MME is primarily composed of TE approaches ( i.e. didactics ) plus a @st year web-based course and preceptor-facilitated training during a @rd year clerkship rotation .


The primary outcome measure is an objective score on an Objective Structured Clinical Examination ( OSCE ) tobacco-counseling smoking case among @rd year medical students from schools who implemented the MME or TE .


MSQuit is the first randomized to evaluate whether a tobacco treatment educational intervention implemented during medical school will improve medical students ' tobacco treatment skills .


We hypothesize that the MME intervention will better prepare students in tobacco dependence treatment as measured by the OSCE .


If a comprehensive tobacco treatment educational learning approach is effective , while also feasible and acceptable to implement , then medical schools may substantially influence skill development and use of the @As among future physicians .


PAD medical therapy has a number of limitations .


RLX showed promises in experimental model mainly through NO release .


Our study is the first to evaluate the efficacy and safety of RLX in PAD .


Eligible PAD La fontaine IIa-IIb patients were randomized in @ groups .


Group A was treated with physical therapy plus oral pRLX , @ ug b.i.d for @ weeks , group B received physical therapy alone .


Pain Free Walking Distance ( PFWD ) and Maximum Walking Distance ( MWD ) at @ and @ wks and at follow up @ months after treatment interruption were performed .


The percentage increases of PFWD in group B were @ + / - @ , @ + / - @ , and @ + / - @ respectively at @ and at @ weeks , and @ months after termination .


In Group A showed significantly higher percentage increases : @ + / - @ p < @ , @ + / - @ p < @ , and @ + / - @ p < @ at the corresponding time points .


The percentage increases of MWD in the B group were @ + / - @ , @ + / - @ and @ + / - @ at the above time points , while in the A group were @ + / - @ p < @ , and @ + / - @ p < @ .


The RLX patients referred a better physical and mental status .


No adverse events during or after the treatment were recorded .


RLX resulted very effective in PAD .


Our results may suggest that the observed functional benefits should come not only from hemodynamic improvement but also from positive vascular remodeling .


To determine whether baseline Heidelberg Retina Tomograph ( HRT ) measurements of the optic disc are associated with the development of open-angle glaucoma ( OAG ) in individuals with ocular hypertension in the European Glaucoma Prevention Study ( EGPS ) .


Retrospective analysis of a prospective , randomized , multicenter , double-masked , controlled clinical trial .


There were @ participants in the HRT Ancillary Study to the EGPS .


Each baseline HRT parameter was assessed in univariate and multivariate proportional hazards models to determine its association with the development of OAG .


Proportional hazards models were used to identify HRT variables that predicted which participants in the EGPS had developed OAG .


Development of OAG was based on visual field and/or optic disc changes .


At a median follow-up time of about @ years , @ participants developed OAG .


In multivariate analyses , adjusting for randomization arm , age , baseline IOP , central corneal thickness , pattern standard deviation , and HRT disc area , the following HRT parameters were associated with the development of OAG : the `` outside normal limits '' classification of the Frederick Mikelberg ( FSM ) discriminant function ( hazard ratio -LSB- HR -RSB- @ , @ % confidence interval -LSB- CI -RSB- : @-@ @ ) , larger mean cup depth ( HR @ , @ % CI : @-@ @ ) , cup-to-disc area ratio ( HR @ , @ % CI : @-@ @ ) , linear cup-to-disc ratio ( HR @ , @ % CI : @-@ @ ) , cup area ( HR @ , @ % CI : @-@ @ ) , smaller rim area ( HR @ , @ % CI : @-@ @ ) , larger cup volume ( HR @ , @ % CI : @-@ @ ) , smaller rim volume ( HR @ , @ % CI : @-@ @ ) , larger maximum cup depth ( HR @ , @ % CI : @-@ @ ) , and cup shape measure ( HR @ , @ % CI : @-@ @ ) .


Several baseline HRT parameters , alone or in combination with baseline clinical and demographic factors , were significantly associated with the development of OAG among the EGPS participants .


The integrated diagnostics ( ID ) algorithm is an implantable device-based tool that collates data pertaining to heart rhythm , heart rate , intrathoracic fluid status , and activity , producing a risk score that correlates with @-day risk of heart failure ( HF ) hospitalization .


We sought to validate the ID algorithm using the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial .


Diagnostic measures of the algorithm include OptiVol fluid index , nighttime heart rate , minutes of patient activity , heart rate variability , and combined measure of cardiac rhythm and biventricular pacing .


Monthly evaluations of ID parameters were assessed for the development of HF symptoms and hospitalization for HF .


A total of @ patients were included : @ ( @ % ) with cardiac resynchronization therapy with defibrillator devices and @ ( @ % ) with implanted cardioverter-defibrillator only .


The mean age was @ @ years , and @ ( @ % ) were men .


A total of @,@ months of follow-up data were available , with @ HF hospitalizations ( event rate @ % per month ) .


There were @ HF hospitalizations during low-risk months ( @ % per month ) , @ during medium-risk months ( @ % per month ) , and @ during high-risk months ( @ % per month ) .


Compared with low-risk months , and @ % confidence intervals ) of HF hospitalizations during medium-risk months was @ ( @-@ @ ) and during high-risk months was @ ( @-@ @ ) .


Multivariable analysis demonstrated that each ID variable had independent association with HF hospitalization .


The risk of HF as determined by the ID algorithm correlated with HF hospitalization and several HF signs and symptoms among patients in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial .


This may present a useful adjunct to detect early signs of HF and adjust therapy to reduce morbidity and costs involved with hospital admission .


To compare effects of combinations of standard and intensive treatment of glycemia and either blood pressure ( BP ) or lipids in the Action to Control Cardiovascular Risk in Diabetes ( ACCORD ) trial .


ACCORD enrolled @,@ type @ diabetes patients aged @-@ years at high risk for cardiovascular disease ( CVD ) events .


Participants were randomly assigned to hemoglobin A@c goals of < @ % ( < @ mmol/mol ; intensive glycemia ) or @-@ @ % ( @-@ mmol/mol ; standard glycemia ) and then randomized a second time to either @ ) systolic BP goals of < @ mmHg ( intensive BP ) or < @ mmHg ( standard BP ) or @ ) simvastatin plus fenofibrate ( intensive lipid ) or simvastatin plus placebo ( standard lipid ) .


Proportional hazards models were used to assess combinations of treatment assignments on the composite primary ( deaths due to CVD , nonfatal myocardial infarction -LSB- MI -RSB- , and nonfatal stroke ) and secondary outcomes .


In the BP trial , risk of the primary outcome was lower in the groups intensively treated for glycemia ( hazard ratio -LSB- HR -RSB- @ ; @ % CI @-@ @ ) , BP ( HR @ ; @ % CI @-@ @ ) , or both ( HR @ ; @ % CI @-@ @ ) compared with combined standard BP and glycemia treatment .


For secondary outcomes , MI was significantly reduced by intensive glycemia treatment and stroke by intensive BP treatment ; most other HRs were neutral or favored intensive treatment groups .


In the lipid trial , the general pattern of results showed no evidence of benefit of intensive regimens ( whether single or combined ) compared with combined standard lipid and glycemia treatment .


The mortality HR was @ ( @ % CI @-@ @ ) in the standard lipid/intensive glycemia group compared with the standard lipid/standard glycemia group .


In the ACCORD BP trial , compared with combined standard treatment , intensive BP or intensive glycemia treatment alone improved major CVD outcomes , without additional benefit from combining the two .


In the ACCORD lipid trial , neither intensive lipid nor glycemia treatment produced an overall benefit , but intensive glycemia treatment increased mortality .


Nitric oxide ( NO ) is essential for the optimal perfusion of the heart and its vasculature .


NO may be insufficient in surgical patients because its precursor arginine is decreased , and the inhibitor of NO synthesis asymmetric dimethylarginine ( ADMA ) is increased .


Besides arginine , the presence of other amino acids essential for the proper metabolism of cardiac cells may be decreased too .


Supplementation of these amino acids with enteral and parenteral nutrition before , during , and after surgery may augment the myocardial and plasma arginine : ADMA ratio and availability of amino acids .


Myocardial glucose metabolism and nutritional conditioning may result in a reduction of cardiac injury and support rapid recovery after major surgery .


We investigated the effect of nutrition before , during , and after surgery on amino acids and the myocardial arginine : ADMA ratio and its relation to myocardial glucose metabolism .


In this trial , @ patients who were undergoing off-pump coronary artery bypass grafting ( CABG ) were randomly assigned between enteral , parenteral , or no nutrition ( control ) from @ d before , during , and until @ d after surgery .


Both enteral and parenteral solutions were prepared with commercially available products and included proteins or amino acids , glucose , vitamins , and minerals .


Concentrations of amino acids including ADMA were analyzed in myocardial tissue and plasma samples .


F-fluorodeoxyglucose positron emission tomography was performed before and after surgery to assess myocardial glucose metabolism .


The myocardial arginine : ADMA ratio increased during surgery and was significantly higher in the enteral and parenteral groups than in the control group -LSB- median ( IQR ) : @ ( @-@ @ ) ( P = @ ) , @ ( @-@ @ ) ( P = @ ) , and @ ( @-@ @ ) , respectively -RSB- .


Furthermore , the change in the preoperative to postoperative plasma arginine : ADMA ratio correlated with the change in myocardial glucose metabolism in positron emission tomography ( r = @ , P = @ ) .


Enteral or parenteral nutrition before , during , and after CABG may positively influence myocardial glucose metabolism by increasing the plasma and myocardial arginine : ADMA ratio .


Benefits of art participation after stroke are becoming increasingly recognized .


Qualitative studies suggest that participation in visual arts creative engagement interventions ( CEIs ) during rehabilitation after stroke may improve mood , self-esteem , hope and some aspects of physical recovery .


This study examines the feasibility of undertaking a randomized controlled trial of a CEI delivered by artists within in-patient stroke rehabilitation to test effectiveness .


This trial is a two arm , single-blind , randomized controlled feasibility trial within in-patient stroke rehabilitation .


We will recruit @ patients receiving stroke rehabilitation in two stroke units in a health board area of Scotland ( @ patients in each arm ) .


Intervention arm participants will receive a visual-arts based CEI facilitated by experienced artists .


Artists will follow an intervention protocol with specific components that enable participants to set , achieve and review artistic goals .


Participants will receive up to eight intervention sessions , four within a group and four one-to-one with the artist .


Control group participants will receive usual care only.Data collection will occur at baseline , post-intervention and three-month follow-up .


Stroke-related health status is the primary outcome ; mood , self-esteem , self-efficacy , perceived recovery control and hope are secondary outcomes .


Semi-structured interviews will be conducted with purposively selected patients , artists and healthcare staff to elicit views and experiences of the intervention and feasibility and acceptability of trial processes .


Recruitment rates , retention rates and patient preference for art participation will also be collected .


Data will indicate , with confidence intervals , the proportion of patients choosing or refusing participation in the CEI and will allow calculation of recruitment rates for a future definitive trial .


Summary data will indicate potential variability , magnitude and direction of difference between groups .


Findings will inform sample size calculations for a definitive trial .


Thematic analysis of qualitative data will be managed using the Framework Approach .


Framework is an analytical approach for qualitative data , commonly used in policy and medical research .


If shown to demonstrate effects , this intervention has the potential to address aspects of stroke recovery previously .


Not routinely addressed in rehabilitation .


The aim of this study was to evaluate the impact of two different therapeutic strategies in patients with partial seizures who were intractable to the first prescribed antiepileptic drug ( AED ) ; alternative monotherapy vs early add-on treatment .


We conducted an open , cluster-randomised , prospective , controlled trial in patients with persistent partial seizures , despite treatment with one AED , who were never administered any other AEDs .


Neurologists were randomised to two strategies : in group A , an alternative monotherapy with a second AED was employed ; in group B , add-on treatment with a second AED was employed .


The primary outcome was the percentage of seizure-free patients during a two-month period after six months of treatment .


The secondary outcomes were : ( i ) the percentage of patients achieving a @ % reduction in the number of seizures at six months ; ( ii ) the quality of life based on the Quality Of Life In Epilepsy scale ; and ( iii ) tolerability .


A total of @ neurologists were included and randomised , and @ patients were evaluated .


At six months , the primary outcome was @ % in group A and @ % in group B ( p = @ ) .


The percentage of patients achieving a @ % reduction in the number of seizures at six months was @ % in group A and @ % in group B ( p = @ ) .


The quality of life and the tolerability did not significantly differ between the two groups .


Alternative monotherapy or early treatment initiation with another AED drug resulted in similar efficacy , and the side effects associated with monotherapy and combined therapies were similar , which suggests that individual susceptibility is more important than the number and burden of AEDs used .


This study was designed to evaluate the effects of perioperative administration of an isotonic electrolyte solution with @ % glucose ( IT ) on blood sodium ( Na + ) and blood glucose ( BG ) concentrations in pediatric patients < @-year-old undergoing plastic surgery in comparison with a conventional hypotonic electrolyte solution with @ % glucose ( HT ) .


Fifty Patients were randomly allocated to HT group and IT group .


Na + and BG were measured at induction of anesthesia ( Tind ) , the end of surgery ( Tend ) , and @ hours after surgery ( T@h ) .


Patient characteristics were similar for the @ groups .


In the HT group , Na + at Tend insignificantly dropped compared with that at Tind , whereas in the IT group Na + was significantly elevated .


Na + at T@h significantly increased compared with that at Tend in each group .


No cases developed new dysnatremia or dysglycemia in IT group .


The incidence of hyponatremia at Tend was significantly lower in the IT group .


A positive correlation between intraoperative Na + concentration changes and the infusion duration was observed in the IT group .


Isotonic solution with @ % glucose is suggested to be safe in infants during and after surgery .


Evaluate changes in active and passive function with onabotulinumtoxinA + standard of care within goal-oriented rehabilitation programmes in adults with focal post-stroke spasticity .


Prospective , @-week double-blind study with an open-label extension .


Subjects were randomized to onabotulinumtoxinA + standard of care or placebo + standard of care , at baseline and at @ weeks , if judged appropriate , with follow-up to @ weeks .


The primary endpoint was the number of patients achieving their principal active functional goal at @ weeks ( or @ weeks after an optional second injection ) .


Secondary endpoints included achievement of a different active or a passive goal at this timepoint .


The intent-to-treat population comprised @ patients .


The proportion of patients achieving their principal active functional goal and secondary active functional goal with onabotulinumtoxinA + standard of care was not statistically different from placebo + standard of care .


Significantly more patients achieved their secondary passive goal with onabotulinumtoxinA + standard of care ( @ % ) vs. placebo + standard of care ( @ % ) ( odds ratio , @ ; @ % confidence interval , @-@ @ ) as well as higher Goal Attainment Scaling levels for upper limb and ankle flexor subgroups .


Addition of onabotulinumtoxinA to standard of care as part of goal-oriented rehabilitation in post-stroke spasticity patients significantly increased passive goal achievement and was associated with higher levels of active function .


Despite targeted antiemetics , data support an unmet need related to the management of delayed nausea and vomiting ( NV ) .


Promising pilot data informed this phase III trial evaluating gabapentin for delayed NV from highly emetogenic chemotherapy ( HEC ) .


Participants were randomized to receive prophylactic treatment with @ mg of dexamethasone and a @HT@ receptor antagonist ( RA ) on the day of chemotherapy , followed by gabapentin @ mg twice a day and dexamethasone ( dex ) or placebo and dex after HEC .


Gabapentin/placebo was started the day of chemotherapy and continued through day @ for the first chemotherapy cycle , whereas dex was titrated down on days @-@ .


The primary end point was complete response ( CR ) , defined as no emesis and no use of rescue medications on days @-@ , using an NV diary .


The percentages of those in each group with a CR were compared by Fisher 's exact test .


Four hundred thirty patients were enrolled in this study .


Forty-seven percent of patients in the gabapentin arm and @ % in the placebo arm had a CR ( P = @ ) .


Mean number of emesis episodes was < @ daily , and mean nausea severity was < @ ( mild ) .


In both arms , patient satisfaction with NV control was greater than @ ( with @ being perfectly satisfied ) .


There were no significant differences in unwanted side effects .


In this study , gabapentin did not significantly improve delayed NV .


Patients were satisfied with the control of their nausea and vomiting irrespective of arm .


The use of a @HT@ RA and dexamethasone provided good control of nausea and vomiting for most patients .


Previous studies suggested intravenous or nebulised magnesium sulphate ( MgSO ( @ ) ) might improve respiratory function in patients with acute asthma .


We aimed to determine whether intravenous or nebulised MgSO ( @ ) improve symptoms of breathlessness and reduce the need for hospital admission in adults with severe acute asthma .


In our double-blind , placebo-controlled trial , we enrolled adults ( aged @ years ) with severe acute asthma at emergency departments of @ hospitals in the UK .


We excluded patients with life-threatening features or contraindication to study drugs .


We used a central randomisation system to allocate participants to intravenous MgSO ( @ ) ( @ g in @ min ) or nebulised MgSO ( @ ) ( three @ mg doses in @ h ) alongside standard therapy including salbutamol , or placebo control plus standard therapy alone .


We assessed two primary outcome measures in all eligible participants who started treatment , according to assigned treatment group : the proportion of patients admitted to hospital within @ days and breathlessness measured on a @ mm visual analogue scale ( VAS ) in the @ h after initiation of treatment .


We adjusted for multiple testing using Simes 's method .


The trial stopped before recruitment was completed because funding expired .


This study is registered , number ISRCTN@ .


Between July @ , @ , and June @ , @ , we recruited @ ( @ % ) of @ patients proposed by the power calculation .


@ ( @ % ) of @ patients allocated nebulised MgSO ( @ ) were admitted to hospital before @ days , as were @ ( @ % ) of @ patients allocated intravenous MgSO ( @ ) and @ ( @ % ) of @ controls .


Breathlessness was assessed in @ ( @ % ) patients allocated nebulised MgSO ( @ ) , @ ( @ % ) patients allocated intravenous MgSO ( @ ) , and @ ( @ % ) controls .


Rates of hospital admission did not differ between patients treated with either form of MgSO ( @ ) compared with controls or between those treated with nebulised MgSO ( @ ) and intravenous MgSO ( @ ) .


Change in VAS breathlessness did not differ between active treatments and control , but change in VAS was greater for patients in the intravenous MgSO ( @ ) group than it was in the nebulised MgSO ( @ ) group ( @ mm , @ to @ ; p = @ ) .


Intravenous or nebulised MgSO ( @ ) did not significantly decrease rates of hospital admission and breathlessness compared with placebo : intravenous MgSO ( @ ) was associated with an odds ratio of @ ( @ % CI @ to @ ; p = @ ) for hospital admission and a change in VAS breathlessness of @ mm ( -@ to @ ; p = @ ) compared with placebo ; nebulised MgSO ( @ ) was associated with an odds ratio of @ ( @ to @ ; p = @ ) for hospital admission and a change in VAS breathlessness of -@ mm ( -@ to @ ; p = @ ) compared with placebo .


Our findings suggest nebulised MgSO ( @ ) has no role in the management of severe acute asthma in adults and at best suggest only a limited role for intravenous MgSO ( @ ) in this setting .


To test the effect of @ weeks of lower body resistance training on hyperglycemia and dyslipidemia , which may be prevalent among nonelderly , nondiabetic , chronically disabled stroke patients .


Randomized controlled study .


Outpatient clinics of rehabilitation centers .


Nonelderly , nondiabetic , chronically disabled stroke subjects ( N = @ ) were enrolled and randomly assigned to an experimental group ( n = @ ) and a control group ( n = @ ) .


Lower body resistance training was performed by subjects in the experimental group @ times a week for @ weeks .


The control group was given duration-matched stretch exercises .


Fasting glucose level , fasting insulin level , @-hour blood glucose level during oral glucose tolerance test , homeostasis model assessment of insulin resistance ( HOMA-IR ) , glycosylated hemoglobin ( Hb A@c ) , total triglyceride level , total cholesterol level , high-density lipoprotein ( HDL ) cholesterol level , low-density lipoprotein ( LDL ) cholesterol level , body mass index , lower limb muscle strength , and Fugl-Meyer motor score .


Before the intervention , @ subjects ( @ % ) had hyperglycemia and @ ( @ % ) had dyslipidemia .


Fifty-one subjects finished the study .


Subjects in the experimental group ( n = @ ) showed significant improvements in fasting insulin and @-hour blood glucose levels ; HOMA-IR ; total cholesterol , HDL cholesterol , and LDL cholesterol levels ; and muscle strength compared with control subjects ( n = @ ) after the intervention ( P < @ ) .


Resistance training may play a significant role in improving hyperglycemia and dyslipidemia , which are frequently present among nonelderly , nondiabetic , chronically disabled stroke patients .


There is little evidence for the optimal form of nonoperative treatment in the management of frozen shoulder .


This study assesses the efficacy of current physiotherapy strategies .


All primary care referrals of frozen shoulder to our physiotherapy department were included during a @-month period .


Of these referrals , @ % met the inclusion criteria for primary idiopathic frozen shoulder .


The @ patients were randomly assigned to @ of @ groups : group exercise class , individual physiotherapy , and home exercises alone .


A single independent physiotherapist , who was blinded to the treatment groups , made all assessments .


Range of motion , Constant score , Oxford Shoulder Score , Short Form @ , and Hospital Anxiety and Disability Scale ( HADS ) outcome measures were performed at baseline , @ weeks , @ months , and @ year .


The exercise class group improved from a mean Constant score of @ at baseline to @ at @ weeks and @ at @ year .


There was a significant improvement in shoulder symptoms on Oxford and Constant scores ( P < @ ) .


This improvement was greater than with individual physiotherapy or home exercises alone ( P < @ ) .


The improvement in range of motion was significantly greater in both physiotherapy groups over home exercises ( P < @ ) .


HADS scores significantly improved during the course of treatment ( P < @ ) .


The improvement in HADS anxiety score was significantly greater in both physiotherapy intervention groups than in home exercises alone .


A hospital-based exercise class can produce a rapid recovery from a frozen shoulder with a minimum number of visits to the hospital and is more effective than individual physiotherapy or a home exercise program .


Primary aim of this study was to evaluate if patient morbidity was improved by diminishing graft thickness and height ; secondary objective was to evaluate if such graft modifications influence root coverage and aesthetic outcomes .


@ Miller class I and II gingival recessions ( GR ) ( @ mm in depth ) were treated with the coronally advanced flap plus extraoral de-epithelialized free gingival graft ( FGG ) .


In @ randomly selected control GRs ( `` big graft group '' ) , the FGG thickness was @ mm and the height was equal to bone dehiscence ( BD ) ; in the other @ test defects ( `` small graft group '' ) , the thickness of the FGG was < @ mm and the height was @ mm .


The post-operative patient morbidity was assessed @ week after the surgery .


The clinical and aesthetic evaluations were performed @ year after the surgery .


Lower analgesic assumption , better post-operative course evaluations , better patient colour match scores and better periodontist aesthetic assessments were reported in the `` small graft '' group .


No statistically significant differences were demonstrated between the two groups in terms of recession reduction , CRC and increase in KTH .


Greater GT increase was obtained in the control-treated sites .


Coronally advanced flap plus CTG of reduced thickness and height was associated with less patient morbidity , better aesthetic evaluations with no difference in RC outcomes .


The purpose of this study was to assess the effect of @-weeks ingestion of a commercialized joint pain dietary supplement ( Instaflex Joint Support , Direct Digital , Charlotte , NC ) compared to placebo on joint pain , stiffness , and function in adults with self-reported joint pain .


Instaflex is a joint pain supplement containing glucosamine sulfate , methylsufonlylmethane ( MSM ) , white willow bark extract ( @ % salicin ) , ginger root concentrate , boswella serrata extract ( @ % boswellic acid ) , turmeric root extract , cayenne , and hyaluronic acid .


Subjects included @ men and women , ages @-@ years , with a history ( > @ months ) of joint pain , and were randomized to Instaflex or placebo ( @ colored gel capsules per day for @ weeks , double-blind administration ) .


Subjects agreed to avoid the use of non-steroidal anti-inflammatory drugs ( NSAID ) and all other medications and supplements targeted for joint pain .


Primary outcome measures were obtained pre - and post-study and included joint pain severity , stiffness , and function ( Western Ontario and McMaster Universities -LSB- WOMAC -RSB- ) , and secondary outcome measures included health-related quality of life ( Short Form @ or SF-@ ) , systemic inflammation ( serum C-reactive protein and @ plasma cytokines ) , and physical function ( @-minute walk test ) .


Joint pain symptom severity was assessed bi-weekly using a @-point Likert visual scale ( @-VS ) .


Joint pain severity was significantly reduced in Instaflex compared to placebo ( @-week WOMAC , @ % versus @ % , respectively , interaction effect P = @ ) , with group differences using the @-VS emerging by week @ of the study ( interaction effect , P = @ ) .


Improvements in ability to perform daily activities and stiffness scores in Instaflex compared to placebo were most evident for the @ % of subjects reporting knee pain ( @-week WOMAC function score , @ % versus @ % , respectively , interaction effect P = @ ; stiffness score , @ % versus @ % , respectively , interaction effect P = @ ) .


Patterns of change in SF-@ , systemic inflammation biomarkers , and the @-minute walk test did not differ significantly between groups during the @-week study


Results from this randomized , double blind , placebo-controlled community trial support the use of the Instaflex dietary supplement in alleviating joint pain severity in middle-aged and older adults , with mitigation of difficulty performing daily activities most apparent in subjects with knee pain .


The aim of this study was to investigate the effects of two different treatment regimes in patients with IgA nephropathy ( IgAN ) : steroids alone and in combination with a medium dose of cyclosporine A ( CsA ) .


Forty-eight IgAN patients @-@ years of age with proteinuria > @ g/@ hours and an estimated glomerular filtration rate ( eGFR ) of > @ mL/min/@ @ m ( @ ) were randomly given either steroids alone ( methylprednisolone ( MP ) group ; n = @ ) or steroids plus CsA treatment ( combination group ; n = @ ) .


The primary endpoint was the reduction of proteinuria by @ % or more of the baseline value .


The secondary endpoint was an increase in the baseline serum creatinine level of @ % or a decrease in the baseline eGFR of @ % .


After @ months of treatment , all patients in the combination group and @ % of the patients in the MP group reached the primary endpoint .


The complete remission rates in the combination group and MP group were @ % and @ % , respectively .


The level of urinary protein excretion declined from @ @ g/@ hours to @ @ g/@ hours ( p < @ ) in the combination group and from @ @ g/@ hours to @ @ g/@ hours ( p < @ ) in the MP group .


Two patients in the combination group reached the secondary endpoint , with a decrease in the eGFR of @ % from the baseline value , while no patients in the MP group achieved this goal .


The patients in the combination group exhibited significant improvements in the eGFR after nine months ( @ @ vs. @ @ mL/min @ m ( @ ) , p = @ ) , while the patients in the MP group showed significant increases in the eGFR after six months of treatment ( @ @ to @ @ mL/min/@ @ m ( @ ) , p = @ ) .


Four patients ( @ % ) developed severe pneumonia during treatment .


Both the full dose of steroids alone and combined treatment with steroids and a medium dose of CsA remarkably reduced the levels of proteinuria and ameliorated the renal function in the IgAN patients .


Infection was the most serious complication during the treatment .


To assess the effect of aging on stretch reflex modulation during walking , soleus H-reflexes obtained in @ middle-aged ( mean age @ years ) and @ young ( mean age @ years ) subjects were compared .


The H-reflex amplitude , muscle activity ( EMG ) of the soleus and tibialis anterior muscles , and EMG/H-reflex gain were measured during @-km/h treadmill walking .


The normalized H-reflex amplitude was lower in the swing phase for the middle-aged group , and there was no difference in muscle activity .


EMG/H-reflex gain did not differ between groups .


H-reflex amplitude during walking was affected by aging , and changes during the swing phase could be seen in the middle-aged subjects .


Subdividing the @ age groups into groups of facilitated or suppressed swing-phase H-reflex revealed that the H-reflex amplitude modulation pattern in the group with facilitated swing-phase H-reflex may be influenced by aging .


The aim of this randomized , prospective and double blinded study is to investigate effects of different esmolol use on hemodynamic response of laryngoscopy , endotracheal intubation and sternotomy in coronary artery bypass graft surgery .


After approval of local ethics committee and patients ' written informed consent , @ patients were randomized into three groups equally .


In Infusion Group ; from @ min before intubation up to @th minute after sternotomy , @ mg/kg/min esmolol infusion , in Bolus Group ; @ min before intubation and sternotomy @ mg/kg esmolol IV bolus and in Control Group ; % @ NaCl was administered .


All demographic parameters were recorded .


Heart rate and blood pressure were recorded before infusion up to anesthesia induction in every minute , during endotracheal intubation , every minute for @ minutes after endotracheal intubation and before , during and after sternotomy at first and fifth minutes .


While area under curve ( AUC ) ( SAPtime ) was being found more in Group B and C than Group I , AUC ( SAPTint and Tst ) and AUC ( SAPT@ ) was found more in Group B and C than Group I ( p < @ ) .


Moreover AUC ( HRTst ) was found less in Group B than Group C but no significant difference was found between Group B and Group I.


This study highlights that esmolol infusion is more effective than esmolol bolus administration on controlling systolic arterial pressure during endotracheal intubation and sternotomy in CABG surgery .


The aim of this study was to determine whether intermittent ambulatory treatment with levosimendan would improve functional capacity , quality of life , and event-free survival in patients with advanced heart failure .


This was a prospective , randomized , double-blind , placebo-controlled , multicentre , parallel-group trial of pulsed infusions of levosimendan in @ outpatients with advanced heart failure ( EF @ % , NYHA class III or IV ) .


The study was conducted at @ centres in Austria , Greece , and Germany .


Levosimendan ( @ g/kg/min ) or placebo was administered for @ h at @-week intervals over @ weeks , in addition to standard care therapy .


The primary outcome was the proportion of patients with a @ % improvement in the @ min walk test and a @ % score increase on the Kansas City Cardiomyopathy Questionnaire at the end of the @-week study period .


Secondary outcomes included event-free survival after @ weeks .


Analyses were performed on an intention-to-treat basis .


The primary endpoint was reached in @ % of patients receiving levosimendan and @ % of patients receiving placebo ( odds ratio @ ; @ % confidence interval @-@ @ ; P = @ ) .


Cardiac death ( four vs. one ) , heart transplants ( two vs. one ) , and acute heart failure ( @ vs. nine ) were more frequent with placebo as compared with levosimendan .


The incidence of side effects was comparable between groups .


Intermittent ambulatory treatment with levosimendan in patients with advanced heart failure did not improve significantly functional capacity or quality of life as compared with placebo .


An adequately powered , event-driven trial is warranted to enlarge on our findings .


This mixed methods study explored the characteristics of and experiences with perceived discrimination in an ethnically diverse urban sample of adults experiencing homelessness and mental illness .


Data were collected in Toronto , Ontario , as part of a @-year national randomized field trial of the Housing First treatment model .


Rates of perceived discrimination were captured from survey questions regarding perceived discrimination among @ ethnoracially diverse participants with moderate mental health needs .


The qualitative component included thirty six in-depth interviews which explored how individuals who bear these multiple identities of oppression navigate stigma and discrimination , and what affects their capacity to do so .


Quantitative analysis revealed very high rates of perceived discrimination related to : homelessness/poverty ( @ % ) , race/ethnicity/skin colour ( @ % ) and mental illness/substance use ( @ % ) .


Immigrants and those who had been homeless three or more years reported higher perceived discrimination on all three domains .


Analysis of qualitative interviews revealed three common themes related to navigating these experiences of discrimination among participants : @ ) social distancing ; @ ) old and new labels/identities ; and , @ ) ` homeland ' cultures .


These study findings underscore poverty and homelessness as major sources of perceived discrimination , and expose underlying complexities in the navigation of multiple identities in responding to stigma and discrimination .


To evaluate the impact of complement factor H ( CFH ) and age-related maculopathy susceptibility @ ( ARMS@ ) risk alleles on the observed response to components of the Age-Related Eye Disease Study ( AREDS ) formulation .


Genetic and statistical subgroup analysis of a randomized , prospective clinical trial .


White patients from the AREDS with category @ or @ age-related macular degeneration ( AMD ) with available DNA ( n = @ ) .


Four genotype groups based on CFH and ARMS@ risk allele number were defined .


Progression to advanced AMD was analyzed by genotype and treatment using Cox proportionate hazards estimates and @-year events .


The effect of predefined genotype group on treatment-specific progression to advanced AMD .


Patients with @ CFH risk alleles and no ARMS@ risk alleles progressed more with zinc-containing treatment compared with placebo , with a hazard ratio ( HR ) of @ ( P = @ ) for zinc and @ ( P = @ ) for AREDS formulation ( AF ) .


Seven-year treatment-specific progression rates were : placebo , @ % ; zinc , @ % ( P = @ ) ; and AF , @ % ( P = @ ) .


Patients with @ or @ CFH risk alleles and @ or @ ARMS@ risk alleles benefited from zinc-containing treatment compared with placebo , with an HR of @ for zinc ( P = @ ) and @ for AF ( P = @ ) .


Seven-year treatment-specific AMD progression rates were as follows : placebo , @ % ; zinc , @ % ( P = @ ) ; and AF , @ % ( P = @ ) .


Zinc and AF treatment each interacted statistically with these @ genotype groups under a Cox model , with P values of @ and @ , respectively .


For patients with @ or @ CFH risk alleles and no ARMS@ risk alleles , neither zinc-containing treatment altered progression compared with placebo , but treatment with antioxidants decreased progression ( HR , @ ; P = @ ) .


Seven-year progression with placebo was @ % and with antioxidants was @ % ( P = @ ) .


For patients with @ CFH risk alleles and @ or @ ARMS@ risk alleles , no treatment was better than placebo ( @ % ) .


The benefit of the AREDS formulation seems the result of a favorable response by patients in only @ genotype group , balanced by neutral or unfavorable responses in @ genotype groups .


To evaluate the effect of ocular draping on rates of bacterial contamination of the ocular surface immediately after intravitreal injection using a plate-type eyelid speculum .


Twelve institutions participated in this prospective randomized study .


Patients from each institution undergoing intravitreal injections were randomly assigned to @ groups , with and without ocular draping .


Following each institution 's standard protocol for aseptic preparation , intravitreal injection was performed using a plate-type eyelid speculum designed for intravitreal injections with or without draping .


Immediately after the intravitreal injection , a cotton swab was used to obtain a sample at the injection site and sent for bacterial culture .


Of @ eyes involved in the study , cultures were positive in five eyes ( @ % ) using standard methods and positive in an additional @ eyes ( @ % ) using methods to increase culture sensitivity .


There was no significant difference in the combined rate of bacterial contamination between the @ groups ( p = @ , Fisher 's exact test ) .


Ocular draping did not decrease the rate of bacterial contamination immediately after intravitreal injection performed using a plate-type eyelid speculum .


To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty ( PKP ) .


Multicenter , prospective , double-masked clinical trial .


We included @ participants from the Cornea Donor Study cohort who had not experienced graft failure @ years after PKP for a moderate risk condition ( principally Fuchs ' dystrophy or pseudophakic/aphakic corneal edema ) .


Corneas from donors @ to @ years old were assigned to participants using a randomized approach , without respect to recipient factors .


Surgery and postoperative care were performed according to the surgeons ' usual routines .


Images of the central endothelium were obtained preoperatively and at intervals for @ years postoperatively .


Images were analyzed by a central image analysis reading center to determine endothelial cell density ( ECD ) .


Endothelial cell density at @ years .


Among study participants with a clear graft at @ years , the @ who received a cornea from a donor @ to @ years old experienced a median cell loss of @ % , resulting in a @-year median ECD of @ cells/mm ( @ ) ( interquartile range -LSB- IQR -RSB- , @-@ cells/mm ( @ ) ) , whereas the @ who received a cornea from a donor @ to @ years old experienced a cell loss of @ % , resulting in a median @-year ECD of @ cells/mm ( @ ) ( IQR , @-@ cells/mm ( @ ) ; P adjusted for baseline ECD = @ ) .


In addition to younger donor age , higher ECD values were significantly associated with higher baseline ECD ( P < @ ) and larger donor tissue size ( P < @ ) .


Forty-two of the @ participants ( @ % ) had an ECD of < @ cells/mm ( @ ) at @ years and only @ ( @ % ) had an ECD of > @ cells/mm ( @ ) .


Substantial cell loss occurs in eyes with a clear graft @ years after PKP , with the rate of cell loss being slightly greater with older donor age .


Greater preoperative ECD and larger donor tissue size are associated with higher ECD at @ years .


Nesfatin-@ is an anorexigenic hormone suggested to regulate obesity .


To investigate the relationship between nesfatin-@ level and anthropometric and metabolic parameters in obese patients , and examine the change in plasma nesfatin-@ level after acupuncture treatment .


@ obese adult patients without diabetes and @ normal weight control subjects were enrolled in this study .


The obese patients were randomly divided into an acupuncture plus diet group ( n = @ ) and a diet only group ( n = @ ) .


Measurements were repeated after @days .


Body mass index ( BMI ) , waist and hip circumferences , serum insulin , lipoprotein and insulin resistance measures were significantly higher , and plasma nesfatin-@ level was significantly lower , in obese patients than in normal weight controls .


In addition , negative correlations were found between plasma nesfatin-@ level and BMI , waist and hip circumferences .


Weight reduction in participants after acupuncture and diet restriction was @ % and @ % , respectively .


Plasma nesfatin-@ level increased from @ to @ ng/mL and from @ to @ ng/mL in acupuncture and diet groups , respectively ; the difference was significant , p < @ .


Plasma nesfatin-@ level is reduced in obese adults , and is increased after acupuncture .


The beneficial effect of acupuncture on obesity is associated with increased plasma nesfatin-@ level .


Fibromyalgia and major depressive disorder ( MDD ) frequently co-occur .


Quetiapine fumarate extended-release ( quetiapine XR ) has demonstrated efficacy in the treatment of MDD and has been shown to have analgesic properties in patients with depression .


The primary objectives of this study were to evaluate the effects of quetiapine XR on depressive and pain symptoms in patients with MDD and comorbid fibromyalgia , and to assess its safety and tolerability .


This was an @-week , single-center , double-blind , randomized , controlled trial .


A total of @ nonpsychotic adult outpatients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition diagnostic criteria for MDD and whose diagnosis of fibromyalgia was confirmed according to the American College of Rheumatology criteria were enrolled .


The primary end point was the mean change from baseline to week @ on the @-item Hamilton Depression Rating ( HAM-D ) scale .


Secondary end points included other depression-rating scores , pain scores , fibromyalgia scores , measures of quality of life and global functioning , and adverse events .


The mean change in the HAM-D score from baseline to week @ was significantly greater in the quetiapine XR group compared with the placebo group ( -@ versus -@ ; P = @ ) .


Improvements in most secondary outcomes were also significantly greater in the quetiapine XR group .


Quetiapine XR was generally well tolerated .


This study is the first to demonstrate that measures of depression , pain , and quality of life are significantly improved with quetiapine XR compared with placebo in patients with a dual diagnosis of MDD and fibromyalgia .


This article reports the effects of three evidence-based interventions of varying intensity , each designed to improve outcomes of hospitalized cognitively impaired older adults .


In this comparative effectiveness study , @ older adults with cognitive impairment ( assessed within @ h of index hospitalization ) were enrolled at one of three hospitals within an academic health system .


Each hospital was randomly assigned one of the following interventions : Augmented Standard Care ( ASC ; lower dose : n = @ ) , Resource Nurse Care ( RNC ; medium dose : n = @ ) or the Transitional Care Model ( TCM ; higher dose : n = @ ) .


Since randomization at the patient level was not feasible due to potential contamination , generalized boosted modeling that estimated multigroup propensity score weights was used to balance baseline patient characteristics between groups .


Analyses compared the three groups on time with first rehospitalization or death , the number and days of all-cause rehospitalizations per patient and functional status through @-month postindex hospitalization .


In total , @ % of the ASC group were rehospitalized or died by day @ compared with day @ for the RNC group versus day @ for the TCM group .


The largest differences between the three groups on time to rehospitalization or death were observed early in the Kaplan-Meier curve ( at @ days : ASC = @ % vs RNC = @ % vs TCM = @ % ) .


The TCM group also demonstrated lower mean rehospitalization rates per patient compared with the RNC ( p < @ ) and ASC groups ( p = @ ) at @ days .


At @-day postindex hospitalization , the TCM group continued to demonstrate lower mean rehospitalization rates per patient only when compared with the ASC group ( p = @ ) .


No significant group differences in functional status were observed .


Findings suggest that the TCM intervention , compared with interventions of lower intensity , has the potential to decrease costly resource use outcomes in the immediate postindex hospitalization period among cognitively impaired older adults .


Although electroconvulsive therapy ( ECT ) is the most effective acute antidepressant intervention , sustained response rates are low .


It has never been systematically assessed whether psychotherapy , continuation ECT , or antidepressant medication is the most efficacious intervention to maintain initial treatment response .


In a prospective , randomized clinical trial , @ inpatients with major depressive disorder ( MDD ) were treated with right unilateral ultra-brief acute ECT .


Electroconvulsive therapy responders received @ months guideline-based antidepressant medication ( MED ) and were randomly assigned to add-on therapy with cognitive-behavioral group therapy ( CBT-arm ) , add-on therapy with ultra-brief pulse continuation electroconvulsive therapy ( ECT-arm ) , or no add-on therapy ( MED-arm ) .


After the @ months of continuation treatment , patients were followed-up for another @ months .


The primary outcome parameter was the proportion of patients who remained well after @ months .


Of @ MDD patients starting the acute phase , @ % responded and @ % remitted to acute ECT .


After @ months of continuation treatment , significant differences were observed in the three treatment arms with sustained response rates of @ % in the CBT-arm , @ % in the ECT-arm , and @ % in the MED-arm .


After @ months , these differences remained stable with sustained response rates of @ % in the CBT-arm , @ % in the ECT-arm , and @ % in the MED-arm .


These results suggest that ultra-brief pulse ECT as a continuation treatment correlates with low sustained response rates .


However , the main finding implicates cognitive-behavioral group therapy in combination with antidepressants might be an effective continuation treatment to sustain response after successful ECT in MDD patients .


Spinal anesthesia ( SA ) is usually associated with hypotension in pregnant women .


We sought to assess the influence of various maternal positions on SA-induced hypotension


The study population comprised @ women at full-term gestation scheduled for elective cesarean section .


They were randomized into @ equal groups : the LL group , in which the patient was placed in the full left-lateral position until the start of surgery with the Whitacre needle bevel oriented laterally ; the LS group , in which the patient was placed in the full left-lateral position initially and then shifted to the left-tilt supine position with the needle bevel oriented laterally ; and the CS group , in which the patient was initially placed in the full left-lateral position and then shifted to the left-tilt supine position with the needle oriented in the cephalad direction .


The incidences of hypotension in the LL , LS , and CS groups were @ % , @ % , and @ % , respectively .


Ephedrine requirements were lower in the LL group than in the LS group ( P < @ ) .


The maternal position during the induction of anesthesia played an important role in the development of hypotension during cesarean delivery .


Adolescent smoking is still highly prevalent in Denmark .


One in four @-year olds indicates that they have tried to smoke , and one in four @-year olds answer that they smoke regularly .


Smoking is more prevalent in socioeconomically disadvantaged populations in Denmark as well as in most Western countries .


Previous school-based programs to prevent smoking have shown contrasting results internationally .


In Denmark , previous programs have shown limited or no effect .


This indicates a need for developing a well-designed , comprehensive , and multi-component intervention aimed at Danish schools with careful implementation and thorough evaluation.This paper describes X : IT , a study including @ ) the development of a @-year school-based multi-component intervention and @ ) the randomized trial investigating the effect of the intervention .


The study aims at reducing the prevalence of smoking among @ to @-year olds by @ % .


The X : IT study is based on the Theory of Triadic Influences .


The theory organizes factors influencing adolescent smoking into three streams : cultural environment , social situation , and personal factors .


We added a fourth stream , the community aspects .


The X : IT program comprises three main components : @ ) smoke-free school premises , @ ) parental involvement including smoke-free dialogues and smoke-free contracts between students and parents , and @ ) a curricular component .


The study encompasses process - and effect-evaluations as well as health economic analyses .


Ninety-four schools in @ municipalities were randomly allocated to the intervention ( @ schools ) or control ( @ schools ) group .


At baseline in September @ , @,@ year @ students were eligible of which @,@ answered the baseline questionnaire ( response rate = @ % ) .


The X : IT study is a large , randomized controlled trial evaluating the effect of an intervention , based on components proven to be efficient in other Nordic settings .


The X : IT study directs students , their parents , and smoking prevention policies at the schools .


These elements have proven to be effective tools in preventing smoking among adolescents .


Program implementation is thoroughly evaluated to be able to add to the current knowledge of the importance of implementation .


X : IT creates the basis for thorough effect and process evaluation , focusing on various social groups .


Advanced oxidation protein products ( AOPP ) are newly identified efficient oxidative stress biomarkers .


In a longitudinal birth cohort the effects were investigated of genetic polymorphisms in five oxidative pathway genes on AOPP levels .


This study is part of a three-arm randomized , double-blind , placebo-controlled trial .


Three hundred and twelve children were included in the present study with AOPP levels measured at @ , @ , @ , @ and @ months of age .


Twelve polymorphisms were genotyped in five oxidative stress pathway genes : glutathione reductase ( GSR ) , glutamylcysteine synthetase ( GCLC ) , glutathione S-transferase ( GST ) P@ , haem oxygenase @ ( HMOX@ ) and superoxide dismutase @ ( SOD@ ) in @ children .


There were @ children assessed for anaemia and clinical malaria infection at the age of @ months .


Two principal components ( PCA@ and PCA@ ) were derived from the AOPP levels measured at the five time points .


PCA@ was significantly associated with anaemia ( p = @ ) , and PCA@ with clinical malaria infection ( p = @ ) .


In the K-Means Cluster Analysis based on levels of AOPP , children were clustered into two groups : Group A ( lower AOPP levels ) and Group B ( higher AOPP levels ) .


The cluster membership was significantly associated with anaemia ( p = @ ) as well as with the GSR RS@ polymorphism ( p = @ ) .


Mixed linear regression analyses found that the single nucleotide polymorphisms GCLC RS@ and HMOX@ RS@ were significantly associated with AOPP levels ( p = @ and p = @ , respectively ) .


Plasma AOPP levels were predictive for anaemia and oxidative stress markers for clinical malaria infection in two year old children .


Several polymorphisms in GCLC , GSR and HMOX@ genes were associated with oxidative stress status of these children .


Whole-grain ( WG ) foods have been suggested to reduce the risk of cardiovascular disease , but studies are inconsistent and effects on cardiovascular risk markers are not clear .


The objective of this study was to assess the impact of increasing WG consumption to at least @ g/d on overall dietary intake , body composition , blood pressure ( BP ) , blood lipids , blood glucose , gastrointestinal microbiology , and gastrointestinal symptoms in healthy , middle-aged adults with habitual WG intake < @ g/d .


Eligible subjects -LSB- @ men , @ women , aged @-@ y , body mass index ( BMI ) : @-@ kg/m ( @ ) -RSB- were identified through use of food frequency questionnaires and subsequently completed @-day food diaries ( @DFDs ) to confirm habitual WG consumption .


Subjects consumed diets high in WG ( > @ g/d ) or low in WG -LSB- < @ g/d , refined-grain ( RG ) diet -RSB- in a crossover study with @-wk intervention periods separated by a @-wk washout .


Adherence was achieved by specific dietary advice and provision of a range of cereal food products .


The @DFDs , diet compliance diaries , and plasma alkylresorcinols were used to verify compliance .


During the WG intervention , consumption increased from @ g/d to @ g/d ( P < @ ) , accompanied by an increase in plasma alkylresorcinols ( P < @ ) and total fiber intake ( P < @ ) , without any effect on energy or other macronutrients .


Although there were no effects on studied variables , there were trends toward increased @-h fecal weight ( P = @ ) and reduction in body weight ( P = @ ) and BMI ( P = @ ) during the WG intervention compared with the RG period .


A combination of dietary advice and provision of commercially available food items enabled subjects with a low-moderate habitual consumption of WG to substantially increase their WG intake , but there was little effect on blood biochemical markers , body composition , BP , fecal measurements , or gut microbiology .


This trial was registered at www.controlled-trials.com as ISRCTN@ .


Biochemical control reduces morbidity and increases life expectancy in patients with acromegaly .


With current medical therapies , including the gold standard octreotide long-acting-release ( LAR ) , many patients do not achieve biochemical control .


Our objective was to demonstrate the superiority of pasireotide LAR over octreotide LAR in medically naive patients with acromegaly .


We conducted a prospective , randomized , double-blind study at @ sites in @ countries .


A total of @ patients with medically naive acromegaly ( GH > @ g/L or GH nadir @ g/L after an oral glucose tolerance test ( OGTT ) and IGF-@ above the upper limit of normal ) were enrolled .


Patients either had previous pituitary surgery but no medical treatment or were de novo with a visible pituitary adenoma on magnetic resonance imaging .


Patients received pasireotide LAR @ mg/@ days ( n = @ ) or octreotide LAR @ mg/@ days ( n = @ ) for @ months .


At months @ and @ , titration to pasireotide LAR @ mg or octreotide LAR @ mg was permitted , but not mandatory , if GH @ g/L and/or IGF-@ was above the upper limit of normal .


The main outcome measure was the proportion of patients in each treatment arm with biochemical control ( GH < @ g/L and normal IGF-@ ) at month @ .


Biochemical control was achieved by significantly more pasireotide LAR patients than octreotide LAR patients ( @ % vs @ % ; P = @ ; @ % vs @ % when including patients with IGF-@ below the lower normal limit ) .


In pasireotide LAR and octreotide LAR patients , respectively , @ % and @ % ( P = @ ) achieved normal IGF-@ , and @ % and @ % achieved GH < @ g/L .


@ % of pasireotide LAR and @ % of octreotide LAR patients who did not achieve biochemical control did not receive the recommended dose increase .


Hyperglycemia-related adverse events were more common with pasireotide LAR ( @ % vs @ % ) .


Pasireotide LAR demonstrated superior efficacy over octreotide LAR and is a viable new treatment option for acromegaly .


We examined whether IV administration of cyclosporine in combination with thrombolysis might reduce cerebral infarct size .


Patients aged @ to @ years , presenting with an anterior-circulation stroke and eligible for thrombolytic therapy , were enrolled in this multicenter , single-blinded , controlled trial .


Fifteen minutes after randomization , patients received either an IV bolus injection of @ mg/kg cyclosporine ( Sandimmune , Novartis ) or placebo .


The primary endpoint was infarct volume on MRI at @ days .


Secondary endpoints included infarct volume according to the site ( proximal/distal ) of arterial occlusion and recanalization after thrombolysis .


From October @ to July @ , @ patients were enrolled .


The primary endpoint was assessed in @ of @ patients .


The reduction of infarct volume in the cyclosporine compared with the control group was overall not significant ( @ mL -LSB- interquartile range , IQR @ , @ mL -RSB- vs @ mL -LSB- IQR @ , @ mL -RSB- , respectively ; p = @ ) .


However , in patients with proximal occlusion and effective recanalization , infarct volume was significantly reduced in the cyclosporine compared with the control group ( @ mL -LSB- IQR @ , @ mL -RSB- vs @ mL -LSB- IQR @ , @ mL -RSB- , respectively ; p = @ ) .


Cyclosporine was generally not effective in reducing infarct size .


However , a smaller infarct size was observed in patients with proximal cerebral artery occlusion and efficient recanalization .


This study provides Class I evidence that in patients with an acute anterior-circulation stroke , thrombolysis plus IV cyclosporine does not significantly decrease @-day MRI infarct volume compared with thrombolysis alone .


Whether listening to background music enhances verbal learning performance is still a matter of dispute .


In this study we investigated the influence of vocal and instrumental background music on verbal learning .


@ subjects were randomly assigned to one of five groups ( one control group and @ experimental groups ) .


All participants were exposed to a verbal learning task .


One group served as control group while the @ further groups served as experimental groups .


The control group learned without background music while the @ experimental groups were exposed to vocal or instrumental musical pieces during learning with different subjective intensity and valence .


Thus , we employed @ music listening conditions ( vocal music with high intensity : VOC_HIGH , vocal music with low intensity : VOC_LOW , instrumental music with high intensity : INST_HIGH , instrumental music with low intensity : INST_LOW ) and one control condition ( CONT ) during which the subjects learned the word lists .


Since it turned out that the high and low intensity groups did not differ in terms of the rated intensity during the main experiment these groups were lumped together .


Thus , we worked with @ groups : one control group and two groups , which were exposed to background music ( vocal and instrumental ) during verbal learning .


As dependent variable , the number of learned words was used .


Here we measured immediate recall during five learning sessions ( recall @ - recall @ ) and delayed recall for @ minutes ( recall @ ) and @ days ( recall @ ) after the last learning session .


Verbal learning improved during the first @ recall sessions without any strong difference between the control and experimental groups .


Also the delayed recalls were similar for the three groups .


There was only a trend for attenuated verbal learning for the group passively listened to vocals .


This learning attenuation diminished during the following learning sessions .


The exposure to vocal or instrumental background music during encoding did not influence verbal learning .


We suggest that the participants are easily able to cope with this background stimulation by ignoring this information channel in order to focus on the verbal learning task .


To determine the relationship between abdominal breathing and tear meniscus volume in healthy women , we investigated the change in tear meniscus volume in two groups : normal breathing and abdominal breathing .


We used a crossover experimental model and examined @ healthy women aged @-@ years ( mean SD , @ @ years ) .


The participants were randomly assigned to one of two groups .


During the first visit , the normal breathing group was subjected to normal breathing for @ min , whereas the abdominal breathing group was subjected to abdominal breathing ( @-second inhalation and @-second exhalation ) for @ min .


During the second visit , the protocols were swapped between the two groups .


We estimated the R wave to R wave ( R-R ) interval , tear meniscus volume , salivary amylase activity , pulse , and blood pressure before and immediately after , @ min after , and @ min after completion of the breathing activity .


After abdominal breathing , compared to that before breathing , the tear meniscus volume increased significantly @ min after breathing ( P < @ ) .


Furthermore , systolic blood pressure showed a significant decrease immediately after abdominal breathing ( P < @ ) .


No significant difference was found in the test parameters in the normal breathing group .


Abdominal breathing for @ minutes increases the tear meniscus volume in healthy women .


Consequently , abdominal breathing may be considered in the treatment of dry eye disease .


Healing tissue of the rotator cuff does not regenerate the native enthesis ; fibrovascular scar tissue is formed instead and this has less favourable biomechanical properties .


The purpose of this study was to determine if the application of adipose tissue-derived stem cells ( ASCs ) could improve biomechanical and histological properties of the repair .


Fifty Sprague-Dawley rats underwent detachment and repair of the supraspinatus tendon , @ for the biomechanical study and @ for the histological examination .


Animals were randomised in two groups to receive either a collagen carrier alone ( untreated group ) or the carrier plus @ ( @ ) ASCs ( ASCs group ) .


A control group ( suture only ) was also included for the histological examination .


The animals were sacrificed at @ and @ weeks for the biomechanical study and at @ hours , and @ and @ weeks for the histological study .


Maximum load failure energy , elastic energy , mechanical deformation , stiffness and absorbed energy were measured .


Immunofluorescence testing was conducted to show the presence of ASCs in the repair area .


There were no differences between the untreated group and the ASCs group in any of the biomechanical variables at the @ - and @-week time points .


The mechanical deformation before failure was higher for the ASCs group compared with the untreated group at @ weeks and @ weeks ( p = @ ) , as was the absorbed energy ( p = @ ) .


Differences in maximum load to failure between @ and @ weeks were significant for the untreated group ( p = @ ) but not for the ASCs group ( p = @ ) .


Histological examination showed less acute inflammation with diminished presence of oedema and neutrophils in the ASCs group .


There were no differences in the orientation of collagen fibres between groups at either time point .


In the ASCs group , collagen was present only at the last time point .


The application of ASCs in a rat rotator cuff repair model did not improve the biomechanical properties of the tendon-to-bone healing .


However , the ASCs group showed less inflammation , which may lead to a more elastic repair and less scarred healing .


The quality of code status discussions ( CSDs ) is suboptimal as physicians often fail to discuss patients ' goals of care and resuscitation outcomes .


We previously demonstrated that internal medicine residents randomized to a communication skills intervention scored higher than controls on a CSD checklist using a standardized patient .


However , the impact of this training on CSD content is unknown .


Compare CSD content between intervention and control residents .


We conducted qualitative analysis of simulated CSDs .


Augmenting a priori codes with constant comparative analysis , we identified key themes associated with resident determination of code status .


We dichotomized each theme as present or absent .


We used chi-square tests to evaluate the association between training and presence of each theme .


Fifty-six residents rotating on the internal medicine service in July @ were randomized to intervention ( n = @ ) or control ( n = @ ) .


Intervention residents completed CSD skills training ( lectures , deliberate practice , and self-study ) .


Six months later , all @ residents completed a simulated CSD .


Comparison of key themes identified in CSDs among intervention and controls .


Fifty-one transcripts were recorded and reviewed .


Themes identified included : exploration of patient values/goals , framing code status as a patient decision , discussion of resuscitation outcomes and quality of life , and making a recommendation regarding code status .


Intervention residents were more likely than controls to explore patient values/goals ( p = @ ) and make a recommendation ( p < @ ) ; and less likely to frame the decision as one solely to be made by the patient ( p = @ ) .


Less than one-third of residents discussed resuscitation outcomes or quality of life .


Training positively influenced CSD content in key domains , including exploration of patient values/goals , making a recommendation regarding code status , and not framing code status as solely a patient decision .


However , despite the intervention , residents infrequently discussed resuscitation outcomes and quality of life .


To determine the relationships among traditional and laparoscopic surgical skills , spatial analysis skills , and video gaming proficiency of third-year veterinary students .


Prospective , randomized , controlled study .


A convenience sample of @ third-year veterinary students .


The students had completed basic surgical skills training with inanimate objects but had no experience with soft tissue , orthopedic , or laparoscopic surgery ; the spatial analysis test ; or the video games that were used in the study .


Scores for traditional surgical , laparoscopic , spatial analysis , and video gaming skills were determined , and associations among these were analyzed by means of Spearman 's rank order correlation coefficient ( rs ) .


A significant positive association ( rs = @ ) was detected between summary scores for video game performance and laparoscopic skills , but not between video game performance and traditional surgical skills scores .


Spatial analysis scores were positively ( rs = @ ) associated with video game performance scores ; however , that result was not significant .


Spatial analysis scores were not significantly associated with laparoscopic surgical skills scores .


Traditional surgical skills scores were not significantly associated with laparoscopic skills or spatial analysis scores .


Results of this study indicated video game performance of third-year veterinary students was predictive of laparoscopic but not traditional surgical skills , suggesting that laparoscopic performance may be improved with video gaming experience .


Additional studies would be required to identify methods for improvement of traditional surgical skills .


Steroids are used for the treatment of laryngitis in vocal performers and other individuals despite the absence of evidence demonstrating their impact on vocal fold inflammation .


Our objective was to examine laryngeal secretion cytokine inflammatory profile changes associated with corticosteroid treatment in a human phonotrauma model .


Prospective , individual , randomized , double-blinded , controlled trial .


Participants included @ healthy females who were randomized to either treatment with oral hydrocortisone or placebo , each given in three doses over @ hours after the experimental induction of acute phonotrauma .


Cytokines associated with inflammation and healing ( interleukin -LSB- IL -RSB- -@ , IL-@ , IL-@ ) were measured in laryngeal secretions before and after vocal loading and at @ and @ hours after treatment .


Proinflammatory mediators IL-@ and IL-@ were doubled in the controls versus the steroid treatment group at @ hours following induction of acute vocal fold inflammation .


Anti-inflammatory cytokine IL-@ showed a @-fold increase in the steroid treatment group versus the controls , indicating anti-inflammatory modulation by steroid treatment .


This study provides biologic evidence supporting the use of steroids for acute vocal fold inflammation associated with phonotrauma .


Vorapaxar , a novel antiplatelet therapy , reduces thrombotic events in patients with a history of myocardial infarction ( MI ) or peripheral artery disease ( PAD ) ; however , because of an increased risk of intracranial hemorrhage , it is contraindicated in patients with a history of stroke .


The aim of this study was to investigate the incidence of new ischemic stroke and subsequent death or intracerebral hemorrhage in patients with MI or PAD and no cerebrovascular disease ( CVD ) treated with vorapaxar .


The TRA @ P-TIMI @ ( Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis In Myocardial Infarction @ ) was a randomized , double-blind , placebo-controlled trial of vorapaxar @ mg daily in @,@ patients with atherosclerosis , stratified by qualifying disease ( MI , PAD , or CVD ) .


A total of @,@ patients with MI/PAD , but no CVD , were enrolled .


In patients with MI/PAD and no prior stroke or transient ischemic attack , vorapaxar reduced first ischemic stroke ( hazard ratio -LSB- HR -RSB- : @ , @ % confidence interval -LSB- CI -RSB- : @ to @ ; p < @ ) .


The risk of hemorrhagic conversion after stroke ( HR : @ , @ % CI : @ to @ ; p = @ ) or death ( HR : @ , @ % CI : @ to @ ; p = @ ) during follow-up was not significantly increased with vorapaxar in patients who had a new ischemic stroke ( n = @ ) .


Although hemorrhagic stroke was increased ( HR : @ , @ % CI : @ to @ ; p = @ ) , overall stroke was significantly reduced ( HR : @ , @ % CI : @ to @ ; p = @ ) .


Vorapaxar reduces ischemic stroke in patients with MI or PAD and no known CVD .


There does not appear to be a significant increase in the risk of hemorrhagic conversion or death in patients who experienced a first ischemic stroke on vorapaxar .


Although primary hemorrhagic stroke is increased , vorapaxar reduces the total incidence of stroke .


( Trial to Assess the Effects of Vorapaxar ( SCH @ ; MK-@ ) in Preventing Heart Attack and Stroke in Patients With Atherosclerosis -LSB- TRA @ P-TIMI @ -RSB- ; NCT@ ) .


We designed a randomized , controlled prospective study aimed at comparing efficacy and tolerability of ezetimibe + fenofibrate treatment versus pravastatin monotherapy in dyslipidemic HIV-positive ( HIV + ) patients treated with protease inhibitors ( PIs ) .


We consecutively enrolled @ HIV + dyslipidemic patients on stable PIs therapy ( LDL cholesterol > @ mg/dl or triglycerides @-@ mg/dl with non-HDL cholesterol > @ mg/dl ) .


After basal evaluation , patients were randomized to a six-month treatment with ezetimibe @ mg/day + fenofibrate @ mg/day or with pravastatin @ mg/day .


Both at the basal evaluation and after the six-month treatment , the patients underwent blood tests for lipid parameters , and muscle and liver enzymes .


At baseline , the two groups ( @ patients each ) were similar with regards to gender , age , BMI , blood pressure and virologic and metabolic parameters .


After the six-month therapy , total cholesterol , LDL cholesterol and non-HDL cholesterol decreased significantly ( p < @ ) in both groups .


high-density lipoprotein ( HDL ) cholesterol increased ( @ @ to @ @ mg/dl , p < @ ) and triglycerides decreased ( from @ @ mg/dl to @ @ mg/dl , p < @ ) in the ezetimibe + fenofibrate group , whereas both parameters remained unchanged in the pravastatin group .


Mean values of creatine kinase ( CK ) , alanine aminotransferase and aspartate aminotransferase were unchanged in both groups ; only one patient in the pravastatin group stopped the treatment after two months , due to increased CK .


In dyslipidemic HIV + patients on PI therapy , the association of ezetimibe + fenofibrate is more effective than pravastatin monotherapy in improving lipid profile and is also well tolerated .


Modified ultrafiltration is used to ameliorate the deleterious effects of cardiopulmonary bypass in pediatric cardiac surgery patients .


The ideal duration of modified ultrafiltration has not been established yet .


We investigated the effects of extended duration of modified ultrafiltration on pulmonary functions and hemodynamics in the early postoperative period in newborns and infants who had transposition of great arteries operations .


Single-center prospective randomized study .


Pediatric cardiac surgery operating room and ICU .


Sixty newborns and infants who had been scheduled to undergo transposition of great arteries operation .


None .


Modified ultrafiltration was applied to all patients following the termination of cardiopulmonary bypass ( for @ , @ , and @ min in groups @ , @ , and @ , respectively ) .


Pulmonary compliance , gas exchange capacity , hemodynamic measurements , inotropic support , blood loss , transfusion requirements , hematocrit level , and duration of ventilatory support were measured after intubation , at termination of cardiopulmonary bypass , at the end of modified ultrafiltration , and in the @st , @th , @th , and @th hours after admission to ICU .


The amount of fluid removed by modified ultrafiltration in groups @ and @ was larger than that of group @ ( p < @ ) .


Systolic blood pressure was significantly increased at the end of modified ultrafiltration in group @ compared to groups @ and @ ( p < @ ) .


Hematocrit levels were significantly increased at the end of modified ultrafiltration in groups @ and @ compared to group @ ( p < @ ) .


Therefore , RBCs were transfused less after modified ultrafiltration in groups @ and @ compared to group @ ( p < @ ) .


Static and dynamic compliance , oxygen index , and ventilation index had improved similarly in all three groups at the end of modified ultrafiltration ( p > @ ) CONCLUSIONS : : Modified ultrafiltration acutely improved pulmonary compliance and gas exchange in all groups .


Increased hematocrit and blood pressure levels were also observed in the longer modified ultrafiltration group .


However , extended duration of modified ultrafiltration did not have a significant impact on duration of intubation or the stay in ICU .


@F-Sodium fluoride ( @F-NaF ) and @F-fluorodeoxyglucose ( @F-FDG ) are promising novel biomarkers of disease activity in aortic stenosis .


We compared @F-NaF and @F-FDG uptake with histological characterization of the aortic valve and assessed whether they predicted disease progression .


Thirty patients with aortic stenosis underwent combined positron emission and computed tomography using @F-NaF and @F-FDG radiotracers .


In @ patients undergoing aortic valve replacement surgery ( @ for each tracer ) , radiotracer uptake ( mean tissue /


= @ ; P = @ ) and osteocalcin ( r = @ ; P = @ ) immunohistochemistry .


There was no significant correlation between @F-FDG uptake and CD@ staining ( r = -@ ; P = @ ) .


After @ year , aortic valve calcification increased from @ ( @-@ ) to @ ( @-@ ) AU ( P < @ ) .


Baseline @F-NaF uptake correlated closely with the change in calcium score ( r = @ ; P < @ ) , and this improved further ( r = @ ; P < @ ) when @F-NaF uptake overlying computed tomography-defined macrocalcification was excluded .


No significant correlation was noted between valvular @F-FDG uptake and change in calcium score ( r = -@ ; P = @ ) .


@F-NaF uptake identifies active tissue calcification and predicts disease progression in patients with calcific aortic stenosis .


Major depressive disorder is highly prevalent among Latinos with limited English language proficiency in the United States .


Although major depressive disorder is highly treatable , barriers to depression treatment have historically prevented Latinos with limited English language proficiency from accessing effective interventions .


The project seeks to evaluate the efficacy of behavioral activation treatment for depression , an empirically supported treatment for depression , as an intervention that may address some of the disparities surrounding the receipt of efficacious mental health care for this population .


Following a pilot study of behavioral activation treatment for depression with @ participants which yielded very promising results , the current study is a randomized control trial testing behavioral activation treatment for depression versus a supportive counseling treatment for depression .


We are in the process of recruiting @ Latinos with limited English language proficiency meeting criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders @th and @th Edition for participation in a single-center efficacy trial .


Participants are randomized to receive @ sessions of behavioral activation treatment for depression ( n = @ ) or @ sessions of supportive counseling ( n = @ ) .


Assessments occur prior to each session and at @ month after completing treatment .


Intervention targets include depressive symptomatology and the proposed mechanisms of behavioral activation treatment for depression : activity level and environmental reward .


We will also examine other factors related to treatment outcome such as treatment adherence , treatment satisfaction , and therapeutic alliance .


This randomized controlled trial will allow us to determine the efficacy of behavioral activation treatment for depression in a fast-growing , yet highly underserved population in US mental health services .


The study is also among the first to examine the effect of the proposed mechanisms of change of behavioral activation treatment for depression ( that is , activity level and environmental reward ) on depression over time .


To our knowledge , this is the first randomized controlled trial to compare an empirical-supported treatment to a control supportive counseling condition in a sample of depressed , Spanish-speaking Latinos in the United States .


Effects on the atrial fibrillatory rate ( AFR ) were studied during infusion with the combined potassium and sodium channel blocker AZD@ .


Patients with persistent atrial fibrillation ( AF ) were randomized to AZD@ or placebo .


Thirty-five patients converted to sinus rhythm ( SR ) and were matched to @ non-converters .


The mean AFR before conversion was @ fibrillations per minute ( fpm ) , having decreased by @ % ; in non-converters , it was @ fpm at the end of infusion , having decreased by @ % .


The rate of decrease was greater in converters at @ min , -@ vs. -@ fpm ( p = @ ) , and at @ min , -@ vs. -@ fpm ( p = @ ) .


The AFR-SD and the exponential decay decreased .


A small left atrial area was the only baseline predictor of conversion to SR. .


AZD@ produced a significantly more rapid decrease of the AFR in converters than in non-converters , but the AFR at baseline was not predictive of conversion .


We examined the cost-effectiveness of extended smoking cessation treatment in older smokers .


Participants who completed a @-week smoking cessation program were factorial randomized to extended cognitive behavioral treatment and extended nicotine replacement therapy .


A free-standing smoking cessation clinic .


A total of @ smokers aged @ years and older were recruited from the community .


The trial measured biochemically verified abstinence from cigarettes after @ years and the quantity of smoking cessation services utilized .


Trial findings were combined with literature on changes in smoking status and the age - and gender-adjusted effect of smoking on health-care cost , mortality and quality of life over the long term in a Markov model of cost-effectiveness over a lifetime horizon .


The addition of extended cognitive behavioral therapy added $ @ in smoking cessation services cost -LSB- P = @ , confidence interval ( CI ) = $ @-@ -RSB- .


At the end of follow-up , cigarette abstinence rates were @ % with extended cognitive behavioral therapy and @ % without this therapy ( P < @ , odds ratio @ , CI @-@ @ ) .


The model-based incremental cost-effectiveness ratio was $ @ per quality-adjusted life year ( QALY ) .


Probabilistic sensitivity analysis found that the additional $ @ in lifetime cost of the intervention had a @ % confidence interval of - $ @ to @ ; the @ additional QALYs had a confidence interval of @-@ @ , and that the intervention was cost-effective against a $ @/QALY acceptance criterion in @ % of the replicates .


Extended nicotine replacement therapy was not cost-effective .


Adding extended cognitive behavior therapy to standard cessation treatment was cost-effective .


Further intensification of treatment may be warranted .


The diagnosis of childhood pulmonary tuberculosis remains a challenge .


The effectiveness of the Keith Edwards scoring system used to diagnose tuberculosis is controversial .


We evaluated this scoring system in the present study .


A prospective randomized study was conducted between March @ and December @ at the Kimpese General Evangelical Hospital in the Democratic Republic of Congo .


The results of the Keith Edwards score were considered for the @ children ( @ pulmonary tuberculosis and @ case controls ) who were enrolled in the study .


The association between different parameters and the score and between these parameters and pulmonary tuberculosis were statistically analyzed using univariate and multivariate tests .


Eighty-five ( @ % ) out of the @ children diagnosed as having pulmonary tuberculosis and @ ( @ % ) of the case controls had a positive score .


The age of the patient , duration of the disease , nutritional status , tuberculosis contact , positive tuberculin skin test , and lymph node enlargement showed a significant statistical association with the score and pulmonary tuberculosis ( P < @ ) .


The score 's sensitivity and specificity were @ % and @ % , respectively .


The positive predictive value and negative predictive value were found to be @ % and @ % , respectively .


The positive likelihood ratio was @ , the negative likelihood ratio was @ , and overall agreement was @ % .


The Keith Edwards score could be good tool for public health purposes , but it might be less effective for individual diagnosis of childhood pulmonary tuberculosis because of low specificity .


Further studies are required to evaluate and validate the diagnostic value of clinical and radiological symptoms in childhood pulmonary tuberculosis .


To assess lesion detection and diagnostic confidence of computed tomography ( CT ) of the chest performed at less than @ mSv with @ iterative reconstruction ( IR ) techniques .


Ten patients gave written informed consent for the acquisitions of images at submillisievert dose ( @ mSv ) , in addition to clinical standard-dose ( SD ) chest CT ( @ mSv ) .


Submillisievert images were reconstructed with iDose and iterative model reconstruction ( IMR ) .


Two radiologists assessed lesion detection , margins , diagnostic confidence , and visibility of small structures .


Objective noise and noise spectral density were measured .


Lesion detection was identical for standard-dose filtered back projection ( FBP ) , submSv iDose , and submSv IMR .


Lesion margins were better seen for @ % of detected lung lesions with submSv IMR compared to standard-dose FBP and submSv iDose ( P < @ ) .


Visibility of abdominal structures , and diagnostic confidence with submSv iDose and submSv IMR were similar to standard-dose FBP .


There was @ % to @ % noise reduction with submSv IMR and @ % to @ % higher noise with iDose compared to standard-dose FBP ( P < @ ) .


Submillisievert IMR improves delineation of lesion margins compared to standard-dose FBP and submSv iDose .


The effects of glucose-and-fructose ( GF ) coingestion on cycling time trial ( TT ) performance and physiological responses to exercise were examined under postprandial conditions .


Eight trained male cyclists ( age , @ @ yr ; height , @ @ cm ; weight , @ @ kg ; VO@max , @ @ mLkgmin ) completed the study .


Subjects ingested either an artificially sweetened placebo ( PL ) , a moderate-glucose beverage ( MG , @ gmin ) , a high-glucose beverage ( HG , @ gmin ) , or a GF beverage ( @ gmin , @:@ ratio ) during approximately @ h of exercise , including @ h of constant-load cycling ( @ % Wmax , @ @ W ) , immediately followed by a computer-simulated @-km TT .


Physiological responses ( VE , VO@ , RER , HR , blood glucose level , blood lactate level , and RPE ) and incidences of gastrointestinal distress were assessed during early ( @-@ min ) , middle ( @-@ min ) , and late exercise ( @-@ min ) and during the TT .


Magnitude-based qualitative inferences were used to evaluate differences between treatments .


In comparison with that in PL ( @ @ min ) , TT performances were faster with GF ( @ @ min , `` very likely '' benefit ) , MG ( @ @ min , `` likely '' benefit ) , and HG ( @ @ min , `` possible '' benefit ) .


GF resulted in a `` likely '' improvement versus HG ( @ % ) and an `` unclear '' effect relative to MG ( @ % ) .


MG was `` possibly '' beneficial versus HG ( @ % ) .


Few incidences of GI distress were reported in any trials .


GF ingestion seems to enhance performance , relative to PL and HG .


However , it is unclear whether GF improves performance versus moderate doses of glucose .


To observe the impacts of the acupoint catgut implantation on postpartum pain of uterine contraction with qi and blood deficiency .


One hundred and ten primiparas of natural delivery differentiated as qi and blood deficiency pattern in TCM were selected as the subjects .


They were randomized into an acupoint catgut implantation group ( @ cases ) and a routine nursing group ( @ cases ) .


In the acupoint catgut implantation group , the catgut was implanted in Zigong ( EX-CA @ ) , Zusanli ( ST @ ) , Sanyinjiao ( SP @ ) , Pishu ( BL @ ) and Geshu ( BL @ ) in @ h after delivery ; additionally , the routine post-delivery nursing was adopted .


In the routine nursing group , the routine post-delivery nursing was applied simply .


Visual analogue scale ( VAS ) and the pain relief time of uterine contraction were compared in @ h , @ h , @ h and @ h after acupoint catgut implantation between the two groups .


VAS Scores in @ h , @ h , @ h and @ h after acupoint catgut implantation in the acupoint catgut implantation group were lower apparently than those in the routine nursing group ( @ + / - @ vs @ + / - @ , @ + / - @ vs @ + / - @ , @ + / - @ vs @ + / - @ , @ + / - @ vs @ + / - @ , all P < @ ) .


The pain relief was achieved in ( @ + / - @ ) h in the acupoint catgut implantation group and was ( @ + / - @ ) h in the routine nursing group .


The pain relief in the acupoint catgut implantation group was achieved more quickly ( P < @ ) .


The intervention of acupoint catgut implantation in @ h after natural delivery in primiparas prevents effectively postpartum pain of uterine contraction .


The cosmetic appearance of a facial scar is a concern for patients undergoing Mohs micrographic surgery ( MMS ) .


Although suturing technique may influence scar cosmesis , few studies have been published comparing suturing methods for MMS repair .


To compare the cosmetic appearance of facial MMS scars sutured with either continuous or interrupted percutaneous nylon sutures .


Patients with facial MMS defects were randomized to have half their scar sutured with interrupted @-@ nylon stitches , whereas the other half of the scar was closed with running @-@ nylon stitches .


The appearance of each half of the scar was assessed at @ week , @ weeks , and @ months by the principal investigator .


Blinded photographic evaluation at @ week and @ months was completed by a plastic surgeon and general dermatologist .


A total of @ patients were entered into the trial , and @ completed all time point assessments .


There was no statistically significant difference in scar outcome using each of the @ scar assessment scales , at any time point , for any assessor ( blinded and nonblinded ) .


Interrupted and continuous @-@ nylon sutures result in an equivalent final cosmetic appearance of facial MMS scars .


Given its advantages , running sutures may be the preferred closure technique for facial repair .


The German Society of Radiation Oncology initiated a multicenter trial to evaluate core processes and subprocesses of radiotherapy by prospective evaluation of all important procedures in the most frequent malignancies treated by radiation therapy .


The aim of this analysis was to assess the required resources for interstitial high-dose-rate ( HDR ) and low-dose-rate ( LDR ) prostate brachytherapy ( BRT ) based on actual time measurements regarding allocation of personnel and room occupation needed for specific procedures .


Two radiotherapy centers ( community hospital of Offenbach am Main and community hospital of Eschweiler ) participated in this prospective study .


Working time of the different occupational groups and room occupancies for the workflow of prostate BRT were recorded and methodically assessed during a @-month period .


For HDR and LDR BRT , a total of @ and @ measurements , respectively , were documented .


The time needed for treatment preplanning was median @min for HDR ( n = @ measurements ) and @min for LDR BRT ( n = @ ) .


Catheter implantation with intraoperative HDR real-time planning ( n = @ ) , postimplantation HDR treatment planning ( n = @ ) , and remotely controlled HDR afterloading irradiation ( n = @ ) required median @ , @ , and @min , respectively .


For LDR real-time planning ( n = @ ) and LDR treatment postplanning ( n = @ ) , the assessed median duration was @ and @min , respectively .


Room occupancy and overall mean medical staff times were @ and @min respectively , for HDR , and @ and @min , respectively , for LDR BRT .


In this prospective analysis , the resource requirements for the application of HDR and LDR BRT of prostate cancer were assessed methodically and are presented for first time .


Management of ureteral stones remains controversial .


To determine whether optimizing the extracorporeal shock wave lithotripsy delivery rate would improve the treatment of solitary ureteral stones we compared the outcomes of @ delivery rates in a prospective randomized trial .


From July @ to October @ , @ consecutive patients were randomized to extracorporeal shock wave lithotripsy at a shock wave delivery rate of @ and @ pulses per minute in @ and @ , respectively .


The primary study end point was the stone-free rate at @-month followup .


Secondary end points were stone disintegration , treatment time , complications and the rate of secondary treatments .


Descriptive statistics were used to compare end points between the @ groups .


The adjusted OR and @ % CI were calculated to assess predictors of success .


The stone-free rate at @ months was significantly higher in patients who underwent extracorporeal shock wave lithotripsy at a shock wave delivery rate of @ pulses per minute than in those who received @ pulses per minute ( @ % vs @ % , p = @ ) .


Patients with proximal ( @ % vs @ % , p = @ ) and mid ureteral stones ( @ % vs @ % , p = @ ) accounted for the observed difference but not those with distal ureteral stones ( @ % vs @ % , p = @ , respectively ) .


Treatment time , complications and the rate of secondary treatments were comparable between the @ groups .


On multivariable analysis the shock wave delivery rate of @ pulses per minute , proximal stone location , stone density , stone size and an absent indwelling Double-J stent were independent predictors of success .


Optimizing the extracorporeal shock wave lithotripsy delivery rate can achieve excellent results for ureteral stones .


To examine penile vibratory stimulation ( PVS ) in the treatment of post-prostatectomy urinary incontinence ( UI ) .


Patients with post-prostatectomy UI were included in a @-week trial .


A @-hr pad test and a @-hr voiding diary were collected at baseline .


Participants were randomized to receive PVS for the first @ weeks ( group @ ) or for the final @ weeks ( group @ ) of the study .


The primary outcome was the difference in leakage between groups @ and @ at @ weeks as measured by changes in the pad test .


The trial was registered at www.clinicaltrials.org ( NCT@ ) .


Data from @ men were available for analyses .


The difference in the change on the pad test between the groups did not reach statistical significance at @ weeks ( P = @ ) while the change in incontinence episodes between groups approached statistical significance ( P = @ ) .


However , there was a median reduction of -@ g ( P = @ ) on the pad test and a median reduction in daily incontinence episodes of -@ ( P = @ ) in group @ at @ weeks .


At @ weeks , group @ had a median decrease on the pad test of -@ g ( P = @ ) and no change in incontinence episodes .


A pooled analysis showed a decline on the pad test of -@ g ( P = @ ) after PVS .


Small improvements were seen in subjective symptom scores and @ % stated to be satisfied with PVS .


Self-limiting side effects were experienced by @ % of patients .


PVS is feasible in the treatment of post-prostatectomy UI .


Larger trials are needed to document the clinical efficacy .


No five-year long-term follow-up data is available regarding the prognostic value of GDF-@ .


Our aim is to evaluate the long-term prognostic value of admission growth-differentiation factor @ ( GDF-@ ) regarding death or myocardial infarction ( MI ) in patients with non-ST-elevation acute coronary syndrome ( NSTE-ACS ) .


This is a subanalysis from the ICTUS ( Invasive versus Conservative Treatment in Unstable coronary Syndromes ) trial , including troponin positive NSTE-ACS patients .


The main outcome for the current analysis was @-year death or spontaneous MI .


GDF-@ samples were available in @ patients .


The prognostic value of GDF-@ , categorized into < @ ng/L , @-@ ng/L and > @ ng/L , was assessed in unadjusted and adjusted Cox regression models .


Adjustments were made for identified univariable risk factors .


The additional discriminative and reclassification value of GDF-@ beyond the independent risk factors was assessed by the category-free net reclassification improvement ( @/@ NRI ( > @ ) ) and the integrated discrimination improvement ( IDI ) RESULTS : Compared to GDF-@ < @ ng/L , a GDF-@ > @ ng/L was associated with an increased hazard ratio for death or spontaneous MI , mainly driven by mortality .


GDF-@ levels were predictive after adjustments for other identified predictors .


Additional discriminative value was shown with the IDI , not with the NRI .


In patients presenting with NSTE-ACS and elevated troponin T , GDF-@ provides prognostic information in addition to identified predictors for mortality and spontaneous MI and can be used to identify patients at high risk during long-term follow-up .


Dietary patterns that are considered healthy ( eg , the Dietary Approaches to Stop Hypertension diet and Mediterranean diet ) may be more successful in reducing typical cardiovascular disease risks compared to dietary patterns considered unhealthy ( eg , energy-dense diets such as the typical American diet ) .


This study assessed the effects of a Korean diet , the @ Dietary Guidelines for Americans ( DGA ) , and a typical American diet on cardiometabolic risk factors , including lipid levels and blood pressure , in overweight , non-Asian individuals in the United States with elevated low-density lipoprotein cholesterol .


The study was a three-period crossover , controlled-feeding study from January @ to May @ .


Thirty-one subjects were randomly allocated to one of six possible sequential orders for consuming the three diets for @ weeks , each separated by a @-day break .


Data analysis included @ subjects on the Korean diet periods and @ in the DGA and typical American diet periods .


Subjects remained weight stable .


Lipid profile , blood pressure , insulin , glucose , and @-hour urinary sodium were determined at baseline and at the end of each diet period .