At baseline , @ months , and @ months after randomization , participants completed a questionnaire and provided a blood sample .


Analysts were blinded to intervention arm .


The immediate intervention group ( -@ % -LSB- standard error ( SE ) @ -RSB- ) showed a significant improvement in HbA@c scores ( -@ % , P = @ ) compared with the delayed intervention group ( -@ % , P = @ ) .


No significant changes were seen for dietary end points or changes in physical activity .


We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group .


This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA@c levels in Hispanic adults with HbA@c levels higher than @ % .


To evaluate the impact of a clinical pharmacy program on health outcomes in patients with type @ diabetes undergoing insulin therapy at a teaching hospital in Brazil .


A randomized controlled trial with a @-month follow-up period was performed in @ adults , aged @ years or older , with type @ diabetes who were taking insulin and who had an HbA@c level @ % .


Patients in the control group ( CG ) ( n = @ ) received standard care , patients in the intervention group ( IG ) ( n = @ ) received an individualized pharmacotherapeutic care plan and diabetes education .


The primary outcome measure was change in HbA@c .


Secondary outcomes included diabetes and medication knowledge , adherence to medication , insulin injection and home blood glucose monitoring techniques and diabetes-related quality of life .


Outcomes were evaluated at baseline and @ months using questionnaires .


Diabetes knowledge , medication knowledge , adherence to medication and correct insulin injection and home blood glucose monitoring techniques significantly improved in the intervention group but remained unchanged in the control group .


At the end of the study , mean HbA@c values in the control group remained unchanged but were significantly reduced in the intervention group .


Diabetes-related quality of life significantly improved in the intervention group but worsened significantly in the control group .


The program improved health outcomes and resulted in better glycemic control in patients with type @ diabetes undergoing insulin therapy .


Improving school water , sanitation and hygiene ( WASH ) conditions reduces pupil absence and illness .


However , these benefits may depend on the conditions of the latrines and availability of consumables .


We sought to determine whether a low-cost , policy-relevant , environmental-level latrine cleaning intervention could improve latrine cleanliness , increase its use and reduce absenteeism .


In a three-arm , cluster-randomized trial we assessed absence via periodical roll-call among @ @ pupils in @ schools that had previously received WASH improvements as part of the SWASH + project .


Latrine conditions and use were also assessed using structured observation .


Latrine cleanliness increased significantly during the post-intervention period among schools receiving the latrine cleaning package compared to controls , as did handwashing with soap .


We found no difference in latrine use and absence across arms .


The additive impact of cleaning may not have been strong enough to impact absence above and beyond reductions attributable to the original WASH infrastructure improvements and basic hygiene education the schools previously received .


Improving latrine conditions is important for the dignity and well-being of pupils , and investments and strategies are necessary to ensure that school toilets are clean and pupil-friendly .


Several studies have identified relationships between weight loss and adipokine levels ; however , none have looked at the combined effect of aerobic exercise training with the consumption of a low - or a high-glycemic diet .


We examined the effects of @ wk of aerobic exercise combined with either a low-glycemic index diet ( @ U ) plus exercise ( LoGIX ) or a high-glycemic index diet ( @ U ) diet plus exercise ( HiGIX ) on plasma leptin and adiponectin ( total and high molecular weight -LSB- HMW -RSB- ) in @ older obese adults ( age = @ @ yr , body mass index = @ @ kgm ) .


Insulin sensitivity was calculated from an oral glucose tolerance test .


Fasting HMW adiponectin and leptin were quantified from plasma samples obtained before the insulin sensitivity index obtained from the oral glucose tolerance test .


Glucose and insulin measures were obtained before and every @ min during the test .


Dual-energy x-ray absorptiometry and computerized tomography were used to determine body composition and to quantify subcutaneous and visceral abdominal adiposity , respectively .


Fasting leptin was significantly decreased in both groups ( LoGIX : preintervention = @ @ , postintervention = @ @ ; HiGIX : preintervention = @ @ , postintervention = @ @ ngmL ; P = @ ) , and HMW adiponectin was significantly increased ( LoGIX : preintervention = @ @ , postintervention = @ @ ; HiGIX : preintervention = @ @ , postintervention = @ @ pgmL ; P = @ ) after the @-wk intervention .


Total body fat was reduced after both interventions .


Visceral fat mass was inversely correlated with HMW adiponectin , whereas subcutaneous fat correlated with leptin .


The data suggest that exercise training , independent of dietary glycemic index , favorably alters HMW adiponectin and leptin secretion and that a reduction in visceral fat mass is a key factor regulating HMW adiponectin in older obese persons .


Allogeneic mesenchymal precursor cells ( MPCs ) have been effective in large animal models of ischemic and nonischemic heart failure ( HF ) .


To evaluate the feasibility and safety of @ doses ( @ , @ , or @ million cells ) of immunoselected allogeneic MPCs in chronic HF patients in a phase @ trial .


We sequentially allocated @ patients to a dosing cohort ( @ per dose group ) and randomized them to transendocardial MPC injections ( n = @ ) or mock procedures ( n = @ ) .


The primary objective was safety , including antibody testing .


Secondary efficacy end points included major adverse cardiac events ( MACE ; cardiac death , myocardial infarction , or revascularization ) , left ventricular imaging , and other clinical-event surrogates .


Safety and MACE were evaluated for up to @ years .


MPC injections were feasible and safe .


Adverse events were similar across groups .


No clinically symptomatic immune responses were noted .


MACE was seen in @ patients : @ of @ ( @ % ) MPC-treated and @ of @ ( @ % ) control patients .


We found no differences between MPC-treated and control patients in survival probability , MACE-free probability , and all-cause mortality .


We conducted a post hoc analysis of HF-related MACE ( HF hospitalization , successfully resuscitated cardiac death , or cardiac death ) and events were significantly reduced in the @ million MPC group ( @/@ ) versus control ( @/@ ; @ % ) , @ million MPC group ( @/@ ; @ % ) , and @ million MPC group ( @/@ ; @ % ) ; the @ million MPC group differed significantly from all groups according to Kaplan-Meier statistics > @ years ( P = @ for @ million MPC group versus control ) .


Transendocardial injections of allogeneic MPCs were feasible and safe in chronic HF patients .


High-dose allogeneic MPCs may provide benefits in this population .


Despite the excess risk of mortality in young women ( @ years of age ) after acute myocardial infarction ( AMI ) , little is known about young women 's health status ( symptoms , functioning , quality of life ) during the first year of recovery after an AMI .


We examined gender differences in health status over time from baseline to @ months after AMI .


A total of @ AMI patients ( @ % women ) @ to @ years of age were enrolled from @ US and @ Spanish hospitals .


Data were obtained by medical record abstraction and patient interviews at baseline hospitalization and @ and @ months after AMI .


Health status was measured by generic ( Short Form-@ ) and disease-specific ( Seattle Angina Questionnaire ) measures .


We compared health status scores at all @ time points and used longitudinal linear mixed-effects analyses to examine the independent effect of gender , adjusting for time and selected covariates .


Women had significantly lower health status scores than men at each assessment ( all P values < @ ) .


After adjustment for time and all covariates , women had Short Form-@ physical/mental summary scores that were -@ ( @ % confidence interval -LSB- CI -RSB- , -@ to -@ ) and -@ points ( @ % CI , -@ to -@ ) lower than those of men , as well as worse Seattle Angina Questionnaire physical limitations ( -@ points lower ; @ % CI , -@ to -@ ) , more angina ( -@ points lower ; @ % CI , -@ to -@ ) , and poorer quality of life ( -@ points lower ; @ % CI , -@ to -@ ) .


Although both genders recover similarly after AMI , women have poorer scores than men on all health status measures , a difference that persisted throughout the entire year after discharge .


This pilot study examined the feasibility outcome recruitment , safety and compliance of the investigation for stochastic resonance whole-body vibration ( SR-WBV ) training .


Another aim was to evaluate the effect size of one SR-WBV intervention session on Short Physical Performance Battery ( SPPB ) , Expanded Timed Get Up-and-Go ( ETGUG ) , isometric maximal voluntary contraction ( IMVC ) and rate of force development ( IRFD ) and chair rising ( CR ) .


Randomised double-blinded controlled cross-over pilot study .


Feasibility outcomes included recruitment , safety and compliance .


For secondary outcomes , SPPB , ETGUG , IMVC , IRFD and CR were measured before and @-min after intervention .


Nonparametric Rank-Order Tests of Puri and Sen L Statistics to Ranked Data were proposed .


Wilcoxon signed-ranked tests were used to analyse the differences after SR-WBV intervention and sham intervention .


Treatment effects between the interventions were compared by a Mann-Whitney U test .


Among @ eligible frail elderly , @ agreed to participate and @ drop out .


The adherence was @ of @ intervention sessions .


For secondary outcome , effect sizes ( ES ) for SR-WBV intervention on SPPB , ETGUG and CR were determined .


This pilot study indicate that the training protocol used in this form for frail elderly individuals is feasible but with modification due to the fact that not all defined feasibility outcomes target was met .


SR-WBV with @Hz , noise level @ shows benefit improvements on SPPB ( ES @ ) , ETGUG ( part sit-to-stand movement : ES @ ; total time : ES @ ) and CR ( ES @ ) .


Further research is desired to determine whether a new adapted training protocol is necessary for SR-WBV in the `` skilling up '' phase in frail elderly individuals .


The Effectiveness and Cost of ICD follow-up Schedule with Telecardiology ( ECOST ) trial evaluated prospectively the economic impact of long-term remote monitoring ( RM ) of implantable cardioverter defibrillators ( ICDs ) .


The analysis included @ patients randomly assigned to RM ( active group ) vs. ambulatory follow-ups ( control group ) .


Patients in the active group were seen once a year unless the system reported an event mandating an ambulatory visit , while patients in the control group were seen in the ambulatory department every @ months .


The costs of each follow-up strategy were compared , using the actual billing documents issued by the French health insurance system , including costs of ( i ) ( a ) ICD-related ambulatory visits and transportation , ( b ) other ambulatory visits , ( c ) cardiovascular treatments and procedures , and ( ii ) hospitalizations for the management of cardiovascular events .


The ICD and RM system costs were calculated on the basis of the device remaining longevity at the end of the study .


The characteristics of the study groups were similar .


Over a follow-up of @ months , the mean non-hospital costs per patient-year were @ @ in the active , vs. @ @ in the control group ( P = @ ) , a @ difference mainly due to device management .


The hospitalization costs per patient-year were @ @ and @ @ in the active and control groups , respectively ( P = @ ) .


Adding the ICD to the non-hospital costs , the savings were @ ( P = @ ) or , when the monitoring system was included , @ ( P = @ ) per patient-year .


From the French health insurance perspective , the remote management of ICD patients is cost saving .


To test if posterior retroperitoneoscopic adrenalectomy ( PRA ) is superior to lateral transperitoneal laparoscopic adrenalectomy ( LTLA ) .


Most popular LTLA has been recently challenged by an increasing popularity of PRA , which is believed by many surgeons ( not evidence-based ) as superior to LTLA in the treatment of small and benign adrenal tumors .


Participants were assigned randomly to PRA or LTLA and followed for @ years after surgery .


The primary endpoint was the duration of surgery .


Secondary endpoints were blood loss , conversion rate , postoperative recovery , morbidity , and costs .


Sixty-five patients were included , of whom @ ( PRA @ , LTLA @ ) completed the @-year follow-up .


The following differences were identified in favor of PRA vs LTLA : shorter duration of surgery ( @ vs @ minutes ) , lower intraoperative blood loss ( @ vs @ mL ) , diminished pain intensity within @ hours postoperatively , lower prevalence of shoulder-tip pain ( @ % vs @ % ) , shorter time to oral intake ( @ vs @ hours ) , shorter time to ambulation ( @ vs @ hours ) , shorter length of hospital stay , and lower cost ( @ vs @ ) , respectively ( P < @ for all ) .


No differences were noted in conversion rate or morbidity except for herniation occurring more often after LTLA than PRA ( @ % vs @ % , P = @ ) and need for hernia repair ( @ % vs @ % , P = @ ) , respectively .


Both approaches were equally safe .


However , outcomes of PRA operations were superior to LTLA in terms of shorter surgery duration , lower blood loss , lower postoperative pain , faster recovery , improved cost-effectiveness , and abolished risk of surgical access site herniation .


Our group conducted a cluster-randomised trial in @ villages of Orissa , India to measure the impact of a rural sanitation intervention implemented under the government of India 's Total Sanitation Campaign , on diarrhoea and soil-transmitted helminth infections .


This paper reports on a process evaluation conducted in the context of the trial .


Process evaluation data were collected through review of key documentation , quantitative surveys , direct observations , and semi-structured interviews with staff from implementing NGOs and community members .


Between March @ and March @ , trained enumerators recorded observations on latrine construction status every @-@ weeks in the @ intervention villages and noted activities reported to have taken place based on NGO staff interviews and review of NGO records .


A survey among @ % of households in intervention and control villages was conducted to compare levels of awareness of key intervention components .


In addition , @ % of village water and sanitation committee ( VWSC ) members were interviewed to measure their level of involvement in the intervention delivery .


The percentage of households with a latrine ( completed or under construction ) increased from @ % at baseline to @ % one year after the start of the intervention in March @ .


Almost none of the intervention households recall any form of participatory community-level activities at the start of the programme , although intervention households were generally more aware of the Total Sanitation Campaign ( @ % versus @ % , p < @ ) , VWSCs ( @ % versus @ % , p < @ ) , adolescent girls groups ( @ % versus @ % , p < @ ) , wall paintings ( @ % versus @ % , p < @ ) and were more likely to report a household visit on sanitation during the past three months ( @ % versus @ % , p < @ ) .


We found no strong evidence of an association between levels of awareness of or participation in mobilisation activities and levels of latrine coverage in intervention villages .


The levels of coverage achieved and the levels of awareness of the mobilisation process in our intervention villages were lower than planned , but similar to those reported elsewhere in India under the TSC .


Our process evaluation highlights important gaps between the TSC guidelines and their implementation on the ground .


Nonspecific low back pain ( NLBP ) is the diagnosis for individuals with back pain that has no underlying medical cause ( eg , tumor , infection , fracture , herniated disc , spinal stenosis ) .


The American College of Physicians ( ACP ) and American Pain Society ( APS ) recommend multidisciplinary treatments for NLBP that lasts more than @ weeks .


This approach , however , is impractical for many physicians to implement , and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines .


This study evaluated the efficacy of a mobile-Web intervention called `` FitBack '' to help users implement self-tailored strategies to manage and prevent NLBP occurrences .


A total of @ adults were recruited , screened , consented , and assessed online at baseline , at @ months ( T@ ) , and at @ months ( T@ ) .


After baseline assessments , participants were randomized into three groups : FitBack intervention , alternative care group that received @ emails urging participants to link to six Internet resources for NLBP , and control group .


The FitBack group also received weekly email reminder prompts for @ weeks plus emails to do assessments .


The control group was only contacted to do assessments .


Users of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical , behavioral , and worksite outcome measures at @-month follow-up .


In addition , users of the FitBack program performed better than the alternative care group on current back pain , behavioral , and worksite outcomes at @-month follow-up .


For example , subjects in the control group were @ times more likely to report current back pain than subjects in the FitBack group ; subjects in the alternative care group were @ times more likely to report current back pain at @-month follow-up .


Further , the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at @-month follow-up on patient activation , constructs of the Theory of Planned Behavior , and attitudes toward pain .


This research demonstrated that a theoretically based stand-alone mobile-Web intervention that tailors content to users ' preferences and interests can be an effective tool in self-management of low back pain .


When viewed from the RE-AIM perspective ( ie , reach , efficacy/effectiveness , adoption , implementation fidelity , and maintenance ) , this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people .


The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign , which might have provided additional support for participants .


Still , more research is needed on how self-guided mobile-Web interventions will be used over time and to understand factors associated with continuing user engagement .


Our aim was to study the impact of delay from symptom onset to first coronary device oninfarct size and clinical outcomes at @ days and @ year in patients with ST-segment elevation myocardial infarction ( STEMI ) treated with primary percutaneous coronary intervention .


Longer delay from symptom onset to reperfusion has been linked to increased mortality and worse clinical outcome .


The mechanisms underpinning this association are not entirely clear .


The INFUSE-AMI trial ( INFUSE-Anterior Myocardial Infarction ) randomized patients with anterior STEMI undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation within @ h of symptom onset to intralesion ( IL ) bolus abciximab versus no abciximab and to thrombus aspiration versus no aspiration .


The primary endpoint was contrast magnetic resonance infarct size ( IS ) ( percentage of left ventricular mass ) at @ days .


Time to reperfusion was classified as < @ versus @ h.


There were @ patients ( @ % ) with < @-h delay and @ patients ( @ % ) with @-h delay .


Patients with longer delay were significantly older , more often women , and diabetic .


Earlier reperfusion was not associated with higher rates of final Thrombolysis In Myocardial Infarction flow grade @ or myocardial blush grade @/@ , but was an independent predictor of smaller IS ( p = @ by multivariable linear regression ) .


Mortality at @ year was reduced in patients with shorter delay to reperfusion ( @ % vs. @ % , p = @ ) .


In patients with large anterior myocardial infarction undergoing relatively early reperfusion , longer delays to reperfusion were associated with larger IS and @-year mortality , but notwith reduced reperfusion success .


( The INFUSE - Anterior Myocardial Infarction -LSB- AMI -RSB- Study ; NCT@ ) .


Fat accumulation in nonadipose tissue is linked to insulin resistance and metabolic diseases .


Earlier studies have shown that hepatic lipid accumulation can occur after @ d of a high-fat diet in humans , and this fat accumulation can be blunted by the ingestion of additional proteins .


In this study , we explored whether a single high-fat meal increased the lipid content in liver and skeletal muscle as measured by using in vivo proton magnetic resonance spectroscopy ( H-MRS ) and whether the addition of protein can modulate the postprandial ectopic lipid storage .


Intrahepatic lipid ( IHL ) and intramyocellular lipid ( IMCL ) concentrations were determined by using H-MRS before and @ and @ h after a high-fat with added protein meal ( @ % of energy from fat ) or a high-fat without added protein meal ( mean SEM : @ @ g of protein ; @ @ kcal added ) in a randomized crossover study .


IHL and IMCL concentrations were converted to absolute concentrations ( g/kg wet weight ) by using water as an internal reference .


Nine lean , healthy subjects -LSB- @ men and @ women ; mean ( SD ) age : @ @ y ; mean body mass index ( in kg/m ) : @ @ -RSB- were included in this study .


IHL concentrations increased @ % ( P < @ ) at @ h after the meal and did not further increase after @ h.


In contrast , IMCL concentrations were not altered during the postprandial period ( P = @ ) .


The addition of protein to a single high-fat meal did not change the postprandial accumulation of fat in the liver ( P = @ ) or skeletal muscle ( P = @ ) .


In this study , we showed that a single energy-dense , high-fat meal induced net lipid accumulation in the liver , which was detected by using in vivo H-MRS .


This noninvasive approach might bring new opportunities to study postprandial hepatic lipid dynamics .


The addition of protein did not change the ectopic lipid retention after a single high-fat meal .


Rates of self-harm are high and have recently increased .


This trend and the repetitive nature of self-harm pose a significant challenge to mental health services .


To determine the efficacy of a structured group problem-solving skills training ( PST ) programme as an intervention approach for self-harm in addition to treatment as usual ( TAU ) as offered by mental health services .


A total of @ participants ( aged @-@ years ) were randomly assigned to TAU plus PST or TAU alone .


Assessments were carried out at baseline and at @-week and @-month follow-up and repeated hospital-treated self-harm was ascertained at @-month follow-up .


The treatment groups did not differ in rates of repeated self-harm at @-week , @-month and @-month follow-up .


Both treatment groups showed significant improvements in psychological and social functioning at follow-up .


Only one measure ( needing and receiving practical help from those closest to them ) showed a positive treatment effect at @-week ( P = @ ) and @-month ( P = @ ) follow-up .


Repetition was not associated with waiting time in the PST group .


This brief intervention for self-harm is no more effective than treatment as usual .


Further work is required to establish whether a modified , more intensive programme delivered sooner after the index episode would be effective .


Assimilating the diagnosis complete spinal cord injury ( SCI ) takes time and is not easy , as patients know that there is no ` cure ' at the present time .


Brain-computer interfaces ( BCIs ) can facilitate daily living .


However , inter-subject variability demands measurements with potential user groups and an understanding of how they differ to healthy users BCIs are more commonly tested with .


Thus , a three-class motor imagery ( MI ) screening ( left hand , right hand , feet ) was performed with a group of @ able-bodied and @ complete spinal-cord-injured people ( paraplegics , tetraplegics ) with the objective of determining what differences were present between the user groups and how they would impact upon the ability of these user groups to interact with a BCI .


Electrophysiological differences between patient groups and healthy users are measured in terms of sensorimotor rhythm deflections from baseline during MI , electroencephalogram microstate scalp maps and strengths of inter-channel phase synchronization .


Additionally , using a common spatial pattern algorithm and a linear discriminant analysis classifier , the classification accuracy was calculated and compared between groups .


It is seen that both patient groups ( tetraplegic and paraplegic ) have some significant differences in event-related desynchronization strengths , exhibit significant increases in synchronization and reach significantly lower accuracies ( mean ( M ) = @ % ) than the group of healthy subjects ( M = @ % ) .


The results demonstrate significant differences in electrophysiological correlates of motor control between healthy individuals and those individuals who stand to benefit most from BCI technology ( individuals with SCI ) .


They highlight the difficulty in directly translating results from healthy subjects to participants with SCI and the challenges that , therefore , arise in providing BCIs to such individuals .


Patient satisfaction with treatment is an important outcome in facial aesthetic medicine .


To evaluate subject satisfaction with onabotulinumtoxinA treatment of glabellar lines ( GL ) and crow 's feet lines ( CFL ) using the validated Facial Line Satisfaction Questionnaire ( FLSQ ) .


In this randomized double-blind study , subjects with moderate/severe GL and CFL received onabotulinumtoxinA ( @ U , GL ; @ U , CFL ) or placebo .


Over @ days , the following were assessed : satisfaction , achievement of treatment expectations , satisfaction with duration of treatment ( FLSQ ) , severity of GL and CFL ( Facial Wrinkle Scale -LSB- FWS -RSB- ) , and aesthetic improvement ( Global Aesthetic Improvement Scale ) .


Satisfaction in the per-protocol population was significantly greater at Day @ in the onabotulinumtoxinA group ( n = @ ) compared with placebo ( n = @ ) for GL ( @ % vs @ % ; p < @ ) .


Most subjects treated with onabotulinumtoxinA remained satisfied up to @ days .


Achievement of treatment expectations ( @ % ; Day @ ) , satisfaction ( @ % ; Day @ ) , and satisfaction with the duration of treatment ( @ % ; Day @ ) were significantly better with onabotulinumtoxinA than placebo ( p < @ ) for GL and CFL combined .


Efficacy ( FWS ) and aesthetic improvement were observed in most subjects at Days @ and @ , respectively .


High satisfaction rates are achieved and sustained in subjects treated with onabotulinumtoxinA for GL and CFL combined .


To compare efficacy and safety of chloral hydrate ( CH ) , chloral hydrate and promethazine ( CH + P ) and chloral hydrate and hydroxyzine ( CH + H ) in electroencephalography ( EEG ) sedation .


In a parallel single-blinded randomized clinical trial , ninety @-@ y-old uncooperative kids who were referred to Pediatric Neurology Clinic of Shahid Sadoughi University , Yazd , Iran from April through August @ , were randomly assigned to receive @mg/kg of chloral hydrate or @mg/kg of chloral hydrate and @mg/kg of promethazine or @mg/kg of chloral hydrate and @mg/kg of hydroxyzine .


The primary endpoint was efficacy in sufficient sedation ( obtaining four Ramsay sedation score ) and successful completion of EEG .


Secondary endpoint was clinical adverse events .


Thirty nine girls ( @ % ) and @ boys ( @ % ) with mean age of @ y were assessed .


Sufficient sedation and completion of EEG were achieved in @ % ( N = @ ) of chloral hydrate group , in @ % ( N = @ ) of CH + H group and in @ % ( N = @ ) of CH + P group ( p = @ ) .


Mild clinical adverse events including vomiting -LSB- @ % ( N = @ ) in CH , @ % ( N = @ ) in CH + P , @ % ( N = @ ) in CH + H -RSB- , agitation in @ % of CH + P ( N = @ ) group and mild transient hypotension in @ % of CH + H ( N = @ ) group occurred .


Safety of these three sedation regimens was not statistically significant different ( p = @ ) .


Combination of chloral hydrate-antihistamines can be used as the most effective and safe sedation regimen in drug induced sleep electroencephalography of kids .


The relationship of clinical variables for cognitive functioning and other variables such as multiple neuropsychiatric symptoms and quality of life are usually analyzed bivariately and multivariately .


In randomized controlled trials analyses are mostly performed on individual outcome variables .


To unravel interdependencies of determinants and outcome variables , Structural Equation Modeling ( SEM ) was applied .


Using SEM , we explored interdependencies of clinical determinants ( MMSE , BI , and NPI-sum severity ) and quality of life ( EQ@D ) in psychogeriatric patients ( including dementia ) suffering from cognitive problems and multiple neuropsychiatric symptoms .


MMSE and BI showed direct and indirect impact on EQ@D , but the association with NPI-sum severity was minor .


The identified model showed that R ( @ ) of EQ@D varied from @ to @ .


This clinical-empirical study showed that SEM could be utilized to unravel and identify a model of complex direct and indirect effects of MMSE and BI on EQ@D .


In relation to NPI-sum severity , however , the validity of EQ@D seemed insufficient in psychogeriatric patients .


Consequently , the cost-benefit analyses and cost-effectiveness analyses using quality-adjusted life-year measures of an intervention in psychogeriatric patients with multiple neuropsychiatric symptoms , based on EQ@D , are considered questionable .


Construction of a quality of life instrument that is more sensitive with regard to multiple neuropsychiatric symptoms in psychogeriatric patients is highly recommended .


Motive-oriented therapeutic relationship ( MOTR ) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders , in particular with borderline personality disorder ( BPD ) .


The present randomized controlled study using an add-on design is the first study to test this assumption in a @-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance .


A total of @ patients were randomized .


They were either allocated to a manual-based short variant of the general psychiatric management ( GPM ) treatment ( in @ sessions ) or to the same treatment where MOTR was deliberately added to the treatment .


Treatment attrition and integrity analyses yielded satisfactory results .


The results of the intent-to-treat analyses suggested a global efficacy of MOTR , in the sense of an additional reduction of general problems , i.e. symptoms , interpersonal and social problems ( F@ , @ = @ , p < @ ) .


However , they also showed that MOTR did not yield an additional reduction of specific borderline symptoms .


It was also shown that a stronger therapeutic alliance , as assessed by the therapist , developed in MOTR treatments compared to GPM ( Z@ = @ , p < @ ) .


These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising .


Moreover , the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD .


verification of a hypothesis assuming that @-HT@ receptor blockade by intravenous administration of ondansetron reduces the incidence of hypotension and bradycardia in patients undergoing spinal anaesthesia for Caesarean section .


The study design was approved by the Bioethics Committee and included @ patients undergoing elective Caesarean section , randomly assigned to ondansetron group ( group @ ) or placebo group ( group P ) .


Finally group @ encompassed @ patients administered ondansetron @ mg i.v. dissolved in @ ml @ % NaCl whereas group P consisted of @ patients receiving @ % NaCl @ mg .


Systolic and diastolic pressures were measured every @ minutes since the onset of anaesthesia .


Heart rate ( HR ) was monitored continuously The criterion of hypotension requiring ephedrine was a decrease in systolic pressure by @ % compared to its baseline value or a decrease in systolic pressure below @ mm Hg .


The criterion of bradycardia was a decrease in HR below @/min .


Hypotension was observed in @ group @ patients ( @ % ) and in @ group P patients ( @ % ) ; the difference was not statistically significant .


Bradycardia was noted in @ group @ patient ( @ % ) and in @ group P patients ( @ % ) ; the difference was not statistically significant .


A hypothesis assuming a reduction in pressure following subarachnoid anaesthesia for Caesarean section after the administration of @ mg of ondansetron was not confirmed .


Access , enrollment , and engagement with primary and specialty health care services present significant challenges for rural populations worldwide .


The Alabama Veterans Rural Health Initiative evaluated an innovative outreach intervention combining motivational interviewing , patient navigation , and health services education to promote utilization of the United States Veterans Administration Healthcare System ( VA ) by veterans who live in rural locations .


Community outreach workers completed the intervention and assessment , enrolling veterans from @ counties in a southern state .


A total @ participants were randomized to either an enhanced enrollment and engagement outreach condition ( EEE , n = @ ) or an administrative outreach ( AO , n = @ ) condition .


EEE participants enrolled and attended VA appointments at higher rates and within fewer days than those who received AO .


Eighty-seven percent of EEE veterans attended an appointment within @ months , compared to @ % of AO veterans ( P < @ ) .


The median time to first appointment was @ days for the EEE group and @ days for the AO group ( P < @ ) .


Additionally , a race by outreach group interaction emerged : black and white individuals benefited equally from the EEE intervention ; however , black individuals who received AO took significantly longer to attend appointments than their white counterparts .


Results provide needed empirical support for a specific outreach intervention that speeds enrollment and engagement for rural individuals in VA services .


Planned interventions to improve service utilization should ameliorate ambivalence about accessing health care in addition to addressing traditional systems or environmental-level barriers .


Ex vivo , bronchial epithelial cells from people with asthma are more susceptible to rhinovirus infection caused by deficient induction of the antiviral protein , IFN - .


Exogenous IFN - restores antiviral activity .


To compare the efficacy and safety of inhaled IFN - with placebo administered to people with asthma after onset of cold symptoms to prevent or attenuate asthma symptoms caused by respiratory viruses .


A total of @ people with asthma on inhaled corticosteroids ( British Thoracic Society Steps @-@ ) , with a history of virus-associated exacerbations , were randomized to @-day treatment with inhaled IFN - ( n = @ ) or placebo ( n = @ ) within @ hours of developing cold symptoms and were assessed clinically , with relevant samples collected to assess virus infection and antiviral responses .


A total of @ % of randomized patients developed a defined cold .


In this modified intention-to-treat population , asthma symptoms did not get clinically significantly worse ( mean change in six-item Asthma Control Questionnaire < @ ) and IFN - treatment had no significant effect on this primary endpoint , although it enhanced morning peak expiratory flow recovery ( P = @ ) , reduced the need for additional treatment , and boosted innate immunity as assessed by blood and sputum biomarkers .


In an exploratory analysis of the subset of more difficult-to-treat , Step @-@ people with asthma ( n = @ IFN - ; n = @ placebo ) , Asthma Control Questionnaire-@ increased significantly on placebo ; this was prevented by IFN - ( P = @ ) .


Although the trial did not meet its primary endpoint , it suggests that inhaled IFN - is a potential treatment for virus-induced deteriorations of asthma in difficult-to-treat people with asthma and supports the need for further , adequately powered , trials in this population .


Clinical trial registered with www.clinicaltrials.gov ( NCT @ ) .


Pelvic organ prolapse ( POP ) increases in prevalence with age ; recurrence after surgical repair is common .


The objective of the study was to determine the effects of local estrogen treatment on connective tissue synthesis and breakdown in the vaginal wall of postmenopausal women planning surgical repair of POP .


This was a randomized trial .


The study was conducted at an academic tertiary medical center .


Postmenopausal women with a uterus and symptomatic anterior and/or apical prolapse at stage @ or greater participated in the study .


Estrogen ( Premarin ) or placebo cream for @ weeks preoperatively was the intervention .


Full-thickness anterior apical vaginal wall biopsies were obtained at the time of hysterectomy and analyzed for mucosa and muscularis thickness , connective tissue synthesis , and degradation .


Serum levels of estrone and @-estradiol were analyzed at baseline and the day of surgery using highly sensitive liquid chromatography-tandem mass spectrometry .


Fifteen women per group ( n = @ total ) were randomized ; @ per group underwent surgery .


Among drug-adherent participants ( n = @ estrogen , n = @ placebo ) , epithelial and muscularis thickness was increased @ - and @-fold ( P = @ and P = @ , respectively ) by estrogen .


Collagen types @ and @ mRNA increased @ - and @-fold in the vaginal muscularis ( P < @ for both ) ; collagen type Ia protein increased @-fold in the muscularis ( P = @ ) , whereas collagen III was not changed significantly .


MMP-@ ( human macrophage elastase ) mRNA was suppressed in the vaginal mucosa from estrogen-treated participants ( P = @ ) , and matrix metalloprotease-@ activity was decreased @-fold in the mucosa and @-fold in the muscularis ( P = @ ) .


Consistent with menopausal norms , serum estrone and @-estradiol were low and did not differ among the two groups .


Vaginal estrogen application for @ weeks preoperatively increased synthesis of mature collagen , decreased degradative enzyme activity , and increased thickness of the vaginal wall , suggesting this intervention improves both the substrate for suture placement at the time of surgical repair and maintenance of connective tissue integrity of the pelvic floor .


There is a need for psychosocial interventions for men with prostate cancer to promote adaptive coping with the challenges and distress associated with diagnosis , treatment and recovery .


In addition , interventions are needed that help to overcome barriers to psychosocial treatment such as limited face-to-face psychosocial support services , a shortage of adequately trained professionals , geographical distance , perceived and personal stigma and a preference for consumer-centric and self-directed learning .


My Road Ahead is an online cognitive behaviour therapy ( CBT ) intervention for prostate cancer .


This protocol describes a randomised controlled trial ( RCT ) that will evaluate the efficacy of this online intervention alone , the intervention in combination with a moderated online forum , and the moderated online forum alone .


This study utilises a RCT design with three groups receiving : @ ) the @-module My Road Ahead intervention alone ; @ ) the My Road Ahead intervention plus a moderated online forum ; and @ ) the moderated online forum alone .


It is expected that @ men with localised prostate cancer will be recruited into the RCT .


Online measures will assess men 's psychological distress as well as sexual and relationship adjustment at baseline , post-intervention , @ month follow-up and @ month follow-up .


The study is being conducted in Australia and participants will be recruited from April @ to Feb @ .


The primary aim of this study is to evaluate the efficacy of My Road Ahead in reducing psychological distress .


To our knowledge , My Road Ahead is the first self-directed online psychological intervention developed for men who have been treated for localised prostate cancer .


The RCT will assess the efficacy of this intervention in improving psychological well-being , sexual satisfaction , relationship satisfaction and overall quality of life .


If successful , this intervention could provide much needed support to men receiving treatment for localised prostate cancer in a highly accessible manner .


Neutrophil gelatinase-associated lipocalin ( NGAL ) is a biomarker of acute kidney injury ( AKI ) , and levels reflect severity of disease in critically ill patients .


However , continuous venovenous hemofiltration ( CVVH ) may affect plasma levels by clearance or release of NGAL by activated neutrophils in the filter , dependent on the anticoagulation regimen applied .


We therefore studied handling of NGAL by CVVH in patients with AKI .


Immediately before initiation of CVVH , prefilter blood was drawn .


After @ , @ , @ , and @ minutes of CVVH , samples were collected from pre - and postfilter ( in - and outlet ) blood and ultrafiltrate .


CVVH with the following anticoagulation regimens was studied : no anticoagulation in case of a high bleeding tendency ( n = @ ) , unfractionated heparin ( n = @ ) , or trisodium citrate ( n = @ ) .


NGAL levels were determined with enzyme-linked immunosorbent assay ( ELISA ) .


Concentrations of NGAL at inlet and outlet were similar , and concentrations did not change over time in any of the anticoagulation groups ; thus no net removal or production of NGAL occurred .


Concentrations of NGAL at inlet correlated with disease severity at initiation of CVVH and at the end of a CVVH run .


Concentrations of NGAL in the ultrafiltrate were lower with citrate-based CVVH ( P = @ ) and decreased over time , irrespective of anticoagulation administered ( P < @ ) .


The sieving coefficient and clearance of NGAL were low and decreased over time ( P < @ ) .


The plasma level and biomarker value of NGAL in critically ill patients with AKI are not affected by CVVH , because clearance by the filter was low .


Furthermore , no evidence exists for intrafilter release of NGAL by neutrophils , irrespective of the anticoagulation method applied .


To improve the clinical course of ulcerative colitis ( UC ) , more accurate serum diagnostic and assessment methods are required .


We used serum metabolomics to develop diagnostic and assessment methods for UC .


Sera from UC patients , Crohn 's disease ( CD ) patients , and healthy volunteers ( HV ) were collected at multiple institutions .


The UC and HV were randomly allocated to the training or validation set , and their serum metabolites were analyzed by gas chromatography mass spectrometry ( GC/MS ) .


Using the training set , diagnostic and assessment models for UC were established by multiple logistic regression analysis .


Then , the models were assessed using the validation set .


Additionally , to establish a diagnostic model for discriminating UC from CD , the CD patients ' data were used .


The diagnostic model for discriminating UC from HV demonstrated an AUC of @ , @ % sensitivity , and @ % specificity in the training set and @ % sensitivity and @ % specificity in the validation set .


Another model for discriminating UC from CD exhibited an AUC of @ , @ % sensitivity , and @ % specificity in the training set and @ % sensitivity in the validation set .


The model for assessing UC showed an AUC of @ , @ % sensitivity , and @ % specificity in the training set and @ % sensitivity , @ % specificity , and a significant correlation with the clinical activity index ( rs = @ , P < @ ) in the validation set .


Our models demonstrated high performance and might lead to the development of a novel treatment selection method based on UC condition .


In endemic areas , gestational malaria is responsible for low birth weight and maternal anaemia .


Quinine is the reference treatment for acute malaria in pregnant women , irrespective of term .


However , quinine administration is associated with various side-effects .


We evaluated the impact of the homeopathic medicine China rubra @CH on the side-effects of quinine used as treatment for acute malaria in pregnant women in Cotonou , Benin .


This prospective , comparative , randomised study was carried out between June and December @ in the Saint Jean-Baptiste Medical Centre , Cotonou .


Women were included if they were > @ months pregnant and had a clinical diagnosis of malaria confirmed by a positive thick blood smear .


The study population was divided into two groups : ( i ) patients who presented between the @st and @th of each month and who received China rubra @CH plus quinine ( China group ) ; and ( ii ) patients who presented from the @th to the end of each month and who received treatment with quinine only ( Standard group ) .


The aim was to compare the frequency of side-effects of quinine in the two groups until day @ after the start of treatment .


Neither the patients nor the care givers were blinded to study treatment .


Statistical comparison of the two groups was carried out with an alpha risk fixed at @ % .


@ women were recruited : @ received quinine plus China rubra @CH ( China group ) and @ received quinine only ( Standard group ) .


A decrease in proportion of patients presenting with side-effects was observed in the China group from day @ to day @ of follow-up ( @ % -@ % ) whereas the proportion of patients with side-effects in the Standard group did not change significantly ( @ % on day @ vs. @ % on day @ ) .


Ninety-six ( @ % ) patients in the China group and @ ( @ % ) in the Standard group reported at least one side-effect during follow-up ( p < @ ) .


The most frequently reported side-effects were tinnitus , dizziness and asthenia .


This preliminary study shows the interest of China rubra @CH in limiting the side-effects of quinine used for the treatment of acute malaria in pregnant women .


Growth Hormone ( GH ) dosage in childhood is adjusted for body size , but there is no consensus whether body weight ( BW ) or body surface area ( BSA ) should be used .


We aimed at comparing the biological effect and cost-effectiveness of GH treatment dosed per m@ BSA in comparison with dosing per kg BW in girls with Turner syndrome ( TS ) .


Serum IGF-I , GH dose , and adult height gain ( AHG ) from girls participating in two Dutch and five Swedish studies on the efficacy of GH were analyzed , and the cumulative GH dose and costs were calculated for both dose adjustment methods .


Additional medication included estrogens ( if no spontaneous puberty occurred ) and oxandrolone in some studies .


At each GH dose , the serum IGF-I standard deviation score remained stable over time after an initial increase after the start of treatment .


On a high dose ( at @ m@ equivalent to @-@ @ mg/kg/day ) , AHG was at least equal on GH dosed per m@ BSA compared with dosing per kg BW .


The cumulative dose and cost were significantly lower if the GH dose was adjusted for m@ BSA .


Dosing GH per m@ BSA is at least as efficacious as dosing per kg BW , and is more cost-effective .


Planning for renal replacement therapy , such as referral for arteriovenous fistula placement and transplantation , often is guided by level of estimated glomerular filtration rate ( eGFR ) .


The use of risk equations might enable more accurate estimation of time to end-stage renal disease ( ESRD ) , thus improving patient care .


Prospective observational study .


@,@ participants in the African American Study of Kidney Disease and Hypertension ( AASK ) cohort .


Age , sex , urine protein-creatinine ratio @g/g , APOL@ high-risk status , and @-year antecedent eGFR decline .


Cumulative incidence of ESRD from @ different starting points : eGFR of @ and @mL/min/@ @ m ( @ ) and @-year ESRD risk of @ % , @ % , and @ % , estimated by a published @-variable kidney failure risk equation .


@ participants developed eGFR of @mL/min/@ @ m ( @ ) , @ developed eGFR of @mL/min/@ @ m ( @ ) , and @ , @ , and @ developed @-year ESRD risks of @ % , @ % , and @ % , respectively .


The @-year cumulative incidence of ESRD was @ % from eGFR of @mL/min/@ @ m ( @ ) , @ % from eGFR of @mL/min/@ @ m ( @ ) , @ % from @ % ESRD risk , @ % from @ % ESRD risk , and @ % from @ % ESRD risk .


From eGFR of @mL/min/@ @ m ( @ ) , there were several risk factors that predicted ESRD risk .


From eGFR of @mL/min/@ @ m ( @ ) , only level of proteinuria did ; median time to ESRD was @ and @ months in those with higher and lower proteinuria , respectively .


Median times were less variable from corresponding ESRD risk thresholds .


For example , median times to ESRD from @ % ESRD risk were @ and @ months among those with higher and lower proteinuria , respectively .


Relatively homogeneous population of African Americans with hypertensive kidney disease .


Results of the present study suggest the potential benefit of incorporating kidney failure risk equations into clinical care , with selection of a specific threshold guided by its intended use .


The Composite Variability Index ( CVI ) , derived from the electroencephalogram , was developed to assess the antinociception-nociception balance , whereas the Bispectral Index ( BIS ) was developed to assess the hypnotic state during anesthesia .


We studied the relationships between these indices , level of hypnosis ( BIS level ) , and antinociception ( predicted remifentanil effect-site concentrations , CeREMI ) before and after stimulation .


Also , we measured their association with movement in response to a noxious stimulus .


We randomized @ patients to one of @ groups targeting different hypnotic levels ( BIS @ , @ , and @ ) and various CeREMI ( @ , @ , @ , or @ ng/mL ) .


At pseudo-steady state , baseline values were observed , and a series of stimuli were applied .


Changes in BIS , CVI , heart rate ( HR ) , and mean arterial blood pressure ( MAP ) between baseline and response period were analyzed in relation to level of hypnosis , antinociception , and somatic response to the stimuli .


CVI and BIS more accurately correlate with somatic response to an Observer Assessment of Alertness and Sedation-noxious stimulation than HR , MAP , CeREMI , and propofol effect-site concentration ( Tukey post hoc tests P < @ ) .


Change in CVI is more adequate to monitor response to stimulation than changes in BIS , HR , or MAP ( as described by the Mathews Correlation Coefficient with significance level set at P < @ ) .


In contrast , none of the candidate analgesic state indices was uniquely related to a specific opioid concentration and is extensively influenced by the hypnotic state as measured by BIS .


CVI appears to correlate with somatic responses to noxious stimuli .


However , unstimulated CVI depends more on hypnotic drug effect than on opioid concentration .


Acclimatization at natural altitude effectively prevents acute mountain sickness ( AMS ) .


It is , however , unknown whether prevention of AMS is also possible by only sleeping in normobaric hypoxia .


In a placebo-controlled , double-blind study @ healthy unacclimatized male subjects , aged @ to @ years , slept for @ consecutive nights at either a fractional inspired oxygen ( Fio@ ) of @ to @ ( average target altitude @ m ; treatment group ) or @ ( control group ) .


Four days later , AMS scores and incidence of AMS were assessed during a @-hour exposure in normobaric hypoxia at Fio@ = @ ( equivalent to @ m ) .


Because of technical problems with the nitrogen generators , target altitude was not achieved in the tents and only @ of @ subjects slept at an average altitude considered sufficient for acclimatization ( > @ m ; average , @ m ) .


Therefore , in a subgroup analysis these subjects were compared with the @ subjects of the control group with the lowest sleeping altitude .


This analysis showed a significantly lower AMS-C score ( @ ; @ % CI , @ to @ ) vs @ ; @ % CI , @ to @ ; P = @ ) and lower Lake Louise Score ( @ ; @ % CI , @ to @ vs @ ; @ % CI , @ to @ ; P = @ ) for the treatment subgroup .


The incidence of AMS defined as an AMS-C score greater than @ was also significantly lower ( @ % vs @ % ; P < @ ) .


Sleeping @ consecutive nights in normobaric hypoxia ( equivalent to @ m ) reduced symptoms and incidence of AMS @ days later on exposure to @ m.


Sevoflurane is an ideal agent for anesthesia since its respiratory irritant effect is minimal during mask induction .


Emergence agitation ( EA ) is a common problem after anesthesia with sevoflurane .


In this study it was aimed to compare the effects of dexmedetomidine and remifentanyl on emergence agitation after sevoflurane anesthesia in adults undergoing septoplasty operation .


This prospective , randomized , double-blind study was conducted in Yenimahalle State Hospital after obtaining local Ethics Committee approval and patient 's written informed consent .


The patients were randomized into dexmedetomidine and remifentanyl groups .


Hemodynamic parameters including heart rat , Mean arterial pressure , and sPO@ were recorded .


The patients were followed for @ hour at the recovery room .


Categorical data was analyzed using c@ test .


Hemodynamic data was evaluated using unpaired t test for intergroup and paired t-test for within group comparisons .


Data not normally distributed was compared using Mann Whitney U test .


p < @ was considered statistically significant .


Demographic data were similar in both groups ( p > @ ) .


Riker score was similar in both groups .


VAS score was also not significantly different between both groups at the recovery room .


Our study demonstrated that Dexmedotimidine and Remifentanyl had equal effectiveness in reducing emergence agitation in patients undergoing septoplasty under Sevoflurane anesthesia .


To analyze the analysis of recurrence rates of single versus double burr holes in patients with subacute and chronic subdural hematomas .


The study was a prospective randomized controlled trial on patients with subacute and chronic subdural hematomas .


Collections with membranes or septae were excluded from the study .


A written consent was taken from the patient or patient party after explaining the procedure .


A total of @ patients were enrolled in the study over a period of @-months in the Department of Neurosurgery , Sheri-Kashmir-Institute of Medical Sciences , Srinagar , Kashmir .


Recurrence rates in single and double-burr-hole groups were @ % and @ % respectively , which was not statistically significant .


Most of the subdural hematomas can be dealt by single burr-hole drainage .


Abdominal adiposity is associated with low BMD and decreased growth hormone ( GH ) secretion , an important regulator of bone homeostasis .


The purpose of our study was to determine the effects of a short course of GH on markers of bone turnover and bone marrow fat in premenopausal women with abdominal adiposity .


In a @-month , randomized , double-blind , placebo-controlled trial we studied @ abdominally obese premenopausal women ( @-@ y ) who underwent daily sc injections of GH vs. placebo .


Main outcome measures were body composition by DXA and CT , bone marrow fat by proton MR spectroscopy , P@NP , CTX , @ ( OH ) D , hsCRP , undercarboxylated osteocalcin ( ucOC ) , preadipocyte factor @ ( Pref @ ) , apolipoprotein B ( ApoB ) , and IGF-@ .


GH increased IGF-@ , P@NP , @ ( OH ) D , ucOC , bone marrow fat and lean mass , and decreased abdominal fat , hsCRP , and ApoB compared with placebo ( p < @ ) .


There was a trend toward an increase in CTX and Pref-@ .


Among all participants , a @-month increase in IGF-@ correlated with @-month increase in P@NP ( p = @ ) , suggesting that subjects with the greatest increases in IGF-@ experienced the greatest increases in bone formation .


A six-month decrease in abdominal fat , hsCRP , and ApoB inversely predicted @-month change in P@NP , and @-month increase in lean mass and @ ( OH ) D positively predicted @-month change in P@NP ( p@ @ ) , suggesting that subjects with greatest decreases in abdominal fat , inflammation and ApoB , and the greatest increases in lean mass and @ ( OH ) D experienced the greatest increases in bone formation .


A six-month increase in bone marrow fat correlated with @-month increase in P@NP ( trend ) , suggesting that subjects with the greatest increases in bone formation experienced the greatest increases in bone marrow fat .


Forward stepwise regression analysis indicated that increase in lean mass and decrease in abdominal fat were positive predictors of P@NP .


When IGF-@ was added to the model , it became the only predictor of P@NP .


GH replacement in abdominally obese premenopausal women for @ months increased bone turnover and bone marrow fat .


Reductions in abdominal fat , and inflammation , and increases in IGF-@ , lean mass and vitamin D were associated with increased bone formation .


The increase in bone marrow fat may reflect changes in energy demand from increased bone turnover .


Worms may protect against allergy .


Early-life worm exposure may be critical , but this has not been fully investigated .


To investigate whether worms in pregnancy and in early childhood are associated with childhood eczema incidence .


The Entebbe Mother and Baby Study , an anthelminthic treatment trial , enrolled pregnant women between @ and @ in Uganda .


Mothers were investigated for worms during pregnancy and children annually .


Eczema was doctor-diagnosed from birth to age five years .


A planned observational analysis was conducted within the trial cohort to investigate associations between worms and eczema .


Data for @ live-born children were analysed .


Hookworm was the most prevalent maternal worm ( @ % ) .


Childhood worms were less prevalent .


Eczema incidence was @ / @ person-years .


Maternal hookworm was associated with reduced eczema incidence -LSB- adjusted hazard ratio ( @ % confidence interval ) , p-value : @ ( @-@ @ ) , @ -RSB- and modified effects of known risk factors for eczema : Dermatophagoides-specific IgE in children was positively associated with eczema incidence if the mother had no hookworm -LSB- @ ( @-@ @ ) , @ -RSB- , but not if the mother had hookworm -LSB- @ ( @-@ @ ) , @ -RSB- , interaction p-value = @ .


Similar interactions were seen for maternal history of eczema -LCB- -LSB- @ ( @-@ @ , @ ) vs. -LSB- @ ( @-@ @ ) , @ -RSB- , interaction p-value = @ -RCB- , female gender -LCB- -LSB- @ ( @-@ @ ) , @ vs. -LSB- @ ( @-@ @ ) , @ -RSB- , interaction p-value = @ -RCB- and allergen-specific IgE .


Childhood Trichuris trichiura and hookworm were inversely associated with eczema .


Maternal hookworm modifies effects of known risk factors for eczema .


Mechanisms by which early-life worm exposures influence allergy need investigation .


Worms or worm products , and intervention during pregnancy have potential for primary prevention of allergy .


Epidermal growth factor receptor ( EGFR ) has been hypothesised to modulate the effectiveness of anti-HER@ therapy .


We used a standardised , quantitative immunofluorescence assay and a novel EGFR antibody to evaluate the correlation between EGFR expression and clinical outcome in the North Central Cancer Treatment Group ( NCCTG ) N@ trial .


Tissue microarrays were constructed that allowed analysis of @ patients randomly assigned to receive chemotherapy alone ( Arm A ) , sequential trastuzumab after chemotherapy ( Arm B ) and chemotherapy with concurrent trastuzumab ( Arm C ) .


Measurement of EGFR was performed using the EGFR antibody , D@B@ , on the fluorescence-based AQUA platform .


The result was validated using an independent retrospective metastatic breast cancer cohort ( n = @ ) .


Epidermal growth factor receptor assessed as a continuous ( logarithmic transformed ) variable shows an association with disease-free survival in Arm C ( P = @ ) but not in Arm A or B. High EGFR expression was associated with worse outcome ( Hazard ratio ( HR ) = @ ; @ % CI @-@ @ , P = @ ) .


Validation in a Greek metastatic breast cancer cohort showed an HR associated with high EGFR expression of @ ( P = @ ) .


High expression of EGFR appears to be associated with decreased benefit from adjuvant concurrent trastuzumab .


Since other treatment options exist for HER@-driven tumours , further validation of these data may select patients for alternative or additive therapy .


To evaluate an integrated telehealth intervention ( Integrated Telehealth Education and Activation of Mood ( I-TEAM ) ) to improve chronic illness ( congestive heart failure , chronic obstructive pulmonary disease ) and comorbid depression in the home healthcare setting .


Randomized controlled trial .


Hospital-affiliated home healthcare setting .


Medically frail older homebound individuals ( N = @ ) .


The @-month intervention consisted of integrated telehealth chronic illness and depression care , with a telehealth nurse conducting daily telemonitoring of symptoms , body weight , and medication use ; providing eight weekly sessions of problem-solving treatment for depression ; and providing for communication with participants ' primary care physicians , who also prescribed antidepressants .


Control participants were allocated to usual care with in-home nursing plus psychoeducation ( UC+P ) .


The two groups were compared at baseline and @ and @ months after baseline on clinical measures ( depression , health , problem-solving ) and @ months after baseline on health utilization ( readmission , episodes of care , and emergency department ( ED ) visits ) .


Depression scores were @ % lower in the I-TEAM group than in the UC+P group at @ and @ months .


Those who received the I-TEAM intervention significantly improved their problem-solving skills and self-efficacy in managing their medical condition .


The I-TEAM group had significantly fewer ED visits ( P = @ ) but did not have significantly fewer days in the hospital at @ months after baseline .


Integrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings .


The aim of this study is to evaluate the effectiveness and complications associated with combined topical diltiazem cream and botulinum toxin A injection versus partial lateral internal sphincterotomy in chronic anal fissure .


This study is a parallel , randomized controlled trial ( using the block randomization method ) .


This study was performed at a university hospital in Iran .


Ninety-nine patients who had chronic anal fissures were included .


A total of @ patients were randomly assigned to @ groups ; the first group received combined topical diltiazem ointment ( for @ weeks ) and botulinum toxin A injection ( once ) ( n = @ ) , and the second group received partial lateral internal sphincterotomy ( n = @ ) .


All the patients were followed up for @ year .


The primary outcomes measured were the healing of the anal fissure and the development of incontinence as the major adverse event during the @-year follow-up period .


The overall healing rate was @ % and @ % in the botulinum toxin A-diltiazem and partial lateral internal sphincterotomy groups ( p < @ ) .


The patients in the partial lateral internal sphincterotomy group experienced significantly higher incontinence scores ( p = @ ) according to the Cleveland Clinic Florida-Fecal Incontinence scoring system .


In patients who had chronic anal fissure for @ months , no statistical difference was observed in the healing rate between the botulinum toxin A-diltiazem and partial lateral internal sphincterotomy groups ( @ % vs @ % ) .


However , in the patients with longer chronic fissures , the healing rate was significantly higher in the partial lateral internal sphincterotomy group ( @ % -LSB- @/@ -RSB- vs @ % -LSB- @/@ -RSB- , p < @ ) .


The @-year follow-up period , subjective definitions of itching , and lack of anorectal manometry examinations and data regarding the effect of each treatment on anal sphincter pressure at rest and contraction are the key limitations of this study .


Combined botulinum toxin A injection with a topical application of diltiazem could be as effective as partial lateral internal sphincterotomy in the treatment of chronic anal fissure in patients who have chronic anal fissure for @ months .


However , in chronic anal fissures of longer duration , partial lateral internal sphincterotomy is associated with a significantly higher cure rate .


Although radiotherapy is a key component of curative-intent treatment for locally advanced , unresectable non-small cell lung cancer ( NSCLC ) , it can be associated with substantial pulmonary toxicity in some patients .


Current radiotherapy planning techniques aim to minimize the radiation dose to the lungs , without accounting for regional variations in lung function .


Many patients , particularly smokers , can have substantial regional differences in pulmonary ventilation patterns , and it has been hypothesized that preferential avoidance of functional lung during radiotherapy may reduce toxicity .


Although several investigators have shown that functional lung can be identified using advanced imaging techniques and/or demonstrated the feasibility and theoretical advantages of avoiding functional lung during radiotherapy , to our knowledge this premise has never been tested via a prospective randomized clinical trial .


Eligible patients will have Stage III NSCLC with intent to receive concurrent chemoradiotherapy ( CRT ) .


Every patient will undergo a pre-treatment functional lung imaging study using hyperpolarized @He MRI in order to identify the spatial distribution of normally-ventilated lung .


Before randomization , two clinically-approved radiotherapy plans will be devised for all patients on trial , termed standard and avoidance .


The standard plan will be designed without reference to the functional state of the lung , while the avoidance plan will be optimized such that dose to functional lung is as low as reasonably achievable .


Patients will then be randomized in a @:@ ratio to receive either the standard or the avoidance plan , with both the physician and the patient blinded to the randomization results .


This study aims to accrue a total of @ patients within two years .


The primary endpoint will be a pulmonary quality of life ( QOL ) assessment at @ months post-treatment , measured using the functional assessment of cancer therapy-lung cancer subscale .


Secondary endpoints include : pulmonary QOL at other time-points , provider-reported toxicity , overall survival , progression-free survival , and quality-adjusted survival .


This randomized , double-blind trial will comprehensively assess the impact of functional lung avoidance on pulmonary toxicity and quality of life in patients receiving concurrent CRT for locally advanced NSCLC .


Unexpected requests for non-cardiac surgery requiring discontinuation of dual antiplatelet therapy ( DAPT ) frequently occur in daily clinical practice .


The objectives of this study were to evaluate prevalence , timing and clinical outcomes of such unexpected requests for non-cardiac surgery or other invasive procedures during the first year after drug-eluting stents ( DESs ) implantation .


We prospectively investigated the prevalence , timing and clinical outcomes of unexpected requests for non-cardiac surgery or other procedures during the first year after DESs implantation in @ patients .


The prevalence of requested non-cardiac surgery or invasive procedures was @ % in @ requests and @ % in @ patients .


Among @ requests , those were proposed in @ % < @ month , @ % between @ and @ months , @ % between @ and @ months and @ % between @ and @ months post-DES implantation .


The rates of actual discontinuation of DAPT and non-cardiac surgery or procedure finally performed were @ % ( @ of @ requests ) and @ % ( @ of @ requests ) , respectively .


On multivariate regression analysis , the most significant determinants for actual discontinuation of DAPT were Endeavor zotarolimus-eluting stent implantation with @-month DAPT ( OR = @ , @ % CI @-@ @ , p < @ ) and timing of request ( OR = @ , @ % CI @-@ @ , p < @ ) .


There were no patients with any death , myocardial infarction , or stent thrombosis related with actual discontinuation of DAPT .


Those unexpected requests with premature discontinuation of DAPT were relatively common and continuously proposed during the first year following DES implantation .


No death , myocardial infarction or stent thrombosis occurred in patients with actual discontinuation of DAPT .


In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock , mortality was markedly lower among those who were treated according to a @-hour protocol of early goal-directed therapy ( EGDT ) , in which intravenous fluids , vasopressors , inotropes , and blood transfusions were adjusted to reach central hemodynamic targets , than among those receiving usual care .


We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary .


In @ emergency departments in the United States , we randomly assigned patients with septic shock to one of three groups for @ hours of resuscitation : protocol-based EGDT ; protocol-based standard therapy that did not require the placement of a central venous catheter , administration of inotropes , or blood transfusions ; or usual care .


The primary end point was @-day in-hospital mortality .


We tested sequentially whether protocol-based care ( EGDT and standard-therapy groups combined ) was superior to usual care and whether protocol-based EGDT was superior to protocol-based standard therapy .


Secondary outcomes included longer-term mortality and the need for organ support .


We enrolled @ patients , of whom @ were randomly assigned to protocol-based EGDT , @ to protocol-based standard therapy , and @ to usual care .


Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids , vasopressors , inotropes , and blood transfusions .


By @ days , there were @ deaths in the protocol-based EGDT group ( @ % ) , @ in the protocol-based standard-therapy group ( @ % ) , and @ in the usual-care group ( @ % ) ( relative risk with protocol-based therapy vs. usual care , @ ; @ % confidence interval -LSB- CI -RSB- , @ to @ ; P = @ ; relative risk with protocol-based EGDT vs. protocol-based standard therapy , @ ; @ % CI , @ to @ ; P = @ ) .


There were no significant differences in @-day mortality , @-year mortality , or the need for organ support .


In a multicenter trial conducted in the tertiary care setting , protocol-based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes .


( Funded by the National Institute of General Medical Sciences ; ProCESS ClinicalTrials.gov number , NCT@ . )


A limitation of traditional outcome studies from behavioral interventions is the lack of attention given to evaluating the influence of moderating variables .


This study examined possible moderation effect of baseline activity levels on physical activity change as a result of the Ready for Recess intervention .


Ready for Recess ( August @-September @ ) was a controlled trial with twelve schools randomly assigned to one of four conditions : control group , staff supervision , equipment availability , and the combination of staff supervision and equipment availability .


A total of @ children ( @ boys and @ girls ) from grades @ through @ ( @-@years old ) were asked to wear an Actigraph monitor during school time on @-@days of the week .


Assessments were conducted at baseline ( before intervention ) and post intervention ( after intervention ) .


Initial MVPA moderated the effect of Staff supervision ( = -@ % ; p < @ ) , but not Equipment alone and Staff + Equipment ( p > @ ) .


Participants in the Staff condition that were @ standard deviation ( SD ) below the mean for baseline MVPA ( classified as `` low active '' ) had lower MVPA levels at post-intervention when compared with their low active peers in the control condition ( Mean diff = -@ % ; p = @ ) .


High active individuals ( +@ SD above the mean ) in the Equipment treatment also had lower MVPA values at post-intervention when compared with their highly active peers in the control group ( Mean diff = -@ % ; p = @ ) .


These results indicate that changes in MVPA levels at post-intervention were reduced in highly active participants when recess staff supervision was provided .


In this study , initial MVPA moderated the effect of Staff supervision on children 's MVPA after @months of intervention .


Staff training should include how to work with inactive youth but also how to assure that active children remain active .


The prone position ( PP ) and decubitus position ( DP ) have both been used for thoracoscopic esophagectomy .


However , which of these positions is ergonomically better for the operating surgeon is unknown .


In this randomized controlled trial ( NCT@ ) , we aimed to assess the surgeon 's physical and mental stress in operating on patients in the PP compared with that in the DP .


From October @ to June @ , @ consecutive patients who underwent a three-stage minimally invasive esophagectomy were randomly assigned to the DP or the PP during the thoracic stage .


The same senior surgeon performed all operations .


Objectively , the surgeon 's spontaneous eye blink rate was recorded during thoracoscopic esophagectomy .


Subjectively , the physician 's musculoskeletal symptoms were rated on a scale ranging from @ ( uninfluenced ) to @ ( maximum fatigue ) .


Clinical characteristics , including patient demographics and operative features of the two patient groups , were statistically compared .


There were @ patients in the PP group and @ in the DP group .


The two groups were comparable in patient demographics .


The thoracic stage of the operation was longer in the DP group than in the PP group ( @ @ minutes vs @ @ minutes , p < @ ) , and the volume of blood loss was higher ( @ @ mL vs @ @ mL , p < @ ) .


The surgeon 's eye blink rate at the end of thoracic stage decreased more from baseline in the DP group than in the PP group ( @ @ blinks/min vs @ @ blinks/min , p < @ ) , and the surgeon 's symptom scale score was higher after operation with the patient in the DP than in the PP ( @ @ vs @ @ , p < @ ) .


No conversion to open thoracotomy was recorded in either group .


Thoracoscopic esophagectomy in the PP provided less workload and better ergonomic results than the DP .


Further study based on a larger number of patients is required to confirm these findings .


Improvement in treatment for patients with recurrent ovarian cancer is needed .


Standard therapy in patients with platinum-sensitive recurrent ovarian cancer consists of platinum-based chemotherapy .


Median overall survival is reported between @ and @ months .


Currently , the role of surgery in recurrent ovarian cancer is not clear .


In selective patients a survival benefit up to @ months is reported for patients undergoing complete secondary cytoreductive surgery .


Whether cytoreductive surgery in recurrent platinum-sensitive ovarian cancer is beneficial remains questionable due to the lack of level I-II evidence .


Multicentre randomized controlled trial , including all nine gynecologic oncologic centres in the Netherlands and their affiliated hospitals .


Eligible patients are women , with first recurrence of FIGO stage Ic-IV platinum-sensitive epithelial ovarian cancer , primary peritoneal cancer or fallopian tube cancer , who meet the inclusion criteria .


Participants are randomized between the standard treatment consisting of at least six cycles of intravenous platinum based chemotherapy and the experimental treatment which consists of secondary cytoreductive surgery followed by at least six cycles of intravenous platinum based chemotherapy .


Primary outcome measure is progression free survival .


In total @ patients will be randomized .


Data will be analysed according to intention to treat .


Where the role of cytoreductive surgery is widely accepted in the initial treatment of ovarian cancer , its value in recurrent platinum-sensitive epithelial ovarian cancer has not been established so far .


A better understanding of the benefits and patients selection criteria for secondary cytoreductive surgery has to be obtained .


Therefore the @th ovarian cancer consensus conference in @ stated that randomized controlled phase @ trials evaluating the role of surgery in platinum-sensitive recurrent epithelial ovarian cancer are urgently needed .


We present a recently started multicentre randomized controlled trial that will investigate the role of secondary cytoreductive surgery followed by chemotherapy will improve progression free survival in selected patients with first recurrence of platinum-sensitive epithelial ovarian cancer .


Heart failure with preserved ejection fraction ( HFpEF ) is a heterogeneous syndrome associated with multiple pathophysiologic abnormalities , including left ventricular ( LV ) diastolic dysfunction , longitudinal LV systolic dysfunction , abnormal ventricular-arterial coupling , pulmonary hypertension , and right ventricular ( RV ) remodeling/dysfunction .


However , the relative prognostic significance of each of these pathophysiologic abnormalities in HFpEF is unknown .


We prospectively studied @ patients with HFpEF using echocardiography and sphygmomanometry to assess HFpEF pathophysiologic markers .


Cox proportional hazards analyses were used to determine the associations between pathophysiologic markers and outcomes .


Mean age was @ years ; @ % were women ; @ % were black ; comorbidities were common ; and study participants met published criteria for HFpEF .


RV abnormalities were frequent : @ % had abnormal tricuspid annular plane systolic excursion , @ % had reduced RV fractional area change , and @ % had RV hypertrophy .


During a median follow-up time of @ months , @ ( @ % ) were hospitalized for HF and @ ( @ % ) experienced the composite end point of cardiovascular hospitalization or death .


Decreased LV compliance , measured as reduced LV end-diastolic volume at an idealized LV end-diastolic pressure of @ mm Hg ( EDV@ ) , and RV remodeling , as indicated by increased RV wall thickness , were the @ pathophysiologic markers most predictive of worse outcomes : adjusted hazard ratio per @ SD decrease in EDV@ = @ ( @ % confidence interval -LSB- CI -RSB- , @-@ @ ; P = @ ) , and hazard ratio per @ SD increase in RV wall thickness = @ ( @ % CI , @-@ @ ; P < @ ) .


These associations persisted after additional adjustment for markers of HF severity .


By contrast , markers of LV relaxation , longitudinal LV systolic dysfunction , and ventricular-arterial coupling were not significantly associated with adverse outcomes .


In patients with HFpEF , reduced LV compliance and RV remodeling are the strongest pathophysiologic predictors of adverse outcomes .


We examined the impact of a @ hour complete fast ( vs. fed state ) on two measures of food reward : @ ) ` wanting ' , as measured by response to food images and by the relative-reinforcing value of food ( RRV ) , and @ ) ` liking ' , as measured by response to food images and the hedonic evaluation of foods consumed .


Utilizing a randomized crossover design , @ subjects ( @ male ; @ female ) aged @ yrs with body mass index @ kg/m ( @ ) were randomized and counterbalanced to normal feeding ( FED ) and @-hour fast ( FASTED ) conditions .


Trait characteristics were measured with the Three Factor Eating Questionnaire .


Two computer tasks measured food reward : @ ) RRV progressive ratio task , @ ) explicit ` liking ' and ` wanting ' ( Leeds Food Preference Questionnaire , LFPQ ) .


Also measured were ad libitum energy intake ( EI ; buffet ) and food ` liking ' ( visual analogue scale ) of personalized stimuli .


There were no significant anthropometric changes between conditions .


Appetite scores , hedonic ratings of ` liking ' , and ad libitum EI all significantly increased under the FASTED condition ( p < @ ) .


Under the FASTED condition there were significant increases in the RRV of snack foods ; similarly , explicit ` wanting ' and ` liking ' significantly increased for all food categories .


` Liking ' of sweet foods remained high across-meals under FASTED , but savory foods decreased in hedonic saliency .


Relative to a fed state , we observed an increase in hedonic ratings of food , the rewarding value of food , and food intake after a @ hr fast .


Alliesthesia to food and food cues is suggested by heightened hedonic ratings under the FASTED condition relative to FED .


To determine whether a nurse navigator intervention improves quality of life and patient experience with care for people recently given a diagnosis of breast , colorectal , or lung cancer .


Adults with recently diagnosed primary breast , colorectal , or lung cancer ( n = @ ) received either enhanced usual care ( n = @ ) or nurse navigator support for @ months ( n = @ ) in a two-group cluster randomized , controlled trial with primary care physicians as the units of randomization .


Patient-reported measures included the Functional Assessment of Cancer Therapy-General ( FACT-G ) Quality of Life scale , three subscales of the Patient Assessment of Chronic Illness Care ( PACIC ) , and selected subscales from a cancer adaptation of the Picker Institute 's patient experience survey .


Self-report measures were collected at baseline , @ months , and @ months .


Automated administrative data were used to assess time to treatment and total health care costs .


There were no significant differences between groups in FACT-G scores .


Nurse navigator patients reported significantly higher scores on the PACIC and reported significantly fewer problems with care , especially psychosocial care , care coordination , and information , as measured by the Picker instrument .


Cumulative costs after diagnosis did not differ significantly between groups , but lung cancer costs were $ @,@ less among nurse navigator patients .


Compared with enhanced usual care , nurse navigator support for patients with cancer early in their course improves patient experience and reduces problems in care , but did not differentially affect quality of life .


Epidemiological and experimental studies suggest that exposure to ultrafine particles ( UFP ) might aggravate the allergic inflammation of the lung in asthmatics .


We exposed @ allergic asthmatics in two subgroups in a double-blinded randomized cross-over design , first to freshly generated ultrafine carbon particles ( @ g/m ; @ @ particles/cm for @ h ) and then to filtered air or vice versa with a @-day recovery period in-between .


Eighteen hours after each exposure , grass pollen was instilled into a lung lobe via bronchoscopy .


Another @ hours later , inflammatory cells were collected by means of bronchoalveolar lavage ( BAL ) .


NCT@ ) RESULTS : For the entire study group , inhalation of UFP by itself had no significant effect on the allergen induced inflammatory response measured with total cell count as compared to exposure with filtered air ( p = @ ) .


However , the subgroup of subjects , which inhaled UFP during the first exposure , exhibited a significant increase in total BAL cells ( p = @ ) , eosinophils ( p = @ ) and monocytes ( p = @ ) after filtered air exposure and subsequent allergen challenge @ days later .


Additionally , the potential of BAL cells to generate oxidant radicals was significantly elevated at that time point .


The subgroup that was exposed first to filtered air and @ days later to UFP did not reveal differences between sessions .


Our data demonstrate that pre-allergen exposure to UFP had no acute effect on the allergic inflammation .


However , the subgroup analysis lead to the speculation that inhaled UFP particles might have a long-term effect on the inflammatory course in asthmatic patients .


This should be reconfirmed in further studies with an appropriate study design and sufficient number of subjects .


Zinc plays a role in skin health , and preliminary data have shown its beneficial effects for melasma .


We compared the effect of topical zinc with that of hydroquinone as the standard treatment on severity of melasma .


Ninety-three women with melasma were randomized to receive zinc sulfate @ % or hydroquinone @ % solutions once daily for @months .


They were followed for an additional @months while using sunscreen .


The severity of melasma was assessed at baseline and at @ and @months using the Melasma Area and Severity Index ( MASI ) .


Eighty-two patients completed the study .


The MASI score fell significantly in both groups , but a greater decrease was seen in those who received hydroquinone ( @ % vs @ % , p < @ ) .


Postinflammatory pigmentation occurred in @ % of the zinc group and irritation in @ % of the hydroquinone group .


Topical zinc therapy is not highly effective in reducing the severity of melasma , but further trials are needed to determine whether adding zinc to current topical treatments could improve treatment response .


For the premature infant , extrauterine life is a pathological condition , which greatly amplifies the challenges to the brain in establishing functional oromotor behaviors .


The extent to which suck can be entrained using a synthetically patterned orocutaneous input to promote its development in preterm infants who manifest chronic lung disease ( CLD ) is unknown .


The objective of this study was to evaluate the effects of a frequency-modulated ( FM ) orocutaneous pulse train delivered through a pneumatically charged pacifier capable of enhancing non-nutritive suck ( NNS ) activity in tube-fed premature infants .


A randomized trial to evaluate the efficacy of pneumatic orocutaneous stimulation @ per day on NNS development and length of stay ( LOS ) in the neonatal intensive care unit among @ newborn infants distributed among three sub-populations , including healthy preterm infants , respiratory distress syndrome ( RDS ) and CLD .


Study infants received a regimen of orocutaneous pulse trains through a PULSED pressurized silicone pacifier or a SHAM control ( blind pacifier ) during gavage feeds for up to @ days .


Mixed modeling , adjusted for the infant 's gender , gestational age , postmenstrual age and birth weight , was used to handle interdependency among repeated measures within subjects .


A significant main effect for stimulation mode ( SHAM pacifier vs PULSED orosensory ) was found among preterm infants for NNS bursts per min ( P = @ ) , NNS events per min ( P = @ ) and for total oral compressions per min ( NNS + nonNNS ) ( P = @ ) .


Pairwise comparison of adjusted means using Bonferroni adjustment indicated RDS and CLD infants showed the most significant gains on these NNS performance indices .


CLD infants in the treatment group showed significantly shorter LOS by an average of @ days .


FM PULSED orocutaneous pulse train stimuli delivered through a silicone pacifier are effective in facilitating NNS burst development in tube-fed RDS and CLD preterm infants , with an added benefit of reduced LOS for CLD infants .


Prenatal calcium and iron supplements are recommended in settings of low dietary calcium intake and high prevalence of anemia .


However , calcium administration may inhibit iron absorption .


To overcome calcium-iron interactions , we developed a multi-micronutrient powder containing iron ( @ mg ) , folic acid ( @ g ) , and calcium carbonate granules microencapsulated with a pH-sensitive enteric coating to delay intestinal release .


We aimed to establish in vivo evidence that enteric-coated ( EC ) calcium is bioavailable in pregnant women and to explore the dose-responsiveness of fractional calcium absorption ( FCA ) in pregnancy .


This was a randomized crossover trial in pregnant women ( @-@ wk of gestation ) in Dhaka , Bangladesh .


Participants were allocated to @ of @ dose groups ( @ , @ , or @ mg elemental Ca ) .


FCA was estimated in random order for EC and non-EC ( control ) granules by a dual-stable-isotope method ( ( @ ) Ca-labeled granules and intravenous ( @ ) Ca ) on the basis of the relative recovery of ( @ ) Ca compared with ( @ ) Ca in urine over @ h.


Forty-nine participants with FCA for both EC and non-EC granules were included in the primary analyses .


FCA geometric means were as follows : @ % ( @ mg ) , @ % ( @ mg ) , and @ % ( @ mg ) for non-EC granules compared with @ % ( @ mg ) , @ % ( @ mg ) , and @ % for EC granules .


Cumulative @-h FCA of EC calcium was @ % lower ( P < @ ) than that of non-EC calcium , after adjustment for dose .


In comparison to @ mg , the FCA for the @-mg dose was @ % lower ( P < @ ) and was @ % lower ( P = @ ) for the @-mg dose , after adjustment for formulation .


A pH-sensitive enteric coating substantially reduced calcium absorption from a prenatal multi-micronutrient powder .


In its current formulation , this novel supplement is not suitable for clinical use .


FCA was highly dose-dependent , such that doses of @ and @ mg delivered only negligibly more bioavailable calcium than the @-mg dose .


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


To compare clinical effect of T-shaped locking internal fixation and external fixation in treating dorsal Barton 's fracture , and investigate selective strategy of internal fixation .


From January @ to January @ , @ patients with dorsal Barton 's fracture were randomly divided into two groups .


In treatment group , there were @ males and @ females with an average age of ( @ ) years old ; @ cases were type B , @ cases were type C ; and treated with T-shaped locking internal fixation .


In control group , there were @ male and @ females with an average age of ( @ ) years old ; @ cases were type B , @ cases were type C ; and treated with external fixation .


Volar tilt , ulnar deviation and radial height at @ months after operation were detected and compared between two groups .


Mechara functional evaluation were used to evaluate postoperative clinical effects .


Clinical cure time , postoperative complications , joint mobility and function score were recorded and compared between two groups .


In treatment group , volar tilt was ( @ ) , ulnar deviation was ( @ + @ ) , and radial height was ( @ ) mm ; while volar tilt was ( @ ) , ulnar deviation was ( @ ) , and radial height was ( @ ) mm in control group .


Treatment group was better than control group in volar tilt , ulnar deviation and radial height .


Clinical cure time in treatment group was ( @ ) weeks , shorter than control group ( @ ) weeks .


The incidence of complications in treatment group was lower than control group .


According to Mehara functional evaluation ,@ cases got excellent results , @ good , @ moderate and @ poor in treatment group ; @ cases got excellent results , @ good , @ moderate and @ poor in control group .


Treatment group was better than control group in clinical effects .


T-shaped locking internal fixation with postoperative functional exercise for the treatment of dorsal Barton 's fracture fits for biomechanics demands , and has advantages of stable fixation , rapid recovery , less complications and good functional recovery , it has better clinical effects .


Gastrointestinal bleeding is a common emergency that causes substantial mortality worldwide .


Acute upper and lower gastrointestinal bleeding accounts for about @,@ hospital admissions each year in the UK and causes the death of about @ % of these patients .


Tranexamic acid has been shown to reduce the need for blood transfusion in surgical patients and to reduce mortality in bleeding trauma patients , with no apparent increase in thromboembolic events .


A systematic review of clinical trials of upper gastrointestinal bleeding shows a reduction in the risk of death with tranexamic acid but the quality of the trials was poor and the estimates are imprecise .


The trials were also too small to assess the effect of tranexamic acid on thromboembolic events .


HALT-IT is a pragmatic , randomised , double-blind , placebo-controlled trial which will determine the effect of tranexamic acid on mortality , morbidity ( re-bleeding , non-fatal vascular events ) , blood transfusion , surgical intervention , and health status in patients with acute gastrointestinal bleeding .


Eight thousand adult patients who fulfil the eligibility criteria will be randomised to receive tranexamic acid or placebo .


Adults with significant acute upper or lower gastrointestinal bleeding can be included if the responsible doctor is substantially uncertain as to whether or not to use tranexamic acid in that particular patient .


Trial treatment consists of a loading dose of tranexamic acid ( @ g by intravenous injection ) or placebo ( sodium chloride @ % ) given as soon as possible after randomisation , followed by an intravenous infusion of @ g tranexamic acid or placebo ( sodium chloride @ % ) over @ hours .


The main analyses will compare those allocated tranexamic acid with those allocated placebo , on an intention-to-treat basis .


Results will be presented as effect estimates with a measure of precision ( @ % confidence intervals ) .


Subgroup analyses for the primary outcome will be based on time to treatment , source of bleeding ( upper versus lower ) , suspected variceal bleeding and severity of bleeding .


A study with @,@ patients will have over @ % power to detect a @ % reduction in mortality from @ % to @ % .


We aimed to explore the association between vitamin D levels and the severity , mortality and microbiological etiology of community-acquired pneumonia .


Vitamin D levels ( both , the reservoir form @-OH and the activated form @,@-OH@ ) of @ randomly selected patients with community-acquired pneumonia due to pre-specified pathogens included in the German competence network ( CAPNETZ ) study were measured .


Prior to statistical analysis , values of @-OH and @,@-OH@ were power-transformed to achieve parametric distribution .


All further analyses were performed with seasonally and age adjusted values .


There was only a modest ( Spearman Coefficient @ ) positive correlation between @-OH and @,@-OH@ .


For @,@-OH@ but not @-OH , the general linear model revealed a significant inverse correlation between serum concentration and CURB score ( p = @ ) .


Liver and respiratory co-morbidity were associated with significantly lower @-OH values and renal co-morbidity with significantly lower @,@-OH@ values .


No significant differences of @,@-OH@ or @-OH between different pathogens ( influenza virus , Legionella spp. , Streptococcus pneumoniae ) were detected .


For @,@-OH@ , we found a significant and independent ( controlled for age , season and pathogen ) negative correlation to pneumonia severity .


Therefore , supplementation of non-activated vitamin D to protect from pneumonia may be non-sufficient in patients that have a decreased capacity to hydroxylate @-OH to @,@-OH@ .


To determine the association between interleukin-@ ( IL-@ ) , IL-@ soluble receptor ( sR ) , and soluble tumor necrosis factor receptor-@ ( sTNF-R@ ) and cognitive status in the oldest-old women .


Twenty-year longitudinal cohort study .


Four clinical sites in the United States .


Women from the Study of Osteoporotic Fractures ( N = @ ; mean age @ @ at cognitive status adjudication ) .


At Year @ , cognitive status was adjudicated as normal , mild cognitive impairment ( MCI ) , or dementia .


Inflammatory markers were measured from blood serum at Years @ and @ in a random sample of women .


Over @ years , @ ( @ % ) women developed MCI and @ ( @ % ) dementia .


There were no significant associations between IL-@ or sTNF-R@ and cognitive status .


High IL-@-sR ( @,@ pg/mL , highest tertile ) at Year @ was significantly associated with lower risk of dementia ( odds ratio ( OR ) = @ , @ % confidence interval ( CI ) = @-@ @ ) than in women with lower levels ( < @,@ pg/mL , lower two tertiles ) .


Women with high IL-@-sR at both time points ( OR = @ , @ % CI = @-@ @ ) or who transitioned to a high level ( OR = @ , @ % CI = @-@ @ ) had a lower risk of dementia .


In this cohort of white , high-functioning oldest-old women , a consistently high or an increasing level of IL-@-sR was associated with lower risk of dementia .


Compared with other studies of younger-old adults , this suggests that the effect of inflammation on dementia may differ in younger-old and the oldest-old individuals .


Understanding these differences will be crucial in interpreting results from ongoing clinical trials and in targeting therapeutic strategies to the oldest-old individuals .


Prisoners have extremely high rates of smoking with rates @-@ times higher than the general community .


Many prisoners have used heroin .


The aims of this study were to investigate the impact of heroin use on smoking cessation and the social determinants of health among prisoners .


Secondary analysis of data from a randomised controlled trial of a multi-component smoking cessation intervention involving @ Australian male prisoners .