Effectiveness of a theory-based intervention to increase colorectal cancer screening among Iranian health club members : a randomized trial . Colorectal cancer is the third most commonly diagnosed cancer and the fourth leading cause of death in the world . There are few published studies that have used theory-based interventions designed to increase colorectal cancer screening in community lay health organizations . The present study was guided by the theoretical concepts of the preventive health model . Twelve health clubs of a municipal district in Tehran were randomized to two study groups with equal ratio . The control group received usual services throughout the study while the intervention group also received a theory-based educational program on colorectal cancer screening plus a reminder call . Screening behavior , the main outcome , was assessed 4 months after randomization . A total of 360 members aged 50 and older from 12 health clubs completed a baseline survey . Participants in the intervention group reported increased knowledge of colorectal cancer and screening tests at 4 months follow-up ( p 's < .001 ) . Moreover , exposure to the theory-based intervention significantly improved self-efficacy , perceived susceptibility , efficacy of screening , social support , and intention to be screened for colorectal cancer , from baseline to 4 months follow-up ( p 's < .001 ) . The screening rate for colorectal cancer was significantly higher in the intervention group compared to the control group ( odds ratio = 15.93 , 95 % CI = 5.57 , 45.53 ) . Our theory-based intervention was found to have a significant effect on colorectal cancer screening use as measured by self-report . The findings could have implications for colorectal cancer screening program development and implementation in primary health care settings and through other community organizations .

theory-based intervention

theory-based interventions

theory-based intervention

colorectal cancer screening

Screening behavior

screening rate for colorectal cancer

colorectal cancer screening

colorectal cancer screening

members

Twelve

total of 360 members

aged 50 and older


[ Treatment of autism children : observation on efficacy of behavior training with retention of needles on head ] . OBJECTIVE To observe the effect difference of behavior training with head needling retention and behavior training after acupuncture for autism children . METHODS Sixty qualified autism children were divided randomly into simultaneous head needling retention and behavior training group ( trial group ) and behavior training after acupuncture treatment group ( control group ) with 30 case in each group . Retention needles on the head with simultaneous behavior training was applied for the trial group . The main acupoints included Sishen Xue , Dingshen Sanxue ( 3 points for mental tranquilization ) , Nao Sanxue ( 3 points for the function of brain ) , Shou Zhisanxue ( 3 points for mental activities on hand ) and Zozhi Sonxue ( 3 points for mental activities on foot ) . Other points were combined according to conditions of patients . Needles on the 4 extremities were withdrawn first after 30 minutes , needles on head were remained during behavior training . While behavior training was applied to the control group when acupuncture treatment was completely accomplished . Treatments were applied once a day to both groups . And 3 months was taken as one observation cycle . Estimation was made on therapeutic effect and developing level of autism children with CARS and PEP . RESULTS The total effective rate of the trial group was 83.3 % ( 25/30 ) , better than 66.7 % ( 20/30 ) of the control group ( P < 0.05 ) . The CARS scores of both groups declined after the treatment . And the score of trail group was lower than the control group ( all P < 0.05 ) . While the PEP scores of both groups increased , and the score of trail group was higher than the control group ( all P < 0.05 ) . The increasing level of scores of cognitive understanding and cognitive expression were all better than the control group ( all P < 0.05 ) . CONCLUSION The effect of behavior training with head needle retention on autism children is better than behavior training after acupuncture treatment , especially in enhancing cognition understanding and cognition expression .

behavior training

retention of needles on head ]

behavior training after acupuncture

Retention needles

behavior training .

behavior training

behavior training

therapeutic effect

total effective rate

CARS scores

PEP scores

autism children :

autism children .

Sixty qualified autism children

autism children


A randomized controlled trial of group Stepping Stones Triple P : a mixed-disability trial . Stepping Stones Triple P ( SSTP ) is a parenting program designed for families of a child with a disability . The current study involved a randomized controlled trial of Group Stepping Stones Triple P ( GSSTP ) for a mixed-disability group . Participants were 52 families of children diagnosed with an Autism Spectrum Disorder , Down syndrome , Cerebral Palsy , or an intellectual disability . The results demonstrated significant improvements in parent-reported child behavior , parenting styles , parental satisfaction , and conflict about parenting . Results among participants were similar despite children 's differing impairments . The intervention effect was maintained at 6-month follow-up . The results indicate that GSSTP is a promising intervention for a mixed-disability group . Limitations of the study , along with areas for future research , are also discussed .

Stepping Stones Triple P

Stepping Stones Triple P ( SSTP )

GSSTP

parent-reported child behavior

parenting styles

parental satisfaction

conflict about parenting

52 families of children

Autism Spectrum Disorder

Down syndrome

Cerebral Palsy

intellectual disability


Effect of phrenic nerve palsy on early postoperative lung function after pneumonectomy : a prospective study . BACKGROUND The issue of phrenic nerve preservation during pneumonectomy is still an unanswered question . So far , its direct effect on immediate postoperative pulmonary lung function has never been evaluated in a prospective trial . METHODS We conducted a prospective crossover study including 10 patients undergoing pneumonectomy for lung cancer between July 2011 and July 2012 . After written informed consent , all consecutive patients who agreed to take part in the study and in whom preservation of the phrenic nerve during operation was possible , were included in the study . Upon completion of lung resection , a catheter was placed in the proximal paraphrenic tissue on the pericardial surface . After an initial phase of recovery of 5 days all patients underwent ultrasonographic assessment of diaphragmatic motion followed by lung function testing with and without induced phrenic nerve palsy . The controlled , temporary paralysis of the ipsilateral hemidiaphragm was achieved by local administration of lidocaine 1 % at a rate of 3 mL/h ( 30 mg/h ) via the above-mentioned catheter . RESULTS Temporary phrenic nerve palsy was accomplished in all but 1 patient with suspected catheter dislocation . Spirometry showed a significant decrease in dynamic lung volumes ( forced expiratory volume in 1 second and forced vital capacity ; p < 0.05 ) with the paralyzed hemidiaphragm . Blood oxygen saturation levels did not change significantly . CONCLUSIONS Our results show that phrenic nerve palsy causes a significant impairment of dynamic lung volumes during the early postoperative period after pneumonectomy . Therefore , in these already compromised patients , intraoperative phrenic nerve injury should be avoided whenever possible .

pneumonectomy

pneumonectomy

ultrasonographic

pneumonectomy

pneumonectomy

lung cancer

phrenic nerve


Randomized study of continuous infusion fluorouracil versus fluorouracil plus cisplatin in patients with metastatic colorectal cancer . One hundred twenty-two chemotherapy-naive patients with histologically confirmed colorectal adenocarcinoma were entered into a randomized trial comparing infusional fluorouracil ( FU ) versus cisplatin ( CDDP ) and FU . In both groups , patients received continuous infusion FU 1,000 mg/m2/d for 5 consecutive days every 4 weeks . Patients randomized to CDDP/FU also received CDDP 20 mg/m2 intravenous ( IV ) bolus on days 1 to 5 of each cycle . Patients were comparable in terms of age , performance status , baseline laboratory values , dominant sites of measurable disease , and percent of liver involvement . The partial response rate was significantly greater in patients who received CDDP/FU versus FU alone ( 25 % v 3 % , P = .001 ) . Patients who received CDDP/FU experienced significantly greater toxicity compared with FU alone : grades 3 and 4 hematologic toxicity occurred in 22 % and 0 % of patients , respectively ( P = .0001 ) ; grades 2 to 4 nausea and vomiting occurred in 80 % and 15 % of patients , respectively ( P = .0001 ) . There were no significant differences in either the duration of response ( median , 6 and 4.7 months for CDDP/FU and FU groups , respectively ) or survival ( median 10 , and 12 months , respectively ) . Compared with infusional FU alone , CDDP/FU provided a significantly greater partial response rate with increased toxicity , but it did not improve overall survival in patients with advanced colorectal carcinoma . Therefore , the use of CDDP/FU as routine therapy for the treatment of colorectal carcinoma can not be recommended .

continuous infusion fluorouracil

fluorouracil plus cisplatin

infusional fluorouracil ( FU )

cisplatin ( CDDP )

FU

FU

CDDP/FU

CDDP

CDDP/FU

FU

CDDP/FU

FU

CDDP/FU

FU

FU

CDDP/FU

CDDP/FU

partial response rate

greater toxicity

grades 3 and 4 hematologic toxicity

nausea and vomiting

duration of response

survival

partial response rate

increased toxicity

overall survival

metastatic colorectal cancer

One hundred twenty-two

colorectal adenocarcinoma

advanced colorectal carcinoma


[ It is difficult to predict the effect of minoxidil liniment on hair loss in men ] .

minoxidil liniment

hair loss


Baseline factors predicting placebo response to treatment in children and adolescents with autism spectrum disorders : a multisite randomized clinical trial . IMPORTANCE The finding of factors that differentially predict the likelihood of response to placebo over that of an active drug could have a significant impact on study design in this population . OBJECTIVE To identify possible nonspecific , baseline predictors of response to intervention in a large randomized clinical trial of children and adolescents with autism spectrum disorders . DESIGN , SETTING , AND PARTICIPANTS Randomized clinical trial of citalopram hydrobromide for children and adolescents with autism spectrum disorders and prominent repetitive behavior . Baseline data at study entry were examined with respect to final outcome to determine if response predictors could be identified . A total of 149 children and adolescents 5 to 17 years of age ( mean [ SD ] age , 9.4 [ 3.1 ] years ) from 6 academic centers were randomly assigned to citalopram ( n = 73 ) or placebo ( n = 76 ) . Participants had autistic disorder , Asperger syndrome , or pervasive developmental disorder , not otherwise specified ; had illness severity ratings that were moderate or more than moderate on the Clinical Global Impression-Severity scale ; and scored moderate or more than moderate on compulsive behaviors measured with the modified Children 's Yale-Brown Obsessive-Compulsive Scale . INTERVENTIONS Twelve weeks of treatment with citalopram ( 10 mg/5 mL ) or placebo . The mean ( SD ) maximum dose of citalopram was 16.5 ( 6.5 ) mg by mouth daily ( maximum dose , 20 mg/d ) . MAIN OUTCOMES AND MEASURES A positive response was defined as having a score of at least much improved on the Clinical Global Impression-Improvement scale at week 12 . Baseline measures included demographic ( sex , age , weight , and pubertal status ) , clinical , and family measures . Clinical variables included baseline illness severity ratings ( the Aberrant Behavior Checklist , the Child and Adolescent Symptom Inventory , the Vineland Adaptive Behavior Scales , the Repetitive Behavior Scale-Revised , and the Children 's Yale-Brown Obsessive-Compulsive Scale ) . Family measures included the Caregiver Strain Questionnaire . RESULTS Several baseline predictors of response were identified , and a principal component analysis yielded 3 composite measures ( disruptive behavior , autism/mood , and caregiver strain ) that significantly predicted response at week 12 . Specifically , participants in the placebo group were significantly less likely than participants in the citalopram group to respond at week 12 if they entered the study more symptomatic on each of the 3 composite measures , and they were at least 2 times less likely to be responders . CONCLUSIONS AND RELEVANCE This analysis suggests strategies that may be useful in anticipating and potentially mitigating the nonspecific response in randomized clinical trials of children and adolescents with autism spectrum disorders . TRIAL REGISTRATION clinicaltrials.gov Identifier : NCT00086645 .

placebo

citalopram hydrobromide

citalopram

placebo

citalopram

placebo

response to intervention

the Aberrant Behavior Checklist

Caregiver Strain Questionnaire


The effect of leukocyte reduction filters on inflammatory mediator release during coronary artery bypass grafting . BACKGROUND Extracorporeal circulation used during coronary artery bypass grafting triggers systemic inflammatory response with neutrophil activation which adversely affects ischaemic/reperfused myocardium . One method of myocardial protection during cardiac surgery is the use of blood cardioplegia . Its protective effect is related to cardiac cooling and metabolism reduction , oxygen supply from erythrocytes , and reactive oxygen species scavenging . However , blood cardioplegia is also associated with myocardial damage induced by undesirable morphotic blood elements . AIM To evaluate the effect of the use of leukocyte reduction filters on the activity of polymorphonuclear neutrophils ( PMN ) in patients undergoing surgical myocardial revascularisation . PMN activity was evaluated based on measurements of plasma activity of granulocyte enzymes , lysozyme and beta-glucuronidase . METHODS We studied 40 patients who underwent myocardial revascularisation using extracorporeal circulation . Patients were randomly assigned to two equal groups : in Group I , blood cardioplegia was administered using leukocyte reduction filters , and in Group II , leukocyte reduction filters were not used for blood cardioplegia . Measurements were performed in plasma of arterial and coronary sinus blood samples collected before aortic clamping , immediately after unclamping , and after 25 min of reperfusion . In addition , blood cardioplegic solution samples were collected in Group I from the lines proximal and distal to the filter during first and last administration . Plasma levels of lysozyme and beta-glucuronidase were determined using previously described methods . RESULTS We found a significant decrease in PMN count in filtered blood cardioplegic solution during its first administration ( 0.27 ± 0.07 G/L ) compared to samples collected before filter passage ( 1.73 ± 0.049 G/L ) . Also during last administration , PMN count in filtered blood cardioplegic solution was decreased compared to samples collected before filter passage ( 0.66 ± 0.35 G/L vs. 3.64 ± 1.14 G/L , respectively ) . Significantly lower ( p < 0.02 ) plasma beta-glucuronidase levels were found in arterial blood samples in Group I compared to Group II ( 5.59 ± 1.63 μg/mL immediately after aortic unclamping and 6.59 ± 1.98 μg/mL after 25 min of reperfusion in Group I vs. 10.19 ± 2.66 and 12.83 ± 1.88 μg/mL , respectively , in Group II ) . Beta-glucuronidase levels in coronary sinus blood samples collected after aortic unclamping and at the end of reperfusion were significantly higher in Group II compared to Group I ( p < 0.04 ) . In Group I , plasma lysozyme levels in arterial and venous blood samples did not show significant changes during the surgery . In contrast , plasma lysozyme level in coronary sinus blood samples at the end of reperfusion in Group II was significantly higher compared to that in pre-clamping samples ( p < 0.014 ) . CONCLUSIONS With the use of leukocyte reduction filters , we found significantly lower beta-glucuronidase levels in arterial and coronary sinus blood samples . These findings seem to confirm reduced PMN activation and/or reduced myocardial infiltration by activated PMN . Plasma levels of lysozyme , a characteristic product of PMN degranulation , did not show significant differences between the study groups .

leukocyte reduction filters

leukocyte reduction filters

extracorporeal circulation

PMN count

blood cardioplegic solution

surgical myocardial revascularisation

40 patients


Oxytocin promotes facial emotion recognition and amygdala reactivity in adults with asperger syndrome . The neuropeptide oxytocin has recently been shown to enhance eye gaze and emotion recognition in healthy men . Here , we report a randomized double-blind , placebo-controlled trial that examined the neural and behavioral effects of a single dose of intranasal oxytocin on emotion recognition in individuals with Asperger syndrome ( AS ) , a clinical condition characterized by impaired eye gaze and facial emotion recognition . Using functional magnetic resonance imaging , we examined whether oxytocin would enhance emotion recognition from facial sections of the eye vs the mouth region and modulate regional activity in brain areas associated with face perception in both adults with AS , and a neurotypical control group . Intranasal administration of the neuropeptide oxytocin improved performance in a facial emotion recognition task in individuals with AS . This was linked to increased left amygdala reactivity in response to facial stimuli and increased activity in the neural network involved in social cognition . Our data suggest that the amygdala , together with functionally associated cortical areas mediate the positive effect of oxytocin on social cognitive functioning in AS .

Oxytocin

neuropeptide oxytocin

placebo-controlled

intranasal oxytocin

functional magnetic resonance imaging

oxytocin

neurotypical control

neuropeptide oxytocin

oxytocin

facial emotion recognition

amygdala reactivity

eye gaze

and

emotion recognition

emotion recognition

modulate

performance in a

facial emotion recognition

task

increased left

amygdala reactivity

increased activity

neural network

social cognitive functioning

adults

asperger syndrome

healthy men .


Bismuth subsalicylate in the treatment of gastritis due to Campylobacter pylori . Fifty patients completed an investigator-blind trial comparing bismuth subsalicylate , erythromycin ethylsuccinate , and placebo matched to the bismuth salt in the treatment of gastritis associated with Campylobacter pylori . C. pylori was cleared from 14 ( 77.8 % ) of 18 patients given locally active bismuth , from one ( 6.7 % ) of 15 patients given erythromycin , and from none of 17 patients given placebo . Gastritis resolved in 13 ( 81 % ) of 16 patients treated with bismuth but in only three of 13 receiving erythromycin and in none of 16 patients given placebo . Results of endoscopic examination showed greater improvement in patients cleared of C. pylori than in those with persistent infection . Heartburn improved in 50 % of patients who received bismuth compared with 17 % of those given placebo . The success of bismuth is probably due to its local antimicrobial activity . Erythromycin may have been inactivated by the low pH in the areas colonized with C. pylori . Relapse is less frequent when a combination of bismuth and an antimicrobial agent is used ; such a combination is characterized by local and systemic activity , stability at low pH , and good penetration into gastric mucus .

Bismuth subsalicylate

bismuth subsalicylate

erythromycin ethylsuccinate

placebo

bismuth

active bismuth

erythromycin

placebo

bismuth

erythromycin

placebo

bismuth

placebo

bismuth

Erythromycin

bismuth

Heartburn

local antimicrobial activity

Relapse

local and systemic activity

stability at low pH

good penetration into gastric mucus


A shortened versus standard matched postpartum magnesium sulphate regimen in the treatment of eclampsia : a randomised controlled trial . Magnesium sulphate is currently the most ideal drug for the treatment of eclampsia but its use in Nigeria is still limited due its cost and clinicians inexperience with the drug . The purpose of this study was to determine whether a shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in controlling fits in eclampsia Between January and June 2011 , 98 eclamptic mothers presenting at the labour ward of the University of Maiduguri Teaching Hospital were randomised to receive either the standard Pritchard regimen of magnesium sulphate or a shortened postpartum course in which only two doses of intramuscular magnesium sulphate is given four hours apart . The maternal and fetal outcomes were compared . The primary outcome measure was recurrence of fits . The recurrence of fits and other maternal complications were similar in the two groups . The total dosage of magnesium sulphate in the shortened group was reduced by 40 % in 66 % of patients . The shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in the management of eclampsia .

postpartum magnesium sulphate regimen

Magnesium sulphate

magnesium sulphate

intramuscular magnesium sulphate

magnesium sulphate

magnesium sulphate

recurrence of fits

recurrence of fits

maternal complications

total dosage of magnesium sulphate

reduced

sulphate

effective

management of eclampsia


Effectiveness of nonpharmacologic treatments for acute seasonal allergic conjunctivitis . OBJECTIVE To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit and whether they were as effective as or could enhance topical antiallergic medication . DESIGN Randomized , masked clinical trial . PARTICIPANTS Eighteen subjects ( mean age , 29.5±11.0 years ) allergic to grass pollen . INTERVENTION Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by application of artificial tears ( ATs ) , 5 minutes of cold compress ( CC ) , ATs combined with CC , or no treatment applied at each separate visit in random order . A subset of 11 subjects also had epinastine hydrochloride ( EH ) applied alone and combined with CC in random order or instillation of a volume-matched saline control . MAIN OUTCOME MEASURES Bulbar conjunctival hyperemia , ocular surface temperature , and ocular symptoms repeated before and every 10 minutes after treatment for 1 hour . RESULTS Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with nonpharmaceutical treatments compared with no treatment ( P < 0.05 ) . Artificial tears combined with CC reduced hyperemia more than other treatments ( P < 0.05 ) . The treatment effect of EH was enhanced by combining it with a CC ( P < 0.001 ) . Cold compress combined with ATs or EH lowered the antigen-raised ocular surface temperature to less than the pre-exposure baseline . Artificial tear instillation alone or CC combined with ATs or EH significantly reduced the temperature ( P < 0.05 ) . Cold compress combined with ATs or EH had a similar cooling effect ( P > 0.05 ) . At all measurement intervals , symptoms were reduced for both EH and EH combined with CC than CC or ATs alone or in combination ( P < 0.014 ) . CONCLUSIONS After controlled exposure to grass pollen , CC and AT treatment showed a therapeutic effect on the signs and symptoms of allergic conjunctivitis . A CC enhanced the use of EH alone and was the only treatment to reduce symptoms to baseline within 1 hour of antigenic challenge . Signs of allergic conjunctivitis generally were reduced most by a combination of a CC in combination with ATs or EH .

nonpharmacologic treatments

topical antiallergic medication

epinastine hydrochloride

Bulbar conjunctival hyperemia

ocular surface temperature

ocular symptoms

Bulbar conjunctival hyperemia

ocular symptoms

hyperemia

ocular surface temperature


Early clinical outcomes and toxicity of intensity modulated versus conventional pelvic radiation therapy for locally advanced cervix carcinoma : a prospective randomized study . PURPOSE To evaluate the toxicity and clinical outcome in patients with locally advanced cervical cancer ( LACC ) treated with whole pelvic conventional radiation therapy ( WP-CRT ) versus intensity modulated radiation therapy ( WP-IMRT ) . METHODS AND MATERIALS Between January 2010 and January 2012 , 44 patients with International Federation of Gynecology and Obstetrics ( FIGO 2009 ) stage IIB-IIIB squamous cell carcinoma of the cervix were randomized to receive 50.4 Gy in 28 fractions delivered via either WP-CRT or WP-IMRT with concurrent weekly cisplatin 40 mg/m ( 2 ) . Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events , version 3.0 , and late toxicity was graded according to the Radiation Therapy Oncology Group system . The primary and secondary endpoints were acute gastrointestinal toxicity and disease-free survival , respectively . RESULTS Of 44 patients , 22 patients received WP-CRT and 22 received WP-IMRT . In the WP-CRT arm , 13 patients had stage IIB disease and 9 had stage IIIB disease ; in the IMRT arm , 12 patients had stage IIB disease and 10 had stage IIIB disease . The median follow-up time in the WP-CRT arm was 21.7 months ( range , 10.7-37.4 months ) , and in the WP-IMRT arm it was 21.6 months ( range , 7.7-34.4 months ) . At 27 months , disease-free survival was 79.4 % in the WP-CRT group versus 60 % in the WP-IMRT group ( P=.651 ) , and overall survival was 76 % in the WP-CRT group versus 85.7 % in the WP-IMRT group ( P=.645 ) . Patients in the WP-IMRT arm experienced significantly fewer grade ≥2 acute gastrointestinal toxicities ( 31.8 % vs 63.6 % , P=.034 ) and grade ≥3 gastrointestinal toxicities ( 4.5 % vs 27.3 % , P=.047 ) than did patients receiving WP-CRT and had less chronic gastrointestinal toxicity ( 13.6 % vs 50 % , P=.011 ) . CONCLUSION WP-IMRT is associated with significantly less toxicity compared with WP-CRT and has a comparable clinical outcome . Further studies with larger sample sizes and longer follow-up times are warranted to justify its use in routine clinical practice .

intensity modulated radiation therapy

WP-CRT

WP-IMRT

WP-CRT

WP-IMRT

WP-CRT

IMRT

WP-CRT

WP-IMRT

toxicity

clinical outcome

Acute toxicity

acute gastrointestinal toxicity

disease-free survival

disease-free survival

overall survival

locally advanced cervix carcinoma :


Local contextual processing in major depressive disorder . OBJECTIVE The study investigated local contextual processing in patients with major depressive disorder ( MDD ) . This was defined as the ability to utilize predictive contextual information to facilitate detection of predictable versus random targets . METHOD We recorded EEG in 15 MDD patients and 14 age-matched controls . Recording blocks consisted of targets preceded by randomized sequences of standards and by sequences of standards that included a predictive sequence signaling the occurrence of a subsequent target event . RESULTS Both MDD patients and age-matched controls demonstrated a significant reaction time ( RT ) and P3b latency differences between predicted and random targets . However , patients demonstrated a specific prolongation of these measures during processing of predicted targets , as well as an attenuation of P3b amplitudes for the predictive sequence . In addition , patients target N1 amplitudes were attenuated compared with controls . CONCLUSION MDD patients were able to utilize predictive context in order to facilitate processing of deterministic targets , however , this ability was limited compared to controls , as demonstrated by context-dependent P3b deficits . SIGNIFICANCE These findings suggest that patients with major depression have altered processing of local contextual processing .

EEG

controls

Local contextual processing

local contextual processing

significant

reaction time ( RT )

P3b latency

differences

specific

prolongation

attenuation of

P3b amplitudes

N1 amplitudes

were attenuated

utilize predictive context

ability was limited

15 MDD patients

14 age-matched controls


Intrathecal lentivirus-mediated transfer of interleukin-10 attenuates chronic constriction injury-induced neuropathic pain through modulation of spinal high-mobility group box 1 in rats . BACKGROUND Neuropathic pain is a complex state of chronic pain that is usually accompanied by peripheral and central nervous system damage or dysfunction . Previous studies have indicated that neuroinflammation in the spinal cord is an important contributor to neuropathological and behavioral abnormalities . A series of early inflammatory markers , such as IL-1 , TNF-α , and IFN-γ , and advanced inflammatory markers , such as high-mobility group box 1 ( HMGB1 ) , are involved in neuroinflammation . STUDY DESIGN A randomized , double blind , controlled animal trial . OBJECTIVE In this study , a lentivirus delivering human IL-10 ( LV/hIL-10 ) was administered intrathecally to determine the effects of IL-10 on allodynia and hyperalgesia in a chronic constriction injury-induced ( CCI ) rat model of neuropathic pain . METHODS Sprague-Dawley rats weighting 260 - 320 g were randomly divided into 4 groups . Group Sham ( Sham ) , Group CCI±Normal Saline ( NS ) , Group CCI±LV/hIL-10 ( LV/hIL-10 ) , and Group CCI±LV/control ( vector ) . Rats in each group were intrathecally delivered with NS , LV/control , or recombinant vector LV/hIL-10 in a total volume of 10 μl . Paw withdrawal mechanical thresholds ( PWMT ) and paw withdrawal thermal latency PWTL were measured one day before CCI ( baseline ) and 0 , 3 , 7 , 14 , and 28 days after intrathecal administration . Cerebrospinal fluid ( CSF ) samples were collected during surgical plane anesthesia and the collected CSF samples were used to assay for human IL-10 , rat IL-1β , rat IL-6 , and rat TNF-α by enzyme-linked immunosorbent assay ( ELISA ) . Animals were sacrificed and the L4-5 lumbar segment of the spinal cord was removed for determination of green fluorescent protein ( GFP ) expression . Immunohistochemical analysis was performed using anti HMGB1 antibodies and the expression of HMGB1 protein in the spinal cord was determined by western blot analysis after intrathecal delivery ( n = 8 each ) . RESULTS The results show that intrathecal LV/hIL-10 reverses enhanced pain states . Moreover , the increased level of HMGB1 exhibited in a late stage of CCI was inhibited by exogenous overexpression of hIL-10 in the CCI model . Expression of HMGB1 , RAGE , and pAkt were lower in CCI-induced rats treated with LV/hIL-10 than in those treated with LV/control ( vector ) or saline ( NS ) . Our results showed that IL-10 inhibits activation of the inflammatory HMGB1-RAGE pathway in the CCI rat model . LIMITATIONS Further experimental investigations are needed to clarify the specific biological roles played by HMGB1 in IL-10-mediated regulation of neuropathic pain . CONCLUSION Our results indicate that intrathecal lentiviral-mediated transfer of IL-10 attenuates CCI-induced neuropathic pain in rats . The anti-thermal hyperalgesia and anti-mechanical allodynia may be partly attributable to the decreased expression of HMGB1 and inhibition of HMGB1-RAGE pathway .


Possible etiology of improvements in both quality of life and overlapping gastroesophageal reflux disease by proton pump inhibitor treatment in a prospective randomized controlled trial . BACKGROUND Symptoms suggestive of functional dyspepsia ( FD ) and irritable bowel syndrome ( IBS ) frequently overlap with those of gastroesophageal reflux disease . Despite the high prevalence of symptomatic overlap , the underlying etiology remains poorly defined . We assessed the correlation of symptomatic relief and health-related quality of life ( HRQoL ) with healing of reflux esophagitis to further derive insights into the underlying etiology . METHODS 626 patients with reflux esophagitis were enrolled into one of two treatment groups ( classical healing concept or the complete remission concept ) to investigate differences in treatment intensity . Patients were treated with pantoprazole until esophageal mucosal healing . Remission was followed for up to 6 months without treatment . Gastro-intestinal symptoms and HRQoL were analyzed using disease-specific , psychometrically validated patient-reported outcome instruments ( ReQuest™ , GERDyzer™ ) . RESULTS Symptomatic burden reflected by ReQuest™ substantially decreased from baseline to end of treatment by 83 % and 88 % in either treatment group , respectively . ReQuest™ scores significantly decreased in patients with or without heartburn and in those with symptoms suggestive of FD and IBS , indicating response of all symptom categories to treatment ( p < 0.005 ) . Therapy-associated relief of symptoms was paralleled by substantial gains in HRQoL , which continued to stabilize post-treatment . CONCLUSIONS Pantoprazole is effective in relieving upper and lower gastro-intestinal symptoms overlapping with erosive esophagitis , and provides sustained improvement in HRQoL post-treatment . Our results propose a link between both healing of erosive esophagitis and the slower remission of upper and lower gastro-intestinal symptoms . Since the improvement observed is likely to be multifactorial , the possibility for an immune-mediated etiology and identification of putative susceptibility factors by genome-wide association study may provide focus for future research . TRIAL REGISTRATION ClinicalTrials.gov identifier : NCT00325676 .

classical healing concept

the complete remission concept

pantoprazole

quality of life

reflux esophagitis


Pimecrolimus cream and Tacrolimus ointment in the treatment of atopic dermatitis : a pilot study on patient preference . BACKGROUND Pimecrolimus cream 1 % is approved for mild to moderate atopic dermatitis in children older than two years of age and adults . Tacrolimus ointment 0.03 % is approved for moderate to severe atopic dermatitis in the patient population between two to seventeen years of age and Tacrolimus 0.1 % ointment for moderate to severe atopic dermatitis in patients 18 years of age and older . However , beyond safety and efficacy , the delivery system or vehicle used in topical treatment formulations is equally important in affecting patient satisfaction , tolerability , and subsequent treatment compliance and hence clinical resolution of active disease .

Pimecrolimus cream

Tacrolimus ointment

Pimecrolimus

Tacrolimus ointment

Tacrolimus 0.1 % ointment

atopic dermatitis :

safety and efficacy

clinical resolution

atopic dermatitis

atopic dermatitis

children older than two years of age

adults

atopic dermatitis

two to seventeen years of age

severe atopic dermatitis

18 years of age and older


Group cognitive behavioural therapy and group recreational activity for adults with autism spectrum disorders : a preliminary randomized controlled trial . Although adults with autism spectrum disorder are an increasingly identified patient population , few treatment options are available . This preliminary randomized controlled open trial with a parallel design developed two group interventions for adults with autism spectrum disorders and intelligence within the normal range : cognitive behavioural therapy and recreational activity . Both interventions comprised 36 weekly 3-h sessions led by two therapists in groups of 6-8 patients . A total of 68 psychiatric patients with autism spectrum disorders participated in the study . Outcome measures were Quality of Life Inventory , Sense of Coherence Scale , Rosenberg Self-Esteem Scale and an exploratory analysis on measures of psychiatric health . Participants in both treatment conditions reported an increased quality of life at post-treatment ( d = 0.39 , p < 0.001 ) , with no difference between interventions . No amelioration of psychiatric symptoms was observed . The dropout rate was lower with cognitive behavioural therapy than with recreational activity , and participants in cognitive behavioural therapy rated themselves as more generally improved , as well as more improved regarding expression of needs and understanding of difficulties . Both interventions appear to be promising treatment options for adults with autism spectrum disorder . The interventions ' similar efficacy may be due to the common elements , structure and group setting . Cognitive behavioural therapy may be additionally beneficial in terms of increasing specific skills and minimizing dropout .

Group cognitive behavioural therapy

and

group recreational activity

cognitive behavioural therapy

and

recreational activity

cognitive behavioural therapy

cognitive behavioural therapy

Cognitive behavioural therapy

psychiatric symptoms

dropout rate

efficacy

adults

autism spectrum disorders

adults

autism spectrum disorder

adults

autism spectrum disorders

groups of 6-8 patients

autism spectrum disorders


Japan useful medication program for schizophrenia ( JUMPs ) -long-term study on discontinuation rate , resolution and remission , and improvement in social functioning rate associated with atypical antipsychotic medications in patients with schizophrenia . BACKGROUND It is desirable to establish evidence for the selection of antipsychotics from the viewpoint of recovery of social activity in individual patient with schizophrenia receiving medication . From this perspective , awareness of the importance of studies about drug effectiveness on treatment discontinuation rate , remission rate , and improvement in QOL has grown recently . In Western countries , numerous reports are available in effectiveness studies , which are related to olanzapine and risperidone primarily , whereas evidence for other second-generation antipsychotics ( SGAs ) is poor . In Japan , no effectiveness study has been reported : thus , it is desirable to collect data that will serve as evidence for selection of the 3 SGAs approved after olanzapine . METHODS The present study was a long-term effectiveness study under healthcare setting in Japan . It was designed as an open-label , multicenter , randomized , comparative study involving 104-week oral treatment with 1 of the 3 drugs ( aripiprazole , blonanserin , and paliperidone ) in patients with schizophrenia aged 20 years or over who required antipsychotic medication or switching of the current medication to others for reasons such as lack of efficacy and intolerability . The primary endpoint is treatment discontinuation rate for any causes . The secondary endpoints include remission rate , improvement of social activity , alleviation , aggravation or recurrence of psychiatric symptoms , and safety . The target number of subjects was set at 300 . DISCUSSION Because this study is expected to yield evidence regarding the selection of antipsychotics for facilitating the recovery of social activity in patients with schizophrenia , it is considered highly valuable to perform this effectiveness study under ordinary healthcare setting in Japan . TRIAL REGISTRATION UMIN Clinical Trials Registry 000007942 .

atypical antipsychotic medications

antipsychotics

aripiprazole

blonanserin

paliperidone

antipsychotic medication

remission rate

improvement of social activity

alleviation

safety

schizophrenia

schizophrenia

aged 20 years or over

schizophrenia


18F-FDG PET/CT for early prediction of response to neoadjuvant lapatinib , trastuzumab , and their combination in HER2-positive breast cancer : results from Neo-ALTTO . UNLABELLED Molecular imaging receives increased attention for selecting patients who will benefit from targeted anticancer therapies . Neo-ALTTO ( Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimisation ) enrolled 455 women with invasive human epidermal growth factor receptor 2 ( HER2 ) -positive breast cancer and compared rates of pathologic complete response ( pCR ) to neoadjuvant lapatinib , trastuzumab , and their combination . Each anti-HER2 therapy was given alone for 6 wk , followed by 12 wk of the same therapy plus weekly paclitaxel . The early metabolic effects of the anti-HER2 therapies on the primary tumors and their predictive values for pCR were assessed in a subset of patients . METHODS Eighty-six patients underwent ( 18 ) F-FDG PET/CT at baseline and weeks 2 and 6 of anti-HER2 treatment . An imaging core laboratory provided central validation , and 2 independent reviewers , masked to assigned treatment arm and clinical outcomes , performed consensus ( 18 ) F-FDG PET/CT readings . Maximum standardized uptake value ( SUVmax ) reductions from baseline were used to measure metabolic response . RESULTS Seventy-seven of the 86 enrolled patients presented an evaluable baseline ( 18 ) F-FDG PET/CT scan ; of these , 68 and 66 were evaluable at weeks 2 and 6 , respectively . Metabolic responses in the primary tumors were evident after 2 wk of targeted therapy and correlated highly with metabolic responses at week 6 ( R ( 2 ) = 0.81 ) . pCRs were associated with greater SUVmax reductions at both time points . Mean SUVmax reductions for pCR and non-pCR , respectively , were 54.3 % versus 32.8 % at week 2 ( P = 0.02 ) and 61.5 % versus 34.1 % at week 6 ( P = 0.02 ) . ( 18 ) F-FDG PET/CT metabolic response rates at weeks 2 and 6 were 71.6 % and 60 % , respectively using European Organization for Research and Treatment of Cancer criteria ; pCR rates were twice as high for ( 18 ) F-FDG PET/CT responders than nonresponders ( week 2 : 42 % vs. 21 % , P = 0.12 ; week 6 : 44 % vs. 19 % , P = 0.05 ) . CONCLUSION Early metabolic assessment using ( 18 ) F-FDG PET/CT can identify patients with an increased likelihood of pCR after neoadjuvant trastuzumab , lapatinib , or their combination when given with chemotherapy .

neoadjuvant lapatinib

trastuzumab

their combination

Neo-ALTTO

Neoadjuvant Lapatinib

Trastuzumab

neoadjuvant lapatinib

trastuzumab

combination

anti-HER2 therapy

paclitaxel

anti-HER2 therapies

anti-HER2 treatment

neoadjuvant trastuzumab

lapatinib

combination

chemotherapy

metabolic effects

Metabolic responses

HER2-positive breast cancer :

assessed in a subset of patients .


The efficacy and safety of simultaneous transurethral GreenLight photoselective vaporization of bladder tumor and prostate in patients with bladder tumor and lower urinary tract symptoms . PURPOSE We compared the safety and efficacy of simultaneous transurethral GreenLight photoselective vaporization of bladder tumor and prostate ( PVBT/PVP ) in patients with bladder tumor and bladder outlet obstruction caused by benign prostate hyperplasia ( BPH ) . METHODS Sixty-two patients with bladder tumor were enrolled in our prospective and randomized trial . A total of 37 men underwent simultaneous transurethral PVBT/PVP , and 25 patients underwent PVBT alone . The clinicopathological parameters and the recurrence of bladder tumor on the bladder neck/prostatic fossa were evaluated in all patients . RESULTS Clinicopathological parameters of both groups were similar . The rates of recurrence , progression and tumor recurrence of bladder neck/prostatic fossa were 16.0 , 4.0 and 4.0 % in the simultaneous resection group , and 18.9 , 5.4 and 8.1 % in the group PVBT , respectively . No statistically significant differences were found between the two groups ( P > 0.05 ) . CONCLUSIONS Simultaneous PVBT/PVP may help decrease the overall recurrence rate and tumor recurrence in bladder neck/prostatic fossa . PVBT/PVP can be performed effectively and safely in patients with bladder tumor and BPH .

transurethral PVBT/PVP

PVBT

PVBT/PVP

PVBT/PVP

efficacy and safety

safety and efficacy

bladder tumor and prostate

rates of recurrence

benign prostate hyperplasia ( BPH )

Sixty-two

men

25 patients

patients with bladder tumor and BPH


Immunological changes after minimally invasive or conventional esophageal resection for cancer : a randomized trial . BACKGROUND This study was performed as a substudy analysis of a randomized trial comparing conventional open esophagectomy [ open surgical technique ( OE ) ] by thoracotomy and laparotomy with minimally invasive esophagectomy [ minimally invasive procedure ( MIE ) ] by thoracoscopy and laparoscopy . This additional analysis focuses on the immunological changes and surgical stress response in these two randomized groups of a single center . METHODS Patients with a resectable esophageal cancer were randomized to OE ( n = 13 ) or MIE ( n = 14 ) . All patients received neoadjuvant chemoradiotherapy . The immunological response was measured by means of leukocyte counts , HLA-DR expression on monocytes , the acute-phase response by means of C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) , and interleukin-8 ( IL-8 ) , and the stress response was measured by cortisol , growth hormone , and prolactin . All parameters were determined at baseline ( preoperatively ) and 24 , 72 , 96 , and 168 h postoperatively . RESULTS Significant differences between the two groups were seen in favor of the MIE group with regard to leukocyte counts , IL-8 , and prolactin at 168 h ( 1 week ) postoperatively . For HLA-DR expression , IL-6 , and CRP levels , there were no significant differences between the two groups , although there was a clear rise in levels upon operation in both groups . CONCLUSION In this substudy of a randomized trial comparing minimally invasive and conventional open esophagectomies for cancer , significantly better preserved leukocyte counts and IL-8 levels were observed in the MIE group compared to the open group . Both findings can be related to fewer respiratory infections found postoperatively in the MIE group . Moreover , significant differences in the prolactin levels at 168 h after surgery imply that the stress response is better preserved in the MIE group . These findings indicate that less surgical trauma could lead to better preserved acute-phase and stress responses and fewer clinical manifestations of respiratory infections .

minimally invasive

or

conventional esophageal resection

conventional open esophagectomy

thoracotomy and laparotomy

minimally invasive procedure ( MIE )

thoracoscopy

laparoscopy

neoadjuvant chemoradiotherapy

MIE

Immunological changes

immunological changes

surgical stress response

immunological response

leukocyte counts , IL-8 , and prolactin

leukocyte counts and IL-8 levels

fewer respiratory infections

prolactin levels

stress response

cancer

resectable esophageal cancer


Group therapy for anxiety in children with autism spectrum disorder . AIM To investigate the acceptability and feasibility of adapted group therapy for anxiety in children with autism spectrum disorder in a pilot randomised controlled trial . METHOD A total of 32 children aged 9-13 years were randomised to immediate or delayed therapy using the 'Exploring Feelings ' manual ( Attwood , 2004 ) . Child and parent groups were run in parallel , for seven weekly sessions , under the supervision of experienced psychologists . The primary blinded outcome measures addressed change in overall functioning and in severity of the primary anxiety diagnosis after 3 months . RESULTS Children met diagnostic criteria for 1-6 anxiety disorders ( median 3 ) . At end point , both parents and children in the immediate therapy group were more likely to report a reduction in anxiety symptoms . Fidelity of delivery of the group therapy was high , and attendance was 91 % . CONCLUSIONS This pilot trial established that children and families were willing to be recruited and randomised , the outcome measures were acceptable , the format and content of the groups were feasible within UK child and adolescent mental health services , the intervention was appreciated by families and attrition was very small .

Group therapy

adapted group therapy

immediate or delayed therapy

'Exploring Feelings

immediate therapy

group therapy

anxiety

overall functioning

attendance

children

autism spectrum disorder

children with autism spectrum disorder

32 children

9-13 years


The Autism MEAL Plan : a parent-training curriculum to manage eating aversions and low intake among children with autism . Feeding problems represent a frequent concern reported by caregivers of children with autism spectrum disorders , and growing evidence suggests atypical patterns of intake may place this population at risk of nutritional and/or related medical issues , including chronic vitamin and mineral deficiencies , poor bone growth , and obesity . This combination of factors emphasizes a clear need to identify and disseminate evidence-based treatment of feeding problems associated with autism spectrum disorders . Behavioral intervention represents an effective treatment for chronic feeding concerns in this population ; however , evidence has largely been established with trained therapists working in highly structured settings . This pilot study seeks to fill this gap in the literature by describing and evaluating the Autism MEAL Plan , a behaviorally based parent-training curriculum to address feeding problems associated with autism spectrum disorders . We assessed the feasibility of the intervention in terms of program content and study protocol ( e.g . recruitment and retention of participants , assessment procedures ) , as well as efficacy in terms of changes in feeding behaviors . A total of 10 families participated in the treatment condition , and the program was evaluated using a waitlist control design ( n = 9 ) , representing the first randomized-control study of a feeding intervention in autism spectrum disorders . Results provide provisional support regarding the utility of the program , including high social validity , parent perception of effectiveness , and reduced levels of caregiver stress following intervention . Implications , limitations , and future directions for this line of research are discussed .

The Autism MEAL Plan :

Autism MEAL Plan

waitlist control design

assessment procedures

efficacy

utility of the program

high social validity

parent perception of effectiveness

reduced levels of

caregiver stress

following intervention

autism

children

autism spectrum disorders


Long-term exposure to belatacept in recipients of extended criteria donor kidneys . Patients in the BENEFIT-EXT study received extended criteria donor kidneys and a more intensive ( MI ) or less intensive ( LI ) belatacept immunosuppression regimen , or cyclosporine A ( CsA ) . Patients who remained on assigned therapy through year 3 were eligible to enter a long-term extension ( LTE ) study . Three hundred four patients entered the LTE ( n = 104 MI ; n = 113 LI ; n = 87 CsA ) , and 260 continued treatment through year 5 ( n = 91 MI ; n = 100 LI ; n = 69 CsA ) . Twenty patients died during the LTE ( n = 5 MI ; n = 9 LI ; n = 6 CsA ) , and eight experienced graft loss ( n = 2 MI ; n = 1 LI ; n = 5 CsA ) . Three patients experienced an acute rejection episode ( n = 2 MI ; n = 1 LI ) . The incidence rate of serious adverse events , viral infections and fungal infections was similar across groups during the LTE . There were four cases of posttransplant lymphoproliferative disorder ( PTLD ) from the beginning of the LTE to year 5 ( n = 3 LI ; n = 1 CsA ) ; two of three PTLD cases in the LI group were in patients who were seronegative for Epstein-Barr virus ( EBV ( - ) ) at transplantation . Mean ± SD calculated GFR at year 5 was 55.9 ± 17.5 ( MI ) , 59.0 ± 29.1 ( LI ) and 44.6 ± 16.4 ( CsA ) mL/min/1.73 m ( 2 ) . Continued treatment with belatacept was associated with a consistent safety profile and sustained improvement in renal function versus CsA over time .

MI

less intensive ( LI

belatacept immunosuppression regimen

cyclosporine A ( CsA )

episode

serious


Correlation of cognitive and social outcomes among children with autism spectrum disorder in a randomized trial of behavioral intervention . Although social impairments are considered the hallmark deficit of autism , many behavioral intervention studies rely on cognitive functioning as a primary outcome . Fewer studies have examined whether changes in cognition are associated with changes in social functioning . This study examined whether cognitive gains among 192 students from 47 kindergarten-through-second-grade autism support classrooms participating in a year-long behavioral intervention study were associated with gains in social functioning . Children 's gains in cognitive ability were modestly associated with independent assessors ' and teachers ' evaluations of social functioning but were not associated with changes in parent ratings . Observed social gains were not commensurate with gains in cognition , suggesting the need both for interventions that directly target social functioning and relevant field measures of social functioning .

behavioral intervention .

behavioral intervention

behavioral intervention

interventions

social functioning

cognitive ability

independent assessors '

parent ratings

social gains

children with autism spectrum disorder

support classrooms

Children 's


See what I see , do as I do : promoting joint attention and imitation in preschoolers with autism spectrum disorder . Since imitation and joint attention are both important abilities for young children and since children with autism spectrum disorder show a range of problems in these domains , imitation and joint attention are important targets for intervention . In this study , we examined the possibility of promoting imitation and joint attention by means of a training programme specifically designed for low-intensity , non-residential treatment . Two matched groups of 18 children each participated in the study . The experimental group , receiving the training programme , improved significantly more on joint attention than the group receiving only treatment as usual . Only the experimental group obtained a significantly higher imitation score during the post-test compared to the pre-test . This study shows that it is possible to promote joint attention with a low-intensity treatment programme . The results concerning imitation are more modest . Future replications should involve measures of stability and generalization .

promoting joint attention and imitation

imitation

joint attention

imitation

joint attention

training programme

joint attention

joint attention

higher imitation score

promote joint attention

imitation are more modest .

stability and generalization .

autism spectrum disorder .

autism spectrum disorder

children


Supplementation effect with slow-release urea in feed blocks for Thai beef cattle -- nitrogen utilization , blood biochemistry , and hematology . Four Thai male native beef cattle , initial body weight ( BW ) of 100 ± 3.0 kg were randomly assigned in a 4 × 4 Latin square design to receive four dietary treatments with inclusion of urea calcium sulphate mixture ( U-cas ) in feed block ( FB ) at 0 , 120 , 150 , and 180 g/kg dry matter ( DM ) . Total intakes were increased with the increasing level of U-cas supplementation in FB and the result obtained the highest when supplementation of U-cas in FB at 180 , followed by 150 , 120 , and 0 g/kg DM , respectively . Moreover , supplementation of U-cas in FB at 180 g/kg DM could reduce total N excretion ( 4.1 g/day ) , as compared to others treatments , while N retention and proportion of N retention to N intake were increased up to 6.9 g/day and 14.9 % , respectively . On the other hand , the blood biochemistry and hematological parameters were not different among treatments except concentration of plasma urea N , plasma glucose , and total blood protein were improved especially with U-cas supplementation at 180 g/kg DM in FB . In conclusion , supplementation of U-cas at 180 g/kg in FB improved feed intake , N utilization , and blood biochemistry in Thai native beef cattle fed on rice straw .

effect

reduce total N excretion

to N intake

blood biochemistry

male


Enhanced vascular endothelial growth factor and inflammatory cytokine removal with online hemodiafiltration over high-flux hemodialysis in sepsis-related acute kidney injury patients . Hypercytokinemia plays a central role in pathogenesis and is related to the high mortality in sepsis-related acute kidney injury ( AKI ) . Besides the established cytokines , vascular endothelial growth factor ( VEGF ) is demonstrated as an important factor in enhancing vascular leakage in sepsis . This prospective randomized trial was conducted to compare the efficacy of cytokine removal between online hemodiafiltration ( HDF ) , which combines convective and diffusive solute removal , and high-flux hemodialysis ( HD ) . Twenty-eight sepsis-related AKI patients were included and randomized into online HDF and high-flux HD . The percentages of the reduction ratio in plasma cytokines were measured as primary outcomes . Other clinical parameters were determined as secondary outcomes . When compared with high-flux HD , online HDF provided significantly greater percentages of the reduction ratio in plasma cytokine levels , including VEGF ( P < 0.001 ) , IL-6 ( P = 0.001 ) , IL-8 ( P = 0.021 ) , IL-10 ( P = 0.011 ) , and tumor necrosis factor-α ( P = 0.029 ) . There were no significant differences in intradialytic blood pressures . Online HDF revealed better renal recovery and shorter length of hospitalization than high-flux HD . In conclusion , online HDF in sepsis-related AKI could provide significantly better removal of VEGF and other cytokines and these were associated with better renal outcome than high-flux HD . Thus , online HDF would offer a potential role in hypercytokinemic state in sepsis-related AKI .

online HDF

high-flux HD

reduction ratio in plasma cytokines

Other clinical parameters

VEGF

intradialytic


Use of ketorolac is associated with decreased pneumonia following rib fractures . BACKGROUND The effectiveness of the nonsteroidal anti-inflammatory drug ketorolac in reducing pulmonary morbidity after rib fractures remains largely unknown . METHODS A retrospective cohort study was conducted spanning January 2003 to June 2011 assessing pneumonia within 30 days and potential adverse effects of ketorolac among all patients with rib fractures who received ketorolac < 4 days after injury compared with a random sample of those who did not . RESULTS Among 202 patients who received ketorolac and 417 who did not , ketorolac use was associated with decreased pneumonia ( odds ratio , .14 ; 95 % confidence interval , .04 to .46 ) and increased ventilator-free days ( difference , 1.8 days ; 95 % confidence interval , 1.1 to 2.5 ) and intensive care unit-free days ( difference , 2.1 days ; 95 % confidence interval , 1.3 to 3.0 ) within 30 days . The rates of acute kidney injury , gastrointestinal hemorrhage , and fracture nonunion were not different . CONCLUSIONS Early administration of ketorolac to patients with rib fractures is associated with a decreased likelihood of pneumonia , without apparent risks .

ketorolac

ketorolac

ketorolac

ketorolac

ketorolac

pneumonia

ventilator-free days

intensive care unit-free days

pneumonia

rib fractures

pulmonary morbidity

rib fractures

rib fractures

rib fractures


Effects of repetitive transcranial magnetic stimulation in performing eye-hand integration tasks : four preliminary studies with children showing low-functioning autism . This report , based on four studies with children with low-functioning autism , aimed at evaluating the effects of repetitive transcranial magnetic stimulation delivered on the left and right premotor cortices on eye-hand integration tasks ; defining the long-lasting effects of high-frequency repetitive transcranial magnetic stimulation ; and investigating the real efficacy of high-frequency repetitive transcranial magnetic stimulation by comparing three kinds of treatments ( high-frequency repetitive transcranial magnetic stimulation , a traditional eye-hand integration training , and both treatments combined ) . Results showed a significant increase in eye-hand performances only when high-frequency repetitive transcranial magnetic stimulation was delivered on the left premotor cortex ; a persistent improvement up to 1 h after the end of the stimulation ; better outcomes in the treatment combining high-frequency repetitive transcranial magnetic stimulation and eye-hand integration training . Based on these preliminary findings , further evaluations on the usefulness of high-frequency repetitive transcranial magnetic stimulation in rehabilitation of children with autism are strongly recommended .

eye-hand performances

children

autism

children with low-functioning autism

children

autism


Entomological determinants of insecticide-treated bed net effectiveness in Western Myanmar . BACKGROUND In a large cluster randomized control trial of insecticide-treated bed nets ( ITN ) in Western Myanmar the malaria protective effect of ITN was found to be highly variable and , in aggregate , the effect was not statistically significant . A coincident entomological investigation measured malaria vector abundance and biting behaviour and the human population sleeping habits , factors relevant to ITN effectiveness . METHODS Entomological surveys were carried out using different catching methods to identify potential malaria vector species and characterise their biting habits . The salivary glands were dissected from all female anophelines caught to identify sporozoites by microscopy . FINDINGS Between 1995 and 2000 a total of 4,824 female anopheline mosquitoes were caught with various catching methods . A total of 916 person nights yielded 3,009 female anopheline mosquitoes between 6 pm and 6 am . Except for Anopheles annularis , which showed no apparent preference ( 51 % outdoor biting ) , all major species showed a strong preference for outdoor biting ; Anopheles epiroticus ( 79 % ) , Anopheles subpictus ( 72 % ) , Anopheles maculatus ( 92 % ) , Anopheles aconitus ( 85 % ) and Anopheles vagus ( 72 % ) . Most human biting occurred in the early evening with the peak biting time between 6 pm and 7 pm ( 35 % ) . Overall 51 % ( 1447/2837 ) of all bites recorded were between 6 pm and 8 pm . A large proportion of children were not sleeping under an ITN during peak biting times . Only one An . annularis mosquito ( 0.02 % ) had malaria sporozoites identified in the salivary glands . CONCLUSIONS Peak vector biting occurred early in the evening and mainly occurred outdoors . The limited efficacy of ITN in this area of Western Myanmar may be explained by the biting behaviour of the prevalent Anopheles mosquito vectors in this area .

insecticide-treated bed nets ( ITN )

ITN

ITN

salivary glands were dissected

microscopy

ITN

ITN

effectiveness

protective effect

human population sleeping habits

potential malaria vector species

biting habits .

preference

outdoor biting

human biting

peak biting time

bites recorded

proportion of children

sleeping

malaria sporozoites

Peak vector biting

efficacy

female

916 person

children


Characterization of early thermal burns and the effects of hyperbaric oxygen treatment : a pilot study . BACKGROUND AND AIMS Studies investigating hyperbaric oxygen treatment ( HBOT ) to improve outcome in burns have been inconclusive . In this study , we aimed to characterize early thermal burns injury in adult patients with < 40 % total body surface area ( TBSA ) and to determine the effects of HBOT administered within 24 h to 48 h of a burn injury . METHODS Seventeen subjects were randomized into control ( n = 9 ) and HBOT treatment ( n = 8 ) arms . Burn depth , measured by laser Doppler imaging ( LDI ) and histologically , white blood cell ( WBC ) count and plasma cytokine inflammatory markers were assessed at 24 h ( pre HBOT ) and 48 h ( post HBOT ) post burn , as were immunohistochemistry and microbiology of burns tissue samples at 48 h post burn . RESULTS WBC count and serum interleukin ( IL ) -1β , IL-4 , IL-6 , IL-10 and interferon-γ were significantly elevated 24 h after burn , but no significant changes in any of these parameters were found with HBOT . HBOT had no significant effect on burn depth . Two HBOT patients and four control patients developed positive bacterial cultures . CONCLUSIONS Slower than anticipated recruitment resulted in considerably fewer patients than planned being studied . Inflammatory markers were significantly increased at 24 h in patients with < 40 % TBSA burn . Early HBOT had no apparent effects on any of the parameters measured in this small pilot study . HBOT may possibly have a broad-spectrum antimicrobial effect worthy of further study . We report our methodology in detail as a possible model for future burns studies .

hyperbaric oxygen treatment

hyperbaric oxygen treatment ( HBOT )

HBOT

HBOT treatment

Doppler imaging

Burn depth

white blood cell ( WBC ) count

plasma cytokine inflammatory markers

burns

early thermal burns injury

adult

< 40 % total body surface area ( TBSA

Seventeen


Comparison of three software systems for semi-automatic volumetry of pulmonary nodules on baseline and follow-up CT examinations . BACKGROUND Early diagnosis of lung cancer in a treatable stage is the main purpose of lung cancer screening by computed tomography ( CT ) . Accurate three-dimensional size and growth measurements are essential to assess the risk of malignancy . Nodule volumes can be calculated by using semi-automated volumetric software . Systematic differences in volume measurements between packages could influence nodule categorization and management decisions . PURPOSE To compare volumetric measurements of solid pulmonary nodules on baseline and follow-up CT scans as well as the volume doubling time ( VDT ) for three software packages . MATERIAL AND METHODS From a Lung Cancer Screening study ( NELSON ) , 50 participants were randomly selected from the baseline round . The study population comprised participants with at least one pulmonary nodule at the baseline and consecutive CT examination . The volume of each nodule was determined for both time points using three semi-automated software packages ( P1 , P2 , and P3 ) . Manual modification was performed when automated assessment was visually inaccurate . VDT was calculated to evaluate nodule growth . Volume , VDT , and nodule management were compared for the three software packages , using P1 as the reference standard . RESULTS In 25 participants , 147 nodules were present on both examinations ( volume : 12.0-436.6 mm ( 3 ) ) . Initial segmentation at baseline was evaluated to be satisfactory in 93.9 % of nodules for P1 , 84.4 % for P2 , and 88.4 % for P3 . Significant difference was found in measured volume between P1 and the other two packages ( P < 0.001 ) . P2 overestimated the volume by 38 ± 24 % , and P3 by 50 ± 22 % . At baseline , there was consensus on nodule size categorization in 80 % for P1 & P2 and 74 % for P1 & P3 . At follow-up , consensus on VDT categorization was present in 47 % for P1 & P2 and 44 % for P1 & P3 . CONCLUSION Software packages for lung nodule evaluation yield significant differences in volumetric measurements and VDT . This variation affects the classification of lung nodules , especially in follow-up examinations .

Comparison of three software systems

computed tomography ( CT )

CT scans

three software packages

three semi-automated software packages

( P1 , P2 , and P3 )

Comparison

volumetry of pulmonary nodules

volumetric measurements

volume doubling time ( VDT )

volume of each nodule

VDT

evaluate nodule growth .

VDT

nodule management

measured volume

lung cancer

Lung Cancer


Aripiprazole treatment of irritability associated with autistic disorder and the relationship between prior antipsychotic exposure , adverse events , and weight change . OBJECTIVE The purpose of this study was to evaluate the impact of prior antipsychotic exposure ( PAE ) on safety and tolerability outcomes in pediatric subjects receiving aripiprazole treatment . METHODS This study was a post-hoc analysis of pooled data from two 8-week , double-blind , randomized , placebo-controlled studies evaluating aripiprazole for the treatment of irritability in pediatric subjects with autistic disorder , aged 6-17 years . Subjects were stratified by PAE ; adverse events ( AEs ) , and changes in weight , and metabolic measures were evaluated . For subjects receiving aripiprazole , regardless of PAE , baseline weight , age , gender , and symptom severity were evaluated in a regression model predicting body weight change . RESULTS Of 316 randomized subjects , 259 ( 82.0 % ) were antipsychotic naïve ( AN ) and 57 ( 18.0 % ) had a PAE . Aripiprazole-treated AN subjects were more likely than PAE subjects to report somnolence ( 11.9 % vs. 2.8 % ) , sedation ( 22.7 % vs. 11.1 % ) , or fatigue ( 17.0 % vs. 13.9 % ) . Rates of extrapyramidal disorder and drooling , but not akathisia or tremor , were marginally higher in AN subjects . Overall , 10.8 % of aripiprazole-treated AN subjects had at least one AE leading to discontinuation compared with 8.3 % of aripiprazole-treated PAE subjects . AN subjects receiving aripiprazole had a larger change in weight from baseline to endpoint compared with those receiving placebo ( 1.9 vs. 0.7 kg ; treatment difference 1.2 kg , 95 % CI : 0.5 , 1.9 ) than PAE subjects receiving aripiprazole compared with subjects receiving placebo ( 0.4 vs. -0.4 kg ; treatment difference 0.9 kg , 95 % CI : -0.6 , 2.4 ) . Regression analysis identified that younger subjects with higher baseline weight z-score were at highest risk for weight gain . There were no significant changes in metabolic measures compared with placebo in either group . CONCLUSIONS Weight gain was more pronounced in AN subjects and more likely to occur in younger subjects with a higher baseline weight z-score . AN subjects were more likely to experience AEs related to somnolence . However , based on discontinuations rates from AEs , overall tolerability was good for both AN and PAE groups . CLINICAL TRIAL REGISTRATION Study of aripiprazole in the treatment of children and adolescents with autistic disorder . Registry : www.clinicaltrials.gov . Identifiers : NCT00332241 and NCT00337571 .

Aripiprazole

placebo-controlled

aripiprazole

safety and tolerability outcomes

autistic disorder

autistic disorder

aged 6-17 years .

316 randomized subjects

259 ( 82.0 %

57 ( 18.0 % )

that younger subjects

younger subjects

children and adolescents

autistic disorder


Comparison of meloxicam and a glucosamine-chondroitin supplement in management of feline osteoarthritis . A double-blind randomised , placebo-controlled , prospective trial . OBJECTIVE To compare the efficacy of meloxicam and a glucosamine-chondroitin ( Glu-Ch ) supplement in the management of feline osteoarthritis ( OA ) . METHODS Prospective , blinded , randomized clinical trial . Cats over eight years of age with clinical signs of chronic OA were assigned to one of two groups and Glu-Ch or meloxicam was administered orally for 70 days , followed by a placebo until day 98 . Cats were assessed by a veterinarian on five occasions and the owner completed an assessment form at the same time . RESULTS Data were collected from thirty cats . Pre-treatment disease scores were significantly higher in the meloxicam group for owner mobility ( p=0.01 ) and veterinary lameness ( p=0.02 ) . Owner mobility scores at day 14 ( p=0.01 ) and day 42 ( p=0.002 ) were significantly improved compared to pre-treatment scores for the meloxicam group . When meloxicam and Glu-Ch were discontinued and the placebo commenced , a significant proportion of the meloxicam group showed worsening of all the owner-assessed scores between day 70 and day 98 , when compared to the Glu-Ch group ( mobility p=0.01 ; activity p=0.02 ; temperament p=0.04 ; lifestyle p=0.01 ) . CONCLUSIONS Treatment with meloxicam resulted in a significant improvement in mobility and activity levels of cats with OA until the placebo was introduced . A greater proportion of cats receiving meloxicam medication showed a significant worsening of owner assessment scores once the placed was introduced , when compared to the Glu-Ch group .

meloxicam

glucosamine-chondroitin supplement

meloxicam

Glu-Ch or meloxicam

placebo

meloxicam

meloxicam

meloxicam

meloxicam

meloxicam

meloxicam

feline osteoarthritis .

feline osteoarthritis ( OA )

owner mobility

veterinary lameness

Owner mobility scores

mobility

activity levels

feline osteoarthritis

feline osteoarthritis ( OA )

Cats over eight years of age

clinical signs of chronic OA


A randomized , double-blind , placebo-controlled crossover study of Cappra® for the treatment of mild or mild to moderate erectile dysfunction in Thai male . Erectile dysfunction ( ED ) is one of the major health concerns affects the quality of life among Thai male . The treatment of ED by the first-line drugs is limited to a certain group of patients due to their side effects and costs . Alternative medicine can be beneficial for the treatment of ED . This is a randomized , double-blind , placebo-controlled , crossover study aimed to assess the efficacy and safety of Cappra ( ® ) , a traditional herbal medicine which was used in Thailand for decades , for the treatment of mild and mild to moderate ED in Thai patients . A total of 63 patients with mild or mild to moderate ED were randomized to receive Cappra ( ® ) or placebo for two weeks in the first period , followed by one week washout period . The patients were switched to the alternative treatment in the second period . The efficacy was assessed by the International Index of Erectile Function ( IIEF ) questionnaire and adverse events . Sixty one patients completed the study . There was an improvement of IIEF score for all domains in Cappra ( ® ) group compared with placebo group . The mean change of IIEF score from baseline for erectile function domain of Cappra ( ® ) was significantly higher than placebo ( 4.87 vs 3.44 , p = 0.032 ) . The most common adverse events were dizziness ( 13.3 % Cappra ( ® ) , 9.6 % placebo ) , face numbness ( 1.6 % Cappra ( ® ) , 0 % placebo ) , and tachycardia ( 1.6 % Cappra ( ® ) , 0 % placebo ) . The results from this study demonstrated that Cappra ( ® ) is effective and well-tolerated and can be used as alternative therapy for mild and mild to moderate ED .

placebo-controlled

Cappra

placebo

efficacy

IIEF score

mean change of IIEF score

dizziness

face numbness

tachycardia

male

male

63 patients


Comparative study for the effect of photodynamic therapy , imiquimod immunotherapy and combination of both therapies on 40 lesions of actinic keratosis in Japanese patients . We treated 12 , 15 and 13 Japanese actinic keratosis ( AK ) lesions with 5-aminolevulinic acid photodynamic therapy ( PDT ) , 5 % imiquimod cream and combination of both therapies , respectively , and compared the effects . Patients underwent the second course , when AK lesions remained after the first course . Efficacy was evaluated 1 month after each treatment . Combination therapy cleared all AK lesions only after the first course , while PDT and imiquimod therapy cleared 41.7 % and 66.7 % of AK lesions after the first course , respectively . All residual AK lesions after the first course were cleared by the second courses of PDT or imiquimod therapy . During the course , erosion and crust developed significantly more frequently in combination therapy ( P < 0.001 ) . Most Japanese AK lesions can be satisfactorily treated with either PDT or imiquimod monotherapy . However , only severe cases may better be treated with combination therapy , which show higher efficacy even though adverse events occur frequently .

photodynamic therapy

imiquimod immunotherapy

combination of both therapies

5 % imiquimod cream

combination of both therapies

Efficacy

actinic keratosis

actinic keratosis ( AK )


Effect of clinical context on simulator-based assessment of blood pressure taking - a pilot randomized study . BACKGROUND Blood pressure measurement is an essential clinical skill that can readily be assessed in objective structured clinical examination ( OSCE ) . While the use of simulators can enhance test validity and reliability , the given clinical context may also affect student performance . AIMS To investigate the impact of variations in clinical context on blood pressure measurement in a simulator-based OSCE . METHOD We randomized 162 first-year medical students into four groups that received different lead-in statements before measuring blood pressure on a manikin simulator . These statements described hypothetical patients with different likelihoods of having systemic hypertension . RESULTS The lead-in that described the highest likelihood of hypertension was associated with significantly higher reported readings and lower accuracy . The lead-in that suggested normality yielded the best performance . CONCLUSION Student performance in simulator-based OSCE may be affected by the clinical context provided . However , we argue that construct validity should be viewed in light of the application of a test , in that patients may also present with different cues and likelihoods of having hypertension . Variations in construct design should be further explored to enhance the training and assessment of clinical competence that reflects the unpredictability encountered in daily clinical practice .

simulators

simulator-based OSCE

manikin simulator

simulator-based OSCE

blood pressure

blood pressure

systemic hypertension

likelihood of hypertension

reported readings and lower accuracy

blood pressure taking

first-year medical students

measuring blood pressure

Student


Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication : a randomized study . BACKGROUND Antimicrobial resistance has decreased eradication rates for Helicobacter pylori infection worldwide . A sequential treatment schedule has been reported to be effective , but studies published to date were performed in Italy . We undertook this study to determine whether these results could be replicated in India . METHODS A randomized , open-labeled , prospective controlled trial comparing sequential vs. standard triple-drug therapy was carried out at Lokmanya Tilak Municipal General Hospital , Mumbai . Two hundred and thirty-one patients with dyspepsia were randomized to a 10-day sequential regimen ( 40 mg of pantoprazole , 1 g of amoxicillin , each administered twice daily for the first 5 days , followed by 40 mg of pantoprazole , 500 mg of clarithromycin , and 500 mg of tinidazole , each administered twice daily for the remaining 5 days ) or to standard 14-day therapy ( 40 mg of pantoprazole , 500 mg of clarithromycin , and 1 g of amoxicillin , each administered twice daily ) . RESULTS The eradication rate achieved with the sequential regimen was significantly greater than that obtained with the triple therapy . Per-protocol eradication rate of sequential therapy was 92.4 % ( 95 % CI 85.8-96.1 % ) vs. 81.8 % ( 95 % CI 73.9-87.8 % ) ( p = 0.027 ) for standard drug therapy . Intention-to-treat eradication rates were 88.2 % ( 95 % CI 80.9-93.0 % ) vs. 79.1 % ( 95 % CI 71.1-85.4 % ) , p = 0.029 , respectively . The incidence of major and minor side effects between therapy groups was not significantly different ( 14.6 % in the triple therapy group vs. 23.5 % in sequential group , p = 0.12 ) . Follow up was incomplete in 3.3 % and 4.7 % patients in standard and sequential therapy groups , respectively . Sequential therapy includes one additional antibiotic ( tinidazole ) that is not contained in standard therapy . CONCLUSIONS Sequential therapy was significantly better than standard therapy for eradicating H. pylori infection .

Sequential therapy

standard triple-drug therapy

sequential

standard triple-drug therapy

10-day sequential regimen

40 mg of pantoprazole

1 g of amoxicillin

40 mg of pantoprazole

500 mg of clarithromycin

500 mg of tinidazole

sequential regimen

triple therapy

sequential therapy

eradication rate

Per-protocol eradication rate

Helicobacter pylori infection


A prospective randomized trial comparing hypofractionation with conventional fractionation radiotherapy for T1-2 glottic squamous cell carcinomas : results of a Korean Radiation Oncology Group ( KROG-0201 ) study . BACKGROUND AND PURPOSE To prospectively investigate the effect of radiotherapy fraction size on clinical outcomes in early glottic carcinoma METHODS AND MATERIALS Patients with T1-2 glottic carcinoma were eligible for the protocol . Although 282 patients were required , the study was closed prematurely due to poor accrual with only 156 patients . Of these , 82 patients were allocated to conventional fractionation ( CONV ) arm ( 66 Gy/33 fractions for T1 and 70 Gy/35 fractions for T2 ) , with 74 patients to hypofractionation ( HYPO ) arm ( 63 Gy/28 fractions for T1 and 67.5 Gy/30 fractions for T2 ) . The primary objective was local progression-free survival ( LPFS ) . RESULTS With a median follow-up of 67 months ( range , 2-122 months ) , the 5-year LPFS was 77.8 % for CONV arm and 88.5 % for HYPO arm ( HR 1.55 , p=0.213 ) . No significant difference was observed in the toxicity profile between the two arms . In a subgroup exploratory analysis for T1a disease , the 5-year LPFS trended positively in HYPO arm ( 76.7 % vs. 93.0 % , HR 3.65 , p=0.056 ) . CONCLUSIONS Given that HYPO is at least not inferior to CONV with a similar toxicity profile , the hypofractionation scheme used in this study can be offered to patients with T1-2 glottic carcinoma with potential advantages in terms of local control and a shortened overall treatment time .

effect of radiotherapy fraction size

LPFS

toxicity profile

LPFS

T1-2 glottic squamous cell carcinomas

early glottic carcinoma

patients with T1-2 glottic carcinoma


Therapeutic effect of inhaled budesonide ( Pulmicort® Turbuhaler ) on the inflammatory response to one-lung ventilation . This prospective , double-blind trial was designed to evaluate the effect of inhaled budesonide on lung function and the inflammatory response to one-lung ventilation . One hundred patients scheduled for lobectomy were allocated randomly to pre-operative nebulised budesonide or saline . Bronchoalveolar lavage fluid samples were collected from either the collapsed or the ventilated lung both before one-lung ventilation and 30 min after re-expansion of the lung . The concentrations of serum and bronchoalveolar lavage fluid cytokines were determined . Budesonide treatment , compared with saline , reduced both peak ( mean ( SD ) 3.7 ( 0.4 ) vs 2.5 ( 0.2 ) kPa ) and plateau ( mean ( SD ) 3.1 ( 0.2 ) vs 2.2 ( 0.1 ) kPa , respectively , p < 0.001 for both ) ventilatory pressures . Thirty minutes after re-expansion , lung compliance increased in the budesonide group compared with saline ( 57.5 ( 4.1 ) vs 40.1 ( 3.5 ) ml.cmH ( 2 ) O ( -1 ) , respectively p < 0.001 ) . Budesonide also reduced the concentrations of tumour necrosis factor-α , interleukin-1β , interleukin-6 and interleukin-8 in bronchoalveolar lavage fluid , but increased interleukin-10 30 min after re-expansion ( p < 0.05 for all measures ) . Pre-operative nebulisation of budesonide may be effective in improving ventilatory mechanics and reducing the inflammatory response to one-lung ventilation during thoracic surgery .

budesonide

budesonide

saline

lung function

inflammatory

ventilatory pressures

ventilatory mechanics

inflammatory response

One hundred


Comparative study of actinic keratosis treatment with 3 % diclofenac sodium and 5 % 5-fluorouracil . BACKGROUND Actinic keratosis is a frequent lesion which occurs in sunlight exposed areas . Diclofenac sodium and 5-Fluorouracil are effective , non-invasive and easy-to-apply topical treatment options . OBJECTIVES To assess and compare the effectiveness of 3 % diclofenac sodium associated with 2.5 % hyaluronic acid and of 5 % 5-Fluorouracil for the treatment of actinic keratosis , as well as the patient 's degree of satisfaction and tolerability . METHODS 28 patients with a clinical diagnosis of actinic keratosis were randomized to receive diclofenac sodium or 5-Fluorouracil and were clinically assessed before and after treatment as well as 8 weeks after the end of treatment . Modified versions of the Investigator and Patient Global Improvement Scores were used . RESULTS The average number of lesions in the diclofenac sodium group before and after treatment was 13.6 and 6.6 ( p < 0,001 ) , respectively , while it was 17.4 and 3.15 ( p < 0.001 ) in the 5-Fluorouracil group . There was a significant reduction in the number of lesions in the 5-Fluorouracil group in relation to the diclofenac sodium group ( p < 0.001 ) . To the non-blinded physician , there was a higher satisfactory therapeutic response in the 5-Fluorouracil group ( p < 0.001 ) ; to the blinded physician , there was a higher satisfactory response in this same group , although not statistically significant ( p=0.09 ) . There was a high degree of satisfaction in both groups ( 73 % in the diclofenac sodium group and 77 % in the 5-Fluorouracil group ; p=0.827 ) . Regarding adverse effects , the diclofenac sodium group presented a higher degree of satisfaction ( 93.3 % vs 38.4 % ; p=0.008 ) . Erythema , edema , crusts and itching were significantly higher in the 5-Fluorouracil group . CONCLUSION We concluded that 5-Fluorouracil was more effective ; however , it showed lower tolerability than diclofenac sodium .

3 % diclofenac sodium

5 % 5-fluorouracil

Diclofenac sodium

3 % diclofenac sodium

2.5 % hyaluronic acid

5 % 5-Fluorouracil

diclofenac sodium

diclofenac sodium

diclofenac

diclofenac

diclofenac sodium

diclofenac sodium

assess and compare the effectiveness

average number of lesions

therapeutic response

adverse effects

Erythema , edema , crusts and itching

actinic keratosis

Actinic keratosis

28 patients


There is no sweet escape from social pain : glucose does not attenuate the effects of ostracism . Ostracism causes social pain and is known to activate regions of the brain that are involved in the representation of physical pain . Previous research has observed that acetominophen ( a common pain reliever ) can reduce the pain of exclusion . The taste and consumption of glucose can also relieve physical pain , and the purpose of the current study was to examine whether it might also reduce the negative emotional effects of ostracism . In an appropriately powered experiment , participants were given 25g of glucose or a sucralose placebo before being ostracized while playing Cyberball . Strong effects of ostracism were observed , however , there was no effect of glucose on immediate or delayed self-reported needs or mood . These results are discussed in reference to the possibility that social pain is unlike physical pain since the latter is affected by glucose , which is believed to lessen pain by increasing endogenous opioid activity .

acetominophen

25g of glucose

sucralose placebo

glucose

negative emotional effects of ostracism

glucose

effects of ostracism

emotional effects of ostracism

participants were given 25g of glucose


Central 5-HT4 receptor binding as biomarker of serotonergic tonus in humans : a [ 11C ] SB207145 PET study . Identification of a biomarker that can inform on extracellular serotonin ( 5-HT ) levels in the brains of living humans would enable greater understanding of the way brain circuits are modulated by serotonergic neurotransmission . Substantial evidence from studies in animals and humans indicates an inverse relationship between central 5-HT tonus and 5-HT type 4 receptor ( 5-HT4R ) density , suggesting that 5-HT4R receptor density may be a biomarker marker for 5-HT tonus . Here , we investigated whether a 3-week administration of a selective serotonin reuptake inhibitor , expected to increase brain 5-HT levels , is associated with a decline in brain 5-HT4R binding . A total of 35 healthy men were studied in a placebo-controlled , randomized , double-blind study . Participants were assigned to receive 3 weeks of oral dosing with placebo or fluoxetine , 40 mg per day . Brain 5-HT4R binding was quantified at baseline and at follow-up with [ ( 11 ) C ] SB207145 positron emission tomography ( PET ) . Three weeks of intervention with fluoxetine was associated with a 5.2 % reduction in brain 5-HT4R binding ( P=0.017 ) , whereas placebo intervention did not change 5-HT4R binding ( P=0.52 ) . Our findings are consistent with a model , wherein the 5-HT4R density adjusts to changes in the extracellular 5-HT tonus . Our data demonstrate for the first time in humans that the imaging of central 5-HT4R binding may be used as an in vivo biomarker of the central 5-HT tonus .

placebo-controlled

oral dosing with placebo

fluoxetine , 40 mg per day

Brain 5-HT4R binding

positron emission tomography

brain 5-HT4R binding

5-HT4R density

humans :

living humans


Evaluating proton stereotactic body radiotherapy to reduce chest wall dose in the treatment of lung cancer . Stereotactic body radiotherapy ( SBRT ) can produce excellent local control of several types of solid tumor ; however , toxicity to nearby critical structures is a concern . We found previously that in SBRT for lung cancer , the chest wall ( CW ) volume receiving 20 , 30 , or 40Gy ( V20 , V30 , or V40 ) was linked with the development of neuropathy . Here we sought to determine whether the dosimetric advantages of protons could produce lower CW doses than traditional photon-based SBRT . We searched an institutional database to identify patients treated with photon SBRT for lung cancer with tumors within < 2.5cm of the CW . We found 260 cases ; of these , chronic grade ≥ 2 CW pain was identified in 23 patients . We then selected 10 representative patients from this group and generated proton SBRT treatment plans , using the identical dose of 50Gy in 4 fractions , and assessed potential differences in CW dose between the 2 plans . The proton SBRT plans reduced the CW doses at all dose levels measured . The median CW V20 was 364.0cm ( 3 ) and 160.0cm ( 3 ) ( p < 0.0001 ) , V30 was 144.6cm ( 3 ) vs 77.0cm ( 3 ) ( p = 0.0012 ) , V35 was 93.9cm ( 3 ) vs 57.9cm ( 3 ) ( p = 0.005 ) , V40 was 66.5cm ( 3 ) vs 45.4cm ( 3 ) ( p = 0.0112 ) , and mean lung dose was 5.9Gy vs 3.8Gy ( p = 0.0001 ) for photons and protons , respectively . Coverage of the planning target volume ( PTV ) was comparable between the 2 sets of plans ( 96.4 % for photons and 97 % for protons ) . From a dosimetric standpoint , proton SBRT can achieve the same coverage of the PTV while significantly reducing the dose to the CW and lung relative to photon SBRT and therefore may be beneficial for the treatment of lesions closer to critical structures .

proton stereotactic body radiotherapy

Stereotactic body radiotherapy ( SBRT )

SBRT

20 , 30 , or 40Gy

photon-based SBRT .

photon SBRT

lung cancer

patients treated with photon SBRT

chronic grade ≥ 2 CW pain

10 representative patients


Double-blind , placebo-controlled trial of risperidone plus amantadine in children with autism : a 10-week randomized study . OBJECTIVE This study aimed to investigate the effect of adding amantadine to risperidone for treatment of autism . METHODS Forty outpatients aged 4 to12 years , who were diagnosed with autism spectrum disorders based on the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , Text Revision criteria , were assigned to this double-blind clinical trial . The subjects were divided randomly into 2 groups . One group received risperidone plus amantadine , and the other group received risperidone plus placebo . The dose of risperidone was titrated between 1 and 2.0 mg/d , and the dose of amantadine was 100 or 150 mg/d for patients less than 30 kg or more than 30 kg , respectively . The patients were assessed using the Aberrant Behavioral Checklist-Community ( ABC-C ) and adverse effects checklist as well as clinical global impression-improvement ( CGI-I ) at2 checkpoints of 5-week intervals after the baseline . Informed consentwas obtained from the parents of each participant . RESULTS Among ABC-C subscales , Hyperactivity and Irritability showed significantly greater reduction in the amantadine group than the placebo group . There was no significant difference in adverse effects between the 2 groups . The CGI-I scores show significant improvement in the amantadine group compared to the placebo group . CONCLUSIONS The present study suggests that amantadine may be a potential adjunctive treatment strategy for autism and it was generally well tolerated .

placebo-controlled

risperidone plus amantadine

amantadine to risperidone

risperidone plus amantadine

risperidone plus

placebo

amantadine

amantadine

amantadine

adverse effects checklist

adverse effects

CGI-I scores

children

autism

Forty

aged 4 to12 years

autism spectrum disorders


Do ACE inhibitors improve the response to exercise training in functionally impaired older adults ? A randomized controlled trial . BACKGROUND Loss of muscle mass and strength with ageing is a major cause for falls , disability , and morbidity in older people . Previous studies have found that angiotensin-converting enzyme inhibitors ( ACEi ) may improve physical function in older people . It is unclear whether ACEi provide additional benefit when added to a standard exercise training program . We examined the effects of ACEi therapy on physical function in older people undergoing exercise training . METHODS Community-dwelling people aged ≥ 65 years with functional impairment were recruited through general ( family ) practices . All participants received progressive exercise training . Participants were randomized to receive either 4 mg perindopril or matching placebo daily for 20 weeks . The primary outcome was between-group change in 6-minute walk distance from baseline to 20 weeks . Secondary outcomes included changes in Short Physical Performance Battery , handgrip and quadriceps strength , self-reported quality of life using the EQ-5D , and functional impairment measured using the Functional Limitations Profile . RESULTS A total of 170 participants ( n = 86 perindopril , n = 84 placebo ) were randomized . Mean age was 75.7 ( standard deviation [ SD ] 6.8 ) years . Baseline 6-minute walk distance was 306 m ( SD 99 ) . Both groups increased their walk distance ( by 29.6 m perindopril , 36.4 m placebo group ) at 20 weeks , but there was no statistically significant treatment effect between groups ( -8.6m [ 95 % confidence interval : -30.1 , 12.9 ] , p = .43 ) . No statistically significant treatment effects were observed between groups for the secondary outcomes . Adverse events leading to withdrawal were few ( n = 0 perindopril , n = 4 placebo ) . INTERPRETATION ACE inhibitors did not enhance the effect of exercise training on physical function in functionally impaired older people .

response

exercise training

Loss of muscle mass and strength

falls , disability , and morbidity

physical function

physical function

functionally impaired older adults


Hypotension in response to iloprost , a prostacyclin analogue .

iloprost

Hypotension

Hypotension

iloprost


Combining afferent stimulation and mirror therapy for rehabilitating motor function , motor control , ambulation , and daily functions after stroke . BACKGROUND Mirror therapy ( MT ) and mesh glove ( MG ) afferent stimulation may be effective in reducing motor impairment after stroke . A hybrid intervention of MT combined with MG ( MT + MG ) may broaden aspects of treatment benefits . OBJECTIVE To demonstrate the comparative effects of MG + MT , MT , and a control treatment ( CT ) on the outcomes of motor impairments , manual dexterity , ambulation function , motor control , and daily function . METHODS Forty-three chronic stroke patients with mild to moderate upper extremity impairment were randomly assigned to receive MT + MG , MT , or CT for 1.5 hours/day , 5 days/week for 4 weeks . Outcome measures were the Fugl-Meyer Assessment ( FMA ) and muscle tone measured by Myoton-3 for motor impairment and the Box and Block Test ( BBT ) and 10-Meter Walk Test ( 10 MWT ) for motor function . Secondary outcomes included kinematic parameters for motor control and the Motor Activity Log and ABILHAND Questionnaire for daily function . RESULTS FMA total scores were significantly higher and synergistic shoulder abduction during reach was less in the MT + MG and MT groups compared with the CT group . Performance on the BBT and the 10 MWT ( velocity and stride length in self-paced task and velocity in as-quickly-as-possible task ) were improved after MT + MG compared with MT . CONCLUSIONS MT + MG improved manual dexterity and ambulation . MT + MG and MT reduced motor impairment and synergistic shoulder abduction more than CT. Future studies may integrate functional task practice into treatments to enhance functional outcomes in patients with various levels of motor severity . The long-term effects of MG + MT remain to be evaluated .

afferent stimulation

mirror therapy

Mirror therapy ( MT )

mesh glove ( MG ) afferent stimulation

MT combined with MG ( MT + MG )

MG + MT , MT

control treatment ( CT )

MT + MG

MT

CT

MT + MG

MT

CT

MT + MG

MT

MT + MG

MT + MG

MT

CT.

MG + MT

motor function

motor control

ambulation

daily functions after stroke

Myoton-3 for motor impairment

Box and Block Test ( BBT )

10-Meter Walk Test ( 10 MWT )

kinematic parameters for motor control

Motor Activity Log

FMA total scores

BBT

10 MWT

manual dexterity and ambulation