Microbiota composition was determined by @S rRNA gene sequencing of sputum samples from participants in the BLESS trial , a @-month , double-blind , placebo-controlled trial of twice-daily erythromycin ethylsuccinate ( @ mg ) in adult patients with non-cystic fibrosis bronchiectasis and at least two infective exacerbations in the preceding year .


The primary outcome was within-patient change in respiratory microbiota composition ( assessed by Bray-Curtis index ) between baseline and week @ , comparing erythromycin with placebo .


The BLESS trial is registered with the Australian New Zealand Clinical Trials Registry , number ACTRN@ .


The BLESS trial took place between Oct @ , @ , and Dec @ , @ .


Paired sputum samples were available from @ randomly assigned patients , @ in the placebo group and @ in the erythromycin group .


The change in microbiota composition between baseline and week @ was significantly greater with erythromycin than with placebo ( median Bray-Curtis score @ -LSB- IQR @-@ -RSB- vs @ -LSB- @-@ -RSB- ; median difference @ , @ % CI @-@ ; p = @ ) .


In patients with baseline airway infection dominated by Pseudomonas aeruginosa , erythromycin did not change microbiota composition significantly .


In those with infection dominated by organisms other than P. aeruginosa , erythromycin caused a significant change in microbiota composition ( p = @ -LSB- by analysis of similarity -RSB- ) , representing a reduced relative abundance of Haemophilus influenzae ( @ % -LSB- @-@ -RSB- vs @ % -LSB- @-@ -RSB- ; median difference @ % , @ % CI @-@ ; p = @ ; interaction p = @ ) and an increased relative abundance of P aeruginosa ( @ % -LSB- @-@ -RSB- vs @ % -LSB- @-@ -RSB- ; median difference @ % , @ % CI @-@ ; p = @ ; interaction p = @ ) .


Compared with placebo , erythromycin reduced the rate of pulmonary exacerbations over the @ weeks of the study in patients with P. aeruginosa-dominated infection ( median @ -LSB- IQR @-@ -RSB- vs @ -LSB- @-@ -RSB- ; median difference -@ , @ % CI -@ to -@ ; p = @ ) , but not in those without P. aeruginosa-dominated infection ( @ -LSB- @-@ -RSB- vs @ -LSB- @-@ -RSB- ; median difference @ , -@ to @ ; p = @ ; interaction p = @ ) .


Long-term erythromycin treatment changes the composition of respiratory microbiota in patients with bronchiectasis .


In patients without P. aeruginosa airway infection , erythromycin did not significantly reduce exacerbations and promoted displacement of H. influenzae by more macrolide-tolerant pathogens including P. aeruginosa .


These findings argue for a cautious approach to chronic macrolide use in patients without P. aeruginosa airway infection .


To evaluate whether a combination of misoprostol and oxytocin more effectively reduces blood loss during and after cesarean delivery than does oxytocin alone among women with known risk factors for postpartum hemorrhage ( PPH ) .


A prospective , randomized , double-blind , placebo-controlled trial was performed at a tertiary care center in Kolkata , India , between October @ and December @ .


Women were eligible if they were undergoing emergency cesarean under spinal anesthesia and were at high risk for PPH .


Participants were randomly assigned ( @:@ ) to receive @ g misoprostol or matched placebo sublingually after delivery of the newborn using a computer-generated random number sequence ( block size eight ) .


Participants and providers were masked to assignment .


All participants received @ IU oxytocin .


The primary outcomes were intraoperative and postoperative blood loss .


Both groups contained @ women .


Mean intraoperative blood loss was significantly lower in the misoprostol group ( @ mL ) than in the placebo group ( @ mL ; P < @ ) .


Mean postoperative blood loss was slightly lower in the misoprostol group ( @ mL ) than in the placebo group ( @ mL ; P = @ ) .


Shivering and pyrexia were more frequently associated with misoprostol ( P < @ for both ) .


Misoprostol as an adjunct to oxytocin seemed to more effectively reduce blood loss than did oxytocin alone .


Clinical Trial Registry India : CTRI/@/@ / @ .


This study aimed to assess cost-effectiveness of N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) - guided versus symptom-guided therapy in heart failure ( HF ) patients@ years old .


Cost-effectiveness of NT-proBNP guidance in HF patients is unclear .


It may create additional costs with uncertain benefits .


In the TIME-CHF ( Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure ) , patients with left ventricular ejection fraction ( LVEF ) of@ % were randomized to receive intensified NT-proBNP-guided therapy or standard , symptom-guided therapy .


For cost-effectiveness analysis , @ ( @ % ) patients ( age @ @ years , @ % male ) were eligible .


Incremental cost-effectiveness was calculated as incremental costs per gained life-year and quality-adjusted life-year ( QALY ) within the @-month trial period , as defined per protocol .


NT-proBNP-guided therapy was dominant ( i.e. , more effective and less costly ) over symptom-guided therapy , saving $ @,@ USD ( @ to @ % confidence interval -LSB- CI -RSB- : $ @,@ to $ @,@ ) per patient , with incremental effectiveness of +@ life-years and +@ QALYs .


The probability of NT-proBNP-guided therapy being dominant was @ % , and the probability of saving @ life-year or QALY at a cost of $ @,@ was @ % and @ % , respectively .


Exclusion of residence costs resulted in an incremental cost-effectiveness ratio ( ICER ) of $ @,@ per life-year gained .


Cost-effectiveness of NT-proBNP-guided therapy was most pronounced in patients < @ years old and in those with < @significant comorbidities , being dominant in all sensitivity analyses .


In the worst-case scenario ( excluding residence costs in those with@ comorbidities ) , the ICER was $ @,@ per life-year gained .


NT-proBNP-guided therapy has a high probability of being cost effective in HF patients with reduced LVEF , particularly in patients age @ to @ years or with less than @ comorbidities .


( Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure -LSB- TIME-CHF -RSB- ; ISRCTN@ ) .


Functional magnetic resonance imaging ( fMRI ) studies involving alcohol challenge are important for identifying neural correlates of alcohol 's psychopharmacological effects .


However , evaluating acute alcohol effects on blood oxygen level-dependent ( BOLD ) signal change is complicated by alcohol-related increases in cerebral blood flow ( CBF ) .


The present study aimed to further characterize acute alcohol effects on CBF using intravenous alcohol administration to maximize control over brain alcohol exposure .


Twenty heavy-drinking young adults ( M = @ years old , SD = @ ) completed alcohol and placebo imaging sessions in a within-subject , counter-balanced , placebo-controlled design .


Arterial spin labeling ( ASL ) provided estimates of perfusion change at two target blood alcohol concentrations ( @ and @ mg % ) relative to baseline and relative to a saline control infusion .


Voxel-wise analyses showed widespread and dose-dependent effects of alcohol on CBF increase .


Region-of-interest analyses confirmed these findings , also indicating regional variation in the magnitude of perfusion change .


Additional findings indicated that lower self-reported sensitivity to alcohol corresponded with reduced perfusion change during alcohol administration .


This study provides further evidence for widespread effects of acute alcohol on cerebral perfusion , also demonstrating regional , dose-dependent , and inter-individual variation .


Further research is needed to evaluate implications of these effects for the design and interpretation of pharmacological fMRI studies involving alcohol challenge .


Feasibility randomized controlled trial .


To assess the feasibility of a trial to investigate the effectiveness of a lumbopelvic monitor as a feedback device for modifying postural behavior during daily work-related activities .


Frequent or sustained flexed postures play a role in the development or maintenance of nonspecific low back pain .


The provision of postural feedback could help individuals with or at risk of nonspecific low back pain improve their postural awareness and avoid hazardous or pain-provoking postures .


Sixty-two participants employed in a health care organization were randomly allocated into @ of @ groups : a control group , an intermittent feedback group , and a constant feedback group .


Adherence and follow-up rates were assessed .


Differences in postural pattern between baseline and follow-up measurements were used to assess the effectiveness of the lumbopelvic monitor as a postural feedback device .


Adherence was approximately @ % .


With the exception of @ center , the follow-up overall rates exceeded the a priori desired threshold of @ % .


Within-group comparisons revealed no significant differences in postural pattern for the control group and intermittent feedback group .


The constant feedback group showed a significant reduction in flexed posture at the follow-up period compared with the baseline period .


Differences between groups did not reach statistical significance ; however , the constant feedback group , compared with the control group , demonstrated an effect size ( d ) of @ .


The provision of constant postural feedback seems promising for promoting changes in postural behavior .


This feasibility trial identified adherence and follow-up rates and sample-size estimates important to the conduct of a fully powered efficacy trial .


Level of Evidence Therapy , level @b - .


To evaluate basal and prandial insulin initiation and titration in people with type @ diabetes mellitus ( T@DM ) in primary care and to explore the feasibility of retrospective-continuous glucose monitoring ( r-CGM ) in guiding insulin dosing .


The new model of care features General Practitioners ( GPs ) and Practice Nurses ( PNs ) working in an expanded role , with Credentialed Diabetes Educator - Registered Nurse ( CDE-RN ) support .


Insulin-nave T@DM patients ( HbA@c > @ % -LSB- > @ mmol/mol -RSB- despite maximal oral therapy ) from @ general practices in Victoria , Australia commenced insulin glargine , with glulisine added as required .


Each was randomised to receive r-CGM or self-monitoring of blood glucose ( SMBG ) .


Glycaemic control ( HbA@c ) was benchmarked against specialist ambulatory patients referred for insulin initiation .


Ninety-two patients mean age ( range ) @ ( @-@ ) years ; @ % female ; mean ( SD ) diabetes duration @ ( @ ) years participated .


HbA@c decreased from ( median ( IQR ) ) @ ( @ , @ ) % ; @ ( @ , @ ) mmol/mol to @ ( @ , @ ) % ; @ ( @ , @ ) mmol/mol at @ weeks ( p < @ ) .


Comparing r-CGM ( n = @ ) with SMBG ( n = @ ) , there were no differences in major hypoglycaemia ( p = @ ) or HbA@c ( p = @ ) .


More r-CGM than SMBG participants commenced glulisine ( @/@ vs. @/@ ; p < @ ) .


Results were comparable to @ benchmark patients , with similar low rates of major hypoglycaemia ( @/@ vs. @/@ ; p = @ ) and less loss to follow up in the INITIATION group ( @/@ vs. @/@ ; p = @ ) .


Insulin initiation and titration for T@DM patients in primary care was safe and improved HbA@c with low rates of major hypoglycaemia .


CDE-RNs were effective in a new consultant role .


r-CGM use in primary care was feasible and enhanced post-prandial hyperglycaemia recognition .


Trial registration ACTRN@ .


Platelet-rich plasma ( PRP ) is an autologous preparation of platelets in concentrated plasma that may be beneficial in the treatment of atrophic acne scars by promoting collagen deposition .


Skin needling is a technique that uses a sterile dermaroller to puncture the skin and release growth factors .


The combination of skin needling and PRP could enhance the efficacy of both modalities .


Chemical reconstruction of skin scars technique consists of focal application of high concentration of trichloroacetic acid ( TCA ) on the acne scars to stimulate collagen production .


To evaluate the efficacy and safety of intradermal injection of PRP , @ % focal TCA , and combined skin needling plus topical PRP in the treatment of atrophic acne scars .


Forty-five patients with atrophic acne scars were randomly assigned to @ equal groups ; Group A received intradermal injection of PRP , Group B received chemical reconstruction of skin scars technique with TCA @ % , and Group C was treated by combined skin needling and PRP .


Each patient underwent @ sessions at @-week interval .


All the patients completed the study .


The @ groups showed statistically highly significant improvement in the degree of acne scars after treatment ( p < @ ) .


No major adverse effects were observed in the studied groups .


This is the first study to use intradermal injection of PRP alone for the treatment of atrophic acne scars .


The @ modalities showed a promising efficacy and safety in the treatment of atrophic acne scars .


While the addition of targeted therapy to neoadjuvant chemotherapy ( NACT ) dramatically increases the rate of pathological complete response in HER@-positive breast cancer , no reduction in the rate of mastectomy has been observed in randomised studies .


A retrospective single centre analysis of all patients treated with anti HER@-based NACT for T@-@ breast cancer , focusing on patients treated with mastectomy .


Among @ patients treated between June @ and July @ , surgery was performed immediately post-NACT in @ cases ( @ % ) .


Breast-conserving surgery could be performed for @ of the patients ( @ % ) , with a @-year local relapse-free survival of @ % .


A mastectomy was performed in two cases following patients ' wishes and in @ cases based on pre-NACT findings ( n = @ ) or post-NACT outcomes ( n = @ ) .


For @ out of the @ cases , a good pathological response was observed , and multidisciplinary reanalysis suggests that breast-conserving surgery outright may have been sufficient for @ patients .


Finally , a salvage mastectomy based on post-lumpectomy pathological results was decided in five cases ( @ % ) .


The @-year metastasis-free survival was @ % for all patients operated on after NACT ( n = @ ) .


Given the good efficacy of anti HER@-based NACT , breast-conserving surgery should be standard practice for most patients .


Total mastectomy on the other hand should be restricted to a few patients , mainly those with positive margins on the lumpectomy specimen .


To investigate the @-year efficacy and safety of photorefractive keratectomy ( PRK ) .


Long-term observational case series .


In the setting of a university hospital , a study population of @ patients ( @ eyes ) who had , as part of a randomized prospective trial , undergone PRK @ years previously were studied .


All had received -@ or -@ diopter ( D ) corrections with either @ or @ mm optical zones or a multizone treatment .


The mean preoperative spherical equivalent refractive error ( SEQ ) was -@ D ( range , -@ to -@ D ) .


The outcome measures included visual acuity , refractive error , corneal topography and axial length .


Between @ and @ years there was an increase in mean myopic SEQ of -@ D ( P < @ ) .


In patients younger than @ years of age at time of correction , this increase was -@ D ( P < @ ) with an accompanying increase in variance ( P < @ ) , whereas in those older than @ it was -@ D ( P = @ ) .


In female patients the change was -@ D ( P < @ ) , while in males it was -@ D ( P = @ ) .


The efficacy index at @ years was @ , and the safety index was @ .


Corrected distance visual acuity improved between @ and @ years ( P < @ ) ; @ % of corneas were clear at @ years ; @ eyes had trace haze .


There was an improvement in haze scores between @ and @ years ( P < @ ) .


Cornea power remained unchanged between @ months and @ years ( P = @ ) .


Axial length increased by a mean of @ mm ( P < @ ) .


There was no ectasia .


There was a slight but significant increase in myopic SEQ after PRK between @ and @ years , particularly in those under @ at the time of treatment and in female patients .


Corneal power remained unchanged , but axial length increased .


The procedure was safe , with no long-term sight-threatening complications and with improvements in corrected distance visual acuity and corneal transparency with time .


We investigated data in @ patients from the EXPLOR trial to determine the influence of heart rate ( HR ) and blood pressure ( BP ) on aortic stiffness in response to beta-blockade or angiotensin @ type @ receptor antagonism , administered during @ weeks .


Carotid-femoral pulse wave velocity ( PWV ) was measured with aplanation tonometry ( Sphygmocor ) after @ ( W@ ) and @ weeks ( W@ ) of treatment by the single-pill combination valsartan-amlodipine ( @/@ mg , then @/@ mg ) or an atenolol-amlodipine combination ( @/@ mg , then @/@ mg ) in a prospective , randomized , parallel-groups multicenter trial with PROBE design .


Drugs were up-titrated at W@ .


We analyzed the changes in PWV in relation with the changes in BP and HR , and major covariates , using mixed models in each treatment arm .


The unadjusted reductions in mean BP and PWV were not significantly different between groups .


HR was significantly reduced in the atenolol group , but not in the valsartan group .


After adjustment on BP and HR , PWV significantly decreased with valsartan -LSB- -@ m/s ( -@ to -@ ) at W@ and -@ ( -@ to -@ ) m/s at W@ -RSB- , whereas no significant change was observed after atenolol -LSB- -@ m/s ( -@ to @ ) at W@ and -@ ( -@ to @ ) m/s at W@ -RSB- .


These findings suggest that the reduction in PWV observed after atenolol could be explained by changes in BP and HR , whereas in patients treated by valsartan , about half of the decrease in aortic stiffness was BP-independent .


To evaluate the efficacy of daily low-dose sildenafil for the treatment of nonulcer interstitial cystitis ( IC ) in women .


Forty-eight women with a clinical diagnosis of IC from @ medical centers were randomly assigned to treatment with daily low-dose sildenafil ( @ mg , n = @ ) or placebo ( n = @ ) for @ months .


The O'Leary-Sant IC symptom and problem indices , visual analog scale scores , and a micturition diary with the interval of micturition , the frequency of nocturia , and urgency episodes were recorded before treatment , every @ weeks after the treatment until @ months .


Patient Overall Rating of Improvement in Symptoms was assessed and regarded as effective when the value was above @ % .


The IC symptom and problem indices scores and urodynamic index were significantly improved in sildenafil treatment group as compared with placebo group and baselines at week @ , @ , @ , @ , and @ , as well as @ months after treatment ( P < @ ) .


Urodynamic index including first desire to void , strong desire to void , and maximum cystometric capacity was significantly improved in sildenafil treatment group at week @ and at @ months after treatment ( P < @ ) .


The efficiency of treatment reached @ % .


However , no significant change of the visual analog scale values was observed between @ groups except at week @ in the sildenafil treatment group ( P < @ ) .


All adverse events were mild to moderate and transient .


Daily low-dose sildenafil is an easy , well-tolerated , and effective treatment for IC in women .


Girls in the child welfare system are at high risk of revictimization in adolescence .


The present study compared two interventions designed to decrease revictimization in a diverse sample of adolescent child welfare-involved girls .


The social learning/feminist ( SL/F ) intervention focused on concepts derived from social learning and feminist models of risk , such as sexism and beliefs about relationships .


The risk detection/executive function ( RD/EF ) intervention focused on development of specific executive function abilities related to detecting and responding to risky situations/people .


Participants were randomized to RD/EF ( n = @ ) or SL/F intervention ( n = @ ) .


A group of youth ( n = @ ) engaged in the research assessments only .


Participants ( n = @ ) were assessed before intervention , immediately after intervention , @ months after intervention , and @ months after intervention .


We examined revictimization ( the presence/absence of sexual or physical assault in any relationship ) over time .


Adolescent girls in the RD/EF condition were nearly five times less likely to report sexual revictimization compared with girls in the no-treatment group .


A trend suggested that girls who participated in the SL/F intervention were @ times less likely to report sexual revictimization relative to the no-treatment group .


For physical revictimization , the odds of not being physically revictimized were three times greater in the SL/F condition and two times greater in the RD/EF condition compared with the no-treatment group .


The active interventions did not differ significantly from one another in rates of revictimization , suggesting that practitioners have at least two viable options to engage high-risk youth in revictimization prevention .


To investigate whether magnesium oxide reduces the interfraction motion of the prostate and the amount of rectal filling and rectal gas , which influences prostate position during radiotherapy for prostate cancer .


From December @ to February @ , @ prostate cancer patients scheduled for intensity-modulated radiotherapy ( @ Gy in @ fractions ) using fiducial marker-based position verification were randomly assigned to receive magnesium oxide ( @ mg twice a day ) or placebo during radiotherapy .


In a previous study , we investigated the effect on intrafraction motion and did not find a difference between the treatment arms .


Here , we compared the interfraction prostate motion between the two treatment arms as well as the amount of rectal filling and rectal air pockets using pretreatment planning computed tomography and magnetic resonance imagingscans .


There was no statistically significant difference between the treatment arms in translation and rotation of the prostate between treatment fractions , except for the rotation around the cranial caudal axis .


However , the difference was less than @ and therefore considered not clinically relevant .


There was no significant difference in the amount of rectal filling and rectal air pockets between the treatment arms .


Magnesium oxide is not effective in reducing the interfraction prostate motion or the amount of rectal filling and rectal gas during external-beam radiotherapy .


Therefore , magnesium oxide is not recommended in clinical practice for these purposes .


The primary aim of rheumatoid arthritis ( RA ) treatment is to induce remission , the absence of disease activity .


The objective of this study was to explore the association between clinical endpoints used to gauge RA treatment efficacy and patient-reported outcomes of health-related quality of life , fatigue , and physical function in RA patients treated with secukinumab in a phase @ randomized controlled trial ( RCT ) .


Adult RA patients ( n = @ ) with incomplete responses to methotrexate were randomized equally to receive monthly s.c. injections of secukinumab @mg , @mg , @mg , @mg or placebo .


Clinical endpoints used in this study included the ACR response criteria and its components and simplified disease activity score .


Patient-reported outcomes ( PRO ) included Health Assessment Questionnaire-Disability Index ( HAQ-DI ) , Medical Outcomes Study Short Form-@ -LSB- SF-@ -RSB- Survey , and Functional Assessment of Chronic Illness Therapy-Fatigue ( FACIT-Fatigue ) .


Patients were categorized into mutually exclusive groups according to the magnitude and direction of change from baseline to week @ in each clinical endpoint .


Definitions of minimal important differences -LSB- MID -RSB- in each clinical endpoint were used to categorize patients , as well as thresholds beyond MID .


Mean changes from baseline to week @ were computed for each PRO and analyses of variance to test the differences in PRO changes observed across groups of patients that differed in each clinical endpoint .


Analyses were limited to patients randomized to secukinumab treatment .


All dose groups were combined ( n = @ ) .


Mean changes from baseline in each PRO differed significantly across groups of patients in the expected direction .


With few exceptions , there was considerable agreement between clinical endpoints and PROs concerning the magnitude of change defined as clinically meaningful .


More importantly , results demonstrated that greater improvements in clinical endpoints were associated with incrementally better improvements in HRQoL , fatigue , and physical function .


Results of this study show considerable agreement between minimal thresholds of improvement established for PROs and clinical outcome measures used in RA treatment studies and provide thresholds to be considered in gauging the importance of a treatment effect that goes beyond what is considered as minimally important for PRO measures .


Computed tomography is widely used to diagnose acute appendicitis .


Many adolescents and young adults are exposed to the associated radiation .


A recent single-institution trial has reported promising results for low-dose computed tomography ; however , this technique has not yet been widely adopted .


LOCAT ( low-dose computed tomography for appendicitis trial ) , a multi-institution randomized controlled non-inferiority trial , aims to compare low-dose computed tomography and standard-dose computed tomography as the first-line imaging tests for adolescents and young adults , and therefore to test the generalizability of the previous single-institution trial results .


Participants with suspected appendicitis are randomly assigned to either the low-dose group ( with a typical effective dose of @mSv ) or the standard-dose group ( as used in normal practice at each participating site , typically @mSv ) .


The primary end point is the negative appendectomy rate ( the percentage of the number of uninflamed appendices that were removed among all non-incidental appendectomies ) , which is a consequence of false-positive diagnoses , with a non-inferiority margin of @ percentage points .


The key secondary end point is the appendiceal perforation rate , which is a consequence of delayed ( or false-negative ) diagnoses .


Participant recruitment will be continued until the number of non-incidental appendectomies for each group exceeds @ .


The total number of expected participants approximates @,@ , including those not undergoing appendectomy .


In addition to the study protocol , we elaborate on several challenging or potentially debatable components of the study design , including the broad eligibility criteria , choice of the primary end point , potential effect of using advanced imaging techniques on study results , determining and adjusting the radiation doses , ambiguities in reference standards , rationale for the non-inferiority margin , use of the intention-to-treat approach and difficulties in defining adverse events .


Vitamin D insufficiency has been associated with impaired pancreatic beta-cell function .


We aimed to determine if high dose oral vitamin D@ ( D ) improves beta-cell function and glycaemia in type @ diabetes .


Fifty adults with type @ diabetes diagnosed less than @ months , with normal baseline serum @-OH D ( @D ) , were randomised to @ IU D ( n = @ ) or placebo ( n = @ ) daily for @ months .


Beta-cell function was measured by glucagon-stimulated serum C-peptide ( delta C-peptide -LSB- DCP -RSB- , nmol/l ) .


Secondary outcome measures were fasting plasma glucose ( FPG ) , post-prandial blood glucose ( PPG ) , HbA@c and insulin resistance ( HOMA-IR ) .


In the D group , median serum @D ( nmol/l ) increased from @ to @ ( @ months ) and @ ( @ months ) and median serum @,@ D ( pmol/l ) from @ to @ and @ .


After @ months , change in DCP from baseline in D ( +@ ) and placebo ( -@ ) was not different ( P = @ ) .


However , change in FPG ( mmol/l ) was significantly lower in D ( -@ ) compared to placebo ( +@ ) ( P = @ ) , as was the change in PPG in D ( -@ ) compared to placebo ( +@ ) ( P = @ ) .


Change in HbA@c ( % ) between D ( -@ ) and placebo ( -@ ) was not different ( P = @ ) .


At @ months , changes from baseline in DCP , FPG , PPG and HbA@c were not different between groups .


Oral D@ supplementation in type @ diabetes was associated with transient improvement in glycaemia , but without a measurable change in beta-cell function this effect is unlikely to be biologically significant .


High dose D@ therefore appears to offer little or no therapeutic benefit in type @ diabetes .


This study sought to evaluate the short - and long-term outcomes for smokers with non-ST-segment elevation acute coronary syndromes ( NSTE-ACS ) .


Smoking has been associated with the `` paradox '' of reduced mortality after acute myocardial infarction ( MI ) .


This is thought to be due to favorable baseline characteristics and less diffuse coronary artery disease ( CAD ) among smokers .


In the ACUITY ( Acute Catheterization and Urgent Intervention Triage Strategy ) trial , @,@ patients ( @ % smokers ) with moderate - to high-risk NSTE-ACS underwent angiography and , if indicated , revascularization .


Smokers were significantly younger and had fewer comorbidities than nonsmokers .


Incidence of death and MI were comparable at @ days , although smokers had significantly reduced risks of @-day major bleeding ( hazard ratio -LSB- HR -RSB- : @ , @ % confidence interval -LSB- CI -RSB- : @ to @ ; p = @ ) and @-year mortality ( HR : @ , @ % CI : @ to @ ; p = @ ) .


After correction for baseline and clinical differences , smoking was no longer predictive of major bleeding ( odds ratio : @ , @ % CI : @ to @ ; p = @ ) and was associated with higher @-year mortality ( HR : @ , @ % CI : @ to @ ; p = @ ) .


This pattern of reversed risk after multivariable correction held true for those smokers requiring percutaneous coronary intervention .


Core laboratory angiographic analysis showed that smokers and nonsmokers were comparable in terms of the extent of CAD , Thrombolysis In Myocardial Infarction flow , myocardial blush , and the presence of thrombi .


In contrast to the paradox previously described in ST-segment elevation MI , our analysis finds smoking to be an independent predictor of higher @-year mortality in patients presenting with NSTE-ACS , and our angiographic study demonstrates CAD in smokers that is comparable to that in nonsmokers but evident @ decade earlier .


( Acute Catheterization and Urgent Intervention Triage Strategy -LSB- ACUITY -RSB- ; NCT@ ) .


Despite empirical evidence demonstrating the effectiveness of collaborative stepped care program ( SCP ) in Western countries , such programs have not been evaluated in the east , which has a different services system structure and cultural nuances in seeking help for mental illness .


Furthermore , only a few studies have used SCP for depression and anxiety prevention .


We conducted a trial to test its effectiveness in preventing major depressive disorder and generalized anxiety disorder among primary care patients with subthreshold depression and/or anxiety in Hong Kong .


Subthreshold depression and/or anxiety patients were randomized into the SCP group ( n = @ ) or care as usual ( CAU ) group ( n = @ ) .


The SCP included watchful waiting , telephone counseling , problem solving therapy , and family doctor treatment within one year .


The primary outcome was the onset of major depressive disorder or generalized anxiety disorder in @ months .


The secondary outcomes were depressive and anxiety symptoms , quality of life and time absent from work due to any illness .


Survival analysis showed no differences between the SCP and CAU groups ( the cumulative probability of onset at @ month was @ % in the SCP group and @ % in the CAU group ; Hazard Ratio = @ ; @ % Confidence Interval : @-@ @ ; p = @ ) .


No significant differences were found in secondary outcomes .


Sample size might not have been large enough .


SCP did not show beneficial effect on depression/anxiety prevention compared with CAU in Hong Kong primary care .


As a large majority of patients improved overtime without any intervention , we are not able to exclude the possibility that the intervention might be effective .


Future studies would need to have a larger sample size and conduct on patients with more severe symptoms or perform a second screening .


Compare the impact of two interventions , a web-based support and a folder support , for young persons who care for people who suffer from mental illness .


This study was a randomized control trial , following the CONSORT statements , which compared the impact of two interventions .


Primary outcome variable was stress , and secondary outcome variables were caring situation , general self-efficacy , well-being , health , and quality of life of young informal carers ( N = @ ) .


Data were collected in June @ to April @ , with self-assessment questionnaires , comparing the two interventions and also to detect changes .


The stress levels were high in both groups at baseline , but decreased in the folder group .


The folder group had improvement in their caring situation ( also different from the web group ) , general self-efficacy , well-being , and quality of life .


The web group showed increase in well-being .


Young informal carers who take on the responsibility for people close to them ; suffer consequences on their own health .


They live in a life-situation characterized by high stress and low well-being .


This signals a need for support .


The non-significant differences show that each intervention can be effective , and that it depends upon the individual 's preferences .


This highlights the importance of adopting person-centered approach , in which young persons can themselves choose support strategy .


Hydroxyethyl starch ( HES ) is commonly used as plasma expander during surgery but may be nephrotoxic as seen in studies in patients with sepsis .


The authors hypothesized that the possible nephrotoxicity of @ % HES @/@ @ could be revealed by measurements of urinary excretion of neutrophil gelatinase-associated lipocalin ( u-NGAL ) in patients with normal renal function during hip arthroplasty .


In this randomized , double-blinded , placebo-controlled study , @ patients referred for hip arthroplasty received either @ % HES @/@ @ or isotonic saline @ % ; @ ml/kg during the first hour of surgery and @ ml/kg during the following hours ; @ patients completed the study .


U-NGAL , urine albumin , blood pressure , and plasma concentrations of creatinine , renin , NGAL , albumin , angiotensin-II , and aldosterone were measured before , during , and after surgery .


U-NGAL was defined as primary outcome .


There were no significant differences in U-NGAL ( mean difference and @ % CI ) , plasma creatinine , and urine albumin during the study .


U-NGAL and urine albumin increased significantly in both groups the morning after surgery but was normalized at follow-up after @ to @ days .


Mean arterial pressure was significantly higher during the recovery period in the HES group compared with that in the control group ( @ -LSB- @ -RSB- and @ -LSB- @ -RSB- mmHg , mean -LSB- SD -RSB- , P < @ ) .


Plasma renin and angiotensin-II were nonsignificantly different in both groups , whereas plasma aldosterone was significantly lower in the HES group .


Plasma albumin was reduced in both groups , but to a significantly lower level in the HES group .


The study showed no evidence of a harmful effect of intraoperative infusion of @ % HES @/@ @ on renal function in patients during hip arthroplasty .


We performed a multicentre randomised controlled trial to evaluate the effect on participation in organised screening programmes of a self-sampling device mailed home or picked up at a pharmacy compared with the standard recall letter .


Women aged @-@ non-responding to screening invitation were eligible .


Response rate to first invitation ranged from @ % to @ % between centres .


The control was the standard reminder letter to undergo the test used by the programme ( Pap test in three centres and HPV DNA test in three other centres ) .


Home mailing of the self-sampler was preceded by a letter with a leaflet about HPV .


The analysis was intention-to-treat .


In all , @ women were randomised and recruited : @ in the control arm , @ to receive the self-sampler at home , and @ to pick up the self-sampler at a pharmacy .


Participation was @ % in the control , @ % ( relative participation : @ ; @ % CI @-@ @ ) in home , and @ % ( relative participation : @ ; @ % CI @-@ @ ) in the pharmacy arms , respectively .


The heterogeneity between centres was high ( excess heterogeneity of that expected due to chance , i.e. , I ( @ ) , @ % and @ % for home and pharmacy arm , respectively ) .


The estimated impact on the overall coverage was +@ % for home mail self-sampling compared with +@ % for standard reminder .


Home mailing of self-sampler proved to be an effective way to increase participation in screening programmes , even in those with HPV as primary testing .


Picking up at pharmacies showed effects varying from centre to centre .


Excessive menstrual bleeding , the most common complication caused by intrauterine devices ( IUDs ) , often leads to discontinuation of use .


Our study investigates the effect of vitamin B@ on menstrual bleeding and spotting after insertion of the TCu@A IUD .


This double-blind , randomised controlled trial involved @ Iranian women .


We recruited women who noted that their menstrual flow ( duration , amount , and number of sanitary pads needed ) or intermenstrual spotting had increased one month after the insertion of a TCu@A , and randomly assigned them to two groups .


The intervention group and the control group received @ mg of vitamin B@ or a placebo , respectively , daily , for three months .


We followed all participants for four months .


The Higham scale was used for estimating the volume of menstrual bleeding .


The Mann-Whitney test , paired t-test , independent t-test and Repeated Measure test were used for statistical purposes .


In the intervention group the duration of menstrual bleeding , the number of sanitary pads and the amount of spotting decreased significantly compared to the control group ( p < @ ) .


Vitamin B@ is a safe , natural and cost-effective supplement that is devoid of side effects and reduces menstrual bleeding and spotting caused by a copper bearing-IUD .


The RITUXVAS trial reported similar remission induction rates and safety between rituximab and cyclophosphamide based regimens for antineutrophil cytoplasm antibody ( ANCA ) - associated vasculitis at @months ; however , immunosuppression maintenance requirements and longer-term outcomes after rituximab in ANCA-associated renal vasculitis are unknown .


Forty-four patients with newly diagnosed ANCA-associated vasculitis and renal involvement were randomised , @:@ , to glucocorticoids plus either rituximab ( @mg/m ( @ ) / week@ ) with two intravenous cyclophosphamide pulses ( n = @ , rituximab group ) , or intravenous cyclophosphamide for @-@months followed by azathioprine ( n = @ , control group ) .


The primary end point at @months was a composite of death , end-stage renal disease and relapse , which occurred in @/@ in the rituximab group ( @ % ) and @/@ in the control group ( @ % ) ( p = @ ) .


After remission induction treatment all patients in the rituximab group achieved complete B cell depletion and during subsequent follow-up , @/@ ( @ % ) had B cell return .


Relapses occurred in seven in the rituximab group ( @ % ) and two in the control group ( @ % ) ( p = @ ) .


All relapses in the rituximab group occurred after B cell return .


At @months , rates of the composite outcome of death , end-stage renal disease and relapse did not differ between groups .


In the rituximab group , B cell return was associated with relapse .


Physical activity is a common stimulus of asthmatic symptoms manifestation .


Airway hyperreactivity is a predisposing cause of exercise induced bronchial obstruction , diagnosed by histamine inhalation .


The aim of this study was to determine the relation between the amounts of histamine needed to induce non-specific airway hyperreactivity and exercise-induced bronchial obstruction .


This randomized cross-over study included @ male patients ( age @-@ years ) suffering from bronchial asthma who showed positive results as the reaction after the histamine bronchial provocation test .


Histamine concentrations were in a range of @ to @ mg/mL .


Each patient participated in the exercise stress test conducted on a conveyor belt .


The results of the exercise stress test were considered positive if the FEV@ level dropped by at least @ % from its initial value , @-@ minutes after the test .


All the patients showed positive results as the reaction after the histamine bronchial provocation test , while @ of them showed positive results after the exercise-induced stress test .


There was a statistically highly significant difference in administrated histamine concentrations between the group of patients that had positive results on exercise stress test and those who did not ( @ mg/mL vs @ mg/mL ; U = @ ; p < @ ) .


Also , there was a statistically significant difference concerning the frequency of the positive results regarding histamine concentration after induced stress test ( chi@ = @ ; p = @ ) .


Among the patients with positive results , there was a statistically highly significant number of patients with bronchial obstruction induced by less than @ mg/mL of histamine ( p < @ ) .


A statistically significant relation between the amount of histamine needed to induce bronchial obstruction and the results of the exercise stress test ( p < @ ) was also observed after the testing .


In the group of patients with positive results after the exercise-induced stress test , there were significantly more patients with positive results to non-specific bronchial provocation test with lower histamine concentrations .


Histamine concentrations needed to induce non-specific hyperreactivity of asthmatic airway were shown to be related to the reactivity to physical effort .


The question of whether the placement of the dominant hand against the sternum could improve the quality of manual chest compressions remains controversial .


In the present study , we evaluated the influence of dominant vs nondominant hand positioning on the quality of conventional cardiopulmonary resuscitation ( CPR ) during prolonged basic life support ( BLS ) by rescuers who performed optimal and suboptimal compressions .


Six months after completing a standard BLS training course , @ medical students were instructed to perform adult single-rescuer BLS for @ minutes on a manikin with a randomized hand position .


Twenty-four hours later , the students placed the opposite hand in contact with the sternum while performing CPR .


Those with an average compression depth of less than @ mm were considered suboptimal .


Participants who had performed suboptimal compressions were significantly shorter ( @ @ vs @ @ cm , P = @ ) and lighter ( @ @ vs @ @ kg , P < @ ) than those who performed optimal compressions .


No significant differences in CPR quality were observed between dominant and nondominant hand placements for these who had an average compression depth of greater than @ mm .


However , both the compression depth ( @ @ vs @ @ mm , P = @ ) and proportion of chest compressions with an appropriate depth ( @ % @ % vs @ % @ % , P = @ ) were remarkably higher when compressing the chest with the dominant hand against the sternum for those who performed suboptimal CPR .


Chest compression quality significantly improved when the dominant hand was placed against the sternum for those who performed suboptimal compressions during conventional CPR .


To investigate whether cabergoline ( Cb@ ) , a dopamine agonist , reduces ovarian hyperstimulation syndrome ( OHSS ) in high-risk women undergoing assisted reproductive technology ( ART ) , and to analyze whether cabergoline affects the outcome of ART .


Forty infertile women at risk of developing OHSS were enrolled in the trial .


The inclusion criteria were as follows : infertile women undergoing IVF with serum estradiol concentration > @,@ pg/mL or with > @ follicles > @ mm on the day of human chorionic gonadotropin ( hCG ) administration , and @-@ years of age .


They were randomized into @ groups : the Cb@ group ( n = @ ) received @ mg oral Cb@ per day for @ consecutive days beginning on the day of hCG , and the control group ( n = @ ) received no medication .


Ascites was significantly lower ( p = @ ) in the Cb@ group as compared with the control group .


The incidence of moderate OHSS was also significantly lower ( p = @ ) in the Cb@ as compared to the control group .


There was no evidence of statistically significant differences regarding the parameters of ART outcome .


Our data supports the use of Cb@ in the management of high-risk women undergoing ART and , consequently , achieving lowered risk of OHSS , with no deleterious impact on ART outcomes .


The use of peripherally inserted central venous catheters ( PICC lines ) has reduced the mortality and morbidity of premature newborns .


The usual sites of insertion are the veins in the upper arms but other locations are being used as well .


To examine whether using the axillary vein as a site of insertion of a PICC line affects the frequency of complications .


Our study has a clinical trial design .


A total of @ neonates that had a PICC line inserted were recruited and randomly divided equally in two groups : in Group A ( mean birth weight , standard deviation ( s.d. ) = @ ( @ ) g ) , the PICC line was inserted through the axillary vein , and in Group B ( birth weight = @ ( @ ) g ) , the PICC line was inserted in other sites further from the axillary vein .


The outcomes measured were the total PICC line-related complications , the reason for removing the catheter , the number of total attempts until successful insertion and the mean duration of stay of the catheter .


The likelihood of having an adverse outcome was assessed with Mantel-Haenszel odds ratio ( OR ) .


Premature neonates with axillary PICC lines were @ times less likely to have line-related complications ( inflammation , blockage , edema , infection ) as compared with any other site of insertion ( OR = @ % , confidence interval ( CI ) = @ ( @ to @ ) ) and they were seven times more likely to have the PICC line removed because they achieved full enteral nutrition as compared with the other causes ( OR @ % , confidence interval ( CI ) = @ ( @ to @ ) ) .


There was no statistical difference between the two groups in the number of attempts until successful PICC line insertion ( P = @ ) and the mean duration of stay of the PICC line ( P = @ ) .


The use of the axillary vein as a site of insertion of a PICC line was correlated with significantly less complications in premature newborns as opposed to the other sites of insertion .


Human equilibrative nucleoside transporter @ ( hENT@ ) levels in pancreatic adenocarcinoma may predict survival in patients who receive adjuvant gemcitabine after resection .


Microarrays from @ patients randomized to chemotherapy in the ESPAC-@ trial ( plus controls from ESPAC-@ / @ ) were stained with the @D@G@ anti-hENT@ antibody .


Patients were classified as having high hENT@ expression if the mean H score for their cores was above the overall median H score ( @ ) .


High and low hENT@-expressing groups were compared using Kaplan-Meier curves , log-rank tests , and Cox proportional hazards models .


All statistical tests were two-sided .


Three hundred eighty patients ( @ % ) and @ cores were suitable and included in the final analysis .


Median overall survival for gemcitabine-treated patients ( n = @ ) was @ ( @ % confidence interval -LSB- CI -RSB- = @ to @ ) months vs @ ( @ % CI = @ to @ ) months for @ patients treated with @-fluorouracil/folinic acid ( ( @ ) @ = @ ; P = @ ) .


Median survival for patients treated with gemcitabine was @ ( @ % CI = @ to @ ) months for those with low hENT@ expression vs @ ( @ % CI = @ to @ ) months for those with high hENT@ expression ( ( @ ) = @ ; P = @ ) .


For the @-fluorouracil group , median survival was @ ( @ % CI = @ to @ ) and @ ( @ % CI = @ to @ ) months for those with low and high hENT@ expression , respectively ( ( @ ) = @ ; P = @ ) .


hENT@ levels were not predictive of survival for the @ patients of the observation group ( ( @ ) = @ ; P = @ ) .


Multivariable analysis confirmed hENT@ expression as a predictive marker in gemcitabine-treated ( Wald ( @ ) = @ ; P = @ ) but not @-fluorouracil-treated ( Wald ( @ ) = @ ; P = @ ) patients .


Subject to prospective validation , gemcitabine should not be used for patients with low tumor hENT@ expression .


To evaluate the clinical efficacy of a series of Tongfeng Granule ( TG ) in treating gouty arthritis patients in different stages .


Ninety primary gout patients were randomly assigned to two groups , the TCM treatment group ( @ cases ) and the Western medicine control group ( @ cases ) .


Huzhang Tongfeng Granule in combination of external application of Jinhuang Ointment were given to those in the TCM treatment group in the acute phase , and Yinlian Tongfeng Granule in the remission phase .


Diclofenac Sodium Sustained Release Capsule in combination of external application of Jinhuang Ointment were given to those in the Western medicine control group in the acute phase , and Benzbromarone in the remission phase .


All were treated for three months .


The severity integral of symptoms , effective time , effective rate in the acute phase , the recurrence rate , blood uric acid ( BUA ) , urine uric acid ( UUA ) , serum creatinine ( SCr ) , blood urea nitrogen ( BUN ) , triglyceride ( TG ) , total cholesterol ( TC ) , fasting plasma glucose ( FPG ) , and the incidence of adverse reactions were observed in the two groups during the course of treatment .


The severity integral of symptoms was lowered in the two groups when compared with a former time point ( P < @ ) .


There was no statistical difference in markedly effective rate or the effective rate in the acute phase between the two groups ( P > @ ) .


There was statistical difference in the difference of BUA or UUA between before and after treatment in the two groups ( P < @ ) .


There was statistical difference in TG and SCr in the TCM group between after treatment and before treatment ( P < @ ) .


There was statistical difference in TG and SCr in the two groups between after treatment and before treatment ( P < @ ) .


The recurrence rate was @ % in the TCM treatment group ( @/@ ) , lower than that of the Western medicine control group ( @ % , @/@ , P < @ ) .


A series of Tongfeng Granule could promote the excretion of UUA , reduce the BUA level in the intermission phase , and play a favorable role in the prevention of relapse .


Huzhang Tongfeng Granule could significantly improve inflammatory symptoms and signs of gouty arthritis patients in the acute phase .


National Surgical Adjuvant Breast and Bowel Project ( NSABP ) R-@ was a randomized controlled trial of neoadjuvant chemoradiotherapy in patients with resectable stage II-III rectal cancer .


We hypothesized that patients who underwent abdominoperineal resection ( APR ) would have a poorer quality of life than those who underwent sphincter-sparing surgery ( SSS ) .


To obtain patient-reported outcomes ( PROs ) we administered two symptom scales at baseline and @ year postoperatively : the Functional Assessment of Cancer Therapy-Colorectal ( FACT-C ) and the European Organization for the Research and Treatment of Cancer module for patients with Colorectal Cancer Quality of Life Questionnaire ( EORTC QLQ-CR@ ) .


Scoring was stratified by nonrandomly assigned definitive surgery ( APR vs SSS ) .


Analyses controlled for baseline scores and stratification factors : age , sex , stage , intended surgery , and randomly assigned chemoradiotherapy .


Of @,@ randomly assigned patients , @ had data for planned analyses ; @ % underwent SSS ; @ % underwent APR. .


FACT-C total and subscale scores were not statistically different by surgery at @ year .


For the EORTC QLQ-CR@ functional scales , APR patients reported worse body image ( @ vs @ , P = @ ) at @ year than did SSS patients .


Males undergoing APR reported worse sexual enjoyment ( @ vs @ , P = @ ) at @ year than did those undergoing SSS .


For the EORTC QLQ-CR@ symptom scale scores , APR patients reported worse micturition symptoms than the SSS group at @ year ( @ vs @ , P = @ ) .


SSS patients reported worse gastrointestinal tract symptoms than did the APR patients ( @ vs @ , P < @ ) , as well as weight loss ( @ vs @ , P = @ ) .


Symptoms and functional problems were detected at @ year by EORTC QLQ-CR@ , reflecting different symptom profiles in patients who underwent APR than those who underwent SSS .


Information from these PROs may be useful in counseling patients anticipating surgery for rectal cancer .


Proximal humeral fractures are mainly associated with osteoporosis and are becoming more common with the aging of our society .


The best surgical approach for internal fixation of displaced proximal humeral fractures is still being debated .


In this prospective randomized study , we aimed to investigate whether the deltoid-split approach is superior to the deltopectoral approach with regard to ( @ ) complication rate ; ( @ ) shoulder function ( Constant score ) ; and ( @ ) pain ( visual analog scale -LSB- VAS -RSB- ) for internal fixation of displaced humeral fractures with a polyaxial locking plate .


We randomized @ patients with proximal humeral fractures to receive one of these two approaches ( @ patients for each approach ) .


We prospectively documented demographic and perioperative data ( sex , age , fracture type , hospital stay , operation time , and fluoroscopy time ) as well as complications .


Followup examinations were conducted at @ weeks , @ months , and @ months postoperatively , including radiological and clinical evaluations ( Constant score , activities of daily living , and pain -LSB- VAS -RSB- ) .


Baseline and perioperative data were comparable for both approaches .


The sample size was chosen to provide @ % power , but it reached only @ % as a result of the loss of followups to detect a @-point difference on the Constant score , which we considered the minimum clinically important difference .


Complications or reoperations between the approaches were not different .


Eight patients in the deltoid-split group ( @ % ) needed surgical revisions compared with seven patients in the deltopectoral group ( @ % ; p = @ ) .


Deltoid-split and deltopectoral approaches showed similar Constant scores @ months postoperatively ( Deltoid-split @ ; @ % confidence interval -LSB- CI -RSB- , @-@ versus deltopectoral @ ; @ % CI , @-@ ; p = @ ) , and there were no differences between the groups in terms of pain at @ year ( deltoid-split @ ; @ % CI , @-@ @ versus deltopectoral @ ; @ % CI , @-@ @ ; p = @ ) .


No learning-curve effects were noted ; fluoroscopy use during surgery and function and pain scores during followups were similar among the first @ patients and the next @ patients treated in each group .


The treatment of proximal humeral fractures with a polyaxial locking plate is reliable using both approaches .


For a definitive recommendation for one of these approaches , further studies with appropriate sample size are necessary .


Level II , therapeutic study .


See the Guidelines for Authors for a complete description of levels of evidence .


To assess whether chewing gum prevents postoperative ileus after laparotomy for benign gynecologic surgery .


A randomized study was conducted from December @ , @ , to February @ , @ .


Patients scheduled to undergo laparotomy were randomly assigned to receive chewing gum or routine care after surgery .


A chart review was performed to establish incidence of nausea and vomiting , use of antiemetics , cases of postoperative ileus ( @ episodes of emesis of @ mL or more , with abdominal distention and absence of bowel sounds ) , and time to discharge .


Inpatient surveys recorded the time to specific events .


A total of @ patients were randomly assigned to receive chewing gum ( n = @ ) or routine postoperative care ( n = @ ) .


Fewer participants assigned to receive chewing gum than routine care experienced postoperative nausea ( @ -LSB- @ % -RSB- versus @ -LSB- @ % -RSB- ; P = @ ) and postoperative ileus ( @ vs. @ -LSB- @ % -RSB- ; P = @ ) .


There were no differences in the need for postoperative antiemetics , episodes of postoperative vomiting , readmissions , repeat surgeries , time to first hunger , time to toleration of clear liquids , time to regular diet , time to first flatus , or time to discharge .


Chewing gum after laparotomy for gynecologic surgery is safe and lowers the incidence of postoperative ileus and nausea .


ClinicalTrials.gov : NCT@ .


Among patients without cardiovascular disease ( CVD ) and low @-year CVD risk , the risks of gastrointestinal bleeding and hemorrhagic strokes associated with aspirin use outweigh any potential atheroprotective benefit .


According to the guidelines on primary prevention of CVD , aspirin use is considered appropriate only in patients with @-year CVD risk @ % and inappropriate in patients with @-year CVD risk < @ % .


The goal of this study was to examine the frequency and practice-level variation in inappropriate aspirin use for primary prevention in a large U.S. nationwide registry .


Within the National Cardiovascular Disease Registry 's Practice Innovation and Clinical Excellence registry , we assessed @,@ unique patients receiving aspirin for primary prevention from @ U.S. practices .


The frequency of inappropriate aspirin use was determined for primary prevention ( aspirin use in those with @-year CVD risk < @ % ) .


Using hierarchical regression models , the extent of practice-level variation using the median rate ratio ( MRR ) was assessed .


Inappropriate aspirin use frequency was @ % ( @,@ of @,@ ) in the overall cohort .


There was significant practice-level variation in inappropriate use ( range @ % to @ % ; median @ % ; interquartile range @ % ) for practices ; adjusted MRR was @ ( @ % confidence interval -LSB- CI -RSB- : @ to @ ) .


Results remained consistent after excluding @,@ women age @ years ( inappropriate aspirin use @ % ; median practice-level inappropriate aspirin use @ % ; interquartile range @ % ; adjusted MRR @ -LSB- @ % CI : @ to @ -RSB- ) and after excluding patients with diabetes ( inappropriate aspirin use @ % ; median practice-level inappropriate aspirin use @ % ; interquartile range @ % ; adjusted MRR @ -LSB- @ % CI : @ to @ -RSB- ) .


More than @ in @ patients in this national registry were receiving inappropriate aspirin therapy for primary prevention , with significant practice-level variations .


Our findings suggest that there are important opportunities to improve evidence-based aspirin use for the primary prevention of CVD .


Combining bronchodilators with different mechanisms of action may improve efficacy and reduce risk of side effects compared to increasing the dose of a single agent in chronic obstructive pulmonary disease ( COPD ) .


We investigated this by combining two long-acting bronchodilators : once-daily muscarinic antagonist tiotropium and once-daily @-agonist olodaterol .


Two replicate , double-blind , randomized , @-week studies ( ANHELTO @ -LSB- NCT@ -RSB- and ANHELTO @ -LSB- NCT@ -RSB- ) evaluated the efficacy and safety of olodaterol @ g once daily ( via Respimat ( ) ) combined with tiotropium @ g once daily ( via HandiHaler ( ) ) versus tiotropium @ g once daily ( via HandiHaler ( ) ) combined with placebo ( via Respimat ( ) ) in patients with moderate to severe COPD .


Primary efficacy end points were area under the curve from @-@ hours of forced expiratory volume in @ second ( FEV@ AUC@-@ ) and trough FEV@ after @ weeks ( for the individual trials ) .


A key secondary end point was health status by St George 's Respiratory Questionnaire ( SGRQ ) total score ( combined data set ) .


Olodaterol + tiotropium resulted in significant improvements over tiotropium + placebo in FEV@ AUC@-@ ( treatment differences : @ L -LSB- P < @ -RSB- , ANHELTO @ ; @ L -LSB- P < @ -RSB- , ANHELTO @ ) and trough FEV@ ( treatment differences : @ L -LSB- P < @ -RSB- , ANHELTO @ ; @ L -LSB- P = @ -RSB- , ANHELTO @ ) ; these were supported by secondary end points .


These effects translated to improvements in SGRQ total scores ( treatment difference -@ ; P < @ ) .


The tolerability profile of olodaterol + tiotropium was similar to tiotropium monotherapy .


These studies demonstrated that olodaterol ( Respimat ( ) ) and tiotropium ( HandiHaler ( ) ) provided bronchodilatory effects above tiotropium alone in patients with COPD .


In general , both treatments were well tolerated .


To compare surgical outcomes of volar locking plates ( VP ) and external fixation ( EF ) ( with or without intra-focal fixation ) for AO-type C@ and C@ fractures of the distal radius .


From an initial group of @ patients with AO-type C@ and C@ distal radius fractures who were enrolled in a prospective , randomized study comparing volar plate fixation with external fixation ( with or without intra-focal fixation ) , @ patients were studied .


The researchers evaluated functional assessments ( wrist range of motion , grip strength , and Michigan Hand Questionnaire ) at each patient visit and measured radiographic assessment ( radial inclination , volar tilt , ulnar variance , and articular congruity ) at @ months .


The grip strength of the VP group was significantly greater than that of the EF group at @ and @ months .


The range of motion was significantly greater in the VP group than in the EF group at @ months .


There were no significant differences in the range of motion and grip strength between the @ groups at @ months .


The Michigan Hand Questionnaire score was higher in the VP group than in the EF group at @ months but was same at @ months .


There was no significant difference between groups with respect to volar tilt or radial inclination .


The VP group showed superior radiologic outcomes in terms of the ulnar variance .


One patient in the VP group and @ in the EF group had an intra-articular stepoff deformity greater than @ mm .


This difference did not reach statistical significance .


These results for functional recovery after distal radius surgery offer insight into treatment decisions and interpretations of treatment outcomes for patients with comminuted intra-articular distal radius fractures .


Currently , antiangiogenic strategies in metastatic breast cancer have demonstrated modest improvements in progression-free survival ( PFS ) but not improved quality or duration of survival , warranting evaluation of new agents in a placebo-controlled setting .


Ramucirumab is a human immunoglobulin G@ antibody that binds vascular endothelial growth factor receptor-@ and blocks ligand-stimulated activation .


The ROSE/TRIO -@ trial evaluated ramucirumab with docetaxel in unresectable , locally recurrent , or metastatic breast cancer .


In this double-blind , placebo-controlled , randomized , multinational phase III trial , @,@ patients with human epidermal growth factor receptor @ ( HER@ ) - negative breast cancer who had not received cytotoxic chemotherapy in the advanced setting were randomly assigned at a two-to-one ratio to receive docetaxel @ mg/m ( @ ) plus ramucirumab @ mg/kg or docetaxel @ mg/m ( @ ) plus placebo once every @ weeks .


Treatment continued until disease progression , unacceptable toxicity , or other withdrawal criteria .


Patients were stratified by previous taxane therapy , visceral metastasis , hormone receptor status , and geographic region .


An independent data monitoring committee oversaw the trial .


The primary end point was investigator-assessed PFS .


Median PFS in patients treated with ramucirumab plus docetaxel was @ months , compared with @ months in patients who received placebo plus docetaxel ( hazard ratio -LSB- HR -RSB- , @ ; P = @ ) .


Median overall survival was @ months in patients who received ramucirumab plus docetaxel , compared with @ months in patients who received placebo plus docetaxel ( HR , @ ; P = @ ) .


Toxicities seen at significantly higher rates in patients receiving ramucirumab included fatigue , hypertension , febrile neutropenia , palmar-plantar erythrodysesthesia syndrome , and stomatitis .


Addition of ramucirumab to docetaxel in HER@-negative advanced breast cancer did not meaningfully improve important clinical outcomes .


The Focused Abdominal Sonography in Trauma ( FAST ) scan is used to detect free fluid in the peritoneal cavity , or pericardium , to quickly assess for injuries needing immediate surgical intervention .


Mass-casualty incidents ( MCIs ) are settings where paramedics must make triage decisions in minutes .


The Simple Triage and Rapid Transport ( START ) system is used to prioritize transport .


The FAST scan can be added to the triage of critical patients , and may aid in triage .


This was a single-blinded , randomized control trial .


Ten paramedics with field experience were trained with an ultrasound machine in the performance of the FAST scan .


Two weeks were allowed to pass before testing to simulate the time between training of standard procedures and their implementation .


On test day , five peritoneal dialysis patients with instilled dialysis fluid and five matched control patients were placed in a room in a random order where the paramedics performed FAST scans on each patient .


The paramedics were assessed by declaring positive or negative for each evaluation , as well as being timed for the total exercise .


Of the ninety tests ( one paramedic dropped out due to family emergency ) , the paramedics had a mean accuracy of @ % and median of @ % ( range @ % -@ % ) .


There was a statistically significant higher false-positive rate of @ % than false-negative rate of @ % ( P < @ ) .


Sensitivity was @ % with a specificity of @ % .


Average time taken was @,@ seconds ( @ seconds per patient ) with a range of @-@ ,@ seconds and a median of @,@ seconds .


In this simulation study , paramedics had difficulty performing FAST scans with a high degree of accuracy .


However , they were more apt to call a patient positive , limiting the likelihood for false-negative triage .


To investigate the role of Platelet Activating Factor ( PAF ) in the pathogenesis and development of Age-Related Macular Degeneration ( ARMD ) .


Fifty six patients with ARMD ( @ patients with dry ARMD and @ patients with wet ARMD ) and @ age-matched control participants underwent ophthalmological examination , including visual acuity measurement and evaluation of the retina .


The participants were classified into three groups according to their retinal status , based on indirect fundoscopy , Optical Coherence Tomography and fluorescein angiography findings .


In order to evaluate the concentrations of PAF in serum , blood samples were collected from all participants and were analyzed with ELISA technique .


The concentrations of PAF differed significantly according to macular lesions and were found to be lower in patients with ARMD than control participants .


PAF levels are decreased along with the severity of ARMD .


Understanding the role of PAF in pathogenesis of ARMD could be the impetus for the development of new therapies field of treatment of ARMD or even other retinal diseases .


In a previous UK multi-center randomized study @ children received three doses of @-valent ( PCV-@ ) or @-valent ( PCV-@ ) pneumococcal conjugate vaccine at @ , @ and @ months of age .


At @ months of age , most of these children had pneumococcal serotype-specific IgG concentrations @ g/ml and opsonophagocytic assay ( OPA ) titers @ .


Children who had participated in the original study were enrolled again at @ years of age .


Persistence of immunity following infant immunization with either PCV-@ or PCV-@ and the immune response to a PCV-@ booster at pre-school age were investigated .


In total , @ children were followed-up to the age of @ years and received a PCV-@ booster at this age .


At least @ % of children who received PCV-@ or PCV-@ in infancy retained serotype-specific IgG concentrations @ g/ml against each of @/@ shared serotypes .


For serotypes @ and @C , persistence was lower at @-@ % .


At least @ % of PCV-@ group participants had IgG concentrations @ g/ml against each of @/@ of the additional PCV-@ serotypes ; for serotypes @ and @ this proportion was @ % and @ % .


In the PCV-@ group these percentages were significantly lower for serotypes @ , @ and @F .


A pre-school PCV-@ booster was highly immunogenic and resulted in low rates of local and systemic adverse effects .


Despite some decline in antibody from @ months of age , these data suggest that a majority of pre-school children maintain protective serotype-specific antibody concentrations following conjugate vaccination at @ , @ and @ months of age .


Asymmetric movements with both hands contributed to the improvement of spatially coupled motion .


Thus , the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients .


Twenty-four stroke patients were randomly allocated to an experimental group ( n = @ ) or a control group ( n = @ ) .


Both groups participated in conventional physical therapy for @ min/d , @ d/wk , for @ weeks .


The experimental group also participated in an asymmetric training program using virtual reality reflection equipment , and the control group participated in a symmetric training program .


Both asymmetric and symmetric programs were conducted for @ min/d , @ d/wk , for @ weeks .


To compare upper limb function before and after intervention , the Fugl-Meyer Assessment ( FMA ) , the Box and Block Test ( BBT ) , grip strength , range of motion ( ROM ) , and spasticity were assessed .


Both groups showed significant increases in upper limb function , excepting spasticity , after intervention ( P < @ , @-way repeated-measures analysis of variance -LSB- ANOVA -RSB- ) .


A significant group-time interaction was demonstrated only for shoulder/elbow/wrist items of FMA , BBT , grip strength , and ROM of wrist flexion , extension , and ulnar deviation ( P < @ , @-way repeated-measures ANOVA ) .


This study confirms that the asymmetric training program using virtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients .


We consider that an additional study based on a program using virtual reflection , which is more functional than performing simple tasks , and consisting of tasks relevant to the activities of daily living be conducted .


We aimed to evaluate the clinical efficacy of ciprofloxacin plus fluocinolone acetonide ( antibiotic plus corticosteroid ) ear drops compared to ciprofloxacin ( antibiotic ) ear drops in diffuse otitis externa .


This was a multicentre , randomised , parallel-group , double-blind study involving @ patients of both sexes aged @years or older .


The rate of clinical cure was higher ( p = @ ) with ciprofloxacin plus fluocinolone acetonide than with ciprofloxacin alone .


The mean total symptom score was lower with ciprofloxacin plus fluocinolone acetonide ( p = @ ) .


No differences were found in the percentage of patients reporting resolution of otalgia between patients receiving ciprofloxacin plus fluocinolone acetonide and patients receiving only ciprofloxacin .


Resolution of oedema and otorrhoea ( p = @ and p = @ , respectively ) was higher with ciprofloxacin plus fluocinolone acetonide , as was eradication or presumed eradication ( p = @ ) .


There were eight mild adverse events , three with the ciprofloxacin plus fluocinolone acetonide combination ( not related to the treatment ) and five when ciprofloxacin was administered alone ( directly related to the treatment ) .


Ciprofloxacin plus fluocinolone acetonide is a more effective treatment for diffuse otitis externa than ciprofloxacin alone .


The ciprofloxacin plus fluocinolone acetonide combination also has an excellent safety profile .


Prophylactic use of fresh-frozen plasma ( FFP ) is common practice in patients with a coagulopathy undergoing an invasive procedure .


Evidence that FFP prevents bleeding is lacking , while risks of transfusion-related morbidity after FFP have been well demonstrated .


We aimed to assess whether omitting prophylactic FFP transfusion in nonbleeding critically ill patients with a coagulopathy who undergo an intervention is noninferior to a prophylactic transfusion of FFP .


A multicenter randomized open-label trial with blinded endpoint evaluation was performed in critically ill patients with a prolonged international normalized ratio ( INR ; @-@ @ ) .


Patients undergoing placement of a central venous catheter , percutaneous tracheostomy , chest tube , or abscess drainage were eligible .


Patients with clinically overt bleeding , thrombocytopenia , or therapeutic use of anticoagulants were excluded .


Patients were randomly assigned to omitting or administering a prophylactic transfusion of FFP ( @mL/kg ) .


Outcomes were occurrence of postprocedural bleeding complications , INR correction , and occurrence of lung injury .


Due to slow inclusion , the trial was stopped before the predefined target enrollment was reached .


Eighty-one patients were randomly assigned , @ to FFP and @ to no FFP transfusion .


Incidence of bleeding did not differ between groups , with a total of one major and @ minor bleedings ( p = @ for noninferiority ) .


FFP transfusion resulted in a reduction of INR to less than @ in @ % of transfused patients .


No differences in lung injury scores were observed .


In critically ill patients undergoing an invasive procedure , no difference in bleeding complications was found regardless whether FFP was prophylactically administered or not .


Chronic bacterial prostatitis displays a variety of symptoms ( mainly local pain exhibiting variability in origin and intensity ) .


These symptoms often persist despite bacterial eradication .


The purpose of this article is to exam the role of phytotherapeutic agents as complementary treatment in patients with bacterial prostatitis .


The material consisted of individuals with reported pelvic discomfort and genital pain with or without lower urinary tract symptoms ( LUTS ) and sexual dysfunction visiting our department from March @ to March @ .


Patients underwent Stamey-Meares test ( several cases underwent the two glass test ) .


Depending on history and specific symptoms urethral smear and semen cultures were additionally obtained from several patients .


All patients were randomized into two groups .


Subjects in the first group ( @ patients ) received appropriate antibiotic ( according to the sensitivity test ) for @ days , while subjects in the second group ( @ patients ) received phytotherapeutic agents for @ days , additionally the conventional @ days antibiotic treatment .


The response was tested using laboratory and clinical criteria .


We found no statistically significant differences between the two groups regarding bacterial and symptom persistence rate , however , symptoms burden was lower in patients receiving combinational treatment .


Phytotherapeutic agents may improve pain and prostatitis related difficulty in urination .


Further randomized , placebo-controlled studies are needed to substantiate safer conclusions .


To observe the effect and safety of Xiaozhi particles , integrated taohong Siwu tang and Erchen tang and Xuezhikang capsule in treating hyperlipidaemia ( HLP ) associated with highly active antiretroviral therapy ( HAART ) .


In the multi-centered , randomized controlled clinical study , @ hyperlipidaemia associated with highly active antiretroviral therapy cases were divided into the treatment group treated by Xiaozhi particles , integrated Taohong Siwu tang and Erchen tang , and the control group treated by Xuezhikang capsule .


The treatment course was @ weeks .


The total cholesterol ( Tch ) , triglyceride ( TG ) , low density lipoprotein ( LDL ) and high-density lipoprotein ( HDL ) were observed .


After @ weeks , compared with Xuezhikang capsule , the change difference of Tch , LDL , HDL in the Chinese traditional medicine formula groups of patients is significant ( P < @ ) , the change of the TG has no significant difference .


The effect of Tch , LDL in Xuezhikang capsule groups is better than in traditional Chinese medicine formula group , but the effect of HDL in traditional Chinese medicine formula group is better than in Xuezhikang capsule groups .


Integrated Taohong Siwu tang and Erchen tang , Xiaozhi particles and Xuezhikang capsule can be used to control the hyperlipidaemia associated with highly active antiretroviral therapy as one of the main Chinese native medicine preparation .


Primary care is an ideal setting to treat pediatric obesity .


Effective , low-intensity ( @ contact hours over @ months ) interventions that reduce standardized body mass index ( z-BMI ) and can be delivered by primary care providers are needed .


This pilot randomized controlled trial investigated the effect of @ low-intensity ( @ contact hours over @ months ) pediatric obesity treatments on z-BMI .


Twenty-two families ( children @ @ years , z-BMI of @ @ ) were randomized into @ of @ , @-month , low-intensity conditions : newsletter ( N ) , newsletter and growth monitoring ( N + GM ) , or newsletter and growth monitoring plus family-based behavioral counseling ( N + GM + BC ) .


Anthropometrics and child eating and leisure-time behaviors were measured .


Mixed-factor analyses of variance found a significant ( P < @ ) main effect of time for z-BMI and servings per day of sugar sweetened beverages , with both decreasing over time .


Low-intensity obesity treatments can reduce z-BMI and may be more feasible in primary care .


To evaluate the efficacy of low-level laser therapy ( LLLT ) applied to acupuncture points on the knee joint in combination with exercise and advice in patients with knee osteoarthritis .


Randomised , double-blind , comparative clinical trial .


Forty-nine patients with knee osteoarthritis were assigned at random into two groups : active laser group ( n = @ ) and placebo laser group ( n = @ ) .


Using a gallium aluminium arsenide laser device , patients received either active or placebo LLLT at five acupuncture points on the affected knee during nine sessions .


Patients were assessed using a visual analogue scale ( VAS ) and the Saudi Knee Function Scale ( SKFS ) at baseline , the fifth treatment session , the last treatment session , @ weeks post intervention and @ months post intervention .


VAS scores showed a significant improvement in the active laser group compared with the placebo laser group at @ weeks post intervention -LSB- mean difference -@ , @ % confidence interval ( CI ) of the difference -@ to -@ ; P = @ -RSB- and @ months post intervention ( mean difference -@ , @ % CI of the difference -@ to -@ ; P = @ ) using the independent samples test .


SKFS scores also showed a significant improvement in the active laser group compared with the placebo laser group at the last treatment session ( median difference -@ , @ % CI of the difference -@ to -@ ; P = @ ) and @ months post intervention ( median difference -@ , @ % CI of the difference -@ to -@ ; P = @ ) using the Mann-Whitney U test .


The results demonstrate that short-term application of LLLT to specific acupuncture points in association with exercise and advice is effective in reducing pain and improving quality of life in patients with knee osteoarthritis .


Passive smoking is associated with tuberculosis ( TB ) .


Measures are required to protect non-smoking TB patients from second-hand smoke ( SHS ) .


We developed a behavioural intervention to encourage TB patients to implement smoking restrictions at home in Pakistan .


To assess the likelihood of such an intervention being successful and to inform a definitive trial in future .


This was a pilot randomised controlled trial in which non-smoking TB patients were randomised to receive either individual-based support or individual-based support combined with family reminders .


We recruited patients living with at least one smoker in their homes .


Our primary outcome was urinary cotinine level as a measure of SHS exposure @ months post-randomisation .


Of @ patients assessed for eligibility , @ ( @ % ) patients were recruited and all but one were retained throughout the trial .


A statistically significant absolute reduction was observed in non-smoking participants ' exposure to SHS based on urinary cotinine levels in both Arm @ ( @ % , @ % CI @-@ ) and Arm @ ( @ % , @ % CI @-@ ) between baseline and follow-up at @ months .


The recruitment and retention rates for trial participants make it feasible to conduct a definitive trial in future .


The observed effect size makes it worthwhile to conduct such a trial .


In this study , we aimed to determine the effect of carbon dioxide laser irradiation on enamel surface microhardness .


In this single-blind interventional clinical trial , @ patients needing at least @ premolars extracted for orthodontic purposes participated .


In each subject , @ premolar was treated with the carbon dioxide laser ( beam diameter , @ mm ; power , @ W ) ; the other was exposed to a visible guiding light as the control .


A t-loop was ligated to the bonded brackets to increase caries risk .


After at least @ months , the teeth were extracted , and the surface microhardness was measured .


Scanning electron microscope evaluation was performed on @ sample from each group .


Normal distribution of the data was assessed by the Kolmogorov-Smirnov and Shapiro-Wilks tests .


Mean microhardness values of the @ groups were compared using paired t tests .


The data had normal distributions .


Means and standard deviations of the microhardness in the laser-treated and control groups were @ @ and @ @ Vickers hardness numbers , respectively ; this was different significantly ( P < @ ) .


Scanning electron microscopy showed the enamel surface melting in the laser-treated specimens .


Carbon dioxide laser treatment results in higher enamel surface microhardness around orthodontic brackets .


Patients at high risk of caries might benefit from this intervention .


Exact control of the laser irradiation parameters is recommended .


Down syndrome ( DS ) is the most common human chromosomal abnormality .


It is characterized by mental retardation and several metabolic disturbances , including elevated oxidative stress , which may be causally linked .


Treatment with dietary antioxidants has been suggested as a potential method to alleviate the oxidative damage and retardation of DS patients , but prior supplementation work has been equivocal .


To evaluate the effects of supplementation with antioxidants - tocopherol and - lipoic acid ( ALA ) on oxidative stress biomarkers in DS children .


Ninety-three DS children aged @-@ years from both sexes were randomly allocated to three groups : - tocopherol ( @ IU/day ) , ALA ( @mg/day ) and placebo .


The intervention period was @ months .


A healthy control group consisted @ non-DS siblings .


Serum thiobarbituric acid reactive substances ( TBARS ) and urinary @-hydroxy-@ ' - deoxyguanosine ( @OHdG ) were used as biomarkers of oxidative stress .


DS children had greater levels of baseline oxidative stress than their siblings .


Moreover , males had greater levels of @OHdG than females ( P < @ ) but there was no significant association between age and biomarkers of oxidative stress .


Serum levels of TBARS did not change significantly over time , or relative to placebo .


Although urinary @OHdG concentrations decreased significantly in both - tocopherol and ALA , groups compared with the baseline levels ( P < @ ) , mean final levels of urinary @OHdG concentrations differed significantly only between - tocopherol and placebo groups ( P < @ ) .


- Tocopherol supplementation of the diets of DS children may attenuate oxidative stress at the DNA level .


The only subgroups of patients with heart failure and atrial fibrillation in which the efficacy of cardiac resynchronization therapy has been scientifically proven are patients with indications for right ventricular pacing and patients after atrioventricular junction ablation .


However it is unlikely that atrioventricular junction ablation would be a standard procedure in the majority of the heart failure patients with cardiac resynchronization therapy and concomitant atrial fibrillation due to the irreversible character of the procedure and a spontaneous sinus rhythm resumption that occurs in about @ % of these patients .


Pilot-CRAfT is the first randomized controlled trial evaluating the efficacy of a rhythm control strategy in atrial fibrillation patients with cardiac resynchronization therapy devices .


The aim of this prospective , single center randomized controlled pilot study is to answer the question whether the patients with cardiac resynchronization therapy and permanent atrial fibrillation would benefit from a strategy to restore and maintain sinus rhythm ( that is ` rhythm control ' strategy ) in comparison to rate control strategy .


The study population consists of @ patients with heart failure and concomitant long-standing persistent or permanent atrial fibrillation who underwent a cardiac resynchronization therapy device implantation at least @ months before qualification .


Study participants are randomly assigned to the rhythm control strategy ( including electrical cardioversion and pharmacotherapy ) or to the rate control group whose goal is to control ventricular rate .


The follow-up time is @ months .


The primary endpoint is the ratio of effectively captured biventricular beats .


The secondary endpoints include peak oxygen consumption , six-minute walk test distance , heart failure symptom escalation , reverse remodelling of the heart on echo and quality of life .


The American Heart Association has defined a new metric of ideal cardiovascular health as part of its @ Impact Goals .


We examined whether psychosocial factors in youth predict ideal cardiovascular health in adulthood .


Participants were @ men and @ women from the nationwide Cardiovascular Risk in Young Finns Study .


Psychosocial factors were measured from cohorts @ to @ years of age at the baseline of the study , and ideal cardiovascular health was examined @ years later in adulthood .


The summary measure of psychosocial factors in youth comprised socioeconomic factors , emotional factors , parental health behaviors , stressful events , self-regulation of the child , and social adjustment of the child .


There was a positive association between a higher number of favorable psychosocial factors in youth and greater ideal cardiovascular health index in adulthood ( = @ ; P < @ ) that persisted after adjustment for age , sex , medication use , and cardiovascular risk factors in childhood ( = @ ; P < @ ) .


The association was monotonic , suggesting that each increment in favorable psychosocial factors was associated with improvement in cardiovascular health .


Of the specific psychosocial factors , a favorable socioeconomic environment ( = @ ; P < @ ) and participants ' self-regulatory behavior ( = @ ; P = @ ) were the strongest predictors of ideal cardiovascular health in adulthood .


The findings suggest a dose-response association between favorable psychosocial factors in youth and cardiovascular health in adulthood , as defined by the American Heart Association metrics .


The effect seems to persist throughout the range of cardiovascular health , potentially shifting the population distribution of cardiovascular health rather than simply having effects in a high-risk population .


Effects of depression treatment are obscured by heterogeneity among patients .


Personality types could be one source of heterogeneity that explains variability in treatment response .


Clinically meaningful variations in personality patterns could be captured with data-driven subgroups .


The aim of this study was to identify such personality types and to explore their predictive value for treatment efficacy .


Participants ( N = @ ) in the current exploratory study came from a randomized controlled trial in primary care depressed patients , conducted between January @ and June @ , comparing different treatments .


All participants were diagnosed with a major depressive disorder ( MDD ) according to the DSM-IV .


Primary ( care as usual -LSB- CAU -RSB- or CAU plus a psychoeducational prevention program -LSB- PEP -RSB- ) and specialized ( CAU + PEP + psychiatric consultation or cognitive-behavioral therapy ) treatment were compared .


Personality was assessed with the Neuroticism-Extraversion-Openness Five-Factor Inventory ( NEO-FFI ) .


Personality classes were identified with latent profile analysis ( LPA ) .


During @ year , weekly depression ratings were obtained by trimonthly assessment with the Composite International Diagnostic Interview .


Mixed models were used to analyze the effects of personality on treatment efficacy .


A @-class LPA solution fit best to the NEO-FFI data : Class @ ( vulnerable , n = @ ) was characterized by high neuroticism , low extraversion , and low conscientiousness , and Class @ ( resilient , n = @ ) by medium neuroticism and extraversion and higher agreeableness and conscientiousness .


Recovery was quicker in the resilient class ( class time : P < @ ) .


Importantly , specialized treatment had added value only in the vulnerable class , in which it was associated with quicker recovery than primary treatment ( class time treatment : P < @ ) .


Personality profile may predict whether specialized clinical efforts have added value , showing potential implications for planning of treatments .


Selective laser trabeculoplasty ( SLT ) should be explored as a therapeutic option in eyes with angle closure .


To assess the intraocular pressure ( IOP ) - lowering efficacy of SLT in eyes with primary angle closure ( PAC ) and PAC glaucoma ( PACG ) .


Randomized clinical trial at tertiary eye care institutions of @ patients diagnosed as having PAC or PAC glaucoma in which the angles had opened at least @ ( visible posterior trabecular meshwork on gonioscopy ) after laser iridotomy .


Recruitment and baselinewere completed from June @ to April @ and @-month follow-up was completed from December @ to November @ .


Eligible patients with a baseline IOP greater than @ mm Hg were randomized to either SLT or prostaglandin analog ( PGA ; travoprost , @ % ) .


The SLT was repeated if the IOP reduction was less than @ % from baseline at the @ - or @-month follow-up visit .


The primary outcome measure was the change in IOP from baseline to the final follow-up visit ( at @ months ) .


The frequency of additional postoperative treatments and complications were secondary outcomes .


Fifty patients ( @ eyes ) were randomized to SLT and @ patients ( @ eyes ) to PGA medical therapy .


At @ months , @ patients in the SLT group and @ in the PGA group completed follow-up .


Analysis was based on intent to treat .


At @ months , IOP decreased by @ mm Hg ( @ % CI , @-@ @ ) in the SLT group ( P < @ ) and by @ mm Hg ( @ % CI , @-@ @ ) in the PGA group ( P < @ ) .


There were no differences between the SLT and PGA groups in the absolute mean reduction of IOP ( @ vs @ mm Hg , respectively ; P = @ ) or in the percentage of reduction in IOP ( @ % vs @ % , respectively ; P = @ ) .


Complete success ( IOP @ mm Hg without medications ) was achieved in @ % eyes of the SLT group , compared with @ % of eyes in the PGA group ( P = @ ) .


No patients required glaucoma surgery .


Additional medications were required in @ % of patients in the SLT group compared with @ % in the PGA group ( P = @ ) .


One patient in the SLT group ( @ % ) had a transient posttreatment IOP spike greater than @ mm Hg .


The mean endothelial cell count showed a significant decrease from baseline in the SLT arm ( @ % decrease ; P = @ ) .


No other events such as persistent uveitis or increase in peripheral anterior synechiae were noted in eyes that underwent SLT .


Two patients in the PGA group exited owing to drug-related complications ( @ patient with uveitis and @ with allergic conjunctivitis ) .


Eyes with PAC or PACG respond to SLT in the short term , but the overall long-term therapeutic effectiveness needs further evaluation .


The antiseptic effectiveness of @ % anerdian III , @ % gentamicin , and @ % tobramycin solutions in pre-surgical irrigation of conjunctival sac were compared .


A total of @ cataract patients ( @ eyes ) who had undergone phacoemulsification aspiration combined with intraocular lens insertion ( IOL ) were recruited in this prospective study .


Operative eyes were given @ % levofloxacin eye drops for @ days and then were randomized into three treatment groups : anerdian ( A ) , gentamicin ( B ) and tobramycin ( C ) .


The patients received conjunctival sac irrigation using the respective solutions at @ minutes preoperatively .


Conjunctival sac sampling was performed before and after irrigation and the samples were used for subsequent bacterial culture and swab tests .


The positive culture rate was used as the main outcome .


The positive rates of bacterial culture before conjunctival sac irrigation were @ % ( @ eyes ) in group A , @ % ( @ eyes ) in group B and @ % ( @ eyes ) in group C. Post irrigation , the positive rates in the three groups decreased to @ % ( @ eyes ) , @ % ( @ eyes ) and @ % ( @ eyes ) , respectively .


The positive rates among the three groups did not differ significantly .


However , the positive rate in group A only significantly differed before and after the irrigation ( P < @ ) .


No toxic or allergic reactions were observed on the ocular surface of any patient after irrigation .


The antiseptic effects of the three types of con junctival sac irrigations did not differ .


Observing or hearing about illness in another person can lead to reports of similar symptoms .


Reports can occasionally be widespread .


However , it has been difficult to document whether this is the result of genuine illness or the expression of anxiety with physical terminology .


This study examined the effects of being able to see another blood donor experience vasovagal symptoms .


Data were collected in mobile university blood collection clinics .


Bedside research assistants coded whether the donor was able or not able to see another donor being treated for vasovagal symptoms .


Dependent variables included subjective vasovagal symptoms indicated on the Blood Donation Reactions Inventory ( BDRI ) and the need for treatment oneself .


Given the population of inexperienced donors , many ( @ % of the @,@ participants ) were able to see another donor treated for symptoms .


Being able to see another donor treated was associated with higher scores on the BDRI and an increased likelihood of treatment for vasovagal symptoms oneself .


However , this was limited to non-first-time blood donors , perhaps because of higher levels in first-time donors ( ceiling effects ) or greater attention to the environment in less `` overwhelmed '' repeat donors .


In general , donors who were able to see another react rated themselves as less relaxed and had smaller increases in heart rate .


During the @-year follow-up , first-time donors who were able to see another react were slower to return to give blood again .


Seeing another donor being treated for symptoms contributed to the vasovagal process in many donors .


This environment provides a useful context to study social influences on symptoms and illness .


Prostate cancer is a major public health problem with considerable uncertainties about the effectiveness of population screening and treatment options .


We report the study design , participant sociodemographic and clinical characteristics , and the initial results of the testing and diagnostic phase of the Prostate testing for cancer and Treatment ( ProtecT ) trial , which aims to investigate the effectiveness of treatments for localised prostate cancer .


In this randomised phase @ trial , men aged @-@ years registered at @ primary care centres in nine UK cities were invited to attend a specialist nurse appointment for a serum prostate-specific antigen ( PSA ) test .


Prostate biopsies were offered to men with a PSA concentration of @ g/L or higher .


Consenting participants with clinically localised prostate cancer were randomly assigned to active monitoring ( surveillance strategy ) , radical prostatectomy , or three-dimensional conformal external-beam radiotherapy by a computer-generated allocation system .


Randomisation was stratified by site ( minimised for differences in participant age , PSA results , and Gleason score ) .


The primary endpoint is prostate cancer mortality at a median @-year follow-up , ascertained by an independent committee , which will be analysed by intention to treat in @ .


This trial is registered with ClinicalTrials.gov , number NCT@ , and as an International Standard Randomised Controlled Trial , number ISRCTN@ .


Between Oct @ , @ , and Jan @ , @ , @,@ men were invited to attend an appointment with a specialist nurse .


Of the invited men , @,@ ( @ % ) attended their initial appointment and @,@ ( @ % ) of attenders had a PSA test .


PSA concentration was below the biopsy threshold in @,@ ( @ % ) men .


Of the @ men with a PSA concentration of @-@ g/L , @ ( @ % ) underwent biopsies .


@ men were diagnosed with prostate cancer ( @ % of tested men and @ % of those who had a biopsy ) , of whom @ ( @ % ) had clinically localised disease ( mostly T@c , Gleason score @ ) .


With the addition of @ pilot study participants recruited between @ and @ , @ men were eligible for the treatment trial and @ ( @ % ) agreed to be randomly assigned ( @ to active monitoring , @ to radiotherapy , and @ to radical prostatectomy ) .


Clinical and sociodemographic characteristics of randomly assigned participants were balanced across treatment groups .


The ProtecT trial randomly assigned @ men with localised prostate cancer to active monitoring , radiotherapy , or surgery .