Admission to a nonremote or remote community hospital was associated with similar @-year mortality compared with admission to a tertiary care hospital ( nonremote hospitals , adjusted odds ratio -LSB- OR -RSB- , @ ; P = @ ; remote hospitals , adjusted OR , @ ; P = @ ) .


At @ year , admission to a nonremote community hospital was associated with a lower composite outcome of death or readmission for acute myocardial infarction ( AMI ) ( adjusted OR , @ ; P = @ ) .


One-year mortality rates were not different between patients with NSTEMI admitted to BC community and tertiary care hospitals ; however , the rate of readmission for AMI/death was significantly less in patients admitted to nonremote community hospitals .


This should prompt the evaluation of key outcomes in NSTEMI in other community hospital settings .


There is limited evidence supporting the podiatric treatment of children with juvenile idiopathic arthritis ( JIA ) .


This multicentre randomised controlled trial aimed to determine whether preformed foot orthoses ( FOs ) impacted on pain and quality of life ( QoL ) in children with JIA .


Eligible children were randomised to receive either ` fitted ' FOs with customised chair-side corrections or ` control ' FOs made without corrections .


Changes in pain and QoL were measured using a visual analogue scale and Paediatric Quality of Life questionnaire , respectively .


JIA children were assessed at baseline , @ months and @ months .


@ children were recruited .


@ out of a possible @ assessments ( @ % ) were completed .


A statistically significant greater difference in pain reduction ( baseline - @ months ) was seen between the two groups favouring fitted FOs ( p = @ ) .


The reduction in pain in the fitted FOs group was clinically important ( @ mm ) .


Significant differences in QoL favouring fitted FOs were also identified as measured by the children and independently by their parents/carers .


Fitted FOs may reduce pain and improve QoL in selected children with JIA .


Edgewise fixed orthodontic appliances are available in two different bracket slot sizes ( @ and @ inch ) .


Both systems are used by clinicians worldwide with some orthodontists claiming the superiority and clinical advantages of one system over the other .


However , the scientific evidence supporting this area is scarce and weak .


This leaves the clinician 's choice of bracket slot system to clinical preference .


We aim to compare the @-inch and @-inch pre-adjusted bracket slot systems in terms of the effectiveness of orthodontic treatment .


This is a prospective , multicenter , randomized clinical trial , undertaken in the secondary care hospital environment in the NHS Tayside region of Scotland ( United Kingdom ) .


A total of @ orthodontic patients will be recruited in three centers in secondary care hospitals in NHS Tayside .


The participants will be randomly allocated to treatment with either the @-inch or @-inch bracket slot systems ( n = @ for each group ) using Victory series conventional pre-adjusted bracket systems ( @ M Unitek , Monrovia , United States ) .


Baseline records and outcome data collected during and at the end of orthodontic treatment will be assessed .


The primary outcome measures will be the duration of orthodontic treatment in the maxillary and mandibular arches .


The secondary outcome measures will be the number of scheduled appointments for orthodontic treatment in the maxillary and mandibular arches , treatment outcome using Peer Assessment Rating index ( PAR ) , orthodontically induced inflammatory root resorption ( as measured using periapical radiographs ) and the patient 's perception of wearing orthodontic appliances .


The results from the current study will serve as evidence to guide the clinician in deciding whether the difference in bracket slot size has a significant impact on the effectiveness of orthodontic treatment .


Compare the effectiveness of Papacarie gel for the chemo-mechanical removal of carious lesions on primary teeth to conventional caries removal with a low-speed bur with regard to execution time , clinical aspects and radiographic findings .


A randomized controlled clinical trial with a split-mouth design was carried out .


The sample was composed of @ children aged four to seven years , in whom @ deciduous teeth were randomly divided into two groups : chemo-mechanical caries removal with Papacarie and removal of carious dentin with a low-speed bur .


Each child underwent both procedures and served as his/her own control .


Restorations were performed with glass ionomer cement .


The time required to perform the procedure was also analyzed .


The patients underwent longitudinal clinical and radiographic follow-up of the restorations .


No statistically significant difference between groups was found regarding the time required to perform the procedures and the radiographic follow up .


Statistically significant differences between groups were found in the clinical evaluation at @ and @ months after treatment .


Papacarie is as effective as the traditional method for the removal of carious dentin on deciduous teeth , but offers the advantages of the preservation of sound dental tissue as well as the avoidance of sharp rotary instruments and local anesthesia .


To examine whether hippotherapy has a clinically significant effect on gross motor function in children with cerebral palsy ( CP ) .


Randomized controlled trial .


Outpatient therapy center .


Ninety-two children with CP , aged @-@ years , presenting variable function ( Gross Motor Function Classification System -LSB- GMFCS -RSB- levels I-IV ) .


Hippotherapy ( @ minutes twice weekly for @ consecutive weeks ) .


Gross Motor Function Measure ( GMFM ) -@ , GMFM-@ , and Pediatric Balance Scale .


Pre - and post-treatment measures were completed by @ children ( @ in the intervention group and @ in the control group ) .


Differences in improvement on all three measures significantly differed between groups after the @-week study period .


Dimensions of GMFM-@ improved significantly after hippotherapy varied by GMFCS level : dimension E in level I , dimensions D and E in level II , dimensions C and D in level III , and dimensions B and C in level IV .


Hippotherapy positively affects gross motor function and balance in children with CP of various functional levels .


Treatment options for plantar fasciitis have resulted in varied patient outcomes .


The aim of this study was to compare a novel treatment , cryopreserved human amniotic membrane ( c-hAM ) , to a traditional treatment , corticosteroid .


Our hypothesis was that c-hAM would be safe and comparable to corticosteroids for plantar fasciitis in regard to patient outcomes .


A randomized , controlled , double-blind , single-center pilot study was completed .


Patients were randomized into one of @ treatment groups : c-hAM or corticosteroid .


Patients received an injection at their initial baseline visit with an option for a second injection at their first @-week follow-up .


Total follow-up was obtained for @ weeks after the most recent injection .


The primary outcome measurement was the Foot Health Status Questionnaire ( FHSQ ) .


The secondary outcome measurements were the Visual Analog Scale ( VAS ) and verbally reported percentage improvement .


Data were analyzed between groups for the @ different cohorts ( @ injection versus @ injections ) .


Twenty-three patients had complete follow-up .


Fourteen were randomized to receive corticosteroid and @ were randomized to receive c-hAM .


Three patients in each group received second injections .


With the numbers available , the majority of outcome measurements showed no statistical difference between groups .


The corticosteroid did , however , have greater FHSQ shoe fit improvement ( P = @ ) at @ weeks , FHSQ general health improvement ( P = @ ) at @ weeks , and verbally reported improvement ( P = @ ) at @ weeks in the one-injection cohort .


Cryopreserved hAM had greater FHSQ foot pain improvement ( P = @ ) at @ weeks in the @-injection cohort .


Cryopreserved hAM injection may be safe and comparable to corticosteroid injection for treatment of plantar fasciitis .


This is a pilot study and requires further investigation .


Level I , prospective randomized trial .


Placing a central venous access device via the internal jugular or subclavian vein entails significant risks to both patient and healthcare worker .


The purpose of this randomized , prospective study was to determine whether the accelerated Seldinger technique ( AST ) offers significant safety advantages over the modified Seldinger technique ( MST ) for peripherally inserted central catheter insertion .


Patients were randomly assigned to undergo introducer sheath insertion by means of either MST or AST .


Primary outcome measures included time to completion of introducer sheath insertion , estimated blood loss , and success rate .


Secondary outcome measures included vessel-to-air exposure events and unprotected sharps exposure .


While both insertion methods proved equivalent for successful vessel cannulation , AST was significantly faster ( P = @ ) and resulted in less blood loss ( P = @ ) than MST .


Additionally , AST resulted in significantly fewer vessel-to-air exposure events ( P < @ ) and unprotected sharps exposures ( P < @ ) .


Although this was a relatively small and unblinded study , the high degree of statistical significance of the study results suggests that , for both patients and healthcare workers , AST is faster and safer than MST for PICC peelable introducer sheath insertion .


A significant proportion of patients with rheumatoid arthritis do not respond adequately to biologic treatment .


We hypothesized that lack of response to ( biologic ) disease-modifying antirheumatic drugs ( DMARDs ) is high in patients in whom the subjective , patient-reported component of the Disease Activity Score @ ( DAS@ ) is high at baseline .


The primary aim of our present study was to investigate the contribution of the more subjective versus the objective components of the DAS@ to response to biologic agents in RA patients , as well as the changes in this contribution over time .


The secondary aim was to examine whether the value of this subjective contribution at baseline affects the response to treatment .


The DAS@-P ( the subjective components of the DAS@ relative to the total DAS@ ) was calculated .


Patients were derived from the computer-assisted Management in Early Rheumatoid Arthritis Trial-II and the Biologicals and Outcome Compared and Predicted in Utrecht Region in Rheumatoid Arthritis Study .


Ordinal logistic regression analyses were performed .


The DAS@-P score at baseline was not associated with the level of response according to European League Against Rheumatism criteria at @ months .


Overall , a significant reduction in the DAS@-P score was observed @ months after start of treatment , showing a greater reduction of the combined subjective components in good responders .


The results reject the hypothesis that the lack of response to biologic DMARDs is especially high in patients in whom the patient-reported component of the DAS@ is high at baseline ; these subjective components are not linked to treatment response .


Coordination between breathing and swallowing helps prevent aspiration of foreign material into the respiratory tract .


The authors examined the effects of anesthesia and hypercapnia on swallowing-breathing coordination .


In a randomized controlled crossover study , general anesthesia with propofol or sevoflurane was titrated using an up-down method to identify the threshold for suppression of the motor response to electrical stimulation of the forearm .


Additional measurements included bispectral index , genioglossus electromyogram , ventilation ( pneumotachometer ) , and hypopharyngeal pressure .


During wakefulness and at each level of anesthesia , carbon dioxide was added to increase the end-tidal pressure by @ and @ mmHg .


A swallow was defined as increased genioglossus activity with deglutition apnea and an increase in hypopharyngeal pressure .


Spontaneous swallows were categorized as physiological ( during expiration or followed by expiration ) or pathological ( during inspiration or followed by an inspiration ) .


A total of @ swallows were analyzed .


Anesthesia increased the proportion of pathological swallows ( @ % vs. @ % ) and decreased the number of swallows per hour ( @ vs. @ ) compared to wakefulness .


During anesthesia , hypercapnia decreased hypopharyngeal pressure during inspiration ( -@ vs. -@ mmHg ) and increased minute ventilation , the proportion of pathological swallows ( @ % vs. @ % ) , and the number of swallows per hour ( @ .


vs. @ ) .


Anesthesia impaired the coordination between swallowing and respiration .


Mild hypercapnia increased the frequency of swallowing during anesthesia and the likelihood of pathological swallowing .


During anesthesia , the risk for aspiration may be further increased when ventilatory drive is stimulated .


In ruminants , lower ruminal pH causes massive disruption of ruminal epithelial structure during periods of feeding high-concentrate diets .


However , the influence of excessive organic fatty acids in the lumen of hindgut on the epithelial structure is unclear .


In this study , twelve mid-lactating goats were randomly assigned to either a HC diet group ( @ % concentrate of dry matter ; n = @ ) or a LC diet group ( @ % concentrate of dry matter ; n = @ ) for @ weeks .


The colonic epithelial structure was detected by HE staining and transmission electron microscopy ( TEM ) , and the apoptotic status of epithelial cells was estimated by TUNEL method and caspase activities .


HC goats showed higher level of free lipopolysaccharide ( LPS ) in rumen fluid ( p < @ ) but not in colonic digesta ( p > @ ) , and higher total volatile fatty acid ( VFA ) concentrations in rumen fluid ( p < @ ) and in colonic digesta ( p < @ ) , and higher content of starch in colonic digesta ( p < @ ) compared to LC goats .


HC goats demonstrated profound alterations in the colonic epithelial structure and tight junctions ( TJ ) , apparently due to damage of the epithelium with widened TJs space and nuclear breakdown and mitochondrial swelling .


HC goats showed higher level of apoptosis in the colonic epithelium with higher proportion of TUNEL-positive apoptotic cells and increases of caspase-@ and -@ / @ activities , as well as the lower ratio of bcl-@ / bax mRNA expression in the colonic mucosa ( p < @ ) .


However , - defense mRNA was significantly down-regulated in the colonic mucosa of HC goats compared to LC ( p < @ ) .


HC goats showed higher level of TJ proteins including claudin-@ and claudin-@ in the colonic mucosa than LC ( p < @ ) .


Neither free LPS content in the colonic digesta nor NF - B protein expression in tissues showed significant difference between HC and LC goats ( p > @ ) .


Our results reveal that long-term feeding HC diet to lactating goats causes severe damages to the colonic mucosa barrier associated with activating cells apoptosis .


Earlier kinetics of serum HCV core antigen ( HCVcAg ) and its predictive value on sustained virological response ( SVR ) were investigated in patients with genotype @ HCV infection during antiviral treatment .


In a multi-centered , randomized and positive drug-controlled phase IIb clinical trial on type Y peginterferon -@ b ( NCT@ ) , forty-eight CHC patients who participated in pharmacokinetics were randomly divided into @ cohorts and treated with PegIFN ( type Y peginterferon -@ b @ g , @ g , @ g and PegIFN-@a @ g , respectively , once a week ) and ribavirin ( < @ kg , @ mg daily and@ kg , @ mg daily ) for @ weeks , and then followed up for @ weeks .


@ patients infected with genotype @ HCV and completed the whole process were included in this study .


HCV RNAs were detected at baseline , and weeks @ , @ , @ , @ and @ using Cobas TaqMan .


ARCHITECT HCVcAg was performed at @ , @ , @ , @ , @ and @ h in addition to the above time points .


The receiver operating curves ( ROCs ) were performed to study the predictive values of HCVcAg decline on SVR .


Following antiviral treatment , serum HCVcAg levels rapidly declined within the first week and correlated well with corresponding HCV RNA at baseline , weeks @ , @ , @ , @ and @ ( rs = @ , @ , @ , @ , @ and @ , respectively , P < @ ) .


All of the areas under the receiver operating curves ( AUROCs ) were more than @ and showed good predictive power on SVR at @ , @ , @ , @ , @ and @ h. The@ h was the best predictive time point of HCVcAg decline on SVR because of its largest AUROC ( more than @ ) .


Early kinetics of serum HCVcAg predicts SVR very well in genotype @ CHC patients during antiviral treatment , and its reduction value at @ h is an earlier and stronger predictor on SVR than rapid virological response and early virological response .


( TRN : NCT@ ) .


The pectoral nerves ( Pecs ) block types I and II are novel techniques to block the pectoral , intercostobrachial , third to sixth intercostals , and the long thoracic nerves .


They may provide good analgesia during and after breast surgery .


Our study aimed to compare prospectively the quality of analgesia after modified radical mastectomy surgery using general anesthesia and Pecs blocks versus general anesthesia alone .


One hundred twenty adult female patients scheduled for elective unilateral modified radical mastectomy under general anesthesia were randomly allocated to receive either general anesthesia plus Pecs block ( Pecs group , n = @ ) or general anesthesia alone ( control group , n = @ ) .


Statistically significant lower visual analog scale pain scores were observed in the Pecs group than in the control group patients .


Moreover , postoperative morphine consumption in the Pecs group was lower in the first @ hours after surgery than in the control group .


In addition , statistically significant lower intraoperative fentanyl consumption was observed in the Pecs group than in the control group .


In the postanesthesia care unit , nausea and vomiting as well as sedation scores were lower in the Pecs group compared with the control group .


Overall , postanesthesia care unit and hospital stays were shorter in the Pecs group than in the control group .


The combined Pecs I and II block is a simple , easy-to-learn technique that produces good analgesia for radical breast surgery .


To investigate the effects of different types of nasal packings on middle ear pressure in patients undergoing septoplasty .


Sixty patients who were suffering from nasal obstruction and who had to undergo septoplasty because of nasal septal deviation were included in the study .


After the septoplasty , Merocel packings and internal nasal splints were intraoperatively applied in thirty patients each .


Middle ear pressure was evaluated by tympanometry .


Tympanometric peak pressures were used for this aim .


Acoustic impedance measurements were performed in both ears , and the average values of the two ears were calculated .


Tympanometric measurements were performed for patients during the preoperative period and on the @ ( nd ) and @ ( th ) postoperative days .


There were @ ( @ females , @ males ; average age @ years ) patients in the internal nasal splint group and @ ( @ females , @ males ; average age @ years ) patients in the anterior Merocel packing group .


When the values obtained by acoustic impedancemetry before the operation and on the postoperative @ ( th ) day were compared , there was no statistically significant difference between the groups .


The middle ear pressure significantly decreased in the anterior Merocel packing group compared with that in the internal nasal splint group .


The intragroup comparison of the acoustic impedance measurements of the internal nasal splint group revealed no significant difference between the preoperative acoustic impedance values and the values obtained on the postoperative @ ( nd ) day .


Cannulated silicone intranasal splints are better in terms of patient comfort after an intranasal surgery without effecting eustachian tube function .


Cerebral palsy refers to permanent , mutable motor development disorders stemming from a primary brain lesion , causing secondary musculoskeletal problems and limitations in activities of daily living .


The aim of the present study was to determine the effects of gait training combined with transcranial direct-current stimulation over the primary motor cortex on balance and functional performance in children with cerebral palsy .


A double-blind randomized controlled study was carried out with @ children aged five to @ years with cerebral palsy randomly allocated to two intervention groups ( blocks of six and stratified based on GMFCS level ( levels I-II or level III ) .


The experimental group ( @ children ) was submitted to treadmill training and anodal stimulation of the primary motor cortex .


The control group ( @ children ) was submitted to treadmill training and placebo transcranial direct-current stimulation .


Training was performed in five weekly sessions for @ weeks .


Evaluations consisted of stabilometric analysis as well as the administration of the Pediatric Balance Scale and Pediatric Evaluation of Disability Inventory one week before the intervention , one week after the completion of the intervention and one month after the completion of the intervention .


All patients and two examiners were blinded to the allocation of the children to the different groups .


The experimental group exhibited better results in comparison to the control group with regard to anteroposterior sway ( eyes open and closed ; p < @ ) , mediolateral sway ( eyes closed ; p < @ ) and the Pediatric Balance Scale both one week and one month after the completion of the protocol .


Gait training on a treadmill combined with anodal stimulation of the primary motor cortex led to improvements in static balance and functional performance in children with cerebral palsy .


To determine the effects of dexmedetomidine premedication on the minimum alveolar concentration of sevoflurane for tracheal intubation ( MACTI ) in children .


Prospective , randomized , clinical comparison study .


Operating room of an academic hospital .


@ pediatric , ASA physical status @ patients , aged @ to @ years , scheduled for minor elective surgery .


Patients were randomized to three groups to receive placebo , dexmedetomidine @ g/kg , or dexmedetomidine @ g/kg approximately @ minutes before anesthesia .


Anesthesia was induced with sevoflurane .


Each concentration of sevoflurane for which a tracheal intubation was attempted was predetermined according to modification of the Dixon 's up-and-down method , with @ % as a step size and held constant for at least @ minutes before tracheal intubation .


All responses ( `` movement '' or `` no movement '' ) to tracheal intubation were assessed .


The MACTI of sevoflurane was @ % @ % in the control group , @ % @ % in the @ g/kg dexmedetomidine group , and @ % @ % in the @ g/kg dexmedetomidine group .


Dexmedetomidine premedication ( @ and @ g/kg ) decreased the MACTI of sevoflurane by @ % and @ % , respectively .


There were no clinically significant episodes of hypotension or bradycardia in any patients .


Intranasal dexmedetomidine premedication produces a dose-dependent decrease in the concentration of sevoflurane needed for tracheal intubation in children .


To examine the effect of weight loss on sleep duration , sleep quality , and mood in @ obese men and women who received one of three behavioral weight loss interventions in the Practice-based Opportunities for Weight Reduction trial at the University of Pennsylvania ( POWER-UP ) .


Sleep duration and quality were assessed at baseline and months @ and @ by the Pittsburgh Sleep Quality Index ( PSQI ) questionnaire and mood by the Patient Health Questionnaire-@ ( PHQ-@ ) .


Changes in sleep and mood were examined according to treatment group and based on participants ' having lost @ % of initial weight vs. < @ % .


There were few significant differences between treatment groups in changes in sleep or mood .


At month @ , however , mean ( SD ) min of sleep increased significantly more in participants who lost @ % vs. < @ % ( @ vs. @ min , P = @ ) .


PSQI total scores similarly improved ( declined ) more in those who lost @ % vs. < @ % ( -@ vs. -@ , P < @ ) , as did PHQ-@ scores ( -@ vs. -@ , P < @ ) .


At month @ , only the differences in mood remained statistically significant ( P < @ ) .


Losing @ % of initial weight was associated with short-term improvements in sleep duration and sleep quality , as well as favorable short - and long-term changes in mood .


The STRIDE study assessed whether a lifestyle intervention , tailored for individuals with serious mental illnesses , reduced weight and diabetes risk .


The authors hypothesized that the STRIDE intervention would be more effective than usual care in reducing weight and improving glucose metabolism .


The study design was a multisite , parallel two-arm randomized controlled trial in community settings and an integrated health plan .


Participants who met inclusion criteria were @ years old , were taking antipsychotic agents for @ days , and had a body mass index @ .


Exclusions were significant cognitive impairment , pregnancy/breastfeeding , recent psychiatric hospitalization , bariatric surgery , cancer , heart attack , or stroke .


The intervention emphasized moderate caloric reduction , the DASH ( Dietary Approaches to Stop Hypertension ) diet , and physical activity .


Blinded staff collected data at baseline , @ months , and @ months .


Participants ( men , N = @ ; women , N = @ ; mean age = @ years -LSB- SD = @ -RSB- ) were randomly assigned to usual care ( N = @ ) or a @-month weekly group intervention plus six monthly maintenance sessions ( N = @ ) .


A total of @ participants ( @ % ) completed @-month assessments , and @ ( @ % ) completed @-month assessments , without differential attrition .


Participants attended @ of @ sessions over @ months .


Intent-to-treat analyses revealed that intervention participants lost @ kg more than control participants from baseline to @ months ( @ % CI = -@ kg to -@ kg ) and @ kg more than control participants from baseline to @ months ( @ % CI = -@ kg to -@ kg ) .


At @ months , fasting glucose levels in the control group had increased from @ mg/dL to @ mg/dL and decreased in the intervention group from @ mg/dL to @ mg/dL .


No serious adverse events were study-related ; medical hospitalizations were reduced in the intervention group ( @ % ) compared with the control group ( @ % ) .


Individuals taking antipsychotic medications can lose weight and improve fasting glucose levels .


Increasing reach of the intervention is an important future step .


Verbal autopsy ( VA ) has been proposed to determine the cause of death ( COD ) distributions in settings where most deaths occur without medical attention or certification .


We develop performance criteria for VA-based COD systems and apply these to the Registrar General of India 's ongoing , nationally-representative Indian Million Death Study ( MDS ) .


Performance criteria include a low ill-defined proportion of deaths before old age ; reproducibility , including consistency of COD distributions with independent resampling ; differences in COD distribution of hospital , home , urban or rural deaths ; age - , sex - and time-specific plausibility of specific diseases ; stability and repeatability of dual physician coding ; and the ability of the mortality classification system to capture a wide range of conditions .


The introduction of the MDS in India reduced the proportion of ill-defined deaths before age @ years from @ % to @ % .


The cause-specific mortality fractions ( CSMFs ) at ages @ to @ years for independently resampled deaths and the MDS were very similar across @ disease categories .


By contrast , CSMFs at these ages differed between hospital and home deaths and between urban and rural deaths .


Thus , reliance mostly on urban or hospital data can distort national estimates of CODs .


Age - , sex - and time-specific patterns for various diseases were plausible .


Initial physician agreement on COD occurred about two-thirds of the time .


The MDS COD classification system was able to capture more eligible records than alternative classification systems .


By these metrics , the Indian MDS performs well for deaths prior to age @ years .


The key implication for low - and middle-income countries where medical certification of death remains uncommon is to implement COD surveys that randomly sample all deaths , use simple but high-quality field work with built-in resampling , and use electronic rather than paper systems to expedite field work and coding .


Simple criteria can evaluate the performance of VA-based COD systems .


Despite the misclassification of VA , the MDS demonstrates that national surveys of CODs using VA are an order of magnitude better than the limited COD data previously available .


Depression accounts for the greatest disease burden of all mental health disorders , contributes heavily to healthcare costs , and by @ is set to become the second largest cause of global disability .


Although @ % to @ % of people aged @ years and over are likely to experience depressive symptoms , the condition is under-diagnosed and often inadequately treated in primary care .


Later-life depression is associated with chronic illness and disability , cognitive impairment and social isolation .


With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people .


Currently , management may be limited to the prescription of antidepressants where there may be poor concordance ; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option .


CASPER Plus is a multi-centre , randomised controlled trial of a collaborative care intervention for individuals aged @ years and over experiencing moderate to severe depression .


Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study .


A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care .


The recruitment target is @ participants .


The intervention , behavioural activation and medication management in a collaborative care framework , has been adapted to meet the complex needs of older people .


It is delivered over eight to @ weekly sessions by a case manager liaising with general practitioners .


The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone .


The primary clinical outcome , depression severity , will be measured with the Patient Health Questionnaire-@ ( PHQ-@ ) at baseline , @ , @ and @ months .


Cost effectiveness analysis will assess health-related quality of life using the SF-@ and EQ-@D and will examine cost-consequences of collaborative care .


A qualitative process evaluation will be undertaken to explore acceptability , gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial .


Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care .


Endoscopic placement of a iodine-@ radioactive stent is useful to treat obstructive jaundice with unresectable periampullary tumors .


This study aimed to retrospectively evaluate the obstructive component of biliary radioactive stents and discuss the different obstructive mechanism with common plastic stents .


Twenty consecutive patients with malignant obstruction underwent insertion of stents into the common bile duct , including @ radioactive stents and @ polyethylene stents .


The radioactive stents were withdrawn after @ months or earlier if clinical signs suggested stent clogging .


Polyethylene stents were withdrawn after physical signs suggested stent clogging .


Bacteriologic analyses included identification of aerobic and anaerobic bacteria .


Stent surfaces were observed by scanning electron microscopy .


Stent deposition was identified by Fourier-transformed infrared spectroscopy and pyrolysis derivatization/gas chromatography/mass spectrometry .


Radioactive stent group and polyethylene stent group stents were placed for @ days ( interquartile range @ , @ ) and @ days ( interquartile range @ , @ ) respectively .


The placement duration of the two types of stents was statistically significant .


A variety of microorganisms were cultured from the stent deposits .


Scanning electron microscope images showed a thicker necrotic layer on the external surface of polyethylene stent than the radioactive stent group .


The proportions of obstructive components in each stent were different , but none of them were statistically significant .


Necrotic tumor tissue was found in the radioactive stent group .


Similar clogging events occurred in both radioactive stents and polyethylene stents .


The median duration time of the radioactive stent was shorter , probably because of the smaller inner diameter , and the radioactive seeds exerted no beneficial effect in inhibiting microorganisms .


Previous studies on cognitive and interpersonal interventions have yielded inconsistent results in ischemic heart disease patients .


@ patients aged @ years , and enrolled one week after complete revascularization with urgent/emergent angioplasty for an AMI , were randomized to standard cardiological therapy plus short-term humanistic-existential psychotherapy ( STP ) versus standard cardiological therapy only .


Primary composite end point was : one-year incidence of new cardiological events ( re-infarction , death , stroke , revascularization , life-threatening ventricular arrhythmias , and the recurrence of typical and clinically significant angina ) and of clinically significant new comorbidities .


Secondary end points were : rates for individual components of the primary outcome , incidence of re-hospitalizations for cardiological problems , New York Heart Association class , and psychometric test scores at follow-up .


@ patients were analyzed at one year .


The two treatment groups were similar across all baseline characteristics .


At follow-up , STP patients had had a lower incidence of the primary endpoint , relative to controls ( @/@ vs. @/@ patients ; p = @ , respectively ; NNT = @ ) ; this benefit was attributable to the lower incidence of recurrent angina and of new comorbidities in the STP group ( @/@ vs. @/@ patients , p = @ , NNT = @ ; and @/@ vs. @/@ , p < @ , NNT = @ , respectively ) .


Patients undergoing STP also had statistically fewer re-hospitalizations , a better NYHA class , higher quality of life , and lower depression scores .


Adding STP to cardiological therapy improves cardiological symptoms , quality of life , and psychological and medical outcomes one year post AMI , while reducing the need for re-hospitalizations .


Larger studies remain necessary to confirm the generalizability of these results .


Noroviruses are the most important viral causes of gastroenteritis-related morbidity and mortality .


A randomized , double-blind , placebo-controlled study evaluated an adjuvanted bivalent intramuscular norovirus virus-like particle ( VLP ) vaccine .


Forty-eight adults aged @-@ years received either @ doses containing genotype GI @ VLP and a consensus GII @ VLP or @ doses of placebo .


Doses ( @ g , @ g , @ g , or @ g of each VLP ) were administered @ weeks apart in the first stage .


Subsequently , @ adults , aged @-@ ( n = @ ) , @-@ ( n = @ ) , and @-@ ( n = @ ) years , received @ doses of vaccine containing @ g of each VLP .


Total and class-specific antibody responses , as well as histoblood group antigen ( HBGA ) blocking antibody responses , were measured before and after each dose .


Local reactions were mainly injection site pain/tenderness , with no reported fever or vaccine-related serious adverse events .


One dose of vaccine containing @ g of each VLP increased GI @ geometric mean titers ( GMTs ) by @-fold , @-fold , and @-fold and increased GII @ GMTs by @-fold , @-fold , and @-fold in subjects aged @-@ , @-@ , and @-@ years , respectively .


Serum antibody responses peaked at day @ after the first dose , with no evidence of boosting following a second dose .


Most subjects achieved HBGA-blocking antibody titers of @ .


The vaccine was well tolerated and immunogenic .


Rapid immune response to a single dose may be particularly useful in military personnel and travelers and in the control of outbreaks .


Clinical Trials Registration.NCT@ .


The threshold values of rapid shallow breathing index ( RSBI ) were compared in pressure support ventilation ( PSV ) and T-piece assessments for spontaneous breathing trials ( SBT ) .


The ability of RSBI to also predict successful weaning was evaluated .


Two hundred eight patients were weaned from mechanical ventilation through oral intubation .


They were randomly divided into PSV group ( n = @ ) and T-piece group ( n = @ ) .


The RSBI was calculated as f/VT at SBT of @ and @ minutes .


Receiver operating characteristic curves of RSBI were also generated , cutoff values were determined and the changes in the RSBI were calculated .


Of the @ patients , @ ( @ % ) were successfully weaned from mechanical ventilation , @/@ ( @ % ) in the PSV group and @/@ ( @ % ) in the T-piece group ( P > @ ) .


In the PSV and T-piece groups , the average RSBI at @-minute SBT was @ @ breaths per min/L and @ @ breaths per min/L , respectively ( P < @ ) , and the average RSBI was @ @ % and @ @ % , respectively ( P < @ ) .


Additionally , in the @ groups , an RSBI of @ breaths per min/L ( PSV ) and @ breaths per min/L ( T-piece ) yielded a diagnostic accuracy of @ % and @ % respectively .


However , a RSBI of @ % ( PSV ) and @ % ( T-piece ) yielded a diagnostic accuracy of @ % and @ % respectively .


The threshold values of RSBI , thus @ breaths per min/L ( PSV ) and @ breaths per min/L ( T-piece ) , for predicting successful weaning were more accurate than other values .


Similarly , the change in the RSBI could also predict such successes .


Continuous long-term treatment with nitrates may cause nitrate tolerance .


Nebivolol is a highly selective beta@-adrenergic antagonist with additional nitric oxide ( NO ) - mediated vasodilatory effects .


However , there have been no investigations into whether or not the long-term administration of nebivolol might cause nitrate tolerance .


We performed a randomized , double-blind , placebo-controlled , cross-over study in @ healthy men .


Subjects received @ mg nebivolol or placebo once daily for @ days in random order divided by a drug-free interval of @ weeks .


Forearm blood flow ( FBF ) was measured by venous occlusion plethysmography @ h after oral intake of the first and last doses of nebivolol and placebo , respectively .


FBF was measured again following the intravenous administration of @ g nitroglycerin/kg body weight/min for @ min .


Following @ days of continuous intake of placebo , nitroglycerin increased FBF by @ % ( p < @ ) , whereas nitroglycerin increased FBF by @ % ( p < @ ) following @ days of continuous intake of nebivolol , and the increase after @ days of nebivolol was significantly ( p < @ ) more pronounced than after @ days of placebo .


These findings indicate no evidence of nitrate tolerance caused by long-term administration of nebivolol .


On the contrary , long-term intake of nebivolol increases rather than decreases the NO-mediated vasodilating effects .


Most patients with extensive stage small-cell lung cancer ( ES-SCLC ) who undergo chemotherapy , and prophylactic cranial irradiation , have persistent intrathoracic disease .


We assessed thoracic radiotherapy for treatment of this patient group .


We did this phase @ randomised controlled trial at @ hospitals : @ in Netherlands , @ in the UK , three in Norway , and one in Belgium .


We enrolled patients with WHO performance score @-@ and confirmed ES-SCLC who responded to chemotherapy .


They were randomly assigned ( @:@ ) to receive either thoracic radiotherapy ( @ Gy in ten fractions ) or no thoracic radiotherapy .


All underwent prophylactic cranial irradiation .


The primary endpoint was overall survival at @ year in the intention-to-treat population .


Secondary endpoints included progression-free survival .


This study is registered with the Nederlands Trial Register , number NTR@ .


We randomly assigned @ patients between Feb @ , @ , and Dec @ , @ .


Three withdrew informed consent , leaving @ patients in the thoracic radiotherapy group and @ in the control group .


Mean interval between diagnosis and randomisation was @ weeks .


Median follow-up was @ months .


Overall survival at @ year was not significantly different between groups : @ % ( @ % CI @-@ ) for the thoracic radiotherapy group versus @ % ( @ % CI @-@ ) for the control group ( hazard ratio -LSB- HR -RSB- @ , @ % CI @-@ @ ; p = @ ) .


However , in a secondary analysis , @-year overall survival was @ % ( @ % CI @-@ ) versus @ % ( @ % CI @-@ ; p = @ ) .


Progression was less likely in the thoracic radiotherapy group than in the control group ( HR @ , @ % CI @-@ @ ; p = @ ) .


At @ months , progression-free survival was @ % ( @ % CI @-@ ) versus @ % ( @ % CI @-@ ; p = @ ) .


We recorded no severe toxic effects .


The most common grade @ or higher toxic effects were fatigue ( @ vs @ ) and dyspnoea ( three vs four ) .


Thoracic radiotherapy in addition to prophylactic cranial irradiation should be considered for all patients with ES-SCLC who respond to chemotherapy .


The aim of this study was to test the efficacy of a @-month lifestyle intervention in improving cardiovascular disease risk factors in community-based menopausal transition and early postmenopausal women in China .


One hundred healthy menopausal transition and early postmenopausal women aged @ to @ years were randomly assigned to receive either lifestyle change intervention ( n = @ ) or usual care ( n = @ ) .


Menopause status was defined by the menstrual change criteria of the Stages of Reproductive Aging Workshop + @ based on prospective menstrual calendars .


Women in the intervention group were provided with a colorful booklet that included dietary and physical activity recommendations , were individually interviewed , and completed biophysical cardiovascular risk assessments at the Women 's Health Center ( Beijing , China ) .


Women were encouraged to follow a healthy eating pattern and to increase their aerobic activity ( moderate level , @ d/wk , @ min/d ) .


Women in the control group continued their usual eating patterns and activities .


Weight , body mass index ( BMI ) , waist circumference-to-hip circumference ratio ( WHR ) , waist circumference ( WC ) , body composition , blood pressure ( BP ) , blood glucose , and serum lipids were assessed at baseline , @ months , @ months , and @ months in both groups .


Women in the intervention group were observed to have significant decreases in weight , BMI , WC , WHR , systolic BP , total cholesterol , and low-density lipoprotein cholesterol compared with women in the control group .


At @ months , there were significant decreases in weight ( -@ vs @ kg , P = @ ) , BMI ( -@ vs @ kg/m@ , P = @ ) , WC ( -@ vs @ cm , P = @ ) , and WHR ( -@ vs @ , P = @ ) in the intervention group compared with the control group .


At @ months , there were significant decreases in WC ( -@ vs @ cm , P = @ ) , WHR ( -@ vs -@ , P = @ ) , and systolic BP ( -@ vs -@ mm Hg , P = @ ) favoring the intervention group over the control group .


At @ months , there were significant decreases in total cholesterol ( -@ vs @ mmol/L , P = @ ) and low-density lipoprotein cholesterol ( -@ vs @ mmol/L , P = @ ) in the intervention group versus the control group .


Lifestyle intervention may be an effective means for reducing cardiovascular disease risk factors in menopausal transition and early postmenopausal women in China .


Ninety percent of cases of acute calculous cholecystitis are of mild ( grade I ) or moderate ( grade II ) severity .


Although the preoperative and intraoperative antibiotic management of acute calculous cholecystitis has been standardized , few data exist on the utility of postoperative antibiotic treatment .


To determine the effect of postoperative amoxicillin plus clavulanic acid on infection rates after cholecystectomy .


A total of @ patients treated at @ medical centers for grade I or II acute calculous cholecystitis and who received @ g of amoxicillin plus clavulanic acid @ times a day while in the hospital before and once at the time of surgery were randomized after surgery to an open-label , noninferiority , randomized clinical trial between May @ and August @ .


After surgery , no antibiotics or continue with the preoperative antibiotic regimen @ times daily for @ days .


The proportion of postoperative surgical site or distant infections recorded before or at the @-week follow-up visit .


An imputed intention-to-treat analysis of @ patients showed that the postoperative infection rates were @ % ( @ of @ ) in the nontreatment group and @ % ( @ of @ ) in the antibiotic group ( absolute difference , @ % ; @ % CI , -@ % to @ % ) .


In the per-protocol analysis , which involved @ patients , the corresponding rates were both @ % ( absolute difference , @ % ; @ % CI , -@ % to @ % ) .


Based on a noninferiority margin of @ % , the lack of postoperative antibiotic treatment was not associated with worse outcomes than antibiotic treatment .


Bile cultures showed that @ % were pathogen free .


Both groups had similar Clavien complication severity outcomes : @ patients ( @ % ) in the nontreatment group had a score of @ to I and @ patients ( @ % ) had a score of III to V , and @ patients ( @ % ) in the antibiotic group had a score of @ to I and @ patients ( @ % ) had a score of III to V.


Among patients with mild or moderate calculous cholecystitis who received preoperative and intraoperative antibiotics , lack of postoperative treatment with amoxicillin plus clavulanic acid did not result in a greater incidence of postoperative infections .


To expose residents to two methods of education for point-of-care ultrasound , a traditional didactic lecture and a model/simulation-based lecture , which focus on concepts of cardiopulmonary function , volume status , and evaluation of severe thoracic/abdominal injuries ; and to assess which method is more effective .


Single-center , prospective , blinded trial .


University hospital .


Anesthesiology residents who were assigned to an educational day during the two-month research study period .


Residents were allocated to two groups to receive either a @-minute , one-on-one didactic lecture or a @-minute lecture in a simulation center , during which they practiced on a human model and simulation mannequin ( normal pathology ) .


Data points included a pre-lecture multiple-choice test , post-lecture multiple-choice test , and post-lecture , human model-based examination .


Post-lecture tests were performed within three weeks of the lecture .


An experienced sonographer who was blinded to the education modality graded the model-based skill assessment examinations .


Participants completed a follow-up survey to assess the perceptions of the quality of their instruction between the two groups .


@ residents completed the study .


No differences were noted between the two groups in pre-lecture test scores ( P = @ ) , but significantly higher scores for the model/simulation group occurred on both the post-lecture multiple choice ( P = @ ) and post-lecture model ( P = @ ) examinations .


Follow-up resident surveys showed significantly higher scores in the model/simulation group regarding overall interest in perioperative ultrasound ( P = @ ) as well understanding of the physiologic concepts ( P = @ ) .


A model/simulation-based based lecture series may be more effective in teaching the skills needed to perform a point-of-care ultrasound examination to anesthesiology residents .


Women in academic medicine are not achieving the same career advancement as men , and face unique challenges in managing work and family alongside intense work demands .


The purpose of this study was to investigate how a supportive department/division culture buffered women from the impact of work demands on work-to-family conflict .


As part of a larger intervention trial , the authors collected baseline survey data from @ women assistant professors at the University of Pennsylvania Perelman School of Medicine in @ .


Validated measures of work demands , work-to-family conflict , and a department/division culture were employed .


Pearson correlations and general linear mixed modeling were used to analyze the data .


Authors investigated whether work culture moderated the association between work demands and work-to-family conflict .


Heavy work demands were associated with increased levels of work-to-family conflict .


There were significant interactions between work demands , work-to-family conflict , and department/division culture .


A culture conducive to women 's academic success significantly moderated the effect of work hours on time-based work-to-family conflict and significantly moderated the effect of work overload on strain-based work-to-family conflict .


At equivalent levels of work demands , women in more supportive cultures experienced lower levels of work-to-family conflict .


The culture of the department/division plays a crucial role in women 's work-to-family conflict and can exacerbate or alleviate the impact of extremely high work demands .


This finding leads to important insights about strategies for more effectively supporting the careers of women assistant professors .


The addition of glutamine in preoperative drinks may enhance the benefits of carbohydrate alone .


To evaluate the gastric residual volume after the intake of a beverage containing carbohydrate plus glutamine .


Eleven healthy volunteers ( @-@ years-old ) were randomized in a crossover fashion to intake @ mL ( @h before ) and @ mL ( @h before ) of a beverage containing either @ % maltodextrin ( carbohydrate group ) or @ % maltodextrin plus @ g of glutamine ( glutamine group ) in two different moments @ days apart .


Magnetic ressonance was performed to measure the gastric residual volume ( mL ) @ and @ minutes after the last ingestion .


Gastric residual volume similar to basal condition was found after @h and @h of the intake of beverages .


There was no difference in the mean SD GRV ( mL ) found at @ minutes ( carbohydrate group : @ and glutamine group : @ ) and at @ minutes ( carbohydrate group : @ and glutamine group : @ ) between the two drinks .


Gastric emptying is efficient , and occurs in up to two hours after the intake of a beverage containing either carbohydrate alone or carbohydrate associated with glutamine .


The addition of glutamine to carbohydrate-enriched drink seems to be safe for the use up to @h before an operation .


Little is known about how different antiretrovirals effect inflammation and monocyte activation in human immunodeficiency virus ( HIV ) infection .


We examined plasma specimens obtained during a randomized , double-blinded trial in antiretroviral therapy ( ART ) - naive HIV-infected adults which compared the efficacy of elvitegravir/cobicistat/emtricitabine / tenofovir disoproxil fumarate ( EVG/c/FTC / TDF ) with that of efavirenz/emtricitabine/tenofovir disoproxil fumarate ( EFV/FTC/TDF ) .


From a random sample achieving an HIV type @ RNA load of < @ copies/mL by week @ , changes over @ and @ weeks in levels of biomarkers of monocyte activation ( soluble CD@ -LSB- sCD@ -RSB- and soluble CD@ -LSB- sCD@ -RSB- ) , systemic inflammation ( soluble tumor necrosis factor receptor I -LSB- sTNF-RI -RSB- , interleukin @ -LSB- IL-@ -RSB- , and high-sensitivity C-reactive protein -LSB- hsCRP -RSB- ) , and vascular inflammation ( lipoprotein-associated phospholipase A@ -LSB- Lp-PLA@ -RSB- ) were compared .


Multivariable linear regression was used .


A total of @ participants were included .


Significant differences favoring EVG/c/FTC / TDF were noted for changes in sCD@ , hsCRP , and Lp-PLA@ levels .


Factors independently associated with a larger decrease in the sCD@ level included random assignment to receive EVG/c/FTC / TDF , higher baseline sCD@ level , and larger decreases in hsCRP and sCD@ levels ; factors associated with a larger Lp-PLA@ decrease included higher baseline Lp-PLA@ and IL-@ levels , smaller increases in total cholesterol and triglycerides levels , a larger decrease in the sCD@ level , and a smaller decrease in the sCD@ level .


EVG/c/FTC / TDF led to greater decreases in sCD@ , hsCRP , and Lp-PLA@ levels , compared with EFV/FTC/TDF .


Randomization group independently predicted the change in sCD@ level , and changes in monocyte activation independently predicted the change in Lp-PLA@ level .


There appears to be a more favorable effect of the integrase inhibitor EVG over efavirenz on immune activation , which may affect vascular inflammation .


Vitamin D supplementation may be an inexpensive intervention to reduce heart failure ( HF ) incidence .


However , there are insufficient data to support this hypothesis .


This study evaluates whether vitamin D plus calcium ( CaD ) supplementation is associated with lower rates of HF in postmenopausal women and whether the effects differ between those at high versus low risk for HF .


Analyses were restricted to @ @ ( of original @ @ ) women aged @ to @ years old in the Women 's Health Initiative randomized trial of CaD supplementation who were randomized @:@ in a double-blinded fashion to receive @ mg/d of calcium plus @ IU/d of vitamin D@ or placebo .


Overall , @ adjudicated incident HF cases ( intervention , @ ; control , @ ) occurred during a median follow-up of @ ( interquartile range , @ ) years .


CaD supplementation , compared with placebo , was not associated with reduced HF risk in the overall population , hazard ratio , @ ; P = @ .


However , CaD supplementation had differential effects ( P interaction = @ ) in subgroups stratified by baseline risk status of HF defined by the presence ( high risk = @ @ ) or absence ( low risk = @ @ ) of pre-existing HF precursors including coronary heart diseases , diabetes mellitus , or hypertension : @ % ( hazard ratio , @ -LSB- @ % confidence interval , @-@ @ -RSB- ) lower risk of HF in the low-risk versus hazard ratio , @ ; P = @ , in the high-risk subgroups .


CaD supplementation did not significantly reduce HF incidence in the overall cohort , however , it was beneficial among postmenopausal women without major HF precursors while of little value in high-risk subgroups .


Additional studies are warranted to confirm these findings and investigate the underlying mechanism .


Nonpegylated liposomal doxorubicin liposomal doxorubicin , ( Myocet ; Sopherion Therapeutics , Inc Canada , and Cephalon , Europe ) ( NPLD ; Myocet ( ) ) in combination with trastuzumabHerceptin ( ) ( Hoffmann-La Roche ) has shown promising activity and cardiac safety .


We conducted a randomized phase III trial of first-line NPLD plus trastuzumab and paclitaxel ( Pharmachemie B.V. ) ( MTP ) versus trastuzumab plus paclitaxel ( TP ) in patients with human epidermal growth factor @ receptor ( HER@ ) - positive metastatic breast cancer .


Patients were randomly assigned to NPLD ( M , @ mg/m ( @ ) every @ weeks for six cycles ) , trastuzumab ( T , @ mg/kg loading dose followed by @ mg/kg weekly ) , and paclitaxel ( P , @ mg/m ( @ ) weekly ) or T + P at the same doses until progression or toxicity .


The primary efficacy outcome was progression-free survival ( PFS ) .


One hundred and eighty-one patients were allocated to receive MTP , and @ to TP .


Median PFS was @ and @ months with MTP and TP , respectively -LSB- hazard ratio ( HR ) @ ; two-sided P = @ -RSB- .


In patients with estrogen receptor ( ER ) - and progesterone receptor ( PR ) - negative tumors , PFS was @ and @ months , respectively -LSB- HR @ ; @ % confidence interval ( CI ) @-@ @ -RSB- .


Median overall survival ( OS ) was @ and @ months with MTP and TP , respectively ( HR @ ; two-sided P = @ ) .


In ER - and PR-negative tumors , OS was @ and @ months , respectively ( HR @ ; @ % CI @-@ @ ) .


The frequency of adverse events was higher with MTP , but there was no significant difference in cardiac toxicity between treatment arms .


The trial failed to demonstrate a significant clinical improvement with the addition of M to TP regimen .


The clinical benefit observed in an exploratory analysis in the ER - and PR-negative population deserves consideration for further clinical trials .


To evaluate the efficacy of reflex entropy ( RE ) / state entropy ( SE ) in monitoring the response to nociceptive stimulus during propofol-remifentanil infusion .


After the approval of the hospital ethics committee , sixty American Society of Anesthesiologists ( ASA ) classification @-@ patients , aged @-@ years , receiving the hypogastrium operation undergoing general anesthesia , were randomly allocated to groups A and B with different remifentanil concentrations .


After the concentration of propofol and remifentanil reached balance , tetanic stimulation , intubation , and incision were performed respectively with certain intervals .


RE and SE were monitored during this procedure .


Twelve patients were withdrawn from this study due to the use of vasoactive drugs .


Finally , there were @ cases in group A and @ cases in group B.


The RE and SE were not significantly changed before and after the tetanic stimulation in both groups ( all P > @ ) .


Both RE and SE were significantly increased after intubation in group B ( both P < @ ) and after skin incision in both groups ( all P < @ ) .


Under the same stimulation , RE and SE showed no significant difference among groups administered with different levels of remifentanil ( P > @ ) .


Under the anesthesia with propofol + remifentanil , nociceptive response may cause the increase of RE and SE .


Therefore , RE and SE may be useful parameters for monitoring the nociceptive response during general anaesthesia .


To compare the outcome of deep sclerectomy ( DS ) with and without mitomycin-C ( MMC ) in patients with normal-tension glaucoma ( NTG ) .


We prospectively analysed the results of @ eyes of @ consecutive patients with NTG ( age ; mean SD ; @ @ years ) who underwent DS with a collagen implant .


Patients were randomized to the MMC and non-MMC groups .


Subconjunctival MMC ( @ mg/ml for @ min ) was used intraoperatively in @ of @ eyes .


We defined total success as @ % reduction in intraocular pressure ( IOP ) without medication .


Follow-up time was @ months .


The mean preoperative IOP was significantly reduced from @ @ mmHg to @ @ ( p < @ ) in the MMC group after @-month follow-up and from @ @ mmHg to @ @ ( p < @ ) in the non-MMC group .


At @ months , the mean IOP was significantly lower in the MMC group ( p = @ ) compared with the non-MMC group .


Total success was achieved in @ of @ eyes ( @ % ) in MMC group and in nine of @ eyes ( @ % ) in non-MMC group ( p = @ ) .


The number of glaucoma medications was decreased from @ @ to @ @ in MMC group ( p = @ ) and from @ @ to @ @ in non-MMC group ( p < @ ) .


Goniopuncture was performed in seven eyes ( @ % ) in the MMC group , compared with @ eyes ( @ % ) in the non-MMC group ( p = @ ) .


IOP < @ mmHg was achieved in seven of @ eyes in the MMC group and in two of @ in the non-MMC group ( p = @ ) .


Complication rate was low , and no difference between groups was evident .


Deep sclerectomy seems to be effective and safe in reducing IOP in patients with NTG .


Intraoperative use of MMC results in lower postoperative IOP @-month postoperatively without increased rate of complications .


Vent-HeFT is a multicentre randomized trial designed to investigate the potential additive benefits of inspiratory muscle training ( IMT ) on aerobic training ( AT ) in patients with chronic heart failure ( CHF ) .


Forty-three CHF patients with a mean age of @ years , peak oxygen consumption ( peak VO@ ) @ mL/kg/min , and LVEF @ % were randomized to an AT/IMT group ( n = @ ) or to an AT/SHAM group ( n = @ ) in a @-week exercise programme .


AT involved @ min of ergometer training at @-@ % of maximum heart rate , three times a week for both groups .


In the AT/IMT group , IMT was performed at @ % of sustained maximal inspiratory pressure ( SPImax ) while in the AT/SHAM group it was performed at @ % of SPImax , using a computer biofeedback trainer for @ min , three times a week .


At baseline and at @ months , patients were evaluated for exercise capacity , lung function , inspiratory muscle strength ( PImax ) and work capacity ( SPImax ) , quality of life ( QoL ) , LVEF and LV diameter , dyspnoea , C-reactive protein ( CRP ) , and NT-proBNP .


IMT resulted in a significantly higher benefit in SPImax ( P = @ ) , QoL ( P = @ ) , dyspnoea ( P = @ ) , CRP ( P = @ ) , and NT-proBNP ( P = @ ) .


In both AT/IMT and AT/SHAM groups PImax ( P < @ , P = @ ) , peak VO@ ( P = @ , P = @ ) , and LVEF ( P = @ , P = @ ) improved significantly ; however , without an additional benefit for either of the groups .


This randomized multicentre study demonstrates that IMT combined with aerobic training provides additional benefits in functional and serum biomarkers in patients with moderate CHF .


These findings advocate for application of IMT in cardiac rehabilitation programmes .


Anaesthetists may fail to recognize and manage certain rare intraoperative events .


Simulation has been shown to be an effective educational adjunct to typical operating room-based education to train for these events .


It is yet unclear , however , why simulation has any benefit .


We hypothesize that learners who are allowed to manage a scenario independently and allowed to fail , thus causing simulated morbidity , will consequently perform better when re-exposed to a similar scenario .


Using a randomized , controlled , observer-blinded design , @ first-year residents were exposed to an oxygen pipeline contamination scenario , either where patient harm occurred ( independent group , n = @ ) or where a simulated attending anaesthetist intervened to prevent harm ( supervised group , n = @ ) .


Residents were brought back @ months later and exposed to a different scenario ( pipeline contamination ) with the same end point .


Participants ' proper treatment , time to diagnosis , and non-technical skills ( measured using the Anaesthetists ' Non-Technical Skills Checklist , ANTS ) were measured .


No participants provided proper treatment in the initial exposure .


In the repeat encounter @ months later , @ % in the independent group vs @ % in the supervised group resumed adequate oxygen delivery ( P = @ ) .


The independent group also had better ANTS scores -LSB- median ( interquartile range ) : @ ( @-@ @ ) vs @ ( @-@ ) , P = @ -RSB- .


There was no difference in time to treatment if proper management was provided -LSB- @ ( @-@ ) vs @ ( @-@ ) s , P = @ -RSB- .


Allowing residents to practise independently in the simulation laboratory , and subsequently , allowing them to fail , can be an important part of simulation-based learning .


This is not feasible in real clinical practice but appears to have improved resident performance in this study .


The purposeful use of independent practice and its potentially negative outcomes thus sets simulation-based learning apart from traditional operating room learning .


Cardiovascular disease ( CVD ) and underlying atherosclerosis begin in childhood and are related to CVD risk factors .


This study evaluates tools and strategies to enhance adoption of new CVD risk reduction guidelines for children .


Thirty-two practices , recruited and supported by @ primary care research networks , were cluster randomized to a multifaceted controlled intervention .


Practices were compared with guideline-based individual and composite measures for BMI , blood pressure ( BP ) , and tobacco .


Composite measures were constructed by summing the numerators and denominators of individual measures .


Preintervention and postintervention measures were assessed by medical record review of children ages @ to @ years .


Changes in measures ( pre-post and intervention versus control ) were compared .


The intervention group BP composite improved by @ % , increasing from @ % to @ % , compared with the control group ( @ % to @ % ; P < @ ) .


Intervention group BP interpretation improved by @ % ( from @ % to @ % ) , compared with the control group ( @ % to @ % ; P < @ ) .


The assessment of tobacco exposure or use for @ - to @-year-olds in the intervention group improved by @ % ( from @ % to @ % ) versus the control group ( @ % to @ % ) ( P = @ ) .


No significant change was seen in the BMI or tobacco composites measures .


The overall composite of @ measures improved by @ % ( from @ % to @ % ) for the intervention group versus the control group ( @ % to @ % ) ( P = @ ) .


Significant improvement was demonstrated in the overall composite measure , the composite measure of BP , and tobacco assessment and advice for children aged @ to @ years .


Veliparib ( ABT-@ ) is a potent oral inhibitor of Poly ( ADP-ribose ) polymerase enzyme that is currently in development for the treatment of non-hematologic and hematologic malignancies .


This analysis characterizes the population pharmacokinetics of veliparib , including developing a structural pharmacokinetic model and testing patient demographics and covariates for potential influence on veliparib pharmacokinetics in patients with non-hematologic malignancies .


The analysis dataset included @,@ veliparib concentration values from @ patients with non-hematologic malignancies enrolled in three phase I and one phase II studies .


Population pharmacokinetic modeling was performed using NONMEM .


The likelihood ratio test was used for comparison of nested models , and visual predictive check was employed for model qualification .


Covariates tested included body size measures , creatinine clearance ( CLCR ) , formulation , age , sex , race , liver function tests , and coadministration with temozolomide .


A one-compartment model with first-order absorption and elimination adequately described veliparib pharmacokinetics .


The final model included fixed effects for CLCR on veliparib oral clearance ( CL/F ) and lean body mass ( LBM ) on volume of distribution ( V d/F ) .


CL/F and V d/F were @ L/h ( for a CLCR of @ mL/min ) and @ L ( for an LBM of @ kg ) , respectively .


Only LBM and CLCR were found to be determinants of veliparib V d/F and CL/F , respectively .


Dosage adjustments of veliparib on the basis of body size , age , sex , race , liver function , and temozolomide coadministration are not necessary in patients with non-hematologic malignancies .


This is the first study to characterize the population pharmacokinetics of veliparib , and the developed model will be used to conduct simulations and evaluate veliparib exposure-response relationships .


To determine whether supplementation with vitamin D improves resilience to the adverse effects of earthquakes .


Opportunistic addition to an established randomised double blind placebo controlled trial .


Christchurch , New Zealand , where a prolonged series of catastrophic earthquakes beginning on @ September @ occurred , which caused widespread destruction , fatalities , and extensive psychological damage .


@ healthy adults ( @ women ; @ men ) aged @-@ who were already participating in the vitamin D and acute respiratory infections study ( VIDARIS ) between February @ and November @ .


Participants were randomised to receive an oral dose of either @,@ IU vitamin D@ monthly for two months then @,@ IU monthly ( n = @ ) or placebo ( n = @ ) for a total of @ months .


This is a post hoc analysis from the previously published VIDARIS trial .


The primary endpoint in the current analysis was the self reported effects and overall adverse impact of the Christchurch earthquakes as assessed by questionnaire four months after the most destructive earthquake on @ February @ , which was used as the index event .


The secondary end point was the number of `` psychological '' adverse events that participants reported at their usual monthly appointments as part of the original VIDARIS trial .


@ participants completed the earthquake impact questionnaire ( n = @ in the vitamin D group and @ in the placebo group ) .


There was no significant difference in the number of self reported adverse effects between those receiving vitamin D supplementation and those receiving placebo .


There was also no difference in the overall adverse impact score between treatment groups ( ( @ ) P = @ ) .


The exception was that those in the vitamin D group experienced more adverse effects on family relationships ( @ % v @ % ; ( @ ) P = @ ) .


The number of psychological adverse events-such as fatigue , stress , anxiety , and insomnia-that participants reported at their usual monthly appointments was significantly higher after the earthquake ( ( @ ) P = @ ) but did not differ between treatment groups .


In this trial , vitamin D supplementation did not reduce the adverse impact of earthquakes in healthy adults .


Trial registration Australian New Zealand Clinical Trials Registry ( anzctr.org.au ) ACTRN@ .


Cumulative neurotoxicity is a prominent toxicity of oxaliplatin-based therapy .


Intravenous calcium and magnesium have been extensively used to reduce oxaliplatin-induced neurotoxicity .


This trial was designed to definitively test whether calcium/magnesium decreases oxaliplatin-related neurotoxicity .


In all , @ patients with colon cancer undergoing adjuvant therapy with FOLFOX ( fluorouracil , leucovorin , and oxaliplatin ) were randomly assigned to intravenous calcium/magnesium before and after oxaliplatin , a placebo before and after , or calcium/magnesium before and placebo after .


The primary end point was cumulative neurotoxicity measured by the sensory scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy @ tool .


There were no statistically significant neuropathy differences among the study arms as measured by the primary end point or additional measures of neuropathy , including clinician-determined measurement of the time to grade @ neuropathy by using the National Cancer Institute Common Terminology Criteria for Adverse Events scale or an oxaliplatin-specific neuropathy scale .


In addition , calcium/magnesium did not substantially decrease oxaliplatin-induced acute neuropathy .


This study does not support using calcium/magnesium to protect against oxaliplatin-induced neurotoxicity .


To evaluate the effects of @ mg or @ mg of ranibizumab in eyes with macular telangiectasia type @ without subretinal neovascularization .


Ten eyes were randomized to either @ mg or @ mg ranibizumab group in @ eye only .


Study eye received ranibizumab at baseline and at Months @ and @ .


Injections at Months @ , @ , and @ were at investigator 's discretion .


Participants were followed monthly through @ months with best-corrected visual acuity , fluorescein angiography , and optical coherence tomography .


For study eyes at baseline , median best-corrected visual acuity letter score was @ ( @/@ Snellen equivalent ) and central subfield retinal thickness was @ m. Median number of injections was six .


Median change in best-corrected visual acuity at Month @ was @ letters ( range : -@ to @ letters ) at both doses in the study eye and @ letters ( range : -@ to @ letters ) in the untreated fellow eye .


At Month @ , retinal leakage decreased @ disk area and @ disk area for @ mg and @ mg ranibizumab , respectively .


Median change in central subfield retinal thickness was @ m and -@ m for @ mg and @ mg ranibizumab , respectively .


Ranibizumab ( @ mg or @ mg ) decreases leakage secondary to macular telangiectasia type @ , but accompanying improvements in best-corrected visual acuity appear similar to improvements in the untreated fellow eye where retinal thickness is relatively unchanged .


Patients with transient ischaemic attack ( TIA ) or stroke are at risk for cognitive impairment and dementia .


Currently , there is no known effective strategy to prevent this cognitive decline .


Increasing evidence exists that physical exercise is beneficial for cognitive function .


However , in patients with TIA or stroke who are at risk of cognitive impairment and dementia , only a few trials have been conducted .


In this study , we aim to investigate whether a physical exercise programme ( MoveIT ) can prevent cognitive decline in patients in the acute phase after a TIA or minor ischaemic stroke .


A single-blinded randomised controlled trial will be conducted to investigate the effect of an aerobic exercise programme on cognition compared with usual care .


@ adult patients with a TIA or minor ischaemic stroke less than @ month ago will be randomly allocated to an exercise programme consisting of a @-week aerobic exercise programme and regular follow-up visits to a specialised physiotherapist during the period of @ year or to usual care .


Outcome measures will be assessed at the baseline , and at the @-year and @-year follow-up .


The primary outcome is cognitive functioning measured with the Montreal Cognitive Assessment ( MoCA ) test and with additional neuropsychological tests .


Secondary outcomes include maximal exercise capacity , self-reported physical activity and measures of secondary prevention .


To compare staples with subcuticular sutures for skin closure in emergency Cesarean sections ( CS ) .


One hundred and thirty women ( undergoing emergency CS without previous abdominal delivery ) were randomly assigned to either staples or subcuticular skin closure ( monocryl @-@ ) .


Primary outcome of the study was cosmetic outcome -LSB- as assessed by patient and independent observer : Patient Scar Assessment Scale ( PSAS ) and Observer Scar Assessment Scale ( OSAS ) , respectively -RSB- , @weeks post-operative .


Secondary outcomes were wound complications , operating time , post-operative pain ( visual analogue scale day @ post-operative and patient assessment of pain in scar @weeks post-operative ) , and duration of hospital stay .


@ women were available for evaluation of scar @weeks post-operative .


Cosmetic result of staples was significantly better than subcuticular sutures ( PSAS and OSAS : p value @ and @ , respectively ) , with significantly lesser duration of surgery ( @ vs. @min : p value @ ) and comparable post-operative pain ( pain on day @ and @weeks post-operatively : p value @ and @ , respectively ) and wound complications ( p value @ ) .


However , duration of stay in hospital was increased ( @ vs. @days : p value @ ) .


Staples are the method of choice for skin closure in emergency CS as they are significantly better than subcuticular sutures with respect to cosmesis and duration of surgery .


Post-operative pain and wound complications are comparable in two groups .


However , staples are associated with significantly increased duration of hospital stay .


Trial registered in clinical trial registry CTRI : REF/@/@ / @ .


Chronic thoracic pain after cardiac surgery is prevalent ( @ to @ % ) and may affect patients ' physical and mental health status .


Despite its favorable pharmacokinetic and pharmacodynamic properties , high doses of remifentanil administered during surgery are reported to cause acute postoperative pain and increased requirements for analgesics .


Recently , an association between remifentanil use and the incidence of chronic thoracic pain in the long term was also reported .


Our objective is to investigate the influence of the intraoperative remifentanil on chronic postoperative pain in a prospective randomized controlled trial .


In this prospective , randomized , single-blind clinical trial , all patients ( N = @ ) between @ and @ years undergoing cardiac surgery via sternotomy receive a continuous infusion of propofol together with intermittent intravenous fentanyl at predetermined times perioperatively .


Patients are randomized to receive either an additional continuous infusion of remifentanil ( @ g ( -@ ) kgIBW ( -@ ) min ( -@ ) ) or additional fentanyl ( @ to @ g ) as needed during surgery.The primary end point is the prevalence of chronic thoracic pain @ months after surgery .


Secondary end points include acute postoperative pain ; postoperative analgesic use ; chronic thoracic pain @ and @ months after surgery ; quality of life ( SF-@ ) at @ , @ and @ months after surgery ; work productivity ; and use of health care .


In addition , thermal detection and pain thresholds are measured preoperatively , @ days after surgery and @ months after surgery using quantitative sensory testing ( QST ) .


Finally , the influence of several genetic variances on the different outcomes will be measured .


Chronic thoracic pain is prevalent after cardiac surgery , and research is needed to minimize the risk of chronic persistent postoperative pain , which is an invalidating , long-term complication of surgery .


The objective of this trial is to determine the influence of perioperative remifentanil on long-term pain outcomes for cardiac patients in a prospective randomized trial .


The results may be used to optimize perioperative analgesia techniques and , thereby , improve quality of life after cardiac surgery .


To develop a reliable and safe laryngeal nerve conduction technique and to obtain consistent parameters as normal reference values .


A prospective single-arm study .


A nerve conduction test was performed on the contralateral normal side in @ patients with unilateral vocal fold palsy .


The recording was performed in the intact thyroarytenoid muscle using a monopolar needle .


The electrical stimulation using a @-mm monopolar needle was applied @ cm below the lower margin of the cricoid cartilage , just lateral to the trachea and medial to the carotid artery , and its intensity was gradually increased until the amplitude of the electrical response reached the maximum level .


The latency of the evoked muscle response was acquired at the first evoked waveform deflection from the baseline .


The average latency of the recurrent laryngeal nerves was @ ms. The latencies showed normal distribution according to the quantile-quantile plot and Kolmogorov-Smirnov test ( P = @ ) .


There was no significant difference in latencies between the right and left recurrent laryngeal nerves .


Anthropometric factors including height and weight did not show any correlation with the latencies .


We developed a reliable and safe laryngeal nerve conduction technique and obtained normal reference values for the recurrent laryngeal nerve conduction study .


This laryngeal nerve conduction study can be an additional tool for detecting recurrent laryngeal nerve injury if it is performed in combination with the conventional laryngeal electromyography .


Because increased dopamine neurotransmission occurs with most antidepressants , and because antipsychotics cause behavioural supersensitivity to dopamine , short-term low-dose antipsychotic treatment was tested on depressed patients with an expectation of clinical improvement in the supersensitive phase following drug withdrawal .


This was a randomized , double-blind , placebo-controlled study of @ patients who met criteria for DSM-IV ( ) Major Depressive Disorder , were in a Major Depressive Episode , and had a Hamilton Depression Rating Scale ( HAMD ) rating of @ .


Half the participants received @ mg oral haloperidol each day for @ days , after which they received placebo daily for @ weeks .


The other half received placebo throughout the trial .


One week after stopping the medication , the HAMD ratings of the drug-treated patients fell by @ points , as compared to a reduction of @ points in the placebo-treated patients , when comparing visits @ and @ .


There was no such difference when comparing visits @ and @ .


The differences were not significant , but indicated a trend .


One week after the medication was stopped , the Clinical Global Index fell @ units for the medication-treated patients , compared to @ units for the placebo group ( P = @ ) .


The regimen was well tolerated .


Seven days of an ultra-low dose of @ mg haloperidol , followed by withdrawal of haloperidol , resulted in clinical depression improvement greater than placebo and significantly decreased psychomotor retardation , consistent with haloperidol-induced behavioural supersensitivity to dopamine .


The sample was small .


More patients are needed in a future study .


To determine whether stereopsis of infants treated for monocular cataracts varies with the type of optical correction used .


Randomized prospective clinical trial .


The Infant Aphakia Treatment Study randomized @ patients with unilateral cataracts at age @-@ months to either primary intraocular lens ( IOL ) or contact lens correction .


At @ years of age a masked examiner assessed stereopsis on these patients using @ different tests : ( @ ) Frisby ; ( @ ) Randot Preschool ; and ( @ ) Titmus Fly .


Twenty-eight patients ( @ % ) had a positive response to at least @ of the stereopsis tests .


There was no statistically significant difference in stereopsis between the @ treatment groups : Frisby ( contact lens , @ -LSB- @ % -RSB- ; IOL , @ -LSB- @ % -RSB- ; P = @ ) , Randot ( contact lens , @ -LSB- @ % -RSB- ; IOL , @ -LSB- @ % -RSB- ; P = @ ) , or Titmus ( contact lens , @ -LSB- @ % -RSB- ; IOL , @ -LSB- @ % -RSB- ; P = @ ) .


The median age at surgery for patients with stereopsis was younger than for those without stereopsis ( @ vs @ months ; P = @ ) .


The median visual acuity for patients with stereopsis was better than for those without stereopsis ( @/@ vs @/@ ; P = @ ) .


The type of optical correction did not influence stereopsis outcomes .


However , @ other factors did : age at surgery and visual acuity in the treated eye at age @ years .


Early surgery for unilateral congenital cataract and the presence of visual acuity better than or equal to @/@ appear to be more important than the type of initial optical correction used for the development of stereopsis .


Although the rate of bleeding among patients with atrial fibrillation ( AF ) taking novel oral anticoagulants in randomized controlled trials is described , the rate of bleeding with `` real-world '' use is uncertain .


We conducted a retrospective electronic medical record interrogation and subsequent chart review among patients within Intermountain Healthcare between October @ and November @ .


Patients were included if they had a diagnosis of AF and were receiving either dabigatran or rivaroxaban .


Rates of major bleeding were calculated .


Among @ patients , @ ( @ % ) experienced major bleeding ( @ % confidence interval -LSB- CI -RSB- @-@ @ ) , @ ( @ % ) experienced intracranial hemorrhage ( @ % CI @-@ @ ) , and @ ( @ % ) experienced fatal bleeding .


Of the @ patients experiencing a major bleed , @ ( @ % ) would have been excluded from the Randomized Evaluation of Long-Term Anticoagulation Therapy ( RE-LY ) and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for prevention of Stroke and Embolism Trial in Atrial Fibrillation ( ROCKET AF ) clinical trials .


We observed a rate of major bleeding similar to that reported in randomized clinical trials among patients with AF prescribed dabigatran or rivaroxaban .


Psychosocial problems are highly prevalent among Dutch adolescents .


We have conducted a trial to test whether offering chat-based consultations could be of added value within the context of Dutch Youth Health Care .


This trial was ended prematurely because of recruitment issues .


The aim of this study is to learn from this failed trial and to provide more insight into non-participation .


Sources of data were non-participation forms , oral clarification , patient records , telephone interviews with adolescents that declined to participate , and a questionnaire-based process evaluation among nurses .


Non-participation appears to be a multi-factorial problem .


Of those @ adolescents eligible to participate , the majority ( n = @ , @ % ) declined to do so .


Two-third of those ( n = @ ) also refused usual care , which might be indicative of not wanting help and/or experiencing problems and the validity of the assessment instrument .


The other one-third ( n = @ ) did enrol in usual care and indicated other reasons for non-participation , such as a preference for face-to-face consultations , the extensive information that was provided , and not liking the idea of being randomized .


This study shows that even if a trial fails , we can learn about the challenges of recruiting adolescents in intervention trials .


To investigate the therapeutic effect of Yiqi Huaju Recipe ( YHR ) combined with routine therapy on the blood pressure , the blood pressure variability and other cardiovascular risk factors in hypertension patients complicated with metabolic syndrome ( MetS ) .


Totally @ hypertension patients complicated with MetS were recruited in this study and randomly assigned to the treatment group ( @ cases , treated with basic routine treatment + YHR ) and the control group ( @ cases , treated with basic routine treatment + placebo ) .


The treatment course was @ weeks .


Detected were parameters such as @-h ambulatory blood pressure monitoring ( ABPM ) , body mass index ( BMI ) , waist circumference ( WC ) , waist to hip ratio ( WHR ) , homeostatic model assessment for insulin resistance ( HOMA-IR ) , fasting glycosylated hemoglobin A@c ( HbA@c ) , fasting plasma glucose ( FPG ) , @ h postprandial plasma glucose ( @ h PPG ) , fasting plasma insulin ( FPI ) , serum lipid , etc. .


The anthropometric parameters and plasma glucose levels ( except HbAlc ) were obviously lowered after treatment than before treatment in the treatment group ( P < @ , P < @ ) .


Besides , better effects were obtained in the WC , WHR , @ h PPG , FPI and HOMA-IR ( P < @ ) .


The average blood pressure amplitude , the blood pressure variability , and blood pressure load at any time point were more obviously improved in the two groups after treatment than before treatment ( P < @ , P < @ ) .


Besides , partial indices were better in the treatment group than in the control group ( P < @ , P < @ ) .


YHR combined with routine therapy exhibited better effect on reducing the blood pressure amplitude , the blood pressure variability , and the blood pressure load in hypertension patients complicated with MetS .


It could also effectively decrease the risk of other vascular disease .


Whether there are age-related changes in slow wave activity ( SWA ) rise time , a marker of homeostatic sleep drive , is unknown .


Additionally , although sleep medication use is highest among older adults , the quantitative electroencephalographic ( EEG ) profile of the most commonly prescribed sleep medication , zolpidem , in older adults is also unknown .


We therefore quantified age-related and regional brain differences in sleep EEG with and without zolpidem .


Thirteen healthy young adults aged @ years and @ healthy older adults aged @ years participated in a randomized , double-blind , within-subject study that compared placebo to @mg zolpidem .


Older adults showed a smaller rise in SWA and zolpidem increased age-related differences in SWA rise time such that age differences were observed earlier after latency to persistent sleep .


Age-related differences in EEG power differed by brain region .


Older , but not young , adults showed zolpidem-dependent reductions in theta and alpha frequencies .


Zolpidem decreased stage @ in older adults and did not alter other age-related sleep architecture parameters .


SWA findings provide additional support for reduced homeostatic sleep drive or reduced ability to respond to sleep drive with age .


Consequences of reduced power in theta and alpha frequencies in older adults remain to be elucidated .


To assess the long-term effects of dietary interventions on glycemic control , need for diabetes medications , and remission of type @ diabetes .


Originally , in a two-arm trial design , overweight , middle-aged men and women with newly diagnosed type @ diabetes were randomized to a low-carbohydrate Mediterranean diet ( LCMD ; n = @ ) or a low-fat diet ( n = @ ) .


After @ years , participants who were still free of diabetes medications were further followed up until the primary end point ( need of a diabetic drug ) ; remission of diabetes ( partial or complete ) and changes in weight , glycemic control , and cardiovascular risk factors were also evaluated .


The primary end point was reached in all participants after a total follow-up of @ years in the low-fat group and @ years in the LCMD group ; median survival time was @ years ( @ % CI @-@ @ ) and @ years ( @-@ @ ) , respectively .


The unadjusted hazard ratio for the overall follow-up was @ ( @-@ @ ; P < @ ) .


LCMD participants were more likely to experience any remission ( partial or complete ) , with a prevalence of @ % ( @-@ @ % ) during the first year and @ % ( @-@ @ % ) during year @ compared with @ % ( @-@ @ % ) at year @ and @ % at year @ in the low-fat diet group .


In patients with newly diagnosed type @ diabetes , an LCMD resulted in a greater reduction of HbA@c levels , higher rate of diabetes remission , and delayed need for diabetes medication compared with a low-fat diet .


Many sub-Saharan African countries report high postpartum loss to follow-up of mother-baby pairs .


We aimed to determine whether interactive text messages improved rates of clinic attendance and early infant HIV testing in the Nyanza region of Kenya .


Parallel-group , unblinded , randomized controlled trial .


HIV-positive pregnant women at least @ years old and enrolled in the prevention of mother-to-child transmission of HIV programme were randomized to receive either text messages ( SMS group , n = @ ) or usual care ( n = @ ) .


Messages were developed using formative focus group research informed by constructs of the Health Belief Model .


The SMS group received up to eight text messages before delivery ( depending on gestational age ) , and six messages postpartum .


Primary outcomes included maternal postpartum clinic attendance and virological infant HIV testing by @ weeks postpartum .


The primary analyses were intention-to-treat .


Of the @ enrolled women , @ ( @ % ) had final outcome information .


In the SMS group , @ of @ ( @ % ) women attended a maternal postpartum clinic compared to @ of @ ( @ % ) in the control group ( relative risk @ , @ % confidence interval @-@ @ ) .


HIV testing within @ weeks was performed in @ of @ ( @ % ) infants in the SMS group compared to @ of @ ( @ % ) in the control group ( relative risk @ , @ % confidence interval @-@ @ ) .


Text messaging significantly improved maternal postpartum visit attendance , but overall return rates for these visits remained low .


In contrast , high rates of early infant HIV testing were achieved in both arms , with significantly higher testing rates in the SMS compared to the control infants .


To evaluate the clinical effectiveness and safety of Fangfeng Tongsheng Granule ( FTG ) in the treatment of upper respiratory infection ( superficial cold and interior heat syndrome , exterior and interior excess syndrome ) .


A randomized , double-blinded , multi-centered , placebo-parallel-controlled clinical trial was adopted .


Totally @ patients were enrolled and assigned to two groups , @ patients in the treatment group and @ patients in the control group .


Those in the treatment group took FTG at the daily dose of @ g , twice per day , the therapeutic course being @ days .


Those with axillary temperature more than @ degrees C took one more time before medication .


Those in the control group took simulated agent granules the same dose and dosage as the treatment group .


The effect of Chinese medical syndrome ( ECMS ) , the rate of temperature-dropping-to-normal ( RT ) , the time of temperature-dropping-to-normal ( TT ) , the curative effect of single symptom ( CESS ) and adverse reactions were observed .


Totally @ completed the trial in the treatment group and @ in the control group .


In the treatment group , the cured-effective rate was @ % ( @ / @ ) , the total effective rate was @ % ( @/@ ) , the ECMS score decreased by @ + / - @ , while they were @ % ( @/@ ) , @ % ( @/@ ) , and @ + / - @ , respectively in the control group ( P < @ ) .


The RT was @ % ( @/@ ) in the treatment group and @ % ( @/@ ) in the control group ( P < @ ) .


The TT in the treatment group was superior to that of the control group ( P < @ ) .


As for CESS , all of the three primary symptoms and nine secondary symptoms were improved more obviously in the treatment group than in the control group .


The integral decreased obviously , showing statistical difference ( P < @ ) .


The decrease was more obvious in the treatment group than in the control group ( P < @ ) .


There was no adverse event related to FTG .


FTG was effective and safe in treating upper respiratory infection ( superficial cold and interior heat syndrome , exterior and interior excess syndrome ) .


The Modifications of Diet in Renal Disease ( MDRD ) and Chronic Kidney Disease Epidemiology Collaboration ( CKD-EPI ) are @ equations commonly used to estimate glomerular filtration rate ( eGFR ) .


The predictive performance offered by these equations , particularly in relation to clinical outcomes in elderly hypertensive patients , is not clear .


The Second Australian National Blood Pressure Study cohort was used to investigate the predictive performance of these @ equations for long-term outcomes ( median @ years ) in elderly treated hypertensive patients .


Both equations were used to calculate eGFR in @,@ patients aged @ years and classified as having chronic kidney disease ( CKD ) or no CKD ( eGFR @ml/min/@ @ m@ ) .


More patients were classified as having no CKD using the CKD-EPI equation compared with the MDRD equation ( @ % vs. @ % ; P = @ ) .


Both equations performed similarly in risk prediction of all-cause and cardiovascular mortality with decreased eGFR , except for patients with baseline eGFR of @-@ml / min/@ @ m@ , where the CKD-EPI equation predicted higher risk of all-cause mortality compared with those with no CKD .


However , the magnitude of difference in risk prediction was too small to be clinically meaningful .


Both equations showed similar predictive performance .


However , we observed longer survival and no higher risk in those who were reclassified as having no CKD using the CKD-EPI equation , but these patients were classified earlier as having CKD using the MDRD equation .


There was no clinically relevant difference in predictive performance for long-term survival by eGFR calculated using either of these equations in this elderly hypertensive population .


Ischemic mitral regurgitation is associated with increased mortality and morbidity .


For surgical patients with moderate regurgitation , the benefits of adding mitral-valve repair to coronary-artery bypass grafting ( CABG ) are uncertain .


We randomly assigned @ patients with moderate ischemic mitral regurgitation to CABG alone or CABG plus mitral-valve repair ( combined procedure ) .


The primary end point was the left ventricular end-systolic volume index ( LVESVI ) , a measure of left ventricular remodeling , at @ year .


This end point was assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized as the lowest LVESVI rank .


At @ year , the mean LVESVI among surviving patients was @ ml per square meter of body-surface area in the CABG-alone group and @ ml per square meter in the combined-procedure group ( mean change from baseline , -@ and -@ ml per square meter , respectively ) .


The rate of death was @ % in the combined-procedure group and @ % in the CABG-alone group ( hazard ratio with mitral-valve repair , @ ; @ % confidence interval , @ to @ ; P = @ ) .


The rank-based assessment of LVESVI at @ year ( incorporating deaths ) showed no significant between-group difference ( z score , @ ; P = @ ) .


The addition of mitral-valve repair was associated with a longer bypass time ( P < @ ) , a longer hospital stay after surgery ( P = @ ) , and more neurologic events ( P = @ ) .


Moderate or severe mitral regurgitation was less common in the combined-procedure group than in the CABG-alone group ( @ % vs. @ % , P < @ ) .


There were no significant between-group differences in major adverse cardiac or cerebrovascular events , deaths , readmissions , functional status , or quality of life at @ year .


In patients with moderate ischemic mitral regurgitation , the addition of mitral-valve repair to CABG did not result in a higher degree of left ventricular reverse remodeling .


Mitral-valve repair was associated with a reduced prevalence of moderate or severe mitral regurgitation but an increased number of untoward events .


Thus , at @ year , this trial did not show a clinically meaningful advantage of adding mitral-valve repair to CABG .


Longer-term follow-up may determine whether the lower prevalence of mitral regurgitation translates into a net clinical benefit .


( Funded by the National Institutes of Health and the Canadian Institutes of Health Research ; ClinicalTrials.gov number , NCT@ . )


To investigate the effects of stellate ganglion block ( SGB ) on the peri-operative vasomotor cytokine content and intrapulmonary shunt in patients with esophagus cancer who underwent thoracotomy .


Forty patients undergoing elective resection of esophageal cancer patients who had I ~ II American Society of Anesthesiologist ( ASA ) were randomly divided into total intravenous anesthesia group ( group N , n = @ ) and total intravenous anesthesia combined with SGB group ( group S , n = @ , @ mL/kg @ % lidocaine was used for SGB @ min before induction ) .


Heart rate ( HR ) , mean arterial pressure ( MAP ) , central venous pressure ( CVP ) , mean pulmonary arterial pressure ( MPAP ) and continuous cardiac output ( CCO ) were continuously monitored .