The primary outcome measure of the study was the Bowel Symptom Severity Scale-IBS version .


Ninety diagnosed participants were randomized to each group in a randomized pretest-post-test control group design .


The experimental group received an @-week CBT intervention , and the control group received general information on IBS .


Bowel symptom severity , dysfunctional attitudes , and IBS-quality of life were assessed at baseline and after @ , @ , and @ weeks .


Six experimental and eight control participants withdrew during the study because of various reasons .


Significant effects were found for bowel symptom severity ( frequency : P < @ ; distress : P < @ ; disability : P < @ ) between the experimental ( n = @ ) and the control ( n = @ ) groups .


The overall IBS-quality of life improved over time in the CBT group ( P < @ ) .


The CBT also showed the alleviation of dysphoria ( P = @ ) , interference with activity ( P = @ ) , and health worry ( P = @ ) , and the improvement of body image ( P = @ ) and relationships ( P = @ ) compared with the control group .


CBT proved to be an effective intervention for improving the clinical states of IBS in young female nursing students .


This study was aimed to examine how well readers of newspapers understand cancer survival rate data , and the effect of this understanding on their behavioral intent .


We recruited @ persons who were @ years old or older registered with a market research company .


Participants were randomly divided into @ groups ; @ were assigned one of nine newspaper articles , and the remaining group was assigned the excerpt of the official Association of Clinical Cancer Centers web pages .


The primary outcome was the proportion of respondents with ` sufficient understanding ' , who gave @ % or more correct answers on a @-item knowledge question .


The proportion of participants with sufficient understanding varied across the groups ( range : @-@ @ % , overall , P < @ ) .


Only around @ % of participants answered that they would consider other hospitals in a scenario where the only hospital in the participants ' area had a @-year survival of @ % or less , and answers did not significantly vary between groups ( range : @-@ @ % , overall P = @ ) .


The level of understanding of cancer survival rate varied by variation in media reporting .


However , the effect of behavioral intent on hospital choice did not differ between articles .


Color affects emotions , feelings , and behaviors .


We hypothesized that color used in self-monitoring of blood glucose ( SMBG ) is helpful for patients to recognize and act on their glucose levels to improve glycemic control .


Here , two color-indication methods , color record ( CR ) and color display ( CD ) , were independently compared for their effects on glycemic control in less frequently insulin-treated type @ diabetes .


One hundred twenty outpatients were randomly allocated to four groups with @ factorial design : CR or non-CR and CD or non-CD .


Blood glucose levels were recorded in red or blue pencil in the CR arm , and a red or blue indicator light on the SMBG meter was lit in the CD arm , under hyperglycemia or hypoglycemia , respectively .


The primary end point was difference in glycated hemoglobin ( HbA@c ) reduction in @ weeks .


Secondary end points were self-management performance change and psychological state change .


HbA@c levels at @ weeks were significantly decreased in the CR arm by -@ % but were increased by @ % in the non-CR arm ( P = @ ) .


In addition , diet and exercise scores were significantly improved in the CR arm compared with the non-CR arm .


The exercise score showed significant improvement in the CD arm compared with the non-CD arm but without a significant difference in HbA@c reduction .


Changes in psychological states were not altered between the arms .


CR has a favorable effect on self-management performance without any influence on psychological stress , resulting in improved glycemic control in type @ diabetes patients using less frequent insulin injection .


Thus , active but not passive usage of color-indication methods by patients is important in successful SMBG .


During spinal anesthesia for cesarean delivery , phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output .


Norepinephrine has weak - adrenergic receptor agonist activity in addition to potent - adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine .


In a randomized , double-blinded study , @ healthy patients having cesarean delivery under spinal anesthesia were randomized to have systolic blood pressure maintained with a computer-controlled infusion of norepinephrine @ g/ml or phenylephrine @ g/ml .


The primary outcome compared was cardiac output .


Blood pressure heart rate and neonatal outcome were also compared .


Normalized cardiac output @ min after induction was greater in the norepinephrine group versus the phenylephrine group ( median @ % -LSB- interquartile range , @ to @ % -RSB- versus @ % -LSB- @ to @ % -RSB- , P = @ , median difference @ % , @ % CI of difference between medians @ to @ % ) .


From induction until uterine incision , for norepinephrine versus phenylephrine , systolic blood pressure and stroke volume were similar , heart rate and cardiac output were greater , systemic vascular resistance was lower , and the incidence of bradycardia was smaller .


Neonatal outcome was similar between groups .


When given by computer-controlled infusion during spinal anesthesia for cesarean delivery , norepinephrine was effective for maintaining blood pressure and was associated with greater heart rate and cardiac output compared with phenylephrine .


Further work would be of interest to confirm the safety and efficacy of norepinephrine as a vasopressor in obstetric patients .


Recent studies indicate that perioperative fluid restriction leads to better preserved clinical data as well as reduced complication rates .


This study aimed to determine the probable mechanism of fluid restriction influence on the complication rate of patients undergoing gastrointestinal surgery for malignancy .


Patients ( n = @ ) undergoing restricted fluid regimen ( R group ) or standard fluid regimen ( S group ) were included in this prospective , randomized trial over @ months .


Fluid distribution was determined by Bioelectrical Impedance Analyzer ( BIA ) and the difference between two groups was compared regarding complications and the relationship between complications and fluid distribution changes .


The restricted intravenous fluid regimen significantly reduced perioperative intravenous fluid volume .


Weight gained in S group and was not significantly changed in R group after surgery , especially in POD@ ( media ; R vs. S ; @ vs. @ kg , p = @ ) .


The number of patients with postoperative complications was reduced in R group compared with in S group ( @ % vs. @ % , p = @ ) .


Systemic complications were significantly reduced in R group ( t = -@ , p = @ ) .


Patients with complications had an average of @ complications in R group vs. @ in S group ( t = -@ , p = @ ) .


The multivariate analysis suggested that perioperative fluid distribution changes were associated with the development of postoperative complications .


Perioperative fluid restriction could effect on fluid distribution and reduce tissue and cellular edema , and further , could reduce postoperative complication rates .


Vitamin D deficiency is associated with obesity ; whether repletion supports weight loss and changes obesity-related biomarkers is unknown .


We compared @ mo of vitamin D@ supplementation with placebo on weight , body composition , insulin , and C-reactive protein ( CRP ) in postmenopausal women in a weight-loss intervention .


A total of @ overweight/obese women ( @-@ y of age ) with serum @-hydroxyvitamin D -LSB- @ ( OH ) D -RSB- @ ng/mL but < @ ng/mL were randomly assigned to weight loss + @ IU oral vitamin D@/d or weight loss + daily placebo .


The weight-loss intervention included a reduced-calorie diet ( @ % weight loss goal ) and @ min/wk of moderate-to-vigorous aerobic activity .


Mean @-mo changes in weight , body composition , serum insulin , CRP , and @ ( OH ) D were compared between groups ( intent-to-treat ) by using generalized estimating equations .


A total of @ % of participants completed the @-mo measurements .


The mean ( @ % CI ) change in @ ( OH ) D was @ ( @ , @ ) ng/mL in the vitamin D@ arm compared with -@ ( -@ , -@ ) ng/mL in the placebo arm ( P < @ ) .


Changes in weight -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) kg -RSB- , body mass index ( in kg/m ( @ ) : both -@ ) , waist circumference -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) cm -RSB- , percentage body fat -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) -RSB- , trunk fat -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) kg -RSB- , insulin -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) U/mL -RSB- , and CRP -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) mg/L -RSB- -LSB- corrected -RSB- were similar between groups ( all P > @ ) .


Compared with women who achieved @ ( OH ) D < @ ng/mL , women randomly assigned to vitamin D who became replete ( ie , @ ( OH ) D @ ng/mL ) lost more weight -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) kg ; P = @ -RSB- , waist circumference -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) cm ; P = @ -RSB- , and percentage body fat -LSB- -@ ( -@ , -@ ) compared with -@ ( -@ , -@ ) ; P = @ -RSB- .


Among women with complete pill counts ( @ % adherence ) , the mean decrease in CRP was @ mg/mL ( @ % ) in the vitamin D arm compared with @ mg/mL ( @ % ) in the placebo arm ( P = @ ) .


Vitamin D@ supplementation during weight loss did not increase weight loss or associated factors compared with placebo ; however , women who became replete experienced greater improvements .


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


To determine the initial efficacy of a mailed screening and brief intervention to reduce at-risk drinking in persons aged @ and older .


Pilot randomized controlled trial .


University of California at Los Angeles Department of Medicine Community Offices and Primary Care Network .


Individuals aged @ and older who were identified as at-risk drinkers according to the Comorbidity Alcohol Risk Evaluation Tool ( CARET ) ( N = @ ) .


Participants were assigned randomly to receive personalized mailed feedback outlining their specific risks associated with alcohol use , an educational booklet on alcohol and aging , and the National Institutes of Health Rethinking Drinking : Alcohol and Your Health booklet ( intervention group ) or nothing ( control group ) .


Alcohol-related assessments at baseline and @ months ; CARET-assessed at-risk drinking , number of risks , and types of risks .


At @ months , fewer intervention group participants than controls were at-risk drinkers ( @ % vs @ % ) , binge drinking ( @ % vs @ % ) , using alcohol with a medical or psychiatric condition ( @ % vs @ % ) , or having symptoms of such a condition ( @ % vs @ % ) .


A brief mailed intervention may be an effective approach to intervening with at-risk drinkers aged @ and older .


Tobacco cessation medication adherence is one of the few factors shown to improve smoking cessation rates among methadone-maintained smokers , but interventions to improve adherence to smoking cessation medications have not yet been tested among methadone treatment patients .


Methadone clinic-based , directly observed therapy ( DOT ) programs for HIV and tuberculosis improve adherence and clinical outcomes , but have not been evaluated for smoking cessation .


We describe a randomized controlled trial to evaluate whether a methadone clinic-based , directly observed varenicline therapy program increases adherence and tobacco abstinence among opioid-dependent drug users receiving methadone treatment .


We plan to enroll @ methadone-maintained smokers and randomize them to directly observed varenicline dispensed with daily methadone doses or treatment as usual ( self-administered varenicline ) for @weeks .


Our outcome measures are : @ ) pill count adherence and @ ) carbon monoxide-verified tobacco abstinence .


We will assess differences in adherence and abstinence between the two treatment arms using repeated measures models .


This trial will allow for rigorous evaluation of the efficacy of methadone clinic-based , directly observed varenicline for improving adherence and smoking cessation outcomes .


This detailed description of trial methodology can serve as a template for the development of future DOT programs and can guide protocols for studies among opioid-dependent smokers receiving methadone treatment .


Preoperative patient education is an important part of the informed consent process , and a perceived lack of information can lower patient satisfaction .


We sought to evaluate the effect of a web-based multimedia patient education tool on the perioperative experience of patients undergoing first-time knee arthroscopy for a meniscal tear .


Adult patients undergoing knee arthroscopy for the first time for a primary diagnosis of a meniscal tear were consecutively enrolled into the study from January @ through June @ .


Patients were equally randomized to a control group , who received standard preoperative counseling , or the intervention group , who completed a twenty-minute web-based multimedia tutorial in addition to standard counseling .


The web-based tutorial covered relevant anatomy , pathology , and general perioperative instructions , and it was completed prior to the preoperative visit .


Patients completed surveys that evaluated their preparedness for surgery and knowledge recall at the preoperative visit , on the day of surgery , and after the first postoperative visit .


Sixty-four patients were enrolled , and fifty-five patients ( @ % ; twenty-nine in the control group and twenty-six in the intervention group ) with complete data sets were included in the analysis .


Preoperatively , the intervention group felt significantly more informed about the surgery and more clearly understood the risks and benefits of , and alternatives to , the surgery ( all p < @ ) .


Postoperatively , the intervention group reported being significantly more satisfied with the perioperative education that they had received and felt more informed about their surgery and rehabilitation ( p @ ) .


Patients in the intervention group were significantly more likely to correctly answer questions regarding their surgical details at the first postoperative visit ( p @ ) .


Patients who completed the web-based tutorial had improved preoperative knowledge and preparedness as well as enhanced postoperative knowledge recall regarding their surgical procedure .


The tutorial received high user satisfaction scores with low user burden scores and was an effective tool for enhancing the patients ' perioperative experience .


Postmenopausal women have substantial concerns about weight gain when quitting smoking , which may contribute smoking relapse .


There is a need for smoking cessation and weight gain prevention programs effective in this population .


Two formats of a smoking cessation/weight gain prevention follow-up intervention in postmenopausal weight concerned women were compared : a minimally-tailored group format and a highly tailored , multidisciplinary individual format .


Effects on sustained abstinence and postcessation weight gain were assessed .


Postmenopausal smokers received @ sessions of behavioral counseling over a @-week period , @weeks of the nicotine transdermal patch , and subsequent random assignment to receive follow-up relapse prevention sessions at @ , @ , @ , and @weeks postcessation in either group or individual format .


The sample ( N = @ ) was @ % Caucasian and @ % African-American .


Age : m = @ ( @ ) years , follicle stimulating hormone : m = @ ( @ ) , body mass index ( BMI ) : m = @ ( @ ) , daily smoking rate : m = @ ( @ ) , for m = @ ( @ ) years , Fagerstrm Test for Nicotine Dependence ( FTND ) : m = @ ( @ ) , and carbon monoxide : m = @ ( @ ) ppm .


Abstinence rates in the group condition were significantly higher at @weeks posttreatment .


Group format significantly predicted abstinence rates at @ and @weeks posttreatment , even while controlling for age , race , BMI , CPD , years smoking , FTND , and weight concern .


Weight concern predicted postcessation weight gain at @ and @weeks posttreatment .


Results indicate that smoking cessation programs for postmenopausal women may best be delivered in a group format and that postcessation weight concerns be dealt with prior to a quit date .


Prevailing recommendations call for restricting intake of dietary cholesterol and eggs for those at risk of heart disease , despite accumulating evidence challenging this association .


Our prior studies showed no short-term adverse effects of daily egg intake on cardiac risk factors in at-risk adults .


We conducted this study to determine effects of daily egg consumption in adults with established coronary artery disease ( CAD ) .


Randomized , controlled , single-blind , crossover trial of @ adults ( mean age , @ years ; @ women , @ men ) with CAD assigned to @ of @ possible sequence permutations of @ different treatments ( breakfast with @ eggs , breakfast with cup Egg Beaters , ConAgra Foods , St. Louis , MO , or a high-carbohydrate breakfast part of an ad libitum diet ) for @ weeks , with @-week washout periods .


The primary outcome measure was endothelial function measured as flow-mediated dilatation .


Compared with the control breakfast ( ie , high-carbohydrate breakfast ) , daily consumption of eggs showed no adverse effects on flow-mediated dilatation ( @ % @ % vs @ % @ % , P = @ ) , lipids ( total cholesterol : @ @ mg/dL vs @ @ mg/dL , P = @ ) , blood pressure ( systolic blood pressure : @ @ mm Hg or vs @ @ mm Hg , P = @ ; diastolic blood pressure : @ @ mm Hg vs @ @ mm Hg , P = @ ) , or body weight ( @ @ kg vs @ @ kg , P = @ ) .


No outcomes differed ( P > @ ) between eggs and Egg Beaters .


We found no evidence of adverse effects of daily egg ingestion on any cardiac risk factors in adults with CAD over a span of @ weeks .


To evaluate the effectiveness of a professional one-to-one antenatal breastfeeding support and education intervention on the exclusivity and duration of breastfeeding .


A total of @ primiparous women who attended the antenatal clinics of two geographically distributed public hospitals in Hong Kong were randomized to receive either standard antenatal care or a one-to-one antenatal breastfeeding support and education session .


The primary outcome was the prevalence of exclusive breastfeeding at @ weeks postpartum .


Secondary outcomes were the prevalence of exclusive breastfeeding at @ and @ months postpartum as well as the overall duration of any and exclusive breastfeeding across the first @ months postpartum .


The exclusive breastfeeding rate in the intervention group was @ % at @ weeks postpartum compared with @ % in the standard care group ( P = @ ; @ % confidence interval -LSB- CI -RSB- -@ to @ ) .


There were no significant differences between the two treatment groups in exclusive breastfeeding rates at @ and @ months or in the overall duration of any ( hazard ratio -LSB- HR -RSB- @ , @ % CI @-@ @ -RSB- or exclusive breastfeeding ( HR @ , @ % CI @-@ @ ) .


The study had a least @ % power to detect a @ % increase in the rate of exclusive breastfeeding at @ weeks postpartum .


In a setting with a high breastfeeding initiation rate , one-to-one antenatal breastfeeding support and education did not increase the exclusivity or duration of breastfeeding .


Individuals on hemodialysis have low physical function and activity levels .


Clinical trials have shown improvements in these parameters with exercise programming .


Pedometers have not been extensively evaluated in individuals on hemodialysis .


This randomized clinical trial compared the effects of intradialytic cycling versus a pedometer program on physical function , physical activity and quality of life .


Sixty patients were randomly assigned to two study groups .


The ergometer group cycled during each hemodialysis session for @ weeks .


Pedometer participants followed a home-based walking program for @ weeks .


The primary outcome was aerobic capacity -LSB- VO@peak and @-minute walk ( @MW ) test -RSB- .


Secondary outcomes included lower extremity strength -LSB- sit-to-stand ( SS ) test -RSB- , flexibility -LSB- sit-and-reach ( SR ) test -RSB- , physical activity ( accelerometer ) and health-related quality of life .


Measurements were collected at baseline and at @ and @ weeks .


At @ and @ weeks , there was no significant change in the VO@peak or @MW test between or within study groups .


SS testing in the ergometer group improved from @ ( SD @ ) to @ ( SD @ ) cycles from baseline to @ weeks ( P < @ ) .


Similarly , in the pedometer group , SS cycles improved from @ ( SD @ ) to @ ( SD @ ) ( P < @ ) .


The SR test also significantly improved over time in both the study groups .


No significant changes were noted for other secondary outcomes .


Both intradialytic cycling and pedometer programming improved aspects of physical function .


Neither intervention had a significant effect on aerobic capacity .


No significant differences in any outcomes were identified between interventions groups .


Spondylolisthesis is the major cause of refractory low back pain .


There are many studies of the surgical treatment of spondylolisthesis , but few of conservative treatments .


There is also no optimal conservative treatment protocol , however , low back pain caused by low-grade spondylolisthesis is controlled with non-surgical pain management .


Acupuncture has become a useful method for treating low back pain , but there has not been any study of its efficacy in relation to spondylolisthesis .


This study was designed to establish the feasibility of a randomized controlled trial and the safety of acupuncture for low back pain due to low-grade spondylolisthesis .


The study is a randomized controlled pilot clinical trial of five weeks duration .


Fourteen patients will be recruited and randomly allocated to two groups : an acupuncture plus interlaminar epidural steroid injection group ( experimental group ) , and an interlaminar epidural steroid injection group ( control group ) .


All patients will be administered an interlaminar epidural steroid injection once a week for three weeks ( three injections in total ) , but only the experimental group will receive additional treatment with three acupuncture sessions a week for three weeks ( nine acupuncture sessions in total ) .


The primary outcome will be measured by the visual analogue scale ( VAS ) .


Our primary end point is three-week VAS .


The secondary outcome will be measured using the PainVision system , the short-form McGill Pain Questionnaire , and the Oswestry Disability Index .


Assessments will be made at baseline and at one , three and five weeks thereafter ( that is , the five-week assessment will be made two weeks after treatment cessation ) .


This randomized controlled pilot trial will inform the design of a further full-scale trial .


The outcomes will provide some resources for incorporating acupuncture into existing pain management methods such as interlaminar epidural steroid injection in low-grade spondylolisthesis .


Opioid-induced respiratory depression is potentially lethal .


GAL@ is a calcium-activated potassium ( BKCa ) channel blocker that causes reversal of opioid-induced respiratory depression in animals due to a stimulatory effect on ventilation at the carotid bodies .


To assess in humans whether GAL@ stimulates breathing in established opioid-induced respiratory depression and to evaluate its safety , a proof-of-concept double-blind randomized controlled crossover study on isohypercapnic ventilation ( study @ ) and subsequent double-blind exploratory study on poikilocapnic ventilation and nonrespiratory end points ( study @ ) was performed .


In study @ , intravenous low - and high-dose GAL@ and placebo were administrated on top of low - and high-dose alfentanil-induced respiratory depression in @ healthy male volunteers on two separate occasions .


In study @ , the effect of GAL@/placebo on poikilocapnic ventilation , analgesia , and sedation were explored in eight male volunteers .


Data are mean difference between GAL@ and placebo ( @ % CI ) .


Study @ : Under isohypercapnic conditions , a separation between GAL@ and placebo on minute ventilation was observed by @ ( @ to @ ) l/min ( P < @ ) and @ ( @ to @ ) l/min ( P < @ ) at low-dose alfentanil plus high-dose GAL@ and high-dose-alfentanil plus high-dose GAL@ , respectively .


Study @ : Similar observations were made on poikilocapnic ventilation and arterial pCO@ .


GAL@ had no effect on alfentanil-induced sedation , antinociception and no safety issues or hemodynamic effects became apparent .


GAL@ produces respiratory stimulatory effects during opioid-induced respiratory depression with containment of opioid-analgesia and without any further increase of sedation .


Further studies are needed to confirm these preliminary data .


To compare the clinical outcomes and the rate of complications of @-gauge transconjunctival nonvitrectomizing vitreous surgery ( NVS ) and of @-gauge transconjunctival sutureless vitrectomy surgery for idiopathic epiretinal membrane removal .


In this prospective randomized study , @ phakic eyes of @ consecutive patients with an idiopathic epiretinal membrane were randomized to receive @-gauge NVS ( NVS-group ) or @-gauge vitrectomy ( Standard-group ) .


Main outcome measures were best-corrected visual acuity , central retinal thickness , nuclear density units ' changes , and rate of complications .


Thirty-nine eyes of the Standard-group and @ of the NVS-group were considered in final analysis .


Mean best-corrected visual acuity improved significantly in both groups , with a significant better result at @ months in NVS-group ( P = @ ; t-test ) .


Central retinal thickness decreased significantly in both groups ( P < @ , Tukey test ) , without significant difference between the two groups at any time point .


At @ months , nuclear density increased significantly in the Standard-group ( analysis of variance , P < @ ) , and it did not change in the NVS-group ( analysis of variance , P = @ ) .


Epiretinal membrane recurred in @ % of eyes in the Standard-group and in @ % of eyes in the NVS-group ( Fisher 's exact test , P = @ ) .


The @-gauge NVS is an effective surgical procedure in eyes with epiretinal membrane and it induces less progression of nuclear sclerosis than @-gauge vitrectomy .


National data suggest a higher prevalence of obesity among boys .


One possible cause could be the food choices made by parents on behalf of their children .


This study sought to determine whether and how mothers ' food choices for their children differ by child gender and to understand the drivers of these differences .


Data were analyzed from a randomized controlled trial conducted using a virtual reality-based buffet restaurant .


Overweight mothers filled out questionnaires and received an information module .


They were then immersed in a virtual buffet restaurant to select a lunch for their @ - to @-year-old child .


Of the @ overweight mothers recruited , @ % identified their daughters as the child for whom they would be choosing the food .


The caloric content of boys ' meals was @ calories higher than girls ' ( p = @ ) .


This difference was due to extra calories from the less healthy food category ( p = @ ) .


Multivariate analyses identified more predictors of calorie choices for daughters ' than sons ' meals .


Predictors of calories chosen for girls included : having both biological parents overweight ( = @ ; p = @ ) , mother 's weight ( = @ ; p = @ ) , mother 's education ( = -@ ; p = @ ) , her restriction of her child 's food intake ( = -@ ; p = @ ) , and her beliefs about the importance of genetics in causing obesity ( = @ ; p = @ ) .


Mother 's weight was the sole predictor of boys ' meal calories ( = @ ; p = @ ) .


Differences in dietary choices made for young girls and boys may contribute to lifelong gender differences in eating patterns .


A better understanding of differences in feeding choices made for girls versus boys could improve the design of childhood obesity prevention interventions .


We evaluated the ability of @ genetic variants to provide prognostic information in patients enrolled in the Genetic Substudy of the Surgical Treatment for Ischemic Heart Failure ( STICH ) trials .


Patients assigned to STICH Hypothesis @ were randomized to medical therapy with or without coronary artery bypass grafting ( CABG ) .


Those assigned to STICH Hypothesis @ were randomized to CABG or CABG with left ventricular reconstruction .


In patients assigned to STICH Hypothesis @ ( n = @ ) , no genetic variant met the prespecified Bonferroni-adjusted threshold for statistical significance ( p < @ ) ; however , several variants met nominal prognostic significance : variants in the @-adrenergic receptor gene ( @-AR Gln@Glu ) and in the A@-adenosine receptor gene ( A@-@ T/G ) were associated with an increased risk of a subject dying or being hospitalized for a cardiac problem ( p = @ and @ , respectively ) .


These relationships remained nominally significant even after multivariable adjustment for prognostic clinical variables .


However , none of the @ genetic variants influenced all-cause mortality or the combination of death or cardiovascular hospitalization in the STICH Hypothesis @ population ( n = @ ) by either univariate or multivariable analysis .


We were unable to identify the predictive genotypes in optimally treated patients in these two ischemic heart failure populations .


In rodent models of diabetes , treatment with sodium glucose co-transporter @ ( SGLT@ ) inhibitors improves beta cell function .


This analysis assessed the effects of the SGLT@ inhibitor , canagliflozin , on model-based measures of beta cell function in patients with type @ diabetes .


Data from three Phase @ studies were analysed , in which : ( Study @ ) canagliflozin @ and @ mg were compared with placebo as monotherapy for @ weeks ; ( Study @ ) canagliflozin @ and @ mg were compared with placebo as add-on to metformin + sulfonylurea for @ weeks ; or ( Study @ ) canagliflozin @ mg was compared with sitagliptin @ mg as add-on to metformin + sulfonylurea for @ weeks .


In each study , a subset of patients was given mixed-meal tolerance tests at baseline and study endpoint , and model-based beta cell function parameters were calculated from plasma glucose and C-peptide .


In Studies @ and @ , both canagliflozin doses increased beta cell glucose sensitivity compared with placebo .


Placebo-subtracted least squares mean ( LSM ) ( SEM ) changes were @ ( @ ) and @ ( @ ) pmol min ( -@ ) m ( -@ ) ( mmol/l ) ( -@ ) with canagliflozin @ and @ mg , respectively ( p < @ , Study @ ) , and @ ( @ ) and @ ( @ ) pmol min ( -@ ) m ( -@ ) ( mmol/l ) ( -@ ) ( p < @ , Study @ ) .


In Study @ , beta cell glucose sensitivity was minimally affected , but the insulin secretion rate at @ mmol/l glucose increased to similar degrees from baseline with canagliflozin and sitagliptin -LSB- LSM ( SEM ) changes @ ( @ ) and @ ( @ ) pmol min ( -@ ) m ( -@ ) , respectively ; p < @ for both -RSB- .


Treatment with canagliflozin for @ to @ months improved model-based measures of beta cell function in three separate Phase @ studies .


To examine whether a Web-based cardiovascular health promotion program was associated with changes in self-reported behaviors , attitudes , and biometric indicators in a population of working adults .


Employees ( n = @ ) were recruited and randomized into either an Internet-based or control condition .


Participants completed pre - and postintervention self-report assessments on diet , exercise , smoking , and mental health .


Pre - and postintervention biometric screenings were also obtained on blood pressure , heart rate , weight , and hip/waist circumference .


The intervention was associated with significant improvements in dietary attitudes ( P = @ ; F = @ ) , dietary intentions ( P = @ ; F = @ ) , dietary self-efficacy ( P = @ ; F = @ ) , exercise self-efficacy ( P = @ ; F = @ ) , exercise habits ( P = @ ; F = @ ) , and coping with stress ( P = @ ; F = @ ) and depression ( P = @ ; F = @ ) .


The program showed promise for promoting cardiovascular risk reduction behaviors .


These results are consistent with similar Web-based interventions .


Minimal hepatic encephalopathy ( MHE ) implies subtle impairment of cognitive functions in the absence of features of overt encephalopathy .


We aimed to determine the prevalence of MHE in patients with liver cirrhosis and to find out the effect of rifaximin , probiotics , and l-ornithine l-aspartate ( LOLA ) individually in reversal of MHE by comparing it with placebo group .


This study was carried out in two phases .


Phase I included the recruitment of @ apparently healthy controls and extraction of normative data utilizing three neuropsychometric tests ( NPTs ) and critical flicker frequency ( CFF ) test .


Phase II consisted of screening and recruitment of patients of MHE followed by drugs trial .


A total of @ cirrhotics were screened ; @ were excluded and the remaining @ cirrhotics were screened for MHE using NPTs and/or CFF test .


Of these , @ patients with MHE were randomized to receive LOLA ( n = @ ) , rifaximin ( n = @ ) , probiotics ( n = @ ) , for @ months and were compared with patients who were given placebo ( n = @ ) .


Out of @ cirrhotics , @ ( @ % ) had MHE .


Among these @ MHE patients , @ ( @ % ) patients had CFF < @Hz , @ ( @ % ) patients with MHE had two or more abnormal NPTs , and @ ( @ % ) patients had abnormality on both the CFF values and more than two abnormal NPTs .


Intention-to-treat analysis showed the number of patients who improved after giving treatment were @ % ( @/@ ) , @ % ( @/@ ) , @ % ( @/@ ) , and @ % ( @/@ ) for LOLA , rifaximin , probiotics , and placebo , respectively .


CFF scores and improvement in psychometric tests after treatment were significantly higher ( P < @ ) for LOLA , rifaximin , and probiotics as compared with placebo group .


Prevalence of MHE is high in patients with cirrhosis of liver .


Rifaximin , LOLA , and probiotics are better than giving placebo in patients with MHE .


Endotoxaemia is widely used as an experimental model to study sepsis under controlled conditions .


Nighttime endotoxaemia induces a more pronounced inflammatory stress response compared to daytime .


Previously , we have shown that melatonin has antioxidative and anti-inflammatory effects in inflammatory response to daytime endotoxaemia .


Herein , we examined the effect of melatonin in response to human nighttime endotoxaemia .


Twelve healthy male volunteers were enrolled in a randomized , placebo-controlled , double-blinded cross-over trial .


Subjects were induced by lipopolysaccharide ( LPS ) endotoxin @ ng/kg body weight intravenously at @:@ .


One hour prior to induction of endotoxaemia , an @-h infusion of melatonin @ mg or placebo was initiated .


Blood samples were drawn before and @ , @ , @ and @ h after induction of endotoxaemia and plasma was tested for pro-inflammatory markers ( tumor necrosis factor alpha , TNF - , interleukin-@ , IL-@ , interleukin-@ , IL-@ , and YKL-@ ) , anti-inflammatory markers ( interleukin-@ receptor antagonist , IL-@Ra , interleukin-@ , IL-@ , soluble tumor necrosis factor receptors I and II , sTNF-RI and sTNF-RII ) , marker for oxidative damage ( malondialdehyde ( MDA ) ) and antioxidative enzyme ( ascorbic acid ( AA ) and dehydroascorbic acid ( DHA ) ) .


Compared to placebo , melatonin did not reduce plasma levels of any of pro- and anti-inflammatory markers and it also failed to influence levels of AA , DHA and MDA .


Melatonin has no beneficial effect on inflammation and oxidative damage induced by nighttime endotoxaemia in contrast to daytime endotoxaemia .


Patients with cirrhosis resulting from chronic hepatitis C virus ( HCV ) infection are at risk of life-threatening complications , but consistently achieve lower sustained virological response ( SVR ) than patients without cirrhosis , especially if treatment has previously failed .


We assessed the efficacy and safety of the NS@A inhibitor ledipasvir and the nucleotide polymerase inhibitor sofosbuvir , with and without ribavirin .


In this multicentre , double-blind trial , between Oct @ , @ , and Oct @ , @ , we enrolled patients with HCV genotype @ and compensated cirrhosis who had not achieved SVR after successive treatments with pegylated interferon and protease-inhibitor regimens at @ sites in France .


With a computer-generated randomisation sequence , patients were assigned in a @:@ ratio to receive placebo matched in appearance to study drugs for @ weeks followed by once daily combination fixed-dose tablets of @ mg ledipasvir and @ mg sofosbuvir plus weight-based ribavirin for @ weeks , or ledipasvir-sofosbuvir plus placebo once daily for @ weeks .


The primary endpoint was SVR @ weeks after the end of treatment ( SVR@ ) , for which @ % CIs were calculated with the Clopper-Pearson method .


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


Of @ patients screened , @ entered randomisation , @ were assigned to receive ledipasvir-sofosbuvir plus ribavirin and @ ledipasvir-sofosbuvir .


@ ( @ % ) were men , @ ( @ % ) , were white , @ ( @ % ) had HCV genotype @a , and @ ( @ % ) had non-CC IL@B alleles .


SVR@ rates were @ % ( @ % CI @-@ ) for patients in the ledipasvir-sofosbuvir plus ribavirin group and @ % ( @-@ ) in the ledipasvir-sofosbuvir group .


One patient discontinued treatment because of adverse events while receiving only placebo .


The most frequent adverse events were asthenia and headache , pruritus , and fatigue .


Ledipasvir-sofosbuvir plus ribavirin for @ weeks and ledipasvir-sofosbuvir for @ weeks provided similarly high SVR@ rates in previous non-responders with HCV genotype @ and compensated cirrhosis .


The shorter regimen , when given with ribavirin , might , therefore , be useful to treat treatment-experienced patients with cirrhosis if longer-term treatment is not possible .


Psychostimulants and cannabis are two of the three most commonly used illicit drugs by young Australians .


As such , it is important to deliver prevention for these substances to prevent their misuse and to reduce associated harms .


The present study aims to evaluate the feasibility and effectiveness of the universal computer-based Climate Schools : Psychostimulant and Cannabis Module .


A cluster randomised controlled trial was conducted with @ Year @ students ( mean age = @ years ; SD = @ ) from @ secondary schools in Australia .


Schools were randomised to receive either the six lesson computer-based Climate Schools program or their usual health classes , including drug education , over the year .


The Climate Schools program was shown to increase knowledge of cannabis and psychostimulants and decrease pro-drug attitudes .


In the short-term the program was effective in subduing the uptake and plateauing the frequency of ecstasy use , however there were no changes in meth/amphetamine use .


In addition , females who received the program used cannabis significantly less frequently than students who received drug education as usual .


Finally , the Climate Schools program was related to decreasing students ' intentions to use meth/amphetamine and ecstasy in the future , however these effects did not last over time .


These findings provide support for the use of a harm-minimisation approach and computer technology as an innovative platform for the delivery of prevention education for illicit drugs in schools .


The current study indicated that teachers and students enjoyed the program and that it is feasible to extend the successful Climate Schools model to the prevention of other drugs , namely cannabis and psychostimulants .


Patients with both major depression and personality disorders have a high risk of suicidal behavior .


Lithium is meant to have anti-suicidal properties in patients with affective disorders .


The anti-suicidal effect of lithium in patients with affective disorders and comorbid personality disorders has not been investigated yet .


A post-hoc analysis of a subsample of patients with depression and comorbid personality disorder ( PD ) and a recent suicide attempt ( n = @ ) from the prospective , placebo-controlled lithium intervention study ( N = @ ) , was conducted .


Three patients in the lithium group ( n = @ ) and two patients in the placebo group ( n = @ ) presented a suicide attempt throughout the course of the study .


No differences related to suicidal behavior could be detected between the placebo group and the group with lithium intervention .


On the basis of the small sample size , among patients with comorbid PD , lithium does not seem to have an effect on suicidal behavior in contrast to patients with affective disorders without comorbid PD .


Rural Australian adults are continually shown to be insufficiently active with higher prevalence of lifestyle-related diseases associated with physical inactivity compared to urban adults .


This may , partly , be attributable to the challenges associated with implementing community-based physical activity programs in rural communities .


There is a need for broadly accessible physical activity programs specifically tailored to the unique attributes of rural communities .


The aim of the Rural Environments And Community Health ( REACH ) study is to evaluate the effectiveness of an online-delivered physical activity intervention for increasing regular walking among adults living in rural areas of South Australia .


This is a randomised controlled trial .


The intervention is @-weeks with a @-month follow-up .


Participants will be insufficiently active , aged @ to @years and randomly assigned to either Control or Intervention group .


Participants receive a pedometer , but only the Intervention group will receive access to the purpose built REACH website where they will report steps taken , affect and ratings of perceived exertion during daily walking .


These variables will be used to establish individualised step goals for increasing walking .


Control participants will receive a paper diary to record their variables and generic incremental step goals.The primary outcome measures are time spent in sedentary , light and moderate-to-vigorous intensity physical activity , measured by accelerometry .


Secondary outcomes include @ ) health measures ( anthropometric and physiological ) , @ ) psychological well-being , @ ) diet quality , and @ ) correlates of physical activity ( exercise self-efficacy and physical activity environments ) .


Measures will be collected at baseline , post-intervention , @-month and @-month follow-up .


This protocol describes the implementation of a trial testing the effectiveness of an online resource designed to assist rural Australians to become more physically active .


The outcomes of this study will guide the efforts of health promotion professionals by providing evidence for a relatively inexpensive , widely accessible and effective method for increasing physical activity that can be utilized by anyone with access to the internet .


Findings may indicate future directions for the implementation of physical activity and other health related interventions in rural communities .


To observe the effectiveness of chlortetracycline ( aureomycin ) treatment on vulval white lesions and to explore its possible pathogenesis .


From January @ to April @ , @ patients with vulvar non-neoplastic epithelial disorders were divided into three groups according to therapy regimens received , ie , chlortetracycline treatment group ( @ cases ) , chlortetracycline + beclomethasone treatment group ( @ cases ) , and beclomethasone treatment group ( @ cases ) ; their local changes of vulvar lesions were observed and efficacy of these treatment profiles was evaluated after one year .


Effective rates of chlortetracycline group , chlortetracycline + clobetasol group and clobetasol groups were @ % ( @/@ ) , @ % ( @/@ ) , and @ % ( @/@ ) , respectively .


There was a significant difference among these three groups ( Hc = @ , p = @ ) , the curative rate of clobetasol group was markedly lower than that of the former two groups ( p = @ and p = @ ) , but was not statistical significant ( p = @ ) when compared between the former groups .


The occurrence of vulvar non-neoplastic epithelial disorders may be associated with chlamydia and mycoplasma infection , the chlortetracycline is an effective drug for this illness , the mechanism of which might be related to killing pathogens directly and inhibiting inflammatory mediators .


Drug-related emergency department ( ED ) visits have steadily increased , with substance users relying heavily on the ED for medical care .


The present study aims to identify clinical correlates of problematic drug use that would facilitate identification of ED patients in need of substance use treatment .


Using previously validated tests , @,@ adult ED patients across @ academic institutions were prescreened for drug use as part of a large randomized prospective trial .


Data for @,@ participants who reported drug use in the past @ days were included .


Self-reported variables related to demographics , substance use , and ED visit were examined to determine their correlative value for problematic drug use .


Of the @,@ patients , @,@ ( @ % ) met criteria for problematic drug use ( Drug Abuse Screening Test score @ ) .


Age greater than or equal to @ years , tobacco smoking , daily or binge alcohol drinking , daily drug use , primary noncannabis drug use , resource-intense ED triage level , and perceived drug-relatedness of ED visit were highly correlated with problematic drug use .


Among primary cannabis users , correlates of problematic drug use were age younger than @ years , tobacco smoking , binge drinking , daily drug use , and perceived relatedness of the ED visit to drug use .


Clinical correlates of drug use problems may assist the identification of ED patients who would benefit from comprehensive screening , intervention , and referral to treatment .


A clinical decision rule is proposed .


The correlation between problematic drug use and resource-intense ED triage levels suggests that ED-based efforts to reduce the unmet need for substance use treatment may help decrease overall health care costs .


Little is known regarding patient characteristics that influence the speed of reflux oesophagitis ( RO ) healing .


To investigate patient characteristics that may influence RO healing rates .


A post hoc analysis of clinical trial data for potent acid suppression treatment of RO ( esomeprazole or AZD@ ) was conducted .


Group A underwent endoscopy at baseline , week @ and @ , and group B at baseline , week @ and @ .


Group A patients were sub-grouped as ` rapid ' ( healed at @ weeks ) or unhealed at @ weeks .


Group B patients were sub-grouped as ` slow ' ( healed at @ weeks , not at @ weeks ) or ` refractory ' ( not healed at @ weeks ) .


Logistic regression analysis was performed only for comparisons within group A.


At @ , @ and @ weeks , RO had healed in @ % , @ % and @ % of patients unhealed at previous endoscopy , respectively .


Low-grade -LSB- vs. high-grade ( C or D ) -RSB- RO was the only independent predictor of rapid healing in group A after logistic regression analysis .


Significantly more rapid healers had low grade RO ( A or B ) at baseline than patients with refractory RO ( @ % vs. @ % ; P < @ ) , and significantly more refractory patients had frequent regurgitation at baseline than slow healers ( @ % vs. @ % ; P = @ ) .


Low - ( vs. high - ) grade RO determines the most rapid benefit from acid suppression .


Roughly two-thirds of patients healed with each time increment of potent acid suppression therapy .


This suggests that some unhealed patients may still heal with continued therapy and that truly refractory RO is rare .


( ClinicalTrials.gov : NCT@ ) .


To evaluate the effects of levosimendan on hemodynamics and cardiac function in patients with septic shock .


A prospective single-center randomized controlled trial was conducted .


The patients with septic shock admitted to the Department of Critical Care Medicine of the Third Hospital of Hebei Medical University from June @ to October @ were enrolled .


The patients with septic shock received the conventional treatment according to international guidelines for management of severe sepsis and septic shock .


Thirty-six patients received the examination of echocardiography and left ventricular ejection fraction ( LVEF ) @ after fluid resuscitation were enrolled the study , who were divided into two groups according to random number table , with @ cases in each group .


After the conventional treatment , the patients in dobutamine group received intravenous injection of @ g kg min dobutamine for @ hours immediately after fluid resuscitation , and those in levosimendan group received a @-hour infusion of @ g kg min dobutamine followed by a @-hour infusion of @ g kg min levosimendan .


The hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output ( PiCCO ) and ultrasound during treatment .


Compared with dobutamine group , after the treatment in the levosimendan group , stroke volume index ( SVI ) , cardiac index ( CI ) and left ventricular stroke work index ( LVSWI ) were significantly increased -LSB- SVI ( mL/m ) : @ @ vs. @ @ , t = -@ , P = @ ; CI ( L min m ) : @ @ vs. @ @ , t = -@ , P = @ ; LVSWI ( kg min m ) : @ @ vs. @ @ , t = -@ , P = @ -RSB- , and central venous pressure ( CVP ) , intrathoracic blood volume index ( ITBVI ) and extravascular lung water index ( EVLWI ) were significantly decreased -LSB- CVP ( mmHg , @ mmHg = @ kPa ) : @ @ vs. @ @ , t = @ , P = @ ; ITBVI ( mL/m ) : @ @ vs. @ @ , t = @ , P = @ ; EVLWI ( mL/kg ) : @ @ vs. @ @ , t = @ , P = @ -RSB- .


Cardiac ultrasound showed that compared with dobutamine group , in the levosimendan group , left ventricular end-systolic volume ( LVESI ) and end-diastolic volume ( LVEDI ) were significantly lowered -LSB- LVESI ( mL/m ) : @ @ vs. @ @ , t = @ , P = @ ; LVEDI ( mL/m ) : @ @ vs. @ @ , t = @ , P = @ -RSB- , and the LVEF was significantly increased ( @ @ vs. @ @ , t = -@ , P = @ ) .


Levosimendan also could decrease the lactic acid ( mmol/L : @ @ vs. @ @ , t = @ , P = @ ) , and increase the lactate clearance rate ( mL/min : @ @ vs. @ @ , t = -@ , P = @ ) , @-hour urinary output ( mL : @ @ @ vs. @ @ @ , t = @ , P = @ ) and @-hour cumulative intake ( mL : @ @ @ vs. @ @ @ , t = @ , P = @ ) .


There were no significant differences in total volume of norepinephrine , mortality in intensive care unit ( ICU ) and @-day mortality between two groups .


Levosimendan can increase cardiac ejection function , reduce the heart blood and vascular preload , intrathoracic lung water , improve heart function and systemic hemodynamic indexes of patients with septic shock .


Secreted protein acidic and rich in cysteine ( SPARC ) has been suggested as a new biomarker and therapeutic target in breast cancer , as well as other tumor types .


We evaluated the frequency of SPARC expression among different molecular breast cancer subtypes and its role for therapy response after neoadjuvant chemotherapy .


In this study , pretherapeutic core biopsies of @ patients from the neoadjuvant GeparTrio trial were evaluated for SPARC expression by immunohistochemistry using a standardized immunoreactive score ( IRS ) .


An increased SPARC expression ( IRS @ ) was observed in @ % of all tumors .


In triple-negative tumors , SPARC expression was increased in @ % of tumors , compared with other molecular subtypes ( @ % HR + / HER@ - , @ % HR + / HER@ + and @ % HR - / HER@ + ; P = @ ) .


Increased SPARC expression was associated with an increased pathological complete response ( pCR ) rate of @ % , compared with @ % in tumors with low SPARC expression ( P < @ ) .


In the triple-negative subgroup , pCR rates were @ % in tumors with high SPARC expression , compared with @ % in tumors with low SPARC expression ( P = @ ) .


In multivariable analysis , SPARC was independently predictive in the overall population ( P = @ ) as well as the triple-negative subgroup ( P = @ ) .


SPARC is frequently expressed in breast cancer with triple-negative breast cancer revealing the highest expression rate .


High SPARC expression of the primary tumor is associated with a higher chance of achieving a pathological complete remission after TAC or TAC-NX chemotherapy .


As SPARC is an albumin-binding protein and might mediate intratumoral accumulation of albumin bound drugs , SPARC should be further evaluated as a predictive marker especially for response to albumin-bound drugs like nab-paclitaxel .


To evaluate health-related quality of life ( HRQOL ) and corticosteroid use in patients with moderate to severely active SLE enrolled in two international , multicentre , randomized controlled trials of epratuzumab ( ALLEVIATE-@ and -@ ) and a long-term extension study ( SL@ ) .


Ninety ALLEVIATE patients ( @ % BILAG A , mean BILAG score @ ) were randomized to receive @ mg/m ( @ ) ( n = @ ) or @ mg/m ( @ ) ( n = @ ) epratuzumab or placebo ( n = @ ) , plus standard of care , in @-week cycles .


Corticosteroid use , patient and physician global assessments of disease activity ( PtGA and PGA ) and @-item Medical Outcomes Survey Short Form ( SF-@ ) results were recorded at baseline and every @ weeks .


Both trials were prematurely discontinued due to a drug supply interruption ; patients followed for @ months were analysed .


Twenty-nine patients continued in SL@ , with interim analysis at a median exposure of @ ( range @-@ ) weeks .


At week @ , proportions of patients with a PGA @ % above baseline or with a PtGA improvement greater than or equal to the minimum clinically important difference were higher in the epratuzumab arms than the placebo arm .


PGA and PtGA improvements were sustained but did not reach statistical significance .


At week @ , mean cumulative corticosteroid doses with epratuzumab @ and @ mg/m ( @ ) were @ and @ mg less than placebo ( P = @ and @ , respectively ) .


At week @ , SF-@ scores approached or exceeded US age - and gender-matched norms in five domains with the @ mg/m ( @ ) treatment .


Improvements were maintained in SL@ over @ years .


Epratuzumab treatment produced clinically meaningful and sustained improvements in PGA , PtGA and HRQOL and reductions in corticosteroid doses .


In industrialized countries , low back pain ( LBP ) is one of the leading causes for prolonged sick leave , early retirement , and high health care costs .


Providing the same treatments to all patients is neither effective nor feasible , and may impede patients ' recovery .


Recent studies have outlined the need for subgroup-specific treatment allocation .


This is a cross-sectional study that used baseline data from consecutively recruited patients participating in a guideline implementation trial regarding LBP in primary care .


Classification variables were employment status , age , pain intensity , functional capacity ( HFAQ ) , depression ( CES-D ) , belief that activity causes pain ( FABQ subscale ) , @ scales of the SF-@ ( general health , vitality ) , and days in pain per year .


We performed k-means cluster analyses and split-half cross-validation .


Subsequently , we investigated whether the resulting groups incurred different direct and indirect costs during a @-month period before the index consultation .


A @-cluster solution showed good statistical quality criteria , even after split-half cross-validation .


`` Elderly patients adapted to pain '' ( cluster @ ) and `` younger patients with acute pain '' ( cluster @ ) accounted for @ % of all patients .


Cluster validation showed the lowest direct and indirect costs in these groups .


About @ % of total costs per patient referred to clusters @ and @ ( `` patients with chronic severe pain with comorbid depression '' and `` younger patients with subacute pain and emotional distress '' ) .


Our study adds substantially to the knowledge of LBP-related case-mix in primary care .


Information on differential health care needs may be inferred from our study , enabling decision makers to allocate resources more appropriately and to reduce costs .


Erectile dysfunction ( ED ) has been shown to be associated with a number of physical conditions and affects not only physical but also psychosocial health .


Currently oral , on-demand phosphodiesterase type @ inhibitors ( PDE@i ) are preferred first line treatment .


Though effective , these drugs have limitations and are associated with significant non-compliance , side effects and do not reverse the underlying pathology .


Non-invasive low intensity shockwave therapy ( LISWT ) has been shown to significantly improve erectile function in men previously PDE@i dependent .


We describe our experience and results with this therapy in an Indian population of men with ED .


This study assessed the efficacy of low intensity extracorporeal shockwave therapy ( LI-ESWT ) on Indian men with organic ED who had previously responded to PDE@i .


All the patients underwent a @ month PDE@i washout period .


Men were randomized to receive either @ sessions of LI-ESWT ( n = @ ) or placebo/sham therapy ( n = @ ) .


Before the first treatment , erectile function and penile hemodynamics were assessed to substantiate a vascular etiology for the ED .


Outcomes were assessed using Erection Hardness Score ( EHS ) , International Index of Erectile Function-Erectile Function Domain ( IIEF-EF domain ) and Clinical Global Impression of Change ( CGIC ) scores at @ , @ , @ , @ and @ months post-treatment .


We found a significant increase in the EHS and IIEF-EF Domain scores from visit @ to follow up @ ( @ months ) in the treated group compared to the placebo group .


By @ month after treatment there were highly significant differences between the LI-ESWT and placebo groups ( p < @ ) .


Out of @ men in the LI-ESWT group who completed the study , @ ( @ % ) men at FU@ and @ ( @ % ) at FU@ who were initially unable to achieve spontaneous erections hard enough for penetration ( EHS @ ) were able to do so ( EHS @ ) compared to none in the placebo group .


The treatment was well tolerated and none of the men experienced treatment related discomfort or reported any adverse effects from the treatment .


In this double-blind , placebo-controlled study , LI-ESWT demonstrated a positive long term clinical effect with improvement in erectile function of Indian men with vasculogenic ED who were prior responders to PDE@i therapy .


The efficacy and tolerability of this treatment , coupled with its long term benefits and rehabilitative characteristics , make it an attractive new therapeutic option for men with vasculogenic erectile dysfunction .


The purpose of this article is to prospectively and directly compare the capabilities of non-contrast-enhanced MR angiography ( MRA ) , @D contrast-enhanced MRA , and contrast-enhanced MDCT for assessing pulmonary vasculature in patients with non-small cell lung cancer ( NSCLC ) before surgical treatment .


A total of @ consecutive patients ( @ men and @ women ; mean age , @ years ) with pathologically proven and clinically assessed stage I NSCLC underwent thin-section contrast-enhanced MDCT , non-contrast-enhanced and contrast-enhanced MRA , and surgical treatment .


The capability for anomaly assessment of the three methods was independently evaluated by two reviewers using a @-point visual scoring system , and final assessment for each patient was made by consensus of the two readers .


Interobserver agreement for pulmonary arterial and venous assessment was evaluated with the kappa statistic .


Then , sensitivity , specificity , and accuracy for the detection of anomalies were directly compared among the three methods by use of the McNemar test .


Interobserver agreement for pulmonary artery and vein assessment was substantial or almost perfect ( = @-@ @ ) .


For pulmonary arterial and venous variation assessment , there were no significant differences in sensitivity , specificity , and accuracy among non-contrast-enhanced MRA ( pulmonary arteries : sensitivity , @ % ; specificity , @ % ; accuracy , @ % ; pulmonary veins : sensitivity , @ % ; specificity , @ % ; accuracy , @ % ) , @D contrast-enhanced MRA ( pulmonary arteries : sensitivity , @ % ; specificity , @ % ; accuracy , @ % ; pulmonary veins : sensitivity , @ % ; specificity , @ % ; accuracy , @ % ) , and thin-section contrast-enhanced MDCT ( pulmonary arteries : sensitivity , @ % ; specificity , @ % ; accuracy , @ % ; pulmonary veins : sensitivity , @ % ; specificity , @ % ; accuracy , @ % ) ( p > @ ) .


Pulmonary vascular assessment of patients with NSCLC before surgical resection by non-contrast-enhanced MRA can be considered equivalent to that by @D contrast-enhanced MRA and contrast-enhanced MDCT .


Effective targeted treatment is unavailable for most sarcomas and doxorubicin and ifosfamide-which have been used to treat soft-tissue sarcoma for more than @ years-still have an important role .


Whether doxorubicin alone or the combination of doxorubicin and ifosfamide should be used routinely is still controversial .


We assessed whether dose intensification of doxorubicin with ifosfamide improves survival of patients with advanced soft-tissue sarcoma compared with doxorubicin alone .


We did this phase @ randomised controlled trial ( EORTC @ ) at @ hospitals in ten countries .


We included patients with locally advanced , unresectable , or metastatic high-grade soft-tissue sarcoma , age @-@ years with a WHO performance status of @ or @ .


They were randomly assigned ( @:@ ) by the minimisation method to either doxorubicin ( @ mg/m ( @ ) by intravenous bolus on day @ or @ h continuous intravenous infusion ) or intensified doxorubicin ( @ mg/m ( @ ) ; @ mg/m ( @ ) per day , days @-@ ) plus ifosfamide ( @ g/m ( @ ) over @ days with mesna and pegfilgrastim ) as first-line treatment .


Randomisation was stratified by centre , performance status ( @ vs @ ) , age ( < @ vs @ years ) , presence of liver metastases , and histopathological grade ( @ vs @ ) .


Patients were treated every @ weeks till progression or unacceptable toxic effects for up to six cycles .


The primary endpoint was overall survival in the intention-to-treat population .


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


Between April @ , @ , and May @ , @ , @ patients were randomly assigned to receive doxorubicin and @ to receive doxorubicin and ifosfamide .


Median follow-up was @ months ( IQR @-@ ) in the doxorubicin only group and @ months ( @-@ ) in the combination group .


There was no significant difference in overall survival between groups ( median overall survival @ months -LSB- @ % CI @-@ -RSB- in the doxorubicin group vs @ months -LSB- @-@ -RSB- in the doxorubicin and ifosfamide group ; hazard ratio -LSB- HR -RSB- @ -LSB- @ % CI @-@ -RSB- ; stratified log-rank test p = @ ) .


Median progression-free survival was significantly higher for the doxorubicin and ifosfamide group ( @ months -LSB- @ % CI @-@ -RSB- ) than for the doxorubicin group ( @ months -LSB- @-@ -RSB- ; HR @ -LSB- @ % CI @-@ -RSB- , stratified log-rank test p = @ ) .


More patients in the doxorubicin and ifosfamide group than in the doxorubicin group had an overall response ( @ -LSB- @ % -RSB- of @ patients vs @ -LSB- @ % -RSB- of @ ; p < @ ) .


The most common grade @ and @ toxic effects-which were all more common with doxorubicin and ifosfamide than with doxorubicin alone-were leucopenia ( @ -LSB- @ % -RSB- of @ patients vs @ -LSB- @ % -RSB- of @ patients ) , neutropenia ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , febrile neutropenia ( @ ( @ % ) vs @ -LSB- @ % -RSB- ) , anaemia ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , and thrombocytopenia ( @ -LSB- @ % -RSB- ) vs one -LSB- < @ % -RSB- ) .


Our results do not support the use of intensified doxorubicin and ifosfamide for palliation of advanced soft-tissue sarcoma unless the specific goal is tumour shrinkage .


These findings should help individualise the care of patients with this disease .


To evaluate the relative bioavailability of single pill combination ( SPC ) tablets of linagliptin and metformin compared with separate tablets co-administered in healthy Chinese subjects .


This was an open-label , single-dose , randomized , two-period , crossover study in healthy Chinese subjects with two dose groups : linagliptin @ mg/metformin @ mg and linagliptin @ mg/metformin @ mg .


Within each group ( n = @ ) , subjects received one dose of the SPC tablet in one period and one dose of the separate tablets in the other .


Primary endpoints were area under the plasma concentration-time curve from @ to @ hours ( AUC@-@ ) and maximum plasma concentration ( Cmax ) for linagliptin , and AUC from @ to the last quantifiable concentration ( AUC@-tz ) and Cmax for metformin .


With the linagliptin @ mg/metformin @ mg dose , the adjusted geometric mean ratio of the SPC to the separate tablets for linagliptin was @ % ( @ % confidence interval ( CI ) : @-@ @ ) for AUC@-@ and @ % ( @ % CI : @-@ @ ) for Cmax ; for metformin the ratio was @ % ( @ % CI : @-@ @ ) for AUC@-tz and @ % ( @ % CI : @-@ @ ) for Cmax .


With the linagliptin @ mg/metformin @ mg dose , the ratio with linagliptin for AUC@-@ and Cmax was @ % ( @ % CI : @-@ @ ) and @ % ( @ % CI : @-@ @ ) , respectively ; the same statistical parameters with metformin for AUC@-tz and Cmax were @ % ( @ % CI : @-@ @ ) and @ % ( @ % CI : @-@ @ ) , respectively .


SPC tablets of linagliptin and metformin were bioequivalent to separate tablets co-administered in healthy Chinese subjects .


To examine the effect of intensive glycemic control on cardiovascular disease events ( CVD ) among the major race/ethnic groups in a post-hoc analysis of the VADT .


Participants included @ non-Hispanic Whites , @ Hispanics and @ non-Hispanic Blacks randomized to intensive or standard glucose treatment in VADT .


Multivariable Cox proportional hazards models were constructed to assess the effect of intensive glucose treatment on CVD events among race/ethnic groups .


Mean age was @ years and median follow-up was @ years .


By design , modifiable risk factors were managed equally well in both treatment arms and only differed modestly between race/ethnic groups .


HbA ( @c ) decreased significantly from baseline with intensive glucose treatment in each race/ethnic group , with a trend for a greater response in Hispanics ( P = @ for overall comparison between groups ) .


Intensive glucose treatment was associated with reduced risk of CVD events for Hispanics but not for others ( hazard ratios ranged from @ to @ for Hispanics whereas they were consistently close to @ for others ) .


Sensitivity analyses with different definitions of race/ethnicity or limited to individuals free of previous known CVD yielded similar results .


The results of these analyses support the hypothesis that race/ethnicity is worthy of consideration when tailoring intensive treatment for individuals with long-standing type @ diabetes .


However , additional studies are needed to confirm the findings of this post-hoc analysis .


Audit and feedback to physicians is a commonly used quality improvement strategy , but its optimal design is unknown .


This trial tested the effects of a theory-informed worksheet to facilitate goal setting and action planning , appended to feedback reports on chronic disease management , compared to feedback reports provided without these worksheets .


A two-arm pragmatic cluster randomized trial was conducted , with allocation at the level of primary care clinics .


Participants were family physicians who contributed data from their electronic medical records .


The ` usual feedback ' arm received feedback every six months for two years regarding the proportion of their patients meeting quality targets for diabetes and/or ischemic heart disease .


The intervention arm received these same reports plus a worksheet designed to facilitate goal setting and action plan development in response to the feedback reports .


Blood pressure ( BP ) and low-density lipoprotein cholesterol ( LDL ) values were compared after two years as the primary outcomes .


Process outcomes measured the proportion of guideline-recommended actions ( e.g. , testing and prescribing ) conducted within the appropriate timeframe .


Intention-to-treat analysis was performed .


Outcomes were similar across groups at baseline .


Final analysis included @ physicians from seven clinics and @,@ patients in the intervention arm ( @ % loss to follow up ) and @ physicians from seven clinics and @,@ patients in the usual feedback arm ( @ % loss to follow up ) .


Ten of @ physicians completed the worksheet at least once during the study .


Mean BP was @/@ in the feedback plus worksheet arm and @/@ in the feedback alone arm , while LDL was @ and @ , respectively .


Thus , no significant differences were observed across groups in the primary outcomes , but mean haemoglobin A@c was lower in the feedback plus worksheet arm ( @ % versus @ % , p < @ ) .


Improvements in both arms were noted over time for one-half of the process outcomes .


Appending a theory-informed goal setting and action planning worksheet to an externally produced audit and feedback intervention did not lead to improvements in patient outcomes .


The results may be explained in part by passive dissemination of the worksheet leading to inadequate engagement with the intervention .


The objective of this study was to compare the image quality of a dual-energy nonlinear image blending technique at reduced load of contrast medium with a simulated @-kVp linear blending technique at a full dose during portal venous phase MDCT of the abdomen .


Forty-five patients ( @ men , @ women ; mean age , @ @ -LSB- SD -RSB- years ; mean body weight , @ @ kg ) underwent contrast-enhanced single-phase dual-energy CT of the abdomen by a random assignment to one of three different contrast medium ( iomeprol @ ) dose injection protocols : @ , @ , or @ mL/kg of body weight .


The contrast-to-noise ratio ( CNR ) and noise at the portal vein , liver , aorta , and kidney were compared among the different datasets using the ANOVA .


Three readers qualitatively assessed all datasets in a blinded and independent fashion .


Nonlinear blended images at a @ % reduced dose allowed a significant improvement in CNR ( p < @ for all comparisons ) , compared with simulated @-kVp linear blended images at a full dose .


No statistically significant difference existed in CNR and noise between the nonlinear blended images at a @ % reduced dose and the simulated @-kVp linear blended images at a full dose .


Nonlinear blended images at a @ % reduced dose were considered in all cases to have acceptable image quality .


The dual-energy nonlinear image blending technique allows reducing the dose of contrast medium up to @ % during portal venous phase imaging of the abdomen while preserving image quality .


Major liver resection is associated with haemodynamic , hepatic and renal changes as a result of the procedure .


To compare Desflurane ( D ) versus Sevoflurane ( S ) on hepatic , renal functions , haemodynamics and perioperative course for cirrhotic patients undergoing major liver resection .


A prospective randomized control study with @ patients ( Child A ) ( D , n = @ and S , n = @ ) .


End tidal D or S adjusted with Entropy ( @-@ ) .


Haemodynamics monitored with invasive blood pressure and trans-oesophageal Doppler ( TED ) .


Liver and kidney function tests , blood Glutathione-S-transferase ( GST ) , urinary microalbuminuria ( Microalb ) were assayed .


Extubation time and anaesthetic consumption were recorded .


Systemic vascular resistance ( SVR ) post-resection and stroke volume of D vs S were @ @ vs @ @ dyn.sec.cm ( -@ ) , P < @ , and @ @ vs @ @ ml , P < @ respectively .


Doppler corrected flow time ( FTc ) between groups were comparable ( P > @ ) .


No difference post-operatively regarding hepatic and renal functions , and urine Microalb ( @ @ vs l@ @ @ g/ml , P = @ ) , but a statistically difference was found with GST ( @ -LSB- symbols : see text -RSB- , vs @ -LSB- symbols : see text -RSB- IU/ml , P < @ ) .


Despite a higher D consumption ( @ @ vs @ @ ml , P = @ ) , cost in Egyptian pounds ( LE ) was lower with D ( @ @ vs @ @ , LE , P < @ ) .


Extubation time and ICU stay with D vS ( @ @ vs @ @ min , P < @ ) and ( @ @ vs @ @ , days P = @ ) respectively .


Neither D nor S were clinically superior to the other with respect to liver and kidneys functions , but D was found to preserve better the haemodynamic parameters and enhance recovery at a lower cost .


Acute kidney injury ( AKI ) after cardiopulmonary bypass surgery to correct congenital heart disease is common .


We prevent fluid overload and further cardiac compromise in oliguric infants with continuous peritoneal dialysis ( CPD ) .


The effect of CPD on kidney recovery is unknown , thus indications to discontinue CPD are unclear .


We aimed to determine if CPD affects kidney recovery , measured by urine output and novel urinary AKI biomarker concentrations .


Twenty infants < @ days old with congenital heart disease who underwent bypass surgery and were post-operatively treated with CPD were randomized at the time of clinical readiness for CPD discontinuation to @ ) discontinue CPD ( control ) or @ ) continue @ h more CPD ( experimental ) .


Urine output ( ml/kg per h ) , total output ( ml/kg per h ) and urinary neutrophil gelatinase-associated lipocalin , interleukin-@ , liver-type fatty acid binding protein , and kidney injury molecule-@ were assessed post-surgery until CPD catheter removal .


@ hours preceding randomization , there were no differences in mean urine output or total output ; @ hours post-randomization , the control group had higher mean urine output ( @ @ ml/kg per h vs. @ @ ml/kg per h , p = @ ) but lower total output ( @ @ ml/kg per h vs. @ @ ml/kg per h , p = @ ) .


Median biomarker concentrations did not differ significantly between groups at any time point .


Our results suggest renal replacement therapy does not change the time course of kidney function recovery .


To evaluate the long-term effects of dietary intervention on gastrointestinal symptoms after highly dose-escalated radiotherapy for localized prostate cancer , using boost with protons or high-dose-rate brachytherapy .


Patients were randomized to an intervention group ( n = @ ) advised to reduce insoluble dietary fiber and lactose intake , or to a standard care group ( n = @ ) advised to continue their usual diet .


Gastrointestinal symptoms , other domains of health-related quality of life ( HRQOL ) , and dietary intake were evaluated for @months post-radiotherapy with the European Organization for Research and Treatment of Cancer quality-of-life questionnaires QLQ-C@ and QLQ-PR@ , Gastrointestinal Side Effects Questionnaire , and Food Frequency Questionnaire .


The effect of the intervention on gastrointestinal symptoms was evaluated using generalized estimating equations .


Dietary intervention had no obvious effect on long-term gastrointestinal symptoms or HRQOL .


The intervention group markedly reduced their dietary fiber and lactose intake during radiotherapy , but adherence tended to decline over time .


The vast majority of long-term gastrointestinal symptoms were reported as ' a little ' , with a noticeable difference from pre-treatment only for unintentional stool leakage , limitations on daily activities , and mucus discharge .


Long-term gastrointestinal symptoms were predominantly mild , and dietary intervention was not superior to a usual diet in preventing these symptoms .


Longstanding complex regional pain syndrome ( CRPS ) is refractory to treatment with established analgesic drugs in most cases , and for many patients , alternative pain treatment approaches , such as with neuromodulation devices or rehabilitation methods , also do not work .


The development of novel , effective treatment technologies is , therefore , important .


There are preliminary data suggesting that low-dose immunoglobulin treatment may significantly reduce pain from longstanding CRPS .


LIPS is a multicentre ( United Kingdom ) , double-blind , randomised parallel group , placebo-controlled trial , designed to evaluate the efficacy , safety , and tolerability of intravenous immunoglobulin ( IVIg ) @ g/kg plus standard treatment , versus matched placebo plus standard treatment in @ patients with longstanding complex regional pain syndrome .


Participants with moderate or severe CRPS of between @ and @ years duration will be randomly allocated to receive IVIg @ g/kg ( IntratectTM @ g/l solution for infusion ) or matching placebo administered day @ and day @ after randomisation , followed by two optional doses of open-label medication on day @ after randomisation and on day @ after randomisation .


The primary outcome is the patients ' pain intensity in the IVIG group compared with the placebo group , between @ and @ days after randomisation .


The primary trial objective is to confirm the efficacy and confidently determine the effect size of the IVIG treatment technology in this group of patients .


In vitro fertilisation ( IVF ) treatment provides an opportunity to study early developmental responses to periconceptional dietary interventions .


Retrospective studies have suggested links between preconception diet and fertility , and more recently , a `` Mediterranean '' diet has been reported to increase pregnancy rates by up to @ % .


In addition , a prospective study examining increased intake of omega-@ polyunsaturated fats demonstrated a quickened rate of embryo development after IVF .


However , up to now , few prospective randomised controlled trials have investigated the impact of periconceptional dietary interventions on fertility outcomes .


The study is a randomised controlled trial of a dietary intervention consisting of olive oil for cooking , an olive oil based spread , and a daily supplement drink enriched with Vitamin D ( @ microgram daily ) and marine omega-@ fatty acids ( @g daily ) for @weeks preconception versus a control diet of sunflower seed oil for cooking , a sunflower oil based spread , and a daily supplement drink without added Vitamin D or marine omega-@ fatty acids .


Couples undergoing IVF will be randomised to either the intervention or control group ( @ in each arm ) .


The primary endpoint is embryo developmental competency in vitro , measured by validated morphokinetic markers .


Secondary outcomes will include the effect of the dietary intervention on the nutritional content of the intrauterine environment .


This approach will enable rigorous examination of the impact of the dietary intervention on early embryo development , together with the influence of the peri-implantation intra-uterine nutritional environment .


Traditional Chinese acupuncture ( TCA ) is an effective alternative treatment in migraine headache .


The aim of this study was to compare the therapeutic effect of Yamamoto new scalp acupuncture ( YNSA ) , a recently developed microcupuncture system , with TCA for the prophylaxis and treatment of migraine headache .


In a randomized clinical trial , @ patients with migraine headache were assigned to receive YNSA or TCA .


A pain visual analogue scale ( VAS ) and migraine therapy assessment questionnaire ( MTAQ ) were completed before treatment , after @ and @ sections of treatment , and @ month after completion of therapy .


All the recruited patients completed the study .


Baseline characteristics were similar between the two groups .


Frequency and severity of migraine attacks , nausea , the need for rescue treatment , and work absence rate decreased similarly in both groups .


Recovery from headache and ability to continue daily activities @ hours after medical treatment showed similar improvement in both groups ( p > @ ) .


Classic acupuncture and YNSA are similarly effective in the prophylaxis and treatment of migraine headache and may be considered as alternatives to pharmacotherapy .


The latest meta-analysis demonstrated that acupuncture improves pregnancy rates among women undergoing in vitro fertilization-embryo transfer ( IVF-ET ) , and surface acupoint stimulation , such as transcutaneous electrical acupoint stimulation ( TEAS ) , may have the same or better potential .


To explore the effect of TEAS on the clinical pregnancy rate ( CPR ) and live birth rate ( LBR ) compared with real acupuncture and controls in women undergoing IVF , a multicenter , randomized controlled trial will be conducted .


The inclusion criteria are the following : infertile women < @years of age undergoing a fresh IVF or intracytoplasmic sperm injection cycle , and the study will be restricted to women with the potential for a lower success rate as defined by two or more previous unsuccessful ETs ( fresh or frozen ) .


Those who have severe illnesses possibly precluding IVF or pregnancy , have FSH levels greater than @IU/L , received donor eggs , had been previously randomized for this study or had undergone acupuncture ( in any modality ) as infertility treatment will be excluded .


The subjects will be randomly assigned to the TEAS group ( IVF+TEAS ) , the electro-acupuncture ( EA ) group ( IVF+EA ) , or the control group ( only IVF ) .


A total sample size of @,@ women is required to detect differences in CPR among the three groups .


TEAS or EA treatments will start once every two or three days from day @ of menstruation in the ovarian stimulation cycle until the day of ET .


The parameters of TEAS or EA will be the following : a frequency of @/@Hz , a moderate electrical current of @ to @mA for TEAS and @ to @ mA for EA .


The primary outcome is CPR .


Secondary outcomes are LBR , the number of oocytes aspirated and the total gonadotropin dose used in the stimulation cycle .


This study will provide significant evidence for using a new method ( TEAS ) in IVF .


To assess the efficacy of Korean Immigrants and Mammography-Culture-Specific Health Intervention ( KIM-CHI ) , an educational program for Korean American ( KA ) couples designed to improve mammography uptake among KA women .


A two-group cluster randomized , longitudinal , controlled design .


@ KA religious organizations in the Chicago area .


@ married KA women @ years of age or older who had not had a mammogram in the past year .


The women and their husbands were recruited from @ KA religious organizations .


Couples were randomly assigned to intervention or attention control groups .


Those in the KIM-CHI program ( n = @ couples ) were compared to an attention control group ( n = @ couples ) at baseline , as well as at @ and @ months postintervention on mammogram uptake .


Sociodemographic variables and mammography uptake were measured .


Level of acculturation was measured using the Suinn-Lew Asian Self-Identity Acculturation Scale .


Researchers asked questions about healthcare resources and use , health insurance status , usual source of care , physical examinations in the past two years , family history of breast cancer , and history of mammography .


The KIM-CHI group showed statistically significant increases in mammography uptake compared to the attention control group at @ months and @ months postintervention .


The culturally targeted KIM-CHI program was effective in increasing mammogram uptake among nonadherent KA women .


Nurses and healthcare providers should consider specific health beliefs as well as inclusion of husbands or significant others .


They also should target education to be culturally relevant for KA women to effectively improve frequency of breast cancer screening .


The authors analyzed headache relief after anterior cervical discectomy .


Headache may be relieved after anterior cervical discectomy , but the mechanism is unknown .


If headaches were directly referred from upper cervical pathology , more headache relief would be expected from surgery performed at higher cervical levels .


If spinal kinesthetics were the mechanism , then headache relief may differ between arthroplasty and fusion .


Headache relief after anterior cervical discectomy was quantified by the operated disc level and by the method of operation ( arthroplasty vs arthrodesis ) .


The authors performed a post hoc analysis of an artificial disc trial .


Data on headache pain were extracted from the Neck Disability Index ( NDI ) questionnaire .


A total of @ patients underwent single-level arthroplasty or arthodesis .


Preoperatively , @ % reported NDI headache scores of @ or greater , compared with only @ % -@ % postoperatively .


The model-based mean NDI headache score at baseline was @ ( @ % CI @-@ @ ) and was reduced by @ points after surgery ( @ % CI @-@ @ , p < @ ) .


Higher cervical levels were associated with a greater degree of preoperative headache , but there was no association with headache relief .


There was no significant difference in headache relief between arthroplasty and arthrodesis .


Most patients with symptomatic cervical spondylosis have headache as a preoperative symptom ( @ % ) .


Anterior cervical discectomy with both arthroplasty and arthrodesis is associated with a durable decrease in headache .


Headache relief is not related to the level of operation .


The mechanism for headache reduction remains unclear .


Mild dysphonia in childhood is surprisingly common , yet moderate to severe dysphonia is rare .


The latter has been associated with complex medical conditions and congenital abnormalities .


Intubation injury has also been documented as a cause of childhood dysphonia .


Children born very preterm may be intubated as part of the intensive care administered in the perinatal and neonatal periods , yet there are few studies investigating dysphonia in this population .


This study will be the first to : use an objective acoustic voice assessment in a paediatric study , document the incidence of dysphonia in very preterm children at school age , and conduct a controlled trial of behavioural voice therapy in this population .


This study will consist of three phases : assessment of voice quality and its impact on quality of life in up to @ children born at less than @ weeks ' gestation : assessment of the nature and extent of laryngeal pathology in children with moderate to severe dysphonia ; and a non-blinded , randomised controlled trial of behavioural voice therapy in children with moderate to severe dysphonia .


This study will be the first to use clinical assessment to examine the voice quality of very preterm children , and to use fibre optic endoscopic evaluation of laryngeal function to determine the nature and extent of any laryngeal pathology in such children .


Those participants with significant voice difficulties will be randomised to receive treatment immediately or after the eight week assessment .


Male and female condom ( FC ) functional performance failure declines with user experience .


With the recent availability of a wider range of FCs , it is important to know if women with experience in using one type of FC are more proficient in using another type , even if the FC design is quite different .


A randomized , noninferiority crossover clinical trial assessed the function of four FCs ( FC@ , Woman 's Condom , Cupid and VA w.o.w ) among @ women in Durban , South Africa .


FC functional failure ( breakage , slippage , invagination and misdirection ) by condom type and use period was investigated in women using five FCs of each type ( @ FC uses in total ) .


Of the @ condoms used during intercourse by @ women , @ clinical failures occurred in @ condoms ( @ condoms had one failure , and @ had two failures ) .


Total clinical failure was comparable across FC types .


Of the @ condoms in which failures occurred , the number of failures in the first condom use period was @ ( @ % ) , decreasing to @ events ( @ % ) in the second , @ ( @ % ) in the third and @ ( @ % ) in the fourth .


Only @ failures were reported in the @th use of an FC compared to @ in the first use , irrespective of condom type .


FC failure rates decreased markedly after use of the first five condoms regardless of FC type and continued to fall across the next three use periods .


FC failure rates decrease over @ uses , regardless of FC condom type used .


The decrease is higher at the beginning of use , indicating that improvement is greatest after the first five uses .


Etrolizumab is a humanised monoclonal antibody that selectively binds the @ subunit of the heterodimeric integrins @ and E@ .


We aimed to assess etrolizumab in patients with moderately-to-severely active ulcerative colitis .


In this double-blind , placebo-controlled , randomised , phase @ study , patients with moderately-to-severely active ulcerative colitis who had not responded to conventional therapy were recruited from @ referral centres in @ countries .


Eligible patients ( aged @-@ years ; Mayo Clinic Score -LSB- MCS -RSB- of @ of higher -LSB- or @ in USA -RSB- ; and disease extending @ cm or more from anal verge ) were randomised ( @:@:@ ) to one of two dose levels of subcutaneous etrolizumab ( @ mg at weeks @ , @ , and @ , with placebo at week @ ; or @ mg loading dose -LSB- LD -RSB- at week @ followed by @ mg at weeks @ , @ , and @ ) , or matching placebo .


The primary endpoint was clinical remission at week @ , defined as MCS of @ or less ( with no individual subscore of > @ ) , analysed in the modified intention-to-treat population ( mITT ; all randomly assigned patients who had received at least one dose of study drug , had at least one post-baseline disease-activity assessment , and had a centrally read screening endoscopic subscore of @ ) .


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


Between Sept @ , @ , and July @ , @ , @ patients were randomly assigned , of whom five had a endoscopic subscore of @ or @ and were excluded from the mITT population , leaving @ patients in the etrolizumab @ mg group , @ in the etrolizumab @ mg plus LD group , and @ in the placebo group for the primary analyses .


No patients in the placebo group had clinical remission at week @ , compared with eight ( @ % -LSB- @ % CI @-@ -RSB- ) patients in the etrolizumab @ mg group ( p = @ ) and four ( @ % -LSB- @-@ -RSB- ) patients in the @ mg plus LD group ( p = @ ) .


Adverse events occurred in @ ( @ % ) of @ patients in the etrolizumab @ mg group ( five -LSB- @ % -RSB- of which were regarded as serious ) , @ ( @ % ) of @ patients in the etrolizumab @ mg plus LD group ( two -LSB- @ % -RSB- serious ) , and @ ( @ % ) of @ patients in the placebo group ( five -LSB- @ % -RSB- serious ) .


Etrolizumab was more likely to lead to clinical remission at week @ than was placebo .


Therefore , blockade of both @ and E@ might provide a unique therapeutic approach for the treatment of ulcerative colitis , and phase @ studies have been planned .


Sildenafil ( Viagra , Pfizer ) is being used to treat pulmonary hypertension ( PH ) .


However , there are limited data on the effects of sildenafil on patients with PH after left-sided valvular surgery .


The purpose of this study was to determine the optimal dosage and the effects of sildenafil on prognosis of patients with PH after left-sided valvular surgery .


This randomised controlled trial , double-blind study enrolled patients with PH undergoing left-sided valvular surgery in our hospital from January to December , @ .


Ninety patients were enrolled .


And @ mg/kg sildenafil citrate or placebo was administered through nasogastric tubes , the haemodynamics changes in the @ / @/@/@ hours were assessed .


The sildenafil citrate/placebo was continued to the discharges and the early prognoses of these patients were compared .


Compared with placebo , a @ mg/kg dose of sildenafil significantly reduced the time of mechanical ventilation , stay-in-ICU and hospitalisation duration .


Sildenafil might be beneficial to the early prognosis of patients with PH after left-sided valvular surgery .


Studies suggest that obesity is associated with lower risk of prostate cancer but more aggressive cancers .


As obesity lowers PSA levels , these observations may be influenced by detection bias .


We examined the association between obesity and risk of low - and high-grade prostate cancer in REDUCE , in which biopsies were largely independent of PSA .


The REDUCE study tested dutasteride for prostate cancer risk reduction in men with a PSA of @ to @ ng/mL and a negative biopsy .


Study participants included @,@ men who underwent at least one on-study biopsy .


The association between baseline body mass index ( BMI < @ kg/m ( @ ) normal weight ; @-@ @ kg/m ( @ ) overweight ; and @ kg/m ( @ ) obese ) and risk of high-grade ( Gleason @ ) or low-grade prostate cancer ( Gleason < @ ) versus no prostate cancer was examined using multinomial logistic regression .


Overall , @,@ men ( @ % ) were normal weight , @,@ ( @ % ) overweight , and @,@ ( @ % ) were obese .


Obesity was associated with lower risk of low-grade prostate cancer in both univariable ( OR , @ ; P = @ ) and multivariable analyses ( OR , @ ; P = @ ) .


In univariable analysis , obesity was not associated with high-grade prostate cancer ( OR , @ ; P = @ ) .


However , in multivariable analysis , obesity was associated with increased risk of high-grade prostate cancer ( OR , @ ; P = @ ) .


This analysis was not able to address how obesity may influence prostate cancer progression .


Obesity is associated with decreased risk of low-grade and increased risk of high-grade prostate cancer .


These data provide further support to the hypothesis that obesity is associated with aggressive prostate cancer .


Obesity is linked with aggressive prostate cancer .


Avoiding obesity may prevent the risk of developing high-grade prostate cancer .


To evaluate the effect of a topical , nonsteroidal antiinflammatory drug , nepafenac @ % , in eyes with noncentral diabetic macular edema .


Multicenter , double-masked randomized trial .


Individuals with good visual acuity and noncentral-involved diabetic macular edema were randomly assigned to nepafenac @ % ( N = @ ) or placebo ( nepafenac vehicle , N = @ ) @ times a day for @ months .


The primary outcome was mean change in optical coherence tomography retinal volume at @ months .


Mean baseline retinal volume was @ mm .


At @ months , in the nepafenac and placebo groups respectively , mean change in retinal volume was -@ mm and -@ mm ( treatment group difference : -@ , @ % confidence interval : -@ to @ , P = @ ) .


Central-involved diabetic macular edema was present in @ eyes ( @ % ) and @ eyes ( @ % ) at the @-month visit ( P = @ ) , respectively .


No differences in visual acuity outcomes were identified .


One study participant developed a corneal melt after using nepafenac in the nonstudy eye , which had a history of severe dry eye .


No additional safety concerns were evident .


In eyes with noncentral diabetic macular edema and good visual acuity , topical nepafenac @ % @ times daily for @ year likely does not have a meaningful effect on optical coherence tomography-measured retinal thickness .


Menopause predisposes women to sleep-disordered breathing ( SDB ) and sleep disturbances .


Progestin has a potential to stimulate breathing and to induce sleep .


Our goal was to test these effects objectively and to compare them with the effects of nasal continuous positive airway pressure ( CPAP ) , which is the standard treatment of SDB .


In a placebo-controlled , double-blind , parallel-group trial , we investigated @ postmenopausal women ( @ in the placebo group and @ in the medroxyprogesterone acetate -LSB- MPA -RSB- group ) whose SDB had been treated with nasal CPAP for @ months to @ years prior to study entry .


The @-week trial included measurements with CPAP at baseline , after @ days of placebo or MPA ( @ mg daily ) , and after a @-week washout .


The participants discontinued their nasal CPAP therapy @ week after baseline measurements and went on with study medication .


Two weeks after discontinuation of CPAP therapy , nightly oxygen saturation was sustained higher ( P = @ ) and arterial carbon dioxide tension was lower ( P < @ ) with MPA than with placebo .


Carbon dioxide was also lower than during CPAP ( P < @ ) , and this effect was sustained beyond @ weeks after the cessation of MPA ( P < @ ) .


However , the apnea-hypopnea index of CPAP increased and sleep deteriorated similarly on MPA and placebo after withdrawal of CPAP therapy .


In postmenopausal women with SDB , MPA induces a long-lasting stimulatory effect on breathing without improving sleep quality or the apnea-hypopnea index .


To evaluate the thermal antinociceptive and sedative effects and duration of action of tramadol hydrochloride after oral administration to American kestrels ( Falco sparverius ) .


@ healthy @-year-old American kestrels .


Tramadol ( @ , @ , and @ mg/kg ) and a control suspension were administered orally in a masked randomized crossover experimental design .


Foot withdrawal response to a thermal stimulus was determined @ hour before ( baseline ) and @ , @ , @ , @ , and @ hours after treatment .


Agitation-sedation scores were determined @ to @ minutes before each thermal stimulus test .


The lowest dose of tramadol evaluated ( @ mg/kg ) significantly increased the thermal foot withdrawal thresholds for up to @ hours after administration , compared with control treatment values , and for up to @ hours after administration , compared with baseline values .


Tramadol at doses of @ and @ mg/kg significantly increased thermal thresholds at @ hours after administration , compared with control treatment values , and up to @ hours after administration , compared with baseline values .


No significant differences in agitation-sedation scores were detected between tramadol and control treatments .


Results indicated oral administration of @ mg of tramadol/kg significantly increased thermal nociception thresholds for kestrels for @ hours , compared with a control treatment , and @ hours , compared with baseline values ; higher doses resulted in less pronounced antinociceptive effects .