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METHODS For CPT , we used the forced expiratory technique ( FET ) , which consisted of one or more slow active expirations starting near the total lung capacity ( TLC ) and ending near the residual volume . |
METHODS After each expiration , the child was asked to perform a slow , nonmaximal , diaphragmatic inspiration . |
METHODS After one to four forced breathing cycles , the child was asked to cough and to expectorate . |
METHODS A typical 20-minute CPT session consisted of 10 to 15 FET maneuvers separated by rest periods of 10 to 20 breathing cycles each . |
METHODS During the study , each patient received two CPT sessions in random order on two different days , at the same time of day , with the same physiotherapist . |
METHODS During one of these two sessions , PSV was provided throughout the session ( PSV session ) via a nasal mask using the pressure support generator ARM25 designed for acute patients ( TAEMA , Antony , France ) . |
METHODS The control session was performed with no nasal mask or PSV . |
METHODS Both CPT sessions were performed without supplemental oxygen . |
METHODS Lung function and maximal inspiratory pressures ( PImax ) and expiratory pressures ( PEmax ) were recorded before and after each CPT session . |
RESULTS Mean lung function parameters were comparable before the PSV and the control sessions . |
RESULTS Baseline pulse oximetry ( SpO2 ) was significantly correlated with the baseline vital capacity ( % predicted ) and forced expiratory volume in 1 second ( FEV1 ) ( % predicted ) . |
RESULTS PSV was associated with an increase in tidal volume ( Vt ) from 0.42 + / - 0.01 liters to 1.0 + / - 0.02 liters . |
RESULTS Respiratory rate was significantly lower during PSV . |
RESULTS SpO2 between the FET maneuvers was significantly higher during PSV as compared with the control session . |
RESULTS SpO2 decreases after FET were significantly larger during the control session ( nadir : 91.8 + / - 0.7 % ) than during the PSV session ( 93.8 + / - 0.6 % ) . |
RESULTS Maximal pressures decreased during the control session ( from 71.9 + / - 6.1 to 60.9 + / - 5.3 cmH2O , and from 85.3 + / - 7.9 to 77.5 + / - 4.8 cmH2O , for PImax and PEmax , respectively ) and increased during the PSV session ( from 71.6 + / - 8.6 to 83.9 + / - 8.7 cmH2O , and from 80.4 + / - 7.8 to 88.0 + / - 7.4 cmH2O , for PImax and PEmax , respectively ) . |
RESULTS The decrease in PEmax was significantly correlated with the severity of bronchial obstruction as evaluated based on baseline FEV1 ( % predicted ) . |
RESULTS Forced expiratory flows did not change after either CPT session . |
RESULTS The amount of sputum expectorated was similar for the two CPT sessions ( 5.3 + / - 5.3 g vs 4.6 + / - 4.8 g after the control and PSV session , respectively ; NS ) . |
RESULTS Fifteen patients felt less tired after the PSV session . |
RESULTS Ten patients reported that expectoration was easier with PSV , whereas 4 did not note any difference ; 2 patients did not expectorate . |
RESULTS Nine patients expressed a marked and 5 a small preference for PSV , and 2 patients had no preference . |
RESULTS The physiotherapists found it easier to perform CPT with PSV in 14 patients and did not perceive any difference in 2 patients . |
CONCLUSIONS Our study in CF children shows that respiratory muscle performance , as evaluated based on various parameters , decreased after CPT and that significant falls in oxygen saturation occurred after the FET maneuvers despite the quiet breathing periods between each FET cycle . |
CONCLUSIONS These unwanted effects of CPT were |
###15172654 |
OBJECTIVE Comparing efficacy and safety of ibutilide vs. transoesophageal atrial pacing ( ATP ) for the termination of type I atrial flutter ( AFL ) . |
RESULTS Eighty-seven patients affected by AFL lasting between 2 h and 30 days were randomized in two groups : Group 1-i.v. ibutilide treatment , up to 2 mg , and Group 2-ATP , with `` burst '' and `` ramp '' pacing protocols . |
RESULTS Sinus rhythm was restored in 36/45 ( 80 % ) patients in Group 1 vs. 18/42 ( 43 % ) in Group 2 ( P < 0.0005 ) . |
RESULTS In Group 1 , mean AFL duration was 11.4 + / - 7.7 days in responders vs. 12.1 + / - 7.6 in non-responders ( P = ns ) , while in Group 2 it was 2.7 + / - 1.4 vs. 14.2 + / - 5.4 days ( responders vs. non-responders , respectively , P < 0.0001 ) ; 30/36 ( 83 % ) responders in Group 1 had AFL > 48 h vs. 10/18 ( 56 % ) responders in Group 2 ( P < 0.05 ) . |
RESULTS Non-sustained polymorphic ventricular tachycardia occurred in 2 patients in Group 1 vs. none in Group 2 ( P = ns ) . |
RESULTS It did not require any specific treatment except the interruption of ibutilide infusion . |
CONCLUSIONS Both ibutilide and ATP proved to be safe and effective for recent onset type I AFL termination , but ibutilide was more effective when the arrhythmia had lasted longer than 48 h. |
###9442774 |
OBJECTIVE This study aimed to describe the short-term effects of low-intensity laser treatment in eyes with drusen at risk of having choroidal neovascularization ( CNV ) develop secondary to age-related macular degeneration . |
METHODS The study design was a multicentered , randomized clinical trial of laser treatment versus observation . |
METHODS One hundred fifty-six patients without exudative age-related macular degeneration and with more than 10 large ( > 63 microns ) drusen in each eye were enrolled in the Bilateral Drusen Study . |
METHODS One hundred twenty patients with exudative age-related macular degeneration in 1 eye and more than 10 large drusen in the other eye were enrolled in the Fellow Eye Study . |
METHODS The treatment protocol for most ( 85 % ) of the eyes consisted of 20 laser burns , 100 microns in diameter , in a pattern of 3 rows placed between the 12 - and 6-o'clock positions beyond the temporal perimeter of the foveal avascular zone . |
METHODS The desired intensity of the burns was a gray-white lesion . |
METHODS Whenever the area of drusen had not been reduced by 50 % or more at 6 months , a second treatment was applied nasal to the fovea in a mirror image of the first treatment . |
METHODS During the last 6 months of enrollment , a second laser treatment protocol was adopted that specified 24 laser burns , 100 microns in diameter , in a circular pattern of 2 rows surrounding the macular drusen . |
METHODS Change in visual acuity is the primary outcome measure . |
METHODS Incidence of CNV , change in contrast threshold , and change in critical print size are secondary outcome measures . |
RESULTS In the Bilateral Drusen Study , CNV developed in 4 of 156 treated eyes and in 2 of 156 observed eyes ( P = 0.62 ) ; in the Fellow Eye Study , the proportions are 10/59 treated eyes and 2/61 observed eyes ( P = 0.02 ) . |
RESULTS Changes in visual acuity are similar in treated and observed eyes in the Bilateral Drusen Study through 18 months . |
RESULTS However , by 18 months , observed eyes in the Fellow Eye Study have lost more visual acuity than treated eyes ( P = 0.02 ) . |
RESULTS Changes in contrast threshold are similar in treated and observed eyes in each study . |
CONCLUSIONS Laser treatment to high-risk fellow eyes may increase the short-term incidence of CNV . |
CONCLUSIONS Long-term effects in fellow eyes and effects in patients with bilateral drusen require additional observation . |
###12410458 |
OBJECTIVE The objective of this trial was to compare the effectiveness of intraarticular injection of highly cross-linked hyaluronic acid ( HA ) with intraarticular injection of gaseous oxygen ( O 2 ) in patients with clinical symptoms of cartilage damage in the knee . |
METHODS Based on arthroscopically verified diagnosis , 111 patients were randomised and treated prospectively either with HA or O 2 . |
METHODS The treatment was completed with an exercise program . |
METHODS The follow up was one year . |
METHODS 109 patients ( 56 x HA , 53 x O 2 ) were statistically calculated with the Wilcoxon-test according to the results of the Lysholm-score , the Tegner-activity-index , the Womac-score for pain , stiffness , function and the VAS for pain in rest and under strain . |
RESULTS Both treatments were able to attain a statistically significant reduction of pain ( VAS in rest and under strain , Womac part A ) , a reduction of joint stiffness ( Womac part B ) and improvement of joint function ( Womac part C , Lysholm-score ) during the follow up of one year . |
RESULTS The Tegner-activity-index showed no significant change under both treatments . |
RESULTS The comparison of both treatments showed differences in VAS under strain ( p = 0.001 ) , the Lysholm-score ( p = 0.003 ) , Womac part A ( p = 0.003 ) and part C ( p = 0.001 ) . |
RESULTS As a result HA showed significant better improvements with the VAS and Lysholm-score and oxygen showed significant better changes in the Womac-score part A and C. |
RESULTS The results with cartilage damage 2 degrees were the same as in the total ( VAS strain : p = 0.029 for O 2 , Lysholm-score : p = 0.003 for HA , WOMAC part A : p = 0.009 for HA , Womac part C : p = 0.006 for O 2 ) . |
RESULTS The results with cartilage damage 3 degrees showed significant differences in reduction of joint stiffness ( Womac part B : p = 0.012 ) for O 2 . |
RESULTS For cartilage damage 4 degrees HA showed significant reduction of pain ( VAS rest : p = 0.001 , VAS strain : p = 0.003 ) and O 2 significant reduction of pain and function ( Womac part A : p = 0.004 , part C : p = 0.002 ) . |
CONCLUSIONS Both methods are suitable to improve significantly the discomfort due one year to osteoarthritis . |
CONCLUSIONS The pain relief by HA and the improvement of joint function by O 2 treatment have been shown for higher degrees of cartilage damage . |
###24116853 |
OBJECTIVE To evaluate the safety and tolerability of adjunctive brivaracetam ( BRV ) , a high-affinity synaptic vesicle protein 2A ( SV2A ) ligand , in adults with uncontrolled epilepsy . |
OBJECTIVE Efficacy was also assessed in patients with focal seizures as a secondary objective , and explored by descriptive analysis in patients with generalized seizures . |
METHODS This was a phase III , randomized , double-blind , placebo ( PBO ) - controlled flexible dose trial ( N01254/NCT00504881 ) in adults ( 16-70 years ) with uncontrolled epilepsy ( up to 20 % could be patients with generalized epilepsy ) . |
METHODS After a prospective 4-week baseline , patients were randomized ( 3:1 ) to b.i.d. BRV or PBO , initiated at 20 mg/day and increased , as needed , to 150 mg/day during an 8-week dose-finding period . |
METHODS This was followed by an 8-week stable-dose maintenance period . |
METHODS The treatment period comprised the dose-finding period plus the maintenance period ( 16 weeks ) . |
RESULTS A total of 480 patients were randomized ( BRV 359 , PBO 121 ) ; of these , 431 had focal epilepsy and 49 had generalized epilepsy . |
RESULTS Ninety percent BRV - and 91.7 % PBO-treated patients completed the study . |
RESULTS Similar proportions of patients ( BRV 66.0 % , PBO 65.3 % ) reported adverse events ( AEs ) during the treatment period . |
RESULTS AEs led to treatment discontinuation in 6.1 % and 5.0 % of BRV - and PBO-treated patients , respectively . |
RESULTS The incidence of AEs declined from the dose-finding ( BRV 56.0 % , PBO 55.4 % ) to the maintenance ( BRV 36.8 % , PBO 40.9 % ) period . |
RESULTS The most frequent AEs during the treatment period were headache ( BRV 14.2 % vs. PBO 19.8 % ) , somnolence ( BRV 11.1 % vs. PBO 4.1 % ) , and dizziness ( BRV 8.6 % vs. PBO 5.8 % ) . |
RESULTS The incidence of psychiatric AEs was similar for BRV and PBO ( BRV 12.3 % , PBO 11.6 % ) . |
RESULTS In patients with focal seizures , the baseline-adjusted percent reduction in seizure frequency/week in the BRV group ( n = 323 ) over PBO ( n = 108 ) was 7.3 % ( p = 0.125 ) during the treatment period . |
RESULTS The median percent reduction in baseline-adjusted seizure frequency/week was 26.9 % BRV versus 18.9 % PBO ( p = 0.070 ) , and the 50 % responder rate was 30.3 % BRV versus 16.7 % PBO ( p = 0.006 ) . |
RESULTS In patients with generalized seizures only , the number of seizure days/week decreased from 1.42 at baseline to 0.63 during the treatment period in BRV-treated patients ( n = 36 ) , and from 1.47 at baseline to 1.26 during the treatment period in PBO-treated patients ( n = 13 ) . |
RESULTS The median percent reduction from baseline in generalized seizure days/week was 42.6 % versus 20.7 % , and the 50 % responder rate was 44.4 % versus 15.4 % in BRV-treated and PBO-treated patients , respectively . |
CONCLUSIONS Adjunctive BRV given at individualized tailored doses ( 20-150 mg/day ) was well tolerated in adults with uncontrolled epilepsy , and our results provided support for further evaluation of efficacy in reducing focal and generalized seizures . |
###16876666 |
BACKGROUND Whether continuous renal replacement therapy is better than intermittent haemodialysis for the treatment of acute renal failure in critically ill patients is controversial . |
BACKGROUND In this study , we compare the effect of intermittent haemodialysis and continuous venovenous haemodiafiltration on survival rates in critically ill patients with acute renal failure as part of multiple-organ dysfunction syndrome . |
METHODS Our prospective , randomised , multicentre study took place between Oct 1 , 1999 , and March 3 , 2003 , in 21 medical or multidisciplinary intensive-care units from university or community hospitals in France . |
METHODS Guidelines were provided to achieve optimum haemodynamic tolerance and effectiveness of solute removal in both groups . |
METHODS The two groups were treated with the same polymer membrane and bicarbonate-based buffer . |
METHODS 360 patients were randomised , and the primary endpoint was 60-day survival based on an intention-to-treat analysis . |
RESULTS Rate of survival at 60-days did not differ between the groups ( 32 % in the intermittent haemodialysis group versus 33 % in the continuous renal replacement therapy group [ 95 % CI -8.8 to 11.1 , ] ) , or at any other time . |
CONCLUSIONS These data suggest that , provided strict guidelines to improve tolerance and metabolic control are used , almost all patients with acute renal failure as part of multiple-organ dysfunction syndrome can be treated with intermittent haemodialysis . |
###20450359 |