At @ months , the mortality rate was @ / @ person-years ( py ; @ % CI @-@ @ ) in the combined integrated treatment arm and @ / @ py ( @ % CI @-@ @ ) in the sequential treatment arm ( hazard ratio adjusted for baseline CD@ count and whether MDR-TB treatment was initiated : @ ; @ % CI @-@ @ , P = @ ) .


Despite the small sample size , the @ % reduction in mortality due to early initiation of ART in MDR-TB patients was statistically significant .


To evaluate the effects of propofol , etomidate , and thiopental administered during phacoemulsification ( PE ) cataract extraction on intraocular pressure ( IOP ) and hemodynamic responses with insertion of laryngeal mask airway ( LMA ) .


In a randomized double-blind clinical trial , patients scheduled for PE with general anesthesia were included .


Patients were allocated randomly to @ groups : group @ ( n = @ ) : @ mg/kg etomidate ; group @ ( n = @ ) : @mg/kg propofol ; and group @ ( n = @ ) : @mg/kg thiopental .


IOP , systolic blood pressure , and heart rate ( HR ) were measured before induction as a baseline , @min after induction ( immediately before insertion of LMA ) , and @ and @min after LMA insertion .


Blood pressure ( BP ) and HR of patients during the surgery were monitored and registered before and after induction and intubation .


In @ groups , IOP decreased significantly after injection of drugs and insertion of LMA in comparison to basic values , although IOP after LMA insertion was more than before LMA insertion .


In case of propofol , the changes in IOP between @min after induction and the baseline were higher than others , especially thiopental ( P = @ ) .


BP declined remarkably after induction ( P < @ ) and rose significantly after LMA insertion in all groups , except in the propofol group .


The HR was decreased significantly after induction , except in thiopental .


Propofol prevented IOP increase after induction compared with other drugs .


Decrease in BP and HR after induction and LMA insertion was remarkable .


Thiopental seemed to be the best drug for controlling cardiovascular parameters , especially HR , and it also prevents IOP rise .


Different drug combinations are used for sedation in colonoscopy procedures .


A ketamine-propofol ( ketofol ) mixture provides effective sedation and has minimal adverse effects .


Alfentanil also provides anesthesia for short surgical procedures by incremental injection as an adjunct .


However , no study has investigated the use of ketofol compared with an opioid-propofol combination in colonoscopic procedures .


A total of @ patients , ASA physical status I-II , scheduled to undergo elective colonoscopy , were enrolled in this prospective randomized study and allocated to two groups .


After premedication , sedation induction was performed with @ mg/kg ketamine +@ mg/kg propofol in Group KP , and @ mg/kg alfentanil +@ mg/kg propofol in Group AP .


Propofol was added when required .


Demographic data , colonoscopy duration , recovery time , discharge time , mean arterial pressure ( MAP ) , heart rate ( HR ) , peripheral oxygen saturation , Ramsey Sedation Scale values , colonoscopy patients ' satisfaction scores , and complications were recorded .


The need for additional propofol doses was significantly higher in Group AP than in Group KP .


MAP at minute @ and @ , Ramsey Sedation Scale at minute @ , and discharge time were significantly higher in Group KP than in Group AP .


Additional propofol doses and total propofol dose were significantly lower in Group KP than in Group AP .


Ketofol provided better hemodynamic stability and quality of sedation compared with alfentanil-propofol combination in elective colonoscopy , and required fewer additional propofol ; however , it prolonged discharge time .


Both combinations can safely be used in colonoscopy sedation .


Feasibility and efficacy of computerized auditory cognitive training ( ACT ) was examined among patients with heart failure ( HF ) .


Individuals with HF have four times increased risk of cognitive impairment , yet cognitive intervention studies are sparse .


A pilot randomized controlled design was used .


The ACT group ( n = @ ) and control group ( n = @ ) had similar baseline characteristics .


Seven participants ( @ % ) completed @ hours of ACT .


Medium effect sizes were observed for improved cognition as indicated by auditory processing speed ( d = @ ) , speech processing ( d = @ ) , and working memory ( d = @-@ @ ) .


Small effect sizes were found for improved functional outcomes including HF selfcare ( d = @ ) , Timed Instrumental Activities of Daily Living ( d = @ ) , Six-Minute Walk Test ( d = @ ) and Short-Form-@ ( d = @ ) relative to controls .


Results indicated ACT is feasible among persons with HF .


Despite a small sample size , ACT showed potential for improved speed of processing and working memory and improved functional outcomes , and warrants further exploration .


Impulse control disorders ( ICDs ) in Parkinson disease ( PD ) are common and can be difficult to manage .


The objective of this study was to determine the efficacy and tolerability of naltrexone , an opioid antagonist , for the treatment of ICDs in PD .


Patients with PD ( n = @ ) and an ICD were enrolled in an @-week , randomized ( @:@ ) , double-blind , placebo-controlled study of naltrexone @-@ mg/d ( flexible dosing ) .


The primary outcome measure was response based on the Clinical Global Impression-Change score , and the secondary outcome measure was change in symptom severity using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson 's Disease-Rating Scale ( QUIP-RS ) ICD score .


Forty-five patients ( @ % ) completed the study .


The Clinical Global Impression-Change response rate difference favoring naltrexone in completers was @ % ( @ % confidence interval -LSB- CI -RSB- -@ % to @ % ) .


While this difference was not significant ( odds ratio = @ , @ % CI @-@ @ , Wald @ -LSB- df -RSB- = @ -LSB- @ -RSB- , p = @ ) , naltrexone treatment led to a significantly greater decrease in QUIP-RS ICD score over time compared with placebo ( regression coefficient for interaction term in linear mixed-effects model = -@ , F -LSB- df -RSB- = @ -LSB- @ , @ -RSB- , p = @ ) .


The estimated changes in QUIP-RS ICD scores from baseline to week @ were @ points ( @ % CI @-@ @ ) for naltrexone and @ points ( @ % CI @-@ @ ) for placebo .


Naltrexone treatment was not efficacious for the treatment of ICDs in PD using a global assessment of response , but findings using a PD-specific ICD rating scale support further evaluation of opioid antagonists for the treatment of ICD symptoms in PD .


This study provides Class I evidence that in patients with PD and an ICD , naltrexone does not significantly increase the probability of achieving response .


However , the study lacked the precision to exclude an important difference in response rates .


Elevated low-density lipoprotein cholesterol ( LDL-C ) is a major modifiable risk factor for cardiovascular disease ( CVD ) , a leading cause of death in the United States .


Despite clinical practice guidelines aimed at facilitating LDL-C control , many Veterans do not achieve guideline-recommended LDL-C levels .


We describe a study focused on VA healthcare system users at risk for CVD ( i.e. , LDL-C level > @ mg/dl and/or < @ % cholesterol pill refill adherence in the last @ months ) .


We are conducting a two and a half year randomized controlled trial ( i.e. , intervention administered over @ months ) among Veterans with uncontrolled cholesterol receiving care at select VA-affiliated primary care clinics in North Carolina .


We anticipate enrolling @ diverse patients ( @ % women ; @ % African American ) .


Patients are randomized to an educational control group or intervention group .


Intervention group participants ' medication is provided in special blister packaging labeled for daily use that includes reminders ; MeadWestvaco Corporation 's pre-filled DosePak contains standard doses of statins in accordance with the existing prescriptions .


Pre-filled blister packaging may provide an inexpensive solution to improve medication adherence .


Our study enrolls a diverse sample and provides information about whether an adherence packaging intervention can : @ ) improve medication adherence ; @ ) improve patients ' LDL-C levels ; @ ) be well received by patients and providers ; and @ ) provide a cost effective solution to improve medication adherence .


One third of patients with triple-negative breast cancer ( TNBC ) achieve pathologic complete response ( pCR ) with standard neoadjuvant chemotherapy ( NACT ) .


CALGB @ ( Alliance ) , a @ @ factorial , open-label , randomized phase II trial , evaluated the impact of adding carboplatin and/or bevacizumab .


Patients ( N = @ ) with stage II to III TNBC received paclitaxel @ mg/m ( @ ) once per week ( wP ) for @ weeks , followed by doxorubicin plus cyclophosphamide once every @ weeks ( ddAC ) for four cycles , and were randomly assigned to concurrent carboplatin ( area under curve @ ) once every @ weeks for four cycles and/or bevacizumab @ mg/kg once every @ weeks for nine cycles .


Effects of adding these agents on pCR breast ( ypT@/is ) , pCR breast/axilla ( ypT@/isN@ ) , treatment delivery , and toxicities were analyzed .


Patients assigned to either carboplatin or bevacizumab were less likely to complete wP and ddAC without skipped doses , dose modification , or early discontinuation resulting from toxicity .


Grade @ neutropenia and thrombocytopenia were more common with carboplatin , as were hypertension , infection , thromboembolic events , bleeding , and postoperative complications with bevacizumab .


Employing one-sided P values , addition of either carboplatin ( @ % v @ % ; P = @ ) or bevacizumab ( @ % v @ % ; P = @ ) significantly increased pCR breast , whereas only carboplatin ( @ % v @ % ; P = @ ) significantly raised pCR breast/axilla .


More-than-additive interactions between the two agents could not be demonstrated .


In stage II to III TNBC , addition of either carboplatin or bevacizumab to NACT increased pCR rates , but whether this will improve relapse-free or overall survival is unknown .


Given results from recently reported adjuvant trials , further investigation of bevacizumab in this setting is unlikely , but the role of carboplatin could be evaluated in definitive studies , ideally limited to biologically defined patient subsets most likely to benefit from this agent .


Impaired regulation of lipid oxidation ( metabolic inflexibility ) is associated with obesity and type @ diabetes mellitus .


Recent evidence has indicated that dietary polyphenols may modulate mitochondrial function , substrate metabolism and energy expenditure in humans .


The present study investigated the effects of short-term supplementation of two combinations of polyphenols on energy expenditure ( EE ) and substrate metabolism in overweight subjects .


Eighteen healthy overweight volunteers ( @ women , @ men ; age @ years ; body mass index @ kgm ( -@ ) ) participated in a randomized , double-blind cross-over trial .


Combinations of epigallocatechin-gallate ( E , @mgday ( -@ ) ) + resveratrol ( R , @mgday ( -@ ) ) and E+R +@ mgday ( -@ ) soy isoflavones ( S ) or placebo capsules ( PLA ) were supplemented twice daily for a period of @ days .


On day @ , circulating metabolite concentrations , EE and substrate oxidation ( using indirect calorimetry ) were measured during fasting and postprandial conditions for @h ( high-fat-mixed meal ( @ MJ , @ E % fat ) ) .


Short-term supplementation of E+R increased resting EE ( E+R vs PLA : @ vs @ kJmin ( -@ ) , P = @ ) , whereas both E+R ( @kJ@min ( -@ ) vs @kJ@min ( -@ ) , P = @ ) and E+R+S ( @kJ@min ( -@ ) vs @kJ@min ( -@ ) , P = @ ) increased @-@h-postprandial EE compared with PLA .


Metabolic flexibility , calculated as the postprandial increase to the highest respiratory quotient achieved , tended to be improved by E+R compared with PLA and E+R+S only in men ( E+R vs PLA : @ vs @ , P = @ ; E+R+S : @ , P = @ ) .


E+R+S significantly increased fasting plasma free fatty acid ( P = @ ) and glycerol ( P = @ ) concentrations compared with PLA .


We demonstrated for the first time that combined E+R supplementation for @ days significantly increased fasting and postprandial EE , which was accompanied by improved metabolic flexibility in men but not in women .


Addition of soy isoflavones partially reversed these effects possibly due to their higher lipolytic potential .


The present findings may imply that long-term supplementation of these dosages of epigallocatechin-gallate combined with resveratrol may improve metabolic health and body weight regulation .


Acute pancreatitis ( AP ) is a disease typically requiring in-hospital treatment .


We conducted a trial to assess the feasibility of early discharge from the hospital for patients with mild non-alcoholic acute pancreatitis ( NAAP ) .


Eighty-four patients with mild NAAP were randomized to home or hospital groups after a short hospital stay ( @h ) .


AP was defined by the revised Atlanta criteria .


Mild AP was defined as an Imrie score@ and a harmless acute pancreatitis score ( HAPS ) @ in the first @-h of presentation .


A nurse visited all patients in the home group on the @nd , @rd and @th days .


All patients presented for follow-up in clinic on the @th , @th , and @th days .


The primary outcome was the time to resolution of pain .


Secondary outcomes evaluated included time to resumption of an oral diet , @ day hospital readmission rate as well as the total costs associated with either approach to care .


There was no difference between the groups with regards to demographics , prognostic severity scores , symptoms , and biliary findings .


No patients developed organ failure , pancreatic necrosis , or died in either group .


Time to the resolution of pain and resumption of solid food intake were similar .


Three ( @ % ) patients required readmission within @ days , @ from home and @ from the hospital groups .


The total cost was significantly less in home group ( $ @ vs. $ @ , p < @ ) .


Mild NAAP can be safely treated at home with regular visits by a nurse under the supervision of a physician .


Widespread adoption of this practice may result in large cost savings .


Clopidogrel plays a central role in the treatment of patients undergoing carotid artery stenting ( CAS ) .


The objective was to evaluate the effect of clopidogrel ( @ mg/d ) on platelet reactivity in responders and nonresponders and the antiplatelet effect of different doses of clopidogrel in patients with high on-treatment reactivity ( OTR ) after CAS .


Patients with high OTR ( defined by VerifyNow ( Accumetrics , San Diego , Calif ) assay as @ P@Y@ reaction units -LSB- PRU -RSB- ) were randomly assigned in a @:@ ratio to group @ ( standard-dose clopidogrel therapy : @ mg/d for @ days ) or group @ ( high-dose clopidogrel : @ mg/d for @ days ) .


The study enrolled @ patients .


Of these , @ ( @ % ) were clopidogrel responders ( group @ ) , and @ ( @ % ) had high OTR ( clopidogrel nonresponders ) ; of which , @ were randomly assigned to group @ and @ to group @ .


At baseline , the PRU value did not differ between group @ ( @ @ ) and group @ ( @ @ ; P = @ ) .


Patients displayed reduced mean platelet reactivity levels at @ days in group @ ( @ @ ; P < @ ) and group @ ( @ @ ; P < @ ) .


Although high-dose clopidogrel resulted in more intense platelet function inhibition , the differences between median @-day PRU values ( P = @ ) and the percentage change of PRU ( P = @ ) for groups @ and @ were not significant .


The incidences of transient ischemic attack , stroke , or death at up to @ days after CAS in the high-OTR patients were similar between groups @ and @ ( P = @ ) .


Patients with high OTR undergoing CAS treated with standard-dose and double-dose clopidogrel had significantly reduced platelet reactivity after @ days .


The double dose did not result in statistically significantly greater reductions in reactivity compared with the standard dose .


Home-based exercise training in cardiac rehabilitation ( CR ) has the potential to improve CR uptake , decrease costs and increase self-management skills .


The FIT@Home study evaluates home-based CR with telemonitoring guidance using coaching interventions including strategies for behavioural changes with the aim to maintain adherence to a healthy lifestyle and to improve long-term effects .


In this interim analysis we provide short-term results on exercise capacity , quality of life and training adherence of the first @ patients included in the FIT@Home study .


The study design was a randomised controlled trial .


Low to moderate risk CR patients were randomised to a @-week home-based training ( HT ) programme or a @-week centre-based training ( CT ) programme .


In both groups , training was performed at @-@ % of maximal heart rate ( HRmax ) for @-@min , @-@ times per week .


The HT group received three supervised training sessions , before commencing training with a heart rate monitor in their home environment .


These patients received individual coaching by telephone weekly , based on training data uploaded on the Internet .


The CT programme was performed under the direct supervision of a physical therapist .


Exercise capacity and health-related quality of life were assessed at baseline and at @ weeks .


CT ( n = @ ) and HT ( n = @ ) both showed a significant improvement in peak oxygen uptake ( peak VO@ ) ( @ % and @ % respectively ) and quality of life after @ weeks of training , without significant between-group differences .


The average training intensity of the HT group was @ % of HRmax .


Training adherence was similar between groups .


This analysis shows that HT with telemonitoring guidance has similar short-term effects on exercise capacity and quality of life as CT in CR patients .


Both exposure to hypoxia and exercise training have the potential to modulate appetite and induce beneficial metabolic adaptations .


The purpose of this study was to determine whether daily moderate exercise training performed during a @-day exposure to normobaric hypoxia alters hormonal appetite regulation and augments metabolic health .


Fourteen healthy , male participants underwent a @-day hypoxic confinement at @ m simulated altitude ( FIO@ = @ @ % ) either combined with daily moderate intensity exercise ( Exercise group ; N = @ , Age = @ @ yrs , BMI = @ @ kg m ( -@ ) ) or without any exercise ( Sedentary group ; N = @ Age = @ @ yrs , BMI = @ @ kg m ( -@ ) ) .


A meal tolerance test was performed before ( Pre ) and after the confinement ( Post ) to quantify fasting and postp randial concentrations of selected appetite-related hormones and metabolic risk markers .


@C-Glucose was dissolved in the test meal and @CO@ determined in breath samples .


Perceived appetite ratings were obtained throughout the meal tolerance tests .


While body mass decreased in both groups ( -@ kg ; p = @ ) following the confinement , whole body fat mass was only reduced in the Exercise group ( -@ kg ; p = @ ) .


At Post , postprandial serum insulin was reduced in the Sedentary group ( -@ % ; p = @ ) and postprandial plasma glucose in the Exercise group ( -@ % ; p = @ ) .


Fasting serum total cholesterol levels were reduced ( -@ % ; p = @ ) at Post in the Exercise group only , secondary to low-density lipoprotein cholesterol reduction ( -@ % ; p = @ ) .


No differences between groups or testing periods were noted in fasting and/or postprandial concentrations of total ghrelin , peptide YY , and glucagon-like peptide-@ , leptin , adiponectin , expired @CO@ as well as perceived appetite ratings ( p > @ ) .


These findings suggest that performing daily moderate intensity exercise training during continuous hypoxic exposure does not alter hormonal appetite regulation but can improve the lipid profile in healthy young males .


The use of Web-based apps to promote a healthy lifestyle is increasing , although most of these programs were not assessed using suitable epidemiological methods .


We evaluated the effectiveness of a newly developed Web-based app in promoting a healthy lifestyle and educating adults on such lifestyles .


We also analyzed predictors for success in acquiring and maintaining a healthy lifestyle .


Our aim was to compare people receiving a new Web-based app with people who got an introductory lecture alone on healthy lifestyle , weight change , nutritional knowledge , and physical activity , and to identify predictors of success for maintaining a healthy lifestyle .


Subjects were recruited from the community and were randomized into intervention and control groups .


The intervention subjects received access to the app without any face-to-face support ; the control subjects continued their standard lifestyle .


Measurements were taken by the researcher at baseline and after @ weeks and included weight and waist circumference .


Nutritional knowledge , diet quality , and physical activity duration were obtained using online questionnaires .


The new Web-based app was developed based on current US Department of Agriculture and Israel Ministry of Health recommendations for healthy lifestyle .


The app provides tools for monitoring diet and physical activity while instructing and encouraging healthy diet and physical activity .


Out of @ subjects who were randomized into app and control groups , @ participants ( @ % ) completed the study , @ in the intervention and @ in the control group .


The mean age was @ ( SD @ ) years , and mean Body Mass Index was @ ( SD @ ) .


Among the intervention group only , frequency of app use was @ ( SD @ ) days/week .


The mean change in physical activity was @ ( SD @ ) minutes in the app group and -@ ( SD @ ) minutes in the control group ( P = @ ) .


The mean weight change was -@ ( SD @ ) kg in the app group and -@ ( SD @ ) kg in the control group ( P = @ ) .


Knowledge score increased significantly in the app group , @ ( SD @ ) to @ ( SD @ ) at the end of the study ( P = @ ) compared with the control group .


Diet quality score also increased significantly at the end of the study , from @ ( SD @ ) to @ ( SD @ ; P < @ ) in contrast to the control group .


Success score ( represents the success in maintaining healthy lifestyle ) was higher among the app group ( @ % ) compared with @ % in the control group ( P < @ ) .


The app frequency of use was significantly related to a higher success score ( P < @ ) .


We showed a positive impact of a newly developed Web-based app on lifestyle indicators during an intervention of @ weeks .


These results are promising in the app 's potential to promote a healthy lifestyle , although larger and longer duration studies are needed to achieve more definitive conclusions .


Peroral endoscopic myotomy ( POEM ) has recently been introduced as a promising alternative to laparoscopic Heller myotomy for idiopathic achalasia .


Several proposed technical modifications are yet to be tested in randomized trials .


The objective of our study was to evaluate efficacy and safety of water-jet ( WJ ) assisted POEM versus the conventional ( C ) technique .


The clinical trial registration number is NCT@ .


A prospective randomized trial was carried out in Zhongshan Hospital , Fudan University ( Shanghai , China ) , in @ consenting achalasia patients between August @ and April @ .


Patients eligible for POEM were randomized to use of either the HybridKnife ( WJ group ) or the conventional technique using injection and triangle tip knife interchangeably ( C group ) .


A total of @ patients with comparable characteristics between groups were included .


Procedure time was significantly shorter for the WJ group ( @ @ vs. @ @ min ; p < @ ) , mostly due to less replacement of accessories ( @ @ vs. @ @ ; p < @ ) .


Injection volume was larger in the WJ group ( @ @ vs. @ @ ml ; p < @ ) and was associated with fewer minor bleeding episodes ( @ @ vs. @ @ ; p < @ ) .


No severe complications occurred ; one case of cutaneous emphysema occurred in the WJ group , and four cases occurred in the C group ( p = @ ) , three cases of pneumonia were encountered in the C group and none in the WJ group ( p = @ ) .


Treatment success ( Eckardt score @ ) was achieved in @ % of patients , with no significant differences between groups .


The use of the HybridKnife leads to a significant decrease in POEM procedure time and facilitates reinjection , possibly contributing to a lower rate of minor intra-procedural bleeding .


The aim of the present study was to determine whether specific biochemical and energy concentrations influence gastric emptying of unfortified and fortified mother 's own milk ( MOM ) in stable preterm infants , and whether gastric emptying differs between feeds of unfortified MOM and feeds fortified with S-@ or FM @ human milk fortifier ( HMF ) when infants are fed the same volume under similar conditions .


Influences of infant gestation , age , and weight , and feed characteristics were also explored .


Stomach volumes of @ paired unfortified and fortified MOM feeds were monitored prefeed and postfeed delivery and at @-minute intervals thereafter .


For each feed , MOM samples were analyzed to determine concentrations of total protein , casein , whey , carbohydrate , lactose , fat , and energy .


Fortified feed compositions were calculated by adding fortifier biochemical and energy concentrations to unfortified MOM concentrations .


Ultrasound images were used to calculate infant stomach volumes .


Statistical comparisons were made of paired stomach volume measurements .


Higher feed concentrations of casein were associated with faster gastric emptying during feed delivery ( P = @ ) .


When compared with unfortified MOM , S-@ fortified feeds emptied similarly , whereas FM @ fortified feeds emptied more slowly both during feed delivery and during the postprandial period ( P = @ , < @ , respectively ) .


Gastric emptying was slower for @-hourly feeds compared with that for @-hourly feeds ( P = @ ) and in supine position compared with that in prone ( P = @ ) .


Breast milk composition influences gastric emptying in stable preterm infants , with feeds of higher casein concentration emptying faster during feeding than otherwise equivalent feeds , and FM @ fortified MOM emptying more slowly than unfortified MOM .


Newly emerging evidence showed that glucocorticoids could potentiate natriuretic peptides ' action by increasing the density of natriuretic peptide receptor A , leading to a potent diuresis and a renal function improvement in patients with acute decompensated heart failure ( ADHF ) .


Therefore , glucocorticoid therapy may be used in patients with ADHF .


One hundred two patients with ADHF were randomized to receive glucocorticoids or standard treatment .


Change from baseline in serum creatinine ( SCr ) at day @ and cardiovascular death within @ days were recorded .


The study was terminated early because of slow site initiation and patient enrolment .


Glucocorticoid therapy seemed to be well tolerated .


There was a remarkable SCr reduction after @ days treatment .


The change from baseline in SCr is -@ mg/dL in glucocorticoid group versus -@ mg/dL in standard treatment group ( P < @ ) .


Although sample size is limited , a cardiovascular death reduction at @ days was observed in glucocorticoid group with odds ratio of @ ( @ deaths in glucocorticoid vs. @ deaths in standard treatment group , P < @ ) .


The survival benefit associated with glucocorticoid therapy persisted during the follow-up .


Patient-assessed dyspnea and physician-assessed global clinical status were also improved in glucocorticoid group .


Limited data indicate that glucocorticoid therapy may be used safely in patients with ADHF in short term .


Glucocorticoid therapy did not cause heart failure deterioration .


Further investigations are warranted .


Hip fractures are a common type of fragility fracture that afflict @,@ Americans ( over @,@ per week ) and @,@ Canadians ( over @ per week ) annually .


Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial .


The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at @ months in individuals with femoral neck fractures .


The secondary objective is to determine the impact on health-related quality of life , functional outcomes , health state utilities , fracture healing , mortality and fracture-related adverse events .


FAITH is a multi-centre , multi-national randomized controlled trial utilizing minimization to determine patient allocation .


Surgeons in North America , Europe , Australia , and Asia will recruit a total of at least @,@ patients with low-energy femoral neck fractures .


Using central randomization , patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw .


Patient outcomes will be assessed at one week ( baseline ) , @ weeks , @ , @ , @ , and @ months post initial fixation .


We will independently adjudicate revision surgery and complications within @ months of the initial fixation .


Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test .


This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures .


This trial will not only change current Orthopaedic practice , but will also set a benchmark for the conduct of future Orthopaedic trials .


Compare mechanical and pharmacological ripening for patients with oligohydramnios at term .


Fifty-two patients with oligohydramnios @ cm and Bishop score @ were randomized for labor induction with a vaginal insert containing @ mg timed-release dinoprostone ( PGE@ ) or double-balloon catheter .


The primary outcome was time from induction to active labor .


Time to labor , neonatal outcomes and maternal satisfaction were also compared .


Baseline characteristics were similar .


Time from induction to active labor ( @ with PGE@ vs @ h with double-balloon catheter ; P = @ ) was comparable , with no differences in cesarean rates ( @ vs @ % ; P = @ ) or neonatal outcomes .


The PGE@ group had higher incidence of early device removal ( @ vs @ % ; P = @ ) , mostly because of active labor or non-reassuring fetal heart rate .


Fewer PGE@ patients required oxytocin augmentation for labor induction ( @ vs @ % P = @ ) .


Time to delivery was significantly shorter with PGE@ ( @ vs @ h ; P = @ ) .


Intravaginal PGE@ and double-balloon catheter are comparable methods for cervical ripening in term pregnancies with oligohydramnios .


To explore the efficacy and safety of remifentanyl and propofol injection in total intravenous anesthesia for percutaneous radiofrequency ablation .


@ patients scheduled for PRFA were divided randomly into two groups : group A and group B. Each group contained @ patients .


Those in group A received remifentanyl and propofol injection , and the patients in group B were given oxycodone hydrochloride .


The mean arterial pressure ( MAP ) , heart rate ( HR ) and pulse oxygen saturation ( SPO@ ) were measured and recorded by monitor during the operation .


The chest muscle rigidity , respiratory depression , nausea and vomitting , hypotensio and VAS were also recorded .


Compared with the preoperative , MAP , HR in group A decreased significantly during the operation , increased in group B ( P < @ ) .


VAS was significantly lower in group A than that in group B ( P < @ ) .


@ patients had respiratory depression , @ patient had nausea and vomiting reaction in group A. @ patients had vagus reflex , @ patient had nausea and vomitting reaction in group B.


Total intravenous anesthesia with remifentanyl and propofol for PRFA is safe and reliable .


Respiratory and circulation should be monitored instantly and strictly .


NOX-@ , the catalytic subunit of NADPH oxidase , has a key role in the formation of reactive oxidant species and is implicated in impairing flow-mediated dilation ( FMD ) .


Dark chocolate exerts artery dilatation via down-regulating NOX@-mediated oxidative stress .


The aim of this study was to investigate whether dark chocolate improves walking autonomy in peripheral artery disease ( PAD ) patients via an oxidative stress-mediated mechanism .


FMD , serum levels of isoprostanes , nitrite/nitrate ( NOx ) and sNOX@-dp , a marker of blood NOX@ activity , maximal walking distance ( MWD ) and maximal walking time ( MWT ) were studied in @ PAD patients ( @ males and @ females , mean age : @ years ) randomly allocated to @ g of dark chocolate ( > @ % cocoa ) or @ g of milk chocolate ( @ % cocoa ) in a single blind , cross-over design .


The above variables were assessed at baseline and @ hours after chocolate ingestion .


Dark chocolate intake significantly increased MWD ( +@ % ; P < @ ) , MWT ( +@ % ; P < @ ) , serum NOx ( +@ % ; P < @ ) and decreased serum isoprostanes ( -@ % ; P = @ ) and sNOX@-dp ( -@ % ; P < @ ) ; no changes of the above variables were observed after milk chocolate intake .


Serum epicatechin and its methylated metabolite significantly increased only after dark chocolate ingestion .


Multiple linear regression analysis showed that of MWD was independently associated with of MWT ( P < @ ) and of NOx ( P = @ ) .


In vitro study demonstrated that HUVEC incubated with a mixture of polyphenols significantly increased nitric oxide ( P < @ ) and decreased E-selectin ( P < @ ) and VCAM@ ( P < @ ) .


In PAD patients dark but not milk chocolate acutely improves walking autonomy with a mechanism possibly related to an oxidative stress-mediated mechanism involving NOX@ regulation .


BK virus infection is a significant complication of modern immunosuppression used in kidney transplantation .


Viral reactivation occurs first in the urine ( BK viruria ) and is associated with a high risk of transplant failure .


There are currently no therapies to prevent or treat BK virus infection .


Quinolone antibiotics have antiviral properties against BK virus but efficacy at preventing this infection has not been shown in prospective controlled studies .


To determine if levofloxacin can prevent BK viruria in kidney transplant recipients .


Double-blind , placebo-controlled randomized trial involving @ patients who received a living or deceased donor kidney-only transplant in @ Canadian transplant centers between December @ and June @ .


Participants were randomly assigned to receive a @-month course of levofloxacin ( @ mg/d ; n = @ ) or placebo ( n = @ ) starting within @ days after transplantation .


The primary outcome was time to occurrence of BK viruria ( detected using quantitative real-time polymerase chain reaction ) within the first year after transplantation .


Secondary outcomes included BK viremia , peak viral load , rejection , and patient and allograft survival .


The mean follow-up time was @ weeks in the levofloxacin group and @ weeks in the placebo group ( @ patients had follow-up terminated before the end of the planned follow-up period or development of viruria because the trial was stopped early owing to lack of funding ) .


BK viruria occurred in @ patients ( @ % ) in the levofloxacin group and in @ patients ( @ % ) in the placebo group ( hazard ratio , @ ; @ % CI , @-@ @ ; P = @ ) .


There was no significant difference between the @ groups in regard to any of the secondary end points .


There was an increased risk of resistant infection among isolates usually sensitive to quinolones in the levofloxacin group vs placebo ( @/@ -LSB- @ % -RSB- vs @/@ -LSB- @ % -RSB- , respectively ; risk ratio , @ ; @ % CI , @-@ @ ) as well as a nonsignificant increased risk of suspected tendinitis ( @/@ -LSB- @ % -RSB- vs @/@ -LSB- @ % -RSB- ; risk ratio , @ ; @ % CI , @-@ @ ) .


Among kidney transplant recipients , a @-month course of levofloxacin initiated early following transplantation did not prevent BK viruria .


Levofloxacin was associated with an increased risk of adverse events such as bacterial resistance .


These findings do not support the use of levofloxacin to prevent posttransplant BK virus infection .


In myocardial perfusion single-photon emission computed tomography ( SPECT ) , abdominal activity often interferes with the evaluation of perfusion in the inferior wall , especially after pharmacological stress .


In this randomized study , we examined the effect of carbonated water intake versus still water intake on the quality of images obtained during myocardial perfusion images ( MPI ) studies .


A total of @ MIBI studies were randomized into a carbonated water group and a water group .


The presence of intestinal activity adjacent to the inferior wall was evaluated by two observers .


Furthermore , a semi-quantitative analysis was performed in the adenosine subgroup , using a count ratio of the inferior myocardial wall and adjacent abdominal activity .


The need for repeated SPECT in the adenosine studies was @ % in the carbonated water group versus @ % in the still water group ( p = @ ) .


The inferior wall-to-abdomen count ratio was significantly higher in the carbonated water group compared to the still water group ( @ @ vs. @ @ , p < @ ) .


The effect of carbonated water during rest and after exercise was not significant .


This randomized study showed that carbonated water significantly reduced the interference of extra-cardiac activity in adenosine SPECT MPI .


A hernia repair open surgical simulation computer software was developed at Imperial College London .


A randomized controlled educational trial was conducted to investigate the benefit of the simulation on the development of procedural knowledge .


Medical students in their clinical years were invited to participate in the trial .


Students were block randomized to @ groups : G@ -- Interactive Simulation ; G@ -- Non-interactive Simulation ; G@ -- Video Tutorial ; G@ -- Control .


On completion , they were objectively assessed on their ability to recall the tasks involved in an open inguinal hernia repair in the form of a multiple choice question ( MCQ ) and a simulated discussion with a consultant surgeon .


Fifty-six students completed the study .


Each arm carries similar baseline scores ( pre-intervention MCQ ) with means @ , @ , @ , and @ in G@ to G@ , respectively .


MCQ score improvements and final assessment scores proved better in the intervention groups ( @ , @ , and @ ) compared to controls .


The interactive simulation has shown an objective benefit in teaching medical students the anatomical and procedural knowledge in performing an open inguinal hernia repair .


Given the substantial improvements in cancer screening and cancer treatment in the United States , millions of adult cancer survivors live for years following their initial cancer diagnosis and treatment .


However , latent side effects can occur and some symptoms can be alleviated or managed effectively via changes in lifestyle behaviors .


The purpose of this study was to test the effectiveness of a six-week Web-based multiple health behavior change program for adult survivors .


Participants ( n = @ ) were recruited from oncology clinics , a tumor registry , as well as through online mechanisms , such as Facebook and the Association of Cancer Online Resources ( ACOR ) .


Cancer survivors were eligible if they had completed their primary cancer treatment from @ weeks to @ years before enrollment .


Participants were randomly assigned to the Web-based program or a delayed-treatment control condition .


In total , @ survivors completed the follow-up survey ( six months after completion of the baseline survey ) and participants in the Web-based intervention condition had significantly greater reductions in insomnia and greater increases in minutes per week of vigorous exercise and stretching compared to controls .


There were no significant changes in fruit and vegetable consumption or other outcomes .


The Web-based intervention impacted insomnia and exercise ; however , a majority of the sample met or exceeded national recommendations for health behaviors and were not suffering from depression or fatigue at baseline .


Thus , the survivors were very healthy and well-adjusted upon entry and their ability to make substantial health behavior changes may have been limited .


Future work is discussed , with emphasis placed on ways in which Web-based interventions can be more specifically analyzed for benefit , such as in regard to social networking .


The GUIDE-IT ( Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure ) study is designed to determine the safety , efficacy , and cost-effectiveness of a strategy of adjusting therapy with the goal of achieving and maintaining a target N-terminal pro-B-type natriuretic peptide ( NT-proBNP ) level of < @,@ pg/ml compared with usual care in high-risk patients with systolic heart failure ( HF ) .


Elevations in natriuretic peptide ( NP ) levels provide key prognostic information in patients with HF .


Therapies proven to improve outcomes in patients with HF are generally associated with decreasing levels of NPs , and observational data show that decreases in NP levels over time are associated with favorable outcomes .


Results from smaller prospective , randomized studies of this strategy thus far have been mixed , and current guidelines do not recommend serial measurement of NP levels to guide therapy in patients with HF .


GUIDE-IT is a prospective , randomized , controlled , unblinded , multicenter clinical trial designed to randomize approximately @,@ high-risk subjects with systolic HF ( left ventricular ejection fraction@ % ) to either usual care ( optimized guideline-recommended therapy ) or a strategy of adjusting therapy with the goal of achieving and maintaining a target NT-proBNP level of < @,@ pg/ml .


Patients in either arm of the study are followed up at regular intervals and after treatment adjustments for a minimum of @ months .


The primary endpoint of the study is time to cardiovascular death or first hospitalization for HF .


Secondary endpoints include time to cardiovascular death and all-cause mortality , cumulative mortality , health-related quality of life , resource use , cost-effectiveness , and safety .


The GUIDE-IT study is designed to definitively assess the effects of an NP-guided strategy in high-risk patients with systolic HF on clinically relevant endpoints of mortality , hospitalization , quality of life , and medical resourceuse .


( Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure -LSB- GUIDE-IT -RSB- ; NCT@ ) .


The effects of short-term high-intensity interval training ( HIT ) on cardiac autonomic function are unclear .


The present study assessed cardiac autonomic adaptations to short-term HIT in comparison with aerobic endurance training ( AET ) .


Twenty-six healthy middle-age sedentary men were randomized into HIT ( n = @ , @-@ @ s of all-out cycling efforts with @-min recovery ) and AET ( n = @ , @-@ min at @ % of peak workload ) groups , performing six sessions within @ wk .


The participants underwent a @-h ECG recording before and after the intervention and , additionally , recorded R-R interval data in supine position ( @ min ) at home every morning during the intervention .


Mean HR and low-frequency ( LF ) and high-frequency ( HF ) power of R-R interval oscillation were analyzed from these recordings .


Peak oxygen consumption ( VO@peak ) increased in both groups ( P < @ ) .


Compared with AET ( n = @ ) , HIT ( n = @ ) increased @-h LF power ( P = @ ) , tended to increase @-h HF power ( P = @ ) , and increased daytime HF power ( P = @ ) .


In home-based measurements , supine HF power decreased on the days after HIT ( P = @ , n = @ ) but not AET ( P = @ , n = @ ) session .


The acute response of HF power to HIT session did not change during the intervention .


In conclusion , HIT was more effective short-term strategy to increase R-R interval variability than aerobic training , most probably by inducing larger increases in cardiac vagal activity .


The acute autonomic responses to the single HIT session were not modified by short-term training .


Biomarkers with prognostic and predictive value can help stratify patients with colorectal cancer ( CRC ) into appropriate treatment groups .


We sought to evaluate the clinical utility of P@ protein expression as a biomarker in VICTOR , a large phase III trial of rofecoxib in stage II and III CRC .


Tissue micro arrays were constructed from @ tumors and the expression of P@ was examined by immunohistochemistry .


Tumors were dichotomised as either P@-positive ( nuclear expression in > @ % of cells or the ` absent ' pattern , both representing TP@ mutation ) or P@-negative ( nuclear expression in < @ % of cells ) .


Aberrant P@ expression was found in @ % ( @/@ ) of patients .


It was associated with distal location ( p < @ ) and stage III disease ( p < @ ) .


No effect was observed on disease-free or overall survival , and there was no interaction with chemotherapy or radiotherapy .


Analysis of P@ expression in the patients recruited to the VICTOR trial confirmed that P@ expression is associated with site and stage of CRC .


However , independently , this biomarker has neither prognostic nor predictive utility in this cohort of patients .


To assess the efficacy of analgesia provided by continuous ropivacaine wound infiltration after gynecologic laparoscopy .


Sixty patients who underwent gynecologic laparoscopy at Ajou University School of Medicine , Suwon , Republic of Korea , between March and May @ were randomized to receive either intravenous fentanyl and ketorolac infusion on demand by patient-controlled analgesia ( IV PCA group , n = @ ) or continuous wound infiltration of local ropivacaine ( CWI group , n = @ ) .


Postoperative pain and postoperative nausea and vomiting ( PONV ) were assessed via a visual analog scale .


The number of patients who requested rescue analgesia was recorded .


There was no significant difference in postoperative pain between the @ groups , but more patients requested rescue analgesia in the CWI group than in the IV PCA group in @ hours ( @ versus @ patients , respectively ; P = @ ) .


The PONV scores at @ and @ hours were , respectively , @ and @ in the CWI group , and @ and @ in the IV PCA group ( P = @ ) .


Nine patients requested cessation of IV PCA because of severe nausea or vomiting .


Continuous ropivacaine wound infiltration was found to be as effective as patient-controlled analgesia for postoperative pain relief after gynecologic laparoscopy .


This technique provides good analgesia with less opioid analgesic requirement and few adverse effects .


To assess the reproducibility of an educational intervention EdAl-@ ( Educaci en Alimentaci ) programme in ` Terres de l'Ebre ' ( Spain ) , over @ months , to improve lifestyles , including diet and physical activity ( PA ) .


Reproduction of a cluster randomised controlled trial .


Two semi-rural town-group primary-school clusters were randomly assigned to the intervention or control group .


Pupils ( n = @ ) of whom @ constituted the intervention group ( @ cluster ) and @ constituted the control group ( @ cluster ) .


Ethnicity was @ % Western European .


The mean age ( SD ) was @ years ( @ % females ) at baseline .


Inclusion criteria for clusters were towns from the southern part of Catalonia having a minimum of @ children aged @-@ year ; complete data for participants , including name , gender , date and place of birth , and written informed consent from parents or guardians .


The intervention focused on eight lifestyle topics covered in @ activities ( @ h/activity/session ) implemented by health promoting agents in the primary school over three academic years .


The primary outcome was obesity ( OB ) prevalence and the secondary outcomes were body mass index ( BMI ) collected every year and dietary habits and lifestyles collected by questionnaires filled in by parents at baseline and end-of-study .


At @ months , the OB prevalence and BMI values were similar in intervention and control groups .


Relative to children in control schools , the percentage of boys in the intervention group who performed @ after-school PA h/week was @ % higher ( p = @ ) , whereas the percentage of girls in both groups remained similar .


Also , @ % more boys in the intervention group watched @ television ( TV ) h/day ( p = @ ) , compared to controls ; and no changes were observed in girls in both groups .


Our school-based intervention is feasible and reproducible by increasing after-school PA ( to @ h/week ) in boys .


Despite this improvement , there was no change in BMI and prevalence of OB .


Many people consume alcoholic beverages following a period of physical activity that results in fluid loss through sweating ( e.g. , after sports , work ) .


Adequate rehydration following physical activity may not occur , consequently resulting in the consumption of alcohol in a dehydrated state .


This may have serious implications for the safety of individuals operating motor vehicles .


Therefore , this study investigated the impact of mild-moderate dehydration in combination with moderate alcohol consumption on simulated driving performance .


Fourteen healthy males participated in a placebo-controlled crossover design study involving @ experimental trials ( separated by @ days or more ) .


In each trial , participants were dehydrated by @ percent body mass through exercise .


After a @-min recovery , participants completed a @-min computerized simulated driving task ( drive @ ) .


In @ of the trials , participants were provided with water equivalent to either @ or @ percent body mass loss and also received salt capsules ( NaCl , @ mmol/L ) .


A set volume of alcohol or placebo was then consumed in each trial , incorporating the conditions : dehydration-placebo ( DP ) , dehydration-alcohol ( DA ) , partial rehydration-alcohol ( PA ) , and full rehydration-alcohol ( FA ) .


The volume of the alcoholic beverage was individually calculated and intended to raise the blood alcohol content ( BAC ) to @ percent .


The same driving task was then readministered ( drive @ ) .


Primary outcome measures of driving consisted of standard deviation of lateral position ( SDLP ) , number of side and center line crossings ( LC ) , number of failures to stop at red traffic signals ( FTS ) , number of impacts/collisions with other vehicles or objects ( IMP ) , and time to collision with a specified lead vehicle ( TTC ) .


In addition , reaction time ( RT ) and incorrect inhibition response ( IIR ) behavior to critical events were collected throughout each experimental drive .


Subjective ratings of mood and estimates of alcohol intoxication and driving impairment were also recorded in each trial .


No effects of trial condition were observed on any of the driving performance measures or on subjective ratings of mood , alcohol intoxication , and driving impairment .


SDLP was higher following the consumption of alcohol compared to the placebo trial .


However , no differences in SDLP were recorded between the alcohol trials , indicating that hydration level had no observable interaction with alcohol to influence SDLP performance .


Overall , it appears that dehydration does not exacerbate impairment in driving performance caused by mild-moderate alcohol intoxication .


Further research is required to clarify the effects of alcohol and dehydration at various alcohol doses .


Carboplatin plus paclitaxel administered every @ weeks is standard first-line chemotherapy for patients with advanced ovarian cancer .


A weekly paclitaxel schedule combined with carboplatin every @ weeks prolonged progression-free survival and overall survival in a Japanese phase @ trial .


The aim of our study was to assess whether a weekly schedule of carboplatin plus paclitaxel is more effective than the same drugs given every @ weeks .


We did a multicentre , randomised , phase @ study at @ institutions in Italy and France .


Women with FIGO stage IC-IV ovarian cancer , an ECOG performance status of @ or lower , and who had never received chemotherapy were randomly allocated in a @:@ ratio to receive either carboplatin ( AUC @ mg/mL per min ) plus paclitaxel ( @ mg/m ( @ ) ) every @ weeks for six cycles or carboplatin ( AUC @ mg/mL per min ) plus paclitaxel ( @ mg/m ( @ ) ) every week for @ weeks .


Randomisation was done by computer-based minimisation , stratified by centre , residual disease after surgery , and ECOG performance status .


The study was not blinded .


Coprimary endpoints were progression-free survival and quality of life ( assessed by the Functional Assessment of Cancer Therapy Ovarian Trial Outcome Index -LSB- FACT-O/TOI -RSB- score ) , and analysis was by modified intention to treat .


This report presents the final analysis .


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


@ patients were enrolled into the study between Nov @ , @ , and March @ , @ ; @ withdrew their consent immediately after randomisation and were excluded , and @ were eligible for analysis .


@ women were allocated treatment every @ weeks and @ were assigned to the weekly schedule .


After median follow-up of @ months ( IQR @-@ ) , @ progression-free survival events were recorded .


Median progression-free survival was @ months ( @ % CI @-@ ) in patients assigned to treatment every @ weeks , versus @ months ( @-@ ) in women allocated to the weekly schedule ( hazard ratio @ , @ % CI @-@ ; p = @ ) .


FACT-O/TOI scores differed significantly between the two schedules ( treatment-by-time interaction p < @ ) ; with treatment every @ weeks , FACT-O/TOI scores worsened at every cycle ( weeks @ , @ , and @ ) , whereas for the weekly schedule , after transient worsening at week @ , FACT-O/TOI scores remained stable .


Fewer patients assigned to the weekly group than those allocated treatment every @ weeks had grade @-@ neutropenia ( @ -LSB- @ % -RSB- of @ patients vs @ -LSB- @ % -RSB- of @ patients ) , febrile neutropenia ( two -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , grade @-@ thrombocytopenia ( four -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) , and grade @ or worse neuropathy ( @ -LSB- @ % -RSB- vs @ -LSB- @ % -RSB- ) .


Three deaths during the study were attributed to chemotherapy ; two women died who were allocated treatment every @ weeks and one death was recorded in the group assigned the weekly regimen .


A weekly regimen of carboplatin and paclitaxel might be a reasonable option for first-line treatment of women with advanced ovarian cancer .


Cognitive impairments contribute significantly to inadequate functional recovery following illness episodes in bipolar disorder , yet data on treatment interventions are sparse .


We assessed the cognitive effects of a standardized extract of the medicinal herb Withania somnifera ( WSE ) in bipolar disorder .


Sixty euthymic subjects with DSM-IV bipolar disorder were enrolled in an @-week , double-blind , placebo-controlled , randomized study of WSE ( @ mg/d ) as a procognitive agent added adjunctively to the medications being used as maintenance treatment for bipolar disorder .


Study enrollment and data analyses were completed between December @ and September @ .


Cognitive testing at baseline and @ weeks assessed primary efficacy outcomes .


Psychopathology and adverse events were monitored at scheduled visits .


Fifty-three patients completed the study ( WSE , n = @ ; placebo , n = @ ) , and the @ groups were matched in terms of demographic , illness , and treatment characteristics .


Compared to placebo , WSE provided significant benefits for @ cognitive tasks : digit span backward ( P = @ ) , Flanker neutral response time ( P = @ ) , and the social cognition response rating of the Penn Emotional Acuity Test ( P = @ ) .


The size of the WSE treatment effect for digit span backward was in the medium range ( Cohen d = @ ; @ % CI , @-@ @ ) .


None of the other cognitive tasks showed significant between-group differences .


Mood and anxiety scale scores remained stable , and adverse events were minor .


Although results are preliminary , WSE appears to improve auditory-verbal working memory ( digit span backward ) , a measure of reaction time , and a measure of social cognition in bipolar disorder .


Given the paucity of data for improving cognitive capacity in bipolar disorder , WSE offers promise , appears to have a benign side-effects profile , and merits further study .


Rapid diagnosis and accurate detection of etiological agents in pyogenic spinal infection ( PSI ) patients are important .


The purpose of this study was to evaluate the clinical usefulness of methicillin-resistant Staphylococcus-specific polymerase chain reaction ( MRS-PCR ) and broad-range universal PCR ( U-PCR ) for diagnosing PSI .


A prospective diagnostic study .


Thirty-two clinically suspect PSI patients and six control patients who underwent computerized tomography-guided biopsy and/or surgical treatment were enrolled .


Tissue samples were examined by microbiological culture , histopathology , and real-time PCR ( MRS-PCR and U-PCR ) .


The diagnostic accuracy of real-time PCR was analyzed based on the definitive diagnosis of infection , defined as a positive result from microbiological culture or histopathology .


All six control subjects were negative for PSI for all analyses .


Twelve clinically suspect PSI subjects received definitive diagnoses ( PSI group ) .


The non-PSI group consisted of six control subjects plus the remaining @ patients from the PSI clinically suspect group .


MRS-PCR results were positive for all MRS-cultured PSI subjects .


U-PCR was positive for all subjects in the PSI group with one discrepancy between real-time PCR and microbiological culture results in differentiation between gram-positive and gram-negative bacteria .


In the non-PSI group , MRS-PCR and U-PCR were positive in three and seven cases , respectively .


The sensitivity , specificity , positive predictive value , and negative predictive value of MRS-PCR for diagnosing MRS infection were @ , @ , @ , and @ , respectively ; those for the diagnosis of bacterial infection with U-PCR were @ , @ , @ , and @ , respectively .


Identification of MRS infection and ability to differentiate between gram-positive and gram-negative bacteria is rapidly achieved using MRS-PCR and U-PCR .


Real-time PCR provides a sensitive molecular diagnosis of PSI and may contribute to antibiotic selection .


To evaluate radiation dose , image quality , and optimal level of sinogram-affirmed iterative reconstruction ( SAFIRE ) of cerebral CT angiography ( CTA ) at @ kVp .


One hundred patients were prospectively classified into two groups : Group A ( n = @ ) , @ kVp cerebral CTA with @ levels of SAFIRE reconstruction ( S@-S@ ) ; and Group B ( n = @ ) , @ kVp with filtered back projection ( FBP ) reconstruction .


CT attenuation values , noise , signal-to-noise ratio ( SNR ) and contrast-to-noise ratio ( CNR ) of the internal carotid artery ( ICA ) and middle cerebral artery ( MCA ) were measured .


Subjective image quality was evaluated .


Effective dose ( ED ) was estimated .


CT attenuation and noise of the ICA and MCA in Group A were higher than those of Group B ( all P < @ ) while the SNRICA , SNRMCA , CNRICA , and CNRMCA of Group A at S@-@ were comparable to ( P > @ ) or higher than in Group B ( P < @ ) .


There was no difference in overall image quality between Group A S@-@ and Group B ( P > @ ) .


ED was @ mSv for Group A with @ % ED reduction in comparison to Group B ( @ mSv ) .


Cerebral CTA at @ kVp is feasible , allowing for substantial radiation dose reduction .


SAFIRE S@ level is recommended for obtaining optimal image quality .


@ kVp cerebral CTA is feasible and provides diagnostic image quality .


@ kVp cerebral CTA resulted in @ % effective dose reduction .


S@ level of SAFIRE is recommended for @ kVp cerebral CTA .


Relapse after cessation of desmopressin is an important problem in treating patients with enuresis .


Structured withdrawal of desmopressin tablets has been shown to decrease relapse rates .


However , scientific data are lacking onthe structured withdrawal of the fast melting oral formulation of desmopressin .


We compared relapse rates of structured withdrawal using placebo and direct cessation in a population of patients with enuresis who were desmopressin responders .


Patients diagnosed with enuresis and responding todesmopressin from @ different centers were involved in the study .


Patients wererandomized into @ groups .


Two different structured withdrawal strategies were compared to placebo and direct withdrawal .


Sample size was estimated as@ ( @ patients in each group ) , with a power of @ and an effect size of@ % .


Randomization was performed using NCSS statistical software ( NCSS , Kaysville , Utah ) from a single center .


The relapse rates of the groups were compared using chi-square testing .


Logistic regression analysis was performed todefine the independent factors having an effect onrelapse rates .


Desmopressin treatment was initiated in @ patients , and @ patients were eligible for randomization .


Relapse rates were @ ( @ % ) and @ ( @ % ) for the structured withdrawal groups , which were significantly less than for direct withdrawal ( @ , @ % ) and placebo ( @ , @ % ) .


Logistic regression analysis revealed that initial effective dose of @ cg , greater number of wet nights before treatment and nonstructured withdrawal were associated with higher relapse rates .


We found that structured withdrawal with the fast melting oralformulation of desmopressin results in decreased relapse rates .


Application of astructured withdrawal program was also an independent factor associated withreduced relapse rates , together with lower initial effective dose and number of wet nights per week .


Relapse after cessation of desmopressin is an important problem , and in this study structured withdrawal was observed to be associated with decreased relapse rates compared to placebo and direct withdrawal .


The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at @ year postsurgery in patients randomized to repair ( n = @ ) or replacement ( n = @ ) for severe ischemic mitral regurgitation .


However , patients undergoing repair experienced significantly more recurrent mitral regurgitation than patients undergoing replacement ( @ % vs @ % ) .


We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent mitral regurgitation or die .


Our analysis includes @ patients who were randomized to and received mitral valve repair .


Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors .


Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity .


Of the @ patients , @ received a replacement before leaving the operating room ; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram after repair .


During the @-year follow-up period , @ patients developed moderate/severe mitral regurgitation or died ( @ mitral regurgitation recurrences , @ mitral regurgitation recurrences and death , and @ deaths ) .


The mechanism for recurrent mitral regurgitation was largely mitral valve leaflet tethering .


Our model ( including age , body mass index , sex , race , effective regurgitant orifice area , basal aneurysm/dyskinesis , New York Heart Association class , history of coronary artery bypass grafting , percutaneous coronary intervention , or ventricular arrhythmias ) yielded an area under the receiver operating characteristic curve of @ .


The model demonstrated good discrimination in identifying patients who will survive @ years without recurrent mitral regurgitation after mitral valve repair .


Although our results require validation , they offer a clinically relevant risk score for selection of surgical candidates for this procedure .


To examine the associations between post-traumatic stress disorder ( PTSD ) symptoms , stimulant use , and treatment outcomes among dually diagnosed women .


Participants were @ women who participated in a multisite clinical trial of group treatments for PTSD and addictions .


Generalized linear models indicated Seeking Safety ( SS ; a cognitive-behavioral intervention ) was significantly more effective than Women 's Health Education ( WHE ; a control group intervention ) in reducing stimulant use at follow-up among women who were heavy stimulant users at pre-treatment and who showed improvements in PTSD symptoms .


There were no significant differences between the interventions among women who were light stimulant users at treatment entry .


These findings suggest that integrated treatment of co-occurring PTSD and addictions may be more effective than general health education approaches for heavy stimulant users .


Assessment of frequency of stimulant use among individuals with PTSD symptoms may inform treatment selection for this population .


The prevention of central venous catheter ( CVC ) associated bloodstream infections ( CABSIs ) in paediatric oncology patients is essential .


Ethanol locks can eliminate pathogens colonising CVCs and microbial resistance is rare .


Aim of this study was to determine whether two hour @ % ethanol locks can reduce CABSI in paediatric oncology patients .


We conducted a randomised , double blind , multi-centre trial in paediatric oncology patients ( @-@ years ) with newly inserted CVCs .


Patients were randomly assigned to receive two hour ethanol locks ( @ or @ ml @ % ) or heparin locks ( @ or @ ml @ IU/ml ) , whenever it was needed to use the CVC , maximum frequency once weekly .


Primary outcomes were time to CABSI or death due to CABSI .


We recruited @ patients ( ethanol , n = @ ; heparin , n = @ ) .


In the ethanol group , @/@ ( @ % ) patients developed a CABSI versus @/@ ( @ % ) in the heparin group .


The incidence of CABSI was @ / @ and @ / @ catheter days respectively ( p = @ ) .


The number-needed-to-treat was @ .


No patients died of CABSI .


In particular , Gram-positive CABSIs were reduced ( ethanol , n = @ ; heparin , n = @ ; p = @ ) .


Fewer CVCs were removed because of CABSI in the ethanol group ( p = @ ) .


The ethanol lock patients experienced significantly more transient symptoms compared to the heparin lock patients ( maximum grade @ ) ( nausea , p = @ ; taste alteration , p < @ ; dizziness , p = @ ; blushing , p < @ ) , no suspected unexpected serious adverse reactions ( SUSAR ) occurred .


This is the first randomised controlled trial to show that ethanol locks can prevent CABSI in paediatric oncology patients , in particular CABSI caused by Gram-positive bacteria .


Implementation of ethanol locks in clinical practice should be considered .


Diabetes may confer an increased risk for the cardiovascular health effects of particulate air pollution , but few human clinical studies of air pollution have included people with diabetes .


Ultrafine particles ( UFP , @ nm in diameter ) have been hypothesized to be an important component of particulate air pollution with regard to cardiovascular health effects .


@ never-smoker subjects @-@ years of age , with stable type @ diabetes but otherwise healthy , inhaled either filtered air ( @-@ particles/cm@ ) or elemental carbon UFP ( ~ @ particles/cm@ , ~ @ ug/m@ , count median diameter @ nm ) by mouthpiece , for @ hours at rest , in a double-blind , randomized , crossover study design .


A digital @-lead electrocardiogram ( ECG ) was recorded continuously for @ hours , beginning @ hour prior to exposure .


Analysis of @-minute segments of the ECG during quiet rest showed reduced high-frequency heart rate variability with UFP relative to air exposure ( p = @ ) , paralleled by non-significant reductions in time-domain heart rate variability parameters .


In the analysis of longer durations of the ECG , we found that UFP exposure increased the heart rate relative to air exposure .


During the @ - to @-hour interval after exposure , the average heart rate increased approximately @ beats per minute with UFP , compared to @ beats per minute with air ( p = @ ) .


There were no UFP effects on cardiac rhythm or repolarization .


Inhalation of elemental carbon ultrafine particles alters heart rate and heart rate variability in people with type @ diabetes .


Our findings suggest that effects may occur and persist hours after a single @-hour exposure .


The most common side-effect of ablative fractional skin resurfacing in Asians is post inflammatory hyperpigmentation ( PIH ) .


Various attempts have been made to reduce the occurrence of PIH after laser treatment including sun avoidance , the use of preoperative and postoperative treatment regimens , and treatment using conservative energy settings and epidermal protection .


To determine whether the use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after fractional CO@ laser skin resurfacing reduces the incidence of post laser PIH .


Thirty patients were treated with ablative fractional CO@ resurfacing on both sides of their faces at @mJ and @ % density .


Each subject was randomly treated on one side of the face with petrolatum ointment four times a day for the first week after laser treatment and on the other side of the face with petrolatum ointment four times a day plus broad-spectrum sunscreen with anti-inflammatory agents in the morning starting on the first day after laser treatment .


Transepidermal water loss was recorded at baseline and every day for @week .


Melanin and erythema indexes were measured at baseline , @ - , @-week , @ - , @ - and at @-month post treatment .


Of the @ patients involved in the study , @ received the treatment and attended @ - , @-week , @ - , @ - and @-month post-treatment visits .


Four patients were withdrawn from the study because they could not attend every follow-up visit .


There was no statistically significant difference in transepidermal water loss at baseline , immediately after laser treatment , or at the D@ to D@ follow-up visits .


Erythema index had no significantly statistical difference at baseline , @ - , @ - and at @-month after laser treatment .


Furthermore , there was a statistically significant difference in melanin index at @-week post laser treatment between both sides ( P = @ ) .


Melanin index at the @-week follow-up visit on the side treated with broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after laser treatment was significantly less than the control side .


The use of broad-spectrum sunscreen with anti-inflammatory agents starting on the first day after ablative fractional skin resurfacing can decrease the incidence of PIH after laser treatment at @-week postoperatively .


To prospectively evaluate image quality and radiation dose using a low-dose computed tomography angiography protocol and iterative image reconstruction for high-pitch dual-source CT-angiography ( DSCTA ) of the supraaortic arteries .


DSCTA was performed in @ patients , using either @ kVp tube voltage , @ mAS tube current , @ pitch and filtered back projection , or @ kVp tube voltage , @ mAs tube current , @ pitch , and sinogram affirmed iterative reconstruction .


Measurements of vessel attenuation , of the contrast-to-noise ratio ( CNR ) and the signal-to-noise ratio ( SNR ) were performed to objectively evaluate image quality .


Two readers evaluated subjective image quality and image noise , using a four-point scale .


Effective dose was used to compare the differences in radiation dose .


Low-dose protocol application showed significantly higher vessel opacification ( p = @ ) , and non-significantly higher CNR and SNR values .


There was no difference in the subjective image quality and image noise reading between the protocols .


Effective dose was significantly lower using the low-dose protocol ( @ @ mSv vs. @ @ mSv ; p < @ ) .


The combined use of reduced tube voltage , reduced tube current , and iterative reconstruction reduces radiation dose by @ % in high-pitch DSCTA of the supraaortic arteries without impairment of image quality .


To investigate the efficacy of premedication with pronase , a proteolytic enzyme , in improving image quality during magnifying endoscopy .


The study was of a blinded , randomized , prospective design .


Patients were assigned to groups administered oral premedication of either pronase and simethicone ( Group A ) or simethicone alone ( Group B ) .


First , the gastric mucosal visibility grade ( @-@ ) was determined during conventional endoscopy , and then a magnifying endoscopic examination was conducted .


The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from @ to @ , with a lower score indicating better visibility .


The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views .


The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes .


A total of @ patients were enrolled , and data from @ patients ( M : F = @:@ , mean age @ years ) were analyzed .


The visibility score was significantly higher in the stomach following premedication with pronase ( @ % with a score of @ in Group A vs @ % in Group B , P < @ ) , but there was no difference in the esophagus visibility scores ( @ % with a score of @ in Group A vs @ % in Group B ) .


Fewer water flushes -LSB- mean @ times ( range : @-@ times ) in Group A vs @ times ( range : @-@ times ) in Group B , P < @ -RSB- in the pronase premedication group did not affect the endoscopic procedure times -LSB- mean @ s ( range : @-@ s ) for Group A vs @ s ( range : @-@ s ) for Group B , P = @ -RSB- .


The total gastric mucosal visibility score was also lower in Group A ( @ vs @ in Group B , P < @ ) .


The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes .


Our study tested the hypothesis that sodium ( Na ) - selenite expression treatment can reduce oxidative stress and increase plasma antioxidants , whereas modulating white blood cell antigen expression in severe sepsis .


Selenite is a well known cofactor of glutathione peroxidases and other antioxidant enzymes ; therefore , one may expect an antioxidant effect of treatment .


We randomized @ severe septic patients into treatment and control groups .


Treatment group ( n = @ ) received @-g/@ hours Na-selenite load , followed by a @-g/die medication .


Oxidative stress markers , including malondialdehyde , maximal free radical production , and plasma antioxidants : free sulfhydryl groups , glutathione levels , and superoxide dismutase and catalase enzyme activity were measured .


According to our results , the treatment regime successfully restored serum selenium levels .


Treatment group developed a significant malondialdehyde increase by the fifth study day , whereas reactive oxygen species production decreased significantly .


Reduced glutathione and plasma sulfhydryl groups showed no significant difference .


Treatment group showed deteriorated expression of CD@a and slight increase of CD@d expression on monocytes throughout our study .


Although our Na-selenite treatment regime successfully restored the selenium deficiency of severe septic patients , antioxidant and white blood cell antigen expression modulating effect of the therapy was not observed in our patient group .


Renal colic is typically characterized by the sudden onset of severe pain radiating from the flank to the groin and its acute management in emergency departments essentially aims at rapid pain relief .


Spasmofen ( ) is a brand of Amriya Pharmaceutical Industries in the form of rectal suppositories containing ketoprofen @ mg and hyoscine butylbromide @ mg .


This combination is intended for the rapid relief of severe colicky pain in the renal system , hepatobiliary system , or gastrointestinal tract .


This trial aims to compare a single-dose of Spasmofen rectal suppository to a single intravenous ( IV ) ketorolac tromethamine @ mg/@ mL dose in patients with acute renal colic .


A total of @ eligible consecutive patients presenting to the emergency departments of two medical centers with acute renal colic were included in the study .


Eligible patients who signed the informed consent were randomly assigned into two treatment groups : an experimental group ( Spasmofen group ) who received one Spasmofen rectal suppository plus an IV injection of @ mL of normal saline solution ; and a control group ( ketorolac group ) who received one ketorolac @ mg/@ mL ampoule IV plus one placebo suppository .


Treatment success , defined as a change in the verbal rating score from severe or moderate pain to none or mild at @ minutes after the dose , was compared between groups using the chi-square/Fisher 's exact test .


Percentage reductions in visual pain analog scale ( VPAS ) scores at @ and @ minutes after the dose were compared between groups using the Z-test for proportions .


Successful treatment at @ minutes occurred in @ of @ ( @ % ) of Spasmofen-treated patients and in @ of @ ( @ % ) of ketorolac-treated patients .


The difference was not statistically significant by Fisher 's exact test ( P = @ ) .


The mean percentage reduction of VPAS after @ minutes was @ % in the Spasmofen-treated group and @ % in the ketorolac-treated group .


The difference was also not statistically significant by the Z-test for proportions ( P = @ ) .


Sixty minutes after being treated , Spasmofen was associated with a statistically significant greater reduction in VPAS ( mean % reduction = @ % ) than ketorolac ( @ % ; P = @ ) .


Single-dose Spasmofen rectal suppository might be a safe and effective first-aid treatment for the emergency department relief of acute renal colic .


Iosimenol @ injection is a new isotonic iodinated contrast medium for X-ray angiography .


To investigate the pharmacokinetics and biotransformation , tolerability , and safety of Iosimenol @ in healthy human subjects .


Twenty-four subjects were enrolled and randomized to receive either Iosimenol @ ( @ , @ or @ mL/kg ) or placebo ( @ % saline ) .


In each dosing group , six subjects received Iosimenol @ and two subjects received placebo .


Safety was assessed by physical examination , vital signs , electrocardiography , and laboratory tests .


Adverse events were recorded throughout the study up to @ days after dosing .


Blood samples were collected from @ min before until @ h after the start of dosing and urine samples were collected from @ min before until @ h after the start of dosing .


Iosimenol was quantified in plasma and urine by measuring iodine concentrations with X-ray fluorescence .


High-performance liquid chromatography was used to assess iosimenol biotransformation .


Mean half-lives ( mean standard deviation -LSB- SD -RSB- ) of iosimenol were @ @ h ( @ @ min ) and @ @ h for distribution and terminal elimination phases , respectively .


The apparent volume of distribution was @ @ L/kg , indicating distribution to the extracellular fluid volume .


Iosimenol was excreted within @ h without any sign of metabolic transformation .


Thirty-two adverse events were observed in @ subjects .


All were mild or moderate , and were transient in nature .


Iosimenol was not metabolized , had a distribution volume corresponding to the extracellular space , and was rapidly excreted through the kidneys by glomerular filtration .


The area under the plasma concentration curve and the peak plasma concentration was proportional to dose , while clearance was independent of dose .


Iosimenol @ was well tolerated .


Myoclonic movements are common problems during induction of anaesthesia with etomidate .


The myoclonus occurring after etomidate administration may represent a form of seizure .


Agonistic modulation of the opiate receptor may reduce seizures , and butorphanol acts in such a manner .


The aim of this randomised , double-blind , placebo-controlled clinical trial was to test our hypothesis that pre-treatment with butorphanol might reduce the incidence and severity of myoclonus induced by etomidate .


Patients ( @ ) with American Society of Anaesthesiologists physical status I or II were randomly assigned to one of two groups to receive either @ mg/kg of butorphanol ( n = @ ) or saline ( n = @ ) intravenously .


At two minutes after infusion of butorphanol or saline , @ mg/kg etomidate was given .


The occurrence and severity ( observational score of @-@ ) of myoclonus was assessed during @ minutes after administration of etomidate .


For each patient , blood pressure ( BP ) , saturation of peripheral oxygen ( SpO ) , and heart rate ( HR ) were measured .


The incidence of myoclonus was significantly lower in Group Butorphanol than in Group Saline ( @ % vs @ % ; RR = @ , @ % CI : @-@ @ ; = @ , p < @ ) .


The severity levels of myoclonic movement were also significantly lower in Group Butorphanol than in Group Saline ( p < @ ) .


Throughout the procedure , changes of BP , SpO , and HR did not differ between the groups .


There were no problems with bradycardia or hypotension .


Infusion of @ mg/kg butorphanol @ minutes before etomidate administration is effective for suppressing myoclonus induced by etomidate during induction of general anaesthesia .


Depressive symptoms occur frequently in Dutch society .


Recently a new method for treating depressive symptoms was introduced in the Netherlands .


The method , known as ` multi-moment non-invasive neurostimulation ' ( MNNS ) , involves presenting patients with a series of photographs , each picture having a positive valence .


The purpose of this method is to improve the mood of patients .


So far , however , the method has not been thoroughly tested .


To conduct a pilot study designed to compare the effectiveness of MNNS pictures with pictures from the International Affective Pictures System ( IAPS ) by means of a double-blind randomised controlled trial .


Thirty-three patients with depressive symptoms were randomly assigned to two groups , one representing the experimental condition ( MNNS ) and the other the control condition ( IAPS ) .


Patients were treated for six weeks in one mood-inductive session per week .


The severity of the patients ' depressive symptoms was assessed before the mood-induction treatment began and again at one week and at three months after the final session .


Each group showed a significant reduction in depressive symptoms .


There were no significant differences between the MNNS condition and the control condition with regard to the reduction of depressive symptoms over time .


There was a marked reduction in the depressive symptoms of the patients of both groups which had received short-term treatments involving the viewing of pictures with a positive valence .


This reduction was still apparent three months after the treatment .


The positive pictures presented in the MNNS method were found to be just as effective in reducing depressive symptoms as the positive pictures presented by the IAPS .


Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce .


We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline .


@ psychiatric departments from all over the Netherlands were clustered in pairs and randomized .


In the experimental condition , all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme .


Guideline adherence of individual professionals was measured by means of the response to on-line video fragments .


Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments .


Multilevel analysis showed that the intervention resulted in an improvement of individual professionals .


At the @ month follow-up , professionals who received the intervention showed greater guideline adherence , improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination .


Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists .


No significant effect of the intervention on team performance was found .


The ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey .


This may have caused considerable drop-out and possibly introduced selection bias , as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study .


Our results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients .


Participation in falls prevention activities by older people following presentation to the emergency department ( ED ) with a fall is suboptimal .


This randomised controlled trial ( RCT ) will test the RESPOND programme , an intervention designed to improve older persons ' participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies .


A RCT at two tertiary referral EDs in Melbourne and Perth , Australia .


@ community-dwelling people aged @-@years presenting to the ED with a fall and discharged home will be recruited .


People who require an interpreter or hands-on assistance to walk ; live in residential aged care or > @km from the trial hospital ; have terminal illness , cognitive impairment , documented aggressive behaviour or a history of psychosis ; are receiving palliative care or are unable to use a telephone will be excluded .


Participants will be randomly allocated to the RESPOND intervention or standard care control group .


RESPOND incorporates ( @ ) a home-based risk factor assessment ; ( @ ) education , coaching , goal setting and follow-up telephone support for management of one or more of four risk factors with evidence of effective interventions and ( @ ) healthcare provider communication and community linkage delivered over @months .


Primary outcomes are falls and fall injuries per person-year .


RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk .


Patient-centred models have been successfully trialled in chronic and cardiovascular disease ; however , evidence to support this approach in falls prevention is limited .


Community-acquired pneumonia ( CAP ) is the third-leading infectious cause of death worldwide .


The standard treatment of CAP has not changed for the past fifty years and its mortality and morbidity remain high despite adequate antimicrobial treatment .


Systemic corticosteroids have anti-inflammatory effects and are therefore discussed as adjunct treatment for CAP .


Available studies show controversial results , and the question about benefits and harms of adjunct corticosteroid therapy has not been conclusively resolved , particularly in the non-critical care setting .


This randomized multicenter study compares a treatment with @days of prednisone @mg with placebo in adult patients hospitalized with CAP independent of severity .


Patients are screened and enrolled within the first @hours of presentation after written informed consent is obtained .


The primary endpoint will be time to clinical stability , which is assessed every @hours during hospitalization .


Secondary endpoints will be , among others , all-cause mortality within @ and @days , ICU stay , duration of antibiotic treatment , disease activity scores , side effects and complications , value of adrenal function testing and prognostic hormonal and inflammatory biomarkers to predict outcome and treatment response to corticosteroids .


Eight hundred included patients will provide an @ % power for the intention-to-treat analysis of the primary endpoint .


This largest to date double-blind placebo-controlled multicenter trial investigates the effect of adjunct glucocorticoids in @ patients with CAP requiring hospitalization .


It aims to give conclusive answers about benefits and risks of corticosteroid treatment in CAP .


The inclusion of less severe CAP patients will be expected to lead to a relatively low mortality rate and survival benefit might not be shown .


However , our study has adequate power for the clinically relevant endpoint of clinical stability .


Due to discontinuing glucocorticoids without tapering after seven days , we limit duration of glucocorticoid exposition , which may reduce possible side effects .


KM-@ is a new second-generation nonnucleoside reverse-transcriptase inhibitor that is under development for the treatment of human immunodeficiency virus ( HIV ) type @ infection .


This study determined KM-@ tolerability and pharmacokinetic characteristics in healthy subjects .


A randomized , double-blinded , placebo-controlled , dose-escalation study was conducted in @ healthy South Korean male volunteers .


The subjects were allocated to single - or multiple-dose ( once daily for @ days ) groups that received @ , @ , @ , or @ mg drug or placebo in a @:@ ratio .


Safety and pharmacokinetic assessments were performed during the study .


Plasma and urine concentrations were quantified using liquid chromatography-tandem mass spectrometry .


The average maximum concentration ( Cmax ) and area under the concentration-time curve from time @ to infinity ( AUC ) values of KM-@ for the @-@ mg doses in the single-dose study ranged from @ ng/mL to @,@ ng/mL and @,@ ng h/mL to @,@ ng h/mL , respectively .


Values of the mean Cmax at a steady state and AUC within the dosing interval ranged from @ ng/mL to @,@ ng/mL and @,@ ng h/mL to @,@ ng h/mL , respectively , following @-@ mg doses in the multiple-dose study .


Dose proportionality was not observed for KM-@ .


KM-@ showed a @-fold accumulation after multiple doses in the @ mg dose group .


The mean half-life values ranged between @ and @ hours .


KM-@ was generally well tolerated without serious adverse events .


KM-@ demonstrated dose - and time-dependent nonlinear pharmacokinetic characteristics after single or multiple doses over a dose range ( @-@ mg ) in healthy subjects .


KM-@ showed favorable tolerability in this study .


This Phase I clinical trial information can be used to design further clinical studies appropriately to evaluate KM-@ in patients with HIV-@ infection .


This trial assessed the efficacy of cotrimoxazole lock solution in reducing catheter-related blood stream infections ( CRBSIs ) among hemodialysis ( HD ) patients who were dialyzed using tunneled catheters .


Patients randomly received either heparin ( @ U/ml ) ( control group ) or a mixture of @ mg/ml cotrimoxazole ( based on trimethoprim ) and @ U/ml heparin ( antibiotic group ) as catheters lock solution .


Compared with the control group , CRBSIs rates per @ catheter-days was significantly lower ( @ vs @ events ; p = @ ) and cumulative infection-free catheter survival was significantly higher ( log rank statistic @ ; p = @ ) in the antibiotic group .


There were no statistical differences regarding incidences of catheter removal ( @ % in the antibiotic group vs @ % in the control group ; p = @ ) or thrombosis ( @ % in the antibiotic group vs @ % in the control group ; p = @ ) between the two groups .


cotrimoxazole containing catheter lock solution is effective in reducing CRBSIs incidence and prolonging dialysis catheter survival in HD patients .


There is increasing community and government recognition of the magnitude and impact of adolescent depression .


Family based interventions have significant potential to address known risk factors for adolescent depression and could be an effective way of engaging adolescents in treatment .


The evidence for family based treatments of adolescent depression is not well developed .


The objective of this clinical trial is to determine whether a family based intervention can reduce rates of unipolar depressive disorders in adolescents , improve family functioning and engage adolescents who are reluctant to access mental health services .


The Family Options study will determine whether a manualized family based intervention designed to target both individual and family based factors in adolescent depression ( BEST MOOD ) will be more effective in reducing unipolar depressive disorders than an active ( standard practice ) control condition consisting of a parenting group using supportive techniques ( PAST ) .


The study is a multicenter effectiveness randomized controlled trial .


Both interventions are delivered in group format over eight weekly sessions , of two hours per session .


We will recruit @ adolescents ( @ to @ years old ) and their families , randomized equally to each treatment condition .


Participants will be assessed at baseline , eight weeks and @ weeks .


Assessment of eligibility and primary outcome will be conducted using the KID-SCID structured clinical interview via adolescent and parent self-report .


Assessments of family mental health , functioning and therapeutic processes will also be conducted .


Data will be analyzed using Multilevel Mixed Modeling accounting for time x treatment effects and random effects for group and family characteristics .


This trial is currently recruiting .


Challenges in design and implementation to-date are discussed .


These include diagnosis and differential diagnosis of mental disorders in the context of adolescent development , non-compliance of adolescents with requirements of assessment , questionnaire completion and treatment attendance , breaking randomization , and measuring the complexity of change in the context of a family-based intervention .


Obesity is a leading risk factor for endometrial cancer ( EC ) , particularly Type I forms , which are increasing in the U.S. Although death rates from most cancers have been decreasing , overall mortality in EC is increasing in the U.S. EC survivors ' poor fitness combined with their surgical treatments may make weight loss particularly challenging .


High intensity exercise increases neurotrophins and neurological reward via altered striatal dopamine in animals , and , in humans , chronic high intensity exercise enhances meal-induced satiety and may reduce hedonic eating .


`` Assisted '' exercise , a mode of exercise whereby a patient 's voluntary exercise rate is augmented mechanically , may modulate brain dopamine levels in Parkinson 's Disease patients but has not been previously evaluated as a treatment for obesity .


We describe the rationale and design of the REWARD trial , which has the overarching goal of randomizing @ obese EC survivors to `` assisted '' or voluntary rate cycling to evaluate the efficacy of `` assisted '' exercise in enhancing and sustaining weight loss .


Patients in both arms will receive @ days/week of supervised exercise and @ day/week of a group dietary behavioral intervention for @ weeks and , then , will be followed for @ months .


The primary outcome is weight loss .


Secondary outcomes include measures for body composition , fitness , eating behavior , exercise motivation and , quality of life as well as cognition and food reward and motivation as assessed by functional magnetic resonance imaging ( fMRI ) tasks .


If successful , the REWARD program could be extended to help sustain weight loss in obese cancer and non-cancer patients .


The objective of this study is to evaluate the effectiveness of a simple dyadic ( person with dementia and their main carer ) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia .


A two arm , pragmatic , randomised , controlled , single-blind , parallel-group trial of a dyadic exercise regimen ( individually tailored walking regimen designed to become progressively intensive and last between @-@min , at least five times per week ) .


Community-dwelling individuals with ICD-@ confirmed dementia with the following : clinically significant behavioural and psychological symptoms , a carer willing and able to co-participate in the exercise regimen , and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study .


One hundred and thirty-one dyads were recruited to this study .


There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week @ between the group receiving the dyadic exercise regimen and those that did not ( adjusted difference in means ( intervention minus control ) = -@ , p = @ , @ % CI -LSB- -@ , @ -RSB- ) .


There was a significant between-group difference in caregiver 's burden as measured by the Zarit Caregiver Burden Inventory at week @ ( OR = @ , p = @ , CI -LSB- @ , @ -RSB- ) favouring the exercise group .


This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia , but did seem to attenuate caregiver burden .


Further study to improve exercise uptake are needed .


Consumption of flavonoid-rich foods such as cocoa and tea may reduce cardiovascular disease risk .


The flavonoids epicatechin ( in cocoa and tea ) and quercetin ( in tea ) probably play a role by reducing endothelial dysfunction and inflammation , @ main determinants of atherosclerosis .


We studied the effects of supplementation of pure epicatechin and quercetin on biomarkers of endothelial dysfunction and inflammation .


Thirty-seven apparently healthy ( pre ) hypertensive men and women ( @-@ y ) participated in a randomized , double-blind , placebo-controlled crossover trial .


Participants ingested ( - ) - epicatechin ( @ mg/d ) , quercetin-@-glucoside ( @ mg/d ) , or placebo capsules for a period of @ wk , in random order .


Plasma biomarkers of endothelial dysfunction and inflammation were measured at the start and end of each @-wk intervention period .