IgE sensitization to Aspergillus fumigatus and a positive sputum fungal culture result are common in patients with refractory asthma .


It is not clear whether these patients would benefit from antifungal treatment .


We sought to determine whether a @-month course of voriconazole improved asthma-related outcomes in patients with asthma who are IgE sensitized to A fumigatus .


Asthmatic patients who were IgE sensitized to A fumigatus with a history of at least @ severe exacerbations in the previous @ months were treated for @ months with @ mg of voriconazole twice daily , followed by observation for @ months , in a double-blind , placebo-controlled , randomized design .


Primary outcomes were improvement in quality of life at the end of the treatment period and a reduction in the number of severe exacerbations over the @ months of the study .


Sixty-five patients were randomized .


Fifty-nine patients started treatment ( @ receiving voriconazole and @ receiving placebo ) and were included in an intention-to-treat analysis .


Fifty-six patients took the full @ months of medication .


Between the voriconazole and placebo groups , there were no significant differences in the number of severe exacerbations ( @ vs @ per patient per year , respectively ; mean difference , @ ; @ % CI , @-@ @ ) , quality of life ( change in Asthma Quality of Life Questionnaire score , @ vs @ ; mean difference between groups , @ ; @ % CI , -@ to -@ ) , or any of our secondary outcome measures .


We were unable to show a beneficial effect of @ months of treatment with voriconazole in patients with moderate-to-severe asthma who were IgE sensitized to A fumigatus on either the rate of severe exacerbations , quality of life , or other markers of asthma control .


Opioid antagonists ( e.g. , naltrexone ) and positive modulators of - aminobutyric-acidA ( GABAA ) receptors ( e.g. , alprazolam ) modestly attenuate the abuse-related effects of stimulants like amphetamine .


The use of higher doses to achieve greater efficacy is precluded by side effects .


Combining naltrexone and alprazolam might safely maximize efficacy while avoiding the untoward effects of the constituent compounds .


The present pilot study tested the hypothesis that acute pretreatment with the combination of naltrexone and alprazolam would not produce clinically problematic physiological effects or negative subjective effects and would reduce the positive subjective effects of d-amphetamine to a greater extent than the constituent drugs alone .


Eight nontreatment-seeking , stimulant-using individuals completed an outpatient experiment in which oral d-amphetamine ( @ , @ , and @ mg ) was administered following acute pretreatment with naltrexone ( @ and @ mg ) and alprazolam ( @ and @ mg ) .


Subjective effects , psychomotor task performance , and physiological measures were collected .


Oral d-amphetamine produced prototypical physiological and stimulant-like positive subjective effects ( e.g. , VAS ratings of Active/Alert/Energetic , Good Effect , and High ) .


Pretreatment with naltrexone , alprazolam , and their combination did not produce clinically problematic acute physiological effects or negative subjective effects .


Naltrexone and alprazolam each significantly attenuated some of the subjective effects of d-amphetamine .


The combination attenuated a greater number of subjective effects than the constituent drugs alone .


The present results support the continued evaluation of an opioid receptor antagonist combined with a GABAA-positive modulator using more clinically relevant experimental conditions like examining the effect of chronic dosing with these drugs on methamphetamine self-administration .


The sequencing of learning materials greatly influences the knowledge that learners construct .


Recently , learning theorists have focused on the sequencing of instruction in relation to solving related problems .


The general consensus suggests explicit instruction should be provided ; however , when to provide instruction remains unclear .


We tested the impact of conceptual instruction preceding or following mathematics problem solving to determine when conceptual instruction should or should not be delayed .


We also examined the learning processes supported to inform theories of learning more broadly .


We worked with @ second - and third-grade children .


In a randomized experiment , children received instruction on the concept of math equivalence either before or after being asked to solve and explain challenging equivalence problems with feedback .


Providing conceptual instruction first resulted in greater procedural knowledge and conceptual knowledge of equation structures than delaying instruction until after problem solving .


Prior conceptual instruction enhanced problem solving by increasing the quality of explanations and attempted procedures .


Providing conceptual instruction prior to problem solving was the more effective sequencing of activities than the reverse .


We compare these results with previous , contrasting findings to outline a potential framework for understanding when instruction should or should not be delayed .


Patient adherence to appointments is key to improving outcomes in health care .


`` No-show '' appointments contribute to suboptimal resource use .


Patient navigation and telephone reminders have been shown to improve cancer care and adherence , particularly in disadvantaged populations , but may not be cost-effective if not targeted at the appropriate patients .


In @ clinics within a large academic cancer center , patients who were considered to be likely ( the top @th percentile ) to miss a scheduled appointment without contacting the clinic ahead of time ( `` no-shows '' ) were identified using a predictive model and then randomized to an intervention versus a usual-care group .


The intervention group received telephone calls from a bilingual patient navigator @ days before and @ day before the appointment .


Over a @-month period , of the @,@ appointments scheduled , @ patient appointments were deemed to be at high risk of a `` no-show '' event .


After the patient navigation intervention , the no-show rate in the intervention group was @ % ( @ of @ ) , compared with @ % in the control group ( @ of @ ) ( P < @ ) .


Reaching a patient or family member was associated with a significantly lower no-show rate ( @ % and @ % , respectively ; P < @ and @ , respectively ) compared with leaving a message ( @ % : P = @ ) or no contact ( no-show rate , @ % : P = @ ) .


Telephone navigation targeted at those patients predicted to be at high risk of visit nonadherence was found to effectively and substantially improve patient adherence to cancer clinic appointments .


Further studies are needed to determine the long-term impact on patient outcomes , but short-term gains in the optimization of resources can be recognized immediately .


Insufficient skills in drug dose calculations increase the risk for medication errors .


Even experienced nurses may struggle with such calculations .


Learning flexibility and cost considerations make e-learning interesting as an alternative to classroom teaching .


This study compared the learning outcome and risk of error after a course in drug dose calculations for nurses with the two methods .


In a randomised controlled open study , nurses from hospitals and primary healthcare were randomised to either e-learning or classroom teaching .


Before and after a @-day course , the nurses underwent a multiple choice test in drug dose calculations : @ tasks with four alternative answers ( score @-@ ) , and a statement regarding the certainty of each answer ( score @-@ ) .


High risk of error was being certain that incorrect answer was correct .


The results are given as the mean ( SD ) .


@ men and @ women participated in the study , aged @ ( @ ) years with a working experience of @ ( @ ) years .


The number of correct answers after e-learning was @ ( @ ) and after classroom teaching @ ( @ ) ( p = @ , NS ) ; improvement were @ ( @ ) and @ ( @ ) , respectively ( p = @ , NS ) .


Classroom learning was significantly superior to e-learning among participants with a pretest score below @ .


In support of e-learning was evaluation of specific value for the working situation .


There was no difference in risk of error between groups after the course ( p = @ ) .


The study showed no differences in learning outcome or risk of error between e-learning and classroom teaching in drug dose calculations .


The overall learning outcome was small .


Weak precourse knowledge was associated with better outcome after classroom teaching .


Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube ( ETT ) cuff management .


However , the clinical impact of the volume-time curve application has not been documented .


The purpose of this study was to compare the occurrence and intensity of a sore throat , cough , thoracic pain , and pulmonary function between these @ techniques for ETT cuff management : volume-time curve technique versus minimal occlusive volume ( MOV ) technique after coronary artery bypass grafting .


A total of @ subjects were randomized into @ groups for cuff management after intubation : MOV group ( n = @ ) and volume-time curve group ( n = @ ) .


We measured cuff pressure before extubation .


We performed spirometry @ h before and after surgery .


We graded sore throat and cough according to a @-point scale at @ , @ , @ , and @ h after extubation and assessed thoracic pain at @ h after extubation and quantified the level of pain by a @-point scale .


The volume-time curve group presented significantly lower cuff pressure ( @ @ vs @ @ cm H@O ) , less incidence and intensity of sore throat ( @ h , @ vs @ % ; and @ h , @ vs @ % , P < @ ) , cough ( @ h , @ vs @ % ; and @ h , @ vs @ % , P < @ ) , thoracic pain ( @ @ vs @ @ ) , better preservation of FVC ( @ @ vs @ @ % , P = @ ) , and FEV@ ( @ @ vs @ @ % , P = @ ) compared with the MOV group .


The subjects who received the volume-time curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough , less thoracic pain , and minimally impaired pulmonary function than those subjects who received the MOV technique during the first @ h after coronary artery bypass grafting .


To investigate safety and evidence of efficacy of IBI-@ , an intravitreal , liquid , sustained drug delivery system formulated with triamcinolone acetonide ( TA ) in combination with ranibizumab ( Lucentis ) for neovascular age related macular degeneration .


Patients received a single intravitreal injection of IBI-@ containing either @ mg ( @L ) TA or @ mg ( @L ) TA followed a week later by intravitreal injection of @ mg ranibizumab .


Patients were followed monthly and underwent best corrected visual acuity testing , slit lamp biomicroscopy , dilated ophthalmoscopy , fundus photos and optical coherence tomography .


Patients received pro re nata dosing of ranibizumab .


Patients ranged in age from @ years to @years ( mean @ years ) and all completed @year follow-up .


No serious related adverse events occurred .


Ocular adverse events included mild , transient , elevated intraocular pressure in eight patients and cataract progression in three of the five phakic patients .


At @year , @ of a total @ ( @ % ) possible pro re nata re-Rx 's had been given .


Combination therapy resulted in a median number of @ re-treatments at and including month @ .


Combination therapy IBI-@ and ranibizumab was well-tolerated and resulted in fewer ranibizumab retreatments .


Transient intraocular pressure elevation and cataract progression occurred .


To estimate age at attaining Tanner stages in Ugandan/Zimbabwean HIV-infected children initiating antiretroviral therapy ( ART ) in older childhood and investigate predictors of delayed puberty , particularly age at ART initiation .


Observational analysis within a randomized trial .


Tanner staging was assessed every @ weeks from @ years of age , menarche every @ weeks and height every @-@ weeks .


Age at attaining different Tanner stages was estimated using normal interval regression , considering predictors using multivariable regression .


Growth was estimated using multilevel models with child-specific intercepts and trajectories .


Median age at ART initiation was @ years ( inter-quartile range @ , @ ) ( n = @ ) .


At the first assessment , the majority ( @ % ) were in Tanner stage @ ; median follow-up with staging was @ years .


There was a strong delaying effect of older age at ART initiation on age at attaining all Tanner stages ( P < @ ) and menarche ( P = @ ) ; in boys the delaying effect generally weakened with older age .


There were additional significant delays associated with greater impairments in pre-ART height-for-age Z-score ( P < @ ) in both sexes and pre-ART BMI-for-age in girls ( P < @ ) .


There was no evidence that pre-ART immuno-suppression independently delayed puberty or menarche .


However , older children/adolescents had significant growth spurts in intermediate Tanner stages , and were still significantly increasing their height when in Tanner stage @ ( P < @ ) .


Delaying ART initiation until older childhood substantially delays pubertal development and menarche , independently of immuno-suppression .


This highlights that factors other than CD@ , such as pubertal development , need consideration when making decisions about timing of ART initiation in older children .


To assess the effects of a patient oriented decision aid for prioritising treatment goals in diabetes compared with usual care on patient empowerment and treatment decisions .


Pragmatic randomised controlled trial .


@ general practices in the north of the Netherlands .


@ patients with type @ diabetes aged @ years at the time of diagnosis and managed in primary care between April @ and August @ : @ were allocated to the intervention group and @ to the usual care group .


The intervention comprised a decision aid for people with diabetes , with individually tailored risk information and treatment options for multiple risk factors .


The aid was intended to empower patients to prioritise between clinical domains and to support treatment decisions .


It was offered to participants before a regular diabetes check-up and to their healthcare provider during the consultation .


Four different formats of the decision aid were included for additional explorative analyses .


The primary outcome was the effects on patient empowerment for setting and achieving goals .


The secondary outcomes were changes in the prescribing of drugs to regulate glucose , blood pressure , lipids , and albuminuria .


Data were collected through structured questionnaires and automated data extraction from electronic health records during six months before and after the intervention .


Of all intervention participants , @ ( @ % ) reported to have received the basic elements of the intervention .


For the primary outcome analysis , @ intervention and @ control patients with sufficient baseline and follow-up data could be included .


The mean empowerment score increased @ on a @ point scale in the overall intervention group , which was not significantly different from that of the control group ( mean difference after adjusting for baseline @ , @ % confidence interval -@ to @ ) .


Lipid regulating drug treatment was intensified in @ % of intervention and @ % of control participants with increased cholesterol levels , which did not reach significance when the intervention was compared with the usual care group ( odds ratio @ , @ % confidence interval @ to @ ) .


Prespecified explorative analyses showed that this effect was significant for the printed version of the decision aid in comparison to usual care ( @ , @ to @ ) .


No relevant or significant changes were seen for other treatments .


We found no evidence that the patient oriented treatment decision aid improves patient empowerment by an important amount .


The aid was not used to its full extent in a substantial number of participants .


Bicalutamide blocks androgen action and is frequently used in men with non-metastatic , castration-resistant prostate cancer ( CRPC ) .


By reducing intracellular dihydrotestosterone , dutasteride ( dual @-alpha reductase inhibitor ) could increase the effectiveness of bicalutamide in this setting .


The objective of the study is therefore to prospectively evaluate dutasteride plus bicalutamide in men with asymptomatic , non-metastatic CRPC with rising prostate-specific antigen ( PSA ) .


Prostate cancer patients with rising PSA whilst on first-line androgen deprivation therapy ( ADT ) were randomised ( @:@ ) in a double-blind trial to receive bicalutamide @mg plus placebo or bicalutamide @mg plus dutasteride @ mg once daily for @ months .


Randomisation was stratified by centre ; treatment assignments were generated using GlaxoSmithKline 's RandAll System .


Subjects who completed @ months could participate in the @-year extension .


Central laboratory and study sites/monitors remained treatment-blinded .


Primary end-point was time to disease progression ( TDP ) up to @ months ( defined as PSA progression from baseline or nadir , radiographic disease progression , death from prostate cancer or receipt of rescue medication ) .


There was no statistically significant difference in TDP in @ men treated with bicalutamide/dutasteride ( n = @ ) compared with bicalutamide/placebo ( n = @ ) ( hazard ratio ( HR ) = @ -LSB- @ % confidence interval ( CI ) @ , @ -RSB- ; p = @ ) .


The estimated median TDP was @ days ( @ % CI @ , @ ) in the bicalutamide/placebo group and @ days ( @ % CI @ , @ ) in the bicalutamide/dutasteride group .


There was no statistically significant difference between the treatment groups for any secondary efficacy end-points , including time to treatment failure or PSA response .


In the multivariate analysis , age , non-White race , higher baseline testosterone and lower baseline PSA were associated with longer TDP .


Adverse events were comparable between treatment groups .


In men with non-metastatic CRPC , adding dutasteride to bicalutamide did not significantly prolong TDP .


Prospective data are provided concerning the common practice of using bicalutamide in this setting .


Menopause is the stage when the menstrual period permanently stops , and is a part of every woman 's life .


It usually occurs between the ages of @ and @ years , and is associated with hormonal , physical , and psychological changes .


Estrogen and progesterone levels play the biggest part in menopause .


In this stage , the ovaries make less estrogen and progesterone .


When the body produces less of these hormones , the parts of the body that depend on estrogen to keep them healthy will react and this often causes discomfort for women .


This study tested the impact of a complementary health approach to quality of life in menopausal women .


A community-based interventional study was conducted in selected areas in Kattankulathur Block , Kanchipuram District , Tamil Nadu , India .


A simple random sampling technique was used to select menopausal women for the study .


Of @ menopausal women identified , @ were allocated to a study group and @ to a control group .


The study group underwent yoga training for @ hours per day on @ consecutive days .


After the @-day intensive yoga training program , the menopausal women practiced yoga daily at home for @-@ minutes a day .


Along with daily yoga practice , they underwent group yoga practice for @ days a week under the supervision of one of the investigators until @ weeks .


The yoga training program consisted of Yogasanas , Pranayama ( breathing exercises ) , and meditation .


The standardized World Health Organization QoL BREF scale was used to assess the women 's quality of life .


We distributed an instruction manual on steps of selected yoga practice for the women 's self-reference at home after the @ days of continuous yoga practice .


A yoga practice diary was used to confirm regular performance of yoga .


The women in the control group did not participate in the yoga program ; however , on completion of the study , these women received intensive yoga training for @ days .


There was an extremely high statistically significant difference ( P = @ ) between the study group and the control group with regard to the physical , psychological , social , and environmental domains of quality of life after @ , @ , and @ weeks of yoga therapy .


The mean gain score was high in all the domains of quality of life in the study group at weeks @ , @ , and @ .


The overall mean gain score in the study group was @ versus @ in the control group .


The overall mean gain score difference was @ in all domains of quality of life between the study group and the control group .


In the study group , the physical , psychological , social , and environmental domains of quality of life were greatly improved by practicing yoga for @ weeks .


No adverse events were reported by the women after yoga practice .


Quality of life in menopausal women was greatly improved after @ weeks of yoga practice .


Women who regularly practice yoga find that they are able to enjoy menopause and experience the freedom , liberation , and energy that it brings .


We conclude that yoga is an effective complementary health approach for improving quality of life in menopausal women .


Constipation has a significant impact on quality of life .


Aim of this study was to evaluate the safety and the efficacy for relieving dyschezia symptoms of a CO@-releasing suppository in a randomized , placebo-controlled , clinical trial .


Fifty-three office-based primary care physicians and @ gastroenterologists conducted the study in France , between November @ and January @ .


Patients ( aged @-@ years ) with dyschezia were eligible .


Patients were randomly allocated a once-a-day suppository ( CO@-releasing suppository or placebo ) for @ days .


Primary endpoint was the change , from Day @ to Day @ , in the intensity of discomfort related to dyschezia based on a self-assessed @-@ visual analogue scale .


A total of @ patients were randomized , i.e. @ into the intervention group and @ into the placebo group .


Co-variance analysis showed a greater reduction in discomfort visual analogue scale score in the intervention group ( -@ mm ; standard error of the mean : @ mm ) than in the placebo group ( -@ mm ; standard error of the mean : @ mm ; p < @ ) .


The greater efficacy of the CO@-releasing suppository was confirmed for all secondary efficacy parameters .


No significant side effects for either treatment were observed .


A CO@-releasing suppository is more effective than a placebo for the relief of symptoms of dyschezia .


This efficacy is associated with a good safety profile .


Tubal ectopic pregnancy can be surgically treated by salpingectomy , in which the affected Fallopian tube is removed , or salpingotomy , in which the tube is preserved .


Despite potentially increased risks of persistent trophoblast and repeat ectopic pregnancy , salpingotomy is often preferred over salpingectomy because the preservation of both tubes is assumed to offer favourable fertility prospects , although little evidence exists to support this assumption .


We aimed to assess whether salpingotomy would improve rates of ongoing pregnancy by natural conception compared with salpingectomy .


In this open-label , multicentre , international , randomised controlled trial , women aged @ years and older with a laparoscopically confirmed tubal pregnancy and a healthy contralateral tube were randomly assigned via a central internet-based randomisation program to receive salpingotomy or salpingectomy .


The primary outcome was ongoing pregnancy by natural conception .


Differences in cumulative ongoing pregnancy rates were expressed as a fecundity rate ratio with @ % CI , calculated by Cox proportional-hazards analysis with a time horizon of @ months .


Secondary outcomes were persistent trophoblast and repeat ectopic pregnancy ( expressed as relative risks -LSB- RRs -RSB- with @ % CIs ) and ongoing pregnancy after ovulation induction , intrauterine insemination , or IVF .


The researchers who collected data for fertility outcomes were masked to the assigned intervention , but patients and the investigators who analysed the data were not .


All endpoints were analysed by intention to treat .


We also did a ( non-prespecified ) meta-analysis that included the findings from the present trial .


This trial is registered , number ISRCTN@ .


@ women were randomly assigned between Sept @ , @ , and Nov @ , @ , with @ allocated to salpingotomy and @ to salpingectomy .


Follow-up was discontinued on Feb @ , @ .


The cumulative ongoing pregnancy rate was @ % after salpingotomy and @ % after salpingectomy ( fecundity rate ratio @ , @ % CI @-@ ; log-rank p = @ ) .


Persistent trophoblast occurred more frequently in the salpingotomy group than in the salpingectomy group ( @ -LSB- @ % -RSB- vs @ -LSB- < @ % -RSB- ; RR @ , @-@ ) .


Repeat ectopic pregnancy occurred in @ women ( @ % ) in the salpingotomy group and @ ( @ % ) women in the salpingectomy group ( RR @ , @-@ ) .


The number of ongoing pregnancies after ovulation induction , intrauterine insemination , or IVF did not differ significantly between the groups .


@ ( @ % ) women in the salpingotomy group were converted to salpingectomy during the initial surgery because of persistent tubal bleeding .


Our meta-analysis , which included our own results and those of one other study , substantiated the results of the trial .


In women with a tubal pregnancy and a healthy contralateral tube , salpingotomy does not significantly improve fertility prospects compared with salpingectomy .


To examine the diagnostic accuracy of novel biomarkers of myocardial injury and troponin assays for diagnosis of myocardial infarction .


@ patients randomised to the point-of-care testing arm of the Randomised Assessment of Panel Assay of Cardiac markers ( RATPAC ) study in six emergency departments of low-risk patients presenting with chest pain were studied .


Blood samples were obtained on admission and @ min from admission .


Myocardial infarction was defined by the universal definition of myocardial infarction .


The following diagnostic strategies were compared by receiver operator characteristic curve analysis and comparison of area under the curve : individual marker values and the combination of presentation heart fatty acid binding protein ( HFABP ) and copeptin with troponin .


@ patients had a final diagnosis of myocardial infarction .


Admission samples were available from @/@ patients enrolled in the study .


Areas under the curve were as follows ( CIs in parentheses ) : cardiac troponin I ( cTnI ) Stratus CS @ ( @ to @ ) , cTnI Beckmann @ ( @ to @ ) , cTnI Siemens ultra @ ( @ to @ ) , cardiac troponin T high sensitivity @ ( @ to @ ) , HFABP @ @ ( @ to @ ) copeptin @ ( @ to @ ) .


HFABP and copeptin were diagnostically inferior to troponin .


The combination of HFABP ( at the @th percentile ) and troponin ( at the @th percentile ) increased diagnostic sensitivity .


High-sensitivity cardiac troponin is the best single marker .


Addition of HFABP to high-sensitivity troponin increased diagnostic sensitivity .


Additional measurement of copeptin is not useful in the chest pain population .


Multidimensional tinnitus models describe dysfunctional cognitions as a complicating factor in the process of tinnitus habituation .


However , this concept has rarely been investigated in previous research .


The present study investigated the effects of two cognitive-behavioral treatments on dysfunctional tinnitus-related cognitions in patients with chronic tinnitus .


Furthermore , dysfunctional cognitions were examined as possible predictors of the therapeutic effect on tinnitus distress .


A total of @ patients with chronic tinnitus were randomly assigned to either an Internet-delivered guided self-help treatment ( Internet-based cognitive-behavioral therapy , ICBT ) , a conventional face-to-face group therapy ( cognitive-behavioral group therapy , GCBT ) , or an active control group in the form of a web-based discussion forum ( DF ) .


To assess tinnitus-related dysfunctional thoughts , the Tinnitus Cognitions Scale ( T-Cog ) was used at pre - and post-assessment , as well as at the @ - and @-month follow-up .


Multivariate ANOVAs with post hoc tests revealed significant and comparable reductions of dysfunctional tinnitus-related cognitions for both treatments ( GCBT and ICBT ) , which remained stable over a @ - and @-month period .


Negative correlations were found between the catastrophic subscale of the T-Cog and therapy outcome for ICBT , but not for GCBT .


This means a higher degree of catastrophic thinking at baseline was associated with lower benefit from ICBT directly after the treatment .


Hierarchical regression analysis confirmed catastrophizing as a predictor of poorer therapy outcome regarding emotional tinnitus distress in ICBT .


No associations were detected in the follow-up assessments .


Both forms of CBT are successful in reducing dysfunctional tinnitus-related cognitions .


Catastrophizing significantly predicted a less favorable outcome regarding emotional tinnitus distress in ICBT .


Clinical implications of these results are described .


Dysfunctional cognitions could be targeted more intensively in therapy and in future research on tinnitus .


Handling emergency telephone consultations ( ETCs ) is a challenging and very important task for doctors .


The aims of the study were to document insecurity in medical students during ETCs and to identify the reasons for that insecurity .


We hypothesised that insecurity is associated with advising more urgent action ( e.g. advice to call for an ambulance ) in ETCs .


We used ETCs with simulated patients ( SPs ) , with each student randomly allocated two of four possible cases .


After the training , @ students reported on any insecurity that they had in the various ETC phases .


We analysed the reasons for insecurity using descriptive statistics .


The association between the students ' advice that urgent action was needed and their insecurity was analysed with Spearman rank correlation .


Overall , @ % of the students felt insecure in at least one phase of their ETC. .


History taking was the phase in which students felt most insecure ( @ % ) , followed by the phase of analysing the information given by the patient ( @ % ) .


Perceived insecurity was associated with more urgent advice in one case scenario ( abdominal pain ; correlation r = @ ; p < @ ) .


The other two cases ( child with fever ; chest pain ) also had a positive , but not statistically significant , correlation trend ( p < @ ; p < @ ) .


Insecurity is highly prevalent among medical students in their ETC decision-making .


ETC training in medical schools , with a focus on structured history taking and formulating discriminating questions , might help decrease insecurity in ETCs .


Medical education should also teach management of insecurity .


We investigated the efficacy of intravenous ( IV ) preemptive paracetamol on postoperative total fentanyl consumption and fentanyl-related side effects in patients undergoing open nephrectomy .


A total of @ patients scheduled for elective open nephrectomy under general anesthesia were included .


All patients received Patient-controlled IV analgesia with fentanyl postoperatively .


Patients were randomly allocated into three equal groups : The fentanyl group received @ mL of IV normal saline as a placebo , with the first dose ending @ min before intubation .


In paracetamol group , IV @ g paracetamol was given to the patients @ min after extubation with repeated doses every @ h totally @ times a day .


In preemptive paracetamol group , patients received IV @ g paracetamol every @ h , with the first dose ending @ min before intubation .


Postoperative cumulative fentanyl consumption for @ h was significantly higher in the fentanyl group ( @ @ g ) than those of paracetamol ( @ @ g ) and preemptive paracetamol groups ( @ @ g ) ( P = @ for both ) .


In early postoperative period ( @-@ h ) ; whereas total fentanyl consumption showed no statistically significant difference among groups ( P = @ ) , the nausea-vomiting scores were significantly higher in the fentanyl group compared with other groups ( P = @ ) .


In patients undergoing open nephrectomy , use of preemptive or postoperative paracetamol reduces fentanyl related nausea-vomiting without a decrease in total fentanyl consumption in the early postoperative period .


Furthermore , use of preemptive or postoperative paracetamol reduces total fentanyl requirements in the first @ h postoperatively providing a safe and effective postoperative analgesia .


Brain lesions on diffusion-weighted imaging ( DWI ) are frequently found after carotid artery stenting ( CAS ) , but their clinical relevance remains unclear .


This study sought to investigate whether periprocedural ischemic DWI lesions after CAS or carotid endarterectomy ( CEA ) are associated with an increased risk of recurrent cerebrovascular events .


In the magnetic resonance imaging ( MRI ) substudy of ICSS ( International Carotid Stenting Study ) , @ patients with symptomatic carotid stenosis were randomized to undergo CAS ( n = @ ) or CEA ( n = @ ) .


MRIs were performed @ to @ days before and @ to @ days after treatment .


The primary outcome event was stroke or transient ischemic attack in any territory occurring between the post-treatment MRI and the end of follow-up .


Time to occurrence of the primary outcome event was compared between patients with ( DWI + ) and without ( DWI - ) new DWI lesions on the post-treatment scan in the CAS and CEA groups separately .


Median time of follow-up was @ years ( interquartile range : @ to @ ) .


In the CAS group , recurrent stroke or transient ischemic attack occurred more often among DWI + patients ( @ of @ ) than among DWI - patients ( @ of @ ) , with a cumulative @-year incidence of @ % ( standard error -LSB- SE -RSB- : @ % ) and @ % ( SE : @ % ) , respectively ( unadjusted hazard ratio : @ ; @ % confidence interval : @ to @ ; p = @ ) .


In DWI + and DWI - patients , @ and @ events , respectively , occurred within @ months after treatment .


In the CEA group , there was no difference in recurrent cerebrovascular events between DWI + and DWI - patients .


Ischemic brain lesions discovered on DWI after CAS seem to be a marker of increased risk for recurrent cerebrovascular events .


Patients with periprocedural DWI lesions might benefit from more aggressive and prolonged antiplatelet therapy after CAS .


( A Randomised Comparison of the Risks , Benefits and Cost Effectiveness of Primary Carotid Stenting With Carotid Endarterectomy : International Carotid Stenting Study ; ISRCTN@ ) .


Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting .


We investigated the effectiveness and safety of midwives diagnosing and treating incomplete abortion with misoprostol , compared with physicians .


We did a multicentre randomised controlled equivalence trial at district level at six facilities in Uganda .


Eligibility criteria were women with signs of incomplete abortion .


We randomly allocated women with first-trimester incomplete abortion to clinical assessment and treatment with misoprostol either by a physician or a midwife .


The randomisation ( @:@ ) was done in blocks of @ and was stratified for study site .


Primary outcome was complete abortion not needing surgical intervention within @-@ days after initial treatment .


The study was not masked .


Analysis of the primary outcome was done on the per-protocol population with a generalised linear-mixed effects model .


The predefined equivalence range was -@ % to @ % .


The trial was registered at ClinicalTrials.gov , number NCT@ .


From April @ , @ , to July @ , @ , @ women were assessed for eligibility .


@ women were randomly assigned to each group ( @ to midwife group and @ to physician group ) .


@ women ( @ in the midwife group and @ in the physician group ) were included in the per-protocol analysis .


@ ( @ % ) of women in the midwife group had complete abortion and @ ( @ % ) in the physician group .


The model-based risk difference for midwife versus physician group was -@ % ( @ % CI -@ to @ ) , falling within the predefined equivalence range ( -@ % to @ % ) .


The overall proportion of women with incomplete abortion was @ % ( @/@ ) , similarly distributed between the two groups ( @ % -LSB- @/@ -RSB- in the midwife group , @ % -LSB- @/@ -RSB- in the physician group ) .


No serious adverse events were recorded .


Diagnosis and treatment of incomplete abortion with misoprostol by midwives is equally safe and effective as when provided by physicians , in a low-resource setting .


Scaling up midwives ' involvement in treatment of incomplete abortion with misoprostol at district level would increase access to safe post-abortion care .


Much of the existing literature on physical activity ( PA ) interventions involves physically inactive individuals recruited from community settings rather than clinical practice settings .


Recruitment of patients into interventions in clinical practice settings is difficult due to limited time available in the clinic , identification of appropriate personnel to efficiently conduct the process , and time-consuming methods of recruitment .


The purpose of this report is to describe the approach used to identify and recruit veterans from the Veterans Affairs ( VA ) Pittsburgh Healthcare System Primary Care Clinic into a randomized controlled PA study .


A sampling frame of veterans was developed using the VA electronic medical record .


During regularly scheduled clinic appointments , primary care providers ( PCPs ) screened identified patients for safety to engage in moderate-intensity PA and willingness to discuss the study with research staff members .


Research staff determined eligibility with a subsequent telephone screening call and scheduled a research study appointment , at which time signed informed consent and baseline measurements were obtained .


Of the @,@ veterans in the sampling frame who were scheduled for a primary care appointment during the study period , @,@ ( @ % ) were seen in the clinic and screened by the PCP ; moderate-intensity PA was deemed safe for @,@ ( @ % ) , @ ( @ % ) agreed to be contacted for further screening , @ ( @ % ) were eligible for the study , and @ ( @ % ) enrolled .


Using a semiautomated screening approach that combined an electronically-derived sampling frame with paper and pencil prescreening by PCPs and research staff , VA-STRIDE was able to recruit @ in @ veterans in the sampling frame .


Using this approach , a high proportion of potentially eligible veterans were screened by their PCPs .


We tested the hypothesis that clevidipine , a rapidly acting dihydropyridine calcium channel blocker , is not inferior to nitroglycerin ( NTG ) in controlling blood pressure before cardiopulmonary bypass ( CPB ) during coronary artery bypass grafting ( CABG ) .


In this double-blind study from October @ , @ to April @ , @ , @ patients undergoing CABG with CPB were randomized at four centres to receive intravenous infusions of clevidipine ( @-@gkg ( -@ ) min ( -@ ) ) or NTG ( @ gkg ( -@ ) min ( -@ ) to a clinician-determined maximum dose rate ) from induction of anesthesia through @hr postoperatively .


The study drug was titrated in the pre-CPB period with the aim of maintaining mean arterial pressure ( MAP ) within @mmHg of a clinician-predetermined target .


The primary endpoint was the area under the curve ( AUC ) for the total time each patient 's MAP was outside the target range from drug initiation to the start of CPB , normalized per hour ( AUCMAP-D ) .


The predefined non-inferiority criterion for the primary endpoint was a @ % confidence interval ( CI ) upper limit no greater than @ for the geometric means ratio between clevidipine and NTG .


Total mean -LSB- standard deviation ( SD ) -RSB- dose pre-bypass was @ ( @ ) mg for clevidipine and @ ( @ ) mg for NTG ( P < @ ) .


The geometric mean AUCMAP-D for clevidipine was @mmHgminhr ( -@ ) ( n = @ ) and for NTG was @mmHgminhr ( -@ ) ( n = @ ) ; the geometric means ratio was @ ( @ % CI @ to @ ) .


The geometric mean AUCMAP-D during aortic cannulation was @ mmHgminhr ( -@ ) for clevidipine compared with @ mmHgminhr ( -@ ) for NTG .


Mean ( SD ) heart rate with clevidipine was @ ( @ ) beatsmin ( -@ ) compared with @ ( @ ) beatsmin ( -@ ) for NTG .


There were no clinically important differences between groups in adverse events .


During CABG , clevidipine was not inferior to NTG for blood pressure control pre-bypass .


To observe the efficacy of bromfenac sodium eye drops on relieving the irritative symptoms after LASEK surgery .


Sixty-four people who had received LASEK surgery were randomly divided into two groups , observing the right eye for each group .


group A was given @ % bromfenac sodium eye drops twice a day in three days before surgery and one day after surgery ; group B was given @ % ketorolac tromethamine ( acular ) eye drops four times a day in three days before surgery and on day after surgery .


In the @ ( st ) , @ ( rd ) , @ ( th ) and @ ( th ) day after surgery , irritative symptoms grade , duration of irritation , time for corneal epithelial healing , and uncorrected visual acuity were observed and compared between the two groups .


@ % no discomfort in group A with bromfenac sodium eye drops was observed while @ % ketorolac tromethamine eye drops caused tingling , burning discomfort that lasted for @-@ seconds in @ of the @ subjects ( @ % ) .


No significant difference was observed between the irritation grades of group A and B ( Z = -@ , P = @ ) ; the duration of irritative symptom was significantly shorter in group A than that in group B ( Z = -@ , P = @ ) .


No significant difference was observed between the time of healing and visual acuity recovery of the two groups .


@ % bromfenac sodium eye drops can effectively relieve the post-LASEK irritative symptoms , and it is better tolerated than @ % ketorolac tromethamine eye drops .


Postnatal common mental disorders among women are an important public health problem internationally .


Interventions to prevent postnatal depression have had limited success .


What Were We Thinking ( WWWT ) is a structured , gender-informed , psychoeducational group programme for parents and their first infant that addresses two modifiable risks to postnatal mental health .


This paper describes the protocol for a cluster randomised controlled trial to test the clinical effectiveness and cost-effectiveness of WWWT when implemented in usual primary care .


@ maternal and child health ( MCH ) centres from six diverse Local Government Areas , in Victoria , Australia are randomly allocated to the intervention group ( usual care plus WWWT ) or the control group ( usual care ) .


The required sample size is @ women in each group .


English-speaking primiparous women receiving postpartum healthcare in participating MCH centres complete two computer-assisted telephone interviews : baseline at @weeks and outcome at @months postpartum .


Women attending intervention MCH centres are invited to attend WWWT in addition to usual care .


The primary outcome is meeting Diagnostic and Statistical Manual-IV ( DSM-IV ) diagnostic criteria for major depressive episode ; generalised anxiety disorder ; panic disorder with or without agoraphobia , agoraphobia with or without panic , social phobia , adult separation anxiety or adjustment disorder with depressed mood , anxiety or mixed depressed mood and anxiety within the past @days at @months postpartum .


Secondary outcomes are self-rated general and emotional health , infant sleep problems , method of infant feeding , quality of mother-infant relationship and intimate partner relationship , and healthcare costs and outcomes .


To evaluate the efficacy of the surgical fat-filling procedure ( SFFP ) in the treatment of refractory cough and quality of life ( QOL ) after systematic mediastinal lymphadenectomy in patients with right lung cancer .


This is a blinded , randomized , controlled clinical trial to evaluate refractory cough and QOL in patients after mediastinal lymphadenectomy for lung cancer .


One hundred eligible lung cancer patients were randomly divided into two groups : the fat-filling group and non-filling group .


In the fat-filling group , post-lymphadenectomy residual cavities ( PLRCs ) were filled with fatty tissue autografts after lymph node dissection .


In the non-filling group , the PLRCs remained unfilled .


Clinical endpoints were postoperative cough score and QOL .


The SFFP did not increase intraoperative bleeding , extend operation time , or hospital stay .


Further , night cough was significantly improved after @wk in the fat-filling group after the removal of a chest drainage tube .


QOL issues , such as emotional condition , functional status , and additional concerns , demonstrated a remarkable improvement in the fat-filling group at postoperative @mo compared with the non-filling ( control ) group .


This study demonstrates that filling PLRCs with fatty tissue autografts is a safe and partially effective treatment for refractory cough after major pulmonary resection and mediastinal lymphadenectomy .


This novel procedure significantly improved patient QOL and may prove useful as a relatively safe preventive surgical adjunct operation for refractory cough .


Modafinil has been reported to benefit a subgroup of patients suffering severe fatigue while undergoing chemotherapy .


Docetaxel is associated with fatigue that may lead to premature therapy withdrawal .


We investigated whether modafinil could reduce fatigue during docetaxel chemotherapy .


This multicenter , randomized , double-blind , placebo-controlled study evaluated the efficacy of modafinil in patients with metastatic prostate or breast cancer undergoing docetaxel chemotherapy ( every @ days ; minimum dose @ mg/m ( @ ) ) .


At the start of their third or subsequent chemotherapy cycle , patients with significant docetaxel-associated fatigue were randomized to receive concurrent modafinil @ mg/day or placebo for @ days ( `` treatment periods '' ( TP ) ) .


Docetaxel was continued for up to four further cycles .


Fatigue was evaluated with the fatigue component of the MD Anderson Symptom Inventory ( MDASI ) .


The primary endpoint was cumulative MDASI area under the curve ( AUC ) during the first @ days of study medication during TP@ and TP@ .


Evaluable data were available from @ patients ( @ with prostate cancer ) .


There was no statistically significant difference between the two treatment arms for the primary endpoint ( MSADI AUC@-@ @ vs @ ; @ % confidence interval -@ , @ ; P = @ ) .


Overall toxicity was comparable between treatment groups ; however , the incidence of grade @ nausea and vomiting was higher in the modafinil arm ( @ vs @ % ) .


Assessing and managing chemotherapy-related fatigue remains a major challenge .


There was a lack of difference between the two arms in the planned primary endpoint .


However , there was a modest but consistent trend towards improvement of docetaxel-related fatigue in those treated with modafinil .


Based on the study findings , modafinil for the treatment of fatigue associated with docetaxel chemotherapy elicits modest improvements .


Larger , longer term , randomized , controlled studies are required to clarify the exact role of modafinil in the treatment of docetaxel-related fatigue .


Topiramate ( TOP ) and anticonvulsants in general are considered safe and effective drugs for the treatment of alcohol dependence , even though TOP-induced adverse events are quite common , especially for high initial doses or if titration to @ mg/d is too rapid .


The aim of the present study was to assess the efficacy and tolerability profile of low-dose TOP for relapse prevention .


After detoxification , @ patients were randomized into @ groups as follows : @ patients received @ mg of TOP ( oral , twice daily ) , titrated over @ weeks , and @ patients received placebo ( PLA ) .


Both groups underwent rehabilitation twice a week .


After @ weeks of treatment , compared with the PLA group , patients receiving TOP showed the following : ( @ ) fewer drinking days ( P < @ ) ; ( @ ) less daily alcohol consumption ( P < @ ) ; ( @ ) more days of treatment ( P < @ ) ; ( @ ) reduced levels of craving ( Obsessive-Compulsive Drinking Scale ) and withdrawal symptoms ( Clinical Institute Withdrawal Assessment for Alcohol-Revised ) ; and ( @ ) improvement of anxiety , depression , and obsessive-compulsive symptom severity ( Symptom Check List @ Revised ) .


Despite the small sample size and the short follow-up period , the present PLA-controlled study demonstrated the potential usefulness of TOP , even when administered at a dosage of @ mg/d , for the treatment of detoxified alcohol-dependent subjects , confirming results from previous studies testing higher doses of TOP .


Sympathectomy is currently used as the fourth step of the modified World Health Organization ( WHO ) analgesic ladder .


Sympathectomy can be performed early , before the second step on the ladder .


We hypothesized that early sympathectomy would reduce pain and opioid consumption and improve quality of life .


One hundred nine patients , with inoperable abdominal or pelvic cancer , reporting visceral pain of @-@ on a visual analogue scale and taking nonopioid analgesics were allocated randomly into two groups : either blocks were performed before Step @ of the WHO ladder , then analgesics were managed according to the ladder ( Group I ) or analgesics were given according to the WHO ladder , and blocks were performed as the fourth step after failure of strong opioids to control pain ( Group II ) .


Visual analogue scale scores , responder analysis , daily opioid consumption , related side effects , and quality of life were assessed .


Responders were significantly higher in Group I ( P < @ ) , and partial responders and nonresponders significantly increased in Group II ( P < @ and @ , respectively ) .


Opioid consumption significantly decreased in Group I ( P < @ during first @ months and @ at the last assessment time ) , with concomitant significant reduction in related side effects .


The number of patients who had a good analgesic response on tramadol significantly increased in Group I during the first five months ( P < @ ) .


European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core @ global quality-of-life subscale scores revealed significant improvement until the fifth month in Group I ( P < @ ) .


Sympathectomy before Step @ on the WHO analgesic ladder seems to lead to better pain control , less opioid consumption , and better quality of life in cancer patients .


To study the effects of oromucosal detomidine gel administered sublingually to calves prior to disbudding , and to compare its efficacy with intravenously ( IV ) administered detomidine .


Randomised , prospective clinical study .


Twenty dairy calves aged @ @ days ( mean SD ) , weight @ @ kg .


Detomidine at @ g kg ( -@ ) was administered to ten calves sublingually ( GEL ) and at @ g kg ( -@ ) to ten control calves IV ( V. jugularis ) .


Meloxicam ( @ mg kg ( -@ ) ) and local anaesthetic ( lidocaine @ mg kg ( -@ ) ) were administered before heat cauterization of horn buds .


Heart rate ( HR ) , body temperature and clinical sedation were monitored over @ minutes .


Blood was collected from the V. cephalica during the same period for drug concentration analysis .


Pharmacokinetic variables were calculated from the plasma detomidine concentration-time data using non-compartmental methods .


Statistical analyses compared routes of administration by Student 's t-test and linear mixed models as relevant .


The maximum plasma detomidine concentration after GEL was @ @ ng mL ( -@ ) ( mean SD ) and the time of maximum concentration was @ @ minutes .


The bioavailability of detomidine was approximately @ % with GEL .


Similar sedation scores were reached in both groups after administration of detomidine , but maximal sedation was reached earlier in the IV group ( @ minutes ) than in the GEL group ( @ minutes ) .


HR was lower after IV than GEL from @ to @ minutes after administration .


All animals were adequately sedated , and we were able to administer local anaesthetic without resistance to all of the calves before disbudding .


Oromucosally administered detomidine is an effective sedative agent for calves prior to disbudding .


Several studies have demonstrated that local ischemic preconditioning can reduce myocardial ischemia-reperfusion injury in cardiac surgery patients ; however , preconditioning has not become a standard cardioprotective intervention , primarily because of the increased risk of atheroembolism during repetitive aortic cross-clamping .


In the present study , we aimed to describe and validate a novel technique of preconditioning induction .


Patients undergoing coronary artery bypass grafting ( @ women and @ men ; mean age , @years ) were randomized into @ groups : ( @ ) Controls ( n = @ ) , ( @ ) Perfusion ( n = @ ) , and ( @ ) Preconditioning ( n = @ ) .


All patients were operated under cardiopulmonary bypass using normothermic blood cardioplegia .


Preconditioning was induced by subjecting the hemodynamically unloaded heart to @cycles of @min of ischemia and @min of reperfusion with normokalemic blood prior to cardioplegia .


In the Perfusion group , the heart perfusion remained unaffected for @min .


Troponin I ( TnI ) levels were analyzed before surgery , and @ , @ , @h , and @days after surgery .


The secondary endpoints included the cardiac index , plasma natriuretic peptide level , and postoperative use of inotropes .


Preconditioning resulted in a significant reduction in the TnI level on the @th postoperative day only ( @ and @ ng/ml in Preconditioning and Perfusion groups , respectively , P < @ ) .


In addition , cardiac index was significantly higher in the Preconditioning group than in the Control and Perfusion groups just after weaning from cardiopulmonary bypass .


The number of patients requiring inotropic support with@ agents after surgery was significantly lower in the Preconditioning and Perfusion group than in the Control group ( P < @ ) .


No complications of the procedure were recorded in the Preconditioning group .


The preconditioning procedure described can be performed safely in cardiac surgery patients .


The application of this technique of preconditioning was associated with certain benefits , including improved left ventricular function after weaning from cardiopulmonary bypass and a reduced need for inotropic support .


However , the infarct-limiting effect of preconditioning in the early postoperative period was not evident .


The procedure does not involve repetitive aortic cross-clamping , thus avoiding possible embolic complications .


Minimal-change nephrotic syndrome ( MCNS ) is a common cause of steroid sensitive nephrotic syndrome ( NS ) with frequent relapse .


Although steroids and calcineurin inhibitors ( CNIs ) are the cornerstone treatments , the use of rituximab ( RTX ) , a monoclonal antibody targeting B cells , is an efficient and safe alternative in childhood .


Because data from adults remain sparse , we conducted a large retrospective and multicentric study that included @ adults with MCNS and receiving RTX .


Complete ( NS remission and withdrawal of all immunosuppressants ) and partial ( NS remission and withdrawal of at least one immunosuppressants ) clinical responses were obtained for @ and @ patients , respectively ( overall response @ % ) , including @ patients that only received RTX and had a complete clinical response .


After a follow-up time of @ months ( @-@ ) , relapses occurred in @ responder patients -LSB- @ % , median time @ months ( @-@ ) -RSB- .


Seventeen of these received a second course of RTX and then had a complete ( n = @ ) or partial ( n = @ ) clinical response .


From multivariate analysis , on-going mycophenolate mofetil ( MMF ) therapy at the time of RTX was the only predictive factor for RTX failure -LSB- HR = @ @ % CI ( @-@ @ ) , P = @ -RSB- .


Interestingly , nine patients were still in remission at @ months ( @-@ ) after B-cell recovery .


No significant early or late adverse event occurred after RTX therapy .


RTX is safe and effective in adult patients with MCNS and could be an alternative to steroids or CNIs in patients with a long history of relapsing MCNS .


Extracorporeal circulation ( ECC ) of blood during cardiopulmonary surgery has been shown to stimulate various proinflammatory molecules such as cytokines and chemokines .


The biochemical oxidation/reduction pathways of - lipoic acid suggest that it may have antioxidant properties .


In this study we aimed to evaluate only patients with coronary heart disease and those planned for coronary artery bypass graft operation .


Blood samples were obtained from the patients before the operation ( P@ ) and one ( P@ ) , four ( P@ ) , @ ( P@ ) and @ hours ( P@ ) after administration of - lipoic acid ( LA ) .


The patients were divided into two groups , control and LA treatment group .


Levels of interleukin - @ ( IL-@ ) and -@ ( IL-@ ) , complement @ ( C@ ) and @ ( C@ ) , anti-streptolysin ( ASO ) , C-reactive protein ( CRP ) and haptoglobin were assessed in the blood samples .


Cytokine IL-@ and IL-@ levels were significantly higher after surgery .


Compared with the control groups , LA significantly decreased IL-@ and IL-@ levels in a time-dependent manner .


CRP levels did not show significant variation in the first three time periods .


CRP levels were higher after surgery , especially in the later periods .


These results demonstrate that CRP formation depends on cytokine release .


C@ and C@ levels were significantly higher after surgery than in the pre-operative period .


LA treatment decreased C@ and C@ levels .


Therefore , LA administration may be useful for the treatment of diseases and processes where excessive cytokine release could cause oxidative damage .


Our findings suggest a possible benefit of using LA during cardiac surgery to reduce cytokine levels .


To study the intraocular distribution and safety of polymethylmethacrylate nanoparticles loaded with carboplatin after posterior subtenon injection in humans .


Prospective , interventional , comparative case series .


Six patients ( mean age : @ @ years ) , scheduled to undergo planned uniocular enucleation in aninstitutional setting , were randomly divided into @ groups .


Each group received a @mg/mL posterior subtenon injection of nanoparticle carboplatin in the eye to be enucleated .


Two eyes were enucleated @ , @ and @ hours post injection .


Intravenous blood was collected during enucleation .


The concentration of carboplatin reaching various intraocular tissues was determined by inductively coupled plasma atomic emission spectroscopy .


The drug toxicity in the ocular tissues was assessed by histopathology and high-resolution transmission electron microscopy .


The highest level of carboplatin was detected in retinas ( @ @ mg/g ) , up to @ hours post treatment .


The intravitreal concentration continued to increase gradually until @ hours ( @ @ mg/g ) .


The choroids and lenses showed very low levels of carboplatin after @ hours , with negligible amounts at @ hours .


No signs of tissue damage were observed on histopathology or electron microscopy .


Intravenous concentration of carboplatin was undetectable in all patients .


Results may indicate an increased facilitated trans-scleral transport of nanoparticle carboplatin , with a sustained-release behavior but without any associated short-term ocular or systemic side effects in humans .


The very high concentrations achieved in vitreous and retina after a single posterior subtenon injection may be clinically useful for adjunctive treatment of advanced intraocular retinoblastoma with vitreous seeds .


However , further studies are needed to assess long-term toxicity andclinical efficacy .


Serial wide-field fluorescein angiography was performed on eyes with preproliferative ( ischemic ) central retinal vein occlusion to evaluate retinal perfusion .


Serial wide-field fluorescein angiography was performed on @ preproliferative central retinal vein occlusion eyes in the @-year Rubeosis Anti-VEGF ( RAVE ) trial using the Staurenghi lens ( Ocular Staurenghi @SLO Retina Lens ) with a scanning laser ophthalmoscope ( Heidelberg HRA Spectralis ) .


`` Disk area '' was defined anatomically for each eye .


Mean total field of gradable retina was @ disk areas ( range , @-@ ) .


All eyes demonstrated extensive areas of retinal nonperfusion ; at baseline , mean area of retinal perfusion was @ disk areas ( range , @-@ ) , correlating with a mean of @ % perfused retinal area ( range , @-@ @ % ) .


The area of retinal nonperfusion increased in all eyes with a mean loss of approximately @ % of perfused retinal area per year ( range , @-@ @ % ) , which corresponded to a mean @-disk areas ( range , @-@ ) of retina evolving from perfused to nonperfused annually .


The extent of baseline and final nonperfusion was not significantly different between eyes that developed neovascularization and eyes that did not .


In this population of severe central retinal vein occlusion eyes , profound retinal nonperfusion was observed with wide-field fluorescein angiography at baseline and the extent of nonperfusion progressed while undergoing anti-vascular endothelial growth factor therapy .


To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair ( EVAR ) .


The postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators .


Glucocorticoids may reduce postoperative inflammatory responses and enhance recovery , but with limited information on EVAR .


A single-center , randomized , double-blind , placebo-controlled trial of @ patients undergoing elective EVAR between November @ and January @ .


Patients received @ mg/kg of methylprednisolone ( MP ) ( n = @ ) or placebo ( n = @ ) preoperatively .


Primary outcome was a modified version of the systemic inflammatory response syndrome .


Secondary outcome measures were the effect on inflammatory biomarkers , morbidity , and time to meet discharge criteria .


Of @ randomized patients , @ ( @ % ) were evaluated for the primary outcome .


MP reduced systemic inflammatory response syndrome from @ % to @ % ( P < @ ) ( number needed to treat = @ ) , maximal plasma interleukin @ from @ pg/mL -LSB- interquartile range ( IQR ) = @-@ pg/mL -RSB- to @ pg/mL ( IQR = @-@ pg/mL ) ( P < @ ) and fulfillment of discharge criteria was shorter -LSB- @ days ( IQR = @-@ days ) vs @ days ( IQR = @-@ days ) -RSB- ( P < @ ) .


C-reactive protein , temperature , interleukin @ , and soluble tumor necrosis factor receptor were also reduced ( P < @ ) by MP .


Myeloperoxidase , D-dimer , and matrix metalloproteinase @ were not modified .


No differences in @-day medical ( @ % vs @ % ) ( P = @ ) or surgical ( @ % vs @ % ) morbidity were found in the active group versus the placebo group .


Preoperative MP attenuates the inflammatory response with a faster recovery after EVAR for abdominal aortic aneurysms .


Further safety and dose-response studies are required to allow recommendations for general practice .


The present study tested the hypothesis that pretreatment with metformin decreases postprocedural myocardial injury and improves clinical outcomes in metabolic syndrome patients following percutaneous coronary intervention ( PCI ) .


We enrolled @ metabolic syndrome patients with no prior history of metformin treatment .


Patients scheduled for elective coronary intervention were randomized to the metformin or control group @ days before the procedure .


Creatine kinase-MB ( CK-MB ) and troponin I levels were measured at baseline and @ and @ h after the procedure , and clinical outcomes were monitored for @ year .


Post-PCI myocardial injury as indicated by CK-MB elevation ( @ vs. @ % , p = @ ) and troponin I elevation ( @ vs. @ % , p = @ ) was significantly lower in the metformin group than in the control group .


Postprocedural peak values of CK-MB ( @ @ vs. @ @ ng/ml , p < @ ) and troponin I ( @ @ vs. @ @ ng/ml , p = @ ) were also significantly lower in the metformin group than in the control group .


At @ year , the composite endpoint of death from any cause , post-PCI myocardial infarction ( MI ) , MI after PCI hospitalization or ischemia-driven target lesion revascularization occurred in @ % of metformin-treated patients and @ % of controls ( hazard ratio @ , @ % CI @-@ @ , log rank p = @ ) .


A @-day metformin pretreatment regimen ( @ mg @ times a day ) significantly reduces postprocedural myocardial injury and improves @-year clinical outcomes in metabolic syndrome patients undergoing PCI .


To evaluate tooth position after six and @ months of orthodontics with conventional brackets on one side of the dentition and ligature-less brackets on the other .


Orthodontic Division , Vienna Medical University .


Twenty patients aged @ @ years , symmetrical malocclusion and arch form , no premolar extraction .


Prospective split-mouth study , @-inch SmartClip self-ligating brackets assigned randomly to the left or right dentition , conventional @-inch brackets on the other side .


@ dental landmarks , digitized on plaster casts , represented dental arches at baseline ( t@ ) , @ months and @ months ( t@ , t@ ) .


During t@-t@ , we used @ and @ x @ inch superelastic wires , during t@-t@ connected reverse-curve hemiarch wires : @ x @ inch - titanium on the ligature-less side , and @ x @ inch Elgiloy multiloop wires on conventional brackets .


Morphometric analyses were used to assess differences in dental arch shapes .


Neither initial alignment nor the reverse-curve phase showed statistically significant differences between ligature-less and conventional brackets in moving teeth .


Morphometric shape analyses corroborated current evidence that self-ligating brackets were no more effective than conventional brackets with steel ligatures after @-month initial alignment .


From months @-@ treatment with - titanium reverse-curve wires on @-inch ligature-less brackets resulted in similar tooth positions as accomplished by Elgiloy multiloop wires on @-inch steel-ligature-tied brackets .


To examine the effect of cognitive-behavioral therapy for insomnia ( CBTI ) on sleep improvement , daytime symptoms , and quality of life ( QOL ) in breast cancer survivors ( BCSs ) after cancer treatment .


A prospective , longitudinal , randomized , controlled trial .


Oncology clinics , breast cancer support groups , and communities in Colorado .


@ middle-aged BCSs with chronic insomnia .


Women were randomly assigned to CBTI or behavioral placebo treatment ( BPT ) and completed measures of sleep , QOL , functioning , fatigue , and mood at baseline , postintervention , and at three - and six-month follow-ups .


Sleep outcomes ( e.g. , sleep efficiency , sleep latency , total sleep time , wake after sleep onset , number of nightly awakenings ) ; secondary variables included sleep medication use , insomnia severity , QOL , physical function , cognitive function , fatigue , depression , anxiety , and sleep attitudes or knowledge .


Sleep efficiency and latency improved more in the CBTI group than the BPT group ; this difference was maintained during follow-up .


Women in the CBTI group had less subjective insomnia , greater improvements in physical and cognitive functioning , positive sleep attitudes , and increased sleep hygiene knowledge .


No group differences in improvement were noted relative to QOL , fatigue , or mood .


Nurse-delivered CBTI appears to be beneficial for BCSs ' sleep latency/efficiency , insomnia severity , functioning , sleep knowledge , and attitudes more than active placebo , with sustained benefit over time .


Oncology nurses are in a unique position to identify insomnia in cancer survivors .


When sleep disturbances become chronic , nurses need to make recommendations and referrals .


To observe changes of brain glucose metabolism by needling at Waiguan ( SJ@ ) in cerebral infraction ( CI ) patients using @F-fluorodeoxyglucose ( FDG ) positron-emission computer tomography ( PET/CT ) , thus exploring its effect and mechanisms .


A total of @ patients with CI were recruited in this study .


The location of lesion was limited to the left basal ganglia by CT or MRI scan .


All patients were randomly assigned to three groups .


i.e. , the acupoint group ( Group A ) , the non-acupoint group ( Group B ) , the blank control group ( Group C ) , @ in each group .


Patients in Group A were needled at right Waiguan ( SJ@ ) .


Those in Group B were needled at non-acupoint -LSB- @ mm beside Waiguan ( SJ@ ) -RSB- , whereas those in Group C did not receive any treatment .


All patients underwent PET/CT head scan .


All data were statistically analyzed using SPSS @ Software and SPM@ Software .


Compared with Group C , glucose metabolism increased in bilateral superior temporal gyrus ( BA@ ) , right superior frontal gyrus ( BA@ ) , left cingulate gyrus ( BA@ ) , left culmen and pyramid of cerebellum , and right cerebellar tonsil of cerebellum in Group A. Compared with Group C , glucose metabolism increased in bilateral superior frontal gyrus ( BA@ , BA@ , BA@ ) , bilateral middle frontal gyrus ( BA@ , BA@ ) , left middle frontal gyrus ( BA@ ) , bilateral uncus of limbic lobe ( BA@ , BA@ ) , left cingulate gyrus ( BA@ , BA@ ) , left posterior cingulate gyrus ( BA@ ) , left precuneus ( BA@ ) , left inferior parietal lobule ( BA@ ) , and left lingual gyrus of occipital lobe ( BA@ ) in Group B. Compared with Group B , glucose metabolism increased in bilateral superior temporal gyrus ( BA@ , BA@ ) , right inferior frontal gyrus ( BA@ ) , left culmen and cerebellar tonsil of cerebellum in Group A. Activated encephalic regions of needling at Waiguan ( SJ@ ) were mainly dominated in the healthy side , bilateral superior temporal gyrus , and right inferior frontal gyrus .


Activated encephalic regions of cerebellum were located at the left cerebellar hemisphere , left culmen of anterior cerebella lobe , and bilateral cerebellar tonsil of posterior cerebella lobe .


Needling at Waiguan ( SJ@ ) of CI patients induced increased glucose metabolism in local cerebral regions .


Functional neuroimaging using PET/CT could directly reflect changes of brain glucose metabolism by acupuncture .


Asians are prone to develop epidermal pigmentary lesions as a result of photoaging .


Solar lentigines , especially those which are light in color , show somewhat limited response to pigment lasers and intense pulsed light sources .


We sought to compare the early effects as well as side effects of Q-switched Nd : YAG and Er : YAG micropeel in treating light solar lentigines in Asians .


This was a split-face , evaluator-blind , randomized controlled study .


A single session of treatment was performed on Asian patients with light facial lentigines .


Q-switched Nd : YAG laser was allocated to one half of the face , and Er : YAG micropeel to the other half .


The response to therapy was evaluated by two independent dermatologists with standardized photographs taken @ weeks and @ month after the laser treatment .


Patients ' satisfaction and preference in treatment were also assessed .


Fifteen patients completed the study and were analyzed .


A reduction in pigment was observed with both lasers during the study period .


The degree of pigment reduction in the Q-switched Nd : YAG treated side of the face was significantly higher than that of the Er : YAG micropeel treated side at @-week follow-up ( p < @ ) .


The degree of pigment reduction between the Q-switched Nd : YAG-treated side and the Er : YAG micropeel-treated side was similar at @-month follow-up ( p = @ ) .


While there is no perfect therapy for light solar lentigines , a single session of Q-switched Nd : YAG laser and Er : YAG micropeel was shown to reduce pigmentation .


The immediate effects ( @-week follow-up ) were better with the Q-switched Nd : YAG laser but there was no great difference between the two laser types at @-month follow-up due to the greater degree of post-inflammatory hyperpigmentation following Q-switched Nd : YAG .


Both laser types could be applied either singly in turns , or in combination for maximal efficacy in future .


Daclizumab is a humanized monoclonal antibody that blocks the - subunit of the interleukin-@ receptor with demonstrated benefits in the treatment of multiple sclerosis .


The present work aimed to characterize the pharmacokinetics of daclizumab high-yield process ( HYP ) in healthy volunteers .


Three double-blind , randomized , placebo-controlled , phaseI studies evaluated the pharmacokinetics of daclizumab HYP in healthy volunteers following single subcutaneous administration ( @ , @ , or @mg ) , multiple subcutaneous administrations ( @ or @mg biweekly with a @mg loading dose ) , or single intravenous administration ( @ or @mg ) .


Measurable serum concentrations ( n = @ ) from @ subjects treated with daclizumab HYP in the three studies were analyzed using non-linear mixed-effects modeling .


A two-compartment model with a first-order absorption and elimination adequately described daclizumab HYP pharmacokinetics .


Daclizumab HYP clearance , inter-compartmental clearance , and central and peripheral volumes of distribution were @mL/h , @mL/h , @ L , and @ L , respectively , scaled by -LSB- bodyweight ( kg ) / @ -RSB- with @ and @ exponents for clearance and volume parameters , respectively .


Lag-time , mean absorption time , and absolute bioavailability ( @-@mg ) for subcutaneous administration were @h , @ days , and @ % , respectively .


Bodyweight explained only ~ @ % of daclizumab HYP pharmacokinetic variability .


With this limited dataset , sex , age , race , or presence of antibodies did not correlate with daclizumab HYP clearance .


The estimated effective half-life was @-@days .


The developed model was robust in bootstrap evaluation and predicted the data adequately in stochastic simulations .


Daclizumab HYP is characterized by slow clearance , linear pharmacokinetics ( at doses@mg ) , high subcutaneous bioavailability , and a half-life suitable for monthly administration .


The Surviving Sepsis Campaign recommends targeting a mean arterial pressure of at least @ mm Hg during initial resuscitation of patients with septic shock .


However , whether this blood-pressure target is more or less effective than a higher target is unknown .


In a multicenter , open-label trial , we randomly assigned @ patients with septic shock to undergo resuscitation with a mean arterial pressure target of either @ to @ mm Hg ( high-target group ) or @ to @ mm Hg ( low-target group ) .


The primary end point was mortality at day @ .


At @ days , there was no significant between-group difference in mortality , with deaths reported in @ of @ patients in the high-target group ( @ % ) and @ of @ patients in the low-target group ( @ % ) ( hazard ratio in the high-target group , @ ; @ % confidence interval -LSB- CI -RSB- , @ to @ ; P = @ ) .


There was also no significant difference in mortality at @ days , with @ deaths ( @ % ) and @ deaths ( @ % ) , respectively ( hazard ratio , @ ; @ % CI , @ to @ ; P = @ ) .


The occurrence of serious adverse events did not differ significantly between the two groups ( @ events -LSB- @ % -RSB- and @ events -LSB- @ % -RSB- , respectively ; P = @ ) .


However , the incidence of newly diagnosed atrial fibrillation was higher in the high-target group than in the low-target group .


Among patients with chronic hypertension , those in the high-target group required less renal-replacement therapy than did those in the low-target group , but such therapy was not associated with a difference in mortality .


Targeting a mean arterial pressure of @ to @ mm Hg , as compared with @ to @ mm Hg , in patients with septic shock undergoing resuscitation did not result in significant differences in mortality at either @ or @ days .


( Funded by the French Ministry of Health ; SEPSISPAM ClinicalTrials.gov number , NCT@ . )


The main aim of the study was to evaluate the effect on subjects ' temperature measurement readings when using the infrared tympanic thermometer after correct earphone placement and use , with or without music transmission through the earphone .


A comparative study design was adopted .


A sample of @ healthy people was randomly divided into three groups .


Subjects in all groups used an earphone that had been correctly placed in the right ear only : Group @ : listened to heavy metal music through the earphone ( @ participants ) ; Group @ : listened to classical music through the earphone ( @ participants ) ; Group @ : no music or sound was transmitted through the earphone ( @ participants ) .


Average differences ( CI @ % ) and Pearson correlations for the temperature measured in the right ear , which was exposed to the different independent variables , and the left ear which was not exposed , were calculated at different times : ( @ ) after @ minutes compared to the baseline measurement ; ( @ ) after @ minutes compared to the @ minutes measurement ; and ( @ ) after @ minutes compared to the baseline measurement .


The inter-ear temperature correlation at the baseline was Pearson r @ ( p = @ ) .


There was a significant decrease in the correlations between right and left ear temperatures in Group @ and in Group @ which was demonstrated after @ minutes of earphone use , and reached critical values after @ minutes of use in all groups .


The average warmth in the right ear , as perceived by participants after @ minutes , was reported .


Using the Numerical Rating Score the average was @ + / - @ for Group @ , for Group @ was @ + / - @ and for Group @ was @ + / - @ ( p = @ ) .


Within the limitations of the study , which involved a limited number of healthy people the results show that it is best to not measure tympanic temperature in an ear that has very recently had an earphone in place .


The aim of this study was to assess the efficacy of neoadjuvant anastrozole and fulvestrant treatment of large operable or locally advanced hormone-receptor-positive breast cancer not eligible for initial breast-conserving surgery , and to identify genomic changes occurring after treatment .


One hundred and twenty post-menopausal patients were randomised to receive @mg anastrozole ( @ patients ) or @mg fulvestrant ( @ patients ) for @ months .


Genomic DNA copy number profiles were generated for a subgroup of @ patients before and after treatment .


A total of @ patients were evaluable for efficacy and @ for toxicity .


The objective response rate determined by clinical palpation was @ % ( @ % CI = @-@ @ ) in the anastrozole arm and @ % ( @ % CI = @-@ @ ) in the fulvestrant arm .


The breast-conserving surgery rate was @ % ( @ % CI = @-@ @ ) in the anastrozole arm and @ % ( @ % CI = @-@ @ ) in the fulvestrant arm .


Pathological responses > @ % occurred in @ patients ( @ % ) in the anastrozole arm and @ ( @ % ) in the fulvestrant arm .


The Ki-@ score fell after treatment but there was no significant difference between the reduction in the two arms ( anastrozole @ % ( @ % CI = @-@ @ ) before , @ % ( @ % CI = @-@ @ ) after , n = @ ; fulvestrant @ % ( @ % CI = @-@ @ ) before , @ % ( @ % CI = @-@ @ ) after , n = @ ) or between the reduction in Ki-@ in clinical responders and non-responders .


Genomic analysis appeared to show a reduction of clonal diversity following treatment with selection of some clones with simpler copy number profiles .


Both anastrozole and fulvestrant were effective and well-tolerated , enabling breast-conserving surgery in over @ % of patients .


Clonal changes consistent with clonal selection by the treatment were seen in a subgroup of patients .


The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service ( BRS ) on patient weight loss following bariatric surgery at @ year .


A single-site open-randomised parallel group control trial based at St. Richard 's Hospital in Chichester in the UK .


Patients ( n = @ ) were recruited immediately prior to Roux-en-Y gastric bypass and randomly allocated to receive either treatment as usual ( n = @ ) or the BRS ( n = @ ) .


The BRS involved three @-min one-to-one sessions with a health psychologist and provided information , support and mentoring pre and post surgery addressing psychological issues such as dietary control , self esteem , coping and emotional eating .


Weight loss was assessed at @ year .


The key outcome variable was BMI and change in BMI .


Follow-up weight was available for @ patients .


Intention-to-treat analysis ( n = @ ) using last measured weights showed that mean change in BMI by @ year post surgery was -@ .


There was no significant difference between the two groups ( control group = -@ , @ % CI = @-@ @ ; intervention = -@ , @ % CI = @-@ @ ; p ( @ ) = @ ) .


Similarly , explanatory analysis ( n = @ ) showed a mean change in BMI of -@ .


The difference between the two groups was not significant ( control group = -@ , @ % CI = @-@ @ ; intervention = -@ , @ % CI = @-@ @ ; p ( @ ) = @ ) .


Psychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by @ year .


It is argued that psychological support should be targeted to patients who start to demonstrate weight regain at a later stage .


The Orsiro Hybrid sirolimus-eluting stent is a newly developed third-generation drug-eluting stent , featuring a unique dual-polymer mix .


An active bioabsorbable polymer delivers the anti-proliferative drug , sirolimus , via controlled release , while a passive biocompatible polymeric coating shields the metallic strut from surrounding tissue , preventing interaction .


To date , the Orsiro Hybrid sirolimus-eluting stent has excelled in terms of late lumen loss at @ months in a first-in-man single-arm trial .


However , the efficacy and safety data for Orsiro Hybrid sirolimus-eluting stents in a broader population of all-comers are limited .


The present study offers an angiographic and clinical comparison of the Orsiro Hybrid sirolimus-eluting stent and the Resolute Integrity zotarolimus-eluting stent in the treatment of patients with coronary artery disease .


The ORIENT trial is a multicenter , randomized , open-label , parallel-arm study designed to demonstrate the non-inferiority of the Orsiro Hybrid sirolimus-eluting stent relative to the Resolute Integrity zotarolimus-eluting stent .


A total of @ patients with a spectrum of coronary artery disease will undergo prospective , random assignment to a Orsiro Hybrid sirolimus-eluting stent or Resolute Integrity zotarolimus-eluting stent ( @:@ ratio ) , for a primary endpoint of in-stent late lumen loss at @ months by quantitative coronary angiography .


Secondary @-month clinical endpoints are death , target lesion revascularization , target vessel revascularization , myocardial infarction , stent thrombosis and target lesion failure ( a composite of cardiac death , target lesion revascularization and target vessel-related myocardial infarction ) .


The ORIENT trial is the first study to date comparing the Orsiro Hybrid sirolimus-eluting stent with the Resolute Integrity zotarolimus-eluting stent for efficacy and safety in a population of all-comers with coronary artery disease .


Patients receiving oral anticoagulation ( OAC ) who undergo drug-eluting stent ( DES ) implantation require additional dual antiplatelet therapy with aspirin and clopidogrel .


Such triple therapy confers an elevated bleeding risk , and its optimal duration is not known .


The goal of this study was to evaluate whether shortening the duration of clopidogrel therapy from @ months to @ weeks after DES implantation was associated with a superior net clinical outcome in patients receiving concomitant aspirin and OAC .


In this randomized , open-label trial , we enrolled patients receiving OAC who underwent DES implantation at @ European centers between September @ and December @ .


A total of @ patients receiving concomitant aspirin and OAC were randomized to either @-week clopidogrel therapy ( n = @ ) or @-month clopidogrel therapy ( n = @ ) .


The primary endpoint was a composite of death , myocardial infarction ( MI ) , definite stent thrombosis , stroke , or Thrombolysis In Myocardial Infarction ( TIMI ) major bleeding at @ months .


The primary endpoint occurred in @ patients ( @ % ) in the @-week group compared with @ patients ( @ % ) in the @-month group ( hazard ratio -LSB- HR -RSB- : @ ; @ % CI : @ to @ ; p = @ ) .


There were no significant differences for the secondary combined ischemic endpoint of cardiac death , MI , definite stent thrombosis , and ischemic stroke ( @ -LSB- @ % -RSB- vs. @ -LSB- @ % -RSB- ; HR : @ ; @ % CI : @ to @ ; p = @ ) or the secondary bleeding endpoint of TIMI major bleeding ( @ -LSB- @ % -RSB- vs. @ -LSB- @ % -RSB- ; HR : @ ; @ % CI : @ to @ ; p = @ ) .


Six weeks of triple therapy was not superior to @ months with respect to net clinical outcomes .


These results suggest that physicians should weigh the trade-off between ischemic and bleeding risk when choosing the shorter or longer duration of triple therapy .


( Triple Therapy in Patients on Oral Anticoagulation After Drug Eluting Stent Implantation -LSB- ISAR-TRIPLE -RSB- ; NCT@ ) .


The Veterans Affairs Diabetes Trial previously showed that intensive glucose lowering , as compared with standard therapy , did not significantly reduce the rate of major cardiovascular events among @ military veterans ( median follow-up , @ years ) .


We report the extended follow-up of the study participants .


After the conclusion of the clinical trial , we followed participants , using central databases to identify procedures , hospitalizations , and deaths ( complete cohort , with follow-up data for @ % of participants ) .


Most participants agreed to additional data collection by means of annual surveys and periodic chart reviews ( survey cohort , with @ % follow-up ) .


The primary outcome was the time to the first major cardiovascular event ( heart attack , stroke , new or worsening congestive heart failure , amputation for ischemic gangrene , or cardiovascular-related death ) .


Secondary outcomes were cardiovascular mortality and all-cause mortality .


The difference in glycated hemoglobin levels between the intensive-therapy group and the standard-therapy group averaged @ percentage points during the trial ( median level , @ % vs. @ % ) and declined to @ to @ percentage points by @ years after the trial ended .


Over a median follow-up of @ years , the intensive-therapy group had a significantly lower risk of the primary outcome than did the standard-therapy group ( hazard ratio , @ ; @ % confidence interval -LSB- CI -RSB- , @ to @ ; P = @ ) , with an absolute reduction in risk of @ major cardiovascular events per @ person-years , but did not have reduced cardiovascular mortality ( hazard ratio , @ ; @ % CI , @ to @ ; P = @ ) .


No reduction in total mortality was evident ( hazard ratio in the intensive-therapy group , @ ; @ % CI , @ to @ ; P = @ ; median follow-up , @ years ) .


After nearly @ years of follow-up , patients with type @ diabetes who had been randomly assigned to intensive glucose control for @ years had @ fewer major cardiovascular events per @ person-years than those assigned to standard therapy , but no improvement was seen in the rate of overall survival .


( Funded by the VA Cooperative Studies Program and others ; VADT ClinicalTrials.gov number , NCT@ . )


To determine inter - and intra-tester reliability of strength measurements during maximal electrically induced contractions ( MEIC ) using a hand-held dynamometer ( HHD ) .


Thirty-seven healthy young female adults , mean age ( SD ) @ ( @ ) years , were tested by two examiners during two sessions , with order of examiners randomized .


Biphasic pulses ( phase duration -- @s ; pulse frequency -- @Hz ) were employed in order to induce contractions of the quadriceps femoris muscle at a maximally tolerated current level .


Strength of maximal voluntary isometric contractions ( MVIC ) and of MEIC was recorded with a HHD utilizing a stabilization belt .


Good to excellent inter - and intra-tester reliability were determined with intra-class correlation coefficients ranging between @ and @ , and no bias in the Bland-Altman plots .


The @ % repeatability ranged between @ and @ kg for the MVIC and MEIC , and between @ and @ % for the % MVIC .


Our results confirm previous findings indicating good to excellent reliability of quadriceps femoris muscle MVIC assessment with a HHD .


However , a high @ % repeatability range indicates the HHD is not sufficiently reliable as an indicator of the force level attained during electrically induced contractions .


Other methods need to be investigated to assist in determining whether MEIC have reached therapeutic levels .


To compare the effects of a @-week supplementation between two different mixtures of antioxidants and placebo on aerobic exercise performance in acute normobaric hypoxia .


Seventeen subjects were randomly assigned in a double-blind fashion to receive a broad-based antioxidants supplement containing beta-carotene , ascorbic acid , d-alpha-tocopherol-succinate , N-acetylcysteine , riboflavin , zinc , and selenium ( antioxidant capsule group -LSB- AO group -RSB- ) , or a combination of alpha-ketoglutaric acid ( - KG ) and @-hydroxymethylfurfural ( @-HMF ; CYL concentrate supplementation group -LSB- CS group -RSB- ) , or placebo ( PL group ) .


Before and after supplementation , subjects performed two incremental cycle-exercise tests until exhaustion .


The first test was conducted under normoxic conditions ( LA , FiO@ of @ % , ~ @ m ) and the second after the @-week supplementation period under normobaric hypoxic conditions ( AHA , FiO@ of @ % , ~ @m ) .


In CS peak cycling performance ( peak power ) declined from LA to AHA @ % ( @ % CI : @-@ @ ) less compared with PL ( p = @ ) and @ % ( @ % CI : @-@ @ ) less compared with AO ( p = @ ) .


Better maintenance of aerobic exercise capacity in CS was associated with an attenuated reduction in maximal heart rate in hypoxia .


Aerobic exercise performance was less impaired in acute normobaric hypoxia after @ weeks with supplementation of - KG and @-HMF compared with a broad-based antioxidants supplement or PL .


Previous reports of the RAPID-axSpA trial ( NCT@ ) described the efficacy and safety of certolizumab pegol ( CZP ) over @ weeks in patients with axial spondyloarthritis ( SpA ) , including ankylosing spondylitis ( AS ) and nonradiographic axial SpA .


We report efficacy and safety data up to week @ of the study .


The RAPID-axSpA trial is double-blind and placebo-controlled to week @ , dose-blind to week @ , and open-label to week @ .


Outcome variables included Assessment of SpondyloArthritis international Society criteria for @ % and @ % improvement in disease activity ( ASAS@/@ ) , ASAS partial remission responses ( analyzed by nonresponder imputation ) , AS Disease Activity Score ( ASDAS ) , ASDAS inactive disease , ASDAS major improvement , Bath AS Disease Activity Index ( BASDAI ) , Bath AS Functional Index ( BASFI ) , and Bath AS Metrology Index ( BASMI ) linear score ( analyzed by the last observation carried forward method ) .


Safety data were collected for patients treated with @ dose of CZP .


Of the @ patients who were randomized , @ received CZP from week @ .


Of these , @ % completed week @ , @ % completed week @ , and @ % completed week @ .


Improvements in ASAS responses were maintained to week @ ( for ASAS@ , @ % , @ % , and @ % at weeks @ , @ , and @ , respectively ) , as well as improvements in ASDAS , BASDAI ( mean score @ , @ , and @ at weeks @ , @ , and @ , respectively ) , BASFI , and BASMI linear score .


Comparable improvements were observed with both dosing regimens ( @ mg every @ weeks or @ mg every @ weeks ) and in patients with AS and those with nonradiographic axial SpA .


In the safety set , adverse events occurred in @ patients ( @ % ) and serious adverse events in @ ( @ % ) .


No deaths or malignancies were reported .


Clinical improvements to week @ in both CZP dosing regimens were sustained to week @ .


Similar sustained improvements were observed in AS and nonradiographic axial SpA subpopulations .


The safety profile was consistent with previous reports from RAPID-axSpA , with no new safety signals observed with longer exposure .


Transradial access ( TRA ) has been associated with reduced access site-related bleeding complications and mortality after percutaneous coronary intervention ( PCI ) .


It is unclear , however , whether these observed benefits are influenced by baseline bleeding risk .


This study investigated the relationship between baseline bleeding risk , TRA utilization , and procedure-related outcomes in patients undergoing PCI enrolled in the British Cardiovascular Intervention Society database .


Baseline bleeding risk was calculated by using modified Mehran bleeding risk scores in @,@ PCI procedures performed between @ and @ .


Four categories for bleeding risk were defined for the modified Mehran risk score ( MMRS ) : low ( < @ ) , moderate ( @ to @ ) , high ( @ to @ ) , and very high ( @ ) .


The impact of baseline bleeding risk on @-day mortality and its relationship with access site were studied .


TRA was independently associated with a @ % reduction in @-day mortality risk ( odds ratio -LSB- OR -RSB- : @ -LSB- @ % confidence interval ( CI ) : @ to @ -RSB- ; p < @ ) , with the magnitude of mortality reduction related to baseline bleeding risk ( MMRS < @ , OR : @ -LSB- @ % CI : @ to @ -RSB- ; MMRS @ , OR : @ -LSB- @ % CI : @ to @ -RSB- ) .


In patients with an MMRS < @ , TRA was used in @,@ ( @ % ) of @,@ PCI procedures ; TRA was used in @,@ ( @ % ) of @,@ PCI procedures in patients with an MMRS @ , illustrating that TRA was used less in those at highest risk from bleeding complications ( p < @ ) .


TRA was independently associated with reduced @-day mortality , and the magnitude of this effect was related to baseline bleeding risk ; those at highest risk of bleeding complications gained the greatest benefit from adoption of TRA during PCI .


Patients with severe acute exacerbations of asthma often receive inappropriate antibiotic treatment .


We aimed to determine whether serum procalcitonin ( PCT ) levels can effectively and safely reduce antibiotic exposure in patients experiencing exacerbations of asthma .


In this randomized controlled trial , a total of @ patients requiring hospitalization for severe acute exacerbations of asthma were screened for eligibility to participate and @ completed the @-month follow-up visit .


Patients were randomized to either PCT-guided ( PCT group ) or standard ( control group ) antimicrobial therapy .


In the control group , patients received antibiotics according to the attending physician 's discretion ; in the PCT group , patients received antibiotics according to an algorithm based on serum PCT levels .


The primary end point was antibiotic exposure ; secondary end points were clinical recovery , length of hospital stay , clinical and laboratory parameters , spirometry , number of asthma exacerbations , emergency room visits , hospitalizations and need for corticosteroid use due to asthma .


PCT guidance reduced antibiotic prescription ( @ % versus @ % , respectively ; P < @ ) and antibiotic exposure ( relative risk , @ ; @ % confidence interval , @ to @ ; P < @ ) compared to standard therapy .


There were no significant differences in clinical recovery , length of hospital stay or clinical , laboratory and spirometry outcomes in both groups .


Number of asthma exacerbations , emergency room visits , hospitalizations and need for corticosteroid use due to asthma were similar during the @-month follow-up period .


A PCT-guided strategy allows antibiotic exposure to be reduced in patients with severe acute exacerbation of asthma without apparent harm .


Respiratory syncytial virus ( RSV ) bronchiolitis in infancy is a major risk factor for recurrent wheezing and asthma .


Because azithromycin attenuated neutrophilic airway inflammation in a murine viral bronchiolitis model , demonstration of similar effects in human subjects might provide a strategy for the prevention of postbronchiolitis recurrent wheezing .


We sought to investigate whether azithromycin treatment during RSV bronchiolitis reduces serum and nasal lavage IL-@ levels and the occurrence of postbronchiolitis recurrent wheezing .


We performed a randomized , double-masked , placebo-controlled proof-of-concept trial in @ otherwise healthy infants hospitalized with RSV bronchiolitis who were treated with azithromycin or placebo for @ days .


IL-@ levels were measured in nasal lavage fluid and serum on randomization , day @ , and day @ ( nasal lavage only ) .


The occurrence of wheezing episodes was assessed monthly over the ensuing @ weeks .


Compared with placebo , azithromycin treatment did not reduce serum IL-@ levels at day @ ( P = @ ) but resulted in a greater decrease in nasal lavage fluid IL-@ levels by day @ ( P = @ ) .


Twenty-two percent of azithromycin-treated participants experienced at least @ wheezing episodes compared with @ % of participants in the placebo group ( P = @ ) .


Azithromycin treatment resulted in prolonged time to the third wheezing episode ( P = @ ) and in fewer days with respiratory symptoms over the subsequent year in comparison with placebo ( @ vs @ days , P = @ ) .


In this proof-of-concept study azithromycin treatment during RSV bronchiolitis reduced upper airway IL-@ levels , prolonged the time to the third wheezing episode , and reduced overall respiratory morbidity over the subsequent year .


To evaluate panitumumab plus modified fluorouracil , leucovorin , and oxaliplatin ( mFOLFOX@ ) or bevacizumab plus mFOLFOX@ in patients with previously untreated wild-type ( WT ) KRAS exon @ ( codons @ and @ ) metastatic colorectal cancer ( mCRC ) .