We conclude that PCEA with @mg/mL ropivacaine might provide the greatest benefit for labor analgesia .


The purpose of this study was to assess the inflammatory status of the aqueous humor in the fellow eye after uneventful cataract surgery in the first eye .


At the screening stage , aqueous humor samples from @ first-eye and @ second-eye cataract patients were collected just before cataract surgery and assayed using human cytokine antibody array .


Screened cytokines were then verified using a suspension array system with aqueous humor samples obtained from @ first-eye and @ second-eye cataract patients .


The cytokine antibody array revealed that interleukin-@ receptor antagonist ( Il-@ra ) and macrophage inflammatory protein ( MIP ) -@ a and MIP-@b were expressed at high levels in first-eye patients and were lower in second-eye patients , whereas opposite trends were found for monocyte chemoattractant protein @ ( MCP-@ ) and for regulated on activation , normal T expressed and secreted ( RANTES ) ( all , P < @ , Student 's t-test ) .


However , only MCP-@ and IL-@ra were significantly different between the two groups after Bonferroni correction ( both P < @ ) .


In the replication stage , the suspension cytokine array revealed that only MCP-@ expression was significantly greater in the aqueous humor of second-eye patients than in that of first-eye patients ( P = @ , Student 's t-test ) .


This study revealed that expression of MCP-@ , a pain-related inflammatory chemokine , was significantly increased in aqueous humor in the contralateral eye after first-eye cataract surgery .


This suggests there may be a sympathetic ophthalmic type uveitis in the contralateral eye after first-eye cataract surgery and that may help to explain why second-eye phacoemulsification is often more painful .


( ClinicalTrials.gov number , NCT@ . )


Observed associations between increased fruit and vegetable ( F&V ) consumption , particularly those F&V s that are rich in flavonoids , and vascular health improvements require confirmation in adequately powered randomized controlled trials .


This study was designed to measure the dose-response relation between high-flavonoid ( HF ) , low-flavonoid ( LF ) , and habitual F&V intakes and vascular function and other cardiovascular disease ( CVD ) risk indicators .


A single-blind , dose-dependent , parallel randomized controlled dietary intervention study was conducted .


Male and female low-F & V consumers who had a @-fold increased risk of CVD ( n = @ ) were randomly assigned to receive an HF F&V , an LF F&V , or a habitual diet , with HF and LF F&V amounts sequentially increasing by @ , @ , and @ ( +@ , +@ , and +@ ) portions/d every @ wk over habitual intakes .


Microvascular reactivity ( laser Doppler imaging with iontophoresis ) , arterial stiffness -LSB- pulse wave velocity , pulse wave analysis ( PWA ) -RSB- , @-h ambulatory blood pressure , and biomarkers of nitric oxide ( NO ) , vascular function , and inflammation were determined at baseline and at @ , @ , and @ wk .


In men , the HF F&V diet increased endothelium-dependent microvascular reactivity ( P = @ ) with +@ portions/d ( at @ wk ) and reduced C-reactive protein ( P = @ ) , E-selectin ( P = @ ) , and vascular cell adhesion molecule ( P = @ ) with +@ portions/d ( at @ wk ) .


HF F&V s increased plasma NO ( P = @ ) with +@ portions/d ( at @ wk ) in the group as a whole .


An increase in F&V s , regardless of flavonoid content in the groups as a whole , mitigated increases in vascular stiffness measured by PWA ( P = @ ) and reductions in NO ( P = @ ) in the control group .


These data support recommendations to increase F&V intake to @ portions daily , with additional benefit from F&V s that are rich in flavonoids , particularly in men with an increased risk of CVD .


We examined the effectiveness of traditional technical training ( TT ) and quiet eye training ( QET ) on the performance of @-handed square knot tying among first-year surgery residents under normal and high-anxiety conditions .


Twenty surgery residents were assigned randomly to @ of @ groups and completed pretest , training , and simple and complex retention tests under conditions of high and low anxiety .


The TT group received traditional instruction on improving hand movements ; the QET group received feedback on their gaze behaviors .


Participants wore an eye tracker that recorded simultaneously their gaze and hand movements .


Dependent variables were knot tying performance ( % ) , quiet eye duration ( % ) , number of fixations , and total movement time ( s ) .


Both groups improved their knot tying performance ( P < @ ) from pretest to the low anxiety conditions ( mean difference : QET , @ % ; TT , @ % ) ; however , only the QET group maintained their knot tying performance under the high-anxiety conditions ( mean difference : QET , @ % ; P < @ ) , with the TT group decreasing their performance close to pretest levels ( P > @ ) .


The QET group also demonstrated more efficient gaze and hand movements post training .


These data demonstrate the effectiveness of training gaze behaviors , not only to improve the effectiveness and efficiency of performance , but also to mediate negative effects of anxiety on performance .


These findings may have important implications for medical educators and practitioners , as well as surgeons who may be ( re ) training or learning new procedures .


Chronic subdural hematoma ( CSDH ) recurs after surgical evacuation in @-@ % of patients .


Inserting subdural drain might reduce the recurrence rate , but is not commonly practiced .


There are few prospective studies to evaluate the effect of subdural drains .


A prospective randomized study to investigate the effect of subdural drains in the on recurrence rates and clinical outcome following burr-hole drainage ( BHD ) of CSDH was undertaken .


During the study period , @ patients with CSDH were assessed for eligibility .


Among @ patients fulfilling the eligibility criteria , @ each were assigned to `` drain group '' ( drain inserted into the subdural space following BHD ) and `` without drain group '' ( subdural drain was not inserted following BHD ) using random allocation software .


The primary end point was recurrence needing re-drainage up to a period of @ months from surgery .


Recurrence occurred in @ of @ patients with a drain , and @ of @ patients in without drain group ( P = @ ) .


The mortality was @ % in patients with drain and @ % in patients without drain group ( P = @ ) .


The medical and surgical complications were comparable between the two study groups .


Use of a subdural drain after burr-hole evacuation of a CSDH reduces the recurrence rate and is not associated with increased complications .


No effective pharmacotherapy for methamphetamine ( MA ) use disorder has yet been found .


This study evaluated sustained-release methylphenidate ( MPH-SR ) compared with placebo ( PLA ) for treatment of MA use disorder in people also undergoing behavioral support and motivational incentives .


This was a randomized , double-blind , placebo-controlled design with MPH-SR or PLA provided for @ weeks ( active phase ) followed by @ weeks of single-blind PLA .


Twice-weekly clinic visits , weekly group counseling ( CBT ) and motivational incentives ( MI ) for MA-negative urine drug screens ( UDS ) were included .


Treatment sites were in Los Angeles , California ( LA ) and Honolulu , Hawaii ( HH ) , USA .


A total of @ MA-dependent ( via DSM-IV ) participants ( LA = @ ; HH = @ ) .


The primary outcome measure is self-reported days of MA use during the last @ days of the active phase .


Included in the current analyses are drug use ( UDS and self-report ) , retention , craving , compliance ( dosing , CBT , MI ) , adverse events and treatment satisfaction .


No difference was found between treatment groups in self-reported days of MA use during the last @ days of the active phase ( P = @ ) .


In planned secondary outcomes analyses , however , the MPH group had fewer self-reported MA use days from baseline through the active phase compared with the PLA group ( P = @ ) .


The MPH group also had lower craving scores and fewer marijuana-positive UDS than the PLA group in the last @ days of the active phase .


The two groups had similar retention , other drug use , adverse events and treatment satisfaction .


Methylphenidate may lead to a reduction in concurrent methamphetamine use when provided as treatment for patients undergoing behavioral support for moderate to severe methamphetamine use disorder , but this requires confirmation .


Depression and adherence to antidepressant treatment are important clinical concerns in diabetes care .


While patient-provider communication patterns have been associated with adherence for cardiometabolic medications , it is unknown whether interpersonal aspects of care impact antidepressant medication adherence .


To determine whether shared decision-making , patient-provider trust , or communication are associated with early stage and ongoing antidepressant adherence .


Observational new prescription cohort study .


Kaiser Permanente Northern California .


One thousand five hundred twenty-three adults with type @ diabetes who completed a survey in @ and received a new antidepressant prescription during @-@ .


Exposures included items based on the Trust in Physicians and Interpersonal Processes of Care instruments and the Consumer Assessment of Healthcare Providers and Systems ( CAHPS ) communication scale .


Measures of adherence were estimated using validated methods with physician prescribing and pharmacy dispensing data : primary non-adherence ( medication never dispensed ) , early non-persistence ( dispensed once , never refilled ) , and new prescription medication gap ( NPMG ; proportion of time without medication during @ months after initial prescription ) .


After adjusting for potential confounders , patients ' perceived lack of shared decision-making was significantly associated with primary non-adherence ( RR = @ , p < @ ) , early non-persistence ( RR = @ , p < @ ) and NPMG ( estimated @ % greater gap in medication supply , p < @ ) .


Less trust in provider was significantly associated with early non-persistence ( RRs @-@ @ , ps < @ ) and NPMG ( estimated NPMG differences @-@ % , ps < @ ) .


All patients were insured and had consistent access to and quality of care .


Patients ' perceptions of their relationships with providers , including lack of shared decision-making or trust , demonstrated strong associations with antidepressant non-adherence .


Further research should explore whether interventions for healthcare providers and systems that foster shared decision-making and trust might also improve medication adherence .


To evaluate the feasibility of full-mouth debridement ( subgingival scaling and root planning , SRP ) by @ times within @ week and compare the clinical effects of different sequences of debridement-antibiotic usage in patients with severe chronic periodontitis ( CP ) .


A double-blinded , placebo-controlled , randomized clinical trial was conducted in @ severe CP patients ( @ males and @ females , @ @ years old on average from @ to @ ) receiving @ different sequences of debridement-antibiotictherapy : Group A , antibiotic usage ( metronidazole , MTZ , @ g , tid , @ d ; amoxicillin , AMX @ g , tid , @ d ) was started together with SRP ( completed by @ times in @ d ) ; Group B , antibiotic usage ( MTZ @ g , tid , @ d ; AMX @ g , tid , @ d ) was started @ d after SRP ( completed by @ times in @ d ) ; Group C , SRP alone -LSB- probing depth ( PD ) , bleeding index ( BI ) and tooth mobility -RSB- was examined .


The average full-mouth probing depth , the average full-mouth proximal probing depth ( pPD ) , the percentage of sites with PD > @ mm ( PD > @ mm % ) , the percentage of sites with proximal PD > @ mm ( pPD > @ mm % ) , the average bleeding index ( BI ) and the percentage of sites with bleeding on probing ( BOP % ) were calculated .


Clinical examinations were performed at baseline and @ months post therapy .


( @ ) Compared with baseline conditions , all the subjects showed clinical improvements in all the parameters evaluated @ months post therapy , P < @ .


( @ ) Significant difference were observed in the average PD changes between Group A -LSB- ( @ @ ) mm -RSB- , Group B -LSB- ( @ @ ) mm -RSB- and Group C -LSB- ( @ @ ) mm -RSB- , P < @ .


No significant difference was observed in the average PD changes between Group B and Group C , P = @ .


Significant differences were observed in the average pPD changes between Group A -LSB- ( @ @ ) mm -RSB- and Group C -LSB- ( @ @ ) mm -RSB- , P < @ .


No significant difference was observed in BI and BOP % changes between Group A , Group B and Group C.


For patients with severe chronic periodontitis , it is safe and feasible to receive full-mouth SRP by @ times within @ week .


The short-term ( @ months ) advantages in PD changes are observed in patients receiving SRP and antibiotic usage at the same time comparing with patients using antibiotics after SRP or SRP alone .


In a phase @ dose-escalation study , combined inhibition of T-cell checkpoint pathways by nivolumab and ipilimumab was associated with a high rate of objective response , including complete responses , among patients with advanced melanoma .


In this double-blind study involving @ patients with metastatic melanoma who had not previously received treatment , we randomly assigned patients in a @:@ ratio to receive ipilimumab ( @ mg per kilogram of body weight ) combined with either nivolumab ( @ mg per kilogram ) or placebo once every @ weeks for four doses , followed by nivolumab ( @ mg per kilogram ) or placebo every @ weeks until the occurrence of disease progression or unacceptable toxic effects .


The primary end point was the rate of investigator-assessed , confirmed objective response among patients with BRAF V@ wild-type tumors .


Among patients with BRAF wild-type tumors , the rate of confirmed objective response was @ % ( @ of @ patients ) in the group that received both ipilimumab and nivolumab ( combination group ) versus @ % ( @ of @ patients ) in the group that received ipilimumab and placebo ( ipilimumab-monotherapy group ) ( P < @ ) , with complete responses reported in @ patients ( @ % ) in the combination group and no patients in the ipilimumab-monotherapy group .


The median duration of response was not reached in either group .


The median progression-free survival was not reached with the combination therapy and was @ months with ipilimumab monotherapy ( hazard ratio associated with combination therapy as compared with ipilimumab monotherapy for disease progression or death , @ ; @ % confidence interval , @ to @ ; P < @ ) .


Similar results for response rate and progression-free survival were observed in @ patients with BRAF mutation-positive tumors .


Drug-related adverse events of grade @ or @ were reported in @ % of the patients who received the combination therapy as compared with @ % of the patients who received ipilimumab monotherapy .


Select adverse events with potential immunologic causes were consistent with those in a phase @ study , and most of these events resolved with immune-modulating medication .


The objective-response rate and the progression-free survival among patients with advanced melanoma who had not previously received treatment were significantly greater with nivolumab combined with ipilimumab than with ipilimumab monotherapy .


Combination therapy had an acceptable safety profile .


( Funded by Bristol-Myers Squibb ; ClinicalTrials.gov number , NCT@ . )


To study which variables are able to influence women 's experience of pain during diagnostic hysteroscopy .


Multivariate analysis ( phase II ) after a randomized , controlled trial ( phase I ) .


Endoscopic gynecologic center .


In phase I , @ patients were analyzed .


Group A : @ women with carbon dioxide ( CO@ ) ; group B : @ women with normal saline .


In phase II , @ patients were assigned to two different groups according to their pain experience as measured by a visual analogue scale ( VAS ) : group VAS > @ ( @ patients ) ; group VAS@ ( @ patients ) .


Free-anesthesia diagnostic hysteroscopy performed using CO@ or normal saline as distension media .


Procedure time , VAS score , image quality , and side effects during and after diagnostic hysteroscopy .


In phase I the median pain score in group A was @ , whereas in group B it was @ .


In phase II the duration of the procedure , nulliparity , and the use of normal saline were significantly correlated with VAS > @ .


A higher presence of cervical synechiae was observed in the group VAS > @ .


The multivariate analysis revealed an inverse correlation between parity and a VAS > @ , whereas the use of normal saline , the presence of synechiae in the cervical canal , and the duration of the hysteroscopy were all directly correlated to a VAS score > @ .


Pain in hysteroscopy is significantly related to the presence of cervical synechiae , to the duration of the procedure , and to the use of normal saline ; conversely , parity seems to have a protective role .


OCEANS , a randomized , placebo-controlled , phase III trial , found that adding bevacizumab to gemcitabine-carboplatin ( GC ) significantly improved investigator-determined progression-free survival ( PFS ) and objective response rate ( ORR ) in platinum-sensitive , recurrent ovarian cancer .


To evaluate the reliability of assessment of progression and objective response per RECIST , radiologic and clinical data were assessed by an independent review committee ( IRC ) .


Radiologic images and clinical data were provided prospectively to the IRC for all randomized patients ( N = @ ) .


Data were reviewed in a blinded fashion per RECIST ( modified v@ @ ) .


PFS and ORR were analyzed based on the IRC assessment .


Concordance between investigator - and IRC-assessed progression and objective response was assessed .


The IRC analysis demonstrated a statistically significant increase in PFS ( hazard ratio -LSB- HR -RSB- = @ ; @ % confidence interval -LSB- CI -RSB- = @ to @ , p < @ ) consistent with the benefit reported by investigators ( HR = @ ; @ % CI = @ to @ , p < @ ) .


The concordance rate , defined by agreement on progression status , was @ % overall , and comparable between treatment arms ( bevacizumab , @ % vs. placebo , @ % ) .


IRC-assessed ORR was significantly improved with bevacizumab ( bevacizumab , @ % vs. placebo , @ % ; p < @ ) , consistent with the investigator-assessed results .


The concordance rate for objective response was @ % overall , and comparable between treatment arms ( bevacizumab , @ % vs. placebo , @ % ) .


IRC-determined results were highly consistent with those determined by investigators , demonstrating that bevacizumab plus GC provides a significant improvement in PFS and ORR .


These results suggest that investigators can reliably assess disease progression and objective response in recurrent ovarian cancer using RECIST , without the necessity of a full IRC review .


To explore the impacts on the fine movement of upper extremity with flaccid paralysis in stroke treated with acupuncture and motor imagery .


Sixty-two cases of flaccid paralysis of upper extremity in stroke were randomized into an observation group ( @ cases ) and a control group ( @ cases ) .


In the control group , the conventional western medication and the passive movement of the extremity were applied .


Additionally , the penetrating needling technique was used at the head points -LSB- penetrating needling from Baihui ( GV @ ) to Taiyang ( EX-HN @ ) -RSB- and the local affected extremity -LSB- penetrating needling from Jianyu ( LI @ ) to Binao ( LI@ @ ) , from Quchi ( LI @ ) to Shaohai ( HT @ ) , from Waiguan ( TE @ ) to Neiguan ( PC @ ) , etc -RSB- .


The needles were retained for @ min .


In the observation group , on the basic treatment as the control group , during the needle retaining , the motor imagery therapy was supplemented .


The treatment was given once a day , @ treatments a week , for @ weeks totally in the either group .


The scores in the action research arm test ( ARAT ) and the modified Fugl-Meyer assessment ( FMA ) were recorded at the moment of enrollment , in @ and @ weeks of treatment , in the @th and @th weeks , as well as after @ days separately .


( @ ) ARAT score : since the @nd week , ARAT scores in the observation group were all improved significantly as compared with those in the control group at the each time points ( all P < @ ) .


In the observation group , the scores were improved significantly in the pair comparison at the time points ( all P < @ ) .


In the control group , the score in the @nd week was not different significantly as compared with that before treatment ( P > @ ) , but the scores at the rest time points were improved significantly in the pair comparison ( all P < @ ) ; ( @ ) FMA score : in the @nd week and on the @th day , FMA score in the observation group was higher significantly than those in the control group ( both P < @ ) .


In the observation group , the scores were all improved significantly in the pair comparison at the time points ( all P < @ ) .


In the control group , except that in comparison between the @th day and the @th week ( P > @ ) , the results were all P < @ at the rest time points .


The early intervention of the combined therapy of acupuncture and motor imagery effectively promotes the recovery of the coordination function and the fine movement of upper extremity , especially the improvements of the fine movement in stroke at flaccid paralysis stage .


The efficacy is better than the single acupuncture treatment .


This paper attempts to describe the patterns of exercise and the perceived benefits and barriers to exercise in an urban south Indian population .


Study participants were recruited from the baseline survey of the D-CLIP ( Diabetes Community Lifestyle Improvement Program ) .


Frequency , duration , type and location of exercise were assessed using a questionnaire , while a Likert type scale was used to assess perceived benefits of and barriers to exercise .


Quality of life was measured using the EQ-@D .


Out of @ participants ( @ % males ) , @ % reported doing @min of exercise/week ( `` exercisers '' ) compared to @ % `` non-exercisers '' .


Exercisers were significantly older ( @ vs. @ years ) , better educated ( @ % vs. @ % ) , had a higher monthly income ( @ % vs. @ % ) , consumed more fruits ( @ % vs. @ % ) and vegetables ( @ % vs. @ % ) and had better perceived state of health ( @ % vs. @ % ) , compared to non-exercisers .


Exercisers had significantly lower HOMA-IR , higher Matsuda index and lower prevalence of low HDL cholesterol compared to non-exercisers .


However , there were no significant differences in cardio-metabolic risk factors like diabetes , hypertension and obesity between the two groups .


Walking was the most common type of exercise .


Both exercisers and non-exercisers perceived the benefits of exercising , but barriers weighed more heavily on exercise behaviour .


Urgent steps are needed to improve overall exercise levels in India by addressing barriers and improving the quality of exercise performed so as to enhance overall metabolic health .


To investigate if a six-year intensive lifestyle intervention in people with pre-diabetes lead to reduction of cardiovascular events and cardiovascular disease ( CVD ) mortality in subsequent @ years .


Five hundreds and nineteen subjects with normal glucose tolerance ( NGT ) and @ subjects with impaired glucose tolerance ( IGT ) in Da Qing city were recruited in the study in @ .


The IGT subjects randomly assigned to either the no-intervention group or one of three lifestyle intervention groups ( diet , exercise , or diet plus exercise ) to receive a @-year lifestyle intervention .


In @ , the participants were followed up to assess the primary outcomes of cardiovascular events and CVD mortality by a questionnaire and medical records .


Subjects in IGT no-intervention group had the highest incidences of cardiovascular events ( @ % ) and CVD mortality ( @ % ) , while those in NGT group had the lowest incidences of cardiovascular events ( @ % ) and CVD mortality ( @ % ) after @-year follow-up .


The incidences of cardiovascular events and CVD mortality in IGT intervention subjects were @ % and @ % , respectively .


The multivariable analyses showed that , after controlling of age , gender , BMI smoking , blood pressure and cardiovascular event at baseline , the CVD mortality and incidence of cardiovascular events in IGT no-intervention group was @ ( HR = @ , @ % CI @-@ @ , P = @ ) and @ ( HR = @ , @ % CI @-@ @ , P = @ ) times of those in NGT group .


However , the CVD mortality and incidence of cardiovascular events were not different in the IGT intervention group compared with those in the NGT group ( HR = @ , @ % CI @-@ @ , P = @ and HR = @ , @ % CI @-@ @ , P = @ , respectively ) .


Subjects with IGT were at high risk for cardiovascular events and mortality .


A six-year lifestyle intervention in this population can reduce both the incidence of cardiovascular event and CVD mortality .


Anesthesia induction using propofol ( @ mg/kg ) and remifentanil ( @ g/kg ) without the use of muscle relaxants has been associated with a lower incidence of successful intubation .


Dexmedetomidine has been found to effectively decrease the requirements for propofol and remifentanil and to attenuate the hemodynamic response to intubation .


Therefore , in this study , we examined intubating conditions and hemodynamic changes in children after induction with dexmedetomidine ( @ g/kg ) combined with propofol ( @ mg/kg ) and remifentanil ( @ g/kg ) .


This randomized , double-blinded , and placebo-controlled study included @ ASA physical status I children aged @ to @ years .


The children were randomly allocated to a dexmedetomidine group ( group D ) or a placebo group ( group P ) .


After IV administration of atropine ( @ mg/kg ) , anesthesia was induced with an infusion of dexmedetomidine ( @ g/kg ) over @ minutes for group D , whereas normal saline was infused for group P. Propofol ( @ mg/kg ) was then injected IV over @ to @ seconds , followed by an infusion of remifentanil ( @ g/kg ) over @ minute for both groups .


One minute later , laryngoscopy and tracheal intubation were performed .


For group D and group P , tracheal intubation was successful in @ % ( @/@ ) and @ % ( @/@ ) of patients ( P = @ ) , respectively .


Excellent conditions were present in @ of @ and @ of @ of intubations , respectively , resulting in an overall incidence of excellent conditions of @ % ( @/@ ) and @ % ( @/@ ) , respectively ( P = @ ) .


Systolic blood pressure significantly increased after the IV injection of dexmedetomidine compared with baseline readings ( P = @ , with a confidence interval of @-@ mm Hg ) .


A single dose of dexmedetomidine ( @ g/kg ) improved intubation conditions in children after induction with propofol ( @ mg/kg ) and remifentanil ( @ g/kg ) without muscle relaxants .


Dexmedetomidine did not affect the hemodynamic response to intubation .


Carbapenem-resistant Enterobacteriaceae ( CRE ) are emerging .


In attempt to eradicate CRE colonization , we conducted a semirandomized , prospective , controlled trial using oral nonabsorbable antibiotics .


Consecutive hospitalized CRE carriers were studied .


Patients whose rectal isolates were gentamicin sensitive but colistin resistant were treated with gentamicin .


Patients whose isolates were colistin sensitive but gentamicin resistant were treated with colistin .


Patients whose isolates were sensitive to both drugs were randomized to @ groups of oral antibiotic treatment : gentamicin , colistin , or both .


Patients whose isolates were resistant to both drugs , and those who did not consent , were followed for spontaneous eradication .


One hundred fifty-two patients were included ; @ were followed for spontaneous eradication for a median duration of @ days ( controls ) , and @ received @ of the @ drug regimens : gentamicin , @ ; colistin , @ ; both drugs , @ , followed for a median duration of @ days .


Eradication rates in the @ treatment groups were @ % , @ % , and @ % , respectively , each significantly higher than the @ % spontaneous eradication rate in the control group ( P < @ , P < @ , and P = @ , respectively ) with no difference between the regimens .


No significant adverse effects were observed .


Oral antibiotic treatment with nonabsorbable drugs to which CRE is susceptible appears to be an effective and safe for eradication of CRE colonization and , thereby , may reduce patient-to-patient transmission and incidence of clinical infection with this difficult-to-treat organism .


Energy expenditure ( EE ) increases with overfeeding , but it is unclear how rapidly this is related to changes in body composition , increased body weight , or diet .


The objective was to quantify the effects of excess energy from fat or protein on energy expenditure of men and women living in a metabolic chamber .


We conducted a randomized controlled trial in @ participants who ate @ % excess energy for @ d from @ % , @ % , or @ % protein diets .


Twenty-four-hour EE ( @EE ) and sleeping EE ( SleepEE ) were measured on days @ , @ , and @ of overfeeding and on day @ while consuming the baseline diet ( usually day @ ) .


Metabolic and molecular markers of muscle metabolism were measured in skeletal muscle biopsy specimens .


In the low-protein diet group whose excess energy was fat , the @EE and SleepEE did not increase during the first day of overfeeding .


When extra energy contained protein , both @EE and SleepEE increased in relation to protein intake ( r = @ , P = @ ) .


The @EE over @ wk in all @ groups was correlated with protein intake ( r = @ , P = @ ) but not energy intake ( r = @ ; P = @ ) .


SleepEE was unchanged by overfeeding in the low-protein diet group , and baseline surface area predicted increased @EE in this group .


Protein and fat oxidation were reciprocally related during overfeeding .


Observed @EE was higher than predicted on days @ ( P @ ) , @ ( P = @ ) , and @ ( P = @ ) .


There was no relation between change in fat mass and change in EE .


Excess energy , as fat , does not acutely increase @EE , which rises slowly as body weight increases .


Excess energy as protein acutely stimulates @EE and SleepEE .


The strongest relation with change in @EE was the change in energy expenditure in tissue other than muscle or fat-free mass .


This article describes a study that aimed to validate the Self-care in Chronic Conditions Partners in Health Scale instrument in the Mexican population .


The instrument has been validated in Australia for use as a screening tool by primary healthcare professionals to assess the self-care skills and abilities of people with a chronic illness .


Validation was conducted using baseline data for @ people with diabetes , hypertension and cancer aged @ or older who were users of healthcare centres in Tampico , Tamaulipas , Mexico .


Results show high reliability and validity of the instrument and three themes were identified : knowledge , adherence , and dealing with and managing side effects .


The findings suggest the scale is useful as a generic self-rated clinical tool for assessing self-management in a range of chronic conditions , and provides an outcome measure for comparing populations and change in patient self-management knowledge and behaviour .


The authors recommend validating the scale in other Latin-American settings with more research into the effect of gender on self - management .


Non-invasive near-infrared spectroscopy ( NIRS ) offers the possibility to determine regional cerebral oxygen saturation ( rSO@ ) in patients with cardiac arrest .


Limited data from recent studies indicate a potential for early prediction of neurological outcome .


Sixty cardiac arrest patients were prospectively enrolled , @ in-hospital cardiac arrest ( IHCA ) and @ out-of-hospital cardiac arrest ( OHCA ) patients respectively .


NIRS of frontal brain was started after return of spontaneous circulation ( ROSC ) during admission to ICU and was continued until normothermia .


Outcome was determined at ICU discharge by the Pittsburgh Cerebral Performance Category ( CPC ) and @ months after cardiac arrest .


A good outcome ( CPC @-@ ) was achieved in @ ( @ % ) patients , while @ ( @ % ) had a poor outcome ( CPC @-@ ) .


Patients with good outcome had significantly higher rSO@ levels ( CPC @-@ : rSO@ @ % ; CPC @-@ : rSO@ @ % ; p < @ ) .


For good and poor outcome median rSO@ within the first @h period was @ % and @ % respectively and for the following @h period @ % and @ % ( p < @ ) .


Outcome prediction by area of rSO@ below a critical threshold of rsO@ = @ % within the first @h yielded @ % specificity and @ % sensitivity for poor outcome .


On average , rSO@ within the first @h after ROSC is significantly lower in patients with poor outcome , but rSO@ ranges largely overlap between outcome groups .


Our data indicate limited potential for prediction of poor outcome by frontal brain rSO@ measurements .


This study aimed to examine whether reductions in sitting time through alternating @-min bouts of sitting and standing can reduce postprandial glucose , insulin , and triglyceride responses .


Twenty-three overweight/obese sedentary office workers ( @ males and six females ; mean SD : age , @ @ yr ; body mass index , @ @ kg m ( -@ ) ) undertook two short-term ( @ d ) experimental conditions in an equal , randomized ( @:@ ) order .


In a simulated office environment , participants performed typical occupational tasks for @ h d ( -@ ) while in a @ ) seated work posture ( control condition ) or @ ) interchanging between a seated and standing work posture every @ min using an electric , height-adjustable workstation ( intervention condition ) .


Fasting and postprandial blood samples after a mixed test drink were collected hourly for @ h on days @ and @ of each condition to assess serum insulin , plasma glucose , and triglycerides .


Dietary intake ( kJ d ( -@ ) ) and physical activity were standardized during each condition .


The trial was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN@ ) .


After adjustment for time ( days @ and @ ) , incremental area under the analyte time curve differed significantly between conditions for plasma glucose ( P = @ ) but not for serum insulin or plasma triglycerides .


Adjusted mean glucose incremental area under the analyte time curve was lowered by @ % after the intervention condition ( @ mM h ( -@ ) ( confidence interval , @-@ @ ) ) relative to the control condition ( @ mM h ( -@ ) ( confidence interval , @-@ @ ) ) .


No temporal changes ( days @ vs @ ) between conditions were observed .


Alternating standing and sitting in @-min bouts results in modest beneficial effects on postprandial glucose responses in overweight/obese office workers .


Pneumococcal conjugate vaccines ( PCV ) reduce disease due to Streptococcus pneumoniae .


We aimed to determine the efficacy of different PCV schedules in Gambian children .


We reanalysed data from a randomised placebo-controlled trial .


Infants aged @-@ weeks were allocated to three doses of nine-valent PCV ( n = @ ) or placebo ( n = @ ) and followed until age @ months .


We categorised participants to compare : ( a ) a first dose at age @ or @ weeks , ( b ) intervals of @ or @ months between doses , and ( c ) different intervals between second and third doses .


The primary endpoint was first episode of radiologic pneumonia ; other endpoints were hospitalisation and mortality .


Using the placebo group as the reference population , Poisson regression models were used with follow-up after the first dose to estimate the efficacy of each schedule and from age @ weeks to estimate the incidence rate difference between schedules .


Predicted efficacy in the groups aged @ weeks ( n = @ , @ events ) or @ weeks ( n = @ , @ events ) at first dose against radiologic pneumonia were @ % ( @ % CI @-@ % ) and @ % ( @ % CI @-@ % ) , against hospitalisation @ % ( @ % CI @-@ % ) and @ % ( @ % CI @-@ % ) , and against mortality @ % ( @ % CI -@ to @ % ) and @ % ( @ % CI -@ to @ % ) respectively .


Predicted efficacy in the groups with intervals of @ month ( n = @ , @ events ) or @ months ( n = @ , @ events ) between doses against radiologic pneumonia were @ % ( @ % CI @-@ % ) and @ % ( @ % CI @-@ % ) , against hospitalisation @ % ( @ % CI @-@ % ) and @ % ( @ % CI @-@ % ) , and against mortality @ % ( @ % CI -@ to @ % ) and @ % ( @ % CI -@ to @ % ) respectively .


Efficacy did not differ by interval between second and third doses , nor did the incidence rate difference between schedules .


We found no evidence that efficacy or effectiveness of PCV@ differed when doses were given with modest variability around the scheduled ages or intervals between doses .


Data are scarce on the advantage of ultrasound-guided spinal anaesthesia in patients with easily identifiable bony landmarks .


In this study , we compared the use of ultrasound to the landmark method in patients with no anticipated technical difficulty , presenting for caesarean delivery under spinal anaesthesia .


A total of @ pregnant women were recruited in this randomized , controlled study .


Ultrasound examination and spinal anaesthesia were performed by three anaesthetists with experience in ultrasound-guided neuraxial block .


Patients were randomized to either the Ultrasound Group ( n = @ ) or the Landmark Group ( n = @ ) .


In both groups the level of L@-@ or L@-@ was identified by ultrasound ( transverse and longitudinal approach ) or palpation .


The primary outcome was the procedure time , measured from the time of skin puncture by the introducer to the time of viewing cerebrospinal fluid at the hub of the spinal needle .


Secondary outcomes were the number of skin punctures , number of passes , and incidence of successful spinal blockade .


The average procedure time , number of skin punctures and needle passes , were similar in both groups .


The number of patients with successful spinal anaesthesia after one puncture was not statistically different between the groups .


The present results indicate that when performed by anaesthetists experienced in both ultrasound and landmark techniques , the use of ultrasound does not appear to increase the success rate of spinal anaesthesia , or reduce the procedure time or number of attempts in obstetric patients with easily palpable spines .


Low-dose computed tomography ( LDCT ) lung screening has been associated with a @ % reduction in lung cancer mortality .


A major barrier to the adoption of lung screening is the potential negative psychological impact of a false-positive ( FP ) screen , occurring in @ % to @ % of those screened .


The objective of this study was to assess the impact of abnormal findings on health-related quality of life ( HRQoL ) and anxiety in the American College of Radiology ( ACRIN ) / National Lung Screening Trial ( NLST ) .


The NLST was a randomized screening trial comparing LDCT with chest X-ray screening ( CXR ) .


This study was part of the original protocol .


A total of @ participants at @ of @ ACRIN sites who had baseline HRQoL assessments were asked to complete the Short Form-@ and the State Trait Anxiety Inventory ( form Y-@ ) questionnaires to assess short-term ( @ month ) and long-term ( @ months ) effects of screening .


FP were lung cancer-free at @ year , and true-positives ( TP ) were not .


Of the total participants , @ ( @ % ) participants were FP , @ ( @ % ) were TP , @ ( @ % ) had significant incidental findings ( SIFs ) , and @ ( @ % ) had negative screens .


Participants had been randomized to LDCT ( n = @ ) and CXR ( n = @ ) .


Short-term and long-term HRQoL and state anxiety did not differ across participants with FP , SIF , or negative screens .


Short-term and long-term HRQoL were lower and anxiety was higher for TP participants compared to participants with FP , SIF , and negative screens .


In a large multicenter lung screening trial , participants receiving a false-positive or SIF screen result experienced no significant difference in HRQoL or state anxiety at @ or at @ months after screening relative to those receiving a negative result .


To determine if brief primary care interventions can affect children 's media viewing habits and exposure to violence .


English - and Spanish-speaking parents of @ - to @-year-old children presenting to a pediatric primary care clinic participated in a randomized controlled trial .


There were @ intervention groups ; one group viewed @ minutes from the Play Nicely program and another received a handout , `` Pulling the Plug on TV Violence . ''


There were @ control groups ; the primary control group received standard primary care , and the alternative control group viewed a program about obesity prevention .


The outcome measure was parental report of changes in media viewing habits and changes in exposure to violence .


A total of @ of @ parents who were randomized completed a @-week follow-up survey .


Compared with the primary control group , parents in the video intervention group were more likely to report a change in their children 's media viewing habits ( odds ratio -LSB- OR -RSB- @ ; @ % confidence interval -LSB- CI -RSB- @-@ @ ) and a change in their children 's exposure to violence ( OR @ ; @ % CI @-@ @ ) .


Compared with the primary control group , parents in the handout group were more likely to report a change in their children 's media viewing habits ( OR @ ; @ % CI @-@ @ ) and a change in their children 's exposure to violence ( OR @ ; @ % CI @-@ @ ) .


Brief primary care interventions can affect children 's media viewing habits and children 's exposure to violence .


These results have implications for how to improve primary care services related to decreasing children 's media exposure and violence prevention .


Dual-chamber implantable cardioverter-defibrillators ( ICDs ) may improve specificity and reduce the risk of inappropriate shocks , and enhance atrial arrhythmia ( AT/AF ) detection to permit stroke prevention compared with single-chamber ICDs , but at additional expense and risk .


Patients ( n = @ ) receiving primary prevention ICDs at two USA and two Israeli centres were randomized to dual-chamber or single-chamber devices between December @ and December @ and were followed for @ year .


Programming in both groups included : delayed detection to avoid therapy for non-sustained episodes ; high detection cut-off rates to avoid treating slower , better tolerated arrhythmias ; minimized right ventricular pacing ; and routine use of supraventricular-ventricular tahcycardia discriminators and antitachycardia pacing .


The primary outcome was the proportion of patients with inappropriate shocks .


One patient in each group ( @ % ) received inappropriate shocks ( P = @ ) .


Death occurred in two patients in the single-chamber arm , and in none of the patients in the dual-chamber arm ( P = @ ) .


New AT/AF was detected in @ patients ( @ % ) in the dual-chamber group , vs. no patients in the single-chamber group ( P < @ ) .


Among US participants , the mean cost of dual - vs. single-chamber ICD implantation was $ @ @ vs. $ @ @ , respectively ( P < @ ) ; there was no difference in the quality of life ( EQ-@D index difference @ , P = @ ; EQ VAS difference @ , P = @ ) .


When optimal programming is utilized , inappropriate shocks are rare in primary prevention patients with both single - and dual-chamber ICDs .


The routine use of dual-chamber ICDs increases the expense without reducing inappropriate shocks or improving the quality of life at @ year .


The zinc content of maize , a major global food staple , is generally insufficient alone to meet the requirements of young children .


The primary objective of this study was to determine whether substitution of biofortified maize ( @ g zinc/g grain ) for control maize ( @ g zinc/g ) was adequate to meet zinc physiologic requirements in young children for whom maize was the major food staple .


A secondary objective was to compare total daily zinc absorption when maize flour was fortified with zinc oxide to a total concentration of @ g zinc/g .


Participants included @ rural Zambian children with a mean age of @ mo who were randomly assigned to receive @ of @ maize types ( control , biofortified , or fortified ) all of which were readily consumed ( > @ g on @ d ) .


Total daily zinc intake ( from maize and low-zinc relish ) was determined from duplicate diet collections .


Multiplication by fractional absorption of zinc , measured by a dual isotope ratio technique , determined the total daily zinc absorption on the day the test meals were given .


The mean SD total daily zinc intake ( milligrams per day ) from the biofortified maize ( @ @ ) was higher ( P < @ ) than for the control maize ( @ @ ) .


Intake of zinc from the fortified maize ( @ @ ) did not differ from the biofortified maize .


Fractional absorption of zinc from control maize ( @ @ ) did not differ from the biofortified maize ( @ @ ) .


Total daily absorption of zinc ( milligrams per day ) from the biofortified maize ( @ @ ) was higher ( P = @ ) than for the control maize ( @ @ ) , but did not differ from the fortified maize ( @ @ ) .


These results indicate that feeding biofortified maize can meet zinc requirements and provide an effective dietary alternative to regular maize for this vulnerable population .


This trial was registered at clinicaltrials.gov as NCT@ .


Duck viral hepatitis ( DVH ) is an acute disease of young ducklings with few convenient and effective veterinary drugs to treat .


In pathology , present study mainly focused on the immune mechanism , but very few studies have concerned with the role of oxidative stress in the pathogenesis of DVH .


To study the antioxidative and hepatoprotective effects of icariin and its phosphorylated derivative against DVH , we prepared phosphorylated icariin ( p-icariin ) using the sodium trimetaphosphate-sodium tripolyphosphate method .


Ducklings were drunk with icariin and p-icariin after being challenged with duck hepatitis virus @ ( DHV-@ ) .


We recorded the number of dead ducklings , gross pathological changes in the liver , and changes in indices of oxidative stress and liver injury .


The correlations between these indices were also analyzed .


Exposure to DHV-@ induced significant oxidative damage in ducklings .


Administration of icariin or p-icariin attenuated liver pathological injury and significantly increased the survival rate , with better outcomes in ducklings treated with p-icariin than in those treated with icariin .


Icariin and p-icariin also attenuated the changes in oxidative stress and liver injury .


We found positive correlations among indices of oxidative stress ( malondialdehyde and inducible nitric oxide synthase ) and liver injury ( alanine aminotransferase , alkaline phosphatase , and lactate dehydrogenase ) , suggesting that DHV-@ causes significant oxidative damage , which is related to the extent of hepatic injury .


Icariin and p-icariin improved the survival and attenuated oxidative stress and liver dysfunction induced by DHV-@ .


These outcomes were better in ducklings treated with p-icariin than in those treated by icariin .


The clinical effects of both components were related to their antioxidant activities .


The evidence for choices between antipsychotics for children and adolescents with schizophrenia and other psychotic disorders is limited .


The main objective of the Tolerability and Efficacy of Antipsychotics ( TEA ) trial is to compare the benefits and harms of quetiapine versus aripiprazole in children and adolescents with psychosis in order to inform rational , effective and safe treatment selections .


The TEA trial is a Danish investigator-initiated , independently funded , multi-centre , randomised , blinded clinical trial .


Based on sample size estimation , @ patients aged @-@ years with psychosis , antipsychotic-nave or treated for a limited period are , @:@ randomised to a @ - week , double-blind intervention with quetiapine versus aripiprazole .


Effects on psychopathology , cognition , health-related quality of life , and adverse events are assessed @ , @ , and @ weeks after randomisation .


The primary outcome is change in the positive symptom score of the Positive and Negative Syndrome Scale .


The recruitment period is @-@ .


Antipsychotics are currently the only available pharmacologic treatments for psychotic disorders .


However , information about head-to-head differences in efficacy and tolerability of antipsychotics are scarce in children and adolescents .


The TEA trial aims at expanding the evidence base for the use of antipsychotics in early onset psychosis in order to inform more rational treatment decisions in this vulnerable population .


Here , we account for the trial design , address methodological challenges , and discuss the estimation of sample size .


To compare DBT and FFDM in the classification of microcalcification clusters ( MCs ) using BI-RADS .


This Institutional Review Board-approved study was undertaken in three centres .


A total of @ MCs evaluated with both DBT and FFDM were randomised for prospective reading by six experienced breast radiologists and classified using BI-RADS .


The benign/malignant ratio of MC was @/@ .


Of @/@ discordant results , DBT classified MCs as R@ whereas FFDM classified them as R@ in @ and R@ in @ .


Three of these ( @/@ = @ % ) were malignant ; @ ( @ % ) were nonmalignant and were correctly classified as R@ on DBT but incorrectly classified as R@ on FFDM .


Estimated sensitivity and specificity , respectively , were @ % ( @ % CI : @ % to @ % ) and @ % ( @ % CI : @ % to @ % ) for FFDM and @ % ( @ % CI : @ % to @ % ) and @ % ( @ % CI : @ % to @ % ) for DBT .


Overall intra - and interobserver agreements were @ ( @ % CI : @-@ @ ) and @ ( @ % CI : @-@ @ ) .


Most MCs are scored similarly on FFDM and DBT .


Although a minority ( @/@ ) of MCs are classified differently on FFDM ( benign MC classified as R@ ) and DBT ( malignant MC classified as R@ ) , this may have clinical relevance .


The BI-RADS classification of MC differs for FFDM and DBT in @/@ cases DBT assigned lower BI-RADS classes compared to FFDM in @ clusters In @/@ DBT may have missed some malignant and high-risk lesions In @/@ the ` underclassification ' on DBT was correct , potentially avoiding unnecessary biopsies DBT may miss a small proportion of malignant lesions .


To compare the use of low pneumoperitoneum pressure ( LPP ; @mm Hg ) vs standard pneumoperitoneum pressure ( SPP ; @mm Hg ) during mini-laparoscopic hysterectomy ( MLH ) .


Randomized controlled trial ( Canadian Task Force classification I ) .


Tertiary care center .


Forty-two consecutive women scheduled to undergo MLH to treat benign uterine disease .


Women were randomly selected to undergo MLH using LPP ( n = @ ) or SPP ( n = @ ) .


MLH was performed via @-mm ancillary ports .


The primary outcome was to evaluate changes in abdominal and shoulder-tip pain via a @-mm visual analog scale at @ , @ , and @hours postoperatively .


All procedures were completed via mini-laparoscopy without the need to increase intra-abdominal pressure or convert to conventional laparoscopy or open surgery .


Intraoperatively , @ episode of severe bradycardia occurred in the LPP group , whereas no intraoperative complications were recorded in the SPP group ( p = @ ) .


No postoperative complications were recorded ( p > @ ) .


Abdominal pain was similar between groups at each time point .


Incidence and intensity of shoulder-tip pain at @ and @hours postoperatively was lower in the LPP group than in the SPP group ( p < @ ) , whereas no between-group differences were observed at @hours ( p > @ ) .


Rescue analgesic requirement did not differ statistically between the LPP and SPP groups ( @ % vs @ % , respectively ; p = @ ; odds ratio , @ ; @ % confidence interval , @-@ @ ) .


In experienced hands , use of LPP is safe and feasible .


During performance of MLH , compared with SPP , LPP is asimple method that offers advantages of less shoulder-tip pain .


To verify the clinical efficacy of shu-stream point acupuncture combined with fire needle therapy in the treatment of hand osteoarthritis .


Eighty cases were randomized into an acupuncture group ( shu-stream point acupuncture combined with fire needle therapy ) and a medication group ( votalin emulgel ) .


For the @ cases in the acupuncture group , acupuncture at shu-stream points on the three yang meridians of the hand including Sanjian ( LI @ ) , Zhongzhu ( TE @ ) , Houxi ( SI @ ) and fire needle at Ashi points were applied , the treatments were given once every other day , @ times as a treatment course .


For the @ cases in the medication group , votalin emulgel was prescribed for local embrocation , twice a day , @ days as a treatment course .


The visual analogue scale ( VAS ) of arthralgia , joint function score and the duration of morning stiffness , joint tenderness , swelling were observed before and after treatment in both groups .


After two courses of clinical treatment , the VAS score of arthralgia , joint function score and the duration of morning stiffness , joint tenderness , swelling were statistically significant differences as compared with before treatment ( all P < @ ) , the efficacy in the acupuncture group was superior to that in the medication group ( all P < @ ) .


The cured-markedly effective rate and total effective rate were @ % ( @/@ ) and @ % ( @/@ ) in the acupuncture group , and @ % ( @/@ ) and @ % ( @/@ ) in the medication group respectively , with statistically significant differences between the two groups ( both P < @ ) .


Shu-stream point acupuncture combined with fire needle therapy achieves a significant efficacy in the treatment of hand osteoarthritis .


The comparative outcome with GreenLight ( GL ) photoselective vaporisation of the prostate and transurethral resection of the prostate ( TURP ) in men with lower urinary tract symptoms due to benign prostatic obstruction ( BPO ) has been questioned .


The primary objective of the GOLIATH study was to evaluate the noninferiority of @-W GL XPS ( XPS ) to TURP for International Prostate Symptom Score ( IPSS ) and maximum flow rate ( Qmax ) at @ mo and the proportion of patients who were complication free .


Prospective randomised controlled trial at @ centres in @ European countries involving @ patients with BPO .


@-W GL XPS system or TURP .


Measurements used were IPSS , Qmax , prostate volume ( PV ) , postvoid residual ( PVR ) and complications , perioperative parameters , and reintervention rates .


Noninferiority was evaluated using one-sided tests at the @ % level of significance .


The statistical significance of other comparisons was assessed at the ( two-sided ) @ % level .


The study demonstrated the noninferiority of XPS to TURP for IPSS , Qmax , and complication-free proportion .


PV and PVR were comparable between groups .


Time until stable health status , length of catheterisation , and length of hospital stay were superior with XPS ( p < @ ) .


Early reintervention rate within @ d was three times higher after TURP ( p = @ ) ; however , the overall postoperative reintervention rates were not significantly different between treatment arms .


A limitation was the short follow-up .


XPS was shown to be noninferior ( comparable ) to TURP in terms of IPSS , Qmax , and proportion of patients free of complications .


XPS results in a lower rate of early reinterventions but has a similar rate after @ mo. .


Traditional cardiovascular risk factors lead to endothelial injury and activation of leukocytes and platelets that initiate and propagate atherosclerosis .


We proposed that clopidogrel therapy in patients with stable coronary artery disease imparts a pleiotropic effect that extends beyond antiplatelet aggregation to other atheroprotective processes .


Forty-one subjects were randomized in a double-blind , placebo-controlled , crossover study to receive either clopidogrel @ mg daily or placebo for @ weeks and then transitioned immediately to the other treatment for an additional @ weeks .


We assessed ( @ ) endothelial function as flow-mediated dilation of the brachial artery , ( @ ) arterial stiffness and central augmentation index using applanation tonometry , ( @ ) vascular function as fingertip reactive hyperemia index , ( @ ) inflammation by measuring plasma CD@ ligand and serum high-sensitivity c-reactive protein levels , ( @ ) oxidative stress by measuring plasma aminothiols , and ( @ ) circulating progenitor cells , at baseline and at the end of each @-week treatment period .


Clopidogrel therapy resulted in a significant reduction in soluble CD@ ligand ( P = @ ) , a prothrombotic and proinflammatory molecule derived mainly from activated platelets .


However , clopidogrel therapy had no effect on endothelial function , arterial stiffness , inflammatory and oxidative stress markers , or progenitor cells .


Our findings suggest a solitary antiplatelet effect of clopidogrel therapy in patients with stable coronary artery disease , with no effect on other subclinical markers of cardiovascular disease risk .


Clade B DNA and recombinant modified vaccinia Ankara ( MVA ) vaccines producing virus-like particles displaying trimeric membrane-bound envelope glycoprotein ( Env ) were tested in a phase @a trial in human immunodeficiency virus ( HIV ) - uninfected adults for safety , immunogenicity , and @-month durability of immune responses .


A total of @ individuals received @ doses of JS@ DNA vaccine and @ doses of MVA/HIV@B at @ , @ , @ , and @ months , respectively ( the DDMM regimen ) ; @ doses of MVA/HIV@B at @ , @ , and @ months ( the MMM regimen ) ; or placebo injections .


At peak response , @ % of the DDMM group and @ % of the MMM group had binding antibodies for Env .


These binding antibodies were more frequent and of higher magnitude for the transmembrane subunit ( gp@ ) than the receptor-binding subunit ( gp@ ) of Env .


For both regimens , response rates were higher for CD@ ( + ) T cells ( @ % in the DDMM group and @ % in the MMM group ) than for CD@ ( + ) T cells ( @ % in the DDMM group and @ % in the MMM group ) .


Responding CD@ ( + ) and CD@ ( + ) T cells were biased toward Gag , and > @ % produced @ or @ of the @ cytokines evaluated ( ie , interferon , interleukin @ , tumor necrosis factor , and granzyme B ) .


Six months after vaccination , the magnitudes of antibodies and T-cell responses had decreased by < @-fold .


DDMM and MMM vaccinations with virus-like particle-expressing immunogens elicited durable antibody and T-cell responses .


AR-@ is a small-molecule inhibitor of Rho kinase and a norepinephrine transporter .


The objective of this @-day study was to evaluate the ocular hypotensive efficacy and safety of AR-@ ophthalmic solution compared with a positive control , latanoprost ophthalmic solution , in patients with open-angle glaucoma ( OAG ) or ocular hypertension ( OHT ) .


Double-masked , randomized study in @ private practice ophthalmology clinics .


Participants were required to be adults with a diagnosis of OAG or OHT with unmedicated intraocular pressure ( IOP ) in the range of @ to @ mmHg .


Patients were randomized to receive AR-@ ophthalmic solution @ % , daily ( pm ) , AR-@ ophthalmic solution @ % daily ( pm ) , or latanoprost @ % daily ( pm ) for @ days .


The primary efficacy endpoint was the mean diurnal IOP across subjects within the treatment group at day @ .


Randomized and treated were @ patients , @ ( @ % ) of whom completed the study .


On day @ , mean diurnal IOP was @ , @ , and @ mmHg in the AR-@ @ % , @ % , and latanoprost groups , respectively , representing a decrease from unmedicated baseline of @ , @ , and @ mmHg ( P < @ ) .


The @-mmHg reduction in IOP by AR-@ @ % did not meet the criterion for noninferiority to latanoprost .


The most frequently reported adverse event was conjunctival/ocular hyperemia , with a combined incidence of @ % , @ % , and @ % , respectively .


On day @ at @:@ hours , the incidence of mild to moderate hyperemia by biomicroscopy was @ % , @ % , and @ % , respectively .


AR-@ @ % was less effective than latanoprost by approximately @ mmHg in patients with unmedicated IOPs of @ to @ mmHg .


The major safety finding was ocular hyperemia , which was more common for both concentrations of AR-@ than for latanoprost .


Gamisoyo-San ( GSS ) is a well-known Traditional Korean Medicine shown to be effective on mood disorders .


The purpose of this research is to examine the effect of Gamisoyo-San on generalized anxiety disorder by its differently manufactured preparations .


Multicenter , randomized , double-blinded , placebo-controlled study was set for @ patients with generalized anxiety disorder recruited from November @st @ to December @th @ .


They were given Gamisoyo-San individual extract mixture ( extraction done for each crude materia medica separately ) or Gamisoyo-San multi-compound extract ( extraction done for whole materia medica at once ) or controlled medication .


Hamilton Rating Scale for Anxiety ( HAM-A ) , Korean State-Trait Anxiety Inventory ( K-STAI ) , Penn State Worry Questionnaire ( PSWQ ) , Korean Beck Depression Inventroy ( K-BDI ) , Symptom Checklist-@-Revised ( SCL-@-R ) , and Korean WHO Quality of Life Scale Abbreviated Version ( WHOQOL-BREF ) were evaluated .


We also applied Pattern Identification tool for ` JingJi and ZhengChong ( , Traditional Korean Medicine term which correlates with generalized anxiety disorder ) ' to patients to evaluate different responses among @ patterns .


HAM-A scores of Gamisoyo-San multi-compound extract group showed greater decrease compared to Gamisoyo-San individual extract mixture group and placebo group , but the difference was insignificant .


WHOQOL-BREF scores of Gamisoyo-San multi-compound extract group showed significant increase compared to Gamisoyo-San individual extract mixture group and placebo group .


In Heart blood deficiency pattern , the Gamisoyo-San multi-compound extract group showed significant decrease in K-BDI compared to the Gamisoyo-San individual extract mixture group .


Gamisoyo-San did not improve anxiety level of GAD patients .


However , it can be useful to improve quality of life , and reduce depressive , obsessive-compulsive , somatic symptoms of generalized anxiety disorder .


Gamisoyo-San multi-compound seemed more effective than Gamisoyo-San individual extract mixture , especially in Heart blood deficiency pattern .


The purpose of this pilot clinical trial was to assess the feasibility of recruiting older adults with lumbar spinal stenosis ( LSS ) into a clinical trial that used different dosages of flexion-distraction manipulation .


This randomized controlled trial used a @-group design .


Three groups consisted of chiropractic flexion-distraction manipulation applied at different dosages ( @ , @ , or @ treatments ) .


The fourth group was given @ treatments of placebo care .


Feasibility measures included recruitment goals , adherence to various treatment schedules , credibility of the placebo treatment , and rates of adverse events .


The primary outcome measure was the Swiss Spinal Stenosis Questionnaire , a validated self-report of LSS symptom severity and physical function .


The recruitment and adherence goals of the study were met with a total of @ subjects randomized ( n = @ per group ) and most subjects attending at least @ % of their scheduled visits .


No adverse events were reported by any of the subjects in the trial .


Our placebo treatment did not appear to be credible ; most subjects correctly guessed that they were receiving a placebo treatment .


Between-group effect size estimates were small , indicating larger samples are needed for future studies .


This pilot study showed that it is feasible to recruit patients with LSS and that most subjects will adhere to a @-week treatment schedule .


The information gained from this trial will be useful to inform the design of larger trials .


It is often assumed that animations ( i.e. , videos ) will lead to higher learning compared to static media ( i.e. , pictures ) because they provide a more realistic demonstration of the learning task .


To investigate whether learning basic life support ( BLS ) and cardiopulmonary resuscitation ( CPR ) from video produce higher learning outcomes compared to pictures in reciprocal learning .


A randomized controlled trial .


A total of @ students ( mean age : @ years ) constituting eight intact classes from a secondary school learned BLS in reciprocal roles of doer and helper with tablet PCs .


Student pairs in each class were randomized over a Picture and a Video group .


In the Picture group , students learned BLS by means of pictures combined with written instructions .


In the Video group , BLS was learned through videos with on-screen instructions .


Informational equivalence was assured since instructions in both groups comprised exactly the same words .


BLS assessment occurred unannounced , three weeks following intervention .


Analysis of variance demonstrated no significant differences in chest compression depths between the Picture group ( M = @ mm , @ % CI = @-@ ) and the Video group ( M = @ mm , @ % CI = @-@ ) .


In the Picture group significantly higher percentages of chest compressions with correct hand placement were achieved ( M = @ % , CI = @-@ ) compared to the Video group ( M = @ % , CI = @-@ ) , P = @ , ( p ) ( @ ) = @ .


No other significant differences were found .


Results do not support the assumption that videos are superior to pictures for learning BLS and CPR in reciprocal learning .


Target volumes and organs-at-risk ( OARs ) for radiotherapy ( RT ) planning are manually defined , which is a tedious and inaccurate process .


We sought to assess the feasibility , time reduction , and acceptability of an atlas-based autosegmentation ( AS ) compared to manual segmentation ( MS ) of OARs .


A commercial platform generated @ OARs .


Resident physicians were randomly assigned to modify AS OAR ( AS+R ) or to draw MS OAR followed by attending physician correction .


Dice similarity coefficient ( DSC ) was used to measure overlap between groups compared with attending approved OARs ( DSC = @ means perfect overlap ) .


@ cases were segmented .


Mean SD segmentation time in the AS+R group was @ @ min , compared to @ @ min in the MS cohort , amounting to a @ % time reduction ( Wilcoxon p < @ ) .


For each OAR , AS DSC was statistically different from both AS+R and MS ROIs ( all Steel-Dwass p < @ ) except the spinal cord and the mandible , suggesting oversight of AS/MS processes is required ; AS+R and MS DSCs were non-different .


AS compared to attending approved OAR DSCs varied considerably , with a chiasm mean SD DSC of @ @ and brainstem of @ @ .


Autosegmentation provides a time savings in head and neck regions of interest generation .


However , attending physician approval remains vital .


Weight discrimination is associated with increased risk of obesity .


The mechanism of this relationship is unknown , but being overweight is a highly stigmatized condition and may be a source of chronic stress that contributes to the development and pathophysiology of obesity .


The objective of this study was to test whether weight stigma is associated with physiological risk factors linked to stress and obesity , including hypercortisolism and oxidative stress , independent of adiposity .


We examined the frequency of experiencing situations involving weight stigma and consciousness of weight stigma in relation to hypothalamic -- pituitary -- adrenal axis activity and oxidative stress ( F-isoprostanes ) in @ healthy overweight to obese women .


Independent of abdominal fat , weight stigma was significantly related to measures of cortisol ( including salivary measures of cortisol awakening response and serum morning levels ) as well as higher levels of oxidative stress .


Perceived stress mediated the relationship between weight stigma consciousness and the cortisol awakening response .


These preliminary findings show that weight stigma is associated with greater biochemical stress , independent of level of adiposity .


It is possible that weight stigma may contribute to poor health underlying some forms of obesity .


To determine the impact of adjunctive Buchang Naoxintong Capsule ( , NXT ) on dual antiplatelet therapy in patients with cytochrome P@ @C@ * @ ( CYP@C@ * @ ) polymorphism undergoing percutaneous coronary intervention ( PCI ) .


Ninety patients with CYP@C@ * @ polymorphism were enrolled , and their genotypes were confirmed by polymerase chain reaction ( PCR ) .


The patients were randomly assigned to receive either adjunctive NXT ( triple group , @ cases ) or dual antiplatelet therapy ( dual group , @ cases ) using a computer-generated randomization sequence and sealed envelopes .


Platelet function was assessed at baseline and @ days after treatment with conventional aggregometry .


Subsequent major adverse cardiovascular events ( MACE , including sudden cardiac arrest and acute coronary syndrome ) were recorded during a @-month follow-up .


Baseline platelet function measurements were similar in both groups .


After @ days , percent inhibitions of maximum platelet aggregation and late platelet aggregation were significantly greater in the triple versus dual group ( @ % @ % vs. @ % @ % , P < @ , and @ % @ % vs. @ % @ % , P < @ , respectively ) .


During the @-month follow-up , the rate of subsequent MACE ( @/@ ) was significantly lower in the triple group compared with the dual group ( @/@ ; P < @ ) .


Adjunctive NXT to maintenance dose clopidogrel ( @ g ) could enhance the antiplatelet effect and decrease subsequent MACE in patients with the CYP@C@ * @ polymorphism undergoing PCI .


To investigate the safety , efficacy , and pharmacokinetic profile of dexmedetomidine in preterm and full-term neonates @ to @ weeks gestational age .


Forty-two intubated , mechanically ventilated patients ( n = @ ) were grouped by gestational age into group I ( n = @ ) , @ to < @ weeks , and group II ( n = @ ) , @ to @ weeks .


Within each age group , there were @ escalating dose levels , including a loading dose ( LD , g/kg ) followed by a maintenance dose ( MD , g kg ( -@ ) h ( -@ ) ) for @-@ hours : level @ , @ LD/MD ; level @ , @ LD/MD ; and level @ , @ LD/MD .


The primary endpoint was the number of patients requiring sedation as determined by the Neonatal Pain , Agitation , Sedation Scale .


During dexmedetomidine infusion , @ % of Neonatal Pain , Agitation , Sedation Scale scores were > @ , indicating agitation/pain , with @ patients ( @ % ) requiring more sedation and @ ( @ % ) requiring more analgesia .


Though there was significant variability in pharmacokinetic variables , group I appeared to have lower weight-adjusted plasma clearance ( @ vs @ L h ( -@ ) kg ( -@ ) ) and increased elimination half-life ( @ vs @ hours ) compared with group II .


Fifty-six adverse events ( AEs ) were reported in @ patients ( @ % ) ; only @ AEs ( @ % ) were related to dexmedetomidine .


There were no serious AEs and no AEs or hemodynamic changes requiring dexmedetomidine discontinuation .


Dexmedetomidine is effective for sedating preterm and full-term neonates and is well-tolerated without significant AEs .


Preterm neonates had decreased plasma clearance and longer elimination half-life .


Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection ( STI ) / human immunodeficiency virus ( HIV ) risk behaviors ; however , few have demonstrated long-term efficacy .


To evaluate the efficacy of a telephone counseling prevention maintenance intervention ( PMI ) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a @-month follow-up .


In a @-arm randomized supplemental treatment trial at @ clinics serving predominantly minority adolescents in Atlanta , Georgia , @ African American adolescent girls aged @ to @ years received a primary treatment and subsequently received a different ( supplemental ) treatment ( PMI ) to enhance effects of the primary treatment .


Participants in the experimental condition ( n = @ ) received an adapted evidence-based STI/HIV intervention ( HORIZONS ) and a PMI consisting of brief telephone contacts every @ weeks over @ months to reinforce and complement prevention messages .


Comparison-condition participants ( n = @ ) received HORIZONS and a time - and dose-consistent PMI focused on general health .


The primary outcomes were percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the @-month follow-up .


Behavioral outcomes included the following : ( @ ) proportion of condom-protected sexual acts in the @ months and @ days prior to assessments ; ( @ ) number of sexual episodes during the past @ days in which participants engaged in sexual intercourse while high on drugs and/or alcohol ; and ( @ ) number of vaginal sex partners in the @ months prior to assessments .


During the @-month follow-up , fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections ( @ vs @ participants , respectively ; risk ratio = @ ; @ % CI , @ to @ ; P = @ ) and gonococcal infections ( @ vs @ participants , respectively ; risk ratio = @ ; @ % CI , @ to @ ; P = @ ) .


Participants completing more telephone contacts had a lower risk of chlamydial infection ( risk ratio = @ ; @ % CI , @ to @ ; P = @ ) .


Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the @ days ( mean difference = @ ; @ % CI , @ to @ ; P = @ ) and @ months ( mean difference = @ ; @ % CI , @ to @ ; P = @ ) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol ( mean difference = -@ ; @ % CI , -@ to -@ ; P < @ ) .


Sustaining the long-term impact of an STI/HIV intervention is achievable with brief , tailored telephone counseling .


The first description of the simplified acute physiology score ( SAPS ) II dates back to @ , but little is known about its accuracy in daily practice .


Our purpose was to evaluate the accuracy of scoring and the factors that affect it in a nationwide survey .


Twenty clinical scenarios , covering a broad range of illness severities , were randomly assigned to a convenience sample of physicians or nurses in Swiss adult intensive care units ( ICUs ) , who were asked to assess the SAPS II score for a single scenario .


These data were compared to a reference that was defined by five experienced researchers .


The results were cross-matched with demographic characteristics and data on the training and quality control for the scoring , structural and organisational properties of each participating ICU .


A total of @ caregivers from @ adult ICU providers completed the SAPS II evaluation of one clinical scenario .


The mean SAPS II scoring was @ @ , with a bias of +@ ( @ % CI @-@ @ ) compared to the reference score .


There was no evidence of bias variation according to the case severity , ICU size , linguistic area , profession ( physician vs. nurse ) , experience , initial SAPS II training , or presence of a quality control system .


This nationwide survey revealed substantial variability in the SAPS II scoring results .


On average , SAPS II scoring was overestimated by more than @ % , irrespective of the profession or experience of the scorer or of the structural characteristics of the ICUs .


Stereoscopic vision is a critical part of the human visual system , conveying more information than two-dimensional , monoscopic observation alone .


This study aimed to quantify the contribution of stereoscopy in assessment of radiographic data , using widely available three-dimensional ( @D ) - capable display monitors by assessing whether stereoscopic viewing improved the characterisation of cerebral aneurysms .


Nine radiology registrars were shown @ different volume-rendered ( VR ) models of cerebral computed tomography angiograms ( CTAs ) , each in both monoscopic and stereoscopic format and then asked to record aneurysm characteristics on short multiple-choice answer sheets .


The monitor used was a current model commercially available @D television .


Responses were marked against a gold standard of assessments made by a consultant radiologist , using the original CT planar images on a diagnostic radiology computer workstation .


The participants ' results were fairly homogenous , with most showing no difference in diagnosis using stereoscopic VR models .


One participant performed better on the monoscopic VR models .


On average , monoscopic VRs achieved a slightly better diagnosis by @ % .


Stereoscopy has a long history , but it has only recently become technically feasible for stored cross-sectional data to be adequately reformatted and displayed in this format .


Scant literature exists to quantify the technology 's possible contribution to medical imaging - this study attempts to build on this limited knowledge base and promote discussion within the field .


Stereoscopic viewing of images should be further investigated and may well eventually find a permanent place in procedural and diagnostic medical imaging .


Vaccines against pandemic A/H@N@ influenza should provide protective immunity in children , because they are at greater risk of disease than adults .


This study was conducted to identify the optimal dose of an MF@-adjuvanted , egg-derived , A/H@N@ influenza vaccine for young children .


Children @-@ months ( N = @ ) and @-@ months ( N = @ ) of age received vaccine formulations containing either @ g antigen with half the standard dose of MF@ or @ g antigen with a standard dose of MF@ , or a nonadjuvanted formulation containing @ g antigen ( children @-@ months only ) .


Participants were given @ primary vaccine doses @ weeks apart , followed by @ booster dose of MF@-adjuvanted seasonal influenza vaccine @ year later .


Immunogenicity was assessed by hemagglutination inhibition and microneutralization assays .


All vaccine formulations were highly immunogenic and met all @ European licensure criteria after @ doses .


MF@-adjuvanted vaccines met all licensure criteria after @ dose in both age cohorts , while nonadjuvanted vaccine did not meet all criteria after @ dose in children @-@ months .


A single booster dose was highly immunogenic , and stable antibody persistence was observed in response to all vaccines .


All vaccines were well tolerated .


In this study , a single dose of @ g antigen with half the standard dose of MF@ was shown to be optimal , providing adequate levels of immediate and long-term antibodies in pediatric subjects @-@ months of age .


These data demonstrated that MF@ adjuvant allowed for reduced antigen content and promoted significant long-term antibody persistence in children , with a satisfactory safety profile .


First , to evaluate the clinical effectiveness of a virtual reality ( VR ) - based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program ; second , to compare the subjective experiences ; and third , to contrast the costs of both programs .


Single-blind , randomized , controlled trial .


Neurorehabilitation unit .


Chronic outpatients with stroke ( N = @ ) with residual hemiparesis .


Twenty @-minute training sessions with the telerehabilitation system , conducted @ times a week , in the clinic or in the home .


First , Berg Balance Scale for balance assessment .


The Performance-Oriented Mobility Assessment balance and gait subscales , and the Brunel Balance Assessment were secondary outcome measures .


Clinical assessments were conducted at baseline , @ weeks ( posttreatment ) , and @ weeks ( follow-up ) .


Second , the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences .


Third , cost ( in dollars ) .


Significant improvement in both groups ( in-clinic group -LSB- control -RSB- and a home-based telerehabilitation group ) from the initial to the final assessment in the Berg Balance Scale ( p ( @ ) = @ ; P = @ ) , in the balance ( p ( @ ) = @ ; P = @ ) and gait ( p ( @ ) = @ , P = @ ) subscales of the Tinetti Performance-Oriented Mobility Assessment , and in the Brunel Balance Assessment ( control : ( @ ) = @ ; P = @ ; experimental : ( @ ) = @ ; P = @ ) .


No significant differences were found between the groups in any balance scale or in the feedback questionnaires .


With regard to subjective experiences , both groups considered the VR system similarly usable and motivating .


The in-clinic intervention resulted in more expenses than did the telerehabilitation intervention ( $ @ per person ) .


First , VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions , both complemented with a conventional therapy program ; second , the usability of and motivation to use the @ interventions can be similar ; and third , telerehabilitation interventions can involve savings that vary depending on each scenario .


Transfusion thresholds for acute upper gastrointestinal bleeding are controversial .


So far , only three small , underpowered studies and one single-centre trial have been done .


Findings from the single-centre trial showed reduced mortality with restrictive red blood cell ( RBC ) transfusion .


We aimed to assess whether a multicentre , cluster randomised trial is a feasible method to substantiate or refute this finding .


In this pragmatic , open-label , cluster randomised feasibility trial , done in six university hospitals in the UK , we enrolled all patients aged @ years or older with new presentations of acute upper gastrointestinal bleeding , irrespective of comorbidity , except for exsanguinating haemorrhage .


We randomly assigned hospitals ( @:@ ) with a computer-generated randomisation sequence ( random permuted block size of @ , without stratification or matching ) to either a restrictive ( transfusion when haemoglobin concentration fell below @ g/L ) or liberal ( transfusion when haemoglobin concentration fell below @ g/L ) RBC transfusion policy .


Neither patients nor investigators were masked to treatment allocation .


Feasibility outcomes were recruitment rate , protocol adherence , haemoglobin concentration , RBC exposure , selection bias , and information to guide design and economic evaluation of the phase @ trial .


Main exploratory clinical outcomes were further bleeding and mortality at day @ .


We did analyses on all enrolled patients for whom an outcome was available .


This trial is registered , ISRCTN@ and NCT@ .


Between Sept @ , @ , and March @ , @ , we enrolled @ patients across six hospitals ( @ patients in three hospitals with a restrictive policy and @ patients in three hospitals with a liberal policy ) .


Recruitment rate was significantly higher for the liberal than for the restrictive policy ( @ % vs @ % ; p = @ ) .


Despite some baseline imbalances , Rockall and Blatchford risk scores were identical between policies .


Protocol adherence was @ % ( SD @ ) in the restrictive policy vs @ % ( @ ) in the liberal policy ( difference @ % ; @ % CI @-@ ; p = @ ) .


Mean last recorded haemoglobin concentration was @ ( SD @ ) g/L for patients on the restrictive policy and @ ( @ ) g/L for those on the liberal policy ( difference -@ -LSB- @ % CI -@ to @ -RSB- ; p = @ ) .


Fewer patients received RBCs on the restrictive policy than on the liberal policy ( restrictive policy @ -LSB- @ % -RSB- vs liberal policy @ -LSB- @ % -RSB- ; difference -@ % -LSB- @ % CI -@ to @ -RSB- ; p = @ ) , with fewer RBC units transfused ( mean @ -LSB- SD @ -RSB- vs @ -LSB- @ -RSB- ; difference -@ -LSB- -@ to @ -RSB- ; p = @ ) , although these differences were not significant .


We noted no significant difference in clinical outcomes .


A cluster randomised design led to rapid recruitment , high protocol adherence , separation in degree of anaemia between groups , and non-significant reduction in RBC transfusion in the restrictive policy .


A large cluster randomised trial to assess the effectiveness of transfusion strategies for acute upper gastrointestinal bleeding is both feasible and essential before clinical practice guidelines change to recommend restrictive transfusion for all patients with acute upper gastrointestinal bleeding .


Workplace stress and burnout are pervasive problems , affecting employee performance and personal health .


To evaluate the effects of the Transcendental Meditation program on psychological distress and burnout among staff at a residential therapeutic school for students with severe behavioral problems .


A total of @ secondary schoolteachers and support staff at the Bennington School in Vermont , a therapeutic school for children with behavioral problems , were randomly assigned to either practice of the Transcendental Meditation program or a wait-list control group .


The Transcendental Meditation course was provided by certified instructors .


Outcome measures were assessed at baseline and four months , and included perceived stress , depression , and burnout .


A multivariate analysis of covariance was used to determine overall effects .


Analysis of the @-month intervention data indicated a significant improvement in the main outcomes of the study resulting from practice of the Transcendental Meditation program compared with controls ( Wilks -LSB- @,@ -RSB- = @ ; p = @ ) .


Results of univariate F tests indicated a significant reduction of all main outcome measures : perceived stress ( F -LSB- @,@ -RSB- = @ ; p = < @ ) ; depression ( F -LSB- @,@ -RSB- = @ ; p = @ ) ; and overall teacher burnout ( F -LSB- @,@ -RSB- = @ ; p = @ ) .


Effect sizes ranged from @ to @ .


The Transcendental Meditation program was effective in reducing psychological distress in teachers and support staff working in a therapeutic school for students with behavioral problems .


These findings have important implications for employees job performance as well as their mental and physical health .


To perform a prospective , blinded , randomized interventional trial in patients with recurrent abdominal pain .


The primary endpoint was to determine the abdominal pain intensity after @ weeks of fructose restricted diet .


Secondary endpoints were changes of pain frequency and a secondary symptom score ( SSS ) .


@ individuals with recurrent abdominal pain for more than @ months were randomized .


@ patients were allocated to group A ( diet ) and @ to group B ( no diet ) .


@ weeks later the patients underwent hydrogen breath test and were assigned to the test positive or negative group to identify patients with fructose malabsorption .


@ weeks after intervention the pain score decreased significantly from a median @ in group A to @ and did not change significantly in group B ( @ to @ ) .


In group A both patients with positive and negative breath tests had a significant lower pain score ( -@ and -@ , respectively ) .


Frequency of abdominal pain decreased in both groups but without significant difference , SSS improved only in group A from median @ to @ .


Positive breath test was no predicting factor , neither was abdominal pain during the test .


Fructose restricted diet in children and adolescents with recurrent abdominal pain may be of benefit to improve both abdominal pain symptoms and other secondary symptoms .


Since a negative breath test result does not exclude a positive response to fructose restriction , the hydrogen breath test does not seem to be the appropriate diagnostic mean to predict the response to the diet .


The objective of the current study was to examine predictors and moderators of response to two HIV sexual risk interventions of different content and duration for individuals in substance abuse treatment programs .


Participants were recruited from community drug treatment programs participating in the National Institute on Drug Abuse Clinical Trials Network ( CTN ) .


Data were pooled from two parallel randomized controlled CTN studies ( one with men and one with women ) each examining the impact of a multi-session motivational and skills training program , in comparison to a single-session HIV education intervention , on the degree of reduction in unprotected sex from baseline to @ - and @ - month follow-ups .


The findings were analyzed using a zero-inflated negative binomial ( ZINB ) model .


Severity of drug use ( p < @ ) , gender ( p < @ ) , and age ( p < @ ) were significant main effect predictors of number of unprotected sexual occasions ( USOs ) at follow-up in the non-zero portion of the ZINB model ( men , younger participants , and those with greater severity of drug/alcohol abuse have more USOs ) .


Monogamous relationship status ( p < @ ) and race/ethnicity ( p < @ ) were significant predictors of having at least one USO vs. none ( monogamous individuals and African Americans were more likely to have at least one USO ) .


Significant moderators of intervention effectiveness included recent sex under the influence of drugs/alcohol ( p < @ in non-zero portion of model ) , duration of abuse of primary drug ( p < @ in non-zero portion of model ) , and Hispanic ethnicity ( p < @ in the zero portion , p < @ in the non-zero portion of model ) .


These predictor and moderator findings point to ways in which patients may be selected for the different HIV sexual risk reduction interventions and suggest potential avenues for further development of the interventions for increasing their effectiveness within certain subgroups .


The effect of eating speed on energy intake by weight status is unclear .


To examine whether the effect of eating speed on energy intake is the same in normal-weight and overweight/obese subjects .


The effect of slow and fast eating speed on meal energy intake was assessed in a randomized crossover design .


Thirty-five normal-weight ( aged @ years ; @ women and @ men ) subjects and @ overweight/obese ( @ years ; @ women and @ men ) subjects were studied on @ days during lunch in a metabolic kitchen .


The subjects consumed the same meal , ad libitum , but at different speeds during the two eating conditions .


The weight and energy content of the food consumed was assessed .


Perceived hunger and fullness were assessed at specific times using visual analog scales .


Effect of eating speed on ad libitum energy intake , eating rate ( energy intake/meal duration ) , energy density ( energy intake per gram of food and water consumed ) , and satiety were assessed by mixed-model repeated measures analysis .


Meal energy intake was significantly lower in the normal-weight ( @ vs @ kcal ; P = @ ) but not the overweight/obese ( @ vs @ kcal ; P = @ ) subjects during the slow vs the fast eating condition .


Both groups had lower meal energy density ( P = @ and P = @ , respectively ) and eating rate ( P < @ in both groups ) during the slow vs the fast eating condition .


Both groups reported less hunger ( P = @ and P = @ , respectively ) , and the normal-weight subjects reported more fullness ( P = @ ) at @ minutes after the meal began during the slow compared with the fast eating condition .


There was no eating speed by weight status interaction for any of the variables .


Eating slowly significantly lowered meal energy intake in the normal-weight but not in the overweight/obese group .


It lowered eating rate and energy density in both groups .


Eating slowly led to lower hunger ratings in both groups and increased fullness ratings in the normal-weight group at @ minutes from when the meal began .


Real-time adherence monitoring is now possible through medication storage devices equipped with cellular technology .


We assessed the effect of triggered cell phone reminders and counseling using objective adherence data on antiretroviral therapy ( ART ) adherence among Chinese HIV-infected patients .


We provided ART patients in Nanning , China , with a medication device ( Wisepill ) to monitor their ART adherence electronically .


After @ months , we randomized subjects within optimal ( @ % ) and suboptimal ( < @ % ) adherence strata to intervention vs. control arms .


In months @-@ , intervention subjects received individualized reminders triggered by late dose taking ( no device opening by @ minutes past dose time ) and counseling using device-generated data .


Controls received no reminders or data-informed counseling .


We compared postintervention proportions achieving optimal adherence , mean adherence , and clinical outcomes .


Of @ subjects enrolled , @ ( @ % ) completed the trial .


Preintervention optimal adherence was similar in intervention vs. control arms ( @ % vs. @ % , respectively ; P = @ ) .


In the last intervention month , @ % vs. @ % achieved optimal adherence -LSB- risk ratio ( RR ) : @ , @ % confidence interval ( CI ) : @ to @ -RSB- and mean adherence was @ % vs. @ % ( P = @ ) .


Among preintervention suboptimal adherers , @ % vs. @ % ( RR : @ , CI : @ to @ ) achieved optimal adherence and mean adherence was @ % vs. @ % ( P = @ ) .


Proportions were @ % and @ % among optimal adherers , respectively ( RR : @ , CI : @ to @ ) and mean adherence was @ % vs. @ % ( P = @ ) .


Postintervention clinical outcomes were not significant .


Real-time reminders significantly improved ART adherence in this population .


This approach seems promising for managing HIV and other chronic diseases and warrants further investigation and adaptation in other settings .


There is interest in including recommendations for the replacement of the sodium lost in sweat in individualized hydration plans for athletes .


Although the regional absorbent-patch method provides a practical approach to measuring sweat sodium losses in field conditions , there is a need to understand the variability of estimates associated with this technique .


Sweat samples were collected from the forearms , chest , scapula , and thigh of @ cyclists during @ standardized cycling time trials in the heat and @ in temperate conditions .


Single measure analysis of sodium concentration was conducted immediately by ion-selective electrodes ( ISE ) .


A subset of @ samples was frozen for reanalysis of sodium concentration using ISE , flame photometry ( FP ) , and conductivity ( SC ) .


Sweat samples collected in hot conditions produced higher sweat sodium concentrations than those from the temperate environment ( P = @ ) .


A significant difference ( P = @ ) in estimates of sweat sodium concentration was evident when calculated from the forearm average ( mean @ % CL ; @ @ mmol/L ) compared with using a @-site equation ( @ @ mmol/L ) .


There was a high correlation between the values produced using different analytical techniques ( r@ = @ ) , but mean values were different between treatments ( frozen FP , frozen SC > immediate ISE > frozen ISE ; P < @ ) .


Whole-body sweat sodium concentration estimates differed depending on the number of sites included in the calculation .


Environmental testing conditions should be considered in the interpretation of results .


The impact of sample freezing and subsequent analytical technique was small but statistically significant .


Nevertheless , when undertaken using a standardized protocol , the regional absorbent-patch method appears to be a relatively robust field test .


Neurotoxic effects of brain irradiation include cognitive impairment in @ % to @ % of patients .


Prior studies have suggested that donepezil , a neurotransmitter modulator , may improve cognitive function .


A total of @ adult brain tumor survivors @ months after partial - or whole-brain irradiation were randomly assigned to receive a single daily dose ( @ mg for @ weeks , @ mg for @ weeks ) of donepezil or placebo .


A cognitive test battery assessing memory , attention , language , visuomotor , verbal fluency , and executive functions was administered before random assignment and at @ and @ weeks .


A cognitive composite score ( primary outcome ) and individual cognitive domains were evaluated .


Of this mostly middle-age , married , non-Hispanic white sample , @ % had primary brain tumors , @ % had brain metastases , and @ % underwent prophylactic cranial irradiation .


After @ weeks of treatment , the composite scores did not differ significantly between groups ( P = @ ) ; however , significant differences favoring donepezil were observed for memory ( recognition , P = @ ; discrimination , P = @ ) and motor speed and dexterity ( P = @ ) .


Significant interactions between pretreatment cognitive function and treatment were found for cognitive composite ( P = @ ) , immediate recall ( P = @ ) , delayed recall ( P = @ ) , attention ( P = @ ) , visuomotor skills ( P = @ ) , and motor speed and dexterity ( P < @ ) , with the benefits of donepezil greater for those who were more cognitively impaired before study treatment .


Treatment with donepezil did not significantly improve the overall composite score , but it did result in modest improvements in several cognitive functions , especially among patients with greater pretreatment impairments .


Cryotherapy has been used to enhance recovery after orthopaedic surgery .


Several cooling devices are available but few can guarantee a fixed temperature during a prolonged time and therefore have been criticized .


The arrival of new advanced cryotherapy devices made it possible to test the effect of prolonged cooling on rehabilitation after joint replacement .


The hypotheses of this randomized controlled trial ( RCT ) were that advanced cryotherapy devices compared with cold packs result in ( @ ) better postoperative pain control resulting in a lower consumption of narcotics ; ( @ ) better early ROM ; and ( @ ) less postoperative bleeding and swelling .


A priori sample size calculation had determined that to detect a difference of @ points on the VAS , a sample size of @ subjects per group at followup would be required , given a study power of @ % .


One hundred sixteen patients were included and randomly allocated to receive advanced cryotherapy ( n = @ ) or use of cold packs ( n = @ ) .


The primary outcomes for the study were to evaluate pain with the VAS and analgesics consumption .


Secondary outcomes were postoperative ROM , swelling , and blood loss .


One hundred ( @ in each group ) patients had complete data available for analysis .