Avatar assistant : improving social skills in students with an ASD through a computer-based intervention . This study assessed the efficacy of FaceSay , a computer-based social skills training program for children with Autism Spectrum Disorders ( ASD ) . This randomized controlled study ( N = 49 ) indicates that providing children with low-functioning autism ( LFA ) and high functioning autism ( HFA ) opportunities to practice attending to eye gaze , discriminating facial expressions and recognizing faces and emotions in FaceSay 's structured environment with interactive , realistic avatar assistants improved their social skills abilities . The children with LFA demonstrated improvements in two areas of the intervention : emotion recognition and social interactions . The children with HFA demonstrated improvements in all three areas : facial recognition , emotion recognition , and social interactions . These findings , particularly the measured improvements to social interactions in a natural environment , are encouraging .

computer-based intervention

social skills

efficacy

social skills

students with an ASD


Effects of maternal and dietary selenium ( Se-enriched yeast ) on the expression of p34 ( cdc2 ) and CyclinB1 of germ cells of their offspring in goats . The aim of the study was to evaluate the effect of selenium on the expression of p34 ( cdc2 ) and CyclinB1 ( two components of MPF regulating cell cycle ) of germ cells of their offspring in goats . A herd of 119 Taihang Black Goats , which was randomly divided into 4 treatments , received experimental diet with different Se levels ( from Se-enriched yeast ) for 174d . The four treatments , fed with a basal diet , were supplemented with 0 ( control ) , 0.5 , 2 and 4 mgkg⁻¹ DM Se . Testis samples were collected from the young male goats of each treatment group at the end of the study ( 30d after weaning ) for mRNA expression using real-time PCR and for protein expression by immunohistochemistry assay . Results show that a significant decrease was observed in mRNA expression of p34 ( cdc2 ) and CyclinB1 in the testis of Se-deficient ( Group 1 ) and Se-excess ( Group 4 ) animals compared with that in Groups 2 and 3 . However , no significant changes were found in mRNA expression of p34 ( cdc2 ) between Se-deficient ( Group 1 ) and Se-excess ( Group 4 ) . Also the immunohistochemistry assay detected similar results of protein expression of these two genes . These results suggest , that maternal and dietary Se-induced oxidative stress can modulate the mRNA and protein expression of the cell cycle related genes ( p34 ( cdc2 ) and CyclinB1 ) in the testis of their offspring . In addition , Se deficiency and Se excess could prevent the completion of the cell cycle .

dietary selenium ( Se-enriched yeast )

selenium


Using personalized feedback to reduce alcohol use among hazardous drinking college students : the moderating effect of alcohol-related negative consequences . UNLABELLED Web-based screening and brief interventions that include personalized feedback about their alcohol use have proven to be particularly promising for reducing hazardous drinking among university students . Despite the increasing use of these approaches , there is still relatively little known about how the content of these interventions may influence outcomes and who may benefit most from these approaches . The current study sought to address these issues by examining how individual differences in alcohol consequences influence outcomes of a laboratory-based computerized intervention . METHODS One-hundred and nineteen introductory psychology students who either had two episodes of heavy episodic drinking in the past month or scored ≥8 on the AUDIT participated in this randomized controlled trial for course credit . Participants were assigned to 1 of 4 conditions in this 2 Intervention ( Alcohol Feedback vs. Control ) ×2 Assessment ( Motivational Assessment vs. No Motivational Assessment ) between-subjects design . Quantity of alcohol consumed per week and heavy episodic drinking one month later were the primary dependent variables . RESULTS Controlling for corresponding baseline alcohol measures , hierarchical linear regression analyses showed a significant interaction between intervention condition and baseline alcohol-related consequences . For those who reported more alcohol consequences at baseline , the alcohol intervention resulted in significantly less alcohol use and fewer heavy drinking episodes at follow-up , while no difference was observed between intervention conditions for those with few baseline consequences . Assessment did not moderate intervention effects . DISCUSSION These findings suggest that a feedback-based computerized intervention that includes normative information about alcohol use and consequences may be more effective for hazardous drinking students who are experiencing higher levels of alcohol-related consequences .

personalized feedback

Web-based screening

brief interventions

Quantity of alcohol consumed per week

heavy episodic drinking one month later

less alcohol use

fewer heavy drinking episodes

hazardous drinking

college students

One-hundred and nineteen


Impact of prior pharmacotherapy on remission of psychotic depression in a randomized controlled trial . Having failed to respond to an adequate antidepressant treatment course predicts poorer treatment outcomes in patients with major depression . However , little is known about the impact of prior treatment on the outcome of major depression with psychotic features ( MDpsy ) . We examined the effect of prior treatment history on the outcome of pharmacotherapy of MDpsy in patients who participated in the STOPD-PD study , a randomized , double-blind , clinical trial comparing a combination of olanzapine plus sertraline vs. olanzapine plus placebo . The strength of treatment courses received prior to randomization was classified using a validated method . A hierarchy of outcomes was hypothesized based on treatments received prior to randomization and randomized treatment . A high remission rate was observed in subjects with a history of no prior treatment or inadequate treatment who were treated with a combination of olanzapine and sertraline . A low remission rate was observed in subjects who had previously failed to respond to an antidepressant alone and who were treated with olanzapine monotherapy . A low remission rate was also observed in subjects who had previously failed to respond to a combination of an antipsychotic and an antidepressant . Similar to patients with major depression , these results emphasize the impact of prior pharmacotherapy on treatment outcomes in patients with MDpsy .

pharmacotherapy

pharmacotherapy

olanzapine plus sertraline vs.

olanzapine plus placebo .

olanzapine

sertraline

olanzapine

pharmacotherapy

remission of psychotic depression

outcome of pharmacotherapy

high remission rate

low remission rate

low remission rate

impact of prior pharmacotherapy

psychotic depression

major depression

MDpsy

MDpsy


[ Efficacy of naftopidil in patients with overactive bladder associated with benign prostatic hyperplasia : prospective randomized controlled study to compare differences in efficacy between morning and evening medication ] . A total of 100 patients with benign prostatic hyperplasia ( BPH ) and overactive bladder ( OAB ) symptoms ( BPH/OAB ) , enrolled between June 2006 to March 2008 , were randomly divided into 2 groups of morning medication ( M ) and evening medication ( E ) groups , then 50 mg of naftopidil was given once a day after breakfast or supper for 8 weeks . Data were available for efficacy analysis on 80 patients ( M group ; 43 , E group ; 37 ) . Naftopidil significantly improved the overall international prostatic symptom score ; from 19.2±7.9 to 11.7±5.8 in the M group and from 19.4±6.4 to 12.3±6.8 in the E group ( p < 0.0001 ) , QOL score from 4.9±0.8 to 3.2±1.4 in the M group and from 5.0±0.8 to 3.6±1.3 in the E group ( p < 0.0001 ) , and OAB symptom score from 7.8±2.6 to 5.0±2.5 in the M group ( p < 0.0001 ) and from 8.6±2.9 to 5.8± 3.3 in the E group ( p < 0.0001 ) . There was no significant difference in the incidence of adverse effects between the M group ( 6.1 % ) and E group ( 2.2 % ) . These results suggest that naftopidil improves storage symptoms as well as voiding symptoms regardless of timing of administration .

naftopidil

naftopidil

Naftopidil

BPH/OAB


Effectiveness of sensory integration interventions in children with autism spectrum disorders : a pilot study . The purpose of this pilot study was to establish a model for randomized controlled trial research , identify appropriate outcome measures , and address the effectiveness of sensory integration ( SI ) interventions in children with autism spectrum disorders ( ASD ) . Children ages 6-12 with ASD were randomly assigned to a fine motor or SI treatment group . Pretests and posttests measured social responsiveness , sensory processing , functional motor skills , and social-emotional factors . Results identified significant positive changes in Goal Attainment Scaling scores for both groups ; more significant changes occurred in the SI group , and a significant decrease in autistic mannerisms occurred in the SI group . No other results were significant . The study discusses considerations for designing future outcome studies for children with ASD .

sensory integration interventions

sensory integration ( SI )

fine motor

SI treatment

Goal Attainment Scaling scores

autistic mannerisms

children

autism spectrum disorders

children

autism spectrum disorders

ASD

Children ages 6-12 with

ASD

children

ASD


Safety and efficacy of donepezil in children and adolescents with autism : neuropsychological measures . OBJECTIVE There has been recent interest in the use of cognitive enhancing drugs , such as cholinesterase inhibitors , as a possible treatment for executive functioning ( EF ) deficits in autism spectrum disorder ( ASD ) . The goal of this study was to assess the tolerability , safety , and efficacy of donepezil on EF in a sample of children and adolescents with ASD . METHOD Thirty-four children and adolescents with ASD ( age range 8-17 years ; IQ > 75 ) were enrolled in a 10-week , double-blind , placebo-controlled trial of donepezil ( doses of 5 and 10 mg ) , followed by a 10-week open label trial for placebo nonresponders . RESULTS The effect of donepezil treatment on EF was examined . Despite improvement on a number of EF measures , no statistically significant between-group differences were found ( with gains observed for both the placebo and donepezil groups ) . CONCLUSIONS The results suggest that short-term treatment with donepezil may have limited impact on cognitive functioning in ASD . Future controlled trials may need to consider a longer treatment period to detect significant gains on EF measures .

donepezil

cognitive enhancing drugs

cholinesterase inhibitors

placebo-controlled

donepezil

executive functioning

tolerability

safety

efficacy

children and adolescents with autism :

autism spectrum disorder ( ASD ) .


Anastrozole single-dose protocol in women with oligo- or anovulatory infertility : results of a randomized phase II dose-response study . OBJECTIVE To compare the effects of anastrozole and clomiphene citrate ( CC ) on follicular development and ovulation in infertile women with ovulatory dysfunction . DESIGN Phase II , prospective , randomized , assessor-blind , multicenter , dose-finding , noninferiority study . SETTING Outpatient . PATIENT ( S ) Infertile women with ovulatory dysfunction , aged 18-35 years , and body mass index < 35 kg/m ( 2 ) . INTERVENTION ( S ) Single-dose anastrozole at 5 mg ( n = 39 ) , 10 mg ( n = 39 ) , 20 mg ( n = 39 ) , or 30 mg ( n = 38 ) or a 5-day course of CC at 50 mg/d ( n = 39 ) as starting doses . MAIN OUTCOME MEASURE ( S ) The primary endpoint was the ovulation rate in the first treatment cycle ( cycle 1 ) . Ovulation was defined as a midluteal phase serum P level ≥ 10 ng/mL or clinical pregnancy . RESULT ( S ) In cycle 1 the ovulation rates for a single dose of anastrozole at 5 , 10 , 20 , and 30 mg were 46.2 % , 41.0 % , 23.1 % , and 28.9 % , respectively , whereas that for CC at 50 mg/d was 61.5 % . Among women with fewer than six menses per year , the cumulative ovulation rates over three cycles were comparable in the anastrozole 5 mg ( 52.4 % ) and CC 50 mg/d ( 42.3 % ) groups . CONCLUSION ( S ) In terms of ovulation rates in cycle 1 , single-dose anastrozole at 5 , 10 , 20 , and 30 mg was not as effective as CC at 50 mg/d for 5 days ( noninferiority was not shown ) .

Anastrozole

anastrozole

clomiphene citrate ( CC )

Single-dose anastrozole

5-day course of CC

follicular development and ovulation

ovulation rate

women

anovulatory infertility

ovulatory dysfunction

18-35 years


Effects of diet and Aspergillus oryzae extract or Saccharomyces cervisiae on growth and carcass characteristics of lambs and steers fed to meet requirements of natural markets . Two studies were conducted to determine the effects of diet and feed additive on growth and carcass characteristics of lambs and cattle destined for all natural markets . In Exp . 1 , 48 Dorset × Hampshire lambs ( initial BW 29.4 ± 0.1 kg ) were used in a randomized complete block experiment to determine the effects of Aspergillus oryzae extract , Amaferm ( AMF ) supplementation ( 1 g/d ) in an 85 % concentrate diet on growth and carcass characteristics . Lambs were allotted to 12 pens ( 4 lambs per pen ) , and blocked by sex and BW . Lambs were fed until the average BW of each pen reached a target BW ( 55.4 kg for wethers and 50.0 kg for ewes ) , at which time the entire pen of lambs was slaughtered . Amaferm resulted in a greater ( P=0.07 ) G : F. In Exp . 2 , 168 crossbred steers ( initial BW 300 ± 0.7 kg ) were used in a trial with a 3 × 2 factorial arrangement of treatments to examine the effects of 0.5 g/d of Saccaromyces cervisiae boulardii CNCM 1079-Levucell SB ( LEV ) , or 3 g/d of AMF with 2 corn sources , dry whole-shelled corn or high moisture corn , on growth and carcass characteristics . Neither LEV nor AMF improved ( P > 0.10 ) carcass characteristics compared with control or non-feed-supplemented steers . Addition of LEV to high-concentrate , corn-based diets did not improve ( P > 0.10 ) growth performance of feedlot steers . However , addition of AMF to a diet composed of dry whole-shelled corn resulted in an improvement ( P < 0.05 ) in G : F ( 0.208 vs. 0.194 ) . Results indicate that at the amounts fed , AMF may improve G : F for lambs and steers fed dry corn-based finishing diets .

diet

Aspergillus oryzae extract

Saccharomyces cervisiae

diet

and feed additive

carcass characteristics

growth performance

lambs

lambs

cattle destined for all natural markets


Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers : a cluster randomised controlled trial . BACKGROUND Tobacco use adversely affects oral health . Tobacco use prevention and cessation ( TUPAC ) counselling guidelines recommend that healthcare providers ask about each patient 's tobacco use , assess the patient 's readiness and willingness to stop , document tobacco use habits , advise the patient to stop , assist and help in quitting , and arrange monitoring of progress at follow-up appointments . Adherence to such guidelines , especially among dental providers , is poor . To improve guideline implementation , it is essential to understand factors influencing it and find effective ways to influence those factors . The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers . METHODS Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines . These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers . Specific items will be drawn from the guidelines and the literature on TUPAC studies . After identifying potential implementation difficulties , we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence . For assessing the implementation of TUPAC guidelines , the electronic dental record audit and self-reported questionnaires will be used . DISCUSSION To improve guideline adherence , the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties , as well as designing and evaluating interventions . After having identified implementation difficulties , we will design and test two interventions to enhance TUPAC guideline adherence . Using the cluster randomised controlled design , we aim to provide further evidence on intervention effects , as well as on the validity and feasibility of the theoretical-domain approach . The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers . TRIAL REGISTRATION Current Controlled Trials ISRCTN15427433 .

TUPAC counselling guidelines

TUPAC

theories of behaviour change

guideline adherence

TUPAC guidelines

Theories of behaviour change

questionnaire

electronic dental record audit

self-reported questionnaires

tobacco use habits


Intermittent theta-burst transcranial magnetic stimulation for treatment of Parkinson disease . OBJECTIVE To investigate the safety and efficacy of intermittent theta-burst stimulation ( iTBS ) in the treatment of motor symptoms in Parkinson disease ( PD ) . BACKGROUND Progression of PD is characterized by the emergence of motor deficits , which eventually respond less to dopaminergic therapy and pose a therapeutic challenge . Repetitive transcranial magnetic stimulation ( rTMS ) has shown promising results in improving gait , a major cause of disability , and may provide a therapeutic alternative . iTBS is a novel type of rTMS that may be more efficacious than conventional rTMS . METHODS In this randomized , double-blind , sham-controlled study , we investigated safety and efficacy of iTBS of the motor and dorsolateral prefrontal cortices in 8 sessions over 2 weeks ( evidence Class I ) . Assessment of safety and clinical efficacy over a 1-month period included timed tests of gait and bradykinesia , Unified Parkinson 's Disease Rating Scale ( UPDRS ) , and additional clinical , neuropsychological , and neurophysiologic measures . RESULTS We investigated 26 patients with mild to moderate PD : 13 received iTBS and 13 sham stimulation . We found beneficial effects of iTBS on mood , but no improvement of gait , bradykinesia , UPDRS , and other measures . EEG/EMG monitoring recorded no pathologic increase of cortical excitability or epileptic activity . Few reported discomfort or pain and one experienced tinnitus during real stimulation . CONCLUSION iTBS of the motor and prefrontal cortices appears safe and improves mood , but failed to improve motor performance and functional status in PD . CLASSIFICATION OF EVIDENCE This study provides Class I evidence that iTBS was not effective for gait , upper extremity bradykinesia , or other motor symptoms in PD .

iTBS

rTMS

rTMS

iTBS

iTBS

sham stimulation

iTBS

iTBS

iTBS

Parkinson disease

safety and efficacy

improving gait

disability

safety and clinical efficacy

gait and bradykinesia

additional clinical

neuropsychological

neurophysiologic measures

mood

gait

bradykinesia

UPDRS

EEG/EMG

increase of cortical excitability

epileptic activity

discomfort or pain

tinnitus

safe

improves mood

motor performance and functional status

effective

gait

upper extremity bradykinesia

other motor symptoms in PD

Parkinson disease .

PD


Efficacy of a family practice-based lifestyle intervention program to increase physical activity and reduce clinical and physiological markers of vascular health in patients with high normal blood pressure and/or high normal blood glucose ( SNAC ) : study protocol for a randomized controlled trial . BACKGROUND Previous interventions to increase physical activity and reduce cardiovascular risk factors have been targeted at individuals with established disease ; less attention has been given to intervention among individuals with high risk for disease nor has there been determination of the influence of setting in which the intervention is provided . In particular , family practice represents an ideal setting for the provision and long-term maintenance of lifestyle interventions for patients at risk ( ie high-normal blood pressure or impaired glucose tolerance ) . METHODS/DESIGN The Staged Nutrition and Activity Counseling ( SNAC ) study is a randomized clustered design clinical trial that will investigate the effectiveness and efficacy of a multi-component lifestyle intervention on cardiovascular disease risk factors and vascular function in patients at risk in primary care . Patients will be randomized by practice to either a standard of care lifestyle intervention or a behaviourally-based , matched prescriptive physical activity and diet change program . The primary goal is to increase physical activity and improve dietary intake according to Canada 's Guides to Physical Activity Healthy Eating over 24 months . The primary intention to treat analysis will compare behavioral , physiological and metabolic outcomes at 6 , 12 and 24 months post-randomization including estimation of incident hypertension and/or diabetes . DISCUSSION The design features of our trial , and the practical problems ( and solutions ) associated with implementing these design features , particularly those that result in potential delay between recruitment , baseline data collection , randomization , intervention , and assessment will be discussed . Results of the SNAC trial will provide scientific rationale for the implementation of this lifestyle intervention in primary care . TRIAL REGISTRATION ISRCTN : ISRCTN:42921300 .

multi-component lifestyle intervention

standard of care lifestyle intervention

physical activity

physical activity

dietary intake

hypertension

diabetes

high normal blood pressure

high normal blood glucose ( SNAC )

high risk for disease


Effects of weight loss and exercise on insulin resistance , and intramyocellular triacylglycerol , diacylglycerol and ceramide . AIMS/HYPOTHESIS Intramyocellular lipids , including diacylglycerol ( DAG ) and ceramides , have been linked to insulin resistance . This randomised repeated-measures study examined the effects of diet-induced weight loss ( DIWL ) and aerobic exercise ( EX ) on insulin sensitivity and intramyocellular triacylglycerol ( IMTG ) , DAG and ceramide . METHODS Sixteen overweight to obese adults ( BMI 30.6 ± 0.8 ; 67.2 ± 4.0 years of age ) with either impaired fasting glucose , or impaired glucose tolerance completed one of two lifestyle interventions : DIWL ( n = 8 ) or EX ( n = 8 ) . Insulin sensitivity was determined using hyperinsulinaemic-euglycaemic clamps . Intramyocellular lipids were measured in muscle biopsies using histochemistry and tandem mass spectrometry . RESULTS Insulin sensitivity was improved with DIWL ( 20.6 ± 4.7 % ) and EX ( 19.2 ± 12.9 % ) . Body weight and body fat were decreased by both interventions , with greater decreases in DIWL compared with EX . Muscle glycogen , IMTG content and oxidative capacity were all significantly ( p < 0.05 ) decreased with DIWL and increased with EX . There were decreases in DAG with DIWL ( -12.4 ± 14.6 % ) and EX ( -40.9 ± 12.0 % ) . Ceramide decreased with EX ( -33.7 ± 11.2 % ) , but not with DIWL . Dihydroceramide was decreased with both interventions . Sphingosine was decreased only with EX . Changes in total DAG , total ceramides and other sphingolipids did not correlate with changes in glucose disposal . Stearoyl-coenzyme A desaturase 1 ( SCD1 ) content was decreased with DIWL ( -19.5 ± 8.5 % , p < 0.05 ) , but increased with EX ( 19.6 ± 7.4 % , p < 0.05 ) . Diacylglycerol acyltransferase 1 ( DGAT1 ) was unchanged with the interventions . CONCLUSIONS/INTERPRETATION Diet-induced weight loss and exercise training both improved insulin resistance and decreased DAG , while only exercise decreased ceramides , despite the interventions having different effects on IMTG . These alterations may be mediated through differential changes in skeletal muscle capacity for oxidation and triacylglycerol synthesis . TRIAL REGISTRATION ClinicalTrials.gov NCT00766298 .

weight loss

exercise

diet-induced weight loss ( DIWL )

aerobic exercise ( EX )

spectrometry

insulin resistance


Quitting a weight loss program is associated with anhedonia : preliminary findings of the Lifestyle Intervention Treatment Evaluation Study in northern Finland . OBJECTIVES To examine whether a diagnosis for major depression , chronic depression or specific symptoms of depression is associated with the risk of quitting a weight loss program . STUDY DESIGN The study involved 82 overweight adults participating in the Lifestyle Intervention Treatment Evaluation ( LITE ) follow-up study at Oulu University Hospital in northern Finland . METHODS Psychiatric diagnostic assessments were based on the Structured Clinical Interview for DSMIV disorders ( SCID-I ) conducted by a clinical psychiatrist . Anhedonia ( lack of pleasure ) was assessed as one of the core symptoms of major depression and chronic depression ( dysthymia ) . Anhedonia was defined to be present if the participants reported having suffered a major loss of interest during the previous month . RESULTS Twenty participants ( 24.4 % ) quit during the 6-month intervention period . Anhedonia put individuals at risk of quitting the weight loss program ( bivariate analysis OR 3.1 , 95 % CI 0.8-11.6 , p=0.091 , multivariate analysis OR 6.5 , 95 % CI 1.1-38.2 , p=0.038 ) . However , a diagnosis for major depression or chronic depression did not predict quitting . CONCLUSIONS Individual assessments of obesity and overweight should also include an assessment for subthreshold depression , mainly anhedonia .

weight loss program

weight loss program

Psychiatric diagnostic assessments

Anhedonia ( lack of pleasure )

chronic

Anhedonia

Anhedonia

major depression

chronic depression

major depression

chronic depression

symptoms of depression

adults


Comparison of adaptive pacing therapy , cognitive behaviour therapy , graded exercise therapy , and specialist medical care for chronic fatigue syndrome ( PACE ) : a randomised trial . BACKGROUND Trial findings show cognitive behaviour therapy ( CBT ) and graded exercise therapy ( GET ) can be effective treatments for chronic fatigue syndrome , but patients ' organisations have reported that these treatments can be harmful and favour pacing and specialist health care . We aimed to assess effectiveness and safety of all four treatments . METHODS In our parallel-group randomised trial , patients meeting Oxford criteria for chronic fatigue syndrome were recruited from six secondary-care clinics in the UK and randomly allocated by computer-generated sequence to receive specialist medical care ( SMC ) alone or with adaptive pacing therapy ( APT ) , CBT , or GET . Primary outcomes were fatigue ( measured by Chalder fatigue questionnaire score ) and physical function ( measured by short form-36 subscale score ) up to 52 weeks after randomisation , and safety was assessed primarily by recording all serious adverse events , including serious adverse reactions to trial treatments . Primary outcomes were rated by participants , who were necessarily unmasked to treatment assignment ; the statistician was masked to treatment assignment for the analysis of primary outcomes . We used longitudinal regression models to compare SMC alone with other treatments , APT with CBT , and APT with GET . The final analysis included all participants for whom we had data for primary outcomes . This trial is registered at http : //isrctn.org , number ISRCTN54285094 . FINDINGS We recruited 641 eligible patients , of whom 160 were assigned to the APT group , 161 to the CBT group , 160 to the GET group , and 160 to the SMC-alone group . Compared with SMC alone , mean fatigue scores at 52 weeks were 3·4 ( 95 % CI 1·8 to 5·0 ) points lower for CBT ( p = 0·0001 ) and 3·2 ( 1·7 to 4·8 ) points lower for GET ( p = 0·0003 ) , but did not differ for APT ( 0·7 [ -0·9 to 2·3 ] points lower ; p = 0·38 ) . Compared with SMC alone , mean physical function scores were 7·1 ( 2·0 to 12·1 ) points higher for CBT ( p = 0·0068 ) and 9·4 ( 4·4 to 14·4 ) points higher for GET ( p = 0·0005 ) , but did not differ for APT ( 3·4 [ -1·6 to 8·4 ] points lower ; p=0·18 ) . Compared with APT , CBT and GET were associated with less fatigue ( CBT p = 0·0027 ; GET p = 0·0059 ) and better physical function ( CBT p=0·0002 ; GET p < 0·0001 ) . Subgroup analysis of 427 participants meeting international criteria for chronic fatigue syndrome and 329 participants meeting London criteria for myalgic encephalomyelitis yielded equivalent results . Serious adverse reactions were recorded in two ( 1 % ) of 159 participants in the APT group , three ( 2 % ) of 161 in the CBT group , two ( 1 % ) of 160 in the GET group , and two ( 1 % ) of 160 in the SMC-alone group . INTERPRETATION CBT and GET can safely be added to SMC to moderately improve outcomes for chronic fatigue syndrome , but APT is not an effective addition . FUNDING UK Medical Research Council , Department of Health for England , Scottish Chief Scientist Office , Department for Work and Pensions .

cognitive behaviour therapy

specialist medical care

adaptive pacing therapy ( APT )

APT

CBT

SMC-alone

effectiveness and safety

fatigue

Chalder fatigue questionnaire score

physical function

short form-36 subscale score

serious adverse events

serious adverse reactions

mean fatigue scores

chronic fatigue syndrome

chronic fatigue syndrome


Augmented soft tissue mobilization vs natural history in the treatment of lateral epicondylitis : a pilot study . OBJECTIVE The purpose of this study was to evaluate the effect of augmented soft tissue mobilization ( ASTM ) on the treatment of lateral epicondylitis . METHODS This randomized clinical study assessed 27 subjects ( 12 men and 15 women ) with lateral epicondylitis and were divided randomly into 2 groups . The experimental group ( n = 15 ) received ASTM twice a week for 5 weeks . The subjects of the control group ( n = 12 ) received advice on the natural evolution of lateral epicondylitis , computer ergonomics , and stretching exercises . Patient-rated outcome was assessed at baseline and after 6 weeks and 3 months using a visual analog scale and the Patient-Rated Tennis Elbow Evaluation . The function was assessed using the pain-free grip strength at baseline and after 6 weeks . RESULTS Both groups showed improvements in pain-free grip strength , visual analog scale , and Patient-Rated Tennis Elbow Evaluation . Sample size for larger future randomized clinical trial was 116 participants . CONCLUSION A larger study investigating the same hypothesis is warranted to detect difference in the effects of these treatments strategies . The study design is feasible , and minor improvements will help to minimize the potential bias .

Augmented soft tissue mobilization

natural history

augmented soft tissue mobilization

pain-free grip strength

improvements in pain-free grip strength

visual analog scale

Patient-Rated Tennis Elbow Evaluation

men

women

epicondylitis


Human primary visual cortex ( V1 ) is selective for second-order spatial frequency . A variety of cues can differentiate objects from their surrounds . These include " first-order " cues such as luminance modulations and " second-order " cues involving modulations of orientation and contrast . Human sensitivity to first-order modulations is well described by a computational model involving spatially localized filters that are selective for orientation and spatial frequency ( SF ) . It is widely held that first-order modulations are represented by the firing rates of simple and complex cells ( " first-order " neurons ) in primary visual cortex ( V1 ) that , likewise , have spatially localized receptive fields that are selective for orientation- and SF . Human sensitivity to second-order modulations is well described by a filter-rectify-filter ( FRF ) model , with first- and second-order filters selective for orientation and SF . However , little is known about how neuronal activity in visual cortex represents second-order modulations . We tested the FRF model by using an functional ( f ) MRI-adaptation protocol to characterize the selectivity of activity in visual cortex to second-order , orientation-defined gratings of two different SFs . fMRI responses throughout early visual cortex exhibited selective adaptation to these stimuli . The low-SF grating was a more effective adapter than the high-SF grating , incompatible with the FRF model . To explain the results , we extended the FRF model by incorporating normalization , yielding a filter-rectify-normalize-filter model , in which normalization enhances selectivity for second-order SF but only for low spatial frequencies . We conclude that neurons in human visual cortex are selective for second-order SF , that normalization ( surround suppression ) contributes to this selectivity , and that the selectivity in higher visual areas is simply fed forward from V1 .

FRF model

second-order modulations


[ Effects of parecoxib on morphine dosage in postoperative patient-controlled analgesia following thoracoscope-assisted thoracotomy ] . OBJECTIVE To observe the effect of parecoxib on morphine dosage in patient-controlled analgesia ( PCA ) following thoracoscope-assisted thoracotomy . METHODS A consecutive series of 100 patients undergoing thoracoscope-assisted thoracotomy were randomized into 5 groups and received PCA with morphine doses at 0 , 5 , 10 , 15 , and 20 mg given in 200 ml saline ( groups P ( 1 ) , P ( 2 ) , P ( 3 ) , P ( 4 ) , and P ( 5 ) , respectively ) . Parecoxib ( 40 mg ) was given in all the patients immediately before the operation , and the mixture ( 4-5 ml ) of lidocaine and ropivacaine was administered into the 3 intercostal spaces upper and lower to the incision before chest closure . PCA was administered for each patient . The visual analogue scale ( VAS ) at rest and coughing and the respiratory functional parameters were recorded at 1 , 2 , 4 , 8 , 12 , 24 , 36 , and 48 h after the start of PCA , and the actual and effective button-pressing times ( D ( 1 ) /D ( 2 ) ) in PCA were also recorded . RESULTS No patients showed signs of respiratory inhibition within 24 h after the operation , and the resting VAS was comparable between the groups within the initial 6 postoperative hours . At 8 to 24 h postoperatively , the VAS scores at rest and coughing were significantly higher in P ( 1 ) group than in the other groups ( P < 0.05 ) , and no significant differences were found between the groups at 36 to 48 h. D ( 1 ) /D ( 2 ) in groups P ( 1 ) and P ( 2 ) were significantly different from those in the other 3 groups at 4-24 h , but no such difference was found between groups P ( 3 ) , P ( 4 ) , and P ( 5 ) . CONCLUSION The application of parecoxib may reduce the dosage of morphine in PCA following thoracoscope-assisted thoracotomy and results in good analgesic effect without affecting the patients respiratory function and sputum elimination .

parecoxib

morphine

patient-controlled analgesia

thoracoscope-assisted thoracotomy

parecoxib

patient-controlled analgesia ( PCA )

thoracoscope-assisted thoracotomy

thoracoscope-assisted thoracotomy

PCA with morphine

saline

Parecoxib

( 4-5 ml ) of lidocaine and ropivacaine

PCA

PCA

PCA

parecoxib

morphine

PCA

visual analogue scale ( VAS ) at rest

signs of respiratory inhibition

resting VAS

VAS scores

thoracotomy

100 patients

thoracoscope-assisted thoracotomy


[ Clinical observation on acupuncture for treatment of male osteoporosis ] . OBJECTIVE To compare the therapeutic effects of acupuncture combined with drug and simple drug for treatment of male osteoporosis . METHODS Fifty-five cases were divided into an observation group ( 25 cases ) and a control group ( 30 cases ) randomly . The observation group was treated with acupuncture and moxibustion at Pishu ( BL 20 ) , Shenshu ( BL 23 ) , Mingmen ( GV 4 ) , Shenque ( CV 8 ) and so on combined with taking Alendronate , while the control group was treated with taking Alendronate simply . The improvement of both Integral of Clinical Symptoms ( ICS ) and Bone Mineral Density ( BMD ) of two groups was observed after 6 months treatment . RESULTS The ICS of two groups after treatment both decreased significantly ( both P < 0.001 ) , and the decreasing degree in observation group was more significant than that in control group ( P < 0.001 ) . The BMD of lumbar vertebrae and femur in observation group increased obviously than that before treatment ( P < 0.01 , P < 0.05 ) . The increasing degree of BMD of lumbar vertebrae in observation group after treatment was more obvious than that in control group ( P < 0.05 ) . There were abdominal pain , diarrhea , nausea , vomiting , dyspepsia and other adverse reaction in control group , while the degree and occurrence rate of those in observation group alleviated and decreased obviously . CONCLUSION The effect of acupuncture combined with drug for treatment of male osteoporosis is good with little adverse reaction . This method is better than taking Alendronate .

acupuncture

acupuncture

acupuncture and moxibustion at Pishu

Shenshu

Mingmen

Shenque

Alendronate

Alendronate simply

acupuncture

Integral of Clinical Symptoms ( ICS )

Bone Mineral Density ( BMD )

BMD of lumbar vertebrae

BMD of lumbar vertebrae

male

osteoporosis

male

osteoporosis

Fifty-five cases

male

osteoporosis


Which women default from follow-up cervical cytology tests ? A cohort study within the TOMBOLA trial . OBJECTIVE To identify factors associated with default from follow-up cervical cytology tests . METHODS A cohort study was conducted involving 2166 women , aged 20-59 , with recent low-grade cervical cytology taken within the NHS Cervical Screening Programmes in Scotland and England , and managed by 6-monthly cytology in primary care . For the first ( 6-month ) and second ( 12-month ) surveillance cytology tests separately , women were categorized as 'on-time attendees ' ( attended ≤6 months of test being due ) , 'late attendees ' ( attended greater than 6 months after test was due ) or 'non-attendees ' ( failed to attend ) . Multivariate odds ratios ( ORs ) were computed for factors associated with late and non-attendance . RESULTS For the first surveillance test , risk of non-attendance was significantly higher in younger women , those without post-secondary education , and non-users of prescribed contraception . Factors significantly associated with late attendance for the first test were the same as for non-attendance , plus current smoking and having children . The most important predictor of non-attendance for the second surveillance test was late attendance for the first test ( OR = 9.65 ; 95 % CI , 6.60-16.62 ) . Non-attendance for the second test was also significantly higher among women who were younger , smokers and had negative cytology on the first surveillance test . Late attendance for the second surveillance test was higher in women who were younger , smokers , had children and attended late for the first test . CONCLUSIONS Women at highest risk of default from follow-up cytology tend to be young , smoke , lack post-secondary education , and have defaulted from a previous surveillance appointment . Tackling default will require development of targeted strategies to encourage attendance and research to better understand the reasons underpinning default .

NHS Cervical Screening Programmes

follow-up cervical cytology tests


Delayed perceptual awareness in rapid perceptual decisions . The flourishing of studies on the neural correlates of decision-making calls for an appraisal of the relation between perceptual decisions and conscious perception . By exploiting the long integration time of noisy motion stimuli , and by forcing human observers to make difficult speeded decisions -- sometimes a blind guess -- about stimulus direction , we traced the temporal buildup of motion discrimination capability and perceptual awareness , as assessed trial by trial through direct rating . We found that both increased gradually with motion coherence and viewing time , but discrimination was systematically leading awareness , reaching a plateau much earlier . Sensitivity and criterion changes contributed jointly to the slow buildup of perceptual awareness . It made no difference whether motion discrimination was accomplished by saccades or verbal responses . These findings suggest that perceptual awareness emerges on the top of a developing or even mature perceptual decision . We argue that the middle temporal ( MT ) cortical region does not confer us the full phenomenic depth of motion perception , although it may represent a precursor stage in building our subjective sense of visual motion .

motion coherence and viewing time

slow buildup of perceptual awareness .

motion discrimination

saccades or verbal responses .

Delayed perceptual awareness

rapid perceptual decisions .


Vascular pedicle width in acute lung injury : correlation with intravascular pressures and ability to discriminate fluid status . INTRODUCTION Conservative fluid management in patients with acute lung injury ( ALI ) increases time alive and free from mechanical ventilation . Vascular pedicle width ( VPW ) is a non-invasive measurement of intravascular volume status . The VPW was studied in ALI patients to determine the correlation between VPW and intravascular pressure measurements and whether VPW could predict fluid status . METHODS This retrospective cohort study involved 152 patients with ALI enrolled in the Fluid and Catheter Treatment Trial ( FACTT ) from five NHLBI ARDS ( Acute Respiratory Distress Syndrome ) Network sites . VPW and central venous pressure ( CVP ) or pulmonary artery occlusion pressure ( PAOP ) from the first four study days were correlated . The relationships between VPW , positive end-expiratory pressure ( PEEP ) , cumulative fluid balance , and PAOP were also evaluated . Receiver operator characteristic ( ROC ) curves were used to determine the ability of VPW to detect PAOP < 8 mmHg and PAOP ≥ 18 mm Hg . RESULTS A total of 71 and 152 patients provided 118 and 276 paired VPW/PAOP and VPW/CVP measurements , respectively . VPW correlated with PAOP ( r = 0.41 ; P < 0.001 ) and less well with CVP ( r = 0.21 ; P = 0.001 ) . In linear regression , VPW correlated with PAOP 1.5-fold better than cumulative fluid balance and 2.5-fold better than PEEP . VPW discriminated achievement of PAOP < 8 mm Hg ( AUC = 0.73 ; P = 0.04 ) with VPW ≤67 mm demonstrating 71 % sensitivity ( 95 % CI 30 to 95 % ) and 68 % specificity ( 95 % CI 59 to 75 % ) . For discriminating a hydrostatic component of the edema ( that is , PAOP ≥ 18 mm Hg ) , VPW ≥ 72 mm demonstrated 61.4 % sensitivity ( 95 % CI 47 to 74 % ) and 61 % specificity ( 49 to 71 % ) ( area under the curve ( AUC ) 0.69 ; P = 0.001 ) . CONCLUSIONS VPW correlates with PAOP better than CVP in patients with ALI . Due to its only moderate sensitivity and specificity , the ability of VPW to discriminate fluid status in patients with acute lung injury is limited and should only be considered when intravascular pressures are unavailable .

Conservative fluid management

mechanical ventilation

Vascular pedicle width ( VPW )

Vascular pedicle width ( VPW )

VPW


A prospective , double-blind , randomized , controlled clinical trial comparing standard wound care with adjunctive hyperbaric oxygen therapy ( HBOT ) to standard wound care only for the treatment of chronic , non-healing ulcers of the lower limb in patients with diabetes mellitus : a study protocol . BACKGROUND It has been suggested that the use of adjunctive hyperbaric oxygen therapy improves the healing of diabetic foot ulcers , and decreases the risk of lower extremity amputations . A limited number of studies have used a double blind approach to evaluate the efficacy of hyperbaric oxygen therapy in the treatment of diabetic ulcers . The primary aim of this study is to assess the efficacy of hyperbaric oxygen therapy plus standard wound care compared with standard wound care alone in preventing the need for major amputation in patients with diabetes mellitus and chronic ulcers of the lower limb . METHODS/DESIGN One hundred and eighteen ( 59 patients per arm ) patients with non-healing diabetic ulcers of the lower limb , referred to the Judy Dan Research and Treatment Centre are being recruited if they are at least 18 years of age , have either Type 1 or 2 diabetes with a Wagner grading of foot lesions 2 , 3 or 4 on lower limb not healing for at least 4 weeks . Patients receive hyperbaric oxygen therapy every day for 6 weeks during the treatment phase and are provided ongoing wound care and weekly assessments . Patients are required to return to the study centre every week for an additional 6 weeks of follow-up for wound evaluation and management . The primary outcome is freedom from having , or meeting the criteria for , a major amputation ( below knee amputation , or metatarsal level ) up to 12 weeks after randomization . The decision to amputate is made by a vascular surgeon . Other outcomes include wound healing , effectiveness , safety , healthcare resource utilization , quality of life , and cost-effectiveness . The study will run for a total of about 3 years . DISCUSSION The results of this study will provide detailed information on the efficacy of hyperbaric oxygen therapy for the treatment of non-healing ulcers of the lower limb . This will be the first double-blind randomized controlled trial for this health technology which evaluates the efficacy of hyperbaric oxygen therapy in prevention of amputations in diabetic patients . TRIAL REGISTRATION ClinicalTrials.gov Identifier : NCT00621608 .

adjunctive hyperbaric oxygen therapy

hyperbaric oxygen therapy

standard wound care

hyperbaric oxygen therapy

chronic , non-healing ulcers

diabetic foot ulcers

lower extremity amputations

major amputation

wound healing

effectiveness

safety

healthcare resource utilization

quality of life

cost-effectiveness

amputations

diabetes mellitus

chronic ulcers

One hundred and eighteen

18 years of age

Type 1 or 2 diabetes


Role of oxidized regenerated cellulose in preventing infections at the surgical site : prospective , randomized study in 98 patients affected by a dirty wound . AIM The aim of this study was to evaluate whether oxidized regenerated cellulose ( ORC ) , applied to " dirty " surgical wounds , is able to reduce the microbial load and , consequently , the infection rate as compared to conventional local wound treatment . METHODS The study included 98 patients who underwent intestinal recanalization procedures between December 2003 and December 2008 , with the stoma as the surgical site . Authors considered several risk factors for SSI . The patients were divided into two groups . In group A ( 50 patients ) , the surgical wound , previous site of the stoma , was packed with ORC , whereas in group B ( 48 patients ) gauze soaked in iodine was used . Microbial contamination was evaluated with three swabs ( in subcutaneous tissue and the dermis ) , in the operating room before wound packing and on the 2nd and 3rd postoperative day ( before suturing the skin ) . RESULTS There were no cases of wound dehiscence and no clinically evident superficial or deep surgical site infections in either group . Analysis of all data revealed that there was no or reduced bacterial contamination in the second and third swab in 33 patients ( 66 % ) of Group A versus 12 patients ( 25 % ) of Group B . CONCLUSION Although it is necessary to consider all factors which can have an influence on SSI and use all the means shown to be effective to reduce the risk of SSI , there is a rationale for using ORC to prevent this kind of infection , especially in patients who undergo " dirty " surgery .

oxidized regenerated cellulose

oxidized regenerated cellulose ( ORC )

packed with ORC

gauze soaked in iodine

ORC

oxidized regenerated cellulose ( ORC )

infection rate

surgical wound

Microbial contamination

wound dehiscence

no or reduced bacterial contamination

98 patients affected by a dirty wound .


Pharmacist directed home medication reviews in patients with chronic heart failure : a randomised clinical trial . BACKGROUND Chronic heart failure ( CHF ) accounts for significant morbidity , mortality and health expenditure . Furthermore , patients with CHF are often on numerous pharmacological agents for their comorbidities . The objective of this study was to determine whether a pharmacist directed home medication review intervention had positive effects on CHF patient outcomes . METHODS A total of 120 patients hospitalised for CHF were randomised to receive a pharmacist directed post-discharge home medication review ( n = 64 , 53.3 % ) or standard care ( n = 56 , 46.7 % ) . Participants were followed for 6 months . Primary outcomes were death , CHF hospitalisation and length of hospital stay . RESULTS There were no between group differences in mortality ( hazard ratio = 1.41 , 0.50 to 3.97 ; P = 0.514 ) or CHF hospitalizations ( incidence rate ratio [ IRR ] = 1.74 95 % CI : 0.85-3.60 P = 0.131 ) over the 6 month follow-up period . Days of hospital stay for CHF exacerbations in the 6 month follow-up were significantly greater in the intervention group ( IRR = 2.34 95 % CI : 1.80-3.05 P = 0.000 ) . CONCLUSIONS Post-discharge pharmacy directed home medication review appeared to have no effect on mortality and health care utilisation above that achieved with standard care . The post-acute management of CHF must be a collaborative multi-disciplinary effort by the health care team as it is the additive effect of interventions that are most effective .

home medication

home medication

home medication

standard care

home medication

CHF hospitalisation

mortality

CHF hospitalizations

patients with chronic heart failure :

Chronic heart failure ( CHF )

patients with CHF

CHF patient

CHF


Sequential alternate administration of tamoxifen and medroxyprogesterone acetate in advanced breast cancer : clinical-biological randomized study . From January 1985 to September 1988 , 60 women with advanced breast cancer were randomized in two arms to receive : A ) tamoxifen ( TAM ) ( 20 mg/die ) until progression or B ) TAM ( 20 mg/die for 14 days ) then medroxyprogesterone acetate ( MPA ) ( 1500 mg/die p.o . for 14 days ) followed by 7 days of wash-out before repeating the TAM/MPA treatment . All patients were post-menopausal , previously untreated with hormone therapy , and with tumor receptor status determined immediately before randomization ; all had objectively evaluable lesions . In order to verify hormone receptor variations due to the antiestrogen , when possible a second biopsy was performed after the initial 14 day cycle of TAM . Thirty-one and 29 patients were included respectively in arms A and B . Objective regression ( CR + PR ) was observed in 58 % of group A and 75 % of group B , with CR in 11 % and 23 % , respectively . Differences were not statistically significant . Median time to progression was 12 months for group A and 9 for group B . Overall survival has not yet been reached in group A while it was 34 months for patients of group B. Metrorrhagia was observed in two cases of group A and in 6 of group B , and thrombophlebitis in 1 and 3 cases , respectively . The second biopsy confirmed a clear increase of PgR content in 8/11 cases ( 75 % ) . Plasma level variations of TAM , N-desmethyl TAM and MPA were checked at various intervals on 3 patients of group B , and confirmed that our schedule is able to produce a drug wash-out period for tumor cells . In conclusion , our study demonstrated that while the manipulation of hormone receptors seems possible , results indicating better overall survival and time to progression were not obtained with alternate sequential TAM-MPA therapy .

tamoxifen

medroxyprogesterone acetate

hormone receptor variations

biopsy

Objective regression

Median time to progression

Overall survival

Metrorrhagia

PgR content

advanced breast cancer

women

advanced breast cancer

post-menopausal

evaluable lesions

Thirty-one


Noninfiltrative anesthesia for transrectal prostate biopsy : a randomized prospective study comparing lidocaine-prilocaine cream and lidocaine-ketorolac gel . OBJECTIVES Periprostatic nerve block ( PPNB ) is the standard anesthesia for ultrasound ( US ) guided transrectal prostate biopsy ( TPB ) , but periprostatic infiltration itself constitutes a major , though often neglected , source of discomfort even in patients receiving perianal-intrarectal lidocaine-prilocaine ( PILP ) cream before PPNB . Noninfiltrative anesthesia therefore represents an attractive alternative to periprostatic infiltration . With this in mind , we aimed to determine the efficacy and safety of perianal-intrarectal ( PI ) lidocaine gel , lidocaine-ketorolac gel , and lidocaine-prilocaine cream in relieving pain during TPB . MATERIALS AND METHODS Three hundred consecutive patients scheduled for US-guided TPB were randomized 1:1:1 to receive PI administration of 5 g 2.5 % lidocaine gel 10 minutes before TPB ( Group 1 ) , or a mixture of 5 g 2.5 % lidocaine gel and 0.3 % ketorolac tromethamine solution 1 hour before TPB ( Group 2 ) , or 5 g 2.5 % lidocaine and 2.5 % prilocaine cream 20 minutes before TPB ( Group 3 ) . The 0-to-10 points visual analogue scale ( VAS ) was used for assessing pain at probe insertion and movements ( VAS-1 ) , at prostate sampling ( VAS-2 ) , and maximal procedural pain ( MPP ) . Complications occurring up to 20 days after the procedure were also recorded . RESULTS Four ( 1.3 % ) patients were excluded because of unbearable pain during the procedure , leaving Group 1 with 98 patients , Group 2 with 99 , and Group 3 with 99 ; the 3 groups were comparable for patients ' age , serum PSA , prostate volume , and cancer detection rate . The addition of either ketorolac or prilocaine to lidocaine significantly ( P < 0.0001 ) reduced probe-related , sampling-related , and maximal procedural pain . Compared with lidocaine-prilocaine , lidocaine-ketorolac was less effective in relieving probe-related pain ( mean VAS-1 : 1.47 ± 1.30 vs. 0.39 ± 0.65 ; P < 0.0001 ) but more effective in relieving sampling-related pain ( mean VAS-2 : 0.76 ± 0.94 vs. 1.54 ± 1.02 ; P < 0.0001 ) ; there was no difference in MPP ( mean 1.82 ± 1.21 vs. 1.67 ± 0.95 ) , probably due to such different efficacy on the two pain sources . Complications were similar in the 3 groups . CONCLUSIONS Lidocaine-prilocaine cream was most effective on probe-related pain , whereas lidocaine-ketorolac gel was most effective on sampling-related pain . These noninfiltrative anesthetics were safe , easy to administer , and well accepted by patients ; the possibility to combine them to further improve pain control during TPB deserves further well-designed studies .

Noninfiltrative anesthesia

transrectal prostate biopsy

lidocaine-prilocaine cream

lidocaine-ketorolac gel

anesthesia

Noninfiltrative anesthesia

lidocaine-ketorolac gel

lidocaine-prilocaine cream

lidocaine gel

ketorolac

prilocaine

lidocaine

lidocaine-prilocaine

lidocaine-ketorolac

efficacy and safety

relieving pain

unbearable pain

procedural pain

probe-related pain

transrectal prostate biopsy

transrectal prostate biopsy

TPB

Three hundred

TPB


Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants . Although maternal attachment is an important predictor of infant attachment security and other developmental outcomes , little is known about the formation of maternal attachment in the first few months of the infant 's life , particularly among ethnic minority mothers . The current study examined the predictors of postpartum maternal attachment in a sample of 217 Latina women enrolled in a perinatal depression prevention trial . Mothers ' attachment to their infants was measured at 6-8 weeks postpartum using the Maternal Postnatal Attachment Scale . A variety of predictors of early attachment were explored including : depressive symptoms during pregnancy , pregnancy intention , feelings about the pregnancy , and the quality of the partner relationship . The strongest predictor of lower maternal attachment was depressive symptoms late in pregnancy ; pregnancy intention was marginally predictive of attachment , with lower scores being associated with unwanted pregnancies . The study fills a critical gap in our understanding of the role of depressive symptoms during pregnancy in shaping mothers ' early attachment to their infants .

attachment

Maternal Postnatal Attachment Scale

lower maternal attachment

depressive symptoms

attachment

low-income Latina

infants

women

perinatal depression

depressive symptoms

pregnancy


Hepatobiliary response in postoperative lipid therapy in gastrointestinal surgery . BACKGROUND/AIMS Intravenous lipid emulsions may contribute to the development of total parenteral nutrition ( TPN ) -- induced hepatobiliary complications . METHODS In a prospective , randomised setting the authors compared the short-term hepatic effects of medium-chain triglycerides/short-chain triglycerides ( MCT/LCT ) physical mixture with a four-component intravenous ( i.v . ) lipid emulsion ( LCT , MCT , Olive-oil and Fish-oil ) in patients undergoing elective gastrointestial surgery during the early postoperative period . RESULTS The authors demonstrated that total and conjugated bilirubin , alkaline phosphatase , alanine aminotransferase , aspartate amino transferase and cholinesterase did not change significantly during the 5-days observation period . In contrast to this , gamma-glutamyl transferase ( GGT ) activity increased by 2,4 times during 5-days therapy with the lipid emulsions mentioned above ( SMOF lipid : 21,9 to 52,9 U/L , Lipofundin : from 32,5 to 79,6 U/L ) . CONCLUSION during a 4-days administration hepatic effect of the intravenous lipid emulsions did not differ significantly . The changes in enzyme levels confirm the cholestatic type of hepatobiliary deviations without clinical impact on short-term TPN therapy .

lipid therapy

lipid emulsions

therapy with the lipid emulsions

lipid emulsions

TPN therapy

Hepatobiliary response

total and conjugated bilirubin

alkaline phosphatase

alanine aminotransferase

changes in enzyme levels


Should angioplasty be deferred after infarction ?


An interactive computer program can effectively educate potential users of cystic fibrosis carrier tests . The demand for cystic fibrosis ( CF ) carrier testing is steadily growing , not only from individuals with raised a priori carrier risk , but also from the general population . This trend will likely exceed the availability of genetic counselors , making it impossible to provide standard face-to-face genetic counseling to all those asking for the test . In order to reduce the time needed to educate individuals on the basics of the disease , its genetic transmission , and carrier testing peculiarities , we developed an educational method based on an interactive computer program ( IC ) . To assess the effectiveness of this program and to compare it to a classical genetic counseling session , we conducted a comparative trial . In a population setting of people undergoing assisted reproduction , 44 individuals were randomly assigned to either receiving standard one-on-one genetic counseling or education by the IC program . We measured pre- and post-intervention knowledge about CF genetic transmission and carrier testing . Starting from an equivalent baseline of correct answers to a specially designed multiple-choice questionnaire ( 47 % in the counselor group and 45 % in the computer group ) both groups showed a highly significant and similar increase ( reaching 84 % in the counselor group and 85 % in the computer group ) . The computer program under evaluation can successfully educate individuals considering genetic testing for CF .

interactive computer program

cystic fibrosis carrier

raised a priori carrier risk

44 individuals


[ Presentation of a randomized multicenter study protocol . " Evaluation of adjuvant interferon effectiveness after radical nephrectomy in kidney carcinoma with high risk of relapse " ] .

adjuvant interferon

adjuvant interferon effectiveness


A randomized controlled trial of Hanen 's 'More Than Words ' in toddlers with early autism symptoms . BACKGROUND This randomized controlled trial compared Hanen 's 'More than Words ' ( HMTW ) , a parent-implemented intervention , to a 'business as usual ' control group . METHODS Sixty-two children ( 51 boys and 11 girls ; M age = 20 months ; SD = 2.6 ) who met criteria for autism spectrum disorders ( ASD ) and their parents participated in the study . The HMTW intervention was provided over 3.5 months . There were three measurement periods : prior to randomization ( Time 1 ) and at 5 and 9 months post enrollment ( Times 2 and 3 ) . Children 's communication and parental responsivity were measured at each time point . Children 's object interest , a putative moderator , was measured at Time 1 . RESULTS There were no main effects of the HMTW intervention on either parental responsivity or children 's communication . However , the effects on residualized gains in parental responsivity from Time 1 to both Times 2 and 3 yielded noteworthy effect sizes ( Glass 's Δ = .71 , .50 respectively ) . In contrast , there were treatment effects on child communication gains to Time 3 that were moderated by children 's Time 1 object interest . Children with lower levels of Time 1 object interest exhibited facilitated growth in communication ; children with higher levels of object interest exhibited growth attenuation . CONCLUSIONS The HMTW intervention showed differential effects on child communication depending on a baseline child factor . HMTW facilitated communication in children with lower levels of Time 1 object interest . Parents of children who evidence higher object interest may require greater support to implement the HMTW strategies , or may require different strategies than those provided by the HMTW curriculum .

Hanen 's 'More Than Words '

'business as usual ' control

HMTW intervention

parental responsivity

children 's communication

parental responsivity

toddlers with early autism symptoms .


[ Protective effect of ischemia postconditioning on reperfusion injury in patients with ST-segment elevation acute myocardial infarction ] . OBJECTIVE To observe the effect of ischemia postconditioning during the first minutes of reperfusion for the myocardial reperfusion injury in ST-segment elevation acute myocardial infarction ( STEMI ) patients undergoing emergency percutaneous coronary intervention ( PCI ) . METHODS STEMI patients undergoing emergency PCI in affiliated hospital of Beihua University between October 2006 and January 2009 were randomly divided into two groups : the control group ( n = 34 ) without any intervention after PTCA , and the postconditioning group ( n = 30 ) with ischemia postconditioning within first minutes of reflow by 3 episodes of 30-second inflation and 30-second deflation with the angioplasty balloon . Reperfusion arrhythmias , CK and CKMB , corrected TIMI frame count ( CTFC ) , wall motion score index ( WMSI ) and left ventricular ejection fraction ( LVEF ) by echocardiography were compared between the two groups . MI areas were evaluated with the ECG-54 criteria/32 system and myocardial blush grade ( MBG ) was measured . RESULTS The incidence of reperfusion arrhythmias-frequent ventricular premature ( 26.7 % vs. 52.9 % ) and short array ventricular tachycardia beat ( 23.3 % vs. 58.8 % ) as well as values of peaks CK [ ( 1162 ± 548 ) U/L vs. ( 1732 ± 480 ) U/L , P < 0.01 ] , CKMB [ ( 165 ± 70 ) U/L vs. ( 280 ± 99 ) U/L , P < 0.01 ] , CTFC ( 22.23 ± 3.81 vs. 26.97 ± 3.42 ) , WMSI ( 1.27 ± 0.52 vs. 1.82 ± 0.83 ) , and infarction areas determined by ECG methods ( 10.60 % ± 4.97 % vs.14.65 % ± 6.88 % , all P < 0.05 ) were all significantly lower in the postconditioning group than in control group while LVEF ( 0.55 ± 0.08 vs. 0.47 ± 0.10 ) and MBG ( 2.27 ± 0.64 vs. 1.47 ± 0.61 , all P < 0.05 ) were significantly higher in the postconditioning group than in control group . CONCLUSIONS Ischemia postconditioning can significantly reduce myocardial reperfusion injury in patients with STEMI .

ischemia postconditioning

ischemia postconditioning

emergency PCI

without any intervention after PTCA

postconditioning group

with ischemia postconditioning

angioplasty balloon

Reperfusion arrhythmias

CK and CKMB

corrected TIMI frame count ( CTFC )

wall motion score index ( WMSI )

myocardial blush grade ( MBG )

peaks CK

STEMI

emergency PCI


Evaluation of a preventive intervention for child anxiety in two randomized attention-control school trials . The present research examined the effectiveness of a cognitive-behavioral therapy ( CBT ) based intervention program , FRIENDS , for children from grades 4 to 6 , using random assignment at the school-level and an attention-control design in two longitudinal studies . The first study targeted children with anxiety symptoms ( N=191 , mean age=10.1 ) as screened with self , parent , and teacher-reports ; the second study took a universal approach with full classrooms of children participating ( N=253 , mean age=9.8 ) . The results showed no intervention effect in both studies , with children 's anxiety symptoms decreasing over time regardless of whether they were in the story-reading ( attention control ) or FRIENDS condition . The findings also indicated that girls reported a higher level of anxiety than boys and children in higher grades reported lower anxiety relative to younger children in both studies . In addition , similar patterns were found using a subgroup of children with high-anxiety symptoms from both studies .

preventive intervention

cognitive-behavioral therapy

anxiety symptoms

children 's anxiety symptoms

child

anxiety

children

children

anxiety


Nephrotoxicity of cyclosporin A in patients with newly diagnosed type 1 diabetes mellitus . Renal function was studied in 18 patients with Type 1 diabetes mellitus . All were participating in the Canadian-European randomized placebo-controlled cyclosporin trial in newly diagnosed Type 1 diabetic patients , nine being randomized to placebo , and nine to cyclosporin A . During treatment for 12 to 18 months , cyclosporin A caused significant reductions in the glomerular filtration rate ( before drug withdrawal , cyclosporin 97 +/- 18 vs placebo 125 +/- 16 ml min-1 1.73-m-2 , p less than 0.05 ) , renal plasma flow ( 454 +/- 83 vs 536 +/- 70 ml min-1 1.73-m-2 , p less than 0.05 ) , and lithium clearance ( 17 +/- 3 vs 28 +/- 5 ml min-1 1.73-m-2 , p less than 0.05 ) . The fractional proximal reabsorption was increased ( 0.82 +/- 0.03 vs 0.78 +/- 0.03 , p less than 0.05 ) , and the fractional distal sodium reabsorption reduced ( 0.88 +/- 0.03 vs 0.94 +/- 0.02 , p less than 0.05 ) . These results are in accordance with the hypothesis that the nephrotoxic effect of cyclosporin A results from a preferential constriction of afferent glomerular vessels . One year after withdrawal of the drug , all variables were similar in the two groups , except for blood glucose control which was worse in the cyclosporin A treated group . When corrected for differences in blood glucose control it appeared that in three out of nine patients glomerular filtration rate had not completely returned to the reference range of the placebo group . We conclude that the nephrotoxic side-effects of cyclosporin A treatment for 1 year are reversible . There are , however , signs of minor and perhaps chronic renal injury .

cyclosporin A

placebo

cyclosporin A

cyclosporin A

cyclosporin

cyclosporin A

cyclosporin A

placebo

cyclosporin A

glomerular filtration rate

renal plasma flow

lithium clearance

fractional proximal reabsorption

fractional distal sodium reabsorption

blood glucose control

glomerular filtration rate

type 1 diabetes mellitus .

Type 1 diabetes mellitus

1 diabetic


A simplified approach to virtual colonoscopy using different intestinal preparations : preliminary experience with regard to quality , accuracy and patient acceptability . PURPOSE The authors assessed the quality , diagnostic accuracy and patient acceptability of computed tomography ( CT ) colonography performed using a simplified bowel preparation and software for post-processing digital elimination of stool and fluid data from images compared with the examination obtained with conventional preparation . MATERIALS AND METHODS Two groups of 40 consecutive asymptomatic patients aged between 48 and 72 years underwent CT colonography . In group A , the CT scan was performed with conventional bowel preparation ( a full cathartic dose and oral contrast medium to tag any residue in the 3 days preceding the study ) . In the second group , CT colonography was performed after a reduced bowel preparation , with the oral contrast medium for residue tagging being administered only on the day of the investigation . Examination quality , diagnostic performance and patient acceptability ( rated with a self-completed questionnaire ) in the two groups of patients were compared by using the McNemar test . RESULTS No significant difference was obtained with regard to examination quality ( 180 vs. 165 segments free from stools and fluid , p > 0.05 ) and overall diagnostic accuracy ( 16/17 colonic polyps detected in group A and 12/13 in group B , p > 0.05 ) . The questionnaires revealed a greater acceptability of the reduced bowel preparation compared with the standard procedure ( p=0.01 ) . CONCLUSIONS In asymptomatic patients , the use of software for post-processing digital elimination of residue from images in conjunction with reduced bowel preparation does not reduce examination quality or diagnostic performance when compared with the conventional CT colonography technique and is more acceptable to and better tolerated by the patient .

computed tomography ( CT ) colonography

CT colonography

standard procedure

conventional CT colonography technique

Examination quality

diagnostic performance

examination quality

overall diagnostic accuracy

bowel preparation

examination quality

diagnostic performance

acceptable

tolerated

aged between 48 and 72 years


Tramadol suppository versus placebo for the relief of perineal pain after perineorrhaphy : a randomized controlled trial in Thailand . OBJECTIVE This randomized double-blinded control trial was conducted to compare the effectiveness of tramodol and placebo rectal suppository for the management of postpartum perineal pain after perineorrhaphy . MATERIAL AND METHOD One hundred women who gave birth vaginally with episiotomy and a second- or third-degree tear , were randomly assign to receive two tablets oftramadol 50 mg or two tablets ofplacebo , the pill were physically similar to the real drug . Pain ratings were recorded immediately after perineorrhaphy , 30 minutes , and 1 , 2 , 6 , 12 and 24 hours after first dose on a 10-cm visual analogue scale . Side effects and overall opinion were assessed . RESULTS Tramadol and placebo had no statistical significances in analgesic properties , assessed by the means of pain rating at the different time intervals . There were no serious adverse events reported . CONCLUSION No differences were found in between Tramadol and placebo in relief perineal pain after perineorrhaphy

Tramadol suppository

placebo

tramodol

placebo

oftramadol 50 mg

two tablets ofplacebo

Tramadol

placebo

perineal pain

effectiveness

postpartum perineal pain

Pain ratings

visual analogue scale .

Side effects and overall opinion

analgesic properties

pain rating

no serious adverse events

perineal pain

women

second- or third-degree tear


A randomised non-inferiority controlled trial of a single versus a four intradermal sterile water injection technique for relief of continuous lower back pain during labour . BACKGROUND Almost one third of women suffer continuous lower back pain during labour . Evidence from three systematic reviews demonstrates that sterile water injections ( SWI ) provide statistically and clinically significant pain relief in women experiencing continuous lower back pain during labour . The most effective technique to administer SWI is yet to be determined . Therefore , the aim of this study is to determine if the single injection SWI technique is no less effective than the routinely used four injection SWI method in reducing continuous lower back pain during labour . METHODS/DESIGN The trial protocol was developed in consultation with an interdisciplinary team of clinical researchers . We aim to recruit 319 women presenting at term , seeking analgesia for continuous severe lower back pain during labour . Participants will be recruited from two major maternity hospitals in Australia . Randomised participants are allocated to receive a four or single intradermal needle SWI technique . The primary outcome is the change in self-reported pain measured by visual analogue scale at baseline and thirty minutes post intervention . Secondary outcomes include VAS change scores at 10 , 60 , 90 and 120 min , analgesia use , mode of birth and maternal satisfaction . STATISTICAL ANALYSIS Sample size was calculated to achieve 90 % power at an alpha of 0.025 to detect a non-inferiority margin of ≤1 cm on the VAS , using a one-sided , two-sample t-test . Baseline demographic and clinical characteristics will be analysed for comparability between groups . Differences in primary ( VAS pain score ) and secondary outcomes between groups will be analysed by intention to treat and per protocol analysis using Student 's t-test and ANOVA . CONCLUSION This study will determine if a single intradermal SWI technique is no less effective than the routinely used four injection technique for lower back pain during labour . The findings will allow midwives to offer women requesting SWI during labour an evidence-based alternative technique more easily administered by staff and accepted by labouring women . TRIAL REGISTRATION ACTRN12609000964213 .

sterile water injection technique

sterile water injections ( SWI )

SWI

SWI

intradermal needle SWI technique

pain relief

change in self-reported pain

visual analogue scale

analgesia use

mode of birth

maternal satisfaction

women

women


Fecal butyrate levels vary widely among individuals but are usually increased by a diet high in resistant starch . Butyrate and other SCFA produced by bacterial fermentation of resistant starch ( RS ) or nonstarch polysaccharides ( NSP ) promote human colonic health . To examine variation in fecal variables , especially butyrate , among individuals and the response to these fibers , a randomized cross-over study was conducted that compared the effects of foods supplying 25 g of NSP or 25 g of NSP plus 22 g of RS/d over 4 wk in 46 healthy adults ( 16 males , 30 females ; age 31-66 y ) . Fecal SCFA levels varied widely among participants at entry ( butyrate concentrations : 3.5-32.6 mmol/kg ; butyrate excretions : 0.3-18.2 mmol/48 h ) . BMI explained 27 % of inter-individual butyrate variation , whereas protein , starch , carbohydrate , fiber , and fat intake explained up to 16 , 6 , 2 , 4 , and 2 % of butyrate variation , respectively . Overall , acetate , butyrate , and total SCFA concentrations were higher when participants consumed RS compared with entry and NSP diets , but individual responses varied . Individual and total fecal SCFA excretion , weight , and moisture were higher than those for habitual diets when either fiber diet was consumed . SCFA concentrations ( except butyrate ) and excretions were higher for males than for females . Butyrate levels increased in response to RS in most individuals but often decreased when entry levels were high . Fecal butyrate and ammonia excretions were positively associated ( ( 2 ) = 0.76 ; P < 0.001 ) . In conclusion , fecal butyrate levels vary widely among individuals but consuming a diet high in RS usually increases levels and may help maintain colorectal health .

diet high in resistant starch

Fecal butyrate levels

human colonic health

fecal variables

butyrate

Fecal SCFA levels

acetate

butyrate

total SCFA concentrations

weight

moisture

SCFA concentrations ( except butyrate )

excretions

Butyrate levels

Fecal butyrate

ammonia excretions

fecal butyrate levels

colorectal health


Calcium channel blocker inhibition of AGE and RAGE axis limits renal injury in nondiabetic patients with stage I or II chronic kidney disease . BACKGROUND There is a growing body of evidence that advanced glycation end products ( AGE ) and their receptor ( RAGE ) system are implicated in chronic kidney disease ( CKD ) . We have previously found that a long-acting calcium channel blocker , azelnidipine , but not amlodipine , improves renal injury in CKD patients . However , little is known about the effect of azelnidipine on the AGE-RAGE axis in humans . In this study , we examined whether azelnidipine addition could have renoprotective properties in hypertensive CKD patients by reducing serum levels of AGE and soluble form of RAGE ( sRAGE ) . Thirty nondiabetic stage I or II CKD patients who had already been treated with angiotensin II receptor blockers were enrolled in this study . HYPOTHESIS We hypothesized that azelnidipine treatment could limit renal injury partly by blocking the AGE-RAGE axis . METHODS Patients were randomly divided into 2 groups ; one group was treated with 16 mg azelnidipine and the other with 5 mg amlodipine once daily . They were followed up for 6 months . RESULTS Proteinuria was positively correlated with circulating AGE and sRAGE levels in our subjects . Both drugs exhibited comparable and significant blood pressure ( BP ) -lowering effects . Although neither of them affected glucose , glycated hemoglobin , lipid levels , and estimated glomerular filtration rate , treatment with azelnidipine , but not amlodipine , decreased circulating AGE , sRAGE , proteinuria , and urinary levels of liver-type fatty acid binding protein , a marker of tubular injury , in a BP-lowering-independent manner . CONCLUSIONS Our present results suggest that azelnidipine may exert renoprotective properties in nondiabetic hypertensive CKD patients via its unique inhibitory effects on the AGE-RAGE axis .

AGE

RAGE

azelnidipine

azelnidipine

azelnidipine

azelnidipine

amlodipine

azelnidipine

amlodipine

azelnidipine

renal injury

renal injury

AGE-RAGE axis

AGE-RAGE axis

Proteinuria

circulating AGE and sRAGE levels

blood pressure ( BP ) -lowering effects

renoprotective properties

nondiabetic

stage I or II chronic kidney disease

Thirty

nondiabetic stage I or II CKD patients

nondiabetic hypertensive CKD patients


Quantification of cyproheptadine in human plasma by high-performance liquid chromatography coupled to electrospray tandem mass spectrometry in a bioequivalence study . A rapid , sensitive and specific method to quantify cyproheptadine in human plasma using amitriptyline as the internal standard ( IS ) is described . The analyte and the IS were extracted from plasma by liquid-liquid extraction using a diethyl-ether/dichloromethane ( 70/30 ; v/v ) solvent . After removing and drying the organic phase , the extracts were reconstituted with a fixed volume of acetonitrile/water ( 50/50 v/v ) +0.1 % of acetic acid . The extracts were analyzed by high performance liquid chromatography coupled to electrospray tandem mass spectrometry ( LC-MS/MS ) . Chromatography was performed isocratically using an Alltech Prevail C18 5 µm analytical column , ( 150 mm x 4.6 mm I.D. ) . The method had a chromatographic run time of 4 min and a linear calibration curve ranging from 0.05 to 10 ng/mL ( r2 > 0.99 ) . The limit of quantification was 0.05 ng/mL . This HPLC/MS/MS procedure was used to assess the bioequivalence of cyproheptadine in two cyproheptadine + cobamamide ( 4 mg + 1 mg ) tablet formulations ( Cobactin® [ cyproheptadine + cobamamide ] test formulation supplied from Zambon Laboratórios Farmacêuticos Ltda . and Cobavital® from Solvay Farma ( standard reference formulation ) ) . A single 4 mg + 1 mg [ cyproheptadine + cobamamide ] dose of each formulation was administered to healthy volunteers . The study was conducted using an open , randomized , two-period crossover design with a 1-week washout interval . Since the 90 % CI for Cmax and AUCs ratios were all within the 80-125 % bioequivalence limit proposed by the US Food and Drug Administration , it was concluded that the cyproheptadine test formulation ( Cobactin® ) is bioequivalent to the Cobavital® formulation for both the rate and the extent of absorption of cyproheptadine .

cyproheptadine

cyproheptadine

Chromatography

in human plasma


[ Results of three-year clinical study of prostamol uno efficacy and safety in patients with initial symptoms of prostatic adenoma and risk of its progression ] . Prostamol Uno ( PU ) efficacy and safety were studied in a multicenter , open-population , randomized and comparative trial . PU was given in a single daily dose 320 mg for 36 months to 50 patients with initial symptoms of prostatic adenoma ( PA ) in comparison with 50 matched controls . The trial evaluated PU action on the symptoms progression and quality of life with application of questionnaires IPSS and QoL ( BS ) . It was found that PU treatment relieved PA symptoms by IPSS , while these symptoms progressed in the controls . QoL improved in the study group and deteriorated in the control one . Administration of PU significantly increased urinary flow rate though in the controls urinary flow rate decreased , size of the prostate diminished and increased , respectively . Changes in the PSA were not seen and were insignificant , respectively . The results of the study say that prostamol Uno in a dose 320 mg/day can prevent PA progression without side effects .

prostamol uno

Prostamol Uno ( PU )

PU

PU

efficacy

safety

efficacy

safety

symptoms progression

quality of life

questionnaires IPSS and

QoL ( BS )

QoL

urinary flow rate

urinary flow rate

size of the prostate

PSA

side effects

50 patients

prostatic adenoma ( PA )

50 matched controls


[ Using gaviscon preparation for relief of esophageal , extraesophageal syndromes and functional dyspepsia in elderly patients with GERD ] . OBJECTIVE To compare the clinical efficacy of alginate drug Geviskon and aluminum-magnesium antacids to relieve symptoms of esophageal , extraesophageal syndrome and functional dyspepsia at 3 and 7 days of study in patients with GERD elderly . MATERIALS AND METHODS An open , longitudinal , randomized , parallel-group . The study included 60 patients with " A " degree of ERD , consistently received in-patient treatment in the Municipal KGVV , mean age 79.0 +/- 6.8 years . During the first 12 hours of hospital stay by " sealed envelopes " them randomly divided into equal groups of comparison , given 3 times a day : alginate product -- Geviskon forte dose of 10 ml and aluminum-magnesium antacid drug at a dose of 1 sachet . Assess the frequency and severity of esophageal symptoms , extraesophageal syndrome , functional dyspepsia at 3 and 7 days of study on 5-point scale Likert . The degree of esophageal mucosal injury was determined during endoscopy before the study . RESULTS The technique of alginate compared with antacids provided significantly more complete and earlier effect on the relief of heartburn , regurgitation , chronic cough , sore throat , and EBS . Only Geviskon influenced the symptoms of PPD in patients with GERD . CONCLUSION The clinical features Geviskon the frequency and timing of relief of symptoms of esophageal , extraesophageal syndrome , functional dyspepsia with GERD in the older age groups is higher than that of antacids . Suspension Geviskon may be recommended in patients with middle and old age as an effective and safe symptomatic funds in the first days of exchange rate earlier generations of PPI therapy , as well as monotherapy -- to maintain remission .

gaviscon preparation

Geviskon

aluminum-magnesium antacids

antacids

Geviskon

frequency

degree of esophageal mucosal injury

esophageal

extraesophageal syndrome

functional dyspepsia

elderly patients with GERD ]


Superior fixation of pegged trabecular metal over screw-fixed pegged porous titanium fiber mesh : a randomized clinical RSA study on cementless tibial components . BACKGROUND AND PURPOSE Lasting stability of cementless implants depends on osseointegration into the implant surface , and long-term implant fixation can be predicted using radiostereometric analysis ( RSA ) with short-term follow-up . We hypothesized that there would be improved fixation of high-porosity trabecular metal ( TM ) tibial components compared to low-porosity titanium pegged porous fiber-metal ( Ti ) polyethylene metal backings . METHODS In a prospective , parallel-group , randomized unblinded clinical trial , we compared cementless tibial components in patients aged 70 years and younger with osteoarthritis . The pre-study sample size calculation was 22 patients per group . 25 TM tibial components were fixed press-fit by 2 hexagonal pegs ( TM group ) and 25 Ti tibial components were fixed press-fit and by 4 supplemental screws ( Ti group ) . Stereo radiographs for evaluation of absolute component migration ( primary effect size ) and single-direction absolute component migration ( secondary effect size ) were obtained within the first postoperative week and at 6 weeks , 6 months , 1 year , and 2 years . American Knee Society score was used for clinical assessment preoperatively , and at 1 and 2 years . RESULTS There were no intraoperative complications , and no postoperative infections or revisions . All patients had improved function and regained full extension . All tibial components migrated initially . Most migration of the TM components ( n = 24 ) occurred within the first 3 months after surgery whereas migration of the Ti components ( n = 22 ) appeared to stabilize first after 1 year . The TM components migrated less than the Ti components at 1 year ( p = 0.01 ) and 2 years ( p = 0.004 ) . INTERPRETATION We conclude that the mechanical fixation of TM tibial components is superior to that of screw-fixed Ti tibial components . We expect long-term implant survival to be better with the TM tibial component .

pegged trabecular metal

cementless tibial components

TM

TM

Ti

TM

Ti

Ti

TM

stability

fixation

American Knee Society score

intraoperative complications

no postoperative infections

revisions

migrated

migration of the TM components

long-term implant survival

All patients


Efficacy and safety of transient ulnar artery compression to recanalize acute radial artery occlusion after transradial catheterization . Radial artery occlusion ( RAO ) can result from transradial catheterization . We compared the incidence of RAO with 2 heparin dosage regimens after transradial coronary angiography , and we evaluated the efficacy and safety of transient homolateral ulnar artery compression to achieve acute radial artery recanalization . Patients referred for coronary angiography were randomized to very-low-dose heparin ( 2,000 IU ) or low-dose heparin ( 5,000 IU ) . On sheath removal , hemostasis was obtained using the TR band with a plethysmography-guided patent hemostasis technique . In the case of RAO as assessed by duplex ultrasonography 3 to 4 hours after hemostasis , immediate 1-hour ulnar artery compression was applied . Hematomas > 15 cm ( 2 ) were also assessed . We randomized 465 patients , 222 in the 2,000-IU group and 243 in the 5,000-IU group . The baseline and procedural characteristics were comparable in both groups . The incidence of initial RAO was 5.9 % in the 2,000-IU group and 2.9 % in the 5,000-IU group ( p = 0.17 ) , with a compression time of 2.10 ± 0.78 hours and 2.25 ± 0.82 hours , respectively ( p = 0.051 ) . After ulnar artery compression , the final incidence of RAO was 4.1 % in the 2,000-IU group and 0.8 % in the 5,000-IU group ( p = 0.03 ) . The incidence of local hematoma was 2.3 % and 3.7 % in the 2,000- and 5,000-IU groups , respectively ( p = 0.42 ) . In conclusion , acute RAO after transradial catheterization can be recanalized by early 1-hour homolateral ulnar artery compression . This simple nonpharmacologic method was effective and safe in patients with very-low- and low-dose heparin . Nevertheless , the incidence of final RAO remained significantly lower after a higher anticoagulation level .

transient ulnar artery compression

very-low-dose heparin

low-dose heparin

incidence of initial RAO

465 patients


Microbial protein synthesis , nitrogen capture efficiency and nutrient utilisation in sheep fed on finger millet straw ( Eleucine coracana ) -based diet with different rumen-degradable nitrogen levels . BACKGROUND Microbial protein synthesised in the rumen is a very important protein source for ruminants . It is essential to provide an adequate amount of rumen-degradable nitrogen ( RDN ) for optimum microbial protein synthesis in the rumen on straw-based diets . The objective of this study was to determine the RDN requirement for optimum microbial protein synthesis ( MPS ) , nitrogen capture efficiency ( NCE ) and nutrient utilisation in Nellore rams fed on a finger millet straw ( FMS ) -based diet . RESULTS Thirty-six Nellore sheep were randomly divided into four groups of nine animals each using a balanced , completely randomised design . The animals in group 1 ( RDN0 ) were fed with ad libitum FMS . Those in groups 2 , 3 and 4 ( RDN1 , RDN2 and RDN3 ) were supplemented with groundnut cake to provide RDN levels of 14 , 18 and 23 g RDN kg⁻¹ digestible organic matter intake ( DOMI ) or 21 , 27 and 35 g RDN kg⁻¹ digestible organic matter apparently digested in the rumen ( DOMR ) respectively along with FMS . The digestibility coefficients of all nutrients and MPS increased ( P < 0.05 ) quadratically with increasing level of RDN supplementation . NCE decreased linearly ( P < 0.05 ) as the level of RDN increased . CONCLUSION The results suggest that 12 g RDN kg⁻¹ DOMI or 19 g RDN kg⁻¹ DOMR may be adequate for optimum MPS , NCE and digestibility of nutrients in sheep fed on an FMS-based diet .

finger millet straw ( FMS ) -based diet

ad libitum FMS

groundnut cake

RDN levels


The effect of pain-free treadmill training on fibrinogen , haematocrit , and lipid profile in patients with claudication . OBJECTIVE To assess the effect of pain-free treadmill training on changes of plasma fibrinogen , haematocrit , lipid profile , and walking ability in patients with claudication . DESIGN Randomized control trial . METHODS Sixty-eight patients with peripheral obstructive arterial disease and intermittent claudication ( Fontaine stage II ) were randomly assigned into the treadmill training ( repetitive intervals to onset of claudication pain , three times a week ) or a control group ( no change in physical activity ) over 3 months . Both groups performed treadmill test to assess pain-free walking time ( PFWT ) and maximal walking time ( MWT ) and had blood analyses [ for haematocrit , fibrinogen , triglycerides , and cholesterol : total , high-density lipoprotein ( HDL ) and low-density lipoprotein ( LDL ) ] done at baseline and after 6 and 12 weeks of the study . RESULTS Total and LDL cholesterol levels in the training group decreased ( p < 0.05 ) by 14.8 % and 20,5 % , respectively . Significant ( p < 0.05 ) HDL cholesterol increased ( 14.6 % ) and triglycerides decreased ( 19 % ) in the training group but changes of all these lipids were insignificant in the control group over the 3 months . Haematocrit and fibrinogen changes were insignificant in both groups . PFWT was prolonged by 109 % and MWT increased by 54 % in the training group ( p < 0.01 ) , but not in the control group . CONCLUSION The improvement in walking time over 3 months of pain-free treadmill training parallels with progressive normalization of lipid profiles in patients with claudication .

pain-free treadmill training

pain-free treadmill training

treadmill training

control group

no change in physical activity

treadmill

pain-free walking time ( PFWT )

maximal walking time ( MWT )

Total and LDL cholesterol levels

HDL cholesterol

triglycerides

Haematocrit

fibrinogen

claudication

Sixty-eight

peripheral obstructive arterial disease

intermittent claudication


Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders : a pilot study . BACKGROUND AND AIMS This pilot study tested the efficacy of a developmentally modified CBT for young children with Autism Spectrum Disorders ( ASD ) to teach emotion regulation strategies for reducing anger and anxiety , commonly noted problems in this population . METHOD Eleven 5-7 year-old children participated in a CBT-group while parents participated in psychoeducation . Children were randomly assigned to an experimental or delayed-treatment control group . RESULTS From pre- to post-treatment , all children had less parent reported negativity/lability , better parent reported emotion regulation , and shorter outbursts , and also generated more coping strategies in response to vignettes . Parents also reported increases in their own confidence and their child 's ability to deal with anger and anxiety . CONCLUSIONS This study suggests that young children with high functioning ASD may benefit from CBT to improve regulation of anger and anxiety , and parent training may improve parental self-efficacy . Future studies are needed to make conclusions about its efficacy .

CBT

participated in psychoeducation

emotion regulation

emotion regulation

anger

anxiety

negativity/lability

emotion regulation

shorter outbursts

generated more coping strategies

confidence

ability to deal with anger and anxiety

regulation of anger and anxiety

parental self-efficacy


Specific exercises to treat pregnancy-related low back pain in a South African population . OBJECTIVE To investigate the effect of an exercise program , including specific stabilizing exercises , on pain intensity and functional ability in women with pregnancy-related low back pain . METHODS Fifty women between 16 and 24 weeks of pregnancy were recruited at Tygerberg and Paarl Hospitals , Western Cape , South Africa . Twenty-six women were randomized to a 10-week exercise program and 24 were randomized as controls . RESULTS Overall , the most frequent type of back pain experienced was lumbar pain ( 36 [ 72.0 % ] ) . Pain intensity ( P=0.76 ) and functional ability ( P=0.29 ) were comparable between the groups on study entry . In the study group , there was a significant improvement in pain intensity ( P < 0.01 ) and an improvement in functional ability ( P=0.06 ) at the end of the study . In the control group , there were no significant changes in pain intensity ( P=0.89 ) or functional ability ( P=0.70 ) at the end of the study . CONCLUSION A specific exercise program decreased back pain intensity and increased functional ability during pregnancy in South African women with lumbar and pelvic girdle pain .

Specific exercises

10-week exercise program and

controls .

specific exercise program

lumbar pain

Pain intensity

functional ability

pain intensity

functional ability

pain intensity

functional ability

women

pregnancy-related low back pain

Fifty

Twenty-six women

lumbar and pelvic girdle pain


Concurrent alcohol dependence among methadone-maintained cocaine abusers is associated with greater abstinence . Concurrent alcohol dependence ( AD ) among polysubstance abusers has been associated with negative consequences , although it may not necessarily lead to poor treatment outcomes . One of the most efficacious treatments for cocaine abuse is contingency management ( CM ) , but little research has explored the impact of AD on abstinence outcomes , particularly among patients in methadone maintenance . Using data from three trials of CM for cocaine use , we compared baseline characteristics and posttreatment and follow-up cocaine outcomes between methadone-maintained , cocaine-dependent patients ( N = 193 ) with and without concurrent AD , randomized to standard care ( SC ) with or without CM . Patients with and without concurrent AD had similar baseline characteristics , with the exception that AD patients reported more alcohol use . AD patients achieved longer durations of cocaine abstinence and were more likely to submit a cocaine-negative sample at follow-up than non-AD patients . Patients randomized to CM achieved better outcomes than those randomized to SC , but there was no interaction between treatment condition and AD status . These findings suggest that cocaine-using methadone patients with AD achieve greater cocaine abstinence than their non-AD counterparts and should not necessarily be viewed as more difficult to treat .

alcohol dependence ( AD )

abstinence .

abstinence outcomes

durations of cocaine abstinence

cocaine-negative sample

outcomes

cocaine abstinence


Direct trocar insertion vs. Verres needle use for laparoscopic sterilization . A randomized , prospective trial was designed to compare direct trocar insertion with prior peritoneal insufflation with a Verres needle for laparoscopic tubal sterilization . Direct trocar insertion resulted in fewer instrument insertions ( 21.8 % vs. 7.8 % ) and use of smaller volumes of CO2 ( 2.67 vs. 2.32 L ) . Direct trocar use resulted in a decrease in operating time from 9 minutes , 40 seconds in the needle group to 7 minutes , 30 seconds in the trocar group . Minor omental injuries occurred in a small percentage of each group , while serious complications occurred once in each group .

Direct trocar insertion

Verres needle use

Direct trocar insertion

Direct trocar

instrument insertions

smaller volumes of CO2

operating time

Minor omental injuries

laparoscopic sterilization

laparoscopic tubal sterilization

omental injuries