benralizumab ( p = @ ) .


Numerical , albeit non-significant , improvement in acute exacerbations of COPD , SGRQ-C , CRQ-SAS , and FEV@ were greater in benralizumab-treated patients with baseline blood eosinophil concentrations of @ cells per L or more or @ cells per L or more .


Incidence of treatment-emergent adverse events was similar between the two groups , with the most common events being respiratory disorders ( @ -LSB- @ % -RSB- of @ patients given placebo vs @ -LSB- @ % -RSB- of @ given benralizumab ) and infections ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) .


A higher incidence of serious treatment-emergent adverse events were recorded in patients in the benralizumab group than in those in the placebo group ( @ vs nine patients ) , although none of these events were considered by the investigator to be benralizumab related .


Compared with placebo , benralizumab did not reduce the rate of acute exacerbations of COPD .


However , the results of prespecified subgroup analysis support further investigation of benralizumab in patients with COPD and eosinophilia .


Limited data are available from controlled studies on biomarkers of maternal vitamin B-@ status .


We sought to quantify the effects of pregnancy and lactation on the vitamin B-@ status response to a known and highly controlled vitamin B-@ intake .


As part of a @-@ wk feeding trial , pregnant ( @-@ wk gestation ; n = @ ) , lactating ( @ wk postpartum ; n = @ ) , and control ( nonpregnant , nonlactating ; n = @ ) women consumed vitamin B-@ amounts of @ g/d -LSB- mixed diet ( @ g/d ) plus a prenatal multivitamin supplement ( @ g/d ) -RSB- .


Serum vitamin B-@ , holotranscobalamin ( bioactive form of vitamin B-@ ) , methylmalonic acid ( MMA ) , and homocysteine were measured at baseline and study-end .


All participants achieved adequate vitamin B-@ status in response to the study dose .


Compared with control women , pregnant women had lower serum vitamin B-@ ( -@ % ; P = @ ) at study-end , whereas lactating women had higher ( P = @ ) serum vitamin B-@ throughout the study ( +@ % at study-end ) .


Consumption of the study vitamin B-@ dose increased serum holotranscobalamin in all reproductive groups ( +@ -@ % ; P @ ) .


At study-end , pregnant ( vs. control ) women had a higher holotranscobalamin-to-vitamin B-@ ratio ( P = @ ) with @ % ( vs. @ % ) of total vitamin B-@ in the bioactive form .


Serum MMA increased during pregnancy ( +@ % ; P < @ ) but did not differ by reproductive state at study-end .


Serum homocysteine increased in pregnant women ( +@ % ; P = @ ) but decreased in control and lactating women ( -@ -@ % ; P < @ ) .


Despite these changes , pregnant women had @ % lower serum homocysteine than the other @ groups at study-end ( P @ ) .


Pregnancy and lactation alter vitamin B-@ status in a manner consistent with enhanced vitamin B-@ supply to the child .


Consumption of the study vitamin B-@ dose ( @ times the RDA ) increased the bioactive form of vitamin B-@ , suggesting that women in these reproductive states may benefit from vitamin B-@ intakes exceeding current recommendations .


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


Early mortality for HIV-positive people starting antiretroviral therapy ( ART ) remains high in resource-limited settings , with tuberculosis the most important cause .


Existing rapid diagnostic tests for tuberculosis lack sensitivity among HIV-positive people , and consequently , tuberculosis treatment is either delayed or started empirically ( without bacteriological confirmation ) .


We developed a management algorithm for ambulatory HIV-positive people , based on body mass index and point-of-care tests for haemoglobin and urine lipoarabinomannan ( LAM ) , to identify those at high risk of tuberculosis and mortality .


We designed a clinical trial to test whether implementation of this algorithm reduces six-month mortality among HIV-positive people with advanced immunosuppression .


The TB Fast Track study is an open , pragmatic , cluster randomised superiority trial , with @ primary health clinics randomised to implement the intervention or standard of care .


Adults ( aged @years ) with a CD@ count of @ cells/L or less , who have not received any tuberculosis treatment in the last three months , or ART in the last six months , are eligible .


In intervention clinics , the study algorithm is used to classify individuals as at high , medium or low probability of tuberculosis .


Those classified as high probability start tuberculosis treatment immediately , followed by ART after two weeks .


Medium-probability patients follow the South African guidelines for test-negative tuberculosis and are reviewed within a week , to be re-categorised as low or high probability .


Low-probability patients start ART as soon as possible .


The primary outcome is all-cause mortality at six months .


Secondary outcomes include severe morbidity , time to ART start and cost-effectiveness .


This trial will test whether a primary care-friendly management algorithm will enable nurses to identify HIV-positive patients at the highest risk of tuberculosis , to facilitate prompt treatment and reduce early mortality .


There remains an urgent need for better diagnostic tests for tuberculosis , especially for people with advanced HIV disease , which may render empirical treatment unnecessary .


Guidelines recommend gradual weight loss for the treatment of obesity , indicative of a widely held opinion that weight lost rapidly is more quickly regained .


We aimed to investigate the effect of the rate of weight loss on the rate of regain in obese people .


For this two phase , randomised , non-masked , dietary intervention trial in a Melbourne metropolitan hospital , we enrolled @ participants ( @ men and @ women ) aged @ years with a BMI between @ and @ kg/m@ .


During phase @ , we randomly assigned ( @:@ ) participants with a block design ( block sizes of @ , @ , and @ ) to account for sex , age , and BMI , to either a @-week rapid weight loss or a @-week gradual programme , both aimed at @ % weight loss .


We placed participants who lost @ % or more weight during phase @ on a weight maintenance diet for @ weeks ( phase @ ) .


The primary outcome was mean weight loss maintained at week @ of phase @ .


We investigated the primary outcome by both completers only and intention-to-treat analyses .


This study is registered with the Australian New Zealand Clinical Trials Registry , number ACTRN@ .


@ participants were randomly assigned to the gradual weight loss ( n = @ ) or rapid weight loss ( n = @ ) programme between Aug @ , @ , and March @ , @ .


After phase @ , @ ( @ % ) participants in the gradual weight loss group and @ ( @ % ) in the rapid weight loss group achieved @ % or more weight loss in the allocated time and started phase @ .


At the end of phase @ , both gradual weight loss and rapid weight loss participants who completed the study ( n = @ in gradual weight loss and n = @ in rapid weight loss ) had regained most of their lost weight ( gradual weight loss @ % regain , @ % CI @ vs rapid weight loss @ % , @ ) .


Intention-to-treat analysis showed similar results ( gradual weight loss @ % regain , @ % CI @ vs rapid weight loss @ % , @ ) .


In phase @ , one participant in the rapid weight loss group developed cholecystitis , requiring cholecystectomy .


In phase @ , two participants in the rapid weight loss group developed cancer .


The rate of weight loss does not affect the proportion of weight regained within @ weeks .


These findings are not consistent with present dietary guidelines which recommend gradual over rapid weight loss , based on the belief that rapid weight loss is more quickly regained .


NSABP P-@ provides an opportunity to examine the association of behavioral factors with prospectively monitored cancer incidence and interactions with tamoxifen .


From @ to @ , @,@ women with estimated @-year breast cancer risk greater than @ % or a history of lobular carcinoma in situ ( @ % younger than age @ ; @ % postmenopausal ) were randomly assigned to tamoxifen versus placebo .


Invasive breast cancer , lung cancer , colon cancer , and endometrial cancer were analyzed with Cox regression .


Predictors were baseline cigarette smoking , leisure-time physical activity , alcohol consumption , and established risk factors .


At median @ years follow-up , we observed @ , @ , @ , and @ breast cancer , lung cancer , colon cancer , and endometrial cancer , respectively .


Women who had smoked were at increased risk of breast cancer ( P = @ ; HR = @ for @-@ years smoking , HR = @ for @ years ) , lung cancer ( P < @ ; HR = @ for @-@ years , HR = @ for @ years ) , and colon cancer ( P < @ ; HR = @ for @ years ) versus never-smokers .


Low activity predicted increased breast cancer risk only among women assigned to placebo ( P = @ activity main effect , P = @ activity-treatment interaction ; HR = @ for the placebo group ) and endometrial cancer among all women ( P = @ , HR = @ ) .


Moderate alcohol ( > @-@ drink/day ) was associated with decreased risk of colon cancer ( P = @ ; HR = @ ) versus no alcohol .


There were no other significant associations between these behaviors and cancer risk .


Among women with elevated risk of breast cancer , smoking has an even greater impact on breast cancer risk than observed in past studies in the general population .


Women who smoke or are inactive should be informed of the increased risk of multiple types of cancer .


Extensive-stage small-cell lung cancer ( SCLC ) patients who progress after platinum-based chemotherapy are traditionally categorized as platinum sensitive ( progression @ days from last platinum dose ) or refractory ( progression < @ days ) , a practice arising from seminal observations of worse survival in refractory patients .


Subsequent trials accounted for platinum sensitivity , resulting in higher sample sizes and increased resource use .


To assess whether platinum-sensitivity status remains associated with outcomes , patient-level data from recent Southwest Oncology Group trials in second - and/or third-line extensive-stage SCLC were pooled .


Hazard ratios ( HRs ) for progression-free survival ( PFS ) and overall survival ( OS ) accounting for platinum sensitivity were calculated using unadjusted and adjusted Cox Proportional Hazard models .


Recursive partitioning was performed to define prognostic risk groups .


Of @ patients , @ were platinum sensitive and @ refractory .


HRs from unadjusted Cox PFS and OS models for refractory versus sensitive disease were @ ( @ % confidence interval , @-@ @ ; p = @ ) and @ ( @-@ @ ; p = @ ) , respectively .


Adjusted Cox models showed that only elevated serum lactate dehydrogenase ( HR , @ ; p < @ ) , males ( HR , @ ; p = @ ) , performance status of @ ( HR , @ ; p = @ ) , and weight loss greater than or equal to @ % ( @ , p = @ ) were independently associated with OS .


Platinum-sensitivity status was not associated with PFS ( HR , @ ; p = @ ) or OS ( HR , @ ; p = @ ) , except in a model that excluded @ patients who received more than one prior chemotherapy regimen ( HR , @ ; p = @ ) .


Prognostic groups with differential OS outcomes ( high , intermediate , and poor risk ) were identified .


Platinum-sensitivity status may no longer be strongly associated with PFS or OS in at least one multivariate model .


Validation of prognostic risk groups identified here is warranted .


These data have critical implications in the design of future SCLC trials .


To evaluate the effectiveness of a hydrogel sealant versus a suture in preventing fluid egress after wound leakage in cataract surgery .


Twenty-four ophthalmic clinical practices in the United States .


Prospective randomized parallel-arm controlled multicenter subject-masked study .


Healthy patients having uneventful clear corneal incision ( CCI ) cataract surgery were eligible for the study .


Spontaneous and provoked fluid egress from wounds was evaluated at the time of surgery using a calibrated force gauge .


Eyes with leakage were randomized to receive a hydrogel sealant ( Resure ) or a nylon suture at the main incision site .


Incision leakage was reevaluated @ , @ , @ , and @ days postoperatively .


Of @ eyes , @ had leakage at the time of cataract surgery .


The leak was spontaneous in @ cases ( @ % ) , and @ ( @ % ) of all incisions leaked with @ ounce or less of applied force .


After randomization , @ ( @ % ) of @ eyes in the sealant group and @ ( @ % ) of @ eyes in the suture group had wound leakage with provocation ( P < @ ) .


The overall incidence of adverse ocular events was statistically significantly lower in the sealant group than in the suture group ( P < @ ) .


In this study , @ % of CCIs leaked after cataract surgery .


The hydrogel sealant was safe and effective and better than a suture for the intraoperative management of CCIs with leakage as seen on Seidel testing and for the prevention of postoperative fluid egress .


Various methods are used to assess the height of sensory block to touch under spinal anesthesia for cesarean section .


We tested a novel , inexpensive , miniature , user-dependent plastic neurological wheel against the user-independent Neurotip mounted Neuropen .


Patients received either spinal or combined spinal-epidural anesthesia .


For each patient assessment , the devices were randomly assigned to one of two independent investigators .


The order of device application was randomly permuted .


Neither researcher was involved with anesthetic care .


At @-min intervals for @ min after spinal injection , and again at the end of the operation , the levels of block to loss-of-touch sensation were assessed .


While one investigator evaluated the block , the other left the operating room and vice versa .


Mixed-effects regression and Bland-Altman analysis were used to weigh agreement between devices .


The mean difference in level-to-touch was @ ( @ % CI -@ , @ ) dermatome levels .


Measurement error standard deviation associated with the Neurotip mounted Neuropen and plastic neurological wheel was @ ( @ % CI @ , @ ) and @ ( @ % CI @ , @ ) dermatome levels , respectively .


The difference in measurement error standard deviation was -@ ( @ % CI -@ , @ ) .


This evidence excludes the possibility , with @ % confidence , of clinically significant bias or measurement error differences between methods .


Occasional wide variances in dermatome level were observed with both instruments at the initial assessment only .


The compact plastic neurological wheel is as clinically reliable as the Neurotip mounted Neuropen .


To determine the effects of rumen-protected choline ( RPC ) on health and reproduction in dairy cows .


A total of @ primi - and multiparous German Holstein cows of a high-production dairy herd ( average daily milk yield : @ l ) were assigned randomly to a control or treatment group and were hand fed with @ or @ g/d of RPC as ReaShure , respectively , from @ days before expected calving to @ days post partum ( p. p. ) as a top dressing .


Health data was analyzed for the incidence of fever within the first @ days in milk ( DIM ) as well as the incidence of diseases and the culling rate within the first @ DIM .


Reproduction data were evaluated in terms of the calving data , uterine involution on days @ , @ and @ p. p. , uterine cytology at day @ p. p. , progesterone concentrations during weeks @ and @ p. p. and certain fertility measures .


In the statistical analysis , it was differentiated between the control and treatment groups and between primi - and multiparous animals , and their interactions were analyzed .


The treatment group had less cows with subclinical endometritis , higher sickness rates after day @ p. p. , lower numbers of stillbirths and more cyclic cows in week @ p. p. compared to the control group ( p < @ ) .


Primipara in contrast to multipara had fever more frequently , higher rates of subclinical ketosis p. p. , metritis and lameness , higher numbers of sick cows in the first @ DIM , higher rates of stillbirths and dystocia , showed impaired involution of the uterus on day @ p. p. , fewer animals were cyclic during week @ p. p. and less animals were culled ( p < @ ) .


Statistically significant interactions indicated that more heifers of the treatment group were lame , more heifers of the control group developed fever and subclinical endometritis , cows of the treatment group suffered more metritis and were sick more often in the first @ DIM , and cows of the control group had more dystocia ( p < @ ) .


Overall , supplementing RPC had only minor effects on the health status and reproduction .


Further research in other dairy herds should focus on this topic .


Individuals with a strong family history of colorectal cancer have significant risk for colorectal cancer , although adherence to colonoscopy screening in these groups remains low .


This study assessed whether a tailored telephone counseling intervention can increase adherence to colonoscopy in members of high-risk families in a randomized , controlled trial .


Eligible participants were recruited from two national cancer registries if they had a first-degree relative with colorectal cancer under age @ or multiple affected family members , which included families that met the Amsterdam criteria for hereditary non-polyposis colon cancer ( HNPCC ) , and if they were due for colonoscopy within @ months .


Participants were randomized to receive a tailored telephone intervention grounded in behavioral theory or a mailed packet with general information about screening .


Colonoscopy status was assessed through follow-up surveys and endoscopy reports .


Cox proportional hazards models were used to assess intervention effect .


Of the @ participants ( ages @-@ ) , @ % were female , the majority were White , non-Hispanic , educated , and had health insurance .


Colonoscopy adherence increased @ percentage points in the tailored telephone intervention group , compared with no significant change in the mailed group .


The telephone intervention was associated with a @ % increase in screening adherence compared with the mailed intervention ( HR , @ ; P = @ ) .


A tailored telephone intervention can effectively increase colonoscopy adherence in high-risk persons .


This intervention has the potential for broad dissemination to healthcare organizations or other high-risk populations .


Increasing adherence to colonoscopy among persons with increased colorectal cancer risk could effectively reduce incidence and mortality from this disease .


Hepatitis E virus ( HEV ) is a leading cause of acute hepatitis .


The long-term efficacy of a hepatitis E vaccine needs to be determined .


In an initial efficacy study , we randomly assigned healthy adults @ to @ years of age to receive three doses of either a hepatitis E vaccine ( vaccine group ; @,@ participants ) or a hepatitis B vaccine ( control group ; @,@ participants ) .


The vaccines were administered at @ , @ , and @ months , and the participants were followed for @ months .


In this extended follow-up study , the treatment assignments of all participants remained double-blinded , and follow-up assessments of efficacy , immunogenicity , and safety were continued for up to @ years .


During the @-year study period , @ cases of hepatitis E were identified ; @ cases were confirmed in the vaccine group ( @ cases per @,@ person-years ) , and @ cases in the control group ( @ cases per @,@ person-years ) , representing a vaccine efficacy of @ % ( @ % confidence interval , @ to @ ) in the modified intention-to-treat analysis , rather than ( @ % confidence interval , @ to @ ) -LSB- corrected -RSB- .


Of the participants who were assessed for immunogenicity and were seronegative at baseline , @ % of those who received three doses of the hepatitis E vaccine maintained antibodies against HEV for at least @ years ; HEV antibody titers developed in @ % in the control group .


The rate of adverse events was similar in the two groups .


Immunization with this hepatitis E vaccine induced antibodies against HEV and provided protection against hepatitis E for up to @ years .


( Funded by the Chinese Ministry of Science and Technology and others ; ClinicalTrials.gov number , NCT@ . )


Exercise can improve physical fitness in children and adults with congenital heart disease .


We hypothesized that exercise training would not lead to adverse cardiac remodelling in this population .


This multi-centre randomized controlled trial included children and young adults ( @ to @ years ) with either corrected tetralogy of Fallot or Fontan circulation .


The exercise-group was enrolled in a @ week standardized aerobic dynamic exercise training program .


The control-group continued their life-style and received care as usual .


Both groups underwent cardiopulmonary exercise testing , cardiac magnetic resonance imaging ( MRI ) , echocardiography and neurohormonal assessment , within @ weeks before and @ weeks after the intervention period .


Fifty-six patients were randomized to the exercise-group and @ to the control-group .


We assessed changes between the pre - and the post-intervention period for the exercise group compared to the changes in the control-group .


Peak load increased significantly in the exercise-group compared to the control-group ( exercise-group @ @ W ; control-group @ @ W ; p = @ ) .


There were no adverse events linked to the study .


Ventricular systolic parameters , cardiac dimensions and neurohormonal markers during follow-up did not change in patients allocated to the exercise-group and control-group .


Although there were some isolated minor changes in inflow parameters , there was no consistent pattern of changes , indicating a lack of true change in the diastolic function .


We demonstrated that no clinically relevant adverse cardiac remodelling occurred after @ weeks of exercise training in patients with either corrected tetralogy of Fallot or Fontan circulation .


To compare the efficacy of simulation-based training between the Mimic dV - Trainer and traditional dry lab da Vinci robot training .


A prospective randomized study analyzing the performance of @ robotics-naive participants .


Participants were enrolled in an online da Vinci Intuitive Surgical didactic training module , followed by training in use of the da Vinci standard surgical robot .


Spatial ability tests were performed as well .


Participants were randomly assigned to @ of @ training conditions : performance of @ Fundamentals of Laparoscopic Surgery dry lab tasks using the da Vinci or performance of @ dV-Trainer tasks .


Participants in both groups performed all tasks to empirically establish proficiency criterion .


Participants then performed the transfer task , a cystotomy closure using the daVinci robot on a live animal ( swine ) model .


The performance of robotic tasks was blindly assessed by a panel of experienced surgeons using objective tracking data and using the validated Global Evaluative Assessment of Robotic Surgery ( GEARS ) , a structured assessment tool .


No statistically significant difference in surgeon performance was found between the @ training conditions , dV-Trainer and da Vinci robot .


Analysis of a @ % confidence interval for the difference in means ( -@ to @ ) indicated that the @ methods are unlikely to differ to an extent that would be clinically meaningful .


Based on the results of this study , a curriculum on the dV - Trainer was shown to be comparable to traditional da Vinci robot training .


Therefore , we have identified that training on a virtual reality system may be an alternative to live animal training for future robotic surgeons .


Previously , we showed that high-dose early initiated inhaled corticosteroids during respiratory syncytial virus bronchiolitis partially and transiently prevents subsequent recurrent wheeze .


Here , we study treatment effect on lung function at age @ .


This is a @-year follow-up report of a randomized placebo-controlled trial , in which @ infants hospitalized for respiratory syncytial virus bronchiolitis were treated with early initiated , high-dose inhaled beclomethasone ( n = @ ) or placebo ( n = @ ) for @ months .


The primary outcome was forced expiratory volume in @ second as percentage predicted .


Secondary outcomes were bronchial hyperresponsiveness , physician-diagnosed asthma , hay fever and eczema .


Possible toxicity was assessed by linear growth measurements .


At age @ , no significant differences were found in mean forced expiratory volume in @ second percentage predicted between beclomethasone-treated and placebo-treated patients ( @ vs. @ , mean difference @ ( @ % confidence interval : -@ to @ ) .


The proportion of bronchial hyperresponsiveness , physician-diagnosed asthma , parent reported hay fever and eczema was comparable between groups .


There were no differences in linear growth .


Early initiated prolonged treatment with high-dose inhaled beclomethasone during hospitalization for respiratory syncytial virus infection during infancy did not improve the long-term respiratory outcome , but was safe .


We investigated changes in anisometropia and aniso-axial length with myopia progression in the Correction of Myopia Evaluation Trial ( COMET ) cohort .


Of @ myopic children , @ to < @ years old , enrolled in COMET , @ were followed for @ years .


Cycloplegic autorefraction and axial length ( AL ) in each eye were measured annually .


The COMET eligibility required anisometropia ( interocular difference in spherical equivalent refraction ) of @ diopter ( D ) .


For each child , a linear regression line was fit to anisometropia data by visit , and the regression slope b was used as the rate of change .


Logistic regression was applied to identify factors for significant changes in anisometropia ( b @ D/y , or a cumulative increase in anisometropia @ D over @ years ) .


Similar analyses were applied to aniso-AL .


A total of @/@ ( @ % ) children had refractions at baseline and the @-year visit .


The mean ( SD ) amount of anisometropia increased from @ D ( @ D ) at baseline to @ D ( @ D ) at the @-year visit .


A total of @/@ ( @ % ) had slopes | b | < @ D/y and @ ( @ % ) had slopes | b | @ D/y , with only one negative slope .


Similarly , @/@ ( @ % ) children had little change in aniso-AL over time .


The correlation between changes in anisometropia and aniso-AL over @ years was @ ( P < @ ) .


The correlation between changes in anisometropia and myopia progression was significant ( r = -@ , P < @ ) .


No correlation was found between baseline anisometropia and myopia progression ( r = -@ , P = @ ) .


Myopia and axial length progressed at a similar rate in both eyes for most children in COMET during the period of fast progression and eventual stabilization .


These results may be more generalizable to school-aged myopic children with limited anisometropia at baseline .


( ClinicalTrials.gov number , NCT@ . )


Given the long natural history of prostate cancer , we assessed differing graphical formats for imparting knowledge about the longitudinal risks of prostate cancer recurrence with or without ` hormone ' or ` androgen deprivation ' therapy .


Male volunteers without a history of prostate cancer were randomized to @ of @ risk communication instruments that depicted the likelihood of prostate cancer returning or spreading over @ , @ , and @ years .


The tools differed in format ( line , pie , bar , or pictograph ) and whether the graph also included no numbers , @ number ( indicating the number of affected individuals ) , or @ numbers ( indicting both the number affected and the number unaffected ) .


The main outcome variables evaluated were graphical preference and knowledge .


A total of @ men were recruited ; respondents were least familiar and experienced with pictographs ( P < @ ) , and only @ % preferred this particular format .


Overall accuracy ranged from @ % to @ % , and when assessed across all graphical subtypes , the addition of numerical information did not improve verbatim knowledge ( P = @ ) .


Self-reported numeracy was a strong predictor of accuracy of responses ( odds ratio -LSB- OR -RSB- = @ , P = @ ) , and the impact of high numeracy varied across graphical type , having a greater impact on line ( OR = @ ; @ % confidence interval -LSB- CI -RSB- = @-@ ; P = @ ) and pie charts ( OR = @ ; @ % CI = @-@ ; P = @ ) , without an impact on pictographs ( OR = @ ; @ % CI = @-@ @ ; P = @ ) or bar charts ( OR = @ ; @ % CI = @-@ @ ; P = @ ) .


For longitudinal presentation of risk , baseline numeracy was strongly prognostic for outcome .


However , the addition of numbers to risk graphs improved only the delivery of verbatim knowledge for subjects with lower numeracy .


Although subjects reported the least familiarity with pictographs , they were one of the most effective means of transferring information regardless of numeracy .


Warfarin is the most widely used oral anticoagulant worldwide , but serious bleeding complications are common .


We tested whether genetic variants can identify patients who are at increased risk of bleeding with warfarin and , consequently , those who would derive a greater safety benefit with a direct oral anticoagulant rather than warfarin .


ENGAGE AF-TIMI @ was a randomised , double-blind trial in which patients with atrial fibrillation were assigned to warfarin to achieve a target international normalised ratio of @-@ , or to higher-dose ( @ mg ) or lower-dose ( @ mg ) edoxaban once daily .


A subgroup of patients was included in a prespecified genetic analysis and genotyped for variants in CYP@C@ and VKORC@ .


The results were used to create three genotype functional bins ( normal , sensitive , and highly sensitive responders to warfarin ) .


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


@,@ patients were included in the genetic analysis .


Of @ taking warfarin , @ ( @ % ) were classified as normal responders , @ ( @ % ) as sensitive responders , and @ ( @ % ) as highly sensitive responders .


Compared with normal responders , sensitive and highly sensitive responders spent greater proportions of time over-anticoagulated in the first @ days of treatment ( median @ % , IQR @-@ ; @ % , @-@ ; and @ % , @-@ ; ptrend < @ ) and had increased risks of bleeding with warfarin ( sensitive responders hazard ratio @ , @ % CI @-@ , p = @ ; highly sensitive responders @ , @-@ , p < @ ) .


Genotype added independent information beyond clinical risk scoring .


During the first @ days , when compared with warfarin , treatment with edoxaban reduced bleeding more so in sensitive and highly sensitive responders than in normal responders ( higher-dose edoxaban pinteraction = @ ; lower-dose edoxaban pinteraction = @ ) .


After @ days , the reduction in bleeding risk with edoxaban versus warfarin was similarly beneficial across genotypes .


CYP@C@ and VKORC@ genotypes identify patients who are more likely to experience early bleeding with warfarin and who derive a greater early safety benefit from edoxaban compared with warfarin .


Research shows that multilevel factors influence healthcare delivery and patient outcomes .


The study goal was to examine how clinic type -LSB- academic medical center ( AMC ) or federally qualified health center ( FQHC ) -RSB- and patient characteristics influence time to resolution ( TTR ) among individuals with an abnormal cancer-screening test enrolled in a patient navigation ( PN ) intervention .


Data were obtained from the Ohio Patient Navigation Research Project , a group-randomized trial of @ patients from @ clinics in Columbus , Ohio .


TTR of patient after an abnormal breast , cervical , or colorectal screening test and the clinics ' patient and provider characteristics were obtained .


Descriptive statistics and Cox shared frailty proportional hazards regression models of TTR were used .


The mean patient age was @ years and @ % of patients were white .


In models adjusted for study arm , FQHC patients had a @ % lower rate of resolution than AMC patients ( P = @ ) .


Patient factors of having a college education , private insurance , higher income , and being older were significantly associated with lower TTR .


After adjustment for factors that substantially affected the effect of clinic type ( patient insurance status , education level , and age ) , clinic type was not significantly associated with TTR .


These results suggest that TTR among individuals participating in PN programs are influenced by multiple socioeconomic patient-level factors rather than clinic type .


Consequently , PN interventions should be tailored to address socioeconomic status factors that influence TTR .


These results provide clues regarding where to target PN interventions and the importance of recognizing predictors of TTR according to clinic type .


To compare the application of Coopdech bronchial blocker and double lumen bronchial tube during one lung ventilation in children .


Forty children undergoing one lung ventilation for thoracic surgery at Shantou Central Hospital from January @ to June @ , approved by hospital ethics committee , were randomized into Coopdech bronchial blocker group ( group A ) and double-lumen tube group ( group B ) .


Anesthetic management and lung isolation were performed according to a standardized protocol .


Two groups of children with the intubation time , intubation success rate , collapse score , the frequency of postoperative hoarseness were recorded .


Before and after one lung ventilation in patients of the two groups of PaCO , PaO and airway pressure ( PAW ) changes were recorded .


The intubation time in A was longer than those of group B ( ( @ @ ) vs ( @ @ ) s , P < @ ) , the success rate of intubation ( @ % vs @ % , P < @ ) , collapse score in A group was higher than in group B ( @ % vs @ % , P < @ ) , Sore throat hoarseness occurred after operation in A group was lower than in B group ( @ % vs @ % , P < @ ) , PaO was higher in group A after one lung ventilation for @ min ( ( @ @ ) vs ( @ @ ) mmHg , P < @ ) , PaCO and PAW were lower than group B ( ( @ @ ) vs ( @ @ ) mmHg ; ( @ @ ) vs ( @ @ ) cm HO , P < @ ) .


The Coodech bronchial blocker provided effective surgical exposure with less throat injuries , higher intubation success rate , lower airway pressure in children during video-assisted thoracoscopic surgery .


To test the hypothesis that adding obesity gene feedback ( FTO ) to simple weight control advice at a life stage with raised risk of weight gain ( university ) increases readiness to control weight .


Individually randomized controlled trial comparing the effect of : ( i ) simple weight control advice plus FTO feedback ( FA ) and ( ii ) simple weight control advice only ( AO ) on readiness to engage with weight control .


Differences in stage of change by genotype and differential weight control behaviors were secondary outcomes .


Of @,@ participants randomized , only @ completed follow-up , yielding @ % power to detect a small effect for readiness to control weight .


As predicted , FA participants were more likely to be in the contemplation stage than AO participants ( P = @ ) .


Participants receiving higher-risk genetic results were at a higher stage of change than controls ( P = @ ) , with a trend toward a higher stage of change than those getting lower-risk results ( P = @ ) .


Lower-risk results did not decrease weight control intentions compared with controls ( P = @ ) .


There were no group differences in adherence to recommended weight control behaviors ( P = @ ) .


Adding FTO feedback to weight control advice enhanced readiness to control weight , without evidence for genetic determinism , but had no more effect on behavior than weight control advice alone .


The NOURISHED study : Nice OUtcomes for Referrals with Impulsivity , Self Harm and Eating Disorders.Eating Disorders ( ED ) and Borderline Personality Disorder ( BPD ) are both difficult to treat and the combination presents particular challenges .


Both are associated with vulnerability to loss of mentalization ( awareness of one 's own and others ' emotional state ) .


In BPD , Mentalization Based therapy ( MBT ) has been found effective in reducing symptoms .


In this trial we investigate the effectiveness and cost-effectiveness of MBT adapted for Eating disorders ( Mentalization Based Therapy for Eating Disorders ( MBT-ED ) ) compared to a standard comparison treatment , Specialist Supportive Clinical Management ( SSCM-ED ) in patients with a combination of an Eating Disorder and either a diagnosis of BPD or a history of self-harm and impulsivity in the previous @ months .


We will complete a multi-site single-blind randomized controlled trial ( RCT ) of MBT-ED vs SSCM-ED .


Participants will be recruited from three Eating Disorder Services and two Borderline Personality Disorder Services in London .


Participants allocated to MBT-ED will receive one year of weekly group and individual therapy and participants allocated to SSCM-ED will receive @ sessions of individual therapy over @ year .


In addition , participants in both groups will have access to up to @ hours of dietetic advice .


The primary outcome measure is the global score on the Eating Disorders Examination .


Secondary outcome measures include total score on the Zanarini BPD scale , the Object Relations Inventory , the Depression Anxiety Stress Scales , quality of life and cost-effectiveness .


Measures are taken at recruitment and at @ month intervals up to @ months .


This is the first Randomised Controlled Trial of MBT-ED in patients with eating disorders and symptoms of BPD and will provide evidence to inform therapy decisions in this group of patients .


During MBT-ED mentalization is encouraged , while in SSCM-ED it is not overtly addressed .


This study will help elucidate mechanisms of change in the two therapies and analysis of therapy and interview transcripts will provide qualitative information about the conduct of therapy and changes in mentalization and object relations .


Current guidelines recommend coronary artery bypass graft surgery ( CABG ) when treating significant de novo left main coronary artery ( LM ) stenosis ; however , percutaneous coronary intervention ( PCI ) has a class IIa indication for unprotected LM disease in selected patients .


This analysis compares @-year clinical outcomes in PCI - and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery ( SYNTAX ) trial , the largest trial in this group to date .


The SYNTAX trial randomly assigned @ patients with LM or @-vessel disease to receive either PCI ( with TAXUS Express paclitaxel-eluting stents ) or CABG .


The unprotected LM cohort ( N = @ ) was predefined and powered .


Major adverse cardiac and cerebrovascular event rates at @ years was @ % in PCI patients and @ % in CABG patients ( hazard ratio , @ -LSB- @ % confidence interval , @-@ @ -RSB- ; P = @ ) .


Mortality rate was @ % and @ % in PCI and CABG patients , respectively ( hazard ratio , @ -LSB- @ % confidence interval , @-@ @ -RSB- ; P = @ ) .


Stroke was significantly increased in the CABG group ( PCI @ % versus CABG @ % ; hazard ratio , @ -LSB- @ % confidence interval , @-@ @ -RSB- ; P = @ ) and repeat revascularization in the PCI arm ( @ % versus @ % ; hazard ratio , @ -LSB- @ % confidence interval , @-@ @ -RSB- ; P < @ ) .


Major adverse cardiac and cerebrovascular events were similar between arms in patients with low/intermediate SYNTAX scores but significantly increased in PCI patients with high scores ( @ ) .


At @ years , no difference in overall major adverse cardiac and cerebrovascular events was found between treatment groups .


PCI-treated patients had a lower stroke but a higher revascularization rate versus CABG .


These results suggest that both treatments are valid options for LM patients .


The extent of disease should accounted for when choosing between surgery and PCI , because patients with high SYNTAX scores seem to benefit more from surgery compared with those in the lower tertiles .


To analyze the efficacy of intrarectal ice application as an anesthetic method prior to transrectal ultrasound ( TRUS ) guided prostate biopsy .


A total of @ consecutive men were included into the study prospectively .


Patients were equally randomized as group @ and @ with @ patients each .


Ice was applied as an anesthetic method @ minutes before procedure to the patients in group @ .


Patients in group @ were applied @ mL of @ % lidocaine gel @ minutes before procedure .


Twelve core biopsy procedure was performed for all patients .


The pain level was evaluated using a visual analogue scale ( VAS ) .


Median pain score was @ ( @-@ ) in group @ and @ ( @-@ ) in group @ .


There is significantly difference between groups regarding the mean sense of pain level during the procedure .


( p = @ ) There was also no difference in complications between two groups about presence and duration of macroscopic hematuria and rectal bleeding .


Intrarectal ice application prior to TRUS prostate biopsy has an effect on reducing pain .


Development of new techniques about cold effect or ice can make this method more useful and decrease complication rates .


About six percent of pregnant women suffer from severe fear of childbirth .


These women are at increased risk of obstetric labour and delivery interventions and pre - and postpartum complications , e.g. , preterm delivery , emergency caesarean section , caesarean section at maternal request , severe postpartum fear of childbirth and trauma anxiety .


During the last decade , there is increasing clinical evidence suggesting that haptotherapy might be an effective intervention to reduce fear of childbirth in pregnant women .


The present study has been designed to evaluate the effects of such intervention .


Included are singleton pregnant women with severe fear of childbirth , age @ year , randomised into three arms : ( @ ) treatment with haptotherapy , ( @ ) internet psycho-education or ( @ ) care as usual .


The main study outcome is fear of childbirth .


Measurements are taken at baseline in gestation week @-@ , directly after the intervention is completed in gestation week @ , six weeks postpartum and six months postpartum .


Secondary study outcomes are distress , general anxiety , depression , somatization , social support , mother-child bonding , pregnancy and delivery complications , traumatic anxiety symptoms , duration of delivery , birth weight , and care satisfaction .


The treatment , a standard haptotherapeutical treatment for pregnant women with severe fear of childbirth , implies teaching a combination of skills in eight one hour sessions .


The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes .


The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology .


Low serum vitamin D levels have been associated with increased prevalence of the reproductive tract condition bacterial vaginosis ( BV ) .


The objective of this trial was to evaluate the effect of high-dose vitamin D supplementation on BV recurrence .


This randomized , placebo-controlled , double-blinded trial enrolled @ women with symptomatic BV from an urban sexually transmitted disease clinic ( clinicaltrials.gov registration NCT@ ) .


All participants received @ mg of oral metronidazole twice daily for @ days .


Intervention participants ( n = @ ) also received @ doses of @,@ IU of cholecalciferol ( vitamin D@ ) over @ weeks ; control women ( n = @ ) received matching placebo .


Recurrent BV was assessed via Nugent scoring after @ , @ , and @ weeks .


We assessed the effect of the intervention using an intention-to-treat approach , fitting Cox proportional hazards models to evaluate recurrent BV over the follow-up period .


Most participants ( @ % ) were black , with a median age of @ years .


Median presupplementation serum @-hydroxyvitamin D -LSB- @ ( OH ) D -RSB- was similar across randomization arms : @ ng/mL in the vitamin D arm and @ ng/mL in the control arm .


At trial completion , median @ ( OH ) D among women receiving vitamin D was @ ng/mL , vs @ ng/mL in control women ; @ % of women receiving vitamin D and @ % receiving placebo remained vitamin D deficient ( < @ ng/mL ) .


BV prevalence among women randomized to vitamin D was very similar to those randomized to placebo at the @ - and @-week visits , but by the @-week visit , BV prevalence was @ % among women in the vitamin D arm and @ % among control women .


BV recurrence was not reduced by vitamin D supplementation ( intention-to-treat hazard ratio , @ ; @ % confidence interval , @-@ @ ) .


Among women experiencing recurrent BV , median time to recurrence was @ weeks in the vitamin D arm and @ weeks in the control arm .


Women receiving vitamin D experienced significant increases in serum @ ( OH ) D , but this increase was not associated with decreased BV recurrence in this high-risk sexually transmitted disease clinic population .


To compare the treatment outcomes of women with high-grade squamous intraepithelial lesions ( HSIL ) who underwent immediate loop electrosurgical excision procedure ( LEEP ) and those who had directed biopsies prior to subsequent LEEP .


Women who were referred for HSIL to @ centers in southeast Nigeria were examined via colposcopy .


Those with positive colposcopic findings were randomized to receive either immediate LEEP ( see-and-treat group ) or directed biopsies ( @-step group ) .


Women with directed biopsy-confirmed results underwent follow-up LEEP .


Overtreatment rate , cost , default rate , and cytology-treatment interval were compared between the @ groups .


In total , @ women were included in the study .


The overtreatment rate was similar between the groups .


Treatment cost and cytology-treatment interval were significantly higher in the @-step group ( P = @ ) .


The default rate was significantly lower in the see-and-treat group ( P = @ ) .


Most ( @ -LSB- @ % -RSB- ) participants preferred the see-and-treat approach .


Immediate see-and-treat LEEP for women with HSIL in southeast Nigeria is cheaper , less time-consuming , and associated with better patient compliance than the @-step management procedure .


Furthermore , it does not lead to significantly higher overtreatment .


The immediate see-and-treat approach may be ideal for the management of women with HSIL in low-resource countries .


To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes ( ACS ) in the Platelet Inhibition and Patient Outcomes ( PLATO ) study who were scheduled for non-invasive management .


A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management .


Healthcare costs , event rates and health-related quality of life under treatment with either ticagrelor or clopidogrel over @months were estimated from the PLATO study .


Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources .


To investigate the importance of different healthcare cost structures and life expectancy for the results , the analysis was carried out from the perspectives of the Swedish , UK , German and Brazilian public healthcare systems .


Ticagrelor was associated with lifetime quality-adjusted life-year ( QALY ) gains of @ in Sweden , @ in the UK , @ in Germany and @ in Brazil compared with generic clopidogrel , with increased healthcare costs of @ , @ , @ and @ , respectively .


The cost per QALY gained with ticagrelor was @ , @ , @ and @ from a Swedish , UK , German and Brazilian public healthcare system perspective , respectively .


Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability .


Treatment of patients with ACS scheduled for @months ' non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel .


Ceftriaxone is the foundation of currently recommended gonorrhea treatment .


There is an urgent need for backup treatment options for patients with cephalosporin allergy or infections due to suspected cephalosporin-resistant Neisseria gonorrhoeae .


We evaluated the efficacy and tolerability of @ combinations of existing noncephalosporin antimicrobials for treatment of patients with urogenital gonorrhea .


We conducted a randomized , multisite , open-label , noncomparative trial in @ outpatient sexually transmitted disease clinic sites in Alabama , California , Maryland , and Pennsylvania .


Patients aged @-@ years diagnosed with uncomplicated urogenital gonorrhea were randomly assigned to either gentamicin @ mg intramuscularly plus azithromycin @ g orally , or gemifloxacin @ mg orally plus azithromycin @ g orally .


The primary outcome was microbiological cure of urogenital infections ( negative follow-up culture ) at @-@ days after treatment among @ participants in the per protocol population .


Microbiological cure was achieved by @ % ( lower @-sided exact @ % confidence interval -LSB- CI -RSB- bound , @ % ) of @ evaluable participants receiving gentamicin/azithromycin , and @ % ( lower @-sided exact @ % CI bound , @ % ) of @ evaluable participants receiving gemifloxacin/azithromycin .


Gentamicin/azithromycin cured @ of @ pharyngeal infections and @ of @ rectal infection ; gemifloxacin/azithromycin cured @ of @ pharyngeal and @ of @ rectal infections .


Gastrointestinal adverse events were common in both arms .


Gentamicin/azithromycin and gemifloxacin/azithromycin were highly effective for treatment of urogenital gonorrhea .


Gastrointestinal adverse events may limit routine use .


These non-cephalosporin-based regimens may be useful alternative options for patients who can not be treated with cephalosporin antimicrobials .


Additional treatment options for gonorrhea are needed .


Clinical Trials Registration .


NCT@ .


Targeted temperature management is recommended after out-of-hospital cardiac arrest .


Whether advanced internal cooling is superior to basic external cooling remains unknown .


The aim of this multicenter , controlled trial was to evaluate the benefit of endovascular versus basic surface cooling .


Inclusion criteria were the following : age of @ to @ years , out-of-hospital cardiac arrest related to a presumed cardiac cause , time to return of spontaneous circulation < @ minutes , delay between return of spontaneous circulation and inclusion < @ minutes , and unconscious patient after return of spontaneous circulation and before the start of cooling .


Exclusion criteria were terminal disease , pregnancy , known coagulopathy , uncontrolled bleeding , temperature on admission < @C , in-hospital cardiac arrest , immediate need for extracorporeal life support or hemodialysis .


Patients were randomized between @ cooling strategies : endovascular femoral devices ( Icy catheter , Coolgard , Zoll , formerly Alsius ; n = @ ) or basic external cooling using fans , a homemade tent , and ice packs ( n = @ ) .


The primary end point , that is , favorable outcome evaluated by survival without major neurological damage ( Cerebral Performance Categories @-@ ) at day @ , was not significantly different between groups ( odds ratio , @ ; @ % confidence interval , @-@ @ ; P = @ ) .


Improvement in favorable outcome at day @ in favor of the endovascular group did not reach significance ( odds ratio , @ ; @ % confidence interval , @-@ @ ; P = @ ) .


Time to target temperature ( @C ) was significantly shorter and target hypothermia was more strictly maintained in the endovascular than in the surface group ( P < @ ) .


Minor side effects directly related to the cooling method were observed more frequently in the endovascular group ( P = @ ) .


Despite better hypothermia induction and maintenance , endovascular cooling was not significantly superior to basic external cooling in terms of favorable outcome .


Cognitive comorbidity at epilepsy onset reflects disease severity and provides a baseline estimate of reserve capacities with regard to the effects of epilepsy and its treatment .


Given the high incidence of epilepsy at an older age , this study analyzed objective and subjective cognition as well as quality of life in elderly patients with new-onset focal epilepsy before initiation of anti-epileptic treatment .


A total of @ untreated patients ( @-@ years of age ) with new-onset epilepsy underwent objective assessment of executive function ( EpiTrack ) and performed subjective ratings of cognition ( Portland Neurotoxicity Scale ) and quality of life ( QoL ; QOLIE-@ ) .


According to age-corrected norms , @ % of patients ( N = @ ) demonstrated deficits in executive function ; major determinants were cerebrovascular etiology , neurological comorbidity , and higher body mass index .


Subjective ratings indicated deficits in up to @ % of patients .


Self-perceived deficits were associated with neurological , cardiovascular , and/or psychiatric comorbidity , whereas poorer QoL was related to neurological comorbidity and female gender .


Objectively assessed executive functions correlated with subjective social functioning , energy , motor function , and vigilance .


We found a relatively high QoL , a low rate of subjective impairment , but a high incidence of objective executive deficits in untreated elderly patients with new-onset epilepsy .


Neurological status and body mass index , rather than seizure frequency or severity , were risk factors for cognitive impairment .


Given the relevance of cognition in the course of epilepsy and its treatment , routine screening before treatment initiation is highly recommended .


The potential interest of antifungal treatment of non-immunocompromized patients with sepsis , extra-digestive Candida colonization and multiple organ failure is unknown .


It represents three-quarters of antifungals prescribed in Intensive Care Units .


It may allow early treatment of invasive fungal infection in the incubation phase but expose patients to unnecessary antifungal treatments with subsequent cost and fungal selection pressure .


As early diagnostic tests for invasive candidiasis are still considered to be insufficient , the potential interest in this strategy needs to be demonstrated .


This prospective multicenter , double blind , randomized-controlled trial is conducted in @ French Intensive Care Units .


All adult patients , mechanically ventilated for more than four days with sepsis of unknown origin and with at least one extradigestive fungal colonization site and multiple organ failure are eligible for randomization .


Patients with proven invasive candidiasis are not included .


After a complete mycological screening , patients are allocated to receive micafungin @ mg intravenously once a day or placebo for @ days .


We plan to enroll @ patients .


The main objective is to demonstrate that micafungin increases survival of patients without invasive candidiasis at day @ as compared to placebo .


Other outcomes include day @ and @ survival and organ failure evolution .


Additionally , pharmacokinetics of micafungin in enrolled patients will be measured and evolution of fungal biomarkers and susceptibility profiles of infecting fungi will also be followed .


This study will help to provide guidelines for treating non-immunocompromized patients with fungal colonization multiple organ failure and sepsis of unknown origin .


We evaluated the efficacy and safety of the aromatase inhibitor exemestane in patients with advanced , persistent or recurrent endometrial carcinoma .


We performed an open-label one-arm , two-stage , phase II study of @ mg of oral exemestane in @ patients with advanced ( FIGO stage III-IV ) or relapsed endometrioid endometrial cancer .


Patients were stratified into subsets of estrogen receptor ( ER ) positive and ER negative patients .


Recruitment to the ER negative group was stopped prematurely after @ patients due to slow accrual .


In the ER positive patients , we observed an overall response rate of @ % , and a lack of progression after @ months in @ % of the patients .


No responses were registered in the ER negative patients , and all had progressive disease within @ months .


For the total group of patients , the median progression free survival ( PFS ) was @ months ( @ % CI : @-@ @ ) .


In the ER positive patients the median PFS was @ months ( @ % CI : @-@ @ ) and in the ER negative patients it was @ months ( @ % CI : @-@-@ ) .


In the ER positive patients the median overall survival ( OS ) time was @ months ( @ % CI : @-@ @ ) , in the ER negative patients the corresponding numbers were @ months ( @ % CI : @-@ @ ) .


Treatment with exemestane was well tolerated .


Treatment of estrogen positive advanced or recurrent endometrial cancer with exemestane , an aromatase inhibitor , resulted in a response rate of @ % and lack of progression after @ months in @ % of the patients .


Severe angulation or shortening can be a surgical indication for fifth metacarpal neck fracture .


In a previous meta-analysis , antegrade intramedullary pinning was shown to produce better hand function outcomes than percutaneous transverse pinning or miniplate fixation for treatment of fifth metacarpal neck fractures .


However , the outcomes of retrograde intramedullary pinning , to our knowledge , have not been compared with those of antegrade intramedullary pinning .


We asked whether the clinical and radiographic outcomes of antegrade intramedullary pinning are different from those of percutaneous retrograde intramedullary pinning for treating patients with displaced fifth metacarpal neck fractures .


Forty-six patients with displaced fifth metacarpal neck fractures with an apex dorsal angulation greater than @ were enrolled in our prospective study .


Subjects were treated randomly by antegrade intramedullary pinning ( antegrade group ) or by percutaneous retrograde intramedullary pinning ( retrograde group ) .


Clinical evaluations , which included active ROM of the fifth metacarpophalangeal joint , VAS for pain , grip strength , and DASH score , were performed at @ months and @ months postoperatively .


Radiographic evaluations of apex dorsal angulation and axial shortening were performed preoperatively and @ months postoperatively .


Patients in the antegrade group achieved better outcomes than patients in the retrograde group for all clinical parameters at @ months postoperatively ( ROM : antegrade median @ -LSB- range , @-@ -RSB- versus retrograde @ -LSB- range , @-@ -RSB- , difference of medians @ , p < @ ; VAS : antegrade median of @ -LSB- range , @-@ -RSB- versus retrograde @ -LSB- range , @-@ -RSB- , difference of medians @ , p < @ ; grip strength : antegrade median @ % -LSB- range , @ % -@ % -RSB- versus retrograde @ % -LSB- range , @ % -@ % -RSB- , differences of medians @ % , p < @ ; DASH : antegrade median @ -LSB- range , @-@ @ -RSB- versus retrograde @ -LSB- range , @-@ @ -RSB- , difference of medians @ , p < @ ) , but these differences , with the numbers available , were not observed at @ months postoperatively for any clinical parameters ( ROM : antegrade median @ -LSB- range , @-@ -RSB- versus retrograde @ -LSB- range , @-@ -RSB- , difference of medians @ , p = @ ; VAS : antegrade median @ -LSB- range , @-@ -RSB- versus retrograde @ -LSB- range , @-@ -RSB- , difference of medians @ , p = @ ; grip strength : antegrade median @ % -LSB- range , @ % -@ % -RSB- versus retrograde @ % -LSB- range , @ % -@ % -RSB- , difference of medians @ % , p = @ ; DASH : antegrade median @ -LSB- range , @-@ @ -RSB- versus retrograde of @ -LSB- range , @-@ @ -RSB- , difference of medians @ , p = @ ) .


At @ months postoperatively , there also were no differences , with the numbers available , in radiographic parameters between the antegrade and retrograde fixation groups .


Residual angulation was not different ( antegrade median : @ -LSB- range , @-@ -RSB- , retrograde : @ -LSB- range , @-@ -RSB- , difference of medians @ , p = @ ) .


Shortening between the two groups also was not different ( antegrade median : @ mm -LSB- range , @ mm-@ mm -RSB- , retrograde median : @ mm -LSB- range , @ mm-@ mm -RSB- , difference of medians @ , p = @ ) .


Our study findings suggest antegrade intramedullary pinning has some clinical advantages during the early recovery period over percutaneous retrograde intramedullary pinning for treatment of displaced fifth metacarpal neck fractures , but the advantages are not evident at @ months postoperatively .


In addition , our study showed no differences in radiographic outcomes between antegrade and retrograde techniques .


For patients who require an early return of hand function , such as athletes , antegrade intramedullary pinning can be recommended .


Otherwise , treatment could be decided according to the surgeon 's preference and patient status , and based on consideration of the need for an accessory procedure for pin removal after antegrade intramedullary pinning .


Level I , therapeutic study .


Bedside sonography has become a popular method of assessment of critically ill patients with shock and dyspnea .


This study evaluated the usefulness of integrated cardiopulmonary sonography for assessment of acute pulmonary edema .


A total of @ intensive care unit ( ICU ) patients with acute pulmonary edema were randomly divided into @ groups : a sonography group , which received standard treatment as well as cardiopulmonary sonography , and a control group , which received standard treatment only .


All patients were treated according to the same therapeutic strategies and underwent chest radiography and central venous catheter placement .


Serum myocardial injury marker levels and central venous/arterial blood gas parameters were measured @ , @ , and @ hours after enrollment .


The cumulative fluid infusion volume at @ , @ , @ , and @ hours , the time to diagnosis of the pulmonary edema etiology by the attending physician , the lengths of ICU and hospital stays , and ICU mortality were recorded .


The sonography group had a shorter time to diagnosis and received a smaller fluid infusion volume than the control group .


There were no significant differences in ICU mortality and lengths of ICU and hospital stays between the sonography and control groups .


In patients with cardiogenic pulmonary edema , the sonography group had a significantly shorter ICU stay and a faster return to normal myocardial injury marker levels and perfusion parameters than the control group ( P < @ ) .


Integrated cardiopulmonary sonography resulted in faster and better-informed clinical decision making , shortened the time to diagnosis of the pulmonary edema etiology , and decreased fluid use .


However , the impact of this examination on prognoses requires further study .


We propose that integrated cardiopulmonary sonography may be a useful bedside tool for treatment of ICU patients with acute pulmonary edema .


Biotin functions as a cofactor for several carboxylase enzymes with key roles in metabolism .


At present , the dietary requirement for biotin is unknown and intake recommendations are provided as Adequate Intakes ( AIs ) .


The biotin AI for adults and pregnant women is @ g/d , whereas @ g/d is recommended for lactating women .


However , pregnant and lactating women may require more biotin to meet the demands of these reproductive states .


The current study sought to quantify the impact of reproductive state on biotin status response to a known dietary intake of biotin .


To achieve this aim , we measured a panel of biotin biomarkers among pregnant ( gestational week @ at study entry ; n = @ ) , lactating ( postnatal week @ at study entry ; n = @ ) , and control ( n = @ ) women who participated in a @ - to @-wk feeding study providing @ g of dietary biotin/d as part of a mixed diet .


Over the course of the study , pregnant women excreted @ % more ( vs. control ; P < @ ) @-hydroxyisovaleric acid ( @-HIA ) , a metabolite that accumulates during the catabolism of leucine when the activity of biotin-dependent methylcrotonyl-coenzyme A carboxylase is impaired .


Interestingly , urinary excretion of @-hydroxyisovaleryl-carnitine ( @-HIA-carnitine ) , a downstream metabolite of @-HIA , was @ % lower ( P = @ ) among pregnant ( vs. control ) women , a finding that may arise from carnitine inadequacy during gestation .


No differences ( P > @ ) were detected in plasma biotin , urinary biotin , or urinary bisnorbiotin between pregnant and control women .


Lactating women excreted @ % more ( vs. control ; P = @ ) of the biotin catabolite bisnorbiotin , indicating that lactation accelerates biotin turnover and loss .


Notably , with respect to control women , lactating women excreted @ % less ( P = @ ) urinary @-HIA and @ % less ( P = @ ) urinary @-HIA-carnitine , suggesting that lactation reduces leucine catabolism and that these metabolites may not be useful indicators of biotin status during lactation .


Overall , these data demonstrate significant alterations in markers of biotin metabolism during pregnancy and lactation and suggest that biotin intakes exceeding current recommendations are needed to meet the demands of these reproductive states .


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


Although platelet-rich plasma ( PRP ) has been used in rotator cuff repair , most authors have been unable to report the advantages of this method in clinical trials .


The use of PRP promotes better functional and structural results in arthroscopic rotator cuff repair .


Randomized controlled trial ; Level of evidence , @ .


This was a prospective , randomized , double-blind study with @ groups of @ patients each ( PRP group and control group ) .


Complete supraspinatus tears with retraction of less than @ cm were subjected to arthroscopic single-row repair ; at the end of the surgical procedure , liquid PRP prepared by apheresis was given to the patients in the PRP group with autologous thrombin .


The outcomes were assessed by the University of California at Los Angeles ( UCLA ) and Constant scales , visual analog scale ( VAS ) for pain , and magnetic resonance imaging ( MRI ) before and @ , @ , @ , and @ months after surgery .


The significance level was @ % .


The @ groups of patients exhibited significant clinical improvement ( P < @ ) .


Between the preoperative assessment and @-month follow-up , the mean UCLA score increased from @ @ to @ @ and from @ @ to @ @ in the control and PRP groups , respectively ( P = @ ) .


The mean Constant score increased from @ @ to @ @ in the control group and from @ @ to @ @ in the PRP group ( P = @ ) .


The mean VAS score varied from @ @ and @ @ before surgery to @ @ and @ @ at the @-month assessment in the control and PRP groups , respectively ( P = @ ) .


The only difference was in the mean UCLA score at @ months , with @ @ in the control group and @ @ in the PRP group ( P = @ ) .


The control group exhibited @ case of a complete retear and @ partial retears , and the PRP group exhibited @ cases of partial retears ( P = @ ) .


Platelet-rich plasma prepared by apheresis and applied in the liquid state with thrombin did not promote better clinical results at @-month follow-up .


Given the numbers available for analysis , the retear rate also did not change .


Effective interventions are needed to reduce neurobehavioral impairments in children due to maternal alcohol use during pregnancy .


Currently , health-counseling interventions have shown inconsistent results to reduce prenatal alcohol use .


Thus , more research using health counseling is needed to gain more knowledge about the effectiveness of this type of intervention on reducing alcohol use during pregnancy .


An alternative and promising strategy is computer tailoring .


However , to date , no study has shown the effectiveness of this intervention mode .


The aim was to test the effectiveness of health counseling and computer tailoring on stopping and reducing maternal alcohol use during pregnancy in a Dutch sample of pregnant women using alcohol .


A total of @ Dutch midwifery practices , randomly assigned to @ of @ conditions , recruited @ health counseling , @ computer tailoring , and @ usual care respondents from February to September @ .


Health-counseling respondents received counseling from their midwife according to a health-counseling protocol , which consisted of @ steps addressed in @ feedback sessions .


Computer-tailoring respondents received usual care from their midwife and @ computer-tailored feedback letters via the Internet .


Usual care respondents received routine alcohol care from their midwife .


After @ and @ months , we assessed the effect of the interventions on alcohol use .


Multilevel multiple logistic regression analyses showed that computer-tailoring respondents stopped using alcohol more often compared to usual care respondents @ months after baseline ( @/@ , @ % vs @/@ , @ % ; P = @ ) .


Multilevel multiple linear regression analyses showed that computer-tailoring respondents ( mean @ , SD @ units per week ) with average ( P = @ ) or lower ( P < @ ) alcohol use before pregnancy or with average ( P = @ ) or lower ( P = @ ) social support more strongly reduced their alcohol use @ months after baseline compared to usual care respondents ( mean @ , SD @ units per week ) .


Six months after baseline , @ % ( @/@ ) of the health-counseling respondents had stopped using alcohol .


This @ % difference with the usual care group was not significant .


This is the first study showing that computer tailoring can be effective to reduce alcohol use during pregnancy ; health counseling did not effectively reduce alcohol use .


Future researchers developing a health-counseling intervention to reduce alcohol use during pregnancy are recommended to invest more in recruitment of pregnant women and implementation by health care providers .


Because pregnant women are reluctant to disclose their alcohol use to health professionals and computer tailoring preserves a person 's anonymity , this effective computer-tailoring intervention is recommended as an attractive intervention for pregnant women using alcohol .


The purpose of this study was to investigate the effect of active vs passive scapular correction on pain and pressure pain threshold at the most symptomatic cervical segment in patients with chronic neck pain .


Twenty-three volunteers with chronic , idiopathic neck pain were recruited ( age , @ @ years ; sex -LSB- man/woman -RSB- , @/@ ; Neck Disability Index , @ % @ % ) .


Subjects were randomly allocated to @ groups : active scapular correction or passive scapular correction .


Pressure pain threshold and pain intensity rated on a numerical rating scale during a posteroanterior glide over the most symptomatic cervical segment were measured before and immediately after the active or passive scapular intervention .


Only the active scapular correction produced a reduction in pain ( pre , @ @ ; post , @ @ ; P < @ ) and increase in pressure pain threshold ( pre , @ @ kg/cm ( @ ) ; post , @ @ kg/cm ( @ ) ; P < @ ) at the most painful cervical segment .


An active scapular correction exercise resulted in an immediate reduction of pain and pressure pain sensitivity in patients with chronic neck pain and scapular dysfunction .


Ginger-salt-indirect moxibustion is widely applied to treat urge urinary incontinence after stroke , which is a common complication in stroke survivors .


Moxa cone moxibustion and moxa box moxibustion are the main techniques of ginger-salt-indirect moxibustion .


Our previous study had shown that ginger-salt-indirect moxibustion using moxa cones was feasible and effective for urination disorders post-stroke .


This pilot study aims to assess the feasibility of conducting research to evaluate the efficacy and safety of ginger-salt-indirect moxibustion for patients with post-stroke urge urinary incontinence .


This is a multicentre , prospective , single-blinded , pilot randomised controlled trial .


@ eligible patients will be randomly allocated to three groups .


Treatment group A ( n = @ ) will receive moxa cone moxibustion and routine care ; treatment group B ( n = @ ) will receive moxa box moxibustion and routine care ; control group ( n = @ ) will only receive routine care for stroke recovery .


The entire moxibustion treatment will consist of a total of @ sessions during the course of @weeks .


The primary outcome measure will be the increase in mean volume per void assessed at week @ from the first moxibustion session ( baseline ) .


Secondary outcome measures will include mean frequency of urination per day and quality of life assessments measured by completion of the Incontinence Quality of Life Questionnaire and Barthel Index .


All outcome measures will be assessed at baseline and at @ and @weeks from baseline .


Adverse events in the three groups will be recorded to assess the safety of moxibustion .


As public discourse surrounding obesity highlights the societal costs of obesity and individual 's own responsibility for their weight , being overweight is often framed as immoral .


Such ` moralizing ' messages about being overweight may be a psychological threat for those with high body mass .


Attempting to counter-moralise the public discourse ( i.e. actively arguing that there is nothing ` immoral ' about being overweight ) may relieve this threat , inducing people , especially those with higher ( perceived ) weight , to engage in healthier behaviours .


Two experiments were performed among Dutch and US participants .


( Counter - ) moralisation was manipulated .


Body mass and weight-related self-perceptions were measured .


The dependent variable was healthy vs. unhealthy snack choice .


( Counter - ) moralisation and ( perceived ) overweight jointly predicted snack choice : counter-moralising messages induced healthy snacking , but only among those who regarded themselves to have a high body mass .


The effects of moralising vs. counter-moralising obesity depended on one 's ( perceived ) overweight .


This suggests that , for people with relatively high weight , the current moralising public discourse on obesity works in counterproductive ways .