Although a better improvement in scores of retention tests was demonstrated in the SMS group , the mean subtraction value of the post - and pretests as well as retention - and pre-tests showed no significant difference between the @ groups ( p = @ and p = @ , respectively ) .


Our study shows that teaching via SMS may probably replace traditional face to face teaching for continuing education in working nurses .


Larger studies are suggested to confirm this .


Use of hypotonic intravenous fluids for maintenance requirements is associated with increased risk of hyponatremia that results in morbidity and mortality in children .


Clinical trial data comparing isotonic and hypotonic maintenance fluids in nonsurgical hospitalized pediatric patients outside intensive care units are lacking .


To compare isotonic ( sodium chloride , @ % , and dextrose , @ % ) with hypotonic ( sodium chloride , @ % , and dextrose , @ % ) intravenous maintenance fluids in a hospitalized general pediatric population .


In this double-blind randomized clinical trial , we recruited @ children admitted to a general pediatric unit of a tertiary care children 's hospital from March @ , @ , through August @ , @ ( age range , @ month to @ years ) , with normal baseline serum sodium levels who were anticipated to require intravenous maintenance fluids for @ hours or longer ( intent-to-treat analyses ) .


Children with diagnoses that required specific fluid tonicity and volumes were excluded .


Patients were randomized to receive isotonic or hypotonic intravenous fluid at maintenance rates for @ hours .


The primary outcome was mean serum sodium level at @ hours .


The secondary outcomes were mean sodium level at @ hours , hyponatremia and hypernatremia , weight gain , hypertension , and edema .


Confounding variables were included in multiple regression models .


Post hoc analyses included change from baseline sodium level at @ and @ hours and subgroup analysis of children with primary respiratory diagnosis .


Of @ enrolled patients , @ received isotonic fluids and @ received hypotonic fluids .


The mean ( SD ) sodium level at @ hours was @ ( @ ) mEq/L in the isotonic group and @ ( @ ) mEq/L in the hypotonic group ( @ % CI of the difference , -@ to @ mEq/L ; P = @ ) .


Two patients in the hypotonic group developed hyponatremia , @ in each group developed hypernatremia , @ in each group developed hypertension , and @ in the isotonic group developed edema .


Mean ( SD ) change from baseline to @-hour sodium level was +@ ( @ ) vs -@ ( @ ) mEq/L , respectively ( absolute difference , @ mEq/L ; @ % CI of the difference , -@ to @ mEq/L ; P = @ ) .


Our study results support the notion that isotonic maintenance fluid administration is safe in general pediatric patients and may result in fewer cases of hyponatremia .


Individuals with heterozygous familial hypercholesterolemia ( heFH ) have higher levels of low-density lipoprotein cholesterol ( LDL-C ) and are predisposed to premature cardiovascular disease .


Alirocumab is a fully-human , monoclonal antibody targeted to proprotein convertase subtilisin/kexin type @ currently in Phase @ development for the treatment of hypercholesterolemia .


Described here are three ODYSSEY Phase @ trials , FH I ( NCT@ ) , FH II ( NCT@ ) and HIGH FH ( patients with heFH and LDL-C levels @mg/dL ) ( NCT@ ) , in which alirocumab is further evaluated in the heFH population .


Multicenter , multinational , randomized , double-blind , placebo-controlled studies have been designed to evaluate efficacy and safety of alirocumab in more than @ patients with heFH who are not adequately controlled with a maximally-tolerated stable daily dose of statin for @weeks prior to the screening visit , with or without other lipid-lowering therapy .


Patients are randomized ( @:@ ) to receive alirocumab or placebo via a @-mL subcutaneous auto-injection every @weeks ( Q@W ) for @weeks .


In studies FH I and II , if their Week @ LDL-C level is @mg/dL , patients will undergo a dose uptitration from @ to @mg alirocumab Q@W at Week @ .


In HIGH FH , patients will receive alirocumab @mg Q@W throughout the entire treatment period .


The primary efficacy endpoint in all three studies is the percent change in calculated LDL-C from baseline to Week @ .


The ODYSSEY FH studies are three Phase @ studies aiming to further evaluate the efficacy and long-term safety of alirocumab as an effective therapeutic option for patients with heFH .


To study the efficacy of the domestic recombinant interleukin-@ ( IL-@ ) in the complex treatment of encephalitis .


Forty patients , aged from @ months to @ years , were treated with the drug .


A comparison group involved @ patients who did not receive the drug .


Recombinant IL-@ reduced ( p < @ ) the aggravation of symptoms to @ days , neurological deficit ( @ EDSS scores at discharge from the hospital ) , frequency of exacerbations ( from @ to @ % ) and frequency of cases with the development of multiple sclerosis during @ years ( from @ to @ % ) .


Parameters of the drug efficacy were correlated with positive changes in immunological parameters after @-@ days of treatment .


The study of multimodal evoked potentials demonstrated the positive effect of the drug on the central afferent conduction times .


The follow-up MRI examination showed the decrease in the frequency of focal changes .


Recombinant IL-@ is recommended for treatment of children with encephalitis .


Patients with obstructive sleep apnea ( OSA ) experience respiratory events with greater frequency and severity while in the supine sleeping position .


Postural modification devices ( PMDs ) prevent supine sleep , although there is a paucity of guidance to help clinicians decide when to use PMDs for their patients .


In order for PMDs to treat OSA effectively , patients must experience respiratory events in the supine sleeping position consistently from night to night and must have a low nonsupine apnea and hypopnea index ( AHINS ) .


To document the repeatability of traditionally defined supine predominant OSA on consecutive polysomnography , to determine whether the consistency of the supine-predominant phenotype can be improved by altering the definition of it , and to determine whether a low AHINS is repeatable from night to night .


We recruited @ patients for polysomnography on two separate nights .


Patients were classified as having supine OSA on each night on the basis of traditional and novel definitions , and the classification systems used were compared on the basis of agreement from night to night .


The definition of supine OSA with the highest level of agreement from night to night incorporates a supine AHI ( AHIS ) to AHINS ratio @:@ .


In addition , agreement exists for males , but there is poor agreement for female patients , regardless of the definition applied .


An AHINS < @ events/hour is highly repeatable from night to night .


Males with an AHIS : AHINS ratio @:@ and an AHINS < @ events/hour represent a consistent supine-predominant OSA phenotype from night to night .


This patient group is likely to benefit from treatment with PMD .


The management of depression in patients with poor prognosis cancers , such as lung cancer , creates specific challenges .


We aimed to assess the efficacy of an integrated treatment programme for major depression in patients with lung cancer compared with usual care .


Symptom Management Research Trials ( SMaRT ) Oncology-@ is a parallel-group , multicentre , randomised controlled trial .


We enrolled patients with lung cancer and major depression from three cancer centres and their associated clinics in Scotland , UK .


Participants were randomly assigned in a @:@ ratio to the depression care for people with lung cancer treatment programme or usual care by a database software algorithm that used stratification ( by trial centre ) and minimisation ( by age , sex , and cancer type ) with allocation concealment .


Depression care for people with lung cancer is a manualised , multicomponent collaborative care treatment that is systematically delivered by a team of cancer nurses and psychiatrists in collaboration with primary care physicians .


Usual care is provided by primary care physicians .


The primary outcome was depression severity ( on the Symptom Checklist Depression Scale -LSB- SCL-@ -RSB- , range @-@ ) averaged over the patient 's time in the trial ( up to a maximum of @ weeks ) .


Trial statisticians and data collection staff were masked to treatment allocation , but patients and clinicians could not be masked to the allocations .


Analyses were by intention to treat .


This trial is registered with Current Controlled Trials , number ISRCTN@ .


@ participants were recruited between Jan @ , @ , and Sept @ , @ ; @ were randomly allocated to depression care for people with lung cancer and @ to usual care .


@ ( @ % ) of @ patients had died by @ weeks , all of which were cancer-related deaths .


No intervention-related serious adverse events occurred .


@ ( @ % ) of @ patients provided outcome data ( @ in the depression care for people with lung cancer group and @ in the usual care group ) and were included in the intention-to-treat primary analysis .


Average depression severity was significantly lower in patients allocated to depression care for people with lung cancer ( mean score on the SCL-@ @ -LSB- SD @ -RSB- ) than in those allocated to usual care ( mean score @ -LSB- SD @ -RSB- ) ; difference -@ ( @ % CI -@ to -@ ) ; standardised mean difference -@ ( @ % CI -@ to -@ ) .


Self-rated depression improvement , anxiety , quality of life , role functioning , perceived quality of care , and proportion of patients achieving a @-week treatment response were also significantly better in the depression care for people with lung cancer group than in the usual care group .


Our findings suggest that major depression can be treated effectively in patients with a poor prognosis cancer ; integrated depression care for people with lung cancer was substantially more efficacious than was usual care .


Larger trials are now needed to estimate the effectiveness and cost-effectiveness of this care programme in this patient population , and further adaptation of the treatment will be necessary to address the unmet needs of patients with major depression and even shorter life expectancy .


Glycopyrronium ( NVA@ ) , a once-daily long-acting muscarinic antagonist , has recently been approved for the treatment of patients with chronic obstructive pulmonary disease ( COPD ) .


This study evaluated the effect of glycopyrronium on the QT interval and other cardiac parameters in healthy subjects .


This randomized , partially blinded , single-dose , placebo - and positive - ( moxifloxacin ) controlled , three-way cross-over study investigated the effect of a single inhaled supra-therapeutic dose ( @-fold clinical dose in COPD patients ) of @ g glycopyrronium on the Fridericia-corrected QT interval ( QTcF ; primary objective ) , Bazettcorrected QT interval ( QTcB ) , heart rate , blood pressure , pharmacokinetics ( PK ) , safety , and tolerability .


A total of @ healthy male ( n = @ ) and female ( n = @ ) subjects , aged between @ and @ years , were randomized .


Glycopyrronium did not cause significant QTcF prolongation compared to placebo .


The largest time-matched mean difference to placebo was @ ms at @ minutes , with the upper limit of the two-sided @ % confidence interval ( CI ) being @ ms , excluding a relevant QT effect as defined by the ICH E@ guideline .


Glycopyrronium had a slight bradycardic effect with a mean change of -@ ( @ % CI : -@ , -@ ) beats per minutes ( bpm ) and a maximum of -@ ( @ % CI : -@ , -@ ) bpm at @ hours post-inhalation .


No clinically relevant effects were seen on QTcB , other electrocardiogram ( ECG ) intervals , or blood pressure .


Maximum plasma concentration ( Cmax ) of glycopyrronium was achieved shortly after inhalation ( median tmax = @ minutes ) .


All the treatments were well tolerated with no serious adverse events .


A supra-therapeutic dose of glycopyrronium had a favorable cardiovascular safety profile with no clinically relevant effect on QT interval .


If asthma patients fail to achieve symptom control using a medium dose of inhaled corticosteroid ( ICS ) alone , adding a long-acting @ agonist ( LABA ) is the preferred treatment .


We aimed to compare the effect of two widely available ICS/LABA combinations in these patients in real-life conditions : budesonide/formoterol ( BUD/FM ; Symbicort ( ) ) for maintenance and reliever therapy ( SMART ) and a fixed dose of fluticasone propionate/salmeterol ( FP/SM ) .


Inadequately controlled asthma patients treated with a medium dose of ICS alone , with an Asthma Control Questionnaire ( ACQ ) score > @ and using a short-acting @-agonist ( SABA ) @-@ occasions/week , were enrolled .


Patients were randomized into two groups and treated with two inhalation twice-daily BUD/FM @/@ @ g plus as-needed BUD/FM ( SMART group , n = @ ) or one inhalation twice-daily FP/SM @/@g plus as-needed procaterol ( FP/SM group , n = @ ) for @ weeks .


Both groups showed significant improvement in airway inflammation , pulmonary functions and symptoms from baseline .


The SMART group showed significant improvement in the fraction of nitric oxide , ACQ score , rescue medication use and small airway parameter R@-R@ measured by impulse oscillometry compared with the FP/SM group .


For stepping up treatment from ICS alone to an ICS/LABA combination , SMART is preferable for controlling asthma symptoms by suppressing airway inflammation and improving small airway impairment compared with a fixed dose of FP/SM .


It may be achieved by the property of BUD/FM itself and as-needed use , but the degree of each contribution must be investigated further .


This study assessed the effects of systemic omega-@ on the treatment of recurrent aphthous stomatitis and on the improvement of quality of life .


Fifty participants were randomly assigned to receive either omega-@ ( @ g , @ times daily ) or placebo for @ months .


Assessment of outcome measures including monthly number of new ulcers , average duration of ulcer episodes , and pain level of ulcers was carried out at baseline and monthly for @ months .


Analysis of potential impact on quality of life using the Oral Health Impact Profile @ was carried out at baseline and @ months .


Daily omega-@ treatment achieved a significant reduction in number of ulcers , duration of ulcers , and level of pain by @ months that persisted for @ months .


Mean score on Oral Health Impact Profile @ also significantly improved by @ months .


A daily omega-@ regimen shows promise as therapy for treatment and management of patients with recurrent aphthous stomatitis .


We and others have recently shown that tumor characteristics are altered throughout tumor progression .


These findings emphasize the need for re-examination of tumor characteristics at relapse and have led to recommendations from ESMO and the Swedish Breast Cancer group .


Here , we aim to determine whether tumor characteristics and molecular subtypes in breast cancer metastases confer clinically relevant prognostic information for patients .


The translational aspect of the Swedish multicenter randomized trial called TEX included @ patients with at least one biopsy from a morphologically confirmed locoregional or distant breast cancer metastasis diagnosed from December @ until June @ .


All patients had detailed clinical information , complete follow-up , and metastasis gene expression information ( Affymetrix array GPL@ ) .


We assessed the previously published gene expression modules describing biological processes -LSB- proliferation , apoptosis , human epidermal receptor @ ( HER@ ) and estrogen ( ER ) signaling , tumor invasion , immune response , and angiogenesis -RSB- and pathways ( Ras , MAPK , PTEN , AKT-MTOR , PI@KCA , IGF@ , Src , Myc , E@F@ , and - catenin ) and the intrinsic subtypes ( PAM@ ) .


Furthermore , by contrasting genes expressed in the metastases in relation to survival , we derived a poor metastasis survival signature .


A significant reduction in post-relapse breast cancer-specific survival was associated with low-ER receptor signaling and apoptosis gene module scores , and high AKT-MTOR , Ras , and - catenin module scores .


Similarly , intrinsic subtyping of the metastases provided statistically significant post-relapse survival information with the worst survival outcome in the basal-like -LSB- hazard ratio ( HR ) @ ; @ % confidence interval ( CI ) @-@ @ -RSB- and HER@-enriched ( HR @ ; @ % CI @-@ @ ) subtypes compared with the luminal A subtype .


Overall , @ % of the metastases were basal-like , @ % HER@-enriched , @ % luminal A , @ % luminal B , and @ % normal-like .


We show that tumor characteristics and molecular subtypes of breast cancer metastases significantly influence post-relapse patient survival , emphasizing that molecular investigations at relapse provide prognostic and clinically relevant information .


CLINICALTRIALS.GOV : This is the translational part of the Swedish multicenter and randomized trial TEX , clinicaltrials.gov identifier nct@ ( http://www.clinicaltrials.gov/ct@/show/nct@ ) .


This study aimed to determine whether remote ischemic conditioning ( RIC ) initiated prior to primary percutaneous coronary intervention ( PPCI ) could reduce myocardial infarct ( MI ) size in patients presenting with ST-segment elevation myocardial infarction .


RIC , using transient limb ischemia and reperfusion , can protect the heart against acute ischemia-reperfusion injury .


Whether RIC can reduce MI size , assessed by cardiac magnetic resonance ( CMR ) , is unknown .


We randomly assigned @ ST-segment elevation myocardial infarction patients with TIMI ( Thrombolysis In Myocardial Infarction ) flow grade @ to receive RIC ( four @-min cycles of upper arm cuff inflation/deflation ) or control ( uninflated cuff placed on upper arm for @ min ) protocols prior to PPCI .


The primary study endpoint was MI size , measured by CMR in @ subjects on days @ to @ after admission .


RIC reduced MI size by @ % , when compared with the MI size of control subjects ( @ @ % -LSB- n = @ -RSB- vs. @ @ % -LSB- n = @ -RSB- ; p = @ ) .


At @ h , high-sensitivity troponin T was lower with RIC ( @,@ @ ng/l -LSB- n = @ -RSB- vs. @,@ @ ng/l -LSB- n = @ -RSB- ; p = @ ) .


RIC also reduced the extent of myocardial edema measured by T@-mapping CMR ( @ @ % vs. @ @ % ; p = @ ) and lowered mean T@ values ( @ @ ms vs. @ @ ms ; p = @ ) , precluding the use of CMR edema imaging to correctly estimate the area at risk .


Using CMR-independent coronary angiography jeopardy scores to estimate the area at risk , RIC , when compared with the control protocol , was found to significantly improve the myocardial salvage index ( @ @ vs. @ @ ; p = @ ) .


This randomized study demonstrated that in ST-segment elevation myocardial infarction patients treated by PPCI , RIC , initiated prior to PPCI , reduced MI size , increased myocardial salvage , and reduced myocardial edema .


To perform an analysis and comparative study of the clinical data for patients with cirrhosis and type @ hepatorenal syndrome ( HRS ) who received treatment with terlipressin using high-or low-dose regimens .


A total of @ patients with cirrhosis and type @ HRS who presented for treatment to the Wuhan Medical Treatment Center and Taizhou Central Hospital between March @ and October @ were enrolled in the study .


The patients were randomly assigned to the terlipressin treatment groups for receipt of the high-dose regimen ( @ mg/@ -@ h ; n = @ ) or low-dose regimen ( @ mg/@ h ; n = @ ) .


All patients were assessed for @-hour urine volume , serum blood urea nitrogen ( BUN ) and creatinine ( Cr ) levels , therapeutic effect and prognosis , and adverse reactions .


Measurements were made before and after the treatment , and on post-treatment days @ , @ and @ .


Inter-group differences were assessed by statistical analyses .


The high-dose group showed an increase in @-hour urine volumes from post-treatment day @ ( @ @ ml ) to day @ ( @ @ ml ) , and the volumes on both days were significantly better than those of the low-dose group ( day @:@ @ ml and day @:@ @ ml , t = @ , @ , P = @ , @ ) .


The high-dose group also showed a significantly better decreases in serum BUN levels ( @ @ to @ @ mmol/L vs.low-dose group : @ @ to @ @ mmol/L , t = @ , @ , P = @ , @ ) and in serum Cr values ( @ @ to @ @ vs.low-dose group : @ @ to @ @ , t = @ , @ , P = @ , @ ) .


On post-treatment day @ the @-hour urine volume of patients in the high-dose group decreased ( to @ + / -@ ml ) , but the difference from that of the low-dose group was not significant ( vs. @ @ ml , t = @ , P = @ ) .


The serum BUN level increased in the high-dose group ( to @ @ mmol/L ) , which was statistically different from that in the low-dose group ( vs @ @ mmol/L , t = @ , P = @ ) ; the same trend was seen for the serum Cr value ( @ @ mumol/L vs. @ @ mumol/L , t = @ , P = @ ) .


No statistically significant differences were observed for the groups in regard to significant efficiency , efficiency or @-week survival rate ( x@ = @ , @ , @ , P = @ , @ , @ respectively ) , but the total efficiency was significantly different between the two groups ( x = @ , P = @ ) .


In addition , no serious adverse reactions ( including precordial pain , myocardial infarction or intestinal necrosis ) were observed in either group .


Terlipressin therapy at both high and low dosages can lead to significant beneficial effects within as little as @ days after the treatment ; however , the high-dose appears to produce a better lasting efficacy ( at day @ after the treatment ) .


The difference in doses does not appear to markedly affect significant efficiency , efficiency , nor the @-week survival rate .


To evaluate the effect of a clinic-based screening and referral system ( Well Child Care , Evaluation , Community Resources , Advocacy , Referral , Education -LSB- WE CARE -RSB- ) on families ' receipt of community-based resources for unmet basic needs .


We conducted a cluster randomized controlled trial at @ urban community health centers , recruiting mothers of healthy infants .


In the @ WE CARE clinics , mothers completed a self-report screening instrument that assessed needs for child care , education , employment , food security , household heat , and housing .


Providers made referrals for families ; staff provided requisite applications and telephoned referred mothers within @ month .


Families at the @ control community health centers received the usual care .


We analyzed the results with generalized mixed-effect models .


Three hundred thirty-six mothers were enrolled in the study ( @ per arm ) .


The majority of families had household incomes < $ @,@ ( @ % ) , and @ % had @ unmet basic needs .


More WE CARE mothers received @ referral at the index visit ( @ % vs @ % ; adjusted odds ratio -LSB- aOR -RSB- = @ ; @ % confidence interval -LSB- CI -RSB- , @-@ @ ) .


At the @-month visit , more WE CARE mothers had enrolled in a new community resource ( @ % vs @ % ; aOR = @ ; @ % CI , @-@ @ ) .


WE CARE mothers had greater odds of being employed ( aOR = @ ; @ % CI , @-@ @ ) .


WE CARE children had greater odds of being in child care ( aOR = @ ; @ % CI , @-@ @ ) .


WE CARE families had greater odds of receiving fuel assistance ( aOR = @ ; @ % CI , @-@ @ ) and lower odds of being in a homeless shelter ( aOR = @ ; @ % CI , @-@ @ ) .


Systematically screening and referring for social determinants during well child care can lead to the receipt of more community resources for families .


Inadequate surgical field visualization due to intraoperative bleeding during endoscopic sinus surgery ( ESS ) can cause major complications .


The aim of this prospective study was to compare the effect of preoperative administration of clonidine and melatonin on the quality of the surgical field visualization and selected aspects of presurgical premedication .


Twenty-six patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or melatonin as preoperative premedication .


During the operation , the quality of the surgical field was assessed and graded using the scale proposed by Boezaart .


The evaluations were done at @ , @ , and @ minutes after incision .


The effect of this premedication choice on the intraoperative and postoperative hemodynamic profile was examined in each group .


Anxiolytic effects of both premedication agents were assessed using the visual analogue scale for anxiety ( VAS-A ) .


Propofol dose and induction time ( the time for bispectral index -LSB- BIS -RSB- to reach @ ) , anesthesia and surgical procedures time , and recovery time ( the time for BIS to reach @ ) were assessed in both groups as well .


The quality of the surgical field was consistently better in @ of @ time points in the clonidine group .


Perioperative mean arterial pressure and intraoperative heart rate had a more favorable profile in patients premedicated with clonidine .


There were no differences in other measured parameters between groups .


Premedication with clonidine before ESS provides better quality of surgical field and more favorable hemodynamic profile as compared to melatonin .


To evaluate the effect of oral Lactobacillus reuteri ( L reuteri ) first on the incidence and severity of Necrotising enterocolitis ( NEC ) and second on sepsis .


Prospective randomised controlled study .


Tertiary neonatal intensive care unit .


Preterm infants with a gestational age of @ weeks and a birth weight of @ g were included ( n = @ ) .


Infants in the first group were given @ million CFU/day ( @ drops ) of lyophilised L reuteri ( DSM @ ) mixed in breast milk or formula , starting from first feeding until discharge .


Participants in the control group were given a placebo .


To determine and compare the frequency of NEC and/or death after @ days , frequency of proven sepsis , rates of feeding intolerance and duration of hospital stay .


There was no statistically significant difference between groups in terms of frequency of NEC stage @ ( @ % vs @ % ; p = @ ) or overall NEC or mortality rates ( @ % vs @ % ; p = @ ) .


Frequency of proven sepsis was significantly lower in the probiotic group compared to the control group ( @ % vs @ % ; p = @ ) .


A significant difference was also observed with regard to rates of feeding intolerance ( @ % vs @ % ; p = @ ) and duration of hospital stay ( @ ( @-@ ) vs @ ( @-@ ) days ; p = @ ) .


Our results show that oral L reuteri does not seem to affect the overall rates of NEC and/or death in preterm infants followed up in the neonatal intensive care unit , and significant reductions were observed in the frequency of proven sepsis , rates of feeding intolerance and duration of hospital stay .


Current research suggests that glucose facilitates performance on cognitive tasks which possess an episodic memory component and a relatively high level of cognitive demand .


However , the extent to which this glucose facilitation effect is uniform across the lifespan is uncertain .


This study was a repeated measures , randomised , placebo-controlled , cross-over trial designed to assess the cognitive effects of glucose in younger and older adults under single and dual task conditions .


Participants were @ healthy younger ( average age @ years ) and @ healthy older adults ( average age @ years ) .


They completed a recognition memory task after consuming drinks containing @ g glucose and a placebo drink , both in the presence and absence of a secondary tracking task .


Glucose enhanced recognition memory response time and tracking precision during the secondary task , in older adults only .


These findings do not support preferential targeting of hippocampal function by glucose , rather they suggest that glucose administration differentially increases the availability of attentional resources in older individuals .


Hip and knee osteoarthritis are important causes of pain and disability among older people .


Education and strength training can alleviate symptoms and avoid functional deterioration .


To assess muscle strength , fall risk and quality of life of older people with osteoarthritis and the effects of physiotherapy education and strength training on these variables .


Thirty participants aged @ @ years ( @ % women ) were randomly assigned to receive physiotherapy ( Controls ) , physiotherapy plus education ( Group @ ) and physiotherapy plus strength training ( group @ ) .


At baseline and after @ weeks of intervention , patients were evaluated with the Senior Fitness Test , Timed Up and Go and Quality of Life score short form ( SF-@ ) .


During the intervention period , Senior Fitness Test and Timed Up and Go scores improved in all groups and SF-@ did not change .


The improvement in Senior Fitness Test and Timed Up and Go was more marked in Groups @ and @ than in the control group .


Education and strength training improve functional tests among older people with osteoarthritis .


Concurrent chemoradiotherapy ( CRT ) is the standard treatment for advanced head and neck squamous cell carcinoma .


In this phase II randomized study , the efficacy and toxicity of docetaxel , cisplatin and @-fluorouracil induction chemotherapy ( ICT ) followed by concurrent CRT was compared with those after standard CRT alone in patients with locally advanced , unresectable head and neck cancer .


Between January @ and June @ , @ patients with advanced ( stage III or IV ) unresectable squamous cell carcinoma of the head and neck ( oral cavity , oropharynx , hypopharynx , and larynx ) were randomly assigned to two groups : one receiving two cycles of docetaxel , cisplatin , and @-fluorouracil ICT followed by CRT with three cycles of cisplatin and one treated by CRT alone .


Response rate , local tumor control ( LTC ) , locoregional tumor control ( LRTC ) , overall survival ( OS ) , progression-free survival ( PFS ) , and toxicity results were assessed .


Three patients from the ICT + CRT group did not appear at the first treatment , so a total of @ patients were evaluated in the study ( @ ICT + CRT group and @ CRT group ) .


Three patients died of febrile neutropenia after ICT .


The median follow-up time for surviving patients was @ months ( range @-@ months ) .


The rate of radiologic complete response was @ % following ICT + CRT , whereas @ % after CRT alone .


There were no significant differences in the @-year rates of LTC ( @ vs. @ % ) , LRTC ( @ vs. @ % ) , OS ( @ vs. @ % ) , and PFS ( @ vs. @ % ) in the ICT + CRT group and in the CRT group , respectively .


The rate of grade @-@ neutropenia was significantly higher in the ICT + CRT group than in the CRT group ( @ and @ % ; p = @ ) .


Late toxicity ( grade @ or @ xerostomia ) developed in @ and @ % in the ICT + CRT and CRT groups , respectively .


The addition of ICT to CRT did not show any advantage in our phase II trial , while the incidence of adverse events increased .


The three deaths as a consequence of ICT call attention to the importance of adequate patient selection if ICT is considered .


To evaluate changes in self-reported nocturia in community-dwelling adults aged @ and older who received behavioral treatment for chronic insomnia .


Secondary analysis of a randomized controlled trial of a behavioral intervention for sleep .


Academic medical center .


Of the @ enrollees , this analysis focused on @ who , in addition to insomnia , also reported at least one nightly episode of waking up to void .


The brief behavioral treatment of insomnia ( BBTI ) group ( n = @ ) received instructions on reducing time in bed and setting a regular sleep schedule .


The information control ( IC ) group ( n = @ ) received printed materials .


A nurse clinician delivered both interventions .


Self-reported nocturnal awakenings to void assessed daily for @ days at baseline and @ weeks after the intervention .


Participants who reported at least one episode of nocturia per night at baseline were included in this analysis .


In individuals with nocturia at baseline , the total number of nocturnal voids over the @-day assessment period decreased by @ @ in the BBTI group and increased by @ @ in the IC group ( P = @ , effect size @ ) .


After adjusting for baseline nocturia episodes , the difference remained significant ( P = @ ) .


In older adults with concurrent insomnia and nocturia , behavioral treatment directed solely at insomnia may also improve self-reported nocturia .


Behavioral treatment of insomnia should be further investigated for its effect on nocturia in individuals with concurrent insomnia and nocturia .


Attempts to improve proximal load transfer and minimize stress shielding have included reducing the stiffness of femoral stems and using alternative stem materials , including carbon fiber composites .


An uncemented implant ( SR@ ) composed of a carbon-fiber-composite distal section and a porous-coated titanium-alloy proximal section , designed to improve proximal load transfer and provide good fixation , was clinically evaluated in a prospective randomized study .


Sixty patients were enrolled and randomized to receive either the SR@ stem or an all-metal stem ( Stability ) .


All patients received a cemented all-polyethylene acetabular component and a @-mm metal femoral head .


All uncemented stems were implanted by the same surgeon .


Patients were followed for up to ten years with repeated assessments of bone mineral density , radiographs , Harris hip scores ( HHS ) , and visual analog scale ( VAS ) pain scores .


Ten years postoperatively , nineteen patients who had been treated with the SR@ stem and not lost to follow-up showed a significantly greater increase in proximal bone mineral density ( Gruen zones @ -LSB- p = @ -RSB- and @ -LSB- p = @ -RSB- ) from baseline than did the twenty-two who had been treated with the Stability stem and not lost to follow-up .


In contrast , the Stability group showed a significantly greater increase in distal bone mineral density ( Gruen zones @ -LSB- p = @ -RSB- , @ -LSB- p = @ -RSB- , and @ -LSB- p = @ -RSB- ) compared with the SR@ group .


Radiographs demonstrated one case of progressive migration of an acetabular component used with an SR@ stem and one case of bone resorption in Gruen zones @ and @ in a patient treated with a Stability stem .


There was no significant difference between the SR@ and Stability stems in terms of changes in the total HHS , HHS for pain , HHS for range of motion , or VAS pain scores ten years postoperatively relative to preoperative levels .


There was one reported revision of an SR@ femoral stem at the ten-year review .


The investigational SR@ implant provided increased proximal bone density and reduced distal bone density .


The implant showed promising results at the time of early follow-up , and the clinical outcomes were similar to those of an all-metal stem at the time of a ten-year follow-up .


Coronary artery disease ( CAD ) is accountable for more than @ million deaths each year according to the World Health Organization ( WHO ) .


In a European population @ % of patients diagnosed with CAD are overweight and @ % are obese .


Physical inactivity and overweight are major risk factors in CAD , thus central strategies in secondary prevention are increased physical activity and weight loss .


In a randomized controlled trial @ participants with stable CAD , age @-@ , body mass index @-@kg / m@ and no diabetes are randomized ( @:@ ) to @weeks of intensive exercise or weight loss both succeeded by a @-week follow-up .


The exercise protocol consist of supervised aerobic interval training ( AIT ) at @-@ % of VO@peak @ times weekly for @weeks followed by supervised AIT twice weekly for @weeks .


In the weight loss arm dieticians instruct the participants in a low energy diet ( @-@kcal / day ) for @weeks , followed by @weeks of weight maintenance combined with supervised AIT twice weekly .


The primary endpoint of the study is change in coronary flow reserve after the first @weeks ' intervention .


Secondary endpoints include cardiovascular , metabolic , inflammatory and anthropometric measures .


The study will compare the short and long-term effects of a protocol consisting of AIT alone or a rapid weight loss followed by AIT .


Additionally , it will provide new insight in mechanisms behind the benefits of exercise and weight loss .


We wish to contribute to the creation of effective secondary prevention and sustainable rehabilitation strategies in the large population of overweight and obese patients diagnosed with CAD .


The established interventions for weight loss are resource intensive which can create barriers for full participation and ultimate translation .


The major goal of this pilot study was to evaluate the feasibility , acceptability , and preliminary efficacy of theoretically based behavioral interventions delivered by smartphone technology .


The study randomized @ obese adults to receive one of four interventions for six months : ( @ ) intensive counseling intervention , ( @ ) intensive counseling plus smartphone intervention , ( @ ) a less intensive counseling plus smartphone intervention , and ( @ ) smartphone intervention only .


The outcome measures of weight , BMI , waist circumference , and self-reported dietary intake and physical activity were assessed at baseline and six months .


The sample was @ % female and @ % African American , with an average age of @ years , and average BMI of @ kg/m ( @ ) .


There were trends for differences in weight loss among the four intervention groups .


Participants in the intensive counseling plus self-monitoring smartphone group and less intensive counseling plus self-monitoring smartphone group tended to lose more weight than other groups ( @ kg and @ kg , resp . )


The results of this pilot trial of a weight loss intervention provide preliminary support for using a smartphone application for self-monitoring as an adjunct to behavioral counseling .


Atopic dermatitis is a chronic inflammatory skin disease with a high prevalence rate and a large socioeconomic cost .


There are many treatments for atopic dermatitis , such as antihistamine , tacrolimus and corticosteroids .


However , due to concern about the adverse effects , many patients seek alternative treatments .


In this context , natural products are gaining interest .


KM@ is a functional food consisting of four herbs that are beneficial to skin health .


The purpose of this study is to assess the efficacy and safety of KM@ for atopic dermatitis .


This study is a randomised , double-blind , placebo-controlled and multicentre trial of KM@ .


For this study , we will recruit @ atopic dermatitis patients of both sexes , with ages ranging from @ to @ , from three university hospitals .


The participants will receive either KM@ or a placebo twice a day for @ weeks .


The primary end point will be a change in the scoring atopic dermatitis ( SCORAD ) index .


The secondary end points will include changes to the dermatology life quality index ( DLQI ) and transepidermal water loss ( TEWL ) , among others .


The outcomes will be measured at every visit .


The study will be continued for @ weeks and will include five visits with each subject ( at screening and at @ , @ , @ and @ weeks ) .


This trial will provide research methodologies for evaluate clinical efficacy and safety of KM@ in adult patients with atopic dermatitis .


In addition , we will evaluate the changes in the general skin health status and quality of life .


The study is to investigate drug-drug interaction ( DDI ) between olmesartan medoxomil and hydrochlorothiazide ( HCTZ ) , to confirm bioequivalence ( BE ) of a new combined formulation and coadministration of separate local tablets , and to receive pharmacokinetics and tolerability of the new combined formulation after multiple doses in healthy Chinese subjects .


The @-in-@ study was separated into @ stages .


Stage @ is a four-period crossover study .


@ healthy subjects were equally randomized into four groups .


Each group received the four following regimens in a sequence as Latin square ( @ @ ) design : A : olmesartan medoxomil ; B : HCTZ ; C : test drug ( new combined formulation ) ; D : reference drugs ( co-administration of separate tablets ) .


In stage @ , half of @ subjects were daily dosed with regimen C for @ days .


Blood and urine samples were obtained to receive pharmacokinetics of olmesartan and HCTZ , which were analyzed using the BE evaluation method .


Tolerability was also assessed .


All subjects completed the study and nobody reported serious adverse event ( SAE ) .


The @ % confidence intervals ( CI ) of geometric mean ratio ( GMR ) of log transformed Cmax , AUC@-t , and AUC@ - after single dose showed no DDI and claimed BE .


The mean ratio of accumulation ( Ra ) ( SD ) of olmesartan and HCTZ after multiple doses of new combination formulation is @ ( @ ) and @ ( @ ) .


No significant DDI between olmesartan and HCTZ was found .


The new combination formulation is bioequivalent to co-administration of two separate local tablets .


After multiple doses of the new combination formulation , no significant accumulation was observed .


The new combination formulation is reasonably tolerated well in healthy Chinese subjects after multiple doses .


Achievement of target low-density lipoprotein ( LDL ) levels for secondary prevention is endorsed in Canadian guidelines but has been de-emphasized in the @ American College of Cardiology/American Heart Association coronary artery disease ( CAD ) guidelines in favor of initiation of statins or triple therapy ( antiplatelet agent , angiotensin converting enzyme inhibitor/angiotensin II receptor blocker , and statins ) .


Our objective was to determine which of these @ process-of-care metrics achieved within @ months would be associated with @-year rates of death , myocardial infarction , or stroke and thus be suitable as an end point for quality improvement studies in patients with CAD .


This was a cohort study that followed @ participants for @ years after their involvement in a @-month secondary prevention trial .


Over @ years , @ patients died , @ had myocardial infarction , and @ had stroke .


Six months after randomization , @ ( @ % ) had achieved the LDL target ( @ mmol/L ) , @ ( @ % ) received statins , and @ ( @ % ) received triple therapy .


The @-year composite event rate was significantly lower in patients who achieved the LDL target during the @-month trial than in those who did not ( @ % vs @ % ; adjusted hazard ratio -LSB- aHR -RSB- , @ ; @ % confidence interval -LSB- CI -RSB- , @-@ @ ) , even accounting for statin use ( adjusted P = @ ) .


Conversely , @-year event rates were not lower in patients taking statins at @ months compared with those who were not ( @ % vs @ % ; aHR , @ ; @ % CI , @-@ @ ) or in those receiving triple therapy and those who were not ( @ % vs @ % ; aHR , @ ; @ % CI , @-@ @ ) .


Achievement of LDL targets at @ months is suitable as a metric for CAD quality-improvement studies ; medication use alone was not independently associated with longer term outcomes .


To determine if a health communication intervention targeting parents of high-risk , urban , minority children with asthma could ( i ) improve parental perceptions of connectedness to and communication with their child 's primary care providers ( PCP ) and ( ii ) decrease reliance on emergency departments ( EDs ) and other urgent care services for their child 's asthma-related care .


The design was a single blind , parallel groups , randomized controlled trial .


Parents were recruited from an ED-based asthma clinic serving primarily low-income , minority children in Washington , DC .


The intervention involved face-to-face education on effective communication followed by a single booster call .


Standardized instruments were administered to assess primary care connectedness and healthcare utilization at baseline and @ - and @-months post-enrollment .


A total of @ parents of children @-@ years old were randomized ( @ intervention and @ usual care ) , and @ ( @ % ) were successfully followed for six months .


Only at the two-month follow-up time-point , parents in the intervention group were significantly more likely to identify a PCP as the main source of their child 's asthma care ( adjusted odds ratio : @ , @ % confidence interval : @-@ @ ) and to report a significant reduction in ED visits for asthma care ( adjusted incidence rate ratio : @ , @ % confidence interval : @-@ @ ) .


There was no significant effect on parent communication self-efficacy or number of PCP visits .


A brief , in-person health communication intervention for parents of high-risk children with asthma resulted in improved identification of PCPs as the usual source of asthma care and reduced reliance on EDs for asthma care , albeit only for two months post-intervention .


Bronchiectasis is characterised by excessive production of mucus and pulmonary exacerbations .


Inhaled osmotic agents may enhance mucociliary clearance , but few long-term clinical trials have been conducted .


To determine the impact of inhaled mannitol on exacerbation rates in patients with non-cystic fibrosis ( CF ) bronchiectasis .


Secondary endpoints included time to first exacerbation , duration of exacerbations , antibiotic use for exacerbations and quality of life ( QOL ) ( St George 's Respiratory Questionnaire , SGRQ ) .


Patients with non-CF bronchiectasis and a history of chronic excess production of sputum and @ pulmonary exacerbations in the previous @ months were randomised ( @:@ ) to @ weeks treatment with inhaled mannitol @ mg or low-dose mannitol control twice a day .


Patients were @-@ years of age , baseline FEV@ @ % and @ % predicted and a baseline SGRQ score @ .


@ patients ( @ in the mannitol and @ in the control arm ) were treated .


Baseline demographics were similar in the two arms .


The exacerbation rate was not significantly reduced on mannitol ( rate ratio @ , p = @ ) .


However , time to first exacerbation was increased on mannitol ( HR @ , p = @ ) .


SGRQ score was improved on mannitol compared with low-dose mannitol control ( -@ units , p = @ ) .


Adverse events were similar between groups .


Mannitol @ mg inhaled twice daily for @ months in patients with clinically significant bronchiectasis did not significantly reduce exacerbation rates .


There were statistically significant improvements in time to first exacerbation and QOL .


Mannitol therapy was safe and well tolerated .


To evaluate the pain on injection of propofol via different combinations of fentanyl , sufentanil or remifentanil in gastrointestinal endoscopy .


Total @ patients were randomly allocated into @ groups .


Propofol & fentanil ( PF ) group received @ g/kg fentanyl , propofol & sufentanil ( PS ) group received @ g/kg sufentanil and propofol & remifentanyl ( PR ) group received @ g/kg remifentanyl prior to administration of @-@ mg/kg of propofol .


The propofol & half-fentanil ( Pf ) group , propofol & half-sufentanil ( Ps ) group and propofol & half-remifentanyl ( Pr ) group were given @ g/kg fentanyl , @ g/kg sufentanil and @ g/kg remifentanyl , respectively and later administrated @-@ mg/kg propofol .


All patients were monitored for the blood pressure ( MAP ) , heart rate ( HR ) , and oxygen saturation ( SpO@ ) .


Additionally , the pain intensity was assessed using a @-point verbal rating scale ( VRS ) by professional doctors .


The incidence of pain due to propofol injection in Ps group ( @ % ) was significantly lower than other @ groups .


The heart rate ( HR ) and mean arterial pressure ( MAP ) were maintained within the normal limits in all six groups and there was no hypotension or bradycardia encountered during the study period .


Propofol and sufentanil group was the most suitable program for painless gastroscopy .


The use of firocoxib in horses and its ability to affect performance and potential to allow a horse to compete when it otherwise should not , necessitates establishing appropriate withdrawal time guidelines prior to performance .


To describe plasma concentrations and characterise the pharmacokinetics of @ firocoxib formulations following multiple administrations of the label dose , with respect to recommended plasma thresholds for performance horses .


Balanced @-way crossover prospective study .


Nine healthy mature horses were administered firocoxib injectable solution ( @ mg/kg bwt i.v. s.i.d. for @ days ) , firocoxib paste ( @ mg/kg bwt per os s.i.d. for @ days ) and firocoxib tablets ( @mg s.i.d. for @ days ) .


Blood samples were collected at Time @ and at various times post drug administration until plasma concentrations were below the limit of detection of the assay .


Plasma samples were analysed using liquid chromatography-mass spectrometry and data analysed using noncompartmental analysis .


The mean plasma half-life was @ @ , @ @ and @ @ days for injectable , paste and tablet formulations , respectively .


Plasma concentrations fell below the Racing Medication and Testing Consortium 's recommended threshold for racehorses ( @ng/ml ) by @ days post administration of the final dose for all formulations .


Plasma concentrations never exceeded the threshold concentration ( @ng/ml ) for horse competing in US Equestrian Federation events for any of the formulations .


This study extends current knowledge regarding the pharmacokinetics of firocoxib and provides information that can be used to establish appropriate withdrawal time guidelines following multiple administrations , with respect to already established plasma regulatory threshold concentrations .


The study investigated the long-term effectiveness of the adolescent cognitive behavioral resiliency training Op Volle Kracht ( OVK ) on the secondary outcomes : anxiety symptoms , hopelessness , happiness , life satisfaction , optimism , coping , self-efficacy , and school functioning .


In addition , the study analyzed whether the secondary outcomes moderated the intervention effect on depressive symptoms .


A two-condition ( intervention and control ) cluster randomized controlled trial was conducted .


All adolescents in the @th grade were eligible to participate , unless they , or their parents , declined their participation .


Schools were the unit of randomization .


Missing data were imputed and intent to treat analyses were conducted .


The results were analyzed using Latent Growth Curve Modeling across the @-months follow-up period .


The total sample consisted of @ adolescents ( Mage = @ , SD = @ , @ % girls , @ % Dutch ethnicity ) .


The intervention and control condition consisted of @ adolescents from @ schools and @ adolescents from @ schools , respectively .


OVK did not have an effect on depression , anxiety , hopelessness , happiness , and life satisfaction , but promoted cognitive coping over the course of the follow-up period .


OVK showed small iatrogenic effects on optimism , active coping , social self-efficacy and school grades directly post intervention , but these effects disappeared during the follow-up period .


Finally , none of the outcome variables moderated the intervention effect on depressive symptoms .


The universal resiliency training OVK was not effective in this Dutch sample .


Implications for research and practice were discussed .


Minimally invasive surgical procedures ( MIS ) may offer several advantages over conventional full sternotomy ( FS ) aortic valve replacement ( AVR ) .


A novel class of aortic valve prostheses has been developed for rapid-deployment AVR ( RDAVR ) .


We report a randomized , multicenter trial comparing the outcomes for MIS-RDAVR with those of conventional FS-AVR .


A total of @ patients with aortic stenosis were enrolled in a prospective , multicenter , randomized comparison trial ( CADENCE-MIS ) .


Exclusion criteria included ejection fraction below @ % , AVR requiring concomitant procedures , and recent myocardial infarction or stroke .


Patients were randomized to undergo MIS-RDAVR through an upper hemisternotomy ( n = @ ) or AVR by FS with a conventional stented bioprosthesis ( n = @ ) .


Three patients were excluded before the procedure , and @ more patients who were randomized to undergo RDAVR were excluded because of their anatomy .


Procedural , early clinical outcomes , and functional outcomes were assessed for the remaining @ patients .


Hemodynamic performance was assessed by an echocardiography core laboratory .


Implanted valve sizes were similar between groups ( @ @ vs @ @ mm , p = @ ) .


MIS-RDAVR was associated with significantly reduced aortic cross-clamp times compared with FS-AVR ( @ @ vs @ @ minutes , p < @ ) , although cardiopulmonary bypass times were similar ( @ @ vs @ @ minutes , p = @ ) .


Early clinical outcomes were similar between the two groups , including quality of life measures .


The RDAVR patients had a significantly lower mean transvalvular gradient ( @ vs @ mm Hg , p = @ ) and a lower prevalence of patient-prosthesis mismatch ( @ % vs @ % , p = @ ) @ months postoperatively compared with the FS-AVR patients .


RDAVR by the MIS approach is associated with significantly reduced myocardial ischemic time and better valvular hemodynamic function than FS-AVR with a conventional stented bioprosthesis .


Rapid deployment valves may facilitate the performance of MIS-AVR .


We aim to examine predictors of opiate abstinence status @ months after the end of buprenorphine/naloxone treatment for opioid-dependent participants .


Participants ( n = @ , age > @ years ) received buprenorphine / naloxone treatment for @ weeks and then randomly assigned to undergo dose tapering over either @ days or @ days .


Bivariate analysis was performed to identify possible predictors of successful opiate abstinence outome ( p-value < @ ) .


Logistic regression analysis with backward stepwise selection was , then , performed to produce final model containing independent predictors at p-value < @ .


Bivariate analysis identified several possible predictors including : opioid and drug urine tests result at the end taper ; employment status , family problems , and alcohol use domains of addiction severity index ( ASI ) score ; and clinical opiate withdrawal scale ( COWS ) at the end of stabilization .


Final predictor list identified by logistic regression include : ASI score for family and alcohol problems , COWS at the end of stabilization and opiate urine test at the end of taper .


Participants presenting with a negative urine test for opiate , more severe alcohol , more severe family problems , or more symptoms of opiate withdrawal at the end of stabilization were more likely to have a successful opiate abstinence .


The anxiolytic efficacy of video watching , in the absence of parents , during the mask induction of anesthesia in young children with high separation anxiety has not been clearly established .


We performed this study to determine whether the effect of video distraction on alleviating preoperative anxiety is independent of parental presence and whether a combination of both interventions is more effective than either single intervention in alleviating preoperative anxiety and postoperative behavioral disturbance in preschool children .


In this prospective trial , @ children aged @ to @ years scheduled for elective minor surgery were randomly allocated to @ of @ groups , a video distraction group ( group V ) , a parental presence group ( group P ) , or a combination of video distraction plus parental presence group ( group VP ) during induction of sevoflurane anesthesia .


The Modified Yale Preoperative Anxiety Scale ( mYPAS ) was used to assess anxiety in the preoperative holding area ( baseline ) , immediately after entry to the operating room , and during mask induction .


Compliance during induction , emergence delirium during recovery , and negative behavioral changes at @ day and @ weeks postoperatively were also assessed .


The mYPAS scores were comparable ( P = @ ) , and the number of children exhibiting baseline anxiety ( an mYPAS score > @ ) were not different among the @ groups in the preoperative holding area ( P = @ ) .


After intervention , the changes in mYPAS scores from baseline to induction were not different among the @ groups ( P = @ ) .


The proportion of children with increased mYPAS scores was higher in group P compared with group V from baseline to operating room entry ( Bonferroni-adjusted @ % confidence interval for difference , @ to @ ) but similar from baseline to induction in all @ groups .


Although children in group V were more cooperative during mask induction than those in the other @ groups ( P < @ versus group P and P = @ versus group VP ) , no significant intergroup differences were observed in the incidence of emergence delirium or new-onset negative behavioral change after surgery .


Video distraction , parental presence , or their combination showed similar effects on preoperative anxiety during inhaled induction of anesthesia and postoperative behavioral outcomes in preschool children having surgery .


Methotrexate ( MTX ) , the most used drug in rheumatoid arthritis ( RA ) treatment , showing variability in clinical response , is often associated with genetic polymorphisms .


This study aimed to elucidate the role of methylenetetrahydrofolate reductase ( MTHFR ) C@T and aminoimidazole carboxamide adenosine ribonucleotide transformylase ( ATIC ) T@C polymorphisms and clinicopathological variables in clinical response to MTX in Portuguese RA patients .


Study included @ RA patients treated with MTX for at least six months .


MTHFR C@T and ATIC T@C polymorphisms were genotyped and clinicopathological variables were collected .


Statistical analyses were performed and binary logistic regression method adjusted to possible confounding variables .


Multivariate analyses demonstrated that MTHFR @TT ( OR = @ ; P = @ ) and ATIC @T carriers ( OR = @ ; P = @ ) were associated with over @-fold increased risk for nonresponse .


For clinicopathological variables , noncurrent smokers ( OR = @ ; P = @ ) , patients positive to anti-cyclic citrullinated peptide ( OR = @ ; P = @ ) and antinuclear antibodies ( OR = @ ; P = @ ) , with higher health assessment questionnaire score ( OR = @ ; P = @ ) , and nonsteroidal anti-inflammatory drug users ( OR = @ ; P = @ ) were also associated with nonresponse .


Contrarily , subcutaneous administration route ( OR = @ ; P < @ ) was associated with response .


Our study suggests that MTHFR C@T and ATIC T@C genotyping combined with clinicopathological data may help to identify patients whom will not benefit from MTX treatment and , therefore , assist clinicians in personalizing RA treatment .


In phase @ studies , treatment with the all-oral combination of the nucleotide polymerase inhibitor sofosbuvir and the NS@A inhibitor ledipasvir resulted in high rates of sustained virologic response among previously untreated patients with hepatitis C virus ( HCV ) genotype @ infection .


We conducted a phase @ , open-label study involving previously untreated patients with chronic HCV genotype @ infection .


Patients were randomly assigned in a @:@:@:@ ratio to receive ledipasvir and sofosbuvir in a fixed-dose combination tablet once daily for @ weeks , ledipasvir-sofosbuvir plus ribavirin for @ weeks , ledipasvir-sofosbuvir for @ weeks , or ledipasvir-sofosbuvir plus ribavirin for @ weeks .


The primary end point was a sustained virologic response at @ weeks after the end of therapy .


Of the @ patients who underwent randomization and were treated , @ % had cirrhosis , @ % were black , and @ % had HCV genotype @a infection .


The rates of sustained virologic response were @ % ( @ % confidence interval -LSB- CI -RSB- , @ to @ ) in the group that received @ weeks of ledipasvir-sofosbuvir ; @ % ( @ % CI , @ to @ ) in the group that received @ weeks of ledipasvir-sofosbuvir plus ribavirin ; @ % ( @ % CI , @ to @ ) in the group that received @ weeks of ledipasvir-sofosbuvir ; and @ % ( @ % CI , @ to @ ) in the group that received @ weeks of ledipasvir-sofosbuvir plus ribavirin .


No patient in either @-week group discontinued ledipasvir-sofosbuvir owing to an adverse event .


The most common adverse events were fatigue , headache , insomnia , and nausea .


Once-daily ledipasvir-sofosbuvir with or without ribavirin for @ or @ weeks was highly effective in previously untreated patients with HCV genotype @ infection .


( Funded by Gilead Sciences ; ION-@ ClinicalTrials.gov number NCT@ . )


Providing effective analgesia for total knee arthroplasty ( TKA ) patients remains challenging .


Femoral nerve block ( FNB ) offers targeted pain control ; however , its effect on motor function , related fall risk and impact on rehabilitation has been the source of controversy .


Adductor canal block ( ACB ) potentially spares motor fibres of the femoral nerve , but the comparative effect of the two approaches has not yet been well defined due to considerable variability in pain perception .


Our study compares both single-shot FNB and ACB , side to side , in the same patients undergoing bilateral TKA .


Sixty patients scheduled for bilateral TKA were randomised to receive ultrasound-guided FNB on one leg and ACB on the other , in addition to combined spinal epidural anaesthesia .


The primary outcome was comparative postoperative pain in either extremity at six to eight , @ and @ hours postoperatively .


Secondary comparative outcomes included motor strength ( manually and via dynamometer ) , physical therapy milestones and patient satisfaction .


While pain levels were lowest at six to eight hours postoperatively and increased thereafter ( P < @ ) , no significant differences were seen between extremities at any time point with regard to pain in the quantitative comparison using visual analogue scale ( VAS ) scores ( P = @ ) , motor strength ( P = @ ) , physical therapy milestones or patient satisfaction .


However , in the qualitative comparison , a significant proportion of patients reported the leg receiving ACB to be more painful than that receiving FNB at @ h -LSB- @ % ( n = @ ) vs @ % ( n = @ ) , P = @ ) -RSB- .


Although we could not confirm a benefit in motor function between ACB and FNB , given the equivalent analgesic potency combined with its potentially lower overall impact if neuropraxia should occur , ACB may represent an attractive alternative to FNB .


To assess the effectiveness of in-person and webinar-delivered AFIX ( Assessment , Feedback , Incentives , and eXchange ) consultations for increasing adolescent vaccine coverage .


We randomly assigned @ primary care clinics in North Carolina , serving @ adolescents , to receive no consultation or an in-person or webinar AFIX consultation .


We delivered in-person consultations in April through May @ and webinar consultations in May through August @ .


The state 's immunization registry provided vaccine coverage data for younger patients ( ages @-@ years ) and older patients ( ages @-@ years ) for @ adolescent vaccines : tetanus toxoid , reduced diphtheria toxoid , and acellular pertussis ( Tdap ) ; meningococcal ; and human papillomavirus ( HPV ) vaccines ( @ dose , females only ) .


At the @-month follow-up , AFIX consultations increased vaccine coverage among younger adolescents .


Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap ( @ % -LSB- @ % confidence interval ( CI ) : @ to @ -RSB- ) , meningococcal ( @ % -LSB- @ % CI : @ to @ -RSB- , and HPV ( @ % -LSB- @ % CI : @ to @ -RSB- ) vaccines .


Patients in the webinar versus control arm also experienced larger changes for these vaccines .


AFIX did little to improve coverage among older adolescents .


At @ year , the @ arms showed similar coverage changes .


The effectiveness of in-person and webinar consultations was not statistically different at either time point ( all , P > @ ) .


Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents .


AFIX consultations for adolescents need improvement to have a stronger and more durable impact , especially for HPV vaccine .


With increasing evidence demonstrating the effectiveness of Web-based interventions and mindfulness-based training in improving health , delivering mindfulness training online is an attractive proposition .


The aim of this study was to evaluate the efficacy of two Internet-based interventions ( basic mindfulness and Health Action Process Approach enhanced mindfulness ) with waitlist control .


Health Action Process Approach ( HAPA ) principles were used to enhance participants ' efficacy and planning .


Participants were recruited online and offline among local universities ; @ university students and staff were randomly assigned to three conditions .


The basic and HAPA-enhanced groups completed the @-week fully automated mindfulness training online .


All participants ( including control ) were asked to complete an online questionnaire pre-program , post-program , and at @-month follow-up .


Significant group by time interaction effect was found .


The HAPA-enhanced group showed significantly higher levels of mindfulness from pre-intervention to post-intervention , and such improvement was sustained at follow-up .


Both the basic and HAPA-enhanced mindfulness groups showed better mental well-being from pre-intervention to post-intervention , and improvement was sustained at @-month follow-up .


Online mindfulness training can improve mental health .


An online platform is a viable medium to implement and disseminate evidence-based interventions and is a highly scalable approach to reach the general public .


Skin temperature assessment has historically been undertaken with conductive devices affixed to the skin .


With the development of technology , infrared devices are increasingly utilised in the measurement of skin temperature .


Therefore , our purpose was to evaluate the agreement between four skin temperature devices at rest , during exercise in the heat , and recovery .


Mean skin temperature ( -LSB- Formula : see text -RSB- ) was assessed in thirty healthy males during @ min rest ( @ @ C , @ @ % ) , @ min cycle in the heat ( @ @ C , @ @ % ) , and @ min recovery ( @ @ C , @ @ % ) .


-LSB- Formula : see text -RSB- was assessed at four sites using two conductive devices ( thermistors , iButtons ) and two infrared devices ( infrared thermometer , infrared camera ) .


Bland-Altman plots demonstrated mean bias limits of agreement between the thermistors and iButtons as follows ( rest , exercise , recovery ) : -@ @ , @ @ , -@ @ C ; thermistors and infrared thermometer : @ @ , -@ @ , -@ @ C ; thermistors and infrared camera ( rest , recovery ) : @ @ , @ @ C. Pairwise comparisons of -LSB- Formula : see text -RSB- found significant differences ( p < @ ) between thermistors and both infrared devices during resting conditions , and significant differences between the thermistors and all other devices tested during exercise in the heat and recovery .


These results indicate poor agreement between conductive and infrared devices at rest , during exercise in the heat , and subsequent recovery .


Infrared devices may not be suitable for monitoring -LSB- Formula : see text -RSB- in the presence of , or following , metabolic and environmental induced heat stress .


This study examined the effectiveness of a fully automated web-based programme to increase physical activity in adults with Type @ diabetes .


Between May and July @ , participants were randomly allocated into either a @-week intervention ( n = @ ) or a control ( n = @ ) group .


Participants were adults diagnosed with Type @ diabetes , residing in Australia .


Participants were assessed at baseline , @ and @weeks .


The primary physical activity outcome was self-reported minutes of total physical activity .


Secondary physical activity outcomes included minutes spent walking , and engaged in moderate , and vigorous physical activity .


Additional measures included website satisfaction and website usage .


The intervention consisted of a @-week web-based physical activity intervention developed based on the Theory of Planned Behavior and self-management framework .


Data were analysed from @ to @ .


There was a significant group-by-time interaction ( X ( @ ) ( df = @ ) = @ , p < @ ) for total physical activity favouring the intervention group d = @ , for those who completed the intervention , however this was not significant in the intention-to-treat analysis d = @ .


The intervention yielded high website satisfaction and usage .


In general , there is some evidence for the effectiveness of web-based interventions for improving physical activity levels ; however it is clear that maintaining improvements remains an issue .


The aim of this study was to compare whether the effectiveness of continuous ultrasound ( US ) was superior against pulsed US and against sham US in knee osteoarthritis .


A randomized controlled study was carried out on @ patients diagnosed with knee osteoarthritis according to American College of Rheumatology .


The patients were randomized into the following three treatments : ( @ ) continuous US ( at a frequency of @ MHz with intensity of @ W/cm ) , ( @ ) pulse US ( same frequency and intensity on @:@ pulse ratio ) , and ( @ ) sham US .


All treatments were applied with @-cm head US device five times a week for @ weeks in addition to home exercise program including quadriceps isometric exercise , muscle strength exercises , and stretching exercises of the lower extremity muscles for at least three times per week .


Assessments were performed at baseline , at the end of the treatment , and at the end of the treatments and at the sixth month using the following measurements : Western Ontario and McMaster University Osteoarthritis Index-pain , stiffness , function , visual analog scale-pain at rest , visual analog scale-pain on movement , visual analog scale-disease severity , and @-m walking time .


Among these parameters , the Western Ontario and McMaster University Osteoarthritis Index-pain was the primary outcome .


All groups showed a significant improvement in all parameters in both following visits ( P < @ ) .


However , there was no significant difference between the groups .


Although the mean reduction percent in Western Ontario and McMaster University Osteoarthritis Index-pain was significantly higher in group I ( continuous US ) when compared to sham group ( @ % vs @ % , P < @ ) at the end of the treatment , this result was not found in other pain parameters .


The present study demonstrated that all assessment parameters significantly improved in all groups without a significant difference .


This result suggested that therapeutic US provided no additional benefit in improving pain and functions in addition to exercise training .


Several definitions of treatment response have been proposed for alcohol clinical trials ( e.g. , abstinence and no heavy drinking ) .


However , each of these outcomes allows only one definition of successful response .


In contrast , the cumulative proportion of responders analysis ( CPRA ) includes all of the possible drinking response cutoff points , providing a more complete picture of the therapeutic effects of a treatment .


CPRA has been used to examine the efficacy of analgesics but not alcohol pharmacotherapy .


To demonstrate its potential utility , we conducted CPRA in two large alcohol treatment trials : the COMBINE ( Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence ) trial ( naltrexone ) and a multisite topiramate trial .


CPRA was used to demonstrate the efficacy of naltrexone and topiramate on continuous measures of in-treatment drinking-heavy drinking days and drinks per day-and their reductions from pretreatment .


All possible cutoff points were portrayed for each measure .


We provide graphs to illustrate the effects of the active medications compared with placebo and examined them statistically over a number of salient drinking outcomes to evaluate their efficacy .


Treatment group responder curves were not parallel across the entire range of cutoff points ; rather , they separated only at lower levels of drinking .


In general , effect sizes increased by @-@ @ when going from the lowest drinking level cutoff ( i.e. , abstinence and no heavy drinking ) to the cutoff associated with the maximal treatment effect .


CPRA may be useful in designing subsequent trials and helping to illustrate for treatment providers the likelihood of treatment success given various definitions of a positive response .


Hypertriglyceridemia is one of the risk factors for cardiovascular disease , and reduction oftriglyceride ( TG ) level is recommended in clinical practice guidelines for the treatment .


Recently , andrographolide , a main active compound of Andrographispaniculata has been shown to possess hypolipidemic effects in animals .


To investigate the TG-lowering effects of A. paniculata extract ( APE ) in patients with hypertriglyceridemia ( TG @ mg/dL ) using gemfibrozil treatment as the reference .


A randomized controlled clinical trial was carried out in sixty subjects with hypertriglyceridemia .


They were divided into three groups and treated with low dose of APE ( APE-L , andrographolide @-@ @ mg/day ) , high dose of APE ( APE-H , andrographolide @-@ @ mg/day ) , and gemfibrozil @ mg/day .


The treatments were conducted for @ weeks .


Guidance on lifestyle modifications was provided .


The primary endpoint was the mean difference SD ( @ % CI ) in TG levels ( baseline from the end of treatment ) , which were -@ @ ( -@ , @ ) , @ @ ( @ , @ ) , and @ @ ( @ , @ ) in the APE-L , APE-H , and gemfibrozil groups , respectively .


APE-H @ mg/day and gemfibrozil @ mg/day caused a significant reduction of TG level ( P = @ and @ , respectively ) when compared to the baseline .


There was no notable difference in the safety or tolerability among the treatment groups .


In patients with modest hypertriglyceridemia with lifestyle intervention , APE-H reduced the TG level comparable to the effect of gemfibrozil @ mg/day .


APE treatment was as tolerable as gemfibrozil treatment .


Hence , Andrographis paniculata might be used as an alternative medicine in treating hypertriglyceridemic patients .


Several chemokines , notably eotaxin , mediate the recruitment of eosinophils into tissues via the CCR@ receptor .


In this study , we investigated the role of CCR@ agonists in asthma by observing the effect of a small molecule antagonist of the CCR@ receptor ( GW@ ) on sputum eosinophil counts in patients with eosinophilic asthma .


Clinical and physiological outcomes , the chemotactic activity of sputum supernatant for eosinophils and the presence of eosinophil progenitors in sputum and blood samples were also studied .


In a double-blind parallel group study , @ patients with asthma were randomized to @ mg of GW@ twice daily or matching placebo for @ days followed by prednisone @ mg for @ days .


Of these patients , @ had a sputum eosinophil count > @ % at baseline .


Despite plasma concentrations of drug consistent with > @ % receptor occupancy during the dosing period , the CCR@ antagonist did not significantly reduce eosinophils or eosinophil progenitor cells ( CD@ ( + ) @ ( + ) IL-@R ( + ) ) in sputum or in blood .


The ex vivo chemotactic effect of sputum supernatants on eosinophils was attenuated by GW@ compared to placebo .


There was no improvement in FEV@ ; however , there was a modest but statistically significant improvement in PC@ methacholine ( @ doubling dose ) and ACQ scores , ( @ ) .


Whilst the improvement in PC@ is statistically significant , it is not of clinical significance .


In conclusion , this study calls into question the role of CCR@ in airway eosinophilia in asthma and suggests that other cellular mechanisms mediated by the CCR@ receptor may contribute to airway hyperresponsiveness .


Current evidence suggests that many patients with self-reported non-coeliac gluten sensitivity ( NCGS ) retain gastrointestinal symptoms on a gluten-free diet ( GFD ) but continue to restrict gluten as they report ` feeling better ' .


To investigate the notion that a major effect of gluten in those with NCGS is on mental state and not necessarily on gastrointestinal symptoms .


Twenty-two subjects ( @-@ years , five male ) with irritable bowel syndrome who had coeliac disease excluded but were symptomatically controlled on a GFD , undertook a double-blind cross-over study .


Participants randomly received one of three dietary challenges for @ days , followed by a minimum @-day washout before crossing over to the next diet .


Challenge gluten-free food was supplemented with gluten ( @ g/day ) , whey ( @ g/day ) or not supplemented ( placebo ) .


End-points included mental state as assessed by the Spielberger State Trait Personality Inventory ( STPI ) , cortisol secretion and gastrointestinal symptoms .


Gluten ingestion was associated with higher overall STPI state depression scores compared to placebo -LSB- M = @ , @ % CI ( @-@ @ ) , P = @ -RSB- but not whey -LSB- M = @ , @ % CI ( -@ to @ ) , P = @ -RSB- .


No differences were found for other STPI state indices or for any STPI trait measures .


No difference in cortisol secretion was identified between challenges .


Gastrointestinal symptoms were induced similarly across all dietary challenges .


Short-term exposure to gluten specifically induced current feelings of depression with no effect on other indices or on emotional disposition .


Gluten-specific induction of gastrointestinal symptoms was not identified .


Such findings might explain why patients with non-coeliac gluten sensitivity feel better on a gluten-free diet despite the continuation of gastrointestinal symptoms .


Concomitant carotid and cardiac surgery carries an increased perioperative morbidity and mortality risk .


Whether the hybrid procedure of carotid artery stenting ( CAS ) and coronary bypass surgery decreases the risk of stroke and other complications is still unknown .


The aim of this study was to assess early outcomes after simultaneous hybrid CAS and coronary bypass grafting versus open concomitant carotid and coronary bypass surgery .


We included @ patients in this study .


According to the protocol , all the patients were divided into two groups : Group @ ( @ patients ) with hybrid CAS and coronary bypass surgery and Group @ ( @ patients ) with concomitant carotid and coronary surgery .


Different preoperative , intraoperative and postoperative variables were compared .


The primary end point was combined incidence of stroke and death @ days after surgery or during initial hospitalization .


The secondary end points were myocardial infarction , atrial fibrillation , blood loss and need for blood transfusion and duration of intensive care unit and hospital stay .


Groups @ and @ were similar in preoperative characteristics including age ( @ @ vs @ @ , P = @ ) New York Heart Association class ( @ @ vs @ @ , P = @ ) , EuroSCORE ( @ @ vs @ @ , P = @ ) , the degree of carotid stenosis ( @ @ vs @ @ % , P = @ ) and average left ventricular ejection fraction ( @ @ vs @ @ % , P = @ ) .


Also , the groups did not differ in intraoperative variables with an exception of extracorporeal circulation time ( @ @ vs @ + @ min , P = @ ) , which was significantly shorter in Group @ .


Although rare , and without significant difference , primary end point occurred only in Group @ ( @ stroke and @ death , @ % ) .


There was no difference in the duration of mechanical ventilation , need for transfusion and duration of intensive care unit and hospital stay between the two groups .


Although limited by a small sample size , our results show that the hybrid procedure of carotid stenting and coronary surgery might be a good therapeutic option but further extended studies are needed to assess its real value .


Reduced estimated glomerular filtration rate ( eGFR ) using the cystatin-C derived equations might be a better predictor of cardiovascular disease ( CVD ) mortality compared with the creatinine-derived equations , but this association remains unclear in elderly individuals .


The aims of this study were to compare the predictive values of the Chronic Kidney Disease Epidemiology Collaboration ( CKD-EPI ) - creatinine , CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C eGFR equations for all-cause mortality and CVD events ( hospitalizationsmortality ) .


Prospective cohort study of @ elderly women aged > @ years .


Associations between eGFR and outcomes were examined using Cox regression analysis .


Test accuracy of eGFR equations for predicting outcomes was examined using Receiver Operating Characteristic ( ROC ) analysis and net reclassification improvement ( NRI ) .


Risk of all-cause mortality for every incremental reduction in eGFR determined using CKD-EPI-creatinine , CKD-EPI-cystatin C and the CKD-EPI-creatinine-cystatic C equations was similar .


Areas under the ROC curves of CKD-EPI-creatinine , CKD-EPI-cystatin C and CKD-EPI-creatinine-cystatin C equations for all-cause mortality were @ ( @ % CI @-@ @ ) , @ ( @ % CI @-@ @ ; p = @ ) and @ ( @ % CI @-@ @ ; p = @ ) respectively .


For all-cause mortality , there was no improvement in the reclassification of eGFR categories using the CKD-EPI-cystatin C ( NRI -@ % ; p = @ ) and CKD-EPI-creatinine-cystatin C ( NRI -@ % ; p = @ ) compared with CKD-EPI-creatinine equation .


Similar findings were observed for CVD events .


eGFR derived from CKD-EPI cystatin C and CKD-EPI creatinine-cystatin C equations did not improve the accuracy or predictive ability for clinical events compared to CKD-EPI-creatinine equation in this cohort of elderly women .


The ASPIRE in-clinic study established that automatic suspension of insulin with the threshold suspend ( TS ) feature reduces the duration of induced hypoglycemia .


The study 's crossover design allowed the effects of antecedent hypoglycemia to be studied .


The study enrolled @ subjects who exercised until plasma glucose ( YSI glucose and lactate analyzer ; YSI , Inc. , Yellow Springs , OH ) reached @ mg/dL .


Hypoglycemia was evaluated after the YSI value reached < @ mg/dL .


In TS experiments , insulin was stopped for @ h once a sensor glucose ( SG ) value of @ mg/dL was detected ; in control experiments , basal insulin delivery continued .


Subjects were randomly assigned to Group A ( TS in Period @ ; control in Period @ ) or Group B ( control in Period @ ; TS in Period @ ) .


Experiments were separated by @-@ days .


Hypoglycemia was @ min shorter in Period @ TS experiments ( no preceding control experiment ) than in Period @ TS experiments ( one or more preceding control experiment ( s ) ) ( P < @ ) .


The number of experiments prior to a successful TS experiment was lower for Period @ than for Period @ ( @ @ vs. @ @ ; P < @ ) , as was the cumulative duration of antecedent hypoglycemia ( @ min vs. @ min ; P < @ ) .


The between-groups difference in hypoglycemia duration was not attributable to differences in SG rates of change , the duration of exercise , or area under the curve of < @ mg/dL min in the @ days before the successful experiment ( all P > @ ) .


The TS feature 's ability to mitigate hypoglycemia was decreased by an episode or episodes of prolonged antecedent hypoglycemia , suggesting hypoglycemia begets hypoglycemia .


The effect of antecedent hypoglycemia should be taken into consideration in the design of future experiments assessing strategies to reduce hypoglycemia .


Low-level laser therapy has still not been well established , and it is important to define a standardized protocol for the treatment of temporomandibular disorders ( TMDs ) using low level laser .


There is no consensus on controlled clinical trials concerning the best option for laser therapy with regard to wavelength .


The aim of this study was to evaluate the efficacy of red and infrared laser therapy in patients with TMD , using a randomized parallel-group double-blind trial .


Each hemiface of @ subjects was randomized to receive intervention , in a total of @ sensitive points .


Pain was measured at baseline and time intervals of @ hours , @ days , @ days , and @ days after treatment .


Irradiation of @ J/cm@ in the temporomandibular joints and @ J/cm ( @ ) in the muscles was used in three sessions .


Both treatments had statistically significant results ( P < @ ) ; there was statistical difference between them at @ days in favor of the infrared laser ( P = @ ) .


There was improvement in @ hours , which extended up to @ days in both groups .


Both lasers are effective in the treatment and remission of TMD symptoms .


Extensive discussion with renal patients about treatment intensity is not systematically integrated into their care and often occurs during an acute hospitalization .


We conducted a `` test-of-change '' pilot study to assess the utility of providing an upstream discussion in the ambulatory setting as an additional nephrology consult to assist patients with chronic kidney disease considering treatment choices .


We randomly assigned patients with Stage @ or Stage @ chronic kidney disease who had not yet begun renal dialysis to @ of @ groups .


The test group received the additional nephrology consult and met with an interdisciplinary team composed of a nephrologist , social worker , and clinical ethicist , and the control group did not .


Qualitative data were collected in @ and @ via oral questionnaire .


Both groups received a @-month follow-up assessment .


Patients who received the nephrology consult reported that they experienced help in forming a treatment plan , felt well understood , and had the opportunity to thoroughly discuss questions .


The controls had a @ % increased probability of beginning dialysis and had a statistically significant increase in dialysis and clinic visits ( p < @ and p < @ ) .


Controls also were likelier than the test group to be admitted to the hospital ( @ vs @ admissions per patient in the test group ) , spend more days hospitalized ( @ vs @ bed days per patient ) , and visit the emergency room ( @ vs @ visits per patient ) and clinic ( @ vs @ visits per patient ) .


An additional nephrology consultation proved helpful both qualitatively and quantitatively .


The metabolic syndrome is the most important risk factor for cardiovascular disease .


The heat shock proteins ( HSPs ) are highly conserved families of proteins expressed by a number of cell types following exposure to stressful environmental conditions include several known risk factors for cardiovascular disease .


Recent studies have shown the potential of constituents of saffron in the treatment of atherosclerosis .


We aimed on investigating the effect of saffron on antibody titers to HSP in patients with metabolic syndrome .


This was a randomized , placebo-controlled clinical trial .


One-hundred and five subjects with metabolic syndrome were randomly allocated to one of the three groups : the case group received @ mg/day saffron , the placebo control group received a capsule of placebo and a non-placebo control group received no capsule , for @ weeks .


Antibodies against heat shock proteins @ , @ , @ and @ were determined in all patients before ( week @ ) and after ( week @ and @ ) intervention .


At @ weeks , saffron produced a significantly decrease in AntiHSP@ , @ levels .


Saffron can decrease AntiHSP@ , @ levels in patients with metabolic syndrome .


The results of this study indicate the efficacy of saffron in the improvement of some markers of autoimmunity HSPs in patients with metabolic syndrome .


The objective of this longitudinal study was to determine what typical vitamin D predictors influence the change in vitamin D status from mid-pregnancy to birth .


Plasma @-hydroxyvitamin D -LSB- @ ( OH ) D -RSB- was determined at mid-pregnancy ( @-@ weeks gestation ) and following birth ( n = @ ) .


Usual predictors of vitamin D status -LSB- body mass index ( BMI ) , race , season -RSB- in addition to prenatal supplemental vitamin D intake and docosahexaenoic acid ( DHA ) status at delivery were assessed for their interaction on the change on plasma @ ( OH ) D concentration between the two time points .


Forty-nine percent of women had inadequate vitamin D status -LSB- categorized as deficient ( < @ nmol/L ) or insufficient ( @-@ @ nmol/L ) by IOM guidelines -RSB- at mid-pregnancy and @ % were deficient or insufficient at birth .


Plasma @ ( OH ) D concentration dropped @ % from mid-pregnancy to birth .


Season of birth ( F = @ , P = @ ) and mid-pregnancy plasma @ ( OH ) D concentration ( F = @ , P = @ ) were significant variables in the change of vitamin D status while BMI , race , DHA status , and typical vitamin D intake ( @ IU/day ) from prenatal supplements did not have an effect .


Women who delivered in summer and fall had a @-fold greater plasma @ ( OH ) D concentration than women who delivered in winter in spring ( @ @ and @ @ nmol/L summer and fall , respectively , versus @ @ and @ @ nmol/L in winter and spring , respectively ) .


Typical supplemental vitamin D intake during pregnancy did not prevent precipitous drops in maternal plasma @ ( OH ) D concentration .


Clinicians and dietitians should be aware of the risk of inadequate vitamin D status in pregnant women in the United States relative to their initial vitamin D status and the season of birth .


Osteoarthritis is a common condition , typically treated with orally administered analgesics and non-steroidal anti-inflammatory drugs ( NSAIDs ) .


Chronic administration of NSAIDs , serotonin-norepinephrine reuptake inhibitors ( SNRIs , i.e. , duloxetine ) , and opioid medications ( i.e. , tramadol ) is regularly associated with multiple , serious side effects , in part due to the route of administration .


Transdermal delivery of NSAIDs , such as ibuprofen , represents a potentially alternative treatment for this inflammatory pain condition with a better therapeutic profile .


Investigate the safety and efficacy of a novel transdermal ibuprofen formulation ( VALE-ibuprofen ) containing @ % ibuprofen , compared to a placebo in a randomized , double-blinded clinical trial , for clinical improvement in patients with moderate to severe painful osteoarthritis of the knee .


A randomized , placebo-controlled , double blind , multi-center Phase @ clinical trial .


An academic medical center , and private rheumatology and interventional pain management practices .


The Phase @ clinical study included patients with primary osteoarthritis in a single knee joint with a progression level of moderate to severe based in part on a grade II or III designation according to the Kellgren and Lawrence classification system .


Patients received the corresponding , randomly assigned study formulation ( VALE-ibuprofen or placebo ) for application to the target knee at a dose of @ grams of drug product ( @ mg ibuprofen ) twice daily for @ days .


The evaluation of the efficacy of the treatments utilized the widely accepted methods of the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index and the Visual Analog Scale ( VAS ) scores for the patients .


The results indicate that the transdermal VALE-ibuprofen formulation was very well tolerated from a safety perspective during the @-week trial and also produced significant , positive clinical improvements superior to the placebo in all clinical endpoints tested .


In particular , the WOMACTotal and WOMACPhysical Functioning , for the VALE-ibuprofen , were superior compared to the placebo ( P = @ and P = @ , respectively ) .


Other clinical endpoints including the WOMACPain , WOMACStiffness , and VASResting scores were superior to those obtained from the placebo group , trending towards statistical significance compared to placebo ( P = @ , @ , and @ , respectively ) .


Based on the Patient and Physician Global Impression of Change survey , patient satisfaction slightly improved across both groups ; however , no statistical significance was detectable as compared to the baseline .


The sample size of @ subjects in the final data analysis and the lack of including an orally administered drug group are limitations of this study .


The use of transdermal VALE-ibuprofen has beneficial clinical effects on the pain levels experienced in some patients with moderate to severe osteoarthritis of the knee as measured by the WOMAC Osteoarthritis Indices for stiffness , pain , physical function , and total .


Visual Analog Scales ( VAS ) tests , VASMotion and VASWeight-bearing , again while appeared superior to placebo , were not statistically different from placebo .


Invasion and metastasis remain a critical issue in cervical cancer .


However , the underlying mechanism of it in cervical cancer remains unclear .


The newly discovered protein , TBLR@ , plays a crucial role in regulating various key cellular functions .


In this study , western blot , real-time RT-PCR , immunohistochemical staining , @D morphogenesis Matrigel culture , wound healing and Boyden chamber invasion assays , xenografted tumour model , luciferase assays , and chromatin immunoprecipitation assays were used .


The expression of TBLR@ in cervical cancer cell lines and tissues was significantly upregulated at both the RNA and protein levels compared with that in normal cervical cells .


Statistical analysis suggested that TBLR@ as an independent prognostic factor was significantly correlated with the clinical stage , survival time and recurrence .


Moreover , overexpression of TBLR@ in Hela and Siha cell lines promoted invasion in vitro and in vivo with the increases of the mesenchymal factors vimentin and fibronectin and decreases of the epithelial marker - catenin .


In contrast , RNAi-mediated knockdown of TBLR@ inhibited epithelial-mesenchymal transition in vitro and in vivo .


Further study indicated that this might be mediated via the NF-B and Wnt / - Catenin signalling pathway , and involve regulation of Snail and Twist .


The TBLR@ protein may be a prognostic marker in cervical cancer and play an important role in the invasion and metastasis of human cervical cancer .


To compare aqueous humor pH values in patients during femtosecond laser-assisted cataract surgery with patients during conventional phacoemulsification .


A prospective clinical study was conducted in @ eyes of @ patients who underwent cataract surgery by a single surgeon .


The femtosecond laser group included @ eyes operated on with a femtosecond laser platform ( Catalys ; Abbott Medical Optics , Santa Ana , CA ) and the phacoemulsification group included @ eyes that were operated on with conventional phacoemulsification .


The femtosecond laser group was subdivided into low , medium , and high level of cavitation gas bubbles after docking and the femtosecond laser procedure , according to the judgment of the surgeon .


Aqueous humor samples ( @ to @ mL ) were collected through a paracentesis from each patient after docking , corneal incisions , and nucleus fragmentation in the femtosecond laser group and after corneal incisions but before injection of viscoelastic in the phacoemulsification group , then analyzed with a pH meter .


The mean pH was @ @ ( range : @ to @ ) and @ @ ( range : @ to @ ) in the femtosecond laser and phacoemulsification groups , respectively ( P < @ ) .


In the femtosecond laser group , no significant differences in pH were observed between the three subgroups after docking and the femtosecond laser surgical procedure : low ( @ @ -LSB- range : @ to @ -RSB- ) , medium ( @ @ -LSB- range : @ to @ -RSB- ) , and high ( @ @ -LSB- range : @ to @ -RSB- ) level of gas bubbles .


Cavitation bubbles derived from the photodisruption process in femtosecond laser-assisted cataract surgery lead to an acidic shift of the aqueous humor pH as a result of the transformation of carbon dioxide to carbonic acid .


The level of gas bubbles visible after the laser photodisruption does not seem to correlate with this pH shift .


Further analysis of femtosecond laser-assisted cataract surgery is necessary .


Long-acting @-adrenergic agonists ( LABAs ) are recommended in combination with inhaled corticosteroids ( ICSs ) for asthma management .


Abediterol is a novel , selective , potent , once-daily LABA in development for treatment of asthma and chronic obstructive pulmonary disease .


This study aimed to determine abediterol doses with similar peak bronchodilatory effect to salbutamol @ g , and duration of action compatible with once-daily dosing in patients with persistent , stable asthma .


This was a Phase II , randomized , double-blind , double-dummy , crossover , placebo-controlled , dose-ranging study ( ClinicalTrials.gov NCT@ ) in @ patients with mild-to-moderate asthma who were also receiving an ICS .


Patients received single doses of abediterol @ , @ , @ , or @ g , salbutamol @ g , or placebo in the morning .


Spirometry was performed up to @ h post-dose ; safety and tolerability were assessed throughout the study .


The primary endpoint was change from baseline in peak forced expiratory volume in @ s ( FEV@ ) .


Additional endpoints included trough FEV@ , normalized area under the FEV@ curve ( FEV@ AUC ) up to @ h post-dose , and peak and trough forced vital capacity ( FVC ) .


Abediterol produced dose-dependent improvements in peak FEV@ from baseline compared with placebo , from @ ( @ % CI @ , @ ) to @ L ( @ % CI @ , @ ) for abediterol @ to @ g , respectively ( p < @ all doses ) .


Abediterol @ , @ , and @ g had similar magnitude of peak FEV@ effect to salbutamol .


Dose-dependent changes from baseline in trough FEV@ versus placebo were @ ( @ % CI @ , @ ) to @ L ( @ % CI @ , @ ) for abediterol @ to @ g , respectively ( p < @ ) .


All abediterol doses achieved significant improvements versus placebo in FEV@ AUC @-@ , @-@ , and @-@ h , and peak and trough FVC ( p < @ ) .


Less than @ % of patients experienced treatment-related adverse events for each dose of abediterol ; most were mild to moderate in intensity and the most common were headache and nasopharyngitis .


There were no clinically relevant changes in heart rate .


Abediterol @-@ @ g provided dose-dependent , clinically and statistically significant bronchodilation versus placebo in patients with asthma , with a peak effect similar to salbutamol and duration of action compatible with once-daily dosing .


All doses of abediterol were well tolerated .


To identify the first time point of an MRI-verified response to certolizumab pegol ( CZP ) therapy in patients with rheumatoid arthritis ( RA ) .