The differences in changes over time between the intervention and placebo periods ( intervention - placebo ) were calculated and tested with a linear mixed model for repeated measures .


Epicatechin changed epicatechin - placebo for soluble endothelial selectin ( sE-selectin ) by -@ ng/mL ( @ % CI : -@ , -@ ; P = @ ) but did not significantly change this difference ( -@ ; @ % CI : -@ , @ ; P = @ ) for the z score for endothelial dysfunction .


Quercetin changed quercetin - placebo for sE-selectin by -@ ng/mL ( @ % CI : -@ , -@ ; P = @ ) , that for IL-@ by -@ pg/mL ( @ % CI : -@ , -@ ; P = @ ) , and that for the z score for inflammation by -@ ( @ % CI : -@ , -@ ; P = @ ) .


In ( pre ) hypertensive men and women , epicatechin may contribute to the cardioprotective effects of cocoa and tea through improvements in endothelial function .


Quercetin may contribute to the cardioprotective effects of tea possibly by improving endothelial function and reducing inflammation .


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


Muscle passive contraction of lower limb by neuromuscular electrostimulation ( NMES ) is frequently used in chronic heart failure ( CHF ) patients but no data are available concerning its action on sympathetic activity .


However , Transcutaneous Electrical Nerve Stimulation ( TENS ) is able to improve baroreflex in CHF .


The primary aim of the present study was to investigate the acute effect of TENS and NMES compared to Sham stimulation on sympathetic overactivity as assessed by Muscle Sympathetic Nerve Activity ( MSNA ) .


We performed a serie of two parallel , randomized , double blinded and sham controlled protocols in twenty-two CHF patients in New York Heart Association ( NYHA ) Class III .


Half of them performed stimulation by TENS , and the others tested NMES .


Compare to Sham stimulation , both TENS and NMES are able to reduce MSNA ( @ @ vs @ @ bursts / min , p < @ after TENS and @ @ vs @ @ bursts / min , p < @ , @ after NMES ) .


No variation of blood pressure , heart rate or respiratory parameters was observed after stimulation .


The results suggest that sensory stimulation of lower limbs by electrical device , either TENS or NMES , could inhibit sympathetic outflow directed to legs in CHF patients .


These properties could benefits CHF patients and pave the way for a new non-pharmacological approach of CHF .


Although the majority of smokers are ambivalent about quitting , few treatments specifically target smokers lacking motivation to quit in the near future .


Most existing interventions are instead predicated on the belief that active treatments should only be distributed to smokers interested in quitting , a largely untested assumption .


In the current clinical trial ( N = @ ) , motivated smokers wanting to quit in the next @ days were given a @-week nicotine replacement therapy ( NRT ) sample and a referral to a quitline ( Group MNQ ) , while unmotivated smokers were randomized to receive the same treatment ( Group UNQ ) or a quitline referral only ( Group UQ ) .


Participants were tracked via telephone for @ months to assess quitting behaviors and smoking reduction .


Groups significantly differed across all comparisons with regard to incidence of any quit attempt ( MNQ : @ % , UNQ : @ % , UQ : @ % , p < @ ) and any @-hr quit attempts ( @ % , @ % , @ % , p < @ ) .


Clinically meaningful differences emerged in the rates of floating ( @ % , @ % , @ % ) and point prevalence abstinence ( @ % , @ % , @ % ) .


Compared to participants in Group UQ ( @ % ) , a greater proportion of participants in Group MNQ ( @ % , p = @ ) and Group UNQ ( @ % , p = @ ) reduced their daily cigarette consumption by at least half .


Proxy measures of cessation readiness ( e.g. , motivation ) favored participants receiving active forms of treatment .


Providing NRT samples engaged both motivated and unmotivated smokers into the quitting process and produced positive changes in smoking outcomes .


This suggests that motivation should not be considered a necessary precondition to receiving treatment .


Emerging antimalarial drug resistance in mobile populations remains a significant public health concern .


We compared two regimens of dihydroartemisinin-piperaquine in military and civilians on the Thai-Cambodian border to evaluate national treatment policy .


Efficacy and safety of two and three-day regimens of dihydroartemisinin-piperaquine were compared as a nested open-label evaluation within a malaria cohort study in @ otherwise healthy volunteers ( @ % malaria-infected at baseline ) .


The first @ volunteers with slide-confirmed Plasmodium falciparum or vivax malaria were randomized @:@ to receive either regimen ( total dose @ mg dihydroartemisinin and @ mg piperaquine ) and followed weekly for up to @ months .


The primary endpoint was malaria recurrence by day @ .


Volunteers with vivax infection received primaquine at study discharge with six months follow-up .


Eighty patients ( @ vivax , @ falciparum , and @ mixed ) were randomized to dihydroartemisinin-piperaquine .


Intention-to-treat all-species efficacy at Day @ was @ % for the two-day regimen ( @ % CI @-@ ) and @ % for the three-day regimen ( @ % CI @-@ ) .


PCR-adjusted falciparum efficacy was @ % in both groups with nearly half ( @ % ) still parasitemic at Day @ .


Plasma piperaquine levels were comparable to prior published reports , but on the day of recrudescence were below measurable in vitro piperaquine IC@ levels in all falciparum treatment failures .


In the brief period since introduction of dihydroartemisinin-piperaquine , there is early evidence suggesting declining efficacy relative to previous reports .


Parasite IC@ levels in excess of plasma piperaquine levels seen only in treatment failures raises concern for clinically significant piperaquine resistance in Cambodia .


These findings warrant improved monitoring of clinical outcomes and follow-up , given few available alternative drugs .


Screening for lung cancer has the potential to reduce mortality , but in addition to detecting aggressive tumors , screening will also detect indolent tumors that otherwise may not cause clinical symptoms .


These overdiagnosis cases represent an important potential harm of screening because they incur additional cost , anxiety , and morbidity associated with cancer treatment .


To estimate overdiagnosis in the National Lung Screening Trial ( NLST ) .


We used data from the NLST , a randomized trial comparing screening using low-dose computed tomography ( LDCT ) vs chest radiography ( CXR ) among @ persons at high risk for lung cancer observed for @ years , to estimate the excess number of lung cancers in the LDCT arm of the NLST compared with the CXR arm .


We calculated @ measures of overdiagnosis : the probability that a lung cancer detected by screening with LDCT is an overdiagnosis ( PS ) , defined as the excess lung cancers detected by LDCT divided by all lung cancers detected by screening in the LDCT arm ; and the number of cases that were considered overdiagnosis relative to the number of persons needed to screen to prevent @ death from lung cancer .


During follow-up , @ lung cancers were reported in the LDCT arm and @ in the CXR arm of the NLST .


The probability is @ % ( @ % CI , @ % -@ % ) that any lung cancer detected by screening with LDCT was an overdiagnosis , @ % ( @ % CI , @ % -@ % ) that a non-small cell lung cancer detected by LDCT was an overdiagnosis , and @ % ( @ % CI , @ % -@ % ) that a bronchioalveolar lung cancer detected by LDCT was an overdiagnosis .


The number of cases of overdiagnosis found among the @ participants who would need to be screened in the NLST to prevent @ death from lung cancer was @ .


More than @ % of all lung cancers detected by LDCT in the NLST seem to be indolent , and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer .


The portion size of food is a determinant of energy intake , linking with obese traits .


A healthy plate for portion control has recently been made in a Japanese style .


The aim of the current study was to assess the efficacy of a lifestyle intervention program using the Japanese-style healthy plate on weight reduction in overweight and obese diabetic Japanese subjects .


We randomized overweight and obese diabetic subjects ( n = @ , @ women ) into an intervention group including educational classes on lifestyle modification incorporating the healthy plate ( n = @ ) or a waiting-list control group ( n = @ ) .


The intervention period was three months , and the educational classes using the healthy plate were conducted monthly in a group session for the intervention group .


The body weight , blood glycemic and metabolic measures , and psychosocial variables were measured at the baseline and after the @-month intervention in both groups .


The impression of the intervention was interviewed using a structured questionnaire .


There was one drop-out in the control group .


No adverse events were reported in the groups .


Subjects in the intervention group had a greater weight change from baseline to the end of the @-month intervention period ( -@ + / - @ -LSB- SD -RSB- kg in the intervention group vs. -@ + / - @ kg in the control group , P = @ ) .


Most subjects recorded that the use of a healthy plate could be recommended to other people .


The lifestyle intervention program using the Japanese-style healthy plate , which was developed for portion control , may effectively reduce body weight in overweight and obese diabetic subjects in Japan .


Further studies are needed to establish the efficacy of this methodology on weight management .


In surgical procedures , obesity is a risk factor for the onset of intra and postoperative respiratory complications .


Determine what moment of application of positive pressure brings better benefits on lung function , incidence of atelectasis and diaphragmatic excursion , in the preoperative , intraoperative or immediate postoperative period .


Randomized , controlled , blinded study , conducted in a hospital and included subjects with BMI between @ and @ kg/m@ , @ and @ years , underwent bariatric surgery by laparotomy .


They were underwent preoperative and postoperative evaluations .


They were allocated into four different groups : @ ) Gpre : treated with positive pressure in the BiPAP mode ( Bi-Level Positive Airway Pressure ) before surgery for one hour ; @ ) Gpos : BIPAP after surgery for one hour ; @ ) Gintra : PEEP ( Positive End Expiratory Pressure ) at @ cmH@O during the surgery ; @ ) Gcontrol : only conventional respiratory physiotherapy .


The evaluation consisted of anthropometric data , pulmonary function tests and chest radiography .


Were allocated @ patients , @ in each group .


There were significant differences for the expiratory reserve volume and percentage of the predicted expiratory reserve volume , in which the groups that received treatment showed a smaller loss in expiratory reserve volume from the preoperative to postoperative stages .


The postoperative radiographic analysis showed a @ % prevalence of atelectasis for Gcontrol , @ % for Gintra , @ % for Gpre , and @ % for Gpos .


There was no significant difference in diaphragmatic mobility amongst the groups .


The optimal time of application of positive pressure is in the immediate postoperative period , immediately after extubation , because it reduces the incidence of atelectasis and there is reduction of loss of expiratory reserve volume .


Biomarkers of micronutrient status are needed to best define deficiencies and excesses of essential nutrients .


We evaluated several supporting biomarkers of vitamin A status in Zambian children to determine whether any of the biomarkers were consistent with high liver retinol stores determined by using retinol isotope dilution ( RID ) .


A randomized , placebo-controlled , biofortified maize efficacy trial was conducted in @ rural Zambian children from @ villages .


A series of biomarkers were investigated to better define the vitamin A status of these children .


In addition to the assessment of total-body retinol stores ( TBSs ) by using RID , tests included analyses of serum carotenoids , retinyl esters , and pyridoxal-@ ' - phosphate ( PLP ) by using high-pressure liquid chromatography , retinol-binding protein by using ELISA , and alanine aminotransferase ( ALT ) activity by using a colorimetric assay .


Children ( n = @ ) were analyzed quantitatively for TBSs by using RID .


TBSs , retinyl esters , some carotenoids , and PLP differed by village site .


Serum carotenoids were elevated above most nonintervened reference values for children .


- Carotene , - carotene , and lutein values were > @th percentile from children in the US NHANES III , and @ % of children had hypercarotenemia ( defined as total carotenoid concentration > @ mol/L ) .


Although only @ % of children had serum retinyl esters > @ % of total retinol plus retinyl esters , @ % of children had > @ % as esters , which was consistent with high liver retinol stores .


Ratios of serum retinol to retinol-binding protein did not deviate from @ , which indicated full saturation .


ALT activity was low , which was likely due to underlying vitamin B-@ deficiency , which was confirmed by very low serum PLP concentrations .


The finding of hypervitaminosis A in Zambian children was supported by high circulating concentrations of carotenoids and mildly elevated serum retinyl esters .


ALT-activity assays may be compromised with co-existing vitamin B-@ deficiency .


Nutrition education to improve intakes of whole grains and animal-source foods may enhance vitamin B-@ status in Zambians .


Surgical site infection ( SSI ) is the second most common type of nosocomial infections in the United States .


In Uruguay , the incidence after prostatectomies is @ % .


The aim of our study was to compare the efficacy of two skin antiseptics and to determine possible risk factors for SSI in patients undergoing surgery for benign prostatic hyperplasia ( BPH ) .


A randomized trial included @ patients operated on for BPH , of whom @ ( @ % ) underwent open surgery .


Patients were treated by the same surgical team in a tertiary general hospital that is a referral center for patients with urologic diseases .


Skin antisepsis was performed randomly using either @ % povidone-iodine or chlorhexidine in an alcohol base ( Chemisol ( ) ) .


Possible risk factors investigated were age , renal dysfunction , bladder stones , preoperative urinary catheter , positive preoperative urine culture , operative time and technique , and vesicocutaneous fistula .


Of all patients , @ ( @ % ) had a urinary catheter preoperatively .


Urine cultures were positive in @ patients , of whom @ ( @ % ) had a urinary catheter .


Surgical site infection occurred in @ patients ( @ % ) , and @ % of the causative microorganisms were gram-negative bacteria characteristic of the urinary flora .


The type of antiseptic did not affect the risk of SSI ( p = @ ) .


The most important risk factor for infection was the presence of a urinary catheter preoperatively ( p = @ ) ; also significant were the formation of a vesicocutaneous fistula ( p = @ ) , increasing age ( p = @ ) , and the presence of a positive preoperative urine culture ( p = @ ) .


In a cohort of patients submitted to open prostatectomy , SSI was not related to the type of antiseptic .


The main risk factor was the presence of a urinary catheter preoperatively .


All microorganisms isolated from the SSIs were characteristic of urinary tract infections .


To evaluate the conception rate to fixed-time artificial insemination ( FTAI ) of two oestrus synchronisation programmes in dairy heifers on eight farms over @ years .


The study was conducted in @ and @ on eight farms near Palmerston North , New Zealand .


Nulliparous Friesian and FriesianJersey heifers ( @-@ months of age ) were randomly allocated to one of two oestrus synchronisation programmes .


Group @ ( GPG+P @ ; n = @ ) , received gonadotrophin-releasing hormone ( GnRH ) I/M on Day @ , a progesterone ( P@ ) - releasing intravaginal device from Days @-@ , prostaglandin F@ ( PGF ) I/M on Day @ and a second dose of GnRH at the time of FTAI on Day @ .


The second group ( P@ + PGF ; n = @ ) received a P@-releasing intravaginal device from Days @-@ , PGF on Day @ and FTAI on Day @ .


Pregnancy was diagnosed from Days @-@ by transrectal ultrasonography .


The overall conception rate was @ % and @ % for the GPG+P @ and P@ + PGF groups , respectively .


The odds of conception for the two treatments were not different ( OR = @ ; @ % CI = @-@ @ ) , nor was there any difference between groups in different years ( p = @ ) .


Farm affected conception rate ( p = @ ) , but there was no interaction with treatment ( p = @ ) .


This study has shown that an alternative synchronisation programme can produce similar results in terms of conception rate to the GPG+P @ treatment , currently commonly used in heifers .


More research is required to establish whether other modifications to the GPG+P @ programme can produce similar results at lower costs , and to identify and quantify farm factors which affect the economic benefit of heifer synchronisation .


This study indicated that synchronising heifers with P@ and PGF resulted in conception rates equivalent to those resulting from a GPG+P @ treatment , but with reduced drug costs .


However , because heifers in the GPG+P @ group received the second GnRH injection at the time of AI , they needed only three yardings as opposed to the four required for the heifers treated with P@ and PGF .


Thus , the choice of programme for an individual farm will depend on that farm 's circumstances , in particular the cost of yarding the heifers .


Efficacy and safety are the two considerations when characterising the effects of a new therapy .


We sought to apply an innovative method of assessing the benefit-risk balance using data from a completed randomised controlled trial that compared erlotinib vs placebo added to gemcitabine in patients with advanced pancreatic cancer ( NCIC CTG PA. @ ) .


We applied generalised pairwise comparisons with several prioritised outcome measures ( e.g. , one or more benefit outcomes and one or more risk outcomes ) .


Here , the first priority outcome was overall survival ( OS ) time .


Differences in OS that exceeded @ months were considered clinically meaningful .


The second priority outcome was toxicity .


The overall treatment effect was quantified using the proportion in favour of erlotinib , which can be interpreted as the net proportion of patients who have a better overall outcome with erlotinib as compared with placebo .


Sensitivity analyses were performed .


In this trial @ patients were randomly assigned in a @:@ ratio to receive gemcitabine plus either erlotinib or a matched placebo .


Overall , the method indicated no statistically significant overall treatment effect in favour of erlotinib ; if anything , the point estimate of the net proportion leaned in favour of the placebo group ( overall proportion in favour of erlotinib = -@ % , @ % CI , -@ - @ % ; P = @ ) .


The net proportion was never in favour of the erlotinib group throughout all sensitivity analyses .


Generalised pairwise comparisons make it possible to assess the benefit-risk balance of new treatments using a single statistical test for any number of prioritised outcomes .


The benefit-risk assessment was not in favour of adding erlotinib to gemcitabine for the treatment of patients with advanced pancreatic cancer .


Sedation using intranasal dexmedetomidine is a convenient and well-tolerated technique .


This study evaluated the sedative efficacy of intranasal dexmedetomidine in combination with patient-controlled sedation ( PCS ) for upper gastrointestinal endoscopy .


In this double-blind , randomised , controlled trial , @ patients received either intranasal dexmedetomidine @ g/kg ( dexmedetomidine group ) or intranasal saline ( placebo group ) @h before the procedure .


PCS with propofol and alfentanil was provided for rescue sedation .


Additional sedative consumption , perioperative sedation scores using Observer 's Assessment of Alertness/Sedation ( OAA/S ) scale , recovery , vital signs , adverse events and patient satisfaction were assessed .


Total consumption of PCS propofol and alfentanil was significantly less in the dexmedetomidine than placebo group with a mean difference of -@ mg propofol ( @ % confidence interval -@ to -@ ) and -@ g alfentanil ( @ % confidence interval -@ to -@ ) at the completion of the procedure ( P = @ ) .


Weighted areas under the curve ( AUCw ) of OAA/S scores were significantly lower in the dexmedetomidine group before , during and after procedures ( P < @ , P = @ and P = @ respectively ) .


AUCw of heart rate and systolic blood pressure were also significantly lower during the procedure ( P = @ and P = @ respectively ) with dexmedetomidine .


There was no difference in recovery , side effects or satisfaction .


Intranasal dexmedetomidine with PCS propofol and alfentanil confers deeper perioperative clinical sedation with significantly less use of additional sedatives during upper gastrointestinal endoscopy .


This split-mouth , double-blind randomized controlled trial evaluated radiographic changes in infrabony defects treated with open flap debridement ( OFD ) or OFD associated with enamel matrix derivative ( EMD ) after a @-month follow-up .


The radiographic distance from the CEJ to the bottom of the defect ( BD ) was considered the primary outcome .


CEJ-BC and defect angle were secondary outcomes .


Ten patients presenting @ or more defects were selected .


An individualized film holder was used to take standardized radiographs of the @ defects , at baseline and after @months .


Images were digitized and used to measure the distances from the cemento-enamel junction ( CEJ ) to the alveolar crest ( AC ) , CEJ to the bottom of the defect ( BD ) and infrabony defect angle .


Statistical analysis was performed in SPSS for Windows ( version @ ) .


Paired samples t test was used to compare test and control groups and to evaluate changes within each group .


The level of significance was set at = @ % .


After @months , a significant crestal bone loss was observed for EMD ( @ mm ; p = @ ) but not for OFD ( @ mm ; p = @ ) .


However , no differences were detected between groups ( p = @ ) .


Reduction of the bone defect depth was significant for OFD ( @ mm ; p = @ ) but not for EMD ( @ mm ; p = @ ) , while no differences were detected between them ( p = @ ) .


Both EMD ( @ ; p = @ ) and OFD ( @ ; p = @ ) showed an improvement in defect angle measurements but no significant differences were observed after @months or between the groups ( p = @ ) .


Linear radiographic analysis was not able to demonstrate superiority of EMD treated infrabony defects when compared to ODF after @months .


To develop a mathematical model to adjust the timing of computed tomography ( CT ) scans with the hazard of cancer recurrence in time to facilitate early detection of cancer recurrence .


The clinical data were extracted from the randomized Scandinavian Sarcoma Group ( SSG ) XVIII/Arbeitsgemeinschaft Internistische Onkologie ( AIO ) trial database .


The SSG XVIII/AIO trial was registered ( trial no .


NCT@ ) and approved by the national or institutional review boards .


In the trial , @ - and @-year durations of adjuvant imatinib mesylate in the treatment of patients with gastrointestinal stromal tumor ( GIST ) were compared .


A nonhomogeneous Poisson model with a piecewise log-constant hazard in time that accounts for the nonlinear pattern of GIST recurrence was applied to tumor site , mitotic count , and recurrence data .


The optimal times to obtain follow-up CT scans were computed by modifying the frequency of CT scans with the hazard of tumor recurrence in time .


The hazard-adjusted follow-up schedules were compared with the National Comprehensive Cancer Network ( NCCN ) guidelines of the United States , which suggest imaging with CT at intervals of @-@ months for @-@ years and then annually .


Optimized timing of CT scans on the basis of hazard of recurrence resulted in follow-up schedule options where CT is performed more sparsely than in the NCCN guidelines during adjuvant imatinib administration and more frequently , at approximately @-month intervals , during the first @ years that follow imatinib discontinuation when the risk of recurrence was the greatest .


The number of CT scans could be reduced by a median of @ % ( from @ to nine ) compared with the standard schedules within the first @ years of follow-up without increasing the delay in recurrence detection .


Detection of GIST recurrence may be enhanced by adjusting the timing of the CT scans with the hazard of recurrence .


The method may be applicable to other human tumor types .


Online supplemental material is available for this article .


In the field of intelligence research , it has been shown that some people conceive intelligence as a fixed trait that can not be changed ( entity beliefs ) , whereas others conceive it as a malleable trait that can be developed ( incremental beliefs ) .


What about writing ?


Do people hold similar implicit theories about the nature of their writing ability ?


Furthermore , are these beliefs likely to influence students ' response to a writing intervention ?


We aimed to develop a scale to measure students ' implicit theories of writing ( pilot study ) and to test whether these beliefs influence strategy-instruction effectiveness ( intervention study ) .


In the pilot and intervention studies participated , respectively , @ and @ students ( Grades @-@ ) .


Based on existing instruments that measure self-theories of intelligence , we developed the Implicit Theories of Writing ( ITW ) scale that was tested with the pilot sample .


In the intervention study , @ students received planning instruction based on the self-regulated strategy development model , whereas @ students received standard writing instruction .


Students were evaluated before , in the middle , and after instruction .


ITW 's validity was supported by piloting results and their successful cross-validation in the intervention study .


In this , intervention students wrote longer and better texts than control students .


Moreover , latent growth curve modelling showed that the more the intervention students conceived writing as a malleable skill , the more the quality of their texts improved .


This research is of educational relevance because it provides a measure to evaluate students ' implicit theories of writing and shows their impact on response to intervention .


Acetaminophen ( APAP ) by oral or intravenous ( iv ) routes is used for mild to moderate pain but may take time to be effective .


When fast relief is required and/or oral or iv routes are not available because of the patient 's condition , the transmucosal route may be an alternative .


A new transmucosal/buccal ( b ) pharmaceutical form of APAP dissolved in @ % wt alcohol is compared with other routes of administration .


Two consecutive randomized , crossover , double-blind clinical trials ( CT@ : NCT@ and CT@ : NCT@ ) included @ healthy volunteers .


CT@ compared the pharmacology of @ mg bAPAP with @ g iv APAP .


CT@ compared the pharmacodynamics of @ mg bAPAP with @ g iv and @ mg sublingual ( s ) APAP .


Mechanical pain thresholds are recorded in response to mechanical stimuli applied on the forearm several times during @ minutes .


The objective is to compare the time of onset of antinociception and the antinociception ( area under the curve ) between the routes of administration with analysis of variance ( significance P < @ ) .


bAPAP has a faster time of antinociception onset ( @ minutes , P < @ ) and greater antinociception at @ minutes ( P < @ , CT@ ) and @ minutes ( P < @ , CT@ ) than ivAPAP and sAPAP .


All routes are similar after @ minutes .


bAPAP has a faster antinociceptive action in healthy volunteers .


This attractive alternative to other routes would be useful in situations where oral or iv routes are not available .


This finding must now be confirmed in patients suffering from acute pain of mild and moderate intensity .


To compare toric intraocular lens implantation ( Toric-IOL ) with peripheral corneal relaxing incisions ( PCRIs ) for astigmatism correction in patients undergoing cataract surgery .


@ patients ( @ eyes ) with more than @ diopter ( D ) of preexisting corneal astigmatism were classified as group A ( @-@ @ D ) or group B ( @-@ @ D ) .


The patients were randomized to undergo Toric-IOL or PCRIs in the steep axis with spherical IOL implantation .


LogMAR uncorrected visual acuity ( LogMAR UCVA ) , LogMAR best corrected visual acuity ( LogMAR BCVA ) , error of vector ( | EV | ) , surgery induced refraction correction ( | SIRC | ) , and correction rates ( CR ) were measured @ month and @ months postoperatively .


At @ months postoperatively , all @ eyes had LogMAR BCVA @ .


Patients who underwent PCRIs and Toric-IOL with LogMAR BCVA @ showed no significant differences in group A ( P = @ ) or in group B ( P = @ ) .


Group A showed no significant differences in LogMAR UCVA ( P = @ ) , | EV | ( P = @ ) , | SIRC | ( P = @ ) , and CR ( P = @ ) in patients underwent PCRIs and Toric-IOL .


However , group B showed significant differences in LogMAR UCVA ( P < @ ) , | EV | ( P < @ ) ) , | SIRC | ( P < @ ) , and CR ( P < @ ) .


The LogMAR UCVA and | EV | between @ and @ months showed no significant differences in patients in group A. However , in group B , they are significant differences .


The efficacy and stability of Toric-IOL and PCRIs were equal in low astigmatic patients .


Toric-IOL achieved an enhanced effect over PCRIs in higher astigmatic patients .


PCRIs had the more refractive regression than Toric-IOL in @ months .


Inhibition of angiogenesis is a valuable treatment strategy for ovarian cancer .


Pazopanib is an anti-angiogenic drug active in ovarian cancer .


We assessed the effect of adding pazopanib to paclitaxel for patients with platinum-resistant or platinum-refractory advanced ovarian cancer .


We did this open-label , randomised phase @ trial at @ hospitals in Italy .


We included patients with platinum-resistant or platinum-refractory ovarian cancer previously treated with a maximum of two lines of chemotherapy , Eastern Cooperative Oncology Group performance status @-@ , and no residual peripheral neurotoxicity .


Patients were randomly assigned ( @:@ ) to receive weekly paclitaxel @ mg/m ( @ ) with or without pazopanib @ mg daily , and stratified by centre , number of previous lines of chemotherapy , and platinum-free interval status .


The primary endpoint was progression-free survival , assessed in the modified intention-to-treat population .


This trial is registered with ClinicalTrials.gov , number NCT@ .


This report is the final analysis ; the trial is completed .


Between Dec @ , @ , and Feb @ , @ , we enrolled @ patients : @ were randomly assigned to receive paclitaxel and pazopanib and @ were randomly assigned to receive paclitaxel only .


One patient , in the paclitaxel only group , withdrew from the study and was excluded from analyses .


Median follow-up was @ months ( IQR @-@ ) .


Progression-free survival was significantly longer in the pazopanib plus paclitaxel group than in the paclitaxel only group ( median @ months -LSB- @ % CI @-@ -RSB- vs @ months -LSB- @-@ -RSB- ; hazard ratio @ -LSB- @ % CI @-@ -RSB- ; p = @ ) .


We recorded no unexpected toxic effects or deaths from toxic effects .


Adverse events were more common in the pazopanib and paclitaxel group than in the paclitaxel only group .


The most common grade @-@ adverse events were neutropenia ( @ -LSB- @ % -RSB- in the pazopanib group vs one -LSB- @ % -RSB- in the paclitaxel group ) , fatigue ( four -LSB- @ % -RSB- vs two -LSB- @ % -RSB- ) , leucopenia ( four -LSB- @ % -RSB- vs one -LSB- @ % -RSB- ) , hypertension ( three -LSB- @ % -RSB- vs none -LSB- @ % -RSB- ) , raised aspartate aminotransferase or alanine aminotransferase ( three -LSB- @ % -RSB- vs none ) , and anaemia ( two -LSB- @ % -RSB- vs five -LSB- @ % -RSB- ) .


One patient in the pazopanib group had ileal perforation .


Our findings suggest that a phase @ study of the combination of weekly paclitaxel plus pazopanib for patients with platinum-resistant or platinum-refractory advanced ovarian cancer is warranted .


Clinical mood disorders often become clinically manifest in the later teenage years and early twenties and can be associated with a poor long-term prognosis .


The primary prevention of these disorders would therefore have great public health value .


Nutritional supplements are a feasible intervention for primary prevention and several epidemiological studies have indicated links between low folate status and depressive symptomatology in the general population .


A randomised , double blind , parallel group , placebo-controlled trial in which participants , aged @-@ years , at increased familial risk of mood disorder , were randomised to folic acid ( @ mg daily ) or identical placebo liquid for a maximum of @ months .


Primary outcome data ( the onset of a DSM-IV mood disorder ) were collected from @ participants ; @ per group .


The incidence of mood disorder in the folic acid and placebo groups were @ % and @ % respectively , a non-significant difference .


However , there was post-hoc evidence that folic acid delayed the time to onset of mood disorder in those participants who became unwell .


Small sample size and rate of onset of mood disorders lower than expected .


Although long term folic acid supplementation was well tolerated , with high levels of adherence , there was no evidence that it reduced the incidence of mood disorder compared to those taking placebo .


A third of the @ billion people worldwide without access to improved sanitation live in India , as do two-thirds of the @ billion practising open defecation and a quarter of the @ million who die annually from diarrhoeal diseases .


We aimed to assess the effectiveness of a rural sanitation intervention , within the context of the Government of India 's Total Sanitation Campaign , to prevent diarrhoea , soil-transmitted helminth infection , and child malnutrition .


We did a cluster-randomised controlled trial between May @ , @ , and Dec @ , @ , in @ rural villages in Odisha , India .


Households within villages were eligible if they had a child younger than @ years or a pregnant woman .


Villages were randomly assigned ( @:@ ) , with a computer-generated sequence , to undergo latrine promotion and construction or to receive no intervention ( control ) .


Randomisation was stratified by administrative block to ensure an equal number of intervention and control villages in each block .


Masking of participants was not possible because of the nature of the intervention .


However , households were not told explicitly that the purpose of enrolment was to study the effect of a trial intervention , and the surveillance team was different from the intervention team .


The primary endpoint was @-day prevalence of reported diarrhoea in children younger than @ years .


We did intention-to-treat and per-protocol analyses .


This trial is registered with ClinicalTrials.gov , number NCT@ .


We randomly assigned @ villages to the intervention group and @ villages to the control group .


There were @ households ( @,@ individuals ) in intervention villages and @ households ( @,@ individuals ) in control villages .


The intervention increased mean village-level latrine coverage from @ % of households to @ % , compared with an increase from @ % to @ % in control villages .


Health surveillance data were obtained from @ households with children younger than @ years in the intervention group ( @ children younger than @ years ) , and from @ households ( @ children younger than @ years ) in the control group .


@-day prevalence of reported diarrhoea in children younger than @ years was @ % in the intervention group and @ % in the control group ( period prevalence ratio @ , @ % CI @-@ ) .


@ participants died in the intervention group ( @ children younger than @ years ) and @ died in the control group ( @ children younger than @ years ) .


Increased latrine coverage is generally believed to be effective for reducing exposure to faecal pathogens and preventing disease ; however , our results show that this outcome can not be assumed .


As efforts to improve sanitation are being undertaken worldwide , approaches should not only meet international coverage targets , but should also be implemented in a way that achieves uptake , reduces exposure , and delivers genuine health gains .


To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions .


Cluster randomised controlled trial .


@ general practices in the north west of England .


@ patients with a record of diabetes or heart disease , or both , who had depressive symptoms ( @ on patient health questionaire-@ ( PHQ-@ ) ) for at least two weeks .


Mean age was @ ( SD @ ) .


Participants reported a mean of @ ( SD @ ) long term conditions other than diabetes or heart disease ; @ ( @ % ) were men ; @ ( @ % ) completed the trial .


Collaborative care included patient preference for behavioural activation , cognitive restructuring , graded exposure , and/or lifestyle advice , management of drug treatment , and prevention of relapse .


Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service ; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse .


Usual care was standard clinical practice provided by general practitioners and practice nurses .


The primary outcome was reduction in symptoms of depression on the self reported symptom checklist-@ depression scale ( SCL-D@ ) at four months after baseline assessment .


Secondary outcomes included anxiety symptoms ( generalised anxiety disorder @ ) , self management ( health education impact questionnaire ) , disability ( Sheehan disability scale ) , and global quality of life ( WHOQOL-BREF ) .


@ general practices were randomised to collaborative care and @ to usual care ; three practices withdrew from the trial before patients were recruited .


@ patients were recruited from practices allocated to collaborative care , and @ from practices allocated to usual care .


After adjustment for baseline depression score , mean depressive scores were @ SCL-D@ points lower ( @ % confidence interval -@ to -@ ) in the collaborative care arm , equal to an adjusted standardised effect size of @ .


Patients in the intervention arm also reported being better self managers , rated their care as more patient centred , and were more satisfied with their care .


There were no significant differences between groups in quality of life , disease specific quality of life , self efficacy , disability , and social support .


Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity .


The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity .


Intermittent preventive treatment ( IPT ) in schoolchildren offers a promising option for malaria control .


However , the optimal drug and dosing regimens for IPT remain to be determined .


We conducted a randomized , double-blind , placebo-controlled trial in @ schoolchildren aged @-@ years living in a setting of high malaria transmission in Uganda .


Enrolled children were randomized to dihydroartemisinin-piperaquine ( DP ) given once a month ( IPTm ) , DP given once a school term ( @ treatments over @ months , IPTst ) , or placebo and followed for @ months .


The primary outcome was the incidence of malaria over @ months .


Secondary outcomes included parasite prevalence and anemia over @ months .


Analyses were conducted on an intention-to-treat basis .


In the placebo arm , the incidence of malaria was @ episodes per person-year and the prevalence of parasitemia and anemia was @ % and @ % , respectively .


IPTm reduced the incidence of malaria by @ % ( @ % confidence interval -LSB- CI -RSB- , @ % -@ % , P < @ ) , the prevalence of asymptomatic parasitemia by @ % ( @ % CI , @ % -@ % , P < @ ) , and the prevalence of anemia by @ % ( @ % CI , @ % -@ % , P < @ ) .


IPTst had no significant effect on the incidence of symptomatic malaria or the prevalence of anemia , but reduced the prevalence of asymptomatic parasitemia by @ % ( @ % CI , @ % -@ % , P < @ ) .


Monthly IPT with DP offered remarkable protection against clinical malaria , parasitemia , and anemia in schoolchildren living in a high-malaria-transmission setting .


Pancreatic cancer is often accompanied by severe abdominal or back pain .


It 's the first study to evaluate the analgesic effect of electroacupuncture on pancreatic cancer pain .


A randomized controlled trial compared electroacupuncture with control acupuncture using the placebo needle .


Sixty patients with pancreatic cancer pain were randomly assigned to the electroacupuncture group ( n = @ ) and the placebo control group ( n = @ ) .


Patients were treated on Jiaji ( Ex-B@ ) points T@-T@ bilaterally for @min once a day for @ days .


Pain intensity was assessed with numerical rated scales ( NRS ) before the treatment ( Baseline ) , after @ treatments , and @ days follow-up .


Baseline characteristics were similar in the two groups .


After @ treatment , pain intensity on NRS decreased compared with Baseline ( -@ , @ % confidence interval -LSB- CI -RSB- -@ to-@ @ ) in the electroacupuncture group ; there was little change ( -@ , @ % CI @ to-@ @ ) in control group ; the difference between two groups was statistically significant ( P < @ ) .


Follow-up also found a significant reduction in pain intensity in the electroacupuncture group compared with the control group ( P < @ ) .


Electroacupuncture was an effective treatment for relieving pancreatic cancer pain .


To establish the prevalence of anthelmintic resistance in ovine gastrointestinal nematodes in southern Queensland .


An observational parasitological study using the faecal egg count reduction test .


Sheep farms ( n = @ ) enrolled in this study met the twin criteria of using worm testing for drench decisions and having concerns about anthelmintic efficacy .


On each farm , @ sheep were randomly allocated to one of six treatment groups or an untreated control group .


Faecal samples were collected on day @ and days @-@ for worm egg counts and larval differentiation .


Single - and multi-combination anthelmintics , persistent and non-persistent , oral liquid or capsule , pour-on and injectable formulations were tested .


Monepantel was not tested .


Farmers also responded to a questionnaire on drenching practices .


Haemonchus contortus was the predominant species .


Efficacy < @ % was recorded on @ % of farms for one or more anthelmintics and on @ % of farms for six anthelmintics .


No resistance was identified on three farms .


The @-way combination product was efficacious ( n = @ farms ) .


Napthalophos resistance was detected on one farm only .


Resistance to levamisole ( @ % of farms ) , moxidectin injection ( @ % of farms ) and the closantel/abamectin combination ( @ % of farms ) was identified .


Moxidectin oral was efficacious against Trichostrongylus colubriformis , which was predominant on only one farm .


Of the farms tested , @ % ran meat breeds , @ % dosed more than the recommended dose rate and @ % always , mostly or when possible practised a ` drench and move ' strategy .


This level of anthelmintic resistance in southern Queensland will severely compromise worm control and force increased use of monepantel .


Caudal block ( CB ) has some disadvantages , one of which is its short duration of action after a single injection .


For hypospadias repair , pudendal nerve block ( PNB ) might be a suitable alternative since it has been successfully used for analgesia for circumcision .


We evaluated PNB compared with CB as measured by total analgesic consumption @ hours postoperatively .


In this prospective , double-blinded study , patients were randomized into @ groups , either receiving CB or nerve stimulator-guided PNB .


In the PNB group , patients were injected with @ mL/kg @ % bupivacaine and @ g/kg clonidine .


In the CB group , patients were injected with @ mL/kg @ % bupivacaine and @ g/kg clonidine .


Analgesic consumption was assessed during the first @ hours postoperatively .


The `` objective pain scale '' developed by Hannalah and Broadman was used to assess postoperative pain .


Eighty patients participated in the study , @ in each group .


The mean age in the PNB group was @ ( @ ) years and in the CB group was @ ( @ ) years .


The mean weights in the PNB and CB groups were @ ( @ ) kg and @ ( @ ) kg , respectively .


The percentage of patients who received analgesics during the first @ hours were significantly higher in the CB ( @ % ) compared with the PNB group ( @ % , P < @ ) .


The average amount of analgesics consumed per patient within @ hours postoperatively was higher in the CB group ( paracetamol P < @ , Tramal P = @ ) .


Patients who received PNB had reduced analgesic consumption and pain within the first @ hours postoperatively compared with CB .


Human papillomavirus ( HPV ) self-sampling ( Self-HPV ) may be used as a primary cervical cancer screening method in a low resource setting .


Our aim was to evaluate whether an educational intervention would improve women 's knowledge and confidence in the Self-HPV method .


Women aged between @ and @ years old , eligible for cervical cancer screening , were randomly chosen to receive standard information ( control group ) or standard information followed by educational intervention ( interventional group ) .


Standard information included explanations about what the test detects ( HPV ) , the link between HPV and cervical cancer and how to perform HPV self-sampling .


The educational intervention consisted of a culturally tailored video about HPV , cervical cancer , Self-HPV and its relevancy as a screening test .


All participants completed a questionnaire that assessed sociodemographic data , women 's knowledge about cervical cancer and acceptability of Self-HPV .


A total of @ women were enrolled in @ health care centers in Yaound and the surrounding countryside .


@ women ( @ in the `` control group '' and @ in the `` intervention group '' ) completed the full process and were included into the analysis .


Participants who received the educational intervention had a significantly higher knowledge about HPV and cervical cancer than the control group ( p < @ ) , but no significant difference on Self-HPV acceptability and confidence in the method was noticed between the two groups .


Educational intervention promotes an increase in knowledge about HPV and cervical cancer .


Further investigation should be conducted to determine if this intervention can be sustained beyond the short term and influences screening behavior .


The benefits of combined systemic and liver-directed treatments in inoperable intermediate - or advanced-stage hepatocellular carcinoma ( HCC ) have yet to be defined .


This article presents the planned safety analyses for the first @ patients randomized to radioembolization with yttrium-@ ( ( @ ) Y ) resin microspheres followed by sorafenib ( n = @ ) or sorafenib only ( n = @ ) in the SORAMIC study .


Patients identified for palliative treatment who were poor candidates for transarterial ( chemo ) embolization ( including those failing TACE ) with preserved liver function ( Child-Pugh B@ ) and ECOG performance status < @ were screened .


Radioembolization was administered using a sequential lobar approach .


On day @ after the last radioembolization procedure , sorafenib @ mg twice daily was initiated escalating to @ mg twice daily @ week later ; a matching sorafenib dose schedule was initiated in the control arm .


Patients were followed up for a median of @ months .


Median total implanted activity of ( @ ) Y was @ ( range : @-@ @ ) GBq .


Patients received a similar intensity and duration of sorafenib in the combination-treatment arm ( median daily dose @ mg over @ months ) and control arm ( @ mg over @ months ) .


The incidence of total ( @ vs. @ ) and grade @ ( @ vs. @ ) adverse events was similar in combination-treatment arm and control arm respectively ( P > @ ) .


No significant differences in the number of total or grade @/@ toxicities were recorded for : total bilirubin , albumin , liver enzymes , ascites , Child-Pugh , fatigue , hand-foot skin reaction , blood pressure or diarrhoea .


Radioembolization followed by sorafenib appears to be as well tolerated as sorafenib alone .


Subcutaneous drainage is considered effective for preventing wound infections , but only anecdotal evidence supports its clinical benefit .


The present study evaluated the benefit of subcutaneous drainage in preventing wound infections in patients undergoing liver resection .


Patients scheduled for liver resection were randomly assigned to receive or not receive subcutaneous drains .


After suture of the peritoneum and fascia , a @ Fr drain was placed subcutaneously and connected to a low pressure ( under @cmH@ O ) aspiration reservoir to allow drainage of the full length of the wound .


The primary endpoint was wound infection development within @ days of the liver resection .


We performed liver resections in @ patients with hepatobiliary malignancies .


Between the subcutaneous-drainage group ( n = @ ) and non-drainage group ( n = @ ) , there were no significant differences in the operative variables .


Wound infection occurred in @ drainage group patients ( @ % ) and @ patients ( @ % ) in the non-drainage group ( P = @ ) ; there was no significant difference in the probability of wound infection ( P = @ ) .


No significant differences were found between the groups for the hospital stay duration ( P = @ ) , postoperative complications ( P = @ ) or medical expenses ( P = @ ) .


Subcutaneous drainage does not prevent wound infections in patients undergoing liver resection ; therefore , its routine use is not justified .


While portable , supplemental oxygen is often necessary for patients with chronic obstructive pulmonary disease ( COPD ) to retain independence , it may provide functional limitations because of the increased workload imposed .


This issue may result in nonuse , creating a need to identify carrying modalities that optimize transport .


This study assessed the effects of @ methods of portable oxygen transport on @-minute walk distance ( @ MWD ) , rate of perceived exertion ( RPE ) , heart rate ( HR ) , and oxyhemoglobin saturation ( SpO@ ) .


As weight status is known to impact functional ability in COPD , effects of body mass index ( BMI ) were also assessed .


Data were analyzed using the mixed-model procedure to test for effects of transport modality ( reference , rolling cart , backpack , shoulderstrap ) , time ( minutes @-@ ) , BMI , non-overweight , overweight , and interactions of these variables on outcome parameters .


A main effect of condition was found for @ MWD , and an interaction of condition BMI was found for HR and RPE , and of time BMI for @ MWD and SpO@ .


Participants walked the least distance in rolling cart condition , which was also characterized by the greatest RPE .


For the overweight group , HR was least in the reference compared with other conditions ; but for the non-overweight group , the opposite pattern was observed .


At latter time points , @ MWD was greater in the non-overweight group , while SpO@ was reduced .


Results demonstrate that transport modality of portable oxygen exerts differential effects on functional performance in COPD patients and that BMI may moderate underlying physiologic factors that contribute to performance outcomes .


An increasing body of evidence is being published about single-incision laparoscopic cholecystectomy ( SILC ) , but there are no well-powered trials with an adequate evaluation of post-operative pain .


This randomized trial compares SILC against four-port laparoscopic cholecystectomy ( LC ) with post-operative pain as the primary endpoint .


Hundred patients were randomized to either SILC ( n = @ ) or LC ( n = @ ) .


Exclusion criteria were ( @ ) Acute cholecystitis ; ( @ ) ASA @ or above ; ( @ ) Bleeding disorders ; and ( @ ) Previous open upper abdominal surgery .


Patients and post-operative assessors were blinded to the procedure performed .


The site and severity of pain were compared at @ h , @ h , @ days and @ months post-procedure using the visual analog scale ; non-inferiority was assumed when the lower boundary of the @ % confidence interval of the difference was above -@ and superiority when p @ .


The study arms were demographically similar .


At @ h post-procedure , SILC was associated with less pain at extra-umbilical sites ( rest : p = @ ; movement : p = @ ) .


Pain data were inconclusive at @ h at the umbilical site on movement ; SILC was otherwise non-inferior for pain at all other points .


Operating duration was longer in SILC ( @ vs @ min , p = @ ) .


@ % of patients in each arm suffered complications ( p = @ ) .


Re-intervention rates , analgesic use , return to function , and patient satisfaction did not differ significantly .


SILC has improved short-term pain outcomes compared to LC and is not inferior in both short-term and long-term pain outcomes .


The operating time is longer , but remains feasible in routine surgical practice .


In COPD , the long-acting bronchodilators are not always able to provide an appropriate bronchodilator effect in terms of amplitude and duration and this can result in increased severity of respiratory symptoms and in worsening of health status .


Combined long-acting bronchodilators can address this limitation .


Analysis of a recent study evaluating the efficacy and safety of @ weeks of therapy with glycopyrronium + indacaterol single inhaler ( QVA@ ) versus each component , versus tiotropium and versus placebo .


Such a combination can provide a superior and sustained bronchodilator effect and can minimize the respiratory symptoms resulting from a suboptimally inhibited bronchoconstriction .


Docetaxel plus prednisone is a standard treatment for castration-resistant prostate cancer .


Cyclophosphamide may be an effective combination partner .


This randomised , multicentre , phase II trial compared the combination therapy of docetaxel plus prednisone plus cyclophosphamide with the standard therapy of docetaxel plus prednisone .


Thirty-three patients received six @-week treatment cycles ( in total @ cycles ) .


During treatment , an adequate decline in prostate-specific antigen was seen in both groups ( p = @ ) without between-group differences ( p = @ ) .


No relevant differences between within-group changes were observed for blood pressure , weight , pain score , laboratory variables or quality of life .


There were no serious side effects apart from leucopenia requiring treatment ( docetaxel + prednisone + cyclophosphamide arm ) and no drug-related withdrawals ; all three fatalities were considered to be cancer related .


The oncological effectiveness and tolerability of docetaxel plus prednisone were supported ; an additional effect of cyclophosphamide was not detected .


However , the small number of patients and short observation period restrict the generalisability of the results .


This study aimed to compare continuous and pulsed ultrasound therapy with sham ultrasound in terms of pain , severity of muscle spasm , function , depression , and quality of life in patients with myofascial pain syndrome .


Patients were randomly divided into three groups , including the continuous ultrasound group ( @ MHz , @ W/cm , n = @ ) , the pulsed ultrasound group ( @ MHz , @ W/cm , @:@ ratio , n = @ ) , and control group ( sham , n = @ ) .


The primary outcome measures were severity of pain at rest and during activity ( visual analog scale , @-@ cm ) .


The secondary outcome measures were function ( Neck Pain and Disability Scale ) , depressive mood ( Beck Depression Scale ) , and quality of life ( Nottingham Health Profile ) .


All evaluations were performed at baseline , after treatment , and at the @th and @th wks .


All three groups had significant improvements in all of the pain scores , the severity of muscle spasms , function assessments , and certain subparameters of the quality of life scale ( P < @ ) .


The continuous ultrasound group had significantly greater improvements in pain at rest ( P < @ ) .


However , no statistically significant differences were observed in the other parameters ( P > @ ) .


Continuous ultrasound therapy is more efficient in reducing pain at rest for myofascial pain syndrome patients than is sham or pulsed ultrasound therapy .


There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia .


The addition of adjunctive analgesics , such as fentanyl and clonidine , to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades , and decrease the dose of local anesthetic and supplemental analgesia .


Investigation of the safety and the analgesic efficacy of adding @ g/kg dexmedetomidine to bupivacaine @ % in thoracic paravertebral blocks ( PVB ) in patients undergoing modified radical mastectomy .


A randomized , double-blind trial .


Academic medical center .


Sixty American Society of Anesthesiologists physical status - I - III patients were randomly assigned to receive thoracicPVB with either @ mL of bupivacaine @ % ( Group B , n = @ ) , or @ mL of bupivacaine @ % + @ g/kg dexmedetomidine ( Group BD , n = @ ) .


Assessment parameters included hemodynamics , sedation score , pain severity , time of first analgesics request , total analgesic consumption , and side effects in the first @ hours .


There was a significant reduction in pulse rate and diastolic blood pressure starting at @ minutes in both groups , but more evidenced in group BD ( P < @ ) .


Intraoperative Systolic blood pressure showed a significant reduction at @ minutes in both groups ( P < @ ) then returned to baseline level at @ minutes in both groups .


There was a significant increase in pulse rate starting @ hours postoperative until @ hours postoperatively in group B but only after @ hours until @ hours in group BD ( P < @ ) .


The time of the first rescue analgesic requirement was significantly prolonged in the group BD ( @ @ hours ) in comparison to group B ( @ @ hours ) ( P = @ ) .


The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst @ hours postoperatively was significantly decreased in group BD ( @ @ mg ) compared to group B ( @ @ mg ) ( P = @ ) .


No significant serious adverse effects were recorded during the study .


This study is limited by its sample size .


The addition of dexmedetomidine @ g/kg to bupivacaine @ % in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects .


Regular exercise has been proposed as a potential smoking cessation aid .


This study aimed to determine the effects of an exercise counseling program on cigarette smoking abstinence at @weeks .


A parallel , two-arm , randomized controlled trial was conducted .


Adult cigarette smokers ( n = @ ) who were insufficiently active and interested in quitting were randomized to receive the Fit@Quit intervention ( @ exercise telephone counseling sessions over @months ) plus usual care ( behavioral counseling and nicotine replacement therapy ) or usual care alone .


There were no significant group differences in @-day point-prevalence and continuous abstinence at @months .


The more intervention calls successfully delivered , the lower the probability of smoking ( OR , @ ; @ % CI @-@ @ , p = @ ) in the intervention group .


A significant difference was observed for leisure time physical activity ( difference = @ MET-minutes/week ; @ % CI @-@ @ ; p = @ ) .


Telephone-delivered exercise counseling may not be sufficient to improve smoking abstinence rates over and above existing smoking cessation services .


( Australasian Clinical Trials Registry Number : ACTRN@ . )


The aim of this randomized , double-blinded , prospective study was to determine the effectiveness and side effects of intravenous or epidural use of morphine , bupivacaine or ropivacaine on post-thoracotomy pain management .


Sixty patients undergoing elective thoracotomy procedure were randomly allocated into @ groups by the sealed envelope technique .


Group IVM , EM , EMB and EMR received patient controlled intravenous morphine , and epidural morphine , morphine-bupivacaine and morphine-ropivacaine , respectively .


Perioperative heart rate , blood pressure and oxygen saturation and postoperative pain at rest and during cough , side effects and rescue analgesic requirements were recorded at the @ ( th ) and @ ( th ) minutes and the @ ( nd ) , @ ( th ) , @ ( th ) , @ ( th ) , @ ( th ) , @ ( th ) , @ ( th ) , and @ ( nd ) hour .


Diclofenac sodium requirement during the study was lower in Group EM .


Area under VAS-time curve was lower in Group EM compared to Group IVM , but similar to Group EMB and EMR .


Pain scores at rest were higher at the @ , @ , @ , and @ ( th ) hour in Group IVM compared to Group EM .


Pain scores at rest were higher at the @ ( th ) and @ ( th ) minutes in Group EM and Group IVM compared to Group EMB .


Pain scores during cough at the @ ( th ) minute were higher in Group EM compared to Group EMB .


There was no difference between Group IVM and Group EMR .


Morphine used at the epidural route was found more effective than the intravenous route .


While Group EM was more effective in the late period of postoperative , Group EMB was more effective in the early period .


We concluded that epidural morphine was the most effective and preferred one .


Daclatasvir-containing regimens have the potential to address limitations of current regimens combining peginterferon alfa and ribavirin with first-generation protease inhibitors for treatment of chronic HCV genotype @ infection .


In this randomized , double-blind study , @ Japanese treatment-naive patients received once-daily daclatasvir @ mg or @ mg or placebo , each combined with peginterferon alfa-@b / ribavirin ; @ prior null ( n = @ ) or partial ( n = @ ) responders received the same daclatasvir-containing regimens without a placebo arm .


Daclatasvir recipients with protocol-defined response ( HCV RNA < @ IU/ml at week @ , undetectable at week @ ) were treated for @ weeks ; those without protocol-defined response and placebo recipients continued treatment to week @ .


Sustained virological response @ weeks post-treatment ( SVR@ ) was achieved by @ % , @ % and @ % of treatment-naive patients in the daclatasvir @ mg , @ mg and placebo groups , respectively .


Prior non-responders had more frequent virological failure ; @ % and @ % of daclatasvir @ mg and @ mg recipients , respectively , achieved SVR@ .


Adverse events were similar across groups and were typical of peginterferon alfa-@b / ribavirin .


Pyrexia , headache , alopecia , decreased appetite and malaise were the most common adverse events ; two daclatasvir recipients discontinued due to adverse events .


Daclatasvir @ mg combined with peginterferon alfa-@b and ribavirin achieved a high rate of SVR@ in treatment-naive patients with HCV genotype @ infection , with tolerability similar to that of peginterferon alfa-@b / ribavirin alone .


However , regimens with greater antiviral potency are needed for prior non-responders .


Traumatic brain injury ( TBI ) is commonly accompanied by intracranial bleeding which can worsen after hospital admission .


Tranexamic acid ( TXA ) has been shown to reduce bleeding in elective surgery and there is evidence that short courses of TXA can reduce rebleeding in spontaneous intracranial haemorrhage .


We aimed to determine the effectiveness and safety of TXA in preventing progressive intracranial haemorrhage in TBI .


This is a double blinded , placebo controlled randomized trial .


We enrolled @ patients older than @years with moderate to severe TBI ( post-resuscitation Glasgow Coma Scale ( GCS ) @ to @ ) who had a computerized tomography ( CT ) brain scan within eight hours of injury and in whom there was no immediate indication for surgery .


We excluded patients if they had a coagulopathy or a serum creatinine over than @ milligrams % .


The treatment was a single dose of @ grams of TXA in addition to other standard treatments .


The primary outcome was progressive intracranial haemorrhage ( PIH ) which was defined as an intracranial haemorrhage seen on the second CT scan that was not seen on the first CT scan , or an intracranial haemorrhage seen on the first scan that had expanded by @ % or more on any dimension ( height , length , or width ) on the second scan .


Progressive intracranial haemorrhage was present in @ ( @ % ) of @ patients allocated to TXA and in @ ( @ % ) of @ patients allocated to placebo .


The difference was not statistically significant -LSB- RR = @ ( @ % CI @ to @ ) -RSB- .


There were no significant difference in the risk of death from all causes in patients allocated to TXA compared with placebo -LSB- RR = @ ( @ % CI @ to @ ) -RSB- and the risk of unfavourable outcome on the Glasgow Outcome Scale -LSB- RR = @ ( @ % CI @ to @ ) -RSB- .


There was no evidence of increased risk of thromboembolic events in those patients allocated to TXA .


TXA may reduce PIH in patients with TBI ; however , the difference was not statistically significant in this trial .


Large clinical trials are needed to confirm and to assess the effect of TXA on death or disability after TBI .


The aims of this study were to adapt a traditional recipe into a healthier form by adding @ g of oat - glucan , substituting milk chocolate to dark chocolate with @ % cocoa , and to examine the effect of these alterations on short-term satiety and energy intake .


Study subjects ( n = @ ) were tested in a randomized , crossover design with four products closely matched for energy content .


Four different versions of a traditional recipe including milk chocolate-control ( CON ) , oat - glucan ( B-GLU ) , dark chocolate ( DARK ) or oat - glucan and dark chocolate ( B-GLU + DARK ) were given to subjects on different test days .


After subjects were asked to report visual analog scale ( VAS ) scores on sensory outcomes and related satiety for four hours ad libitum , lunch was served and energy intake of individuals was measured .


VAS scores indicated that none of the test foods exerted an improved effect on satiety feelings .


However , energy intake of individuals during ad libitum lunch was significantly lower in dark chocolate groups ( CON : @ @ kcal versus DARK : @ @ kcal and B-GLU + DARK : @ @ kcal , p = @ ) .


The study demonstrated that substituting dark chocolate for milk chocolate is more effective in inducing satiety during subsequent food intake in healthy subjects .


In recent years , the U.S. has experienced a significant increase in the prevalence of pregnant opioid-dependent women and of neonatal abstinence syndrome ( NAS ) , which is caused by withdrawal from in-utero drug exposure .


While methadone-maintenance currently is the standard of care for opioid dependence during pregnancy , research suggests that buprenorphine-maintenance may be associated with shorter infant hospital lengths of stay ( LOS ) relative to methadone-maintenance .


There is no `` gold standard '' treatment for NAS but there is evidence that buprenorphine , relative to morphine or methadone , treatment may reduce LOS and length of treatment .


Point-of-care clinical trial ( POCCT ) designs , maximizing external validity while reducing cost and complexity associated with classic randomized clinical trials , were selected for two planned trials to compare methadone to buprenorphine treatment for opioid dependence during pregnancy and for NAS .


This paper describes design considerations for the Medication-assisted treatment for Opioid-dependent expecting Mothers ( MOMs ; estimated N = @ ) and Investigation of Narcotics for Ameliorating Neonatal abstinence syndrome on Time in hospital ( INFANTs ; estimated N = @ ) POCCTs , both of which are randomized , intent-to-treat , two-group trials .


Outcomes would be obtained from participants ' electronic health record at three participating hospitals .


Additionally , a subset of infants in the INFANTs POCCT would be from mothers in the MOMs POCCT and , thus , potential interaction between medication treatment of mother and infant could be evaluated .


This pair of planned POCCTs would evaluate the comparative effectiveness of treatments for opioid dependence during pregnancy and for NAS .


The results could have a significant impact on practice .


Uptake of human papillomavirus ( HPV ) vaccinations by @ - to @-year-old girls in England is below ( < @ % ) target ( @ % ) .


This trial assesses ( a ) the impact of financial incentives on uptake and completion of an HPV vaccination program , and ( b ) whether impacts are moderated by participants ' deprivation level .


It also assesses the impact of incentives on decision quality to get vaccinated , as measured by attitudes toward the vaccination and knowledge of its consequences .


One thousand @ - to @-year-old girls were invited to participate in an HPV vaccination program : @ previously uninvited , and @ unresponsive to previous invitations .


Girls randomly received either a standard invitation letter or a letter including the offer of vouchers worth @ ( @ ; $ @ ) for undergoing @ vaccinations .


Girls attending their first vaccination appointment completed a questionnaire assessing decision quality to be vaccinated .


Outcomes were uptake of the first and third vaccinations and decision quality .


The intervention increased uptake of the first ( first-time invitees : @ % vs. @ % , odds ratio -LSB- OR -RSB- = @ , @ % confidence interval -LSB- CI ; @ , @ -RSB- ; previous nonattenders : @ % vs. @ % , OR = @ , @ % CI -LSB- @ , @ -RSB- ) and third ( first-time invitees : @ % vs. @ % , OR = @ , @ % CI -LSB- @ , @ -RSB- ; previous nonattenders : @ % vs. @ % , OR = @ , @ % CI -LSB- @ , @ -RSB- ) vaccinations .


Impacts were not moderated by deprivation level .


Decision quality was unaffected by the intervention .


Although the intervention increased completion of HPV vaccinations , uptake remained lower than the national target , which , in addition to cost effectiveness and acceptability issues , necessitates consideration of other ways of achieving it .


To test whether subconjunctival cyclosporine A ( CsA ) implants affect the incidence and the degree of corneal neovascularization occurring after penetrating keratoplasty .


Prospective , randomized , multicenter , controlled phase @/@ clinical trial .


The study comprised @ trial sites in Germany , India , and the United States .


Enrolled patients ( n = @ ) were randomized to @ of @ groups : treatment group A ( n = @ ) , treatment group B ( n = @ ) , and the control group ( n = @ ) .


Patients from each group received either of @ doses of subconjunctival CsA ( group A , low-dose CsA ; group B , high-dose CsA ) or placebo ( carrier only ) implants at the time of high-risk penetrating keratoplasty .


The incidence and degree of corneal neovascularization occurring after penetrating keratoplasty were evaluated in a substudy ( LX@-@ study : NCT@ ) .


A web-based image upload system was developed .


Standardized digital slit-lamp pictures were quantitatively and objectively evaluated using CellF morphometry software .


No statistically significant difference in incidence and degree of corneal neovascularization developing after penetrating keratoplasty was found between treatment groups and placebo group .


Mean corneal neovascularization area at week @ ( visit @ ) was @ % in treatment group A versus placebo ( @ % ; P = @ ) and @ % in treatment group B versus placebo ( @ % ; P = @ ) .


High-dose subconjunctival CsA implants do not significantly affect corneal neovascularization after high-risk penetrating keratoplasty .


This suggests that local CsA has negligible antiangiogenic effects in the human cornea , at least in the transplant setting .


Cardiovascular diseases ( CVD ) and metabolic alterations are among the majors public health concern that have been reported in people living with HIV infections .


Factors contributing to cardio metabolic syndrome in HIV include body fat distribution , dyslipidemia , insulin resistance , cardiovascular dysfunction and inflammation .


The aim of the study was to determine the effect of Spirulina platensis ( Cyanobacteriaceae ) supplementation versus local diet on lipid profile in HIV-infected antiretroviral-naive patients .


A prospective single-blind , randomized , multicentre study was conducted from February @ to December @ .


A total of @ HIV antiretroviral-nave patients were screened and @ were recruited in this study .


Patients were randomized and received either Spirulina supplementation combined with local diet ( n = @ ) or local diet only ( n = @ ) .


Age , weight , body mass index ( BMI ) , lipid profile , CD@ count , and local food intake variables were assessed on three separate occasions ( three , six and twelve months ) .


An average age of the patients was @ years .


The majority of participants were female @ % .


Regarding the lipid profile , there is a significant increase in HDL-cholesterol and a significant decrease in total cholesterol , LDL-cholesterol and triglycerides in the group of patients who consumed Spirulina platensis .


A change in the atherogenic index defined by the ratio CT/HDL-C substitutable by LDL-C/HDL-C and the TC/HDL decreased significantly from @ at baseline to @ after @ months ( p = @ and p < @ ) in the patients taking Spirulina .


Nutritional supplementation with Spirulina combined with a quantitative and qualitative balanced diet for at least six months can retard an exposition to lipid abnormalities in HIV-infected antiretroviral-naive patients .


Further studies are recommended on a large group of people not infected with HIV and exposed to cardiovascular risk factors .


In the Strategic Reperfusion Early After Myocardial Infarction ( STREAM ) trial , a pharmaco-invasive ( PI ) strategy was compared with primary percutaneous coronary intervention ( pPCI ) in ST-segment-elevation myocardial infarction patients presenting within @ hours after symptom onset but unable to undergo pPCI within @ hour .


At @ days , the PI approach was associated with a nominally but nonstatistically significant lower incidence of the composite primary end point of death , shock , congestive heart failure , and reinfarction when compared with pPCI .


The aim of the present study was to determine the effect of these strategies on @-year mortality .


Vital status at @ year was available in @ of @ ( @ % ) and @ of @ ( @ % ) patients in the PI and pPCI arm , respectively .


At @ year , all-cause mortality rates ( @ % versus @ % ) were similar for PI and pPCI-treated patients ( P = @ ; risk ratio , @ ; @ % confidence interval , @-@ @ ) .


Cardiac mortality rates were similar as well ( @ % versus @ % , P = @ ; risk ratio , @ ; @ % confidence interval , @-@ @ ) .


Overall , only @ patients died between day @ and @ year , @ in the PI arm and @ in the pPCI arm , of whom @ died of noncardiac reasons ( @ in the PI and @ in the pPCI arm ) .


There was no significant difference in @-year all-cause mortality between the @ groups among the prespecified key subgroups .


At @ year , mortality rates in the PI and pPCI arms were similar in ST-segment-elevation myocardial infarction patients presenting within @ hours after symptom onset and unable to undergo pPCI within @ hour .


To use measurement by cycling power meters ( Pmes ) to evaluate the accuracy of commonly used models for estimating uphill cycling power ( Pest ) .


Experiments were designed to explore the influence of wind speed and steepness of climb on accuracy of Pest .


The authors hypothesized that the random error in Pest would be largely influenced by the windy conditions , the bias would be diminished in steeper climbs , and windy conditions would induce larger bias in Pest .


Sixteen well-trained cyclists performed @ uphill-cycling trials ( range : length @-@ @ km , slope @-@ @ % ) in a random order .


Trials included different riding position in a group ( lead or follow ) and different wind speeds .


Pmes was quantified using a power meter , and Pest was calculated with a methodology used by journalists reporting on the Tour de France .


Overall , the difference between Pmes and Pest was -@ % ( @ % CI : -@ % , +@ % ) for all trials and @ % ( -@ % , +@ % ) in conditions without wind ( < @ m/s ) .


The relationship between percent slope and the error between Pest and Pmes were considered trivial .


Aerodynamic drag ( affected by wind velocity and orientation , frontal area , drafting , and speed ) is the most confounding factor .


The mean estimated values are close to the power-output values measured by power meters , but the random error is between @ % and @ % .


Moreover , at the power outputs ( > @ W ) produced by professional riders , this error is likely to be higher .


This observation calls into question the validity of releasing individual values without reporting the range of random errors .


Communication and information in order to reduce anxiety in the intensive care unit ( ICU ) has been described as area needing improvement .


Therefore , the aim of this trial was to evaluate whether a structured information program that intensifies information given in standard care process reduces anxiety in ICU patients .


Multicenter , two-armed , non-blinded , parallel-group randomized controlled trial in hospitals in the cities of Marburg , Halle , and Stuttgart ( Germany ) .


The trial was performed in cardiac surgery , general surgery , and internal medicine ICUs .


Two-hundred and eleven elective and non-elective ICU patients were enrolled in the study ( intervention group , n = @ ; control group , n = @ ) .


The experimental intervention comprised a single episode of structured oral information that was given in addition to standard care and covered two main parts : ( @ ) A more standardized part about predefined ICU specific aspects - mainly procedural , sensory and coping information , and ( @ ) an individualized part about fears and questions of the patient .


The control group received a non-specific episodic conversation of similar length additional to standard care .


Both conversations took place at the beginning of the ICU stay and lasted @-@ minutes .


Study nurses administered both interventions .


The primary outcome ICU-related anxiety ( CINT-Score , @-@ pts. , higher scores indicate higher anxiety ) was assessed after admission to a regular ward .


The primary outcome could be measured in @ intervention group participants and @ control group participants resulting in mean values of @ ( SD @ ) compared to @ ( SD @ ) and a mean difference of -@ ( CI @ % -@ to @ ) .


A structured information intervention additional to standard care during ICU stay had no demonstrated additional benefit compared to an unspecific communication of similar duration .


Reduction of anxiety in ICU patients will probably require more continuous approaches to information giving and communication .


High blood pressure is associated with poor outcome after stroke .


Whether blood pressure should be lowered early after stroke , and whether to continue or temporarily withdraw existing antihypertensive drugs , is not known .


We assessed outcomes after stroke in patients given drugs to lower their blood pressure .


In our multicentre , partial-factorial trial , we randomly assigned patients admitted to hospital with an acute ischaemic or haemorrhagic stroke and raised systolic blood pressure ( systolic @-@ mm Hg ) to @ days of transdermal glyceryl trinitrate ( @ mg per day ) , started within @ h of stroke onset , or to no glyceryl trinitrate ( control group ) .


A subset of patients who were taking antihypertensive drugs before their stroke were also randomly assigned to continue or stop taking these drugs .


The primary outcome was function , assessed with the modified Rankin Scale at @ days by observers masked to treatment assignment .


This study is registered , number ISRCTN@ .


Between July @ , @ , and Oct @ , @ , we enrolled @ patients .


Mean blood pressure was @ ( SD @ ) mm Hg/@ ( @ ) mm Hg at baseline ( median @ h -LSB- @-@ -RSB- after stroke onset ) , and was significantly reduced on day @ in @ patients allocated to glyceryl trinitrate compared with @ controls ( difference -@ -LSB- @ % CI -@ to -@ -RSB- mm Hg / -@ -LSB- -@ to -@ -RSB- mm Hg ; both p < @ ) , and on day @ in @ patients allocated to continue antihypertensive drugs compared with @ patients randomised to stop them ( difference -@ -LSB- @ % CI -@ to -@ -RSB- mm Hg / -@ -LSB- -@ to -@ -RSB- mm Hg ; both p < @ ) .


Functional outcome at day @ did not differ in either treatment comparison-the adjusted common odds ratio ( OR ) for worse outcome with glyceryl trinitrate versus no glyceryl trinitrate was @ ( @ % CI @-@ ; p = @ ) , and with continue versus stop antihypertensive drugs OR was @ ( @-@ ; p = @ ) .


In patients with acute stroke and high blood pressure , transdermal glyceryl trinitrate lowered blood pressure and had acceptable safety but did not improve functional outcome .


We show no evidence to support continuing prestroke antihypertensive drugs in patients in the first few days after acute stroke .


The mercury sphygmomanometer has been the gold standard used for obtaining blood pressure ( BP ) for the National Health and Nutrition Examination Survey ( NHANES ) from @ to the present .


However , due to environmental concerns and an increased use of automated oscillometric BP devices , NHANES has been exploring an alternative to using the standard mercury sphygmomanometer ( mercury ) to measure BP .


The accuracy of Omron HEM-@XL BP readings was compared with that of mercury BP device readings for gender , age group , race and ethnicity , and body mass index categories and cuff-size subgroups .


Each person had three BP measurements per device recorded sequentially .


The order of the devices and readers were randomly assigned .


A total of @,@ participants had three valid systolic readings , and @,@ had three valid diastolic readings .


Omron and mercury measurements were correlated ( r = @ , systolic BP ; r = @ , diastolic BP ) .


Overall , the mean between-device differences ( Omron and mercury ) were -@ mm Hg for systolic and -@ mm Hg for diastolic ( p < @ for both ) .


The mean between-device differences were less than or about @ mm Hg for each subgroup : gender , age group , race and ethnicity , and body mass index categories , and cuff-size subgroups .


The exceptions were mean systolic between-device differences for those using the extra-large BP cuff ( -@ mm Hg ) and obese individuals ( -@ mm Hg ) , and the mean diastolic between-device differences for the underweight group ( -@ mm Hg ) .


Assuming mercury to be the gold standard , between-device agreements for the frequency of high BP ( @/@ mm Hg or more ) and stage II high BP ( @/@ mm Hg or more ) were above chance ( kappa = @ for both ) .


Omron underestimated the high BP frequency by @ % and stage II high BP frequency by @ % .


Lower estimates of high BP by the Omron device may require adjusting future national prevalence estimates accordingly to account for between-device differences .


Challenging behaviors exhibited by individuals with dementia might result from an unmet need that they can not communicate directly due to cognitive restrictions .


A dementia-specific case conference represents a promising means of analyzing and exploring these unmet needs .


The ongoing FallDem study is a stepped-wedged , cluster-randomized trial evaluating the effects of two different types of dementia-specific case conferences on the challenging behaviors of nursing home residents .


This study protocol describes the process evaluation that is conducted , along with the FallDem study.The goal of the process evaluation is to explain potential discrepancies between expected and observed outcomes , and to provide insights into implementation processes and recruitment strategies , as well as the contexts and contextual factors that promote or inhibit the implementation of dementia-specific case conferences .


The process evaluation will use a mixed-method design comprising longitudinal elements , in which quantitative and qualitative data will be gathered .


Qualitative data will be analyzed using content analysis , documentary analysis and a documentary method .


Quantitative data ( standardized questionnaires ) will be analyzed using descriptive statistics .


Both types of data will complement one another and provide a more comprehensive picture of the different objects under investigation .


The process evaluation will allow for a comprehensive understanding of the changing processes and mechanisms underlying the ` black box ' of the complex intervention of the FallDem study .


These findings will provide practical knowledge regarding issues related to the implementation of dementia-specific case conferences in nursing homes .


The Achilles tendon is a tissue that responds to mechanical loads at a molecular and cellular level .


In vitro and in vivo studies have shown that the expression of anabolic and/or catabolic proteins can change within hours of loading and return to baseline levels within @h .


These biochemical changes have not been correlated with changes in whole tendon structure on imaging .


We examined the nature and temporal sequence of changes in Achilles tendon structure in response to competitive game loads in elite Australian football players .


Elite male Australian football players with no history of Achilles tendinopathy were recruited .


Achilles tendon structure was quantified using ultrasound tissue characterisation ( UTC ) imaging , a valid and reliable measure of intratendinous structure , the day prior to the match ( day @ ) , and then reimaged on days @ , @ and @ postgame .


Of the @ participants eligible for this study , @ had no history of tendinopathy ( NORM ) and @ had a history of patellar or hamstring tendinopathy ( TEN ) .


Differences in baseline UTC echopattern were observed between the NORM and TEN groups , with the Achilles of the TEN group exhibiting altered UTC echopattern , consistent with a slightly disorganised tendon structure .


In the NORM group , a significant reduction in echo-type I ( normal tendon structure ) was seen on day @ ( p = @ ) that returned to baseline on day @ .


There was a transient change in UTC echopattern in the Achilles tendon as a result of an Australian football game in individuals without a history of lower limb tendinopathy .


To assess the feasibility of conducting a randomized trial comparing two strategies -LSB- physician ( MD ) vs. non-physician ( non-MD ) -RSB- for approaching substitute decision makers ( SDMs ) for research and to evaluate SDMs ' experiences in being approached for consent .


A pilot mixed methods study of first encounters with SDMs .


Of @ SDMs ( @ eligibility events ) , @ and @ were randomized to MD and non-MD introductions , respectively .


Eighty SDMs ( @ events ) provided consent and @ SDMs ( @ events ) declined consent for studies , including @ SDMs who provided and declined consent .


We identified few missed introductions -LSB- @/@ ( @ % ) -RSB- and protocol violations -LSB- @/@ ( @ % ) -RSB- , high comfort , satisfaction and acceptance scores and similar consent rates in both arms .


SDMs provided consent significantly more often when a patient update was provided in the MD arm .


Most SDMs ( @ % ) felt that physician involvement was inconsequential and preferred physician time to be dedicated to patient care ; however , SDM experiences were closely related to their recall of being approached and recall was poor .


SDMs highlighted @ themes of importance to them in research surrogate decision-making .


SDMs prioritized the personal attributes of the person approaching them over professional designation and preferred physician time to be dedicated to patient care .


A mixed methods design evaluated intervention fidelity and provided the rationale for not proceeding to a larger trial , despite achieving all feasibility metrics in the pilot trial .


Describe the three-year results of a program designed for the adoption of a healthy life style in primary school students on the body mass index ( BMI ) and the consumption of food .


Community randomized and controlled trial .


Two communities in the State of Mexico with similar socio-demographic characteristics were randomized to implement the intervention ( n = @ ) or serve as a control ( n = @ ) .


The intervention was carried out in primary schools and it consisted of education on healthy habits , modification of distributed food and physical activity .


The primary outcome was the change in BMI .


After three years , intervention resulted in a lower increase of BMI ( @ vs. @ Kg/m , p < @ ) and a decreased consumption of total calories , bread , fat and sugar consumption in the schools .


School programs are useful to address childhood obesity , but its benefits are not immediate .


To evaluate the clinical efficacy of electroacupuncture ( EA ) for apoplectic urinary incontinence .


Two hundred and four cases of apoplectic urinary incontinence were randomized into an EA group ( @ cases ) and an indwelling catheter group ( @ cases ) .


The EA was applied at Qugu ( CV @ ) , Zhongji ( CV @ ) , Shuidao ( ST @ ) , Qihai ( CV @ ) and Guanyuan ( CV @ ) , etc. in the EA group ,@ times a week .


Indwelling catheter was applied in the indwelling catheter group at intervals of @-@ hours , and periodic bladder irrigation along with bladder rehabilitation training were also given .


The efficacies were evaluated after @ weeks of treatment .


Before and after treatment , the urination diary ( including the interval of urination , nocturia frequency , urination difficulty , urinary incontinence severity ) , bladder capacity , patients ' satisfaction of the two groups were observed and the efficacy was evaluated .


The total effective rate was @ % ( @/@ ) in the EA group , which was apparently superior to @ % ( @/@ ) in the indwelling catheter group ( P < @ ) ; except for nocturia frequency in the indwelling catheter group , the total score and the subitem score in the urination diary were all improved significantly after treatment in both groups ( all P < @ ) , which were more obvious in the EA group ( P < @ , P < @ ) ; the patients ' satisfaction and bladder capacity were all improved significantly after treatment in both groups ( all P < @ ) , which were more obvious in the EA group ( both P < @ ) .


The EA has an obvious effect for apoplectic urinary incontinence in urinary incontinence alleviation and bladder capacity increase , which has better efficacy than indwelling catheter therapy .


To determine changes in Canine Brief Pain Inventory scores for dogs with osteoarthritis after administration of a monoclonal antibody ( mAb ) against nerve growth factor ( NGF ) that was modified by use of a proprietary process for administration to dogs .


@ adult dogs .


Dogs received the anti-NGF mAb ( @ mg/kg , IV ) at various evaluation times during the study period ; at other evaluation times , dogs received an equivalent volume of PBS solution IV .


Owners determined Canine Brief Pain Inventory pain severity ( PS ) and pain interference ( PI ) scores immediately before ( baseline ) and @ , @ , and @ weeks after administration of the anti-NGF mAb ; owners were unaware of the evaluation time at which the mAb had been administered .


Compared with baseline PS scores ( median , @ ; range , @ to @ ) , dogs had significantly lower PS scores @ weeks ( median , @ ; range , @ to @ ) and @ weeks ( median , @ ; range , @ to @ ) after administration of anti-NGF mAb .


Compared with baseline PI scores ( median , @ ; range , @ to @ ) , dogs had significantly lower PI scores @ weeks ( median , @ ; range , @ to @ ) and @ weeks ( median , @ ; range , @ to @ ) after administration of anti-NGF mAb .


The PS and PI scores @ weeks after mAb administration were lower than baseline scores , although values were not significantly different .


Results of this study suggested the evaluated anti-NGF mAb decreased PS and PI scores for @ weeks after administration .


This treatment may be effective for alleviation of signs of pain in dogs with osteoarthritis for up to @ weeks .


Dilation-assisted stone extraction , also termed small endoscopic sphincterotomy ( EST ) plus endoscopic papillary balloon dilatation , is more efficient than EST alone for removal of large common bile duct ( CBD ) stones .


However , whether this technique can be used for all stones is unclear .


This study was designed to evaluate the efficacy and complications of dilation-assisted stone extraction for CBD stones .


A total of @ patients with CBD stones were randomized to undergo either dilation-assisted stone extraction ( group A ) or EST ( group B ) .


The efficacy and complications of the two techniques were compared .


Groups A and B showed similar outcomes in terms of stone removal .


The short-term and @-year complication rates were also similar between the two groups .


However , the first-session stone removal rate in group A was significantly higher than that in group B. Mechanical lithotripsy was required significantly more often in group B than in group A.


The total procedure time and total fluoroscopy time in group A were significantly shorter than those in group B.


Dilation-assisted stone extraction and EST are safe and effective techniques for the treatment of CBD stones .


Dilation-assisted stone extraction has high efficiency .


This technique is an alternative method for removal of CBD stones .


The @-amino acid ( AA ) signature , including isoleucine , leucine , valine , tyrosine , and phenylalanine , has been associated with incident diabetes mellitus and insulin resistance .


We investigated whether this same AA signature , single-nucleotide polymorphisms in genes in their catabolic pathway , was associated with development of impaired fasting glucose ( IFG ) after atenolol treatment .


Among @ European American participants enrolled in the Pharmacogenomic Evaluation of Antihypertensive Responses ( PEAR ) study and treated with atenolol for @ weeks , we prospectively followed a nested cohort that had both metabolomics profiling and genotype data available for the development of IFG .


We assessed the association between baseline circulating levels of isoleucine , leucine , valine , tyrosine , and phenylalanine , as well as single-nucleotide polymorphisms in branched-chain amino-acid transaminase @ ( BCAT@ ) and phenylalanine hydroxylase ( PAH ) with development of IFG .


All baseline AA levels were strongly associated with IFG development .


Each increment in standard deviation of the @ AAs was associated with the following odds ratio and @ % confidence interval for IFG based on a fully adjusted model : isoleucine @ ( @-@ @ ) , leucine @ ( @-@ @ ) , valine @ ( @-@ @ ) , tyrosine @ ( @-@ @ ) , and phenylalanine @ ( @-@ @ ) .


The composite P value was @ ( -@ ) .


Those with PAH ( rs@ ) AA genotype had the highest incidence of IFG ( P for trend = @ ) .


Our data provide important insight into the metabolic and genetic mechanisms underlying atenolol-associated adverse metabolic effects .


Clinical Trial Registration - http://www.clinicaltrials.gov; Unique Identifier : NCT@ .


Tobacco use is still the leading preventable cause of death and morbidity in the U.S. Web-assisted tobacco interventions are an effective but underutilized tool in assisting smokers with quitting .


The dental visit is an excellent opportunity to assist smokers in quitting by referring them to these tobacco-cessation online programs .


The study purpose was to test two patient referral methods-paper referrals ( information prescriptions ) versus paper plus e-referrals-to a web-assisted smoking-cessation induction system .


RCT that used implementation research methods .


A total of @ community-based dental practices were enrolled and @ smokers were referred to the web-assisted tobacco induction system .


The study intervention was a proactive e-referral of smokers to a web-assisted tobacco induction system called Decide@Quit.org , and the control group used paper referrals ( information prescriptions ) to refer smokers to the Decide@Quit.org .


The outcome measurements were the referral numbers , Decide@Quit registration numbers , and the smokers ' quit rate .


Data were collected in @-@ and analyses were completed in @ .


Although total referrals from intervention practices was lower than control , subsequent proportions of registrations among smokers referred to Decide@Quit.org were nearly fourfold higher ( adjusted mean percentages : @ % vs @ % , p < @ ) in intervention compared with control practices .


Subsequent rates of cessation among referred smokers were threefold higher ( adjusted mean percentages : @ % vs @ % , p = @ ) in intervention practices as compared with control .


Intervention practices using the e-referral system had higher smoker registration numbers and higher quit smoking rates than the control practices .


This study finds that e-referrals are effective in getting smokers to the web-assisted smoking-cessation induction system and in assisting with quitting that more than compensates for any additional effort that e-referrals require on the part of the practitioner .


The plasticity of bone marrow stem cells has been confirmed to self-renew and transdifferentiate into hepatocytes .