Addition of @F-FDG PET improves classification accuracy of IHC to a significant yet minor degree .


These results may form a basis for development of tumor characterization models for treatment allocation purposes .


The EACH study assessed the efficacy of oxaliplatin , @-fluorouracil , and leucovorin ( the FOLFOX@ regimen ) compared with doxorubicin alone in terms of overall survival ( OS ) , progression-free survival ( PFS ) , and safety in patients with advanced hepatocellular carcinoma ( HCC ) .


We present the results of this study in Chinese patients .


In a multicenter , open-label , randomized , phase III study ( NCT@ ) , @ patients ( @ patients from the People 's Republic of China ) were randomized @:@ to receive either FOLFOX@ or doxorubicin until disease progression , intolerable toxicity , death , or surgical resection .


Baseline characteristics of the Chinese patients enrolled in the study were similar for the @ treatment groups and in comparison with the whole EACH cohort .


Median OS at the prespecified time point of treatment was @ months with FOLFOX@ and @ months with doxorubicin ( hazard ratio -LSB- HR -RSB- : @ ; @ % confidence interval -LSB- CI -RSB- :@ -@ ; p = @ ) .


At the end of the follow-up period , median OS was @ months with FOLFOX@ and @ months with doxorubicin ( HR : @ ; @ % CI :@ -@ ; p = @ ) .


Median PFS was @ months and @ months in the FOLFOX@ and doxorubicin groups , respectively ( HR : @ ; @ % CI :@ -@ ; p = @ ) .


The response rate ( RR ) and disease control rate ( DCR ) were significantly higher in the FOLFOX@ group than in the doxorubicin group ( RR : @ % vs. @ % , p = @ ; DCR : @ % vs. @ % , p = @ ) .


Hematological toxicity was more frequently reported in the FOLFOX@ group .


For Chinese HCC patients enrolled in the EACH study , FOLFOX@ significantly improved the RR and DCR and prolonged survival compared with doxorubicin .


Systemic chemotherapy with oxaliplatin-based regimens may play an important role in the treatment of Chinese patients with advanced HCC .


Children are vulnerable to diet inadequacies , which may affect immune function .


Our objective was to determine if a follow-up formula ( FUF ) containing DHA , the prebiotics PDX and GOS , and yeast - glucan affects incidence of respiratory infections and diarrheal disease in healthy children .


In a double-blind , randomized , controlled , prospective trial , @-@ year old children were fed @ servings per day of either a FUF with @ mg DHA , @ g PDX/GOS , and @ mg yeast - glucan per serving or an unfortified , cow 's milk-based beverage ( control ) for @ weeks .


Fecal and blood samples were collected to assess immune markers and iron/zinc status .


Incidence of acute respiratory infections ( ARI ) , diarrheal disease , and antibiotic treatment were obtained from medical records .


The FUF group had fewer episodes and shorter duration of ARI ( mean days -LSB- SE -RSB- ; control = @ -LSB- @ -RSB- ; FUF = @ -LSB- @ -RSB- ; P = @ ) , less antibiotic use ( n -LSB- % -RSB- ; control = @ -LSB- @ % -RSB- ; FUF = @ -LSB- @ % -RSB- ; P = @ ) , and fewer missed days of day care due to illness .


No diarrheal disease was diagnosed in either group .


The FUF group had higher interleukin-@ and white blood cell count at the end of the study .


There were no differences in hemoglobin , serum ferritin and zinc , or fecal secretory immunoglobulin A.


Daily consumption of a FUF was associated with fewer episodes and shorter duration of ARI , as well as less antibiotic use .


The children who consumed the FUF had increased interleukin-@ and white blood cells , suggesting an antiinflammatory mechanism and/or an increase of effector immune cells .


In the PROTECT AF ( Watchman Left Atrial Appendage Closure Technology for Embolic Protection in Patients With Atrial Fibrillation ) trial that evaluated patients with nonvalvular atrial fibrillation ( NVAF ) , left atrial appendage ( LAA ) occlusion was noninferior to warfarin for stroke prevention , but a periprocedural safety hazard was identified .


The goal of this study was to assess the safety and efficacy of LAA occlusion for stroke prevention in patients with NVAF compared with long-term warfarin therapy .


This randomized trial further assessed the efficacy and safety of the Watchman device .


Patients with NVAF who had a CHADS@ ( congestive heart failure , hypertension , age > @ years , diabetes mellitus , and previous stroke/transient ischemic attack ) score @ or @ and another risk factor were eligible .


Patients were randomly assigned ( in a @:@ ratio ) to undergo LAA occlusion and subsequent discontinuation of warfarin ( intervention group , n = @ ) or receive chronic warfarin therapy ( control group , n = @ ) .


Two efficacy and @ safety coprimary endpoints were assessed .


At @ months , the rate of the first coprimary efficacy endpoint ( composite of stroke , systemic embolism -LSB- SE -RSB- , and cardiovascular/unexplained death ) was @ in the device group versus @ in the control group ( rate ratio @ -LSB- @ % credible interval ( CrI ) : @ to @ -RSB- ) and did not achieve the prespecified criteria noninferiority ( upper boundary of @ % CrI @ ) .


The rate for the second coprimary efficacy endpoint ( stroke or SE > @ days ' postrandomization ) was @ versus @ ( risk difference @ -LSB- @ % CrI : -@ to @ -RSB- ) , achieving noninferiority .


Early safety events occurred in @ % of the Watchman arm , significantly lower than in PROTECT AF , satisfying the pre-specified safety performance goal .


Using a broader , more inclusive definition of adverse effects , these still were lower in PREVAIL ( Watchman LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy ) trial than in PROTECT AF ( @ % vs. @ % ; p = @ ) .


Pericardial effusions requiring surgical repair decreased from @ % to @ % ( p = @ ) , and those requiring pericardiocentesis decreased from @ % to @ % ( p = @ ) , although the number of events was small .


In this trial , LAA occlusion was noninferior to warfarin for ischemic stroke prevention or SE > @ days ' post-procedure .


Although noninferiority was not achieved for overall efficacy , event rates were low and numerically comparable in both arms .


Procedural safety has significantly improved .


This trial provides additional data that LAA occlusion is a reasonable alternative to warfarin therapy for stroke prevention in patients with NVAF who do not have an absolute contraindication to short-term warfarin therapy .


To compare the clinical outcome and complications of high viscosity and low viscosity poly-methyl methacrylate bone cement PVP for severe OVCFs .


From December @ to December @ , @ patients with severe OVCFs were randomly assigned to either group H using high viscosity cement ( n = @ ) or group L using low viscosity cement ( n = @ ) .


The clinical outcomes were assessed by the Visual Analog Scale ( VAS ) , Oswestry Disability Index ( ODI ) , Short Form-@ General Health Survey ( SF-@ ) , kyphosis Cobb 's angle , vertebral height , and complications .


Significant improvement in the VAS , ODI , SF-@ scores , kyphosis Cobb 's angle , and vertebral height were noted in both the groups , and there were no significant differences between the two groups .


Cement leakage was seen less in group H. Postoperative assessment using computed tomography identified cement leakage in @ of @ ( @ % ) vertebrae in group H and in @ of @ ( @ % ) vertebrae in group L ( P = @ ) .


The PVP using high viscosity bone cement can provide the same clinical outcome and fewer complications compared with PVP using low viscosity bone cement .


Therapeutic vaccination is a promising novel approach to treat HIV-@ infected people by boosting or redirecting immune system to neutralize critical HIV-@ antigens whose biological effects are relevant in the context of viral pathogenesis .


With the aim to induce neutralizing antibodies to the matrix protein p@ we have developed a peptide-based immunogen ( AT@-KLH ) and evaluated its safety and immunogenicity .


Twenty four asymptomatic HAART-treated HIV-@ + patients were enrolled in a phase I clinical study and were randomized to three groups : @ groups were treated with five IM injection ( Arm A : @g/inoculation ; Arm B : @g/inoculation ) at day ( D ) D@ , D@ , D@ , D@ and D@ ; the control group ( Arm C ) were not injected .


Safety was assessed by monitoring local and systemic adverse events ( AEs ) , recorded till D@ .


Evaluation of immunogenicity was by titering antibodies at D@ , D@ , D@ , D@ , D@ , D@ , D@ , D@ and D@ using ELISA .


In all , @ local and systemic AEs were reported across the three groups .


Most were mild and resolved without sequelae .


Also the few unsolicited events , deemed unrelated to the study vaccines , caused no problems .


No significant changes in the routine laboratory parameters , CD@ T-cell count or HIV-@ viremia were found .


At the time of enrollment @ out of @ patients had no anti-AT@ antibodies , whereas @ exhibited anti-p@ antibodies .


Irrespective of the presence of preimmunization antibodies , all subjects developed high titers of anti-AT@ antibodies ( GM @ ) in response to both AT@-KLH doses .


These antibodies were also capable of recognizing AT@ within the p@ framework .


The AT@ peptide-based approach has allowed to redirect HAART-treated patients ' humoral responses toward a previously untargeted hotspot of functional activity .


Overall , the tested AT@-KLH doses were safe and well tolerated , supporting further exploration of AT@-KLH as an HIV-@ therapeutic vaccine candidate .


Hypertensive patients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death .


Lowering blood pressure ( BP ) after stroke reduces the risk of recurrent stroke , but recent data suggest that lower systolic BP ( SBP ) measured @ years after stroke is associated with increased mortality .


Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear .


All-cause and cardiovascular mortality were examined in relation to average on-treatment SBP after stroke in @ hypertensive patients with electrocardiographic left ventricular hypertrophy randomly assigned to losartan - or atenolol-based treatment who had new strokes during follow-up .


Patients with on-treatment SBP < @ mm Hg ( lowest tertile ) and SBP > @ ( highest tertile ) were compared with patients with average SBP between @ and @ .


During @ years mean follow-up after incident stroke , @ patients ( @ % ) died , @ ( @ % ) from cardiovascular causes .


In multivariate Cox analyses , adjusting for significant univariate predictors of mortality , compared with average SBP between @ and @ , an average SBP < @ was a significant predictor of all-cause ( hazard ratio , @ ; @ % confidence interval , @-@ @ ) and cardiovascular mortality ( hazard ratio , @ ; @ % confidence interval , @-@ @ ) , whereas patients who had an average SBP > @ had no significant increased risk of death .


Lower achieved SBP ( < @ mm Hg ) is associated with a significantly increased risk of cardiovascular and all-cause mortality after initial stroke in hypertensive patients during short-term follow-up .


Further study is required to determine ideal SBP goals after stroke .


LifeWave Energy Enhancer ( LEE ) patches ( LifeWave Corp , San Diego , CA , USA ) on skin produce some changes that are consistent with increased energy production , but little is known about their effects on cortisol concentrations or the peripheral circulation .


The study intended to assess the effects of LEE patches on salivary cortisol , peripheral circulation , and psychological measures on healthy adults .


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


Measurements were made in the laboratory at Mind-Body-Science ( Tucson , AZ , USA ) .


Participants collected some of the saliva samples at work or home .


To obtain pilot data , @ healthy individuals with no chronic conditions were recruited-@ males and @ females-aged @-@ y.


Participants completed baseline psychological questionnaires and provided saliva samples for hormonal analysis .


The next day , fingertip microvascular perfusion was measured , LEE or placebo patches were applied to participants ' wrists , and perfusion scans were repeated , first immediately after and then @ min after application of the patch .


Saliva samples were collected , and questionnaires were completed .


Participants returned at noon and @:@ PM for further scans , and at the end of that time , the patches were removed .


The protocol was repeated the following day using new patches .


The research team analyzed the saliva samples for levels of cortisol and measured the percentage changes in cutaneous microvascular perfusion .


The participants completed the energy visual analog scales ( eVASs ) and the Marlowe-Crowne Social Desirability survey .


After the first patch application , the active group showed significantly higher cortisol concentrations than the placebo group , both at noon-@ @ @ ng/mL vs @ @ ( P = @ ) , respectively-and at @:@ PM - @ @ vs @ @ ( P = @ ) , respectively .


No consistent changes occurred in perfusion .


The eVAS score decreased significantly compared with baseline in the placebo group but not in the active group .


Cortisol concentrations and eVAS scores showed significant differences between groups , which is consistent with the patches increasing energy production , warranting further testing .


Due to the availability of new devices , the use of ventricular assist devices ( VADs ) in children has been increasing ; however , patient selection and optimal timing of device implantation in this population remains uncertain .


A retrospective review of the United Network for Organ Sharing dataset identified @,@ listings without mechanical circulatory support ( MCS ) for isolated pediatric heart transplant , @ to @ .


Patients were randomly divided into a derivation and validation cohort .


A multivariable logistic regression model predicting the likelihood of death or need for MCS within @ days was built using the derivation cohort and tested in the validation cohort .


A simplified score ( PedsMCS score ) was developed and evaluated for accuracy .


The predictive model consisted of variables present at listing ( age , albumin level , creatinine clearance , serum bilirubin , mechanical ventilation , and inotropic support ) .


It had good predictive ability ( C statistic @ ) within the validation cohort .


The simplified PedsMCS score was also predictive ( C statistic @ ) and there was a strong correlation between predicted and expected outcomes ( r = @ , p < @ ) .


Patients with PedsMCS score @ or greater had a significantly higher risk of death or MCS within @ months ( @ % ) than those with low scores ( < @ ) ( @ % , p < @ ) .


A single point increase in PedsMCS score was associated with a @ % increase in the risk of death or MCS with @ months ( p < @ ) .


We have developed and validated a simplified score to predict the need for MCS based on risk factors present at listing .


This will provide more accurate prognostication in children awaiting heart transplant , and may improve patient selection .


Not all hypertensive patients respond well to ACE inhibition .


Here we determined whether renin-angiotensin system ( RAS ) phenotyping , i.e. , the measurement of renin or ACE , can predict the individual response to RAS blockade , either chronically ( enalapril vs. enalapril + candesartan ) or acutely ( enalaprilhydrochlorothiazide , HCT ) .


Chronic enalapril + candesartan induced larger renin rises , but did not lower blood pressure ( BP ) more than enalapril .


Similar observations were made for enalapril + HCT vs. enalapril when given acutely .


Baseline renin predicted the peak changes in BP chronically , but not acutely .


Baseline ACE levels had no predictive value .


Yet , after acute drug intake , the degree of ACE inhibition , like renin , did correlate with BP .


Only the relationship with renin remained significant after chronic RAS blockade .


Thus , a high degree of ACE inhibition and a steep renin rise associate with larger acute responses to enalapril .


However , variation was large , ranging > @mm Hg for a given degree of ACE inhibition or renin .


The same was true for the relationships between renin and BP , and between baseline renin and the maximum reduction in BP in the chronic study .


Our data do not support that RAS phenotyping will help to predict the individual BP response to RAS blockade .


Notably , these conclusions were reached in a carefully characterized , homogenous population , and when taking into account the known fluctuations in renin that relate to gender , age , ethnicity , salt intake and diuretic treatment , it seems unlikely that a cut-off renin level can be defined that has predictive value .


The main challenge in CT screening for lung cancer is the high prevalence of pulmonary nodules and the relatively low incidence of lung cancer .


Management protocols use thresholds for nodule size and growth rate to determine which nodules require additional diagnostic procedures , but these should be based on individuals ' probabilities of developing lung cancer .


In this prespecified analysis , using data from the NELSON CT screening trial , we aimed to quantify how nodule diameter , volume , and volume doubling time affect the probability of developing lung cancer within @ years of a CT scan , and to propose and evaluate thresholds for management protocols .


Eligible participants in the NELSON trial were those aged @-@ years , who have smoked @ cigarettes or more per day for more than @ years , or ten cigarettes or more for more than @ years and were still smoking , or had stopped smoking less than @ years ago .


Participants were randomly assigned to low-dose CT screening at increasing intervals , or no screening .


We included all participants assigned to the screening group who had attended at least one round of screening , and whose results were available from the national cancer registry database .


We calculated lung cancer probabilities , stratified by nodule diameter , volume , and volume doubling time and did logistic regression analysis using diameter , volume , volume doubling time , and multinodularity as potential predictor variables .


We assessed management strategies based on nodule threshold characteristics for specificity and sensitivity , and compared them to the American College of Chest Physicians ( ACCP ) guidelines .


The NELSON trial is registered at www.trialregister.nl , number ISRCTN@ .


Volume , volume doubling time , and volumetry-based diameter of @ non-calcified nodules detected by CT screening in @ participants in the screening group of NELSON were used to quantify lung cancer probability .


Lung cancer probability was low in participants with a nodule volume of @ mm ( @ ) or smaller ( @ % -LSB- @ % CI @-@ -RSB- ) or maximum transverse diameter smaller than @ mm ( @ % -LSB- @-@ -RSB- ) , and not significantly different from participants without nodules ( @ % -LSB- @-@ -RSB- , p = @ and p = @ , respectively ) .


Lung cancer probability was intermediate ( requiring follow-up CT ) if nodules had a volume of @-@ mm ( @ ) ( @ % -LSB- @ % CI @-@ -RSB- ) or a diameter @-@ mm ( @ % -LSB- @-@ -RSB- ) .


Volume doubling time further stratified the probabilities : @ % ( @ % CI @-@ ) for volume doubling times @ days or more , @ % ( @-@ ) for volume doubling times @-@ days , and @ % ( @-@ ) for volume doubling times of @ days or fewer .


Lung cancer probability was high for participants with nodule volumes @ mm ( @ ) or bigger ( @ % -LSB- @ % CI @-@ -RSB- ) or diameters @ mm or bigger ( @ % -LSB- @-@ -RSB- ) .


The simulated ACCP management protocol yielded a sensitivity and specificity of @ % ( @ % CI @-@ ) , and @ % ( @-@ ) , respectively .


A diameter-based protocol with volumetry-based nodule diameter yielded a higher sensitivity ( @ % -LSB- @ % CI @-@ -RSB- ) , and a higher specificity ( @ % -LSB- @-@ ) .


A volume-based protocol ( with thresholds based on lung cancer probability ) yielded the same sensitivity as the ACCP protocol ( @ % -LSB- @ % CI @-@ -RSB- ) , and a higher specificity ( @ % -LSB- @-@ -RSB- ) .


Small nodules ( those with a volume < @ mm ( @ ) or diameter < @ mm ) are not predictive for lung cancer .


Immediate diagnostic evaluation is necessary for large nodules ( @ mm ( @ ) or @ mm ) .


Volume doubling time assessment is advocated only for intermediate-sized nodules ( with a volume ranging between @-@ mm ( @ ) or diameter of @-@ mm ) .


Nodule management protocols based on these thresholds performed better than the simulated ACCP nodule protocol .


The aim of this research was to compare the pharmacodynamics of the combination of mitiglinide and sitagliptin to that of each agent alone in Korean patients with type @ diabetes mellitus ( T@DM ) .


Patients with T@DM received mitiglinide alone , sitagliptin alone , or both drugs together in randomized sequence .


A meal tolerance test ( MTT ) was conducted for each group , and plasma concentrations of glucose , insulin , C-peptide , glucagon , and intact glucagon-like peptide-@ , and dipeptidyl peptidase-@ activity were measured from @ h before breakfast through @ h after breakfast on day @ ( pretreatment ) and day @ ( posttreatment ) of each treatment period .


Integrated values of these pharmacodynamic variables were analyzed for changes from pretreatment to posttreatment and for differences between the three treatment groups .


Twenty-six patients with glycated hemoglobin A@c level of @ % @ % , fasting plasma glucose concentration of @ @ mg/dL , postprandial plasma glucose ( PPG ) concentration of @ @ mg/dL @ h after the MTT , and diabetes duration of @ @ years ( mean SD ) were included in the study .


Compared with mitiglinide or sitagliptin alone , the combination treatment lowered PPG additively ( P < @ vs. mitiglinide or sitagliptin alone ) and the insulin secretory response ( P = @ vs. mitiglinide or sitagliptin alone ) .


The integrated insulin concentrations changed significantly from before to after treatment ( P < @ ) , but the change did not differ between the combination and mitiglinide groups .


The insulinogenic index increased significantly after the combination treatment ( P < @ vs. mitiglinide or sitagliptin alone ) .


The combination of mitiglinide and sitagliptin was generally well tolerated , with no hypoglycemic events .


The combination of mitiglinide and sitagliptin did not trigger hypoglycemia and controlled postprandial glucose excursion more effectively compared with either drug alone .


Alterations of the parameters of heart rate variability , phenomenon associated with autonomic nervous system balance , have been shown as a possibly very important factor for monitoring of cardiocirculatory system in the perioperative period .


Periinduction period of general anaesthesia is very important with significant changes of haemodynamics what could be reflected in the changes of the parameter of heart rate variability .


A hundred patients of ASA I and ASA II status who were scheduled for elective abdominal surgical procedures of moderate stress response , were randomly assigned to group I and group II , who were administered propofol or thiopentone as induction anaesthetic , respectively .


Monitoring during periinduction period included of monitoring of mean blood pressure ( noninvasively ) , heart rate , pulseoxymetry and recording of electrocardiogram by holter ECG recorder for further analysis of heart rate variability , in four time segments in periinduction period : Tp , T@ , T@ , T@ .


Data were presented as mean values of absolute values of the power of the total spectrum of heart rate variability , mean values of the spectrum of low frequency band ( LF ) , mean values of the high frequency range , and the ratio LF/HF .


Analysis of the values of hemodynamic parameters has shown decrease of mean arterial blood pressure after induction of anaesthesia with intravenous anesthetics thiopental or propofol , with simultaneous changes of heart rate in the four time segments in periinduction period , without statistically significant changes between the groups .


Analysis of the values of parameters of heart rate variability measured in the frequency domain has shown changes of mean values of the absolute values of total power spectrum , mean values of the power of low frequency spectrum and mean values of the power of high power spectrum with reduction of the values of total power spectrum , the power of low frequency spectrum and the power of high frequency spectrum , most pronounced just after induction of anaesthesia with slight increase of the values of total power spectrum and individual components of the spectrum of heart rate variability in the later postinduction period , without statistically significant differences between the groups .


The results have shown that in the groups of patients who underwent induction of general anaesthesia with propofol or thiopentone , there have been reductions of the total spectral power and the power of the spectrum of low frequency components and high frequency components with variations in the relationship between the components in the different periods of periinduction time .


In a task-environment where visibility has deteriorated , individuals rely heavily on tactile performance ( perception and manipulation ) to complete complex tasks .


When this happens under hyperbaric conditions , factors like nitrogen narcosis could influence a person 's ability to successfully complete such tasks .


To examine the effect of nitrogen narcosis on a complex neuropsychological task measuring tactile performance at a pressure of @ kPa ( @ atm abs ) , in the absence of visual access to the task .


In a prospective cross-over study , @ commercial divers were tested in a dry chamber at @ kPa and @ kPa .


They completed the Tupperware Neuropsychological Task ( TNT ) of tactile performance without visual access to the task , and completed questionnaires to provide psychological and biographical data , which included trait anxiety and transient mood states , as well as formal qualifications and technical proficiency .


A significant decrement ( @ % , P < @ ) in performance on the TNT at depth was found , irrespective of the sequence of testing .


Generally , neither the psychological nor biographical variables showed any significant effect on tactile performance .


Tactile performance on the surface was a good indicator of performance at depth .


These findings have practical implications for professional diving where conditions of low visibility during deeper diving occur .


Recommendations are made towards managing potential impairments in tactile performance , such as pre-dive practical learning ( ` rehearsal ' ) as an aid to successful completion of tasks .


To compare the results for treatment of basal thumb osteoarthritis with and without the use of a bone tunnel at the base of the first metacarpal .


Women aged @ years or older with stage IV osteoarthritis were randomized to @ of @ treatments .


Patients were evaluated preoperatively and postoperatively at @ and @ months by assessing pain , outcome function measures , range of motion , strength , time to return to work or activities , satisfaction with the results , and complication rate .


A total of @ patients were enrolled in this study .


Three months after surgery , Patient-Rated Wrist and Hand Evaluation pain and total scores were significantly improved in the bone tunnel group compared with the tunnel-free group .


At @ months , however , we found no significant differences for all outcome scores between groups .


In addition , we observed no significant differences between groups in strength , duration to return to work or activities , patient satisfaction , and complication rates .


After the bone tunnel technique , patients have better function and less pain @ months after surgery than do those in the non-bone tunnel group , which indicates faster recovery .


However , @ months after surgery , the functional outcome was similar .


Because of faster recovery , we prefer the bone tunnel technique in the treatment of stage IV osteoarthritis .


Within the field of oncology , increasing access to high quality care has been identified as a priority to reduce cancer disparities .


Previous research reveals that the facilities where patients receive their cancer care have implications for cancer outcomes .


However , there is little understanding of how patients decide where to seek cancer care .


This study examined the factors that shape patients ' pathways to seek their cancer care at a National Cancer Institute-designated comprehensive cancer center ( NCI-CCC ) , and differences in these factors by race , income and education .


In-depth interviews and survey questionnaires were administered to a random sample of @ patients at one NCI-CCC in the Northeast US .


In-depth interview data was first analyzed qualitatively to identify themes and patterns in patients ' pathways to receive their cancer care at an NCI-CCC .


Logistic Regression was used to examine if these pathways varied by patient race , income , and education .


Two themes emerged : following the recommendation of a physician and following advice from social network members .


Quantitative data analysis shows that patient pathways to care at an NCI-CCC varied by education and income .


Patients with lower income and education most commonly sought their cancer care at an NCI-CCC due to the recommendation of a physician .


Patients with higher income and education most commonly cited referral by a specialist physician or the advice of a social network member .


There were no statistically significant differences in pathways to care by race .


Our findings show that most patients relied on physician recommendations or advice from a social network member in deciding to seek their cancer care at an NCI-CCC .


Due to the role of physicians in shaping patients ' pathways to the NCI-CCC , initiatives that strengthen partnerships between NCI-CCCs and community physicians who serve underserved communities may improve access to NCI-CCCs .


The aim of the present study is to determine the possible effect of Bifidobacterium bifidum DN-@ @ on dental plaque of children .


@ children ( @ F and @ M ) , between the ages of @-@ , participated in the present study .


The study had a double blind , randomized crossover design and the experimental period consisted of four consecutive time periods .


During periods @ and @ ( @ weeks each ) , children consumed @ g probiotic fruit yogurt ( Bifidobacterium DN-@ @ ( @ x @ ( @ ) cfu/g ) ) , or a placebo fruit yogurt per day .


Available supragingival plaque ( @ h later ) was collected from teeth @ , @ , @ and @ at baseline and at the end of periods @ and @ .


The counts of dental plaque mutans streptococci ( MS ) were evaluated using Dentocult SM ( Strep Mutans ) .


Changes of pre - and post-treatment levels of dental plaque MS were recorded for four consecutive sampling sites .


There were no statistically differences between transition scores of test and placebo groups regarding different dental plaque sampling sites ( p > @ ) ( unpaired t-test ) .


Within the limitations of the present study , Bifidobacterium bifidum DN-@ @ has no effect on dental plaque MS levels in children .


Accumulating evidence indicates that plastic changes can be maladaptive in nature , resulting in movement and neurological disorders .


The aim of this study was to further the understanding of these neurophysiological changes in sensorimotor integration ( SMI ) using somatosensory evoked potentials ( SEPs ) and concurrent performance changes following a repetitive typing task .


SEPs were recorded following median nerve stimulation at the wrist and performed pre and post intervention .


@ participants were randomly assigned to either an intervention group which performed a @min repetitive typing task or a control group which participated in a @min period of mental recitation .


The P@-N@ amplitude increased by @ % , compared to only @ % increase following the control .


The P@-N@ SEP peak amplitude increased on average @ % following the motor training , compared to only @ % following the control .


Significant improvement in reaction time when comparing performance of the motor task for the intervention group was observed .


The N@ increase supports the involvement of cerebellar connections and the N@ increase provides further support for changes in SMI following motor learning .


Combining motor training tasks with electrophysiological techniques gives insight into the mechanisms of disordered SMI and whether the changes are adaptive or maladaptive .


Electrocardiographic ( ECG ) identification of prior myocardial infarction ( MI ) during right ventricular ( RV ) pacing is of clinical importance .


Proposed ECG criteria have been evaluated only during apical pacing .


We evaluated the effect of pacing site on the predictive performance of ECG signs of prior MI .


The present study is a secondary analysis of a prospective , multicenter study which randomized recipients of an implantable cardioverter defibrillator to an apical versus septal RV lead positioning .


ECGs of patients with or without prior MI were analyzed for the presence of the following criteria : Cabrera sign , Chapman sign , QR pattern in leads I , aVL , V@ or V@ , QR in inferior leads and notching in the descending slope of the QRS complex in inferior leads .


The MI group included @ patients ( @ % apically paced ) , while @ patients had no prior MI ( @ % apically paced ) .


In the total population , the Cabrera sign presented the highest specificity ( @ % ) and diagnostic accuracy ( @ % ) , with a sensitivity of @ % .


The Cabrera sign was the only significant predictor of a prior MI -LSB- OR = @ , ( @ % CI :@ -@ ) , p < @ -RSB- , among all ECG markers .


Pacing site did not significantly influence the sensitivity and specificity of the Cabrera sign for detection of prior MI .


In our study , the Cabrera sign was the only ECG marker that predicted the presence of prior MI during ventricular paced rhythm .


Septal RV lead positioning did not affect the predictive performance of the Cabrera sign .


To observe the protective effect of transcutaneous electrical acupoint stimulation ( TEAS ) on cerebral tissue in elderly hip replacement operation patients during general anesthesia under controlled hypotension .


Forty hip replacement operation patients were randomly divided into general anesthesia ( GA ) control group and TEAS + GA group ( n = @ in each group ) .


Patients of the two groups during operation were treated with controlled hypotension for reducing blood loss .


TEAS ( @ Hz/@ Hz , @-@ mA ) was applied to bilateral Yuyao ( EX-HN @ ) and Fengchi ( GB @ ) and began @ min before GA. .


General anesthesia was performed by intravenous injection of Midazolam , Diprivan , Fentanyl and Cis-atracurium , sevoflurane-inhaling , Remifentanil , etc. , and the patient 's mean arterial pressure was maintained to be about @ % of the normal level ( controlled hypotension ) by using venous administration of Remifentanil about @ min after the operation .


GEM Premier @ blood gas analyzer was used to analyze levels of the arterial oxygen ( CaO@ ) , internal jugular venous oxygen ( CjvO@ ) , arterio-venous oxygen content difference ( Da-jvO@ ) and cerebral oxygen ( CERO@ ) uptake rates of blood samples before controlled hypotension ( T@ ) , @ min after controlled hypotension ( T ) .


@ min after controlled hypotension ( T@ ) and @ min after the end of controlled hypotension ( T@ ) .


Self-comparison of each group showed that in comparison with pre-controlled hypotension , CjvO@ levels at the time-points of T , T@ and T@ were significantly increased in both GA control and TEAS+GA groups ( P < @ ) , while Da-jvO@ and CERO@ uptake rate levels at the time-points of T , .


T@ and T@ in these two groups were significantly decreased ( P < @ ) .


Comparison between two groups showed that CivO@ levels at the time-points of T@ and T@ were significantly higher in the TEAS + GA group than in the GA control group ( P < @ ) .


while Da-jvO@ and CERO@ uptake rate levels at the time-point of T@ were obviously lower in the TEAS + GA group than in the GA control group ( P < @ ) , suggesting a reduction of cerebral oxygen consumption after TEAS .


No significant differences were found between these two groups in blood CjvO@ , Da-jvO@ and CERO@ uptake rate levels at the time-points of T@ and T@ ( P > @ ) .


TEAS can reduce cerebral oxygen uptake rate in elderly patients undergoing hip replacement during controlled hypotension , suggesting a protective effect of TEAS on patient 's cerebral tissue .


Home mechanical ventilation ( HMV ) in the Netherlands is normally initiated in hospital , but this is expensive and often a burden for the patient .


In this randomised controlled study we investigated whether initiation of HMV at home in patients with chronic respiratory failure is non-inferior to an in hospital based setting .


Seventy-seven patients were included , of which @ patients started HMV at home .


All patients were diagnosed with chronic respiratory failure due to a neuromuscular or thoracic cage disease .


Primary outcome was the arterial carbon dioxide ( PaCO@ ) while quality of life and costs were secondary outcomes .


Telemonitoring was used in the home group to provide therapeutic information , for example ; transcutaneous carbon dioxide , oxygen saturation and ventilator information , to the caregivers .


Follow-up was six months .


PaCO@ , improved by @ ( SE@ @ ) kPa in the hospital group and by @ ( @ ) in the home group , both improvements being significant and the latter clearly not inferior .


There were also significant improvements in quality of life in both groups , again not being inferior with home treatment .


This study is the first to show that initiation of HMV at home in a selective group of patients with chronic respiratory failure is as effective for gas exchange and quality of life as hospital initiation .


In addition we found that it is safe , technically feasible and that more than @ per patient can be saved compared to our standard care .


To compare the three non-steroidal anti-inflammatory agents ( NSAIDs ) Diclofenac potassium , Etodolac and Naproxen sodium in relation to pain , swelling and trismus following impacted third molar surgery .


The study was a randomized and a double-blinded study which included @ healthy young individuals with impacted third molars and bone retention .


Patients were randomly assigned to @ groups ( n : @ ) to which Diclofenac potassium , Naproxen sodium and Etodolac were administered orally an hour before the operation .


Impacted third molars were surgically extracted with local anaesthesia .


Visual analog scales ( VAS ) were used to assess the pain in the @th , @th hours and on the @st , @nd , @rd , @th , and @th days postoperatively .


Swelling was evaluated using ultrasound ( US ) and mouth opening ( trismus ) was measured with a composing stick pre and post operatively on the @nd and @th days respectively .


Regarding pain alleviation , Diclofenac potassium was better than Naproxen sodium and Naproxen sodium was better than Etodolac but these differences were not statistically significant .


US measurements showed that the swelling on postoperative @nd day was significantly lowest with Diclofenac potassium as compared to others ( p = @ ) while Naproxen sodium and Etodolac acted similarly ( p = @ ) .


No difference was noted regarding trismus in any of the groups .


NSAIDs ( Diclofenac , Naproxen and Etodolac ) are somehow similarly effective for controlling pain and trismus following extraction of mandibular third molars but Diclofenac potassium surpasses others in reduction of swelling .


To observe the efficacy of the combination of Qilin Pills and levofloxacin in the treatment of asthenospermia accompanied with accessory sex gland infection .


We randomly assigned @ asthenospermia patients with accessory sex gland infection to groups @ and @ of equal number , the former treated with Qilin Pills + levofloxacin , and the latter with levofloxacin only .


Qilin Pills were administered at the dose of @ g tid for @ days , and levofloxacin at the dose of @ g qd for @ days .


We obtained semen parameters , including the percentage of progressively motile sperm and peroxidase-positive white blood cell ( WBC ) count , before and after medication , and compared the clinical effects between the two groups .


All the patients accomplished the clinical trial .


The therapeutic effectiveness rates in improving progressive sperm motility were @ % in group @ and @ % in group @ , with statistically significant differences between the two groups ( P < @ ) .


As for the peroxidase-positive WBC count in semen , the effectiveness rates were @ % and @ % , respectively , with no significant differences between the two groups ( P > @ ) .


For the treatment of asthenospermia accompanied with accessory sex gland infection , Qilin Pills combined with levofloxacin is evidently better than levofloxacin alone in improving sperm motility , and it has no obvious adverse effects .


To investigate the association between feeding patterns and HIV-free survival in children born to HIV-infected mothers and to clarify whether antiretroviral ( ARV ) prophylaxis modifies the association .


From June @ to August @ , HIV-infected pregnant women were counseled regarding infant feeding options , and randomly assigned to triple-ARV prophylaxis ( triple ARV ) until breastfeeding cessation ( BFC ) before age @ months or antenatal zidovudine with single-dose nevirapine ( short-course ARV ) .


Eighteen-month HIV-free survival of infants HIV-negative at @ weeks of age was assessed by feeding patterns ( replacement feeding from birth , BFC < @ months , BFC @ months ) .


Of the @ infants alive and HIV-negative at @ weeks , @ acquired infection and @ died by @ months .


Overall HIV-free survival at @ months was @ -LSB- @ % confidence interval ( CI ) : @-@ @ -RSB- .


In the short-course ARV arm , HIV-free survival ( @ ; CI : @-@ @ ) did not differ by feeding patterns .


In the triple ARV arm , overall HIV-free survival was @ ( CI : @-@ @ ) and BFC < @ months was associated with lower HIV-free survival than BFC @ months ( adjusted hazard ratio : @ ; CI : @-@ @ ) and replacement feeding ( adjusted hazard ratio : @ ; CI : @-@ @ ) .


In the triple ARV arm , @ of @ transmissions occurred after reported BFC ( and @ of @ in the short-course arm ) , indicating that some women continued breastfeeding after interruption of ARV prophylaxis .


In resource-constrained settings , early weaning has previously been associated with higher infant mortality .


We show that , even with maternal triple-ARV prophylaxis during breastfeeding , early weaning remains associated with lower HIV-free survival , driven in particular by increased mortality .


Fluticasone furoate ( FF ) is a novel , once-daily inhaled corticosteroid ( ICS ) that has been shown to improve lung function vs. placebo in asthma patients .


This study evaluated the efficacy and safety of FF @ mcg compared with placebo in asthma patients uncontrolled by non-ICS therapy .


This @-week , multicentre , randomized , double-blind , placebo-controlled , parallel-group , phase III study randomized @ patients ( aged @ years ) to once-daily FF @ mcg administered via the ELLIPTAa dry powder inhaler or placebo .


The primary endpoint was change from baseline in pre-dose evening trough forced expiratory volume in one second ( FEV@ ) .


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


Other endpoints included Asthma Control Test , Asthma Quality of Life Questionnaire and ELLIPTA ease of use questions .


Safety was assessed throughout the study .


There was a significant difference in evening trough FEV@ between FF @ mcg and placebo ( treatment difference : @ mL ; p = @ ) .


There was also a significant difference in rescue-free @-h periods ( @ % ; p = @ ) vs. placebo .


There were numerically greater improvements with FF vs. placebo for all remaining secondary endpoints .


The incidence of adverse events was lower with FF ( @ % ) than with placebo ( @ % ) ; few were treatment-related ( FF @ mcg : n = @ , < @ % ; placebo : n = @ , @ % ) .


FF @ mcg once daily significantly improved FEV@ and percentage of rescue-free @-h periods experienced over @ weeks vs. placebo , and was well tolerated .


The aim of this study was to compare the effects of plyometric training versus basketball technique training on improving neuro-muscular performance .


Thirty-six ( age @ years , body height @ cm , body weight @ kg , BMI @ kgm-@ ) basketball players girls were randomly allocated to @ groups : Basketball Plyometric Training ( BPT , N. = @ ) and Basketball Technique Training ( BTT , N. = @ ) .


The players were tested by two specific tests : counter movement jump ( CMJ ) and squat jump ( SJ ) before and after @ training weeks .


The jump height , as dependent variable , showed a different trend as an effect of the different training protocols , in contrast with the current knowledge .


Manova did not show significant interactions between the two groups for the height of jumps , while significant differences were found for interaction time training ( P < @ ) and for main effect time ( P < @ ) .


After training , the BPT group increased significantly CMJ performance by @ % ( P < @ ) , whereas the BTT group increased by @ % .


Likewise , the BPT group demonstrated a significant greater improvement of jump height than BTT group ( an increase of @ % vs. @ % , P < @ ; respectively ) .


These results suggest that both training protocols proposed in this study improved vertical jump performance .


However , a combination of the two protocols , plyometric training and sport-specific-exercises , could be useful to optimize performance by an easy transition from controlled a-specific to sport-specific performance requirements .


In conclusion , BPT is a safe and effective method of achieving a favourable neuro-muscular performance than BTT in female basketball players .


The objective of this study was to determine the feasibility of telementored instruction in bedside ultrasonography ( US ) using Google Glass .


The authors sought to examine whether first-time US users could obtain adequate parasternal long axis ( PSLA ) views to approximate ejection fraction ( EF ) using Google Glass telementoring .


This was a prospective , randomized , single-blinded study .


Eighteen second-year medical students were randomized into three groups and tasked with obtaining PSLA cardiac imaging .


Group A received real-time telementored education through Google Glass via Google Hangout from a remotely located expert .


Group B received bedside education from the same expert .


Group C represented the control and received no instruction .


Each subject was given @ minutes to obtain a best PSLA cardiac imaging using a portable GE Vscan .


Image clips obtained by each subject were stored .


A second expert , blinded to instructional mode , evaluated images for adequacy and assigned an image quality rating on a @ to @ scale .


Group A was able to obtain adequate images six out of six times ( @ % ) with a median image quality rating of @ ( interquartile range -LSB- IQR -RSB- = @ to @ ) out of @ .


Group B was also able to obtain adequate views six out of six times ( @ % ) , with a median image quality rating of @ ( IQR = @ to @ ) .


Group C was able to obtain adequate views one out of six times ( @ % ) , with a median image quality of @ ( IQR = @ to @ ) .


There were no statistically significant differences between Group A and Group B in the achievement of adequate images for E-point septal separation measurement or in image quality .


In this pilot/feasibility study , novice US users were able to obtain adequate imaging to determine a healthy patient 's EF through telementored education using Google Glass .


These preliminary data suggest telementoring as an adequate means of medical education in bedside US .


This conclusion will need to be validated with larger , more powerful studies including evaluation of pathologic findings and varying body habitus among models .


To compare the pharmacokinetic profiles and to evaluate the bioequivalence of two commercial amoxicillin suspension formulations ( @ mg/@ mL AMOXIL , reference formulation and AMOXI-PED , test formulation ) in healthy Brazilian volunteers .


Under fasting condition , @ volunteers ( @ males and @ females ) were included in this randomized , open-label , two-period crossover ( @-week washout interval ) bioequivalence study .


Blood samples were collected at pre-dose ( @ hour ) and @ , @ , @ , @ , @ , @ , @ , @ , @ , @ , and @ hours after drug ingestion .


Pharmacokinetic parameters ( Cmax , tmax , t@/@ , AUC@-tlast , and AUC@ - ) were calculated from plasma concentrations for both formulations in each subject .


Arithmetic mean values of the pharmacokinetic parameters were : Cmax = @ ( @ ) gmL-@ ; tmax = @ ( @ ) h ; t@/@ = @ ( @ ) h ; AUC@-tlast = @ ( @ ) ghmL-@ ; and AUC@ - = @ ( @ ) ghmL-@ for reference formulation and Cmax = @ ( @ ) gmL-@ ; tmax = @ ( @ ) h ; t@/@ = @ ( @ ) h ; AUC@-tlast = @ ( @ ) ghmL-@ ; and AUC@ - = @ ( @ ) ghmL-@ for test formulation .


The confidence intervals ( @ % CI ) for reference and test formulations were , respectively , @ - @ % for Cmax and @ - @ % for AUC@-t .


Based on the results , both formulations of amoxicillin evaluated in this study were considered bioequivalent according to FDA and ANVISA/Brazil criteria .


Autonomic nervous system dysfunction has been implicated in visceral hypersensitivity .


However , the specific contribution of the parasympathetic nervous system ( PNS ) is unclear .


We aimed to determine whether physiological and pharmacological manipulation of parasympathetic tone influences the development of hypersensitivity in a validated model of acid-induced oesophageal pain .


Prior to , and following , a @-min distal oesophageal infusion of @ M hydrochloric acid , pain thresholds to electrical stimulation were determined in the proximal non-acid exposed oesophagus in healthy subjects .


Validated sympathetic ( skin conductance response ) and parasympathetic ( cardiac vagal tone ) parameters were measured at baseline and continuously thereafter .


In study @ , @ subjects were randomised in a pragmatic blinded crossover design to receive deep breathing or un-paced breathing during acid infusion .


In study @ , @ subjects were randomised in a blinded , crossover design to receive intravenous atropine or placebo ( saline ) with deep breathing during acid infusion .


Study @ : Deep breathing increased cardiac vagal tone ( @ vs -@ , p = @ ) with concomitant withdrawal of skin conductance response ( -@ vs @ , p = @ ) in comparison with un-paced breathing .


Deep breathing prevented the development of acid-induced oesophageal hypersensitivity in comparison with sham breathing ( p = @ ) .


Study @ : Atropine , in comparison with placebo , blocked the attenuating effect of deep breathing on the development of acid-induced oesophageal hypersensitivity ( p = @ ) .


The development of oesophageal hyperalgesia is prevented by physiologically increasing parasympathetic tone .


This effect is pharmacologically blocked with atropine , providing evidence that the PNS influences the development of oesophageal pain hypersensitivity .


Self-management challenges facing adults with epilepsy include limited understanding of the condition and treatment , associated psychosocial issues , and lack of community integration .


Self-management interventions improve patients ' medical , life role , and emotional management .


Previous interventions , developed from expert opinion , indicated issues with participant engagement/retention , and limited follow-up periods .


PACES in Epilepsy addressed methodologic concerns by utilizing patient needs assessment data ( n = @ ) to derive self-management content and program features for evaluation via randomized controlled trial ( RCT ) .


Participants were adults with chronic epilepsy ( n = @ ) , without serious mental illness or substantive intellectual impairment , who were recruited from two epilepsy centers .


Participants were assigned randomly to intervention or treatment-as-usual groups .


Outcomes included the Epilepsy Self-Management Scale ( ESMS ) , Epilepsy Self-Efficacy Scale ( ESES ) , Quality of Life in Epilepsy-@ ( QOLIE-@ ) , Patient Health Questionnaire-@ ( PHQ-@ ) , and the Generalized Anxiety Disorder-@ ( GAD-@ ) , administered at baseline , postintervention ( @weeks ) , and @months postintervention .


The intervention was an @-week group of @-@ adults co-led by a psychologist and trained peer with epilepsy that met one evening per week at a hospital for @min .


Topics included medical , psychosocial , cognitive , and self-management aspects of epilepsy , in addition to community integration and optimizing epilepsy-related communication .


The treatment group provided satisfaction ratings regarding program features .


PACES participants ( n = @ ) improved relative to controls ( n = @ ) on the ESMS ( p < @ ) and subscales -LSB- Information ( p < @ ) ; Lifestyle ( p < @ ) -RSB- ; ESES ( p < @ ) ; and QOLIE-@ ( p = @ ) .


At @-month follow up , PACES participants remained improved on the ESMS ( p = @ ) and Information subscale ( p = @ ) ; and Energy/Fatigue ( p = @ ) and Medication Effects ( p = @ ) of the QOLIE-@ .


Attrition in both groups was low ( @ % in each group ) and all program satisfaction ratings exceeded @ / @ , with leadership ( @ ) , topics ( @ ) , and location ( @ ) as the most highly rated aspects .


A consumer generated epilepsy self-management program appears to be a promising intervention from multiple perspectives , particularly in relation to disability management .


Sublingual immunotherapy ( SLIT ) has been described as a significant intervention in the treatment of allergic rhinitis ( AR ) .


However , factors that may predict treatment outcomes with respect to quality of life ( QoL ) results and mainly the role of olfactory function are still being underestimated .


In this study , we investigated determinants that best predict treatment outcomes for QoL , exploring mainly the role of olfaction .


One hundred forty-five patients following SLIT , @ placebo-controls , and @ healthy subjects were studied .


Olfactory function was objectively evaluated using `` Sniffin ' Sticks '' test pre - and post-cessation of SLIT .


Three categories of validated QoL questionnaires were filled out by all subjects : questionnaire specific for olfaction ( Questionnaire of Olfactory Deficits ) , questionnaires for assessing psychology ( Beck Depression Inventory , Zung Depression Scale , State & Trait Anxiety Inventory ) , general Short Form-@ health survey .


Statistically significant improvement of olfactory function by @ % and of all QoL questionnaires results ( all P < @ ) was observed on final evaluation .


Anosmia , asthma history , and the severity of symptoms-expressed by the Total Symptoms Score-were proven independent determinants of clinically significant improvement in patients ' QoL .


Several factors were found that may predict QoL outcomes in AR patients following SLIT .


To evaluate the effect of peer education on postoperative rehabilitation of patients with laryngeal cancer .


From January @ to December @ , @ cases of primary laryngeal cancer were treated with partial or total laryngectomy as well as tracheotomy in the Department of Head and Neck Surgery in Shandong Provincial Hospital .


The patients were randomly divided into experimental group or control group by Stochastic tables law , @ patients in control group accepted only conventional nursing , @ patients in experimental group accepted both conventional nursing and peer education .


The difference in the treatment nursing cooperation attitude , postoperative recovery , postoperative symptoms and the incidence of complications between two groups were evaluated by postoperative quality of life ( UW-QOL ) , Eysenck personality questionnaire ( EPQ ) and coping style questionnaire ( CSQ ) score .


The independent sample T-test and test were used for statistical analysis .


The patients of experimental group showed more positive attitude to treatment and care compared to the patients of control group ( = @ , P < @ ) .


Experimental group had less time in postoperative wound healing time , gastric tube indwelling time and postoperative hospital stay than control group , with statistically significant differences ( t = @ , t = @ , t = @ , respectively , P < @ ) ; Incidence of postoperative discomfort symptoms in experimental group was less than that in control group ( P < @ ) .


Total score for quality of life ( UW-QOL ) in experimental group was higher than that in control group ( t = @ , P < @ ) .


The P and N scores of EPQ in experimental group were lower than those in control group ( t = @ , t = @ , P < @ ) , while the E score of EPQ in experimental group was significantly higher than that in control group ( t = @ , P < @ ) , with no significant difference in the L score of EPQ between two groups ( P > @ ) .


scores of factor to solve problem and help factor of CSQ in experimental group were higher than those in control group ( t = @ , t = @ , P < @ ) , and the era factor score of experimental group was lower than that of control group ( t = @ , P < @ ) .


Peer education can help the patients with laryngectomy to maintain good psychological and mental status , to cooperate actively with treatment , to reduce symptoms and complications , and to shorten the length of hospital stay , improving their postoperative rehabilitation and quality of life .


To further resolve the clinical equipoise on the choice of chemical sphincterotomy agent for early symptomatic relief of anal fissure by comparing the effectiveness of @ % Diltiazem gel with @ % Glyceryl TriNitrate .


The randomized clinical trial was conducted at Aga Khan University Hospital , Karachi , from February @ , to July @ , @ , and comprised @ adult patients with anal fissure who were equally randomised to either Diltiazem or Glyceryl TriNitrate after taking informed consent .


The creams were applied locally ; the former twice daily , and the latter three times a day for a period of two weeks .


The rest of the treatment was standard .


Patients were followed up in clinic by the principal investigator at two weeks for primary outcome i.e. self-reported symptomatic relief on Visual Analogue Scale , and secondary outcomes i.e. side effects and the overall cost of treatment .


Of the total , @ ( @ % ) patients were males and the overall mean age was @ + / - @ years .


Patients , who used Diltiazem reported more symptomatic relief than Glyceryl TriNitrate ( p < @ ) .


Side effects were found more in Glyceryl TriNitrate than Diltiazem ( p < @ ) , and most common side effect in the former group was headache in @ ( @ % ) patients .


Cost of the treatment was not significantly different between both treatment arms ( p < @ ) .


Chemical sphincterotomy with topical @ % Diltiazem gel is an effective first-line treatment for early symptomatic relief of anal fissures , owing to negligible side effects .


Antenatal magnesium sulfate given to pregnant women at imminent risk of very preterm delivery reduces the risk of cerebral palsy in early childhood , although its effects into school age have not been reported from randomized trials .


To determine the association between exposure to antenatal magnesium sulfate and neurological , cognitive , academic , and behavioral outcomes at school age .


The ACTOMgSO@ was a randomized clinical trial conducted in @ centers in Australia and New Zealand , comparing magnesium sulfate with placebo given to pregnant women ( n = @ magnesium ; n = @ placebo ) for whom imminent birth was planned or expected before @ weeks ' gestation .


Children who survived from the @ centers who participated in the school-age follow-up ( n = @ magnesium ; n = @ placebo ) were invited for an assessment at @ to @ years of age between @ and @ .


Mortality , cerebral palsy , motor function , IQ , basic academic skills , attention and executive function , behavior , growth , and functional outcomes .


Main analyses were imputed for missing data .


Of the @ fetuses known to be alive at randomization , the mortality rate to school age was @ % ( @/@ ) in the magnesium sulfate group and @ % ( @/@ ) in the placebo group ( risk ratio -LSB- RR -RSB- , @ ; @ % CI , @-@ @ , P = @ ) .


Of @ survivors available for follow-up , outcomes at school age ( corrected age @-@ years ) were determined for @ ( @ % ) .


Comparing the magnesium sulfate and placebo groups revealed no statistically significant difference in proportions with cerebral palsy ( @/@ -LSB- @ % -RSB- and @/@ -LSB- @ % -RSB- , respectively ; odds ratio -LSB- OR -RSB- , @ ; @ % CI , @-@ @ ; P = @ ) or abnormal motor function ( @/@ -LSB- @ % -RSB- and @/@ -LSB- @ % -RSB- , respectively ; OR , @ ; @ % CI , @-@ @ ; P = @ ) .


There was also little difference between groups on any of the cognitive , behavioral , growth , or functional outcomes .


Magnesium sulfate given to pregnant women at imminent risk of birth before @ weeks ' gestation was not associated with neurological , cognitive , behavioral , growth , or functional outcomes in their children at school age , although a mortality advantage can not be excluded .


The lack of long-term benefit requires confirmation in additional studies .


The U.S. pivotal trial for the self-expanding valve found that among patients with severe aortic stenosis at increased risk for surgery , the @-year survival rate was @ percentage points higher in patients treated with a self-expanding transcatheter aortic valve bioprosthesis than in those treated with a surgical bioprosthesis .


Longer-term clinical outcomes were examined to confirm if this mortality benefit is sustained .


Patients with severe aortic stenosis who were at increased surgical risk were recruited .


Eligible patients were randomly assigned in a @:@ ratio to transcatheter aortic valve replacement with the self-expanding transcatheter valve ( transcatheter aortic valve replacement -LSB- TAVR -RSB- group ) or to aortic valve replacement with a surgical bioprosthesis ( surgical group ) .


The @-year clinical and echocardiographic outcomes were evaluated in these patients .


A total of @ patients underwent randomization at @ centers in the United States .


The rate of @-year all-cause mortality was significantly lower in the TAVR group ( @ % ) than in the surgical group ( @ % ; log-rank test p < @ ) in the as-treated cohort , with an absolute reduction in risk of @ percentage points .


Similar results were foundin the intention-to-treat cohort ( log-rank test p < @ ) .


The rate of @-year death or major stroke was significantly lower in the TAVR group ( @ % ) than in the surgical group ( @ % ; log-rank test p = @ ) .


In patients with severe aortic stenosis who are at increased surgical risk , the higher rate of survival with a self-expanding TAVR compared with surgery was sustained at @ years .


( Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement ; NCT@ ) .


A prospective , randomized study examined the effect of interventional preoperative education and orientation for scoliosis surgery ( PEOSS ) on anxiety levels of patients undergoing posterior spinal fusion ( PSF ) .


Secondary outcomes analyzed were caregiver anxiety , length of stay , morphine equivalent usage , and patient/caregiver satisfaction .


Patients undergoing PSF were randomly distributed into a control group ( N = @ ) or interventional group ( N = @ ) .


All subjects and caregivers completed the State ( current ) - Trait ( typical ) Anxiety Inventory ( STAI ) at different intervals : preoperative appointment , preoperative holding area , postoperative orthopaedic unit , and discharge .


At discharge , patients and caregivers completed a satisfaction survey .


Significantly higher state anxiety scores were found compared with baseline at all time intervals in both the control group and PEOSS group .


The PEOSS group had higher state anxiety scores than the control group at the postoperative interval ( P = @ ) .


There were no significant differences in the caregiver state anxiety scores between the groups at any time interval .


Trait anxiety scores for both groups remained stable over time , establishing that the measurement tool accurately reflected baseline anxiety .


No significant differences were found in length of stay or morphine equivalent use .


Patient satisfaction scores were higher in the PEOSS group than in the control group ( P = @ ) .


PSF was associated with increased anxiety at all time intervals in adolescents in both groups .


In the PEOSS group , PSF was associated with increased anxiety in the immediate postoperative period .


Despite the increase in anxiety , patient satisfaction was higher in the intervention group .


It is likely that patients need age-appropriate information and educational strategies to minimize anxiety during PSF .


Further work is underway to study and develop more effective interventional strategies .


Level I study .


This randomized double-blind study was conducted to evaluate the analgesic efficacy and safety of addition of three different doses of dexmedetomidine in caudal ropivacaine compared with plain ropivacaine for postoperative analgesia in pediatric day care patients .


Eighty children of American Society of Anesthesiologists grade I-II , aged @-@ years , undergoing lower abdominal and perineal surgery were included .


Children were randomly allocated into four groups .


Group @ received @ % plain ropivacaine @ mlkg ( -@ ) , while group @ , @ , and @ received dexmedetomidine @ , @ , and @ gkg ( -@ ) , respectively , along with @ % ropivacaine @ mlkg ( -@ ) .


Anesthesia was induced and maintained with sevoflurane and @ % N@O in oxygen .


Children were observed for postoperative pain , nausea-vomiting , agitation , sedation , and adverse effects .


Rescue analgesia was provided with oral paracetamol .


Postoperative analgesia was significantly prolonged in all dexmedetomidine groups as compared to plain ropivacaine group ( P < @ ) .


All patients in the plain ropivacaine group required rescue analgesia within first @ postoperative hours , while none in the other three groups .


None of the patients showed delayed anesthetic emergence .


Four patients in the plain ropivacaine group developed agitation , while none in the dexmedetomidine groups .


Patients receiving dexmedetomidine @ gkg ( -@ ) were more sedated as compared to the other groups ( P < @ ) , but it did not delay discharge of the patients .


All three doses of caudal dexmedetomidine appear to be effective for preventing postoperative pain in pediatric day care patients .


Caudal dexmedetomidine used in these doses seems to be safe for day care surgery .


Tofacitinib is an oral Janus kinase ( JAK ) inhibitor for the treatment of rheumatoid arthritis ( RA ) .


The pathways affected by tofacitinib and the effects on gene expression in situ are unknown .


Therefore , tofacitinib effects on synovial pathobiology were investigated .


A randomised , double-blind , phase II serial synovial biopsy study ( A@ ; NCT@ ) in patients with RA with an inadequate methotrexate response .


Patients on background methotrexate received tofacitinib @mg twice daily or placebo for @days .


Synovial biopsies were performed on Days -@ and @ and analysed by immunoassay or quantitative PCR .


Clinical response was determined by disease activity score and European League Against Rheumatism ( EULAR ) response on Day @ in A@ , and at Month @ in a long-term extension study ( A@ ; NCT@ ) .


Tofacitinib exposure led to EULAR moderate to good responses ( @/@ patients ) , while placebo was ineffective ( @/@ patients ) on Day @ .


Tofacitinib treatment significantly reduced synovial mRNA expression of matrix metalloproteinase ( MMP ) -@ and MMP-@ ( p < @ ) and chemokines CCL@ , CXCL@ and CXCL@ ( p < @ ) .


No overall changes were observed in synovial inflammation score or the presence of T cells , B cells or macrophages .


Changes in synovial phosphorylation of signal transducer and activator of transcription @ ( STAT@ ) and STAT@ strongly correlated with @-month clinical responses ( p < @ ) .


Tofacitinib significantly decreased plasma CXCL@ ( p < @ ) at Day @ compared with placebo .


Tofacitinib reduces metalloproteinase and interferon-regulated gene expression in rheumatoid synovium , and clinical improvement correlates with reductions in STAT@ and STAT@ phosphorylation .


JAK@-mediated interferon and interleukin-@ signalling likely play a key role in the synovial response .


Patellar straps or sports tapes are commonly used by athletes with patellar tendinopathy in order to reduce pain and to continue sports participation .


Currently , there is no scientific evidence for the effectiveness of a patellar strap or sports tape in the management of this common injury .


To investigate the effect of the use of a patellar strap and sports tape on pain and sports participation in subjects with patellar tendinopathy .


The study is divided into two parts : a randomised controlled crossover experiment and a randomised controlled trial ( parallel group design ) .


@ patients diagnosed with patellar tendinopathy recruited from sports medical centres and physiotherapist practices .


In the first part of the study , participants serve as their own control by performing three functional tests under four different conditions ( patellar strap , sports tape , placebo tape , and no orthosis ) .


In the second part , participants keep a log for two weeks ( control week and intervention week ) about the pain experienced during and after sports and their level of sports participation .


In the intervention week participants will use the orthosis assigned to them during training and competition .


The amount of pain ( both parts of the study ) and sports participation ( second part only ) will be measured .


To analyse the effects of the orthoses a Linear Mixed Model will be used .


The knowledge gained in this study can be used by practitioners in their advice for athletes with patellar tendinopathy about using patellar strap and sports tape during sports .


A head-to-head comparison was performed between vascular endothelial growth factor blockade and laser for treatment of diabetic macular edema ( DME ) .


Two similarly designed , double-masked , randomized , phase @ trials , VISTA ( DME ) and VIVID ( DME ) .


We included @ patients ( eyes ) with type @ or @ diabetes mellitus who presented with DME with central involvement .


Eyes received either intravitreal aflibercept injection ( IAI ) @ mg every @ weeks ( @q@ ) , IAI @ mg every @ weeks after @ initial monthly doses ( @q@ ) , or macular laser photocoagulation .


The primary efficacy endpoint was the change from baseline in best-corrected visual acuity ( BCVA ) in Early Treatment Diabetic Retinopathy Study ( ETDRS ) letters at week @ .


Secondary efficacy endpoints at week @ included the proportion of eyes that gained @ letters from baseline and the mean change from baseline in central retinal thickness as determined by optical coherence tomography .


Mean BCVA gains from baseline to week @ in the IAI @q@ and @q@ groups versus the laser group were @ and @ versus @ letters ( P < @ ) in VISTA , and @ and @ versus @ letters ( P < @ ) in VIVID .


The corresponding proportions of eyes gaining @ letters were @ % and @ % versus @ % ( P < @ ) in VISTA , and @ % and @ % versus @ % ( P < @ ) in VIVID .


Similarly , mean reductions in central retinal thickness were @ and @ versus @ m ( P < @ ) in VISTA , and @ and @ versus @ m ( P < @ ) in VIVID .


Overall incidences of ocular and nonocular adverse events and serious adverse events , including the Anti-Platelet Trialists ' Collaboration-defined arterial thromboembolic events and vascular deaths , were similar across treatment groups .


At week @ , IAI demonstrated significant superiority in functional and anatomic endpoints over laser , with similar efficacy in the @q@ and @q@ groups despite the extended dosing interval in the @q@ group .


In general , IAI was well-tolerated .


To determine the effects of food on the pharmacokinetics of sublingual asenapine .


Healthy male volunteers ( n = @ , age @-@ years ) randomly received a single sublingual dose of asenapine @ mg after @ h fasting ( Treatment A , reference ) , after a high-fat meal ( Treatment B ) and after @ h fasting with a high-fat meal at @ h post-dose ( Treatment C ) .


Blood samples were drawn over @ h to measure asenapine plasma concentrations .


Effects of food intake on asenapine pharmacokinetics were assessed using bioequivalence criteria and evaluated using a compartmental modelling analysis .


Compared with the reference , mean asenapine exposure ( AUC@-last and AUC@ - ) was approximately @ % lower after intake of a high-fat meal prior to dosing , whereas Cmax decreased by only about @ % .


When a high-fat meal was taken @ h post-dose in the fasting state , asenapine concentrations were similar to the reference during the first @ h post-dose .


After the meal intake , asenapine concentrations decreased quickly for several hours .


Compartmental modelling indicated that a transient @-fold increase in asenapine clearance after eating could explain the asenapine concentration-time profiles for both food regimens .


To our knowledge , this is the first study investigating the effect of food upon the sublingual administration of a drug .


A high-fat meal taken before or @ h post-dose of sublingual asenapine indirectly caused a transient increase in liver blood flow that resulted in a temporal increase in asenapine clearance .


As the effects on asenapine exposure were small and not clinically relevant , no additional restrictions are required for the timing of food intake in relation to asenapine dosing .


Little is known about how the genetic variation in vitamin D modulating genes influences ultraviolet ( UV ) B-induced @-hydroxyvitamin D -LSB- @ ( OH ) D -RSB- concentrations .


In the Food with vitamin D ( VitmaD ) study , we showed that common genetic variants rs@ and rs@ in @-hydroxylase ( CYP@R@ ) and rs@ and rs@ in vitamin D binding protein ( GC ) predict @ ( OH ) D concentrations at late summer and after @-mo consumption of cholecalciferol ( vitamin D ) - fortified bread and milk .


In the current study , called the Vitamin D in genes ( VitDgen ) study , we analyzed associations between the increase in @ ( OH ) D concentrations after a given dose of artificial UVB irradiation and @ single nucleotide polymorphisms located in or near genes involved in vitamin D synthesis , transport , activation , or degradation as previously described for the VitmaD study .


Second , we aimed to determine whether the genetic variations in CYP@R@ and GC have similar effects on @ ( OH ) D concentrations after artificial UVB irradiation and supplementation by vitamin D-fortified bread and milk .


The VitDgen study includes @ healthy Danes who received @ whole-body UVB treatments with a total dose of @ or @ standard erythema doses during a @-d period in winter .


The VitmaD study included @ healthy Danish families who were given vitamin D-fortified bread and milk or placebo for @ mo during the winter .


After UVB treatments , rs@ in CYP@R@ and rs@ in GC predicted UVB-induced @ ( OH ) D concentrations as previously shown in the VitmaD study .


Compared with noncarriers , carriers of @ risk alleles of rs@ and rs@ had lowest concentrations and smallest increases in @ ( OH ) D concentrations after @ UVB treatments and largest decreases in @ ( OH ) D concentrations after @-mo consumption of vitamin D-fortified bread and milk .


Common genetic variants in the CYP@R@ and GC genes modify @ ( OH ) D concentrations in the same manner after artificial UVB-induced vitamin D and consumption of vitamin D-fortified bread and milk .


We evaluated a low-cost strategy for schools to improve the convenience and appeal of drinking water .


We conducted a group-randomized , controlled trial in @ Boston , Massachusetts , schools in April through June @ to test a cafeteria-based intervention .


Signage promoting water and disposable cups were installed near water sources .


Mixed linear regression models adjusting for clustering evaluated the intervention impact on average student water consumption over @ lunch periods .


The percentage of students in intervention schools observed drinking water during lunch nearly doubled from baseline to follow-up compared with controls ( + @ % ; P < @ ) .


The intervention was associated with a @-ounce increase in water intake across all students ( P < @ ) .


Without cups , children were observed drinking @ ( SE = @ ) ounces of water from fountains ; with cups , @ ( SE = @ ) ounces .


The percentage of intervention students observed with sugar-sweetened beverages declined ( -@ % ; P < @ ) .


The current default of providing water through drinking fountains in cafeterias results in low water consumption .


This study shows that an inexpensive intervention to improve drinking water 's convenience by providing cups can increase student water consumption .


Topical photodynamic therapy ( PDT ) for actinic keratoses ( AK ) is hampered by pain during illumination and inferior efficacy in organ-transplant recipients ( OTR ) .


We assessed ablative fractional laser ( AFL ) - assisted daylight photodynamic therapy ( PDT ) ( AFL-dPDT ) compared with daylight PDT ( dPDT ) , conventional PDT ( cPDT ) and AFL alone ( AFL ) in field treatment of AK in OTR .


In each patient , four areas in the same region were randomized to one treatment with AFL-dPDT , dPDT , cPDT and AFL .


AFL was delivered with a @-nm AFL at @ mJ per pulse , @ W , two stacks , @-s pulse-duration , @ % density .


In dPDT and AFL-dPDT , methyl aminolaevulinate ( MAL ) was applied for @ h without occlusion during daylight exposure .


For cPDT , MAL was occluded for @ h followed by red-light ( @ nm ) irradiation at @ J cm ( -@ ) .


The primary end-point was complete response ( CR ) @ months post-treatment .


Sixteen patients with @ AK ( grades I-III ) in field-cancerized skin of the scalp , chest and extremities were treated during August and September @ .


After @ months , CR ( AK I-III ) rates were @ % after AFL-dPDT , @ % after dPDT , @ % after cPDT and @ % after AFL ( P < @ ) .


CR rates in AFL-dPDT , dPDT and cPDT were also significantly different ( P = @ ) .


Median maximal pain scores differed significantly during AFL-dPDT ( @ ) , dPDT ( @ ) , AFL ( @ ) and cPDT ( @ ) ( P < @ ) .


Erythema and crusting were more intense following AFL-dPDT than dPDT and cPDT , but only transient hypopigmentation was observed .


AFL-dPDT is a novel PDT modality that enhances CR with excellent tolerability compared with dPDT and cPDT in difficult-to-treat AK in OTR .


Microprocessor knees have improved the gait and functional abilities of persons with transfemoral amputation .


The Genium prosthetic knee offers an advanced sensor and control system designed to decrease impairment by : allowing greater stance phase flexion , easing transitions between gait phases , and compensating for changes in terrain .


The aim of this study was to determine differences between the knee flexion angle of persons using the Genium knee , the C-Leg knee , and non-amputee controls ; and to evaluate the impact the prostheses on gait and level of impairment of the user .


This study used a randomized experimental crossover of persons with transfemoral amputation using the Genium and C-Leg microprocessor knees ( n = @ ) , with an observational sample of non-amputee controls ( n = @ ) .


Gait analysis by @D motion tracking of subjects ambulating at different speeds on level ground and on @ and @ ramps was completed .


Use of the Genium resulted in a significant increase in peak knee flexion for swing ( @ , p < @ , d = @ ) and stance ( @ , p < @ , d = @ ) phases relative to C-Leg use .


There was a high degree of variability between subjects , and significant differences still remain between the Genium group and the control group 's knee flexion angles for most speeds and slopes .


The Genium knee generally increases flexion in swing and stance , potentially decreasing the level of impairment for persons with transfemoral amputation .


This study demonstrates functional differences between the C-Leg and Genium knees to help prosthetists determine if the Genium will provide functional benefits to individual patients .


The present study aimed to assess the effects of two different sports training methods - traditional and maturational - on the flexibility of female rhythmic gymnasts at different levels of biological maturation .


The sample consisted of @ children , randomly divided ( by draw ) into six groups of @ children ( eight and nine-years old ) : traditional training group ( TG ) ; maturational training group ( MG ) ; and the control group ( CG ) .


These were subdivided into early , normal and late , based on biological maturation assessment by hand/wrist X-ray examination .


Flexibility was evaluated by angle goniometer testing , applying the LABIFIE protocol .


A Lafayette Goniometer Set and Hoorn-Brasil exercise mat were used and the following exercises were performed : external shoulder rotation ( ESR ) and lumbar flexion ( LF ) .


Both the TG and MG participated in twice-weekly , @-minute rhythmic gymnastics classes over @ weeks .


The TG used the traditional sports training method while the MG executed sporting activities according to biological maturation .


The CG received no special treatment .


The results showed a significant improvement ( P < @ ) in the subgroups ( late , normal and early ) for both variables ( ESR = @ and LF = @ ) in the eight and nine-year age groups .


Moreover , in relation to division by biological maturity , better results were recorded in the early subgroups .


Thus , it can be inferred that , due to the changes in important physical parameters as a result of maturation , selecting children for physical education should not be based solely on chronological , but primarily on biological maturation .


Gender differences in the prevalence of sleep apnea/hypopnea syndrome may be mediated via male sex hormones .


Our objective was to determine the exact pathway for a testosterone-mediated increased propensity for central sleep apnea via blockade of the @-reductase pathway of testosterone conversion by finasteride .


Randomization to oral finasteride vs. sham , single-center study .


Sleep research laboratory .


Fourteen healthy young males without sleep apnea .


Hypocapnia was induced via brief nasal noninvasive positive pressure ventilation during stable NREM sleep .


Cessation of mechanical ventilation resulted in hypocapnic central apnea or hypopnea .


The apnea threshold ( AT ) was defined as the end-tidal CO ( P ( ET ) CO ) that demarcated the central apnea closest to the eupneic P ( ET ) CO. .


The CO reserve was defined as the difference in P ( ET ) CO between eupnea and AT .


The apneic threshold and CO reserve were measured at baseline and repeated after at a minimum of @ month .


Administration of finasteride resulted in decreased serum dihydrotestosterone .


In the finasteride group , the eupneic ventilatory parameters were unchanged ; however , the AT was decreased ( @ @ mm Hg vs. @ @ mm Hg , P = @ ) and the CO reserve was increased ( -@ @ mm Hg vs. -@ @ mm Hg , P = @ ) at follow-up , with a significantly lower hypocapnic ventilatory response , thus indicating increased breathing stability during sleep .


No significant changes were noted in the sham group on follow-up study .


Inhibition of testosterone action via the @-reductase pathway may be effective in alleviating breathing instability during sleep , presenting an opportunity for novel therapy for central sleep apnea in selected populations .


Alternative drug therapies are needed for the treatment of portal hypertension .


The aim of this randomized study was to evaluate and compare the effects of carvedilol and nebivolol on the hepatic venous pressure gradient ( HVPG ) response in the patients with liver cirrhosis .


In total , @ cirrhotic patients were randomized into @ groups and treated with carvedilol ( n = @ ) or nebivolol ( n = @ ) .


HVPG was measured at baseline , @ minutes after the administration of carvedilol ( @ mg ) or nebivolol ( @ mg ) , and after @ days of carvedilol ( @ mg ) or nebivolol ( @ mg ) administered daily .


RESULTS .


Carvedilol significantly reduced HVPG from @ mm Hg ( SD , @ ) to @ mm Hg ( SD , @ ) after @ minutes and to @ mm Hg ( SD , @ ) after @ days ( P < @ ) .


Nebivolol reduced HVPG from @ mm Hg ( SD , @ ) to @ mm Hg ( SD , @ ) and @ mm Hg ( SD , @ ) , respectively ( P < @ ) .


Carvedilol effectively decreased HVPG in a greater proportion of the patients after an acute probe ( @ % vs. @ % ) and after @ days of the treatment ( @ % vs. @ % , P < @ ) in comparison with nebivolol .


Carvedilol and nebivolol reduce HVPG in cirrhotic patients ; however , the effect of carvedilol on the HVPG reduction might be superior to that of nebivolol , especially after @ days of treatment .


To compare the efficacy and safety of intravitreal aflibercept injection ( IAI ) with macular grid laser photocoagulation for the treatment of macular edema after branch retinal vein occlusion ( BRVO ) .


The VIBRANT study was a double-masked , active-controlled , randomized , phase III trial .


Treatment-nave eyes with macular edema after BRVO were included in the study if the occlusion occurred within @ months and best-corrected visual acuity ( BCVA ) was between @ and @ Early Treatment Diabetic Retinopathy Study ( ETDRS ) letters ( @/@-@ / @ Snellen equivalent ) .


Eyes ( @ eye per patient ) received either IAI @ mg every @ weeks ( n = @ ) from baseline to week @ or grid laser ( n = @ ) at baseline with a single grid laser rescue treatment , if needed , from weeks @ through @ .


The primary outcome measure was the proportion of eyes that gained @ ETDRS letters from baseline BCVA at week @ .


Secondary end points included mean change from baseline BCVA and central retinal thickness ( CRT ) at week @ .


The proportion of eyes that gained @ ETDRS letters from baseline at week @ was @ % in the IAI group compared with @ % in the laser group ( P = @ ) .


The mean improvement from baseline BCVA at week @ was @ ETDRS letters in the IAI group and @ ETDRS letters in the laser group ( P < @ ) .


The mean reduction in CRT from baseline at week @ was @ m in the IAI group and @ m in the laser group ( P < @ ) .


Traumatic cataract in an IAI patient was the only ocular serious adverse event ( SAE ) that occurred .


There were no cases of intraocular inflammation or endophthalmitis .


The incidence of nonocular SAEs was @ % in the IAI group and @ % in the laser group .


One Anti-Platelet Trialists ' Collaboration-defined event of nonfatal stroke ( @ % ) and @ death ( @ % ) due to pneumonia occurred during the @ weeks of the study , both in patients in the laser group .


Monthly IAI provided significantly greater visual benefit and reduction in CRT at @ weeks than grid laser photocoagulation in eyes with macular edema after BRVO .


Patients undergoing sleeve gastrectomy experience a significant amount of postoperative gastrointestinal ( GI ) symptoms .


The purpose of our study was to assess the efficacy of omentopexy during laparoscopic sleeve gastrectomy ( LSG ) in reducing postoperative food intolerance and GI symptoms .


Morbidly obese patients undergoing LSG were randomly assigned to have LSG with or without omentopexy from May @ to June @ .


A total of @ patients were recruited with @ patients in each group .


Patients and the symptom scorer were blinded as to the assigned surgery .


All procedures were performed by one of two surgeons utilizing the same surgical technique .


Patients were administered standardized surveys , including the Rhodes Index survey , gastroesophageal reflux disease ( GERD ) impact survey , and Eating Assessment Tool ( EAT ) survey at various time points postoperatively to assess nausea , vomiting , retching , frequency of GI symptoms , and level of distress .


There was no significant difference in patient age , percent decrease in BMI at any time point , or length of hospitalization between the two groups ( P > @ ) .


Furthermore , there was no significant difference in Rhodes Index scores , GERD impact scores , or EAT scores at any time point ( P > @ ) .


Patients in the LSG with omentopexy group required significantly more ondansetron perioperatively ( @ @ mg vs. @ @ mg , respectively ; P = @ ) ; however , there was no difference in metoclopramide requirement ( P = @ ) .


Surgical morbidity was not significantly different between the two groups ( P > @ ) .


Finally , there was no significant difference in number of postoperative clinic visits , office telephone encounters , total postoperative readmissions , or postoperative readmissions associated with GI symptoms ( P > @ ) .


Omentopexy did not significantly decrease postoperative food intolerance or GI symptoms in morbidly obese patients undergoing LSG .


Other methods of mitigating postoperative intolerance to oral intake and GI symptoms should be investigated .


The rehabilitation program after flexor tendon repair of zone II laceration varies .


We designed a Prospective Randomized Controlled Trial of controlled passive mobilization ( modified Kleinert ) vs. Place and active hold exercises after zone @-flexor tendon repair by two-strand suture ( Modified kessler ) .


Sixty-four fingers in @ patients with zone @ flexor tendon modified Kessler repairs were enrolled in a prospective randomized controlled trial comparing place and active hold exercises to controlled passive mobilization ( modified Kleinert ) .


The primary outcome measure was total active motion eight weeks after repair as measured by an independent and blinded therapist .


Patients treated with place and active hold exercises had significantly greater total active motion ( @ ) eight weeks after surgery than patients treated with controlled passive mobilization ( @ ) ( modified Klinert ) .


There were no ruptures in either group .


Place and hold achieves greater motion than controlled passive mobilization after a two-strand repair for zone @ flexor tendon repairs .


To determine whether directly measured arterial blood pressure differs among anatomic locations and whether arterial blood pressure is influenced by body position .


@ client-owned dogs undergoing anesthesia .


Dogs undergoing anesthetic procedures had @-gauge catheters placed in both the superficial palmar arch and the contralateral dorsal pedal artery ( group @ -LSB- n = @ -RSB- ) or the superficial palmar arch and median sacral artery ( group @ -LSB- @ -RSB- ) .


Dogs were positioned in dorsal recumbency , and mean arterial blood pressure ( MAP ) , systolic arterial blood pressure ( SAP ) , and diastolic arterial blood pressure ( DAP ) were recorded for both arteries @ times ( @-minute interval between successive measurements ) .


Dogs were positioned in right lateral recumbency , and blood pressure measurements were repeated .


Differences were detected between pressures measured at the @ arterial sites in both groups .


This was especially true for SAP measurements in group @ , in which hind limb measurements were a mean of @ mm Hg higher than carpus measurements when dogs were in dorsal recumbency and @ mm Hg higher than carpus measurements when dogs were in lateral recumbency .


Also , there was significant dispersion about the mean for all SAP , DAP , and MAP measurements .


Results suggested that arterial blood pressures may be dependent on anatomic location and body position .


Because this may affect outcomes of studies conducted to validate indirect blood pressure measurement systems , care must be used when developing future studies or interpreting previous results .


This study was designed to identify the optimal dose of an MF@-adjuvanted , monovalent , A/H@N@ influenza vaccine in healthy paediatric subjects .


Subjects aged @-@ years ( n = @ ) and @-@ years ( n = @ ) were randomized to receive two primary doses of A/H@N@ vaccine containing either @ g antigen with half a standard dose of MF@ adjuvant , @ g antigen with a full dose of MF@ , or ( children @-@ years only ) , a non-adjuvanted @ g formulation .


A booster dose of MF@-adjuvanted seasonal influenza vaccine including homologous A/H@N@ strain was given one year after priming .


Immunogenicity was assessed by haemagglutination inhibition ( HI ) and microneutralization assays .


Vaccine safety was assessed throughout the study ( up to @ months ) .


A single priming dose of either MF@-adjuvanted formulation was sufficient to meet the European licensure criteria for pandemic influenza vaccines ( HI titres @:@ > @ % ; seroconversion > @ % ; and GMR > @ ) .


Two non-adjuvanted vaccine doses were required to meet the same licensure criteria .


After first and second doses , percentage of subjects with HI titres @:@ were between @ % and @ % in the adjuvanted vaccine groups compared with @ % and @ % in the non-adjuvanted group , respectively .


Postvaccination seroconversion rates ranged from @ % to @ % in adjuvanted groups and were @ % ( first dose ) and @ % ( second dose ) in the non-adjuvanted group .


HI titres @:@ after primary doses were achieved in @ % to @ % in adjuvanted groups compared with @ % in the non-adjuvanted group .


Long-term antibody persistence after priming and a robust antibody response to booster immunization were observed in all vaccination groups .


All A/H@N@ vaccine formulations were generally well tolerated .


No vaccine-related serious adverse events occurred , and no subjects were withdrawn from the study due to an adverse event .


An MF@-adjuvanted influenza vaccine containing @ g of A/H@N@ antigen was well tolerated and sufficiently immunogenic to meet all the European licensure criteria after a single dose in healthy children @-@ years old .


To evaluate the analgesic potential of the centrally acting analgesics tramadol , morphine and the novel analgesic tapentadol in a pre-clinical research model of acute nociceptive pain , the tail-flick model in dogs .


Prospective part-randomized pre-clinical research trial .


Fifteen male Beagle dogs ( HsdCpb : DOBE ) , aged @-@ months .


On different occasions separated by at least @ week , dogs received intravenous ( IV ) administrations of tramadol ( @ , @ mg kg ( -@ ) ) , tapentadol ( @ , @ , @ mg kg ( -@ ) ) or morphine ( @ , @ , @ mg kg ( -@ ) ) with subsequent measurement of tail withdrawal latencies from a thermal stimulus ( for each treatment n = @ ) .


Blood samples were collected immediately after the pharmacodynamic measurements of tramadol to determine pharmacokinetics and the active metabolite O-demethyltramadol ( M@ ) .


Tapentadol and morphine induced dose-dependent antinociception with ED@-values of @ mg kg ( -@ ) and @ mg kg ( -@ ) , respectively .


In contrast , tramadol did not induce antinociception at any dose tested .


Measurements of the serum levels of tramadol and the M@ metabolite revealed only marginal amounts of the M@ metabolite , which explains the absence of the antinociceptive effect of tramadol in this experimental pain model in dogs .


Different breeds of dogs might not or only poorly respond to treatment with tramadol due to low metabolism of the drug .


Tapentadol and morphine which act directly on - opioid receptors without the need for metabolic activation are demonstrated to induce potent antinociception in the experimental model used and should also provide a reliable pain management in the clinical situation .


The non-opioid mechanisms of tramadol do not provide antinociception in this experimental setting .


This contrasts to many clinical situations described in the literature , where tramadol appears to provide useful analgesia in dogs for post-operative pain relief and in more chronically pain states .


This paper describes a randomized prospective study conducted in @ patients undergoing caesarean section in spinal anaesthesia at a single hospital between @ and @ to find a suitable anti-emetic strategy for these patients .


Spinal anesthesia was performed in left prone position , at L@/L@ with hyperbaric @ % Bupivacaine according to a cc/cm body height ratio .


There were no opioids given peri-operatively .


The patients received either no prophylaxis ( Group I ) or tropisetron and metoclopramide ( Group II ) or dimenhydrinate and dexamethasone ( Group III ) , or tropisetron as a single medication ( Group IV ) .


The primary outcome was nausea and/or vomiting ( NV ) in the intraoperative , early ( @-@ h ) or late ( @-@ h ) postoperative period .


Multivariate statistical analysis was conducted with a regression analysis and a backward elimination of factors without significant correlation .


All prophylactic agents significantly reduced NV incidence intraoperatively .


Relative risk reduction for NV by prophylaxis was most effective ( @ % ) in Group II ( tropisetron and metoclopramide ) .


In Group III ( dimenhydrinate and dexamethasone ) , NV risk was reduced by @ % and by @ % in Group IV ( tropisetron mono-therapy ) .


The incidence of NV in the early ( @ ?


@ h ) and the late ( @ ?


@ h ) postoperative period was low all over ( @ % ) , but the relative risk reduction of NV in the early postoperative period was @ % ( Group IV ) , @ % ( Group III ) , and @ % ( Group II ) , respectively .


In the late postoperative period , there was no significant difference between the @ groups .


We recommend a prophylactic medication with tropisetron @ mg and metoclopramide @ mg for patients during caesarean section .


These agents are safe , reasonably priced , and highly efficient in preventing nausea and vomiting .


To explore whether topical application of atropine gel controls epiphora secondary to submandibular gland ( SMG ) transplantion for severe keratoconjunctivitis sicca .


Eighteen patients with epiphora after SMG transplantation participated in a double-blind , controlled , crossover study .