Furthermore , intervention patients had higher levels of prevention behaviors : they were less likely to sunbathe in the summer ( @ % vs @ % , P = @ ) and more likely to have performed skin self-examinations in the past year ( @ % vs @ % , P = @ ) .


The intervention was not associated with any clear adverse effects , although there were trends whereby intervention patients were more likely to worry about melanoma and to consult their general practitioner again about the disease .


The combination of use of the SAMScore and general practitioner examination and counseling during consultations is an efficient way to promote patient behaviors that may reduce melanoma risk .


Extending the duration of follow-up and demonstrating an impact on morbidity and mortality remain major issues for further research .


To compare the effectiveness of different methods of recall for repeat Pap smear among women who had normal smears in the previous screening .


Prospective randomized controlled study .


All community clinics in Klang under the Ministry of Health Malaysia .


Women of Klang who attended cervical screening and had a normal Pap smear in the previous year , and were due for a repeat smear were recruited and randomly assigned to four different methods of recall for repeat smear .


The recall methods given to the women to remind them for a repeat smear were either by postal letter , registered letter , short message by phone ( SMS ) or phone call .


Number and percentage of women who responded to the recall within @ weeks after they had received the recall , irrespective whether they had Pap test conducted .


Also the numbers of women in each recall method that came for repeat Pap smear .


The rates of recall messages reaching the women when using letter , registered letter , SMS and phone calls were @ % , @ % , @ % and @ % , respectively .


However , the positive responses to recall by letter , registered letter , phone messages and telephone call were @ % , @ % , @ % and @ % , respectively ( p < @ ) .


Furthermore , more women who received recall by phone call had been screened ( p < @ ) compared to those who received recall by postal letter ( OR = @ , CI = @-@ @ ) .


Both the usual way of sending letters and registered letters had higher chances of reaching patients compared to using phone either for sending messages or calling .


The response to the recall method and uptake of repeat smear , however , were highest via phone call , indicating the importance of direct communication .


When cats purr during examination it is difficult to perform auscultation .


The objective of this study was to determine the prevalence of purring in cats during examination , and identify interventions that could be used to stop purring .


Cats seen at a first opinion clinic were enrolled in the study and their purring status recorded .


Thirty of the purring cats were exposed to up to three different interventions in an attempt to stop purring in a randomised controlled trial including blowing at the ear , use of an ethanol-based aerosol near the cat and proximity to a running tap .


The @ cats in the trial were subjected to a total of @ attempts to stop purring , proximity to a running tap caused @ of @ ( @ % ) cats to stop purring , blowing at the cat 's ears worked in @ of @ ( @ % ) cats , spraying an aerosol close to the cat was effective in @ of @ ( @ % ) cases .


In @ cats ( @ % ) , none of the interventions interrupted purring .


This study provides evidence that placing a purring cat near a running tap and in proximity to the discharge of an ethanol-based aerosol are effective measures to stop purring in order to allow auscultation .


To evaluate the safety of the concurrent combination of bevacizumab with adjuvant radiotherapy ( B-RT ) in breast cancer ( BC ) .


Multicentre , prospective study , of the toxicity of adjuvant radiotherapy ( RT ) alone or B-RT in patients with non-metastatic BC enrolled in randomized Phase @ BEATRICE trial .


Early and late toxicities were assessed by the Common Terminology Criteria for Adverse Events v. @ during and @ months after the completion of RT. .


From @ to @ , @ females received adjuvant B-RT and @ received adjuvant RT alone .


Median follow-up was @ months .


All patients had triple-negative non-metastatic BC and received adjuvant chemotherapy followed by RT. @ % of the @ females treated by concurrent B-RT received whole breast irradiation ( WBI ) with a boost and @ ( @ % ) received post-mastectomy RT. .


Lymph node RT was delivered in @ % of the females with internal mammary chain irradiation .


The mean duration of bevacizumab was @ months .


@ ( @ % ) females treated by RT alone received WBI with a boost and @ % of the females received post-mastectomy RT. .


Lymph node RT was delivered in @ % of the females with internal mammary chain RT in @ % .


Grade @ acute dermatitis was observed in @ % of patients receiving B-RT and @ % of patients receiving RT alone with no significant difference .


@ year after the completion of RT , the most common late grade @-@ toxicities in the B-RT group were pain ( @ % ) , fibrosis ( @ % ) and telangiectasia ( @ % ) .


The concurrent bevacizumab with locoregional RT is associated with acceptable early and late @-year toxicities in patients with BC .


The largest series of this association .


To determine the efficacy and toxicity of higher dose versus standard dose intravenous methotrexate ( MTX ) and pulses of high-dose cytosine arabinoside with asparaginase versus standard dose cytosine arabinoside and teniposide during intensified continuation therapy for higher risk pediatric B-precursor acute lymphoblastic leukemia ( ALL ) .


From @ to @ , the Pediatric Oncology Group conducted a randomized phase III clinical trial in higher risk pediatric B-precursor ALL .


A total of @ patients were randomized in a @ factorial design to receive MTX @ g/m versus @ g/m and to cytosine arabinoside/teniposide versus high-dose cytosine arabinoside/asparaginase during intensified continuation therapy .


Patients receiving standard dose MTX had a @-year disease-free survival ( DFS ) of @ % ; patients receiving higher dose MTX had a @-year DFS of @ % ( P = @ ) .


Outcomes on cytosine arabinoside/teniposide ( DFS of @ ) were similar to higher dose cytosine arabinoside/asparaginase ( DFS of @ % ) ( P = @ ) .


Overall survival rates were not different between MTX doses or cytosine arabinoside/teniposide versus cytosine arabinoside/asparaginase .


Increasing MTX dosing to @ g/m did not improve outcomes in higher risk pediatric B-precursor ALL .


Giving high-dose cytarabine and asparaginase pulses instead of standard dose cytarabine and teniposide produced nonsignificant differences in outcomes , allowing for teniposide to be removed from ALL therapy .


To evaluate how a genomic classifier ( GC ) that predicts the risk of metastasis after prostatectomy would impact adjuvant treatment recommendations made by radiation oncologists and urologists .


The @ specialties often disagree about postprostatectomy adjuvant treatment recommendations .


Twenty-six radiation oncologists and @ urologists with genitourinary oncology expertise reviewed de-identified clinical results from @ patients after radical prostatectomy and made adjuvant treatment recommendations .


The same cases were later randomized and reassigned , and treatment recommendations were made using the clinical information and GC test results together .


Using clinical information alone , observation was recommended in @ % of decisions made by urologists vs @ % by radiation oncologists ( P < @ ) .


The GC test results altered @ % and @ % of treatment recommendations made by radiation oncologists and urologists , respectively .


Multivariate analysis showed GC risk was the strongest factor influencing treatment recommendations by both specialties , with an adjusted odds ratio of @ ( @ % confidence interval -LSB- CI -RSB- , @-@ @ ) and @ ( @ % CI , @-@ @ ) for radiation oncologists and urologists , respectively .


GC results indicating high metastatic risk resulted in intensification of treatment , whereas low metastatic risk resulted in less aggressive recommendations .


The GC results increased interdisciplinary agreement in treatment recommendations , as the odds of a recommendation for adjuvant treatment by urologists vs radiation oncologists increased from @ ( @ % CI , @-@ @ ) to @ ( @ % CI , @-@ @ ) after results of the GC test were available .


The GC test significantly influenced adjuvant postprostatectomy treatment recommendations , reduced disagreement between radiation oncologists and urologists , and has the potential to enhance personalization of postprostatectomy care .


Nonmelanoma skin cancers , such as basal-cell carcinoma and squamous-cell carcinoma , are common cancers that are caused principally by ultraviolet ( UV ) radiation .


Nicotinamide ( vitamin B@ ) has been shown to have protective effects against damage caused by UV radiation and to reduce the rate of new premalignant actinic keratoses .


In this phase @ , double-blind , randomized , controlled trial , we randomly assigned , in a @:@ ratio , @ participants who had had at least two nonmelanoma skin cancers in the previous @ years to receive @ mg of nicotinamide twice daily or placebo for @ months .


Participants were evaluated by dermatologists at @-month intervals for @ months .


The primary end point was the number of new nonmelanoma skin cancers ( i.e. , basal-cell carcinomas plus squamous-cell carcinomas ) during the @-month intervention period .


Secondary end points included the number of new squamous-cell carcinomas and basal-cell carcinomas and the number of actinic keratoses during the @-month intervention period , the number of nonmelanoma skin cancers in the @-month postintervention period , and the safety of nicotinamide .


At @ months , the rate of new nonmelanoma skin cancers was lower by @ % ( @ % confidence interval -LSB- CI -RSB- , @ to @ ) in the nicotinamide group than in the placebo group ( P = @ ) .


Similar differences were found between the nicotinamide group and the placebo group with respect to new basal-cell carcinomas ( @ % -LSB- @ % CI , -@ to @ -RSB- lower rate with nicotinamide , P = @ ) and new squamous-cell carcinomas ( @ % -LSB- @ % CI , @ to @ -RSB- lower rate , P = @ ) .


The number of actinic keratoses was @ % lower in the nicotinamide group than in the placebo group at @ months ( P = @ ) , @ % lower at @ months ( P < @ ) , @ % lower at @ months ( P < @ ) , and @ % lower at @ months ( P = @ ) .


No noteworthy between-group differences were found with respect to the number or types of adverse events during the @-month intervention period , and there was no evidence of benefit after nicotinamide was discontinued .


Oral nicotinamide was safe and effective in reducing the rates of new nonmelanoma skin cancers and actinic keratoses in high-risk patients .


( Funded by the National Health and Medical Research Council ; ONTRAC Australian New Zealand Clinical Trials Registry number , ACTRN@ . )


Anemia affects most pregnant African women and is predominantly due to iron deficiency , but antenatal iron supplementation has uncertain health benefits and can increase the malaria burden .


To measure the effect of antenatal iron supplementation on maternal Plasmodium infection risk , maternal iron status , and neonatal outcomes .


Randomized placebo-controlled trial conducted October @ through April @ in a malaria endemic area among @ rural Kenyan women aged @ to @ years with singleton pregnancies , gestational age of @ to @ weeks , and hemoglobin concentration of @ g/dL or greater .


All women received @ mg iron/day through flour fortification during intervention , and usual intermittent preventive treatment against malaria was given .


Supervised daily supplementation with @ mg of elemental iron ( as ferrous fumarate , n = @ women ) or placebo ( n = @ ) from randomization until @ month postpartum .


Primary outcome was maternal Plasmodium infection at birth .


Predefined secondary outcomes were birth weight and gestational age at delivery , intrauterine growth , and maternal and infant iron status at @ month after birth .


Among the @ participating women , @ women ( @ iron , @ placebo ) were lost to follow-up or excluded at birth ; @ mothers were lost to follow-up postpartum ( @ iron , @ placebo ) .


At baseline , @ of @ women ( @ % ) were iron-deficient .


In intention-to-treat analysis , comparison of women who received iron vs placebo , respectively , yielded the following results at birth : Plasmodium infection risk : @ % vs @ % ( crude difference , -@ % , @ % CI , -@ % to @ % ; P = @ ) ; birth weight : @ g vs @ g ( crude difference , @ g , @ % CI , @ to @ ; P = @ ) ; birth-weight-for-gestational-age z score : @ vs @ ( crude difference , @ , @ % CI , -@ to @ ; P = @ ) ; and at @ month after birth : maternal hemoglobin concentration : @ g/dL vs @ g/dL ( crude difference , @ g/dL , @ % CI , @ to @ ; P < @ ) ; geometric mean maternal plasma ferritin concentration : @ g/L vs @ g/L ( crude difference , @ % , @ % CI , @ % to @ % ; P < @ ) ; geometric mean neonatal plasma ferritin concentration : @ g/L vs @ g/L ( crude difference , @ % , @ % CI , @ % to @ % ; P = @ ) .


Serious adverse events were reported for @ and @ women who received iron and placebo , respectively .


There was no evidence that intervention effects on Plasmodium infection risk were modified by intermittent preventive treatment use .


Among rural Kenyan women with singleton pregnancies , administration of daily iron supplementation , compared with administration of placebo , resulted in no significant differences in overall maternal Plasmodium infection risk .


Iron supplementation led to increased birth weight .


The recent Danish Multicentre Randomized Trial on Single-Lead Atrial ( AAIR ) Pacing versus Dual-Chamber ( DDDR ) Pacing in Sick Sinus Syndrome ( DANPACE ) suggested DDDR pacing as standard care .


However , previous findings supported the routine use of AAIR pacing .


This study investigated the cost-effectiveness of DDDR pacing compared with AAIR pacing for sick sinus syndrome .


A decision-analytical model based on patient-level data from three randomized trials was designed from the Danish healthcare system 's perspective .


The main outcomes were lifetime costs , quality-adjusted lifeyears ( QALYs ) , and net monetary benefit .


Quality-adjusted lifeyears were calculated by utilizing community-based preferences .


Costs were calculated by utilizing the extensive data on resource consumption , from the DANPACE trial .


Data were pooled and adjusted for baseline differences .


Dual-chamber pacing was shown to be cost-effective in all the analyses using a willingness-to-pay ( WTP ) threshold of @,@ / QALY , and most analyses using a WTP of @,@ / QALY .


When pooling the data and adjusting for baseline differences , Monte Carlo simulations revealed a @-@ % probability of DDDR pacing being cost-effective at a WTP of @,@ / QALY , and a @-@ % probability at a WTP of @,@ / QALY .


Dual-chamber pacing was most likely to be cost-effective among elderly patients with comorbidity .


The expected value of perfect information was low and initiation of additional publicly funded Danish trials was discouraged .


Dual-chamber pacing is likely to be a cost-effective treatment for sick sinus syndrome patients .


This study looks at the effect of immediate session-by-session feedback using short questionnaires for evaluating outcome of and alliance in the therapy .


Research data strongly suggests that using this feedback informed treatment improves the outcome of therapy .


However , until now , this method of Miller and Duncan has only been examined in clients ( generally students ) with mild problems and in partner counselling .


The question addressed by this study is whether immediate feedback is also effective when applied during crisis intervention and subsequent brief therapy in a psychiatric patient population in emergency situations .


It also looks at whether ` feedback-informed treatment ' affects the quality of the alliance .


To test the hypotheses , all patients seeking help from the Crisis Intervention & Brief Therapy Team over a two-year period will be followed throughout their treatment up to a maximum of six months and a follow-up period of three months after ending the treatment .


Patients are randomly assigned to two conditions : treatment without feedback and treatment with immediate feedback for each session .


The therapists all operate in both conditions and so they deliver both treatments .


An estimated total of @ patients , aged @years and over , will be included in the study .


The aim of this study is to make clear whether , and to what extent , systematic feedback from the patient in this target group during therapy determines the course and outcomes of therapy .


We also look at whether , and to what extent , the quality of the alliance and the motivation of the person delivering treatment with respect to the instruments play a role .


To report the long-term results of the ARO @-@ randomized trial comparing hyperfractionated accelerated chemoradiation with mitomycin C/@-fluorouracil ( C-HART ) with hyperfractionated accelerated radiation therapy ( HART ) alone in locally advanced head and neck cancer .


The primary endpoint was locoregional control ( LRC ) .


Three hundred eighty-four patients with stage III ( @ % ) and IV ( @ % ) oropharyngeal ( @ % ) , hypopharyngeal ( @ % ) , and oral cavity ( @ % ) cancer were randomly assigned to @Gy/@Gy daily followed by twice-daily @ Gy to a total of @ Gy concurrently with mitomycin C/@-FU ( C-HART ) or @Gy/@Gy daily followed by twice-daily @ Gy to a total dose of @ Gy alone ( HART ) .


Statistical analyses were done with the log-rank test and univariate and multivariate Cox regression analyses .


The median follow-up time was @ years ( @ % confidence interval -LSB- CI -RSB- : @-@ @ years ) .


At @years , the LRC rates were @ % ( C-HART ) versus @ % ( HART , P = @ ) .


The cancer-specific survival and overall survival rates were @ % and @ % ( C-HART ) versus @ % and @ % ( HART , P = @ and P = @ ) , respectively .


According to multivariate Cox regression analysis , the combined treatment was associated with improved LRC ( hazard ratio -LSB- HR -RSB- : @ -LSB- @ % CI : @-@ @ ; P = @ -RSB- ) .


The association between combined treatment arm and increased LRC appeared to be limited to oropharyngeal cancer ( P = @ ) as compared with hypopharyngeal or oral cavity cancer ( P = @ ) .


C-HART remains superior to HART in terms of LRC .


However , this effect may be limited to oropharyngeal cancer patients .


To compare the rates of urinary incontinence ( UI ) and other complications of subtotal abdominal hysterectomy ( SAH ) with total abdominal hysterectomy ( TAH ) at @ years after surgery .


Randomised clinical trial with central , computer-generated randomisation .


Danish multi-centre trial performed in @ departments of gynaecology .


Women referred with benign uterine diseases scheduled for abdominal hysterectomy .


Women were randomised to either SAH ( n = @ ) or TAH ( n = @ ) .


Follow-up data were collected from participants using postal questionnaires sent out @ years after surgery .


Complications of hysterectomy were further examined by scrutinising registered discharge summaries following hospitalisation .


Intention-to-treat and per-protocol analyses were conducted .


Potential bias caused by missing data was handled using multiple imputation .


The primary outcome was UI .


Secondary outcomes included constipation , prolapse of the vaginal vault or cervical stump , satisfaction with sexual life , pelvic pain , postoperative complications and vaginal bleeding .


The response rate was @/@ ( @ % ) .


A significantly higher proportion of respondents had urinary incontinence @ years after SAH @/@ ( @ % ) than TAH @/@ ( @ % ) ( RR @ , @ % confidence interval @-@ @ , P = @ ) .


This difference reduced after multiple imputation to account for missing data ( RR @ , @ % confidence interval @-@ @ , P = @ ) .


Eleven of the @ women ( @ % ) in the SAH group still experienced vaginal bleeding .


No other differences were found between the two types of abdominal hysterectomy .


A smaller proportion of women suffered from UI after TAH than after SAH @ years postoperatively .


Around one in ten women continued to experience vaginal bleeding @ years after SAH .


Two influenza B lineages have been co-circulating since the @s , and because inactivated trivalent influenza vaccine ( TIV ) contains only one B strain , it provides little/no protection against the alternate B-lineage .


We assessed a candidate inactivated quadrivalent influenza vaccine ( QIV ) containing both B lineages versus TIV in healthy adults .


Subjects received one dose of QIV ( lot @ , @ , or @ ) or one of two TIVs ( B strain from Victoria or Yamagata lineage ) ; randomization was @:@:@:@:@ .


Hemagglutination-inhibition assays were performed @-days post-vaccination ; superiority of QIV versus TIV for the alternate B-lineage was demonstrated if the @ % confidence interval ( CI ) lower limit for the GMT ratio was @ , and non-inferiority against the shared strains was demonstrated if the @ % CI upper limit for the GMT ratio was @ .


Reactogenicity and safety were assessed during the post-vaccination period .


NCT@ .


Immunogenicity of QIV lots was consistent , QIV was superior to TIV for the alternate B-lineage strain , and QIV was non-inferior versus TIVs for shared strains ( A/H@N@ , A/H@N@ , B-strain ) .


Reactogenicity and safety profile of the QIV was consistent with seasonal influenza vaccines .


QIV provided superior immunogenicity for the added B strain without affecting the antibody response to the TIV strains , and without compromising safety .


The total enteroscopy rate of single-balloon enteroscopy ( SBE ) using air insufflation is not satisfactory , and whether carbon dioxide ( CO@ ) insufflation increases the total enteroscopy rate of SBE is unknown .


This randomised controlled trial aimed to determine whether CO@ insufflation facilitates the intubation depth and total enteroscopy rate of SBE .


A total of @ eligible patients referred for SBE were randomised to receive either air or CO@ insufflation , and included in the intention-to-test ( ITT ) analysis .


In addition , @ patients in whom enteroscopy was completed were included in the per-protocol ( PP ) analysis .


Both the patients and endoscopists were blinded , and the intubation depth and total enteroscopy rate were defined as the primary outcomes .


The CO@ group showed a superiority of intubation in the ITT analysis ( oral route : @ vs @ cm ; anal route : @ vs @ cm , both p < @ ) , and the total enteroscopy rate ( @ % vs @ % , p = @ ) .


Similar results were obtained in a PP analysis for both outcomes .


In addition , in the PP analysis , the addition of circumference after the procedure was less in the CO@ group ( @ vs @ cm , p = @ ) for the oral route .


No serious complications were reported .


The overall percentage of procedures with significant pathological findings was @ % ; the rates were @ % and @ % ( p = @ , ITT analysis ) in the CO@ and air groups , respectively .


CO@ insufflation improves the intubation depth and total enteroscopy rate in SBE with a good safety profile and acceptability compared with that of air , and thus is recommended for clinical utilisation .


The authors evaluated the effect of an electronic personal health record on the quality of medical care in a community mental health setting .


A total of @ individuals with a serious mental disorder and a comorbid medical condition treated in a community mental health center were randomly assigned to either a personal health record or usual care .


One-year outcomes assessed quality of medical care , patient activation , service use , and health-related quality of life .


Patients used the personal health record a mean of @ times during the @-year intervention period .


In the personal health record group , the total proportion of eligible preventive services received increased from @ % at baseline to @ % at the @-month follow-up , whereas it declined in the usual care group , from @ % to @ % .


In the subset of patients with one or more cardiometabolic conditions ( N = @ ) , the total proportion of eligible services received improved by @ percentage points in the personal health record group and declined by @ percentage points in the usual care group , resulting in a significant difference in change between the two groups .


There was an increase in the number of outpatient medical visits , which appeared to explain many of the significant differences in the quality of medical care .


Having a personal health record resulted in significantly improved quality of medical care and increased use of medical services among patients .


Personal health records could provide a relatively low-cost scalable strategy for improving medical care for patients with comorbid medical and serious mental illnesses .


Bioelectrical impedance analysis would be a more practical tool to measure body composition in clinical settings , dietetic practice and epidemiological studies if patients/subjects did not have to fast before measurements .


The present study assessed whether the ingestion of food or drink had any biologically significant effect on bioimpedance measurements and body composition by the foot-to-foot method .


Fifty-five healthy adults -LSB- @ males and @ females ; mean ( SD ) age @ ( @ ) years ; mean ( SD ) body mass index @ ( @ ) kg m ( -@ ) -RSB- were randomly assigned to a @-day food trial ( high-fat meal or high-carbohydrate meal ) or a @-day drink trial ( water or high electrolyte drink ) .


Body composition measurements were carried out in the fasting state , immediately after meal consumption and every @ min for @ h by the foot-to-foot single frequency bioimpedance technique .


Bioimpedance increased significantly after the ingestion of food and fluid , although the changes were small .


The electrolyte drink , high-fat and high-carbohydrate meals significantly increased the percentage body fat and fat mass .


In all cases , the median percentage changes from baseline were approximately @ % in body fat percentage units .


Although there were statistically significant changes in body composition estimates after food or drink consumption , these were small and within the imprecision of the impedance technique , and so are unlikely to be of clinical significance .


The present study suggests that impedance measures of body fatness in clinical settings do not require strict adherence to fasting , and this should increase the opportunities for clinical application .


Hip fracture ( HF ) in frail elderly patients is associated with poor physical recovery and death .


There is often postoperative blood loss and the hemoglobin ( Hb ) threshold for red blood cell ( RBC ) transfusions in these patients is unknown .


We investigated whether RBC transfusion strategies were associated with the degree of physical recovery or with reduced mortality after HF surgery .


We enrolled @ consecutive post-surgical HF patients ( aged @ years ) with Hb levels < @ g/dL ( @ mmol/L ) who had been admitted from nursing homes or sheltered housing .


Allocation was stratified by residence .


The patients were randomly assigned to either restrictive ( Hb < @ g/dL ; < @ mmol/L ) or liberal ( Hb < @ g/dL ; < @ mmol/L ) RBC transfusions given within the first @ days postoperatively .


Follow-up was at @ days .


No statistically significant differences were found in repeated measures of daily living activities or in @-day mortality rate between the restrictive group ( where @ % died ) and the liberal group ( where @ % died ) .


Per-protocol @-day mortality was higher with the restrictive strategy ( hazard ratio ( HR ) = @ , @ % CI : @-@ @ ; p = @ ) .


The @-day mortality rate was higher for nursing home residents in the restrictive transfusion group ( @ % ) than for those in the liberal group ( @ % ) ( HR = @ , @ % CI : @-@ @ ; p = @ ) .


According to our Hb thresholds , recovery from physical disabilities in frail elderly hip fracture patients was similar after a restrictive RBC transfusion strategy and after a liberal strategy .


Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential to increase survival .


This prospective and randomized study was designed to compare safety , potential complications , and patient and examiner satisfaction of @ anesthetic combinations - etomidate-remifentanil and propofol-remifentanil - in elderly patients undergoing diagnostic gastroscopy .


A group of @ patients , aged @-@ years , scheduled for diagnostic gastroscopy under sedation were prospectively randomized .


After @-@ @ g kg of remifentanil was infused , etomidate or propofol was administered .


Patients in the etomidate group received doses of etomidate at @-@ @ mg kg followed by @-@ mg .


Patients in the propofol group received doses of propofol at @-@ mg kg followed by @-@ mg .


Physiological indexes were evaluated for the @ of @ patients that completed the treatment .


The onset time , duration time , and discharge time were recorded .


Physicians , anesthetists , and patients were surveyed to assess their satisfaction .


Systolic pressure and diastolic pressure decreased significantly after the procedure in the propofol group ( P < @ ) .


The average heart rate was significantly lower in the propofol group ( P < @ ) .


No periods of desaturation ( SpO < @ % ) were observed in either group .


The onset time was earlier in the etomidate group ( P = @ ) .


All adverse events , with the exception of myoclonus , were greater in the propofol group , and physician and patient satisfaction in both groups was similar .


Etomidate-remifentanil administration for sedation and analgesia during gastroscopy resulted in more stable hemodynamic responses and less adverse events in older patients .


Asynchronous e-learning allows for targeted teaching , particularly advantageous when bedside and didactic education is insufficient .


An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation .


We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine ( EM ) rotation improves medical knowledge among residents and students across multiple participating centers .


Trainees on pediatric EM rotations at four large pediatric centers from @ to @ were randomized in a Solomon four-group design .


The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based , interactive , peer-reviewed Flash/HTML@ modules .


Postrotation testing and in-training examination ( ITE ) scores quantified improvements in knowledge .


A @ @ analysis of covariance ( ANCOVA ) tested interaction and main effects , and Pearson 's correlation tested associations between module usage , scores , and ITE scores .


A total of @ of @ participants completed all study elements ; @ had access to asynchronous e-learning modules , and @ were controls who used the current education standards .


No pretest sensitization was found ( p = @ ) .


Use of asynchronous e-learning modules was associated with an improvement in posttest scores ( p < @ ) , from a mean score of @ ( @ % confidence interval -LSB- CI -RSB- = @ to @ ) to @ ( @ % CI = @ to @ ) , a large effect ( partial ( @ ) = @ ) .


Posttest scores correlated with ITE scores ( r ( @ ) = @ , p < @ ) among pediatric residents .


Asynchronous e-learning is an effective educational tool to improve knowledge in a clinical rotation .


Web-based asynchronous e-learning is a promising modality to standardize education among multiple institutions with common curricula , particularly in clinical rotations where scheduling difficulties , seasonality , and variable experiences limit in-hospital learning .


Apnoea , desaturations and bradycardias are common problems in preterm infants which can be treated with nasal continuous positive airway pressure ( NCPAP ) and nasal intermittent positive pressure ventilation ( NIPPV ) .


It is unclear whether synchronised NIPPV ( SNIPPV ) would be even more effective .


To assess the effects of flow-SNIPPV , NIPPV and NCPAP on the rate of desaturations and bradycardias in preterm infants and , secondarily , to evaluate their influence on pattern of breathing and gas exchange .


Nineteen infants ( mean gestational age at study @weeks , @ boys ) with apnoeic spells were enrolled in a randomised controlled trial with a cross-over design .


They received flow-SNIPPV , NIPPV and NCPAP for @h each .


All modes were provided by a nasal conventional ventilator able to provide synchronisation by a pneumotachograph .


The primary outcome was the event rate of desaturations ( @ % arterial oxygen saturation ) and bradycardias ( @bpm ) per hour , obtained from cardiorespiratory recordings .


The incidence of central apnoeas ( @s ) as well as baseline heart rate , FiO@ , SpO@ , transcutaneous blood gases and respiratory rate were also evaluated .


The median event rate per hour during flow-SNIPPV , NIPPV and NCPAP was @ , @ and @ , respectively ( p < @ and @ , compared with flow-SNIPPV ) .


Central apnoeas per hour were @ , @ and @ , respectively ( p = @ , for both compared with flow-SNIPPV ) , while no differences in any other parameter studied were recorded .


Flow-SNIPPV seems more effective than NIPPV and NCPAP in reducing the incidence of desaturations , bradycardias and central apnoea episodes in preterm infants .


The aim of this study was to investigate the effect of different types of anesthesia on stress hormones .


The study was included @ ASAI-II cases scheduled for major lower extremity surgery .


The cases were randomized into @ groups : The EA group was administered epidural anesthesia and the GA group was administered standard general anesthesia .


In order to evaluate the surgical trauma - related stress response , CRP , TSH , cortisol , and fasting blood sugar ( FBS ) levels were measured preoperatively , @ min after surgical incision , and @ h post surgery .


Between-group comparisons ; Preoperative values were not significantly different between the groups .


( P > @,@ ) Pulse rate and cortisol values significantly higher in general group at @ min .


( P < @,@ ) , and the FBS values were significantly higher in the epidural group at @ h. ( P < @,@ ) There were not found differences for other parameters at evaluation times .


No differences were observed between the two anesthesia methods , in terms of minimizing the stress response due to surgical trauma during major low extremity surgery .


Inactivated polio vaccine ( IPV ) is necessary for global polio eradication because oral polio vaccine can rarely cause poliomyelitis as it mutates and may fail to provide adequate immunity in immunocompromised populations .


However , IPV is unaffordable for many developing countries .


Intradermal IPV shows promise as a means to decrease the effective dose and cost of IPV , but prior studies , all using @ % of the standard dose used in intramuscular IPV , resulted in inferior antibody titers .


We randomly assigned @ adults with well-controlled human immunodeficiency virus infection at a ratio of @:@:@:@ to receive @ % of the standard dose of IPV intradermally , @ % of the standard dose intradermally , the full standard dose intramuscularly , or @ % of the standard dose intramuscularly .


Intradermal vaccination was done using the NanoPass MicronJet@ microneedle device .


Baseline immunity was @ % , @ % , and @ % against poliovirus serotypes @ , @ , and @ , respectively .


After vaccination , antibody titers increased a median of @-fold .


Vaccine response to @ % of the standard dose administered intradermally was comparable to that of the standard dose of IPV administered intramuscularly and resulted in higher ( although not significantly ) antibody titers .


Intradermal administration had higher a incidence of local side effects ( redness and itching ) but a similar incidence of systemic side effects and was preferred by study participants over intramuscular administration .


A @ % reduction in the standard IPV dose without reduction in antibody titers is possible through intradermal administration .


A current recommendation for locoregionally advanced nasopharyngeal carcinoma ( NPC ) is conventional fractionated radiotherapy with concurrent cisplatin plus adjuvant cisplatin and fluorouracil ( PF ) .


In this randomized trial , the authors evaluated the potential therapeutic benefit from changing to an induction-concurrent chemotherapy sequence , replacing fluorouracil with oral capecitabine , and/or using accelerated rather than conventional radiotherapy fractionation .


Patients with stage III through IVB , nonkeratinizing NPC were randomly allocated to @ of @ treatment arms .


The protocol was amended in @ to permit confining randomization to the conventional fractionation arms .


The primary endpoint was progression-free survival .


Secondary endpoints included overall survival and safety .


In total , @ patients were accrued , and @ patients were randomly allocated to all @ treatment arms .


Comparisons of induction PF versus adjuvant PF did not indicate a significant improvement .


Unadjusted comparisons of induction cisplatin and capecitabine ( PX ) versus adjuvant PF indicated a favorable trend in progression-free survival for the conventional fractionation arm ( P = @ ) ; analyses that were adjusted for other significant factors and fractionation reflected a significant reduction in the hazards of disease progression ( hazard ratio -LSB- HR -RSB- , @ ; @ % confidence interval -LSB- CI -RSB- , @-@ @ ) and death ( HR , @ ; @ % CI , @-@ @ ) .


Unadjusted comparisons of induction sequences versus adjuvant sequences did not reach statistical significance , but adjusted comparisons indicated favorable improvements by induction sequence .


Comparisons of induction PX versus induction PF revealed fewer toxicities ( neutropenia and electrolyte disturbance ) , unadjusted comparisons of efficacy were statistically insignificant , but adjusted analyses indicated that induction PX had a lower hazard of death ( HR , @ ; @ % CI , @-@ @ ) .


Changing the fractionation from conventional to accelerated did not achieve any benefit but incurred higher toxicities ( acute mucositis and dehydration ) .


Preliminary results indicate that the benefit of changing to an induction-concurrent sequence remains uncertain ; replacing fluorouracil with oral capecitabine warrants further validation in view of its convenience , favorable toxicity profile , and favorable trends in efficacy ; and accelerated fractionation is not recommended for patients with locoregionally advanced NPC who receive chemoradiotherapy .


Cannabis is the most frequently used illegal substance in the United States and Europe .


There is a dramatic increase in the demand for treatment for cannabis dependence .


Cannabis users frequently have co-morbid mood symptoms , especially depression and anxiety , and regular cannabis users may self-medicate for such symptoms .


We report a double-blind , placebo-controlled treatment study , for the prevention of cannabis use in cannabis-dependent individuals .


Regular cannabis-dependent users ( n = @ ) were treated for @ weeks with weekly cognitive-behavior and motivation-enhancement therapy sessions together with escitalopram @mg/day .


Urine samples were collected to monitor delta-@ tetrahydrocannabinol ( THC ) during treatment and questionnaires were administered to assess anxiety and depression .


We observed a high rate of dropout ( @ % ) during the @-week treatment program .


Fifty-two patients were included in the intention-to-treat analysis .


Of these , ten ( @ % ) remained abstinent after @ weeks of treatment as indicated by negative urine samples for THC .


Escitalopram provided no advantage over placebo in either abstinence rates from cannabis or anxiety and depression scores during the withdrawal and abstinent periods .


Escitalopram treatment does not provide an additional benefit either for achieving abstinence , or for the treatment of the cannabis withdrawal syndrome .


Due to limitations of our study , namely , a high dropout rate and effects of low abstinence rates on measures of anxiety , depression and withdrawal , it is premature to conclude that selective serotonin reuptake inhibitors are not effective for treatment of the cannabis withdrawal syndrome .


Contrast medium-induced acute kidney injury ( CI-AKI ) is a cardiovascular complication after myocardial infarction treated with emergency percutaneous coronary intervention .


The aim of this randomized , sham-controlled trial was to evaluate the impact of remote ischemic preconditioning ( RIPC ) on CI-AKI in patients with ST-elevation myocardial infarction who received emergency primary percutaneous coronary intervention .


Patients with a suspected ST-elevation myocardial infarction were randomly assigned at a @:@ ratio to receive percutaneous coronary intervention either with ( n = @ ) or without ( n = @ ) RIPC ( intermittent arm ischemia through three cycles of @min of inflation and @min of deflation of a blood pressure cuff ) .


A total of @ RIPC patients and @ control patients met all study criteria .


The primary endpoint was the incidence of CI-AKI , which was defined as an increase in serum creatinine > @ mg/dL or > @ % over the baseline value @-@h after administration of contrast medium .


The incidence of CI-AKI was @ % ( n = @ ) in the RIPC group and @ % ( n = @ ) in the control group ( p = @ ) .


The odds ratio of CI-AKI in patients who received RIPC was @ ( @ % confidence interval : @-@ @ ; p = @ ) .


In patients with ST-elevation myocardial infarction , RIPC before percutaneous coronary intervention reduced the incidence of CI-AKI .


We studied adjuvant daily sildenafil citrate during and after radiotherapy for prostate cancer for erectile function preservation .


We performed a randomized , prospective trial of @patients with localized prostate cancer treated with radiotherapy who received sildenafil citrate ( @ mg daily ) or placebo ( @:@ randomization ) .


Medication/placebo was initiated @ days before treatment and continued daily for @months .


Before therapy and @ , @ , @ , @ , @ and @ months after radiotherapy patients completed the IIEF questionnaire , including the erectile function domain , the I-PSS questionnaire and the RAND SF-@ .


All IIEF domains werescored .


At @ months erectile function scores were better for sildenafil citrate than placebo ( p = @ ) , @ % of patients on sildenafil citrate vs @ % on placebo had mild/no erectile dysfunction ( p = @ ) and the sildenafil citrate arm had superior overall satisfaction ( p = @ ) and IIEF total scores ( p = @ ) .


At @months erectile function and IIEF scores were no longer significantly better for sildenafil citrate ( p = @ and @ , respectively ) and yet overall satisfaction scores were higher ( p = @ ) .


Sexual desire scores in patients who received sildenafil citrate were higher at @ months although they had completed drug therapy @ months previously ( p = @ ) .


At @ months @ % of patients on sildenafil citrate and @ % of those on placebo achieved functional erection with or without erectile dysfunction medication ( p = @ ) .


Daily sildenafil citrate during and after radiotherapy for prostate cancer was associated with improved overall sexual function compared with placebo for various sexual function domains .


To our knowledge this is the largestrandomized , prospective , controlled trial to show the usefulness of a phosphodiesterase-@ inhibitor as a rehabilitation strategy in patients with prostate cancer who received radiation therapy .


EPHESUS was a multicentre , double-blind clinical trial in which @ patients with acute myocardial infarction ( AMI ) complicated by LV systolic dysfunction ( LVSD ) were randomized to receive eplerenone ( n = @ ) or placebo ( n = @ ) .


A total of @ EPHESUS patients were treated with PCI , which is now the standard treatment for AMI .


This EPHESUS substudy examined the effects of eplerenone upon cardiovascular outcomes in PCI-treated patients .


EPHESUS patients were divided into PCI-treated and non-PCI-treated cohorts , and the effect of eplerenone upon mortality and other major adverse cardiovascular outcomes was assessed in each cohort .


The PCI-treated patients ( n = @ ) were younger , and had better renal function and fewer co-morbidities than non-PCI-treated patients ( n = @ ) .


Cardiovascular mortality was significantly lower in PCI-treated patients as compared with non-PCI-treated patients ( @ % vs. @ % , P < @ ) .


However , the incidence of non-fatal events was similar in PCI-treated and non-PCI-treated cohorts .


There was no statistical difference between the PCI-treated and non-PCI-treated cohorts in the primary or secondary outcomes of the trial .


Eplerenone administration , compared with placebo , in the PCI-treated cohort did not affect PCI-related clinical outcomes , including recurrence of angina , the occurrence of acute coronary syndromes , or the need for further revascularization .


The beneficial effects of eplerenone in the EPHESUS trial exist for both PCI - and non-PCI-treated AMI patients with LVSD .


Eplerenone has minimal , if any , effect upon reducing PCI-related adverse events in the PCI-treated cohort .


To test whether elevated umbilical cord serum inflammatory cytokine levels predicted subsequent cerebral palsy ( CP ) or neurodevelopmental delay ( NDD ) .


Nested case-control analysis within a clinical trial of antenatal magnesium sulfate ( MgSO@ ) before anticipated preterm birth ( PTB ) for prevention of CP , with evaluation of surviving children at the age of @ .


NDD was defined as a Bayley psychomotor developmental index ( PDI ) and/or mental developmental index ( MDI ) < @ .


Controls , defined as surviving children without CP and with Bayley PDI and MDI@ , were matched by race and gestational age .


Cord serum was analyzed for interleukin-@ ( IL-@ ) interleukin-@ beta ( IL-@ ) , and tumor necrosis factor - ( TNF - ) levels .


Elevated cytokine levels were defined as@th percentile in placebo-exposed controls .


Analyses compared case/control cytokine levels , adjusting for MgSO@ exposure , gestational age , race/ethnicity , and sociodemographic differences .


Logistic regression analysis with @ cases and @ controls showed that elevated IL-@ and IL-@ were more common in cord blood serum from infants with subsequent low MDI as compared with controls .


After adjusting for additional confounders , the significant differences were no longer evident .


Cytokine levels ( IL-@ , IL-@ , and TNF - ) were not elevated with CP or low PDI .


Cord serum IL-@ , IL-@ , and TNF - levels in preterm infants are not associated with subsequent CP or NDD .


Multiple tasking is an integral part of daily mobility .


Patients with Parkinson 's disease have dual tasking difficulties due to their combined motor and cognitive deficits .


Two contrasting physiotherapy interventions have been proposed to alleviate dual tasking difficulties : either to discourage simultaneous execution of dual tasks ( consecutive training ) ; or to practice their concurrent use ( integrated training ) .


It is currently unclear which of these training methods should be adopted to achieve safe and consolidated dual task performance in daily life .


Therefore , the proposed randomized controlled trial will compare the effects of integrated versus consecutive training of dual tasking ( tested by combining walking with cognitive exercises ) .


Hundred and twenty patients with Parkinson 's disease will be recruited to participate in this multi-centered , single blind , randomized controlled trial .


Patients in Hoehn & Yahr stage II-III , with or without freezing of gait , and who report dual task difficulties will be included .


All patients will undergo a six-week control period without intervention after which they will be randomized to integrated or consecutive task practice .


Training will consist of standardized walking and cognitive exercises delivered at home four times a week during six weeks .


Treatment is guided by a physiotherapist twice a week and consists of two sessions of self-practice using an MP@ player .


Blinded testers will assess patients before and after the control period , after the intervention period and after a @-week follow-up period .


The primary outcome measure is dual task gait velocity , i.e. walking combined with a novel untrained cognitive task to evaluate the consolidation of learning .


Secondary outcomes include several single and dual task gait and cognitive measures , functional outcomes and a quality of life scale .


Falling will be recorded as a possible adverse event using a weekly phone call for the entire study period .


This randomized study will evaluate the effectiveness and safety of integrated versus consecutive task training in patients with Parkinson 's disease .


The study will also highlight whether dual task gait training leads to robust motor learning effects , and whether these can be retained and carried-over to untrained dual tasks and functional mobility .


To evaluate the efficacy of a novel , angular , continuous passive motion device for self-treatment at home in patients with mild-to-moderate , non-specific , chronic low back pain ( LBP ) .


Prospective , randomised , waiting-list-controlled ( WLC ) trial .


Recruitment and assessment were conducted at the Koren Centre for Physical Therapy .


Self-treatment was performed at home .


Thirty-six patients with a score @ on the numeric rating scale ( NRS ) for pain were enrolled .


Twenty-eight patients completed treatment .


Participants were randomised to receive the Kyrobak ( Radiancy , Hod-hasharon , Israel ) at enrolment -LSB- immediate treatment ( IT ) group -RSB- or @ weeks later ( WLC group ) .


Self-treatment was prescribed for @minutes , one to three times per day , for @ weeks .


The treatment period was followed by a @-week follow-up period .


Primary outcome was self-reported pain level ( NRS ) .


Three weeks of self-treatment with the Kyrobak reduced pain levels significantly in the IT group compared with the WLC group -LCB- mean -LSB- standard deviation ( SD ) -RSB- NRS score from baseline to post-treatment : IT group , @ ( @ ) , @ % confidence interval ( CI ) @ to @ ; WLC group , -@ ( @ ) , @ % CI -@ to @ ; effect mean difference @ -RCB- .


This benefit was maintained over the follow-up period -LSB- from baseline to end of follow-up , mean ( SD ) NRS score @ ( @ ) , @ % CI @ to @ -RSB- .


Multi-linear regression analysis found that higher baseline pain resulted in greater pain reduction ( P = @ ) .


Eighty-three percent of participants with a baseline NRS score > @ ( threshold determined by logistic regression , P = @ ) achieved the minimal important change criterion of NRS score @ .


Daily NRS score reduced gradually over the treatment period -LSB- regression slope -@ ( @ ) , @ % CI -@ to -@ -RSB- .


Preliminary evidence suggests that the Kyrobak may be beneficial for short-term relief of non-specific , chronic LBP , particularly in participants with a moderate level of pain .


A longer treatment period may lead to a further reduction in pain .


Our objective was to assess the safety , feasibility , and effects of the standardized @-week mindfulness-based stress reduction ( MBSR ) course in adults with migraines .


Stress is a well-known trigger for headaches .


Research supports the general benefits of mind/body interventions for migraines , but there are few rigorous studies supporting the use of specific standardized interventions .


MBSR is a standardized @-week mind/body intervention that teaches mindfulness meditation/yoga .


Preliminary research has shown MBSR to be effective for chronic pain syndromes , but it has not been evaluated for migraines .


We conducted a randomized controlled trial with @ episodic migraineurs randomized to either MBSR ( n = @ ) or usual care ( n = @ ) .


Our primary outcome was change in migraine frequency from baseline to initial follow-up .


Secondary outcomes included change in headache severity , duration , self-efficacy , perceived stress , migraine-related disability/impact , anxiety , depression , mindfulness , and quality of life from baseline to initial follow-up .


MBSR was safe ( no adverse events ) , with @ % dropout and excellent adherence ( daily meditation average : @ minutes , range @-@ minutes/day ) .


Median class attendance from @ classes ( including retreat day ) was @ ( range -LSB- @ , @ -RSB- ) ; average class attendance was @ @ .


MBSR participants had @ fewer migraines/month ( MBSR : @ to @ vs control : @ to @ migraines/month , @ % confidence interval CI -LSB- -@ , @ -RSB- , P = @ ) , an effect that did not reach statistical significance in this pilot sample .


Headaches were less severe , although not significantly so ( -@ points/headache on @-@ scale , -LSB- -@ , @ -RSB- , P = @ ) and shorter ( -@ hours/headache , -LSB- -@ , -@ -RSB- , P = @ ) vs control .


Migraine Disability Assessment and Headache Impact Test-@ dropped in MBSR vs control ( -@ , -LSB- -@ , -@ -RSB- , P = @ and -@ , -LSB- -@ , -@ -RSB- , P = @ , respectively ) .


Self-efficacy and mindfulness improved in MBSR vs control ( @ -LSB- @ , @ -RSB- , P = @ and @ -LSB- @ , @ -RSB- , P = @ respectively ) .


MBSR is safe and feasible for adults with migraines .


Although the small sample size of this pilot trial did not provide power to detect statistically significant changes in migraine frequency or severity , secondary outcomes demonstrated this intervention had a beneficial effect on headache duration , disability , self-efficacy , and mindfulness .


Future studies with larger sample sizes are warranted to further evaluate this intervention for adults with migraines .


This study was prospectively registered ( ClinicalTrials.gov identifier NCT@ ) .


To evaluate the possible advantages of combination therapy with diquafosol tetrasodium and sodium hyaluronate for dry eye after laser in situ keratomileusis ( LASIK ) .


Prospective randomized comparative trial .


A total of @ eyes of @ patients who underwent LASIK were enrolled in this study .


Patients were randomly assigned to @ of @ treatment groups according to the postoperative treatment : artificial tears , sodium hyaluronate , diquafosol tetrasodium , and a combination of hyaluronate and diquafosol .


Questionnaire responses reflecting subjective dry eye symptoms , uncorrected and corrected visual acuity , functional visual acuity , manifest refraction , tear break-up time , fluorescein corneal staining , Schirmer test , and corneal sensitivity were examined before and @ week and @ month after LASIK .


Distance uncorrected visual acuity was significantly better in the combination group than in the hyaluronate group @ week and @ month after LASIK .


Near uncorrected visual acuity was significantly better in the combination group than in the artificial tear and diquafosol groups @ week and @ month after LASIK .


Distance functional visual acuity improved significantly only in the combination group @ month after LASIK .


The Schirmer value in the combination group was significantly higher than that in the hyaluronate group at @ month after LASIK .


Subjective dry eye symptoms in the combination group improved significantly compared with those in the other groups @ week after surgery .


Our results suggest that hyaluronate and diquafosol combination therapy is beneficial for early stabilization of visual performance and improvement of subjective dry eye symptoms in patients after LASIK .


Management of Type @ diabetes comes with substantial personal and psychological demands particularly during adolescence , placing young people at significant risk for mental health problems .


Supportive parenting can mitigate these risks , however the challenges associated with parenting a child with a chronic illness can interfere with a parent 's capacity to parent effectively .


Interventions that provide support for both the adolescent and their parents are needed to prevent mental health problems in adolescents ; to support positive parent-adolescent relationships ; and to empower young people to better self-manage their illness .


This paper presents the research protocol for a study evaluating the efficacy of the Nothing Ventured Nothing Gained online adolescent and parenting intervention which aims to improve the mental health outcomes of adolescents with Type @ diabetes .


A randomized controlled trial using repeated measures with two arms ( intervention and wait-list control ) will be used to evaluate the efficacy and acceptability of the online intervention .


Approximately @ adolescents with Type @ diabetes , aged @-@ years and one of their parents/guardians will be recruited from pediatric diabetes clinics across Victoria , Australia .


Participants will be randomized to receive the intervention immediately or to wait @ months before accessing the intervention .


Adolescent , parent and family outcomes will be assessed via self-report questionnaires at three time points ( baseline , @ weeks and @ months ) .


The primary outcome is improved adolescent mental health ( depression and anxiety ) .


Secondary outcomes include adolescent behavioral ( diabetes self-management and risk taking behavior ) , psychosocial ( diabetes relevant quality of life , parent reported child well-being , self-efficacy , resilience , and perceived illness benefits and burdens ) ; metabolic ( HbA@c ) outcomes ; parent psychosocial outcomes ( negative affect and fatigue , self-efficacy , and parent experience of child illness ) ; and family outcomes ( parent and adolescent reported parent-adolescent communication , responsibility for diabetes care , diabetes related conflict ) .


Process variables including recruitment , retention , intervention completion and intervention satisfaction will also be assessed .


The results of this study will provide valuable information about the efficacy , acceptability and therefore the viability of delivering online interventions to families affected by chronic illnesses such as Type @ diabetes .


The aim of this study was to investigate the effects of piribedil on vigilance and cognitive performance in patients with Parkinson disease experiencing excessive daytime sleepiness on pramipexole or ropinirole .


In this @-week randomized , active-controlled , rater-blinded phase III study , eligible patients were randomly assigned to either receive piribedil or to continue on pramipexole or ropinirole .


The primary outcome was the median reaction times during the second @ minutes of the subtest `` vigilance '' of the Test battery for Attention Performances ( TAP ) .


Secondary outcomes included the Epworth Sleepiness Scale , Unified Parkinson 's Disease Rating Scale , neuropsychological testing , and items of the Clinical Global Impression .


Forty-four patients received piribedil ; @ continued on either pramipexole or ropinirole .


There was no difference in the primary end point reaction time of the TAP subtest vigilance between piribedil and the comparator ( @ vs @ milliseconds , P = @ ) .


Piribedil reduced daytime sleepiness with lower Epworth Sleepiness Scale scores at the end of treatment compared with the comparator ( -@ vs -@ points ; P = @ ) .


The median Unified Parkinson 's Disease Rating Scale III score at the end of treatment was comparable between the @ groups .


Neuropsychological tests revealed no significant between-treatment differences .


A higher therapeutic effect and global improvement were shown by the Clinical Global Impression of piribedil-treated patients .


This study shows that switching from pramipexole or ropinirole to piribedil has no effect on the reaction time of the TAP subtest vigilance but upholds the same therapeutic motor effect and reduces daytime sleepiness to a clinically relevant degree in patients with excessive daytime sleepiness .


A fractional erbium-doped glass @,@-nm and a fractional bipolar radiofrequency ( RF ) device are effective in the treatment of atrophic acne scars .


To compare the clinical effectiveness and side effects of fractional bipolar RF with those of fractional erbium-doped glass in atrophic acne scars treatment .


Twenty Thai subjects with atrophic acne scars received three split-face monthly treatments , one side with fractional bipolar RF and the other with fractional erbium-doped glass .


Three independent physicians and patients evaluated improvement in acne scars @weeks after the last treatment .


Side effects were also recorded after each treatment .


The study found significant improvement in acne scars after treatment with fractional bipolar RF and with a fractional erbium-doped glass device without a statistically significant difference between the two devices .


The side effects of both devices were pain , transient facial erythema , and scab formation .


The pain score with fractional erbium-doped glass was higher than that with fractional bipolar RF , but duration of scab shedding was shorter .


One case had postinflammatory hyperpigmentation on only the side treated with fractional erbium-doped glass .


Fractional bipolar RF and fractional erbium-doped glass have similar effectiveness for the treatment of atrophic acne scars .


Levodopa-carbidopa intestinal gel ( LCIG ) is delivered continuously via intrajejunal percutaneous gastrostomy tube .


To examine long-term safety , efficacy and quality of life of LCIG in an open-label extension study .


Patients received @ weeks of open-label LCIG treatment following a @-week double-blind , double-dummy trial in which they were randomized to either LCIG or immediate-release oral levodopa-carbidopa .


Patient cohort designation was by receipt of LCIG in the preceding trial randomization ( continuing-LCIG vs. LCIG-nave patients ) .


Sixty-two of @ subjects in the double-blind proceeded to the open-label extension .


Most subjects ( @ % ) reported @ adverse event ( AE ) ; only @ subjects ( @ % ) discontinued due to AEs .


AE incidence declined gradually over @ weeks .


Serious AEs were reported by @ % .


LCIG-nave patients ( N = @ ) showed a decrease in `` Off '' time and an increase in `` On '' time without troublesome dyskinesia ( change from baseline to final visit in mean -LSB- SD -RSB- hours = -@ -LSB- @ -RSB- P < @ and @ -LSB- @ -RSB- P = @ , respectively ) , while continuing-LCIG patients ( N = @ ) showed sustained `` Off '' time duration and further improvement in `` On '' time without troublesome dyskinesia ( -@ -LSB- @ -RSB- P = @ and @ -LSB- @ -RSB- P = @ , respectively ) .


The majority of patients in both groups ( LCIG-nave , continuing-LCIG , respectively ) were rated ` Much Improved ' or ` Very Much Improved ' at final visit on the Clinical Global Impression-Improvement scale ( @ % , @ % ) .


Continuing-LCIG patients continued to derive benefit from LCIG while the magnitude of improvement among LCIG-nave patients was similar to that observed for patients on LCIG in the preceding double-blind study .


The overall AE profile was consistent with previous phase @ clinical trials involving the LCIG system .


The clinical epidemiology of acanthosis nigricans ( AN ) has not been entirely studied .


Most studies mention only its prevalence taking any `` typical site '' as a whole .


These studies were carried out at different ages , races , anthropometries , and skin phototypes without analyzing the comparative clinical connotation of different sites .


Furthermore , it has never been explored as a potential early expression of insulin resistance before it becomes clinically evident .


The objective was to determine the prevalence and body distribution of AN in easy-access sites to physical examination in a Latin American youth population and its clinical implications as an early marker for obesity .


We conducted a prospective , cross-sectional , observational study in @ randomly selected students .


Participants ' mean age was @ years .


Overweight and obesity occurred in @ % and @ % , respectively .


@ observers blindly assessed neck , axillae , elbow and knuckles .


AN was identified in any of the examined sites in @ % of the participants .


Its prevalence increased from @ % to @ % from normal to obese anthropometric categories .


AN occurred in @-@ sites in @ % , @ % , @ % and @ % of cases , respectively .


The knuckles was the site with the highest prevalence of AN as an overall group ( @ % ) and in the normal ( @ % ) and overweight body mass index ( @ % ) categories and there was a higher prevalence in the cases above the median in the normal body mass index category .


In the obese group , AN was slightly more common in the neck but all sites had a very similar high prevalence .


AN occurs with a high prevalence in Latin American youths , and its prevalence is much higher in a `` non-classical '' and ignored location where it is very easy to detect during physical examination : the knuckles .


It may also occur earlier in this location in the evolution to obesity .


The presence of AN in the knuckles in any patient , even if they have a normal body mass index , might indicate the likelihood of an early clinical manifestation of insulin resistance and metabolic consequences .


In older adults , loss of mobility due to sarcopenia is exacerbated in men with low serum T. T replacement therapy is known to increase muscle mass and strength , but the effect of weekly ( WK ) vs monthly ( MO ) administration on specific fiber types is unknown .


To determine the efficacy of WK vs MO T replacement on the size and functional capacity of individual fast and slow skeletal muscle fiber types .


Subjects were randomized into a @-month , double-blind , placebo-controlled trial .


All subjects ( ages , @-@ y ) were community-dwelling men who had T levels < @ ng/dL .


Subjects were dosed weekly for @ months , receiving continuous T ( WK , n = @ ; @ mg T enanthate , im injection ) , monthly cycled T ( MO , n = @ ; alternating months of T and placebo ) , or placebo ( n = @ ) .


Muscle biopsies of the vastus lateralis were obtained before and after treatment .


Main outcomes for individual slow and fast fibers included fiber diameter , peak force ( P@ ) , rate of tension development , maximal shortening velocity , peak power , and Ca ( @ + ) sensitivity .


Both treatments increased fiber diameter and peak power , with WK treatment @-fold more effective than MO in increasing type I fiber P@ .


WK effects on fiber diameter and force were @-fold higher in slow fibers compared to fast fibers .


In fast type II fibers , diameter and P@ increased similarly between treatments .


The increased power was entirely due to increased fiber size and force .


In conclusion , T replacement effects were fiber-type dependent , restricted to increases in cell size , P@ , and peak power , and dependent on the paradigm selected ( WK vs MO ) .


Postoperative atrial fibrillation ( POAF ) is a common complication after cardiac surgery and predicts increased morbidity and mortality .


Identification of patients at high risk of POAF with the help of circulating biomarkers may enable early preventive treatment but data are limited , especially in contemporary surgical patients .


Plasma concentrations of N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) and high-sensitivity cardiac troponin T ( hs-cTnT ) were measured at enrollment , on the morning of cardiac surgery , at end surgery , and @ days postsurgery in @ patients undergoing cardiac surgery , randomized to perioperative supplementation with oral fish oil or placebo in the Omega-@ Fatty Acids for Prevention of Post-Operative Atrial Fibrillation trial ( OPERA ) .


The primary endpoint was incident POAF lasting @ s , centrally adjudicated and confirmed electrocardiographically .


Higher levels of NT-proBNP and hs-cTnT before surgery were associated with older age , renal or cardiac dysfunction and EuroSCORE .


NT-proBNP peaked on postoperative day @ ( @ -LSB- @-@ -RSB- ng/L , median -LSB- Q@-Q@ -RSB- ) , while hs-cTnT peaked at the end of surgery ( @ -LSB- @-@ -RSB- ng/L ) .


Fish oil supplementation did not alter the time course of the cardiac biomarkers ( P > @ ) .


Concentrations of NT-proBNP or hs-cTnT , on the morning of surgery , or changes in their level between morning of surgery and postsurgery , were not significantly associated with POAF after adjustment for clinical and surgical characteristics .


Among patients undergoing cardiac surgery , NT-proBNP and hs-cTnT are related to clinical and surgical characteristics , have different perioperative time courses but are not independently associated with risk of POAF .


To evaluate whether myo-inositol supplementation , an insulin sensitizer , reduces the rate of gestational diabetes mellitus ( GDM ) and lowers insulin resistance in obese pregnant women .


In an open-label , randomized trial , myo-inositol ( @ g plus @ micrograms folic acid twice a day ) or placebo ( @ micrograms folic acid twice a day ) was administered from the first trimester to delivery in pregnant obese women ( prepregnancy body mass index @ or greater .


We calculated that @ women in each arm would be required to demonstrate a @ % GDM reduction in the myo-inositol group with a statistical power of @ % ( = @ ) .


The primary outcomes were the incidence of GDM and the change in insulin resistance from enrollment until the diagnostic oral glucose tolerance test .


From January @ to April @ , @ pregnant women at @-@ weeks of gestation were randomized at two Italian university hospitals , @ to myo-inositol and @ to placebo .


Most characteristics were similar between groups .


The GDM rate was significantly reduced in the myo-inositol group compared with the control group , @ % compared with @ % , respectively ( P = @ ; odds ratio @ , @ % confidence interval @-@ @ ) .


Furthermore , women treated with myo-inositol showed a significantly greater reduction in the homeostasis model assessment of insulin resistance compared with the control group , -@ compared with @ ( P = @ ) .


Myo-inositol supplementation , started in the first trimester , in obese pregnant women seems to reduce the incidence in GDM through a reduction of insulin resistance .


A major barrier to successful treatment in alcohol dependence is psychiatric comorbidity .


During treatment , the time to relapse is shorter , the drop-out rate is increased , and long-term alcohol consumption is greater for those with comorbid major depression or anxiety disorder than those with an alcohol use disorder with no comorbid mental disorder .


The treatment of alcohol dependence and psychological disorders is often the responsibility of different services , and this can hinder the treatment process .


Accordingly , there is a need for an effective integrated treatment for alcohol dependence and comorbid anxiety and/or depression .


We aim to assess the effectiveness of a specialized , integrated intervention for alcohol dependence with comorbid anxiety and/or mood disorder using a randomized design in an outpatient hospital setting .


Following a three-week stabilization period ( abstinence or significantly reduced consumption ) , participants will undergo complete formal assessment for anxiety and depression .


Those patients with a diagnosis of an anxiety and/or depressive disorder will be randomized to either @ ) integrated intervention ( cognitive behavioral therapy ) for alcohol , anxiety , and/or depression ; or @ ) usual counseling care for alcohol problems .


Patients will then be followed up at weeks @ , @ , and @ .


The primary outcome measure is alcohol consumption ( total abstinence , time to lapse , and time to relapse ) .


Secondary outcome measures include changes in alcohol dependence severity , depression , or anxiety symptoms and changes in clinician-rated severity of anxiety and depression .


The study findings will have potential implications for clinical practice by evaluating the implementation of specialized integrated treatment for comorbid anxiety and/or depression in an alcohol outpatient service .


To determine the efficacy of @ hour nicotine patches among pregnant smokers , with the dose individually adjusted according to saliva cotinine levels ( potential range @-@ mg/day ) .


Randomised , double blind , placebo controlled , parallel group , multicentre trial ( Study of Nicotine Patch in Pregnancy , SNIPP ) between October @ and January @ .


@ maternity wards in France .


@ pregnant smokers aged more than @ years and between @ and @ weeks ' gestation , who smoked at least five cigarettes a day .


After exclusions , @ women were randomised : @ to nicotine patches and @ to placebo patches .


Data were available on @ live births in each group .


Nicotine and identical placebo patches were administered from quit day up to the time of delivery .


Doses were adjusted to saliva cotinine levels when smoking to yield a substitution rate of @ % .


Participants were assessed monthly and received behavioural smoking cessation support .


The primary outcomes were complete abstinence ( self report confirmed by carbon monoxide level in expired air @ ppm ) from quit date to delivery , and birth weight .


The secondary outcomes were point prevalence of abstinence , time to lapse ( a few puffs ) or relapse , and delivery and birth characteristics .


All data were analysed on an intention to treat basis .


Complete abstinence was achieved by @ % ( n = @ ) of women in the nicotine patch group and @ % ( n = @ ) in the placebo patch group ( odds ratio @ , @ % confidence interval @ to @ ) .


The median time to the first cigarette smoked after target quit day was @ days in both groups ( interquartile range @-@ in the nicotine patch group , @-@ in the placebo patch group ) .


The point prevalence abstinence ranged from @ % to @ % in the nicotine patch group and @ % to @ % in the placebo patch group without statistically significant differences .


The nicotine substitution rate did not differ from @ % , and the self reported median compliance rate was @ % ( interquartile range @-@ % ) in the nicotine patch group and @ % ( @-@ % ) in the placebo patch group , assessed at @ visits .


The mean birth weight was @ g ( SE @ g ) in the nicotine patch group and @ g ( SE @ g ) in the placebo patch group ( P = @ ) .


Diastolic blood pressure was significantly higher in the nicotine patch group than in the placebo patch group .


The frequency of serious adverse events was similar between the groups , although more non-serious adverse reactions , mainly of skin , occurred in the nicotine patch group .


The nicotine patch did not increase either smoking cessation rates or birth weights despite adjustment of nicotine dose to match levels attained when smoking , and higher than usual doses .


Once-daily losartan reduces BP in a dose-dependent manner and is well tolerated in hypertensive children aged @-@ years .


This study assessed the dose-response relationship , safety , and tolerability of losartan in hypertensive children aged @ months to @ years .


This was a @-week , randomized , open-label , dose-ranging study , with a @-year extension .


Patients were randomized to losartan at the following dosages : @ mg/kg per day ( low ) , @ mg/kg per day ( medium ) , or @ mg/kg per day ( high ) .


Losartan was titrated to the next dose level ( to a @ mg/kg per day maximum dosage , not exceeding @ mg/d , which was not one of the three original doses offered at randomization ) at weeks @ , @ , and @ for patients who did not attain their goal BP and were not taking the highest dose .


Dose response was evaluated by analyzing the slope of change in sitting systolic BP ( SBP ; primary end point ) and diastolic BP ( DBP ; secondary end point ) after @ weeks compared with baseline .


Adverse events ( AEs ) were recorded throughout .


Of the @ patients randomized , @ were included in the analysis ( low dose , n = @ ; medium dose , n = @ ; and high dose , n = @ ) .


Mean sitting BP decreased from baseline in the low - , medium - , and high-dose groups by @ , @ , and @ mmHg , respectively , for SBP and @ , @ , and @ mmHg , respectively , for DBP after @ weeks .


No dose-response relationship was established by the slope analysis on SBP ( P = @ ) or DBP ( P = @ ) .


The BP-lowering effect was observed throughout the @-year extension .


The incidence of AEs was low and comparable between groups .


Hypertensive children aged @ months to @ years treated with losartan @-@ @ mg/kg per day had clinically significant decreases from baseline in SBP and DBP , yet no dose-response relationship was evident .


Losartan , at a dosage up to @ mg/kg per day , was well tolerated .


The yellow-card scheme continues to be one of the principal methods for signal generation in pharmacovigilance .


Nevertheless , under-reporting , one of its disadvantages , delays alert signals and has a negative influence on public health .


Educational interventions in pharmacovigilance may have a positive impact on the spontaneous reporting of adverse drug reactions ( ADRs ) .


To assess the duration of the effect and effectiveness of an educational intervention in pharmacovigilance designed to improve ADR reporting in a robust pharmacovigilance system .


A spatial , cluster randomized controlled trial was conducted covering all National Health System physicians in the northwest of Spain and targeting those who were actively engaged in clinical practice ( n = @,@ ) .


Of these , @,@ were assigned in three spatial clusters to the intervention group ( six hospitals and @ primary care centers ) and @,@ in four clusters to the control group ( seven hospitals and @ primary care centers ) .


The educational intervention consisted of two complementary approaches -- one active ( group sessions ) , the other passive ( educational material , reporting form ) - implemented from November @ to December @ , with a follow-up period of @ months .


Intervention participation was @ % in a hospital setting and @ % in primary care settings .


ADR reporting in the intervention group increased by @ % ( @ % confidence interval -LSB- CI -RSB- : @-@ @ ) across the follow-up .


The ADR reporting rate per @,@ physicians/year in the intervention group rose from @ to @ following the intervention ( @ and @ in the first and second @-month period , respectively ) .


For the intervention group , relative risk ( RR ) was @ ( @ % CI : @-@ @ ) and @ ( @ % CI : @-@ @ ) in the first and second @-month period , respectively adjusted to baseline values .


There was an increase in unexpected ADR reporting ( RR @ , @ % CI @-@ @ ) .


Pharmacovigilance educational interventions that have proved effective can be successfully applied in different geographical areas .


A high baseline notification rate could account for the educational program having a moderate effect .


This @-year randomized controlled prospective study evaluated the implant success rate and peri-implant tissue response following single immediate implant placement and provisionalization ( IIPP ) with and without subepithelial connective tissue graft ( SCTG ) in the esthetic zone .


Implants were placed either IIPP with SCTG ( test group ) or IIPP without SCTG ( control group ) .


The implants were evaluated both clinically and radiographically before surgery , immediately after implant placement , and @ , @ , and @ months after implant placement .


Data were analyzed using Friedman , Wilcoxon signed-rank , and Mann-Whitney U tests at the significance level of = @ .


Twenty implants ( @ test , @ control ) were placed in @ patients ( @ men , @ women ) between the ages of @ and @ ( mean age , @ years ) .


At @ year , all implants remained osseointegrated , with overall mean marginal bone changes of -@ mm and -@ mm for the test and control groups , respectively .


Mean facial gingival level change was significantly more pronounced in the control group ( -@ mm ) than in the test group ( -@ mm ) .


The modified Plaque Index scores showed that patients were able to maintain a good level of hygiene throughout the study .


At @ year , the Papilla Index indicated that more than @ % papilla fill was observed in @ % of the test sites and @ % of the control sites .


Within the limitations of this study , SCTG was shown to be beneficial in maintaining facial gingival level when performed in conjunction with IIPP procedures .


Naltrexone , an opioid antagonist , may facilitate reduction in drinking among young adults .


We compared the efficacy and safety of naltrexone administered daily plus targeted dosing with placebo to reduce drinking in young adults who engage in heavy drinking .


A randomized , double-blind , placebo-controlled study was conducted in an outpatient research center in March @-January @ .


Participants were aged @-@ years and reported @ heavy drinking days in the prior @ weeks .


Interventions included naltrexone @ mg daily plus @ mg targeted ( at most daily ) in anticipation of drinking ( n = @ ) or daily/targeted placebo ( n = @ ) .


All participants received a personalized feedback session and brief counseling every other week .


Primary outcomes were percent heavy drinking days and percent days abstinent over the @-week treatment period .


Secondary outcomes included number of drinks per drinking day and percentage of days with estimated blood alcohol concentration ( BAC ) levels @ g/dL .


Of @ randomized patients , @ began treatment , comprising the evaluable sample .


During treatment , percent heavy drinking days ( naltrexone : mean = @ , SD = @ ; placebo : mean = @ , SD = @ ) ( P = @ ) and percent days abstinent ( naltrexone : mean = @ , SD = @ ; placebo : mean = @ , SD = @ ) ( P = @ ) did not differ by group .


Naltrexone significantly reduced the number of drinks per drinking day ( naltrexone : mean = @ , SD = @ ; placebo : mean = @ , SD = @ ) ( P = @ ) and percentage of drinking days with estimated BAC @ g/dL ( naltrexone : mean = @ , SD = @ ; placebo : mean = @ , SD = @ ) ( P = @ ) .


There were no serious adverse events .


Sleepiness was more common with naltrexone .


Naltrexone did not reduce frequency of drinking or heavy drinking days , but reduced secondary measures of drinking intensity .


While effects were modest , the risk-benefit ratio favors offering naltrexone to help young adult heavy drinkers reduce the amount of alcohol they drink .


Neointimal hyperplasia secondary to vascular smooth muscle cell ( VSMC ) activation limits the long-term patency of saphenous vein grafts ( SVGs ) .


We compared markers of vascular injury and VSMC activation in SVGs harvested using the pedicled ` no-touch ' ( NT ) vs the conventional ( CON ) technique .


Patients undergoing coronary artery bypass surgery were enrolled in the PATENT SVG trial ( clinicaltrials.gov NCT@ ) .


Patients were randomly allocated to have SVGs harvested with the NT technique from one leg and the CON method from the other .


SVG segments underwent morphometry , histological and electron microscopy assessments and transcript measurements of VSMC activation and differentiation markers .


Leg wound functional recovery and harvest site complications were assessed using a quality-of-life questionnaire .


A total of @ patients ( @ @ years ) were enrolled .


SVGs harvested using the NT vs CON technique exhibited preserved intimal , medial and adventitial architecture .


CON harvest was associated with greater medial Kruppel-like factor @ transcript levels ( @ @ vs @ @ , P < @ ) .


CON samples had significantly lower medial serum response factor ( @ @ vs @ @ , P < @ ) and myocardin ( @ @ vs @ @ , P < @ ) transcript levels .


MicroRNA-@ , an inhibitor of VSMC activation and differentiation , was higher in the NT vs CON samples ( @ @ vs @ @ , P < @ ) .


Leg assessment scores were worse in the NT legs at @ months , but similar to CON scores at @ months .


SVGs harvested using the ` NT ' technique exhibit an early molecular and morphological pattern consistent with decreased VSMC activation compared with CON harvesting .


Functional leg recovery was similar in both groups at @ months .


Larger studies are required to corroborate these findings .


The standard technique for the placement of ventricular catheters ( VC ) comprises a high proportion of malpositioning of the catheter ( @ to @ % ) .


Technical advances such as neuronavigation or ultrasound have been shown to increase the accuracy of the procedure .


Since these means result in significant technical and time consuming efforts , they are used for selected cases only .


In order to simplify the controlled placement of ventricular catheters a newly developed smartphone assisted guiding tool has been introduced .


In this study the efficacy and safety of this guiding tool is determined .


This study is a multicentre , randomised , controlled trial .


A total of @ patients planned for an elective shunting procedure will be enrolled throughout @ study centres within two years .


The primary objective of the trial is to show the superiority of the guided placement in comparison to the standard freehand technique of ventricular catheter application .


Patients will be followed up for @ days after the operation in regard to image-based evaluation of the catheter position as well as possible shunt dysfunction and complications .


The Guided Application of Ventricular Catheters ( GAVCA ) trial compares the guided catheter positioning with the standard freehand technique of catheter placement in hydrocephalic patients .


If superiority is shown , the standard technique may be changed with the advantage of a more reliable and safer positioning of the ventricular catheter with just a slight effort in time and pre-operative planning .


Angiotensin type @ receptor ( AT @ R ) antagonists are extensively used for blood pressure control in elderly patients with hypertension .


This study aimed to investigate the inhibitory effects of AT @ R antagonist valsartan on platelet aggregation and the occurrence of cardio-cerebral thrombotic events in elderly patients with hypertension .


Two-hundred and ten patients with hypertension and aged > @ years were randomized to valsartan ( n = @ ) or amlodipine ( n = @ ) on admission .


The primary endpoint was platelet aggregation rate ( PAR ) induced by arachidonic acid at discharge , and the secondary endpoint was the rate of thrombotic events including brain infarction and myocardial infarction during follow-up .


Human aortic endothelial cells ( HAECs ) were stimulated by angiotensin II ( Ang II , @ nmol/L ) with or without pretreatment of valsartan ( @ nmol/L ) , and relative expression of cyclooxygenase-@ ( COX-@ ) and thromboxane B @ ( TXB @ ) and both p@ mitogen-activated protein kinase ( p@MAPK ) and nuclear factor-kB ( NF-kB ) activities were assessed .


Statistical analyses were performed by GraphPad Prism @ software ( GraphPad Software , Inc. , California , USA ) .


PAR was lower after treatment with valsartan ( @ @ % vs. @ @ % , P < @ ) , associated with more reduced plasma levels of COX-@ ( @ @ U/L vs. @ @ U/L , P < @ ) and TXB @ ( @ @ pg/ml vs. @ @ pg/ml ) ( all P < @ ) .


Plasma COX-@ and TXB @ levels correlated significantly with PAR in overall patients ( r = @ , P < @ ) .


During follow-up ( median , @ months ) , there was a significantly lower thrombotic event rate in patients treated with valsartan ( @ % vs. @ % , P = @ ) .


Relative expression of COX-@ and secretion of TXB @ with concordant phosphorylation of p@MAPK and NF-kB were increased in HAECs when stimulated by Ang II ( @ nmol/L ) but were significantly decreased by valsartan pretreatment ( @ nmol/L ) .


AT @ R antagonist valsartan decreases platelet activity by attenuating COX-@ / TXA @ expression through p@MAPK and NF-kB pathways and reduces the occurrence of cardio-cerebral thrombotic events in elderly patients with hypertension .


Women with primary ovarian insufficiency ( POI ) display low androgen levels , which could contribute to mood and behavioral symptoms observed in this condition .


We examined the effects of physiologic testosterone therapy added to standard estrogen/progestin therapy on quality of life , self-esteem , and mood in women with POI .


One hundred twenty-eight women with @ , XX spontaneous POI participated in a @-month randomized , placebo-controlled , parallel-design investigation of the efficacy of testosterone augmentation of estrogen/progestin therapy .


Quality of life , self-esteem , and mood symptoms were evaluated with standardized rating scales and a structured clinical interview .


Differences in outcome measures between the testosterone and placebo treatments were analyzed by Wilcoxon rank sum tests .


No differences in baseline characteristics , including serum hormone levels ( P > @ ) , were found .


Baseline mean ( SD ) Center for Epidemiologic Studies Depression Scale scores were @ ( @ ) and @ ( @ ) for testosterone and placebo , respectively ( P = @ ) .


After @ months of treatment , measures of quality of life , self-esteem , and mood symptoms did not differ between treatment groups .


Serum testosterone levels achieved physiologic levels in the testosterone group and were significantly higher compared with placebo ( P < @ ) .


Baseline testosterone levels were not associated with either adverse or beneficial clinical effects .


A @-g testosterone patch achieves physiologic hormone levels in women with POI .


Our findings suggest that augmentation of standard estrogen/progestin therapy with physiologic testosterone therapy in young women with POI neither aggravates nor improves baseline reports of quality of life or self-esteem and had minimal effects on mood .


Other mechanisms might play a role in the altered mood accompanying this disorder .


Hospitalists have been shown to lower patient costs through better resource utilization and decreased length of stay , but it is unclear whether hospitalists are associated with quality of care .


We examined the association between the presence of hospitalists and @-day predicted excess all-cause hospital mortality and readmissions among Medicare patients admitted to a hospital with any of @ conditions : heart failure , acute myocardial infarction , and pneumonia .


Using national hospital-level , case mix-adjusted , risk-standardized , @-day all-cause excess mortality and readmission data from the Centers for Medicare and Medicaid Services , we used descriptive and bivariate statistics to illustrate trends across hospitals .


Using multivariable ordinary least squares regression to control for hospital-level characteristics , we then estimated the association between the presence of hospitalists and predicted hospital mortality and readmission .


After multivariable adjustment , the presence of hospitalists was associated with lower probability of readmission for all @ target conditions .


No significant associations for any of the target conditions were found in all-cause mortality models .


Hospitalists are already integral to the delivery of inpatient care at most institutions .


This study , however , showed an association at the national level of the presence of hospitalists with an important and timely quality measure : reduction of readmission rates .


Future research is indicated to explore specific causation pathways for the impact of hospitalists on quality of care .


To compare central corneal sublayer pachymetry and biomechanical properties after femtosecond lenticule extraction ( FLEX ) and small-incision lenticule extraction ( SMILE ) .


A prospective , randomized , single-masked clinical trial of @ patients treated for moderate to high myopia with FLEX in one eye and SMILE in the other .


Anterior segment optical coherence tomography imaging ( Heidelberg Spectralis ; Heidelberg Engineering GmbH , Heidelberg , Germany ) was used to measure central corneal thickness ( CCT ) and epithelial , flap/cap , and residual stromal bed thickness centrally .


The Ocular Response Analyzer ( Reichert Ophthalmic Instruments , Buffalo , NY ) was used to assess corneal hysteresis ( CH ) and corneal resistance factor ( CRF ) .


Patients were examined before and @ months after surgery .


Mean decrease in CCT was @ m in FLEX-treated eyes and @ m in SMILE-treated eyes ( P = @ ) , which is equivalent to approximately @ m/diopters corrected .


Mean central epithelial thickness increased @ @ m in FLEX-treated eyes and @ @ m in SMILE-treated eyes ( P = @ ) .


Achieved mean flap/cap thickness was @ @ m from the expected thickness in FLEX-treated eyes and @ @ m in SMILE-treated eyes ( P = @ ) .


CH was reduced @ @ mm Hg in FLEX-treated eyes and @ @ mm Hg in SMILE-treated eyes ( P = @ ) .


CRF was reduced @ @ mm Hg in FLEX-treated eyes and @ @ mm Hg in SMILE-treated eyes ( P = @ ) .


CH and CRF were highly correlated with CCT , but not patient age .


In this paired-eye study , the flap-based FLEX and cap-based SMILE resulted in almost identical changes in central corneal sublayer pachymetry and biomechanical properties for moderate to high myopia @ months after treatment .


Smokers have a lower body weight compared to non-smokers .


Smoking cessation is associated with weight gain in most cases .


A hormonal mechanism of action might be implicated in weight variations related to smoking , and leptin might be implicated .


We made secondary analyses of an RCT , with a hypothesis-free exploratory approach to study the dynamic of leptin following smoking cessation .


We measured serum leptin levels among @ sedentary smokers willing to quit who participated in a randomized controlled trial assessing a @-week moderate-intensity physical activity intervention as an aid for smoking cessation .


We adjusted leptin for body fat levels .


We performed linear regressions to test for an association between leptin levels and the study group over time .


One year after smoking cessation , the mean serum leptin change was +@ mg/l ( SD @ ) in the control group and +@ mg/l ( SD @ ) in the intervention group ( p of the difference < @ ) .


When adjusted for body fat levels , leptin was higher in the control group than in the intervention group ( p of the difference < @ ) .


The mean weight gain was +@ ( SD @ ) Kg in the intervention and +@ ( SD @ ) Kg in the control groups , respectively ( p not significant ) .


Serum leptin levels significantly increased after smoking cessation , in spite of substantial weight gain .


The leptin dynamic might be different in chronic tobacco users who quit smoking , and physical activity might impact the dynamic of leptin in such a situation .


Clinical trial registration number : NCT@ .


Low-income black residents of Baltimore City have disproportionately higher rates of obesity and chronic disease than other Maryland residents .


Increasing the availability and affordability of healthy food are key strategies to improve the food environment and can lead to healthier diets .


This paper describes B'More Healthy : Retail Rewards ( BHRR ) , an intervention that tests the effectiveness of performance-based pricing discounts and health communications , separately and combined , on healthy food purchasing and consumption among low-income small store customers .


BHRR is @x@ factorial design randomized controlled trial .


Fifteen regular customers recruited from each of @ participating corner stores in Baltimore City were enrolled .


Food stores were randomized to @ ) pricing intervention , @ ) communications intervention , @ ) combined intervention , or @ ) control .


Pricing stores were given a @-@ % price discount on selected healthier food items , such as fresh fruits , frozen vegetables , and baked chips , at the point of purchase from two food wholesale stores during the @-month trial .


Storeowners agreed to pass on the discount to the consumer to increase demand for healthy food .


Communications stores received visual and interactive materials to promote healthy items , including signage , taste tests , and refrigerators .


Primary outcome measures include consumer food purchasing and associated psychosocial variables .


Secondary outcome measures include consumer food consumption , store sales , and associated storeowner psychosocial factors .


Process evaluation was monitored throughout the trial at wholesaler , small store , and consumer levels .


This is the first study to test the impact of performance-based pricing and communications incentives in small food stores , an innovative strategy to encourage local wholesalers and storeowners to share responsibility in creating a healthier food supply by stocking , promoting , and reducing costs of healthier foods in their stores .


Local food wholesalers were involved in a top-down , participatory approach to develop and implement an effective and sustainable program .


This study will provide evidence on the effectiveness of price incentives and health communications , separately and combined , among a low-income urban U.S.


Loxapine , a first-generation antipsychotic , delivered with a novel inhalation delivery device developed for the acute treatment of agitation in patients with schizophrenia or bipolar disorder was evaluated in subjects with asthma or chronic obstructive pulmonary disease ( COPD ) .


Separate randomized , double-blind , parallel-arm , placebo-controlled trials compared two administrations of inhaled loxapine ( @mg ) @hr apart with placebo in @ subjects with asthma and in @ subjects with COPD .


A thermally-generated drug aerosol of loxapine was delivered to the deep lung for rapid systemic absorption .


Controller medications were continued throughout the study , but quick-relief bronchodilators were withheld from @-@hr before through @hr after dose @ , unless indicated as rescue .


All airway adverse events ( AEs ) were of mild or moderate severity .


Symptomatic bronchospasm occurred in @ % of subjects with asthma after inhaled loxapine and @ % after placebo ; and in @ % of COPD subjects after inhaled loxapine and @ % after placebo .


Subjects required inhaled albuterol as follows : asthma : @ % after inhaled loxapine and @ % after placebo ; and COPD : @ % after inhaled loxapine and @ % after placebo .


Respiratory signs/symptoms requiring treatment responded to rescue bronchodilator -LSB- forced expiratory volume in @sec ( FEV ( @ ) ) return to within @ % of baseline -RSB- within @hr in @ of @ events in asthma subjects and four of seven events in COPD subjects , the remainder by the last spirometry .


In subjects with either asthma or COPD , FEV ( @ ) decline and bronchospasm can occur following inhaled loxapine , but more frequently in asthmatic subjects .