Modeling hippocampal and neocortical contributions to recognition memory : a complementary-learning-systems approach . The authors present a computational neural-network model of how the hippocampus and medial temporal lobe cortex ( MTLC ) contribute to recognition memory . The hippocampal component contributes by recalling studied details . The MTLC component can not support recall , but one can extract a scalar familiarity signal from MTLC that tracks how well a test item matches studied items . The authors present simulations that establish key differences in the operating characteristics of the hippocampal-recall and MTLC-familiarity signals and identify several manipulations ( e.g. , target-lure similarity , interference ) that differentially affect the 2 signals . They also use the model to address the stochastic relationship between recall and familiarity and the effects of partial versus complete hippocampal lesions on recognition .

hippocampal and neocortical

hippocampal

simulations

recognition

recognition memory .

hippocampal-recall

MTLC-familiarity signals

recognition

recognition memory


Micronized flavonoids in pain control after hemorrhoidectomy : a prospective randomized controlled study . PURPOSE We conducted a prospective randomized controlled study to evaluate the effect of micronized flavonoid fractions ( MFF ) on pain after hemorrhoidectomy . METHODS The subjects were 112 consecutive patients randomly assigned either to receive MFF ( group 1 ) for 1 week or not to receive MFF , as a control ( group 2 ) , after hemorrhoidectomy , The severity of pain and the number of intramuscular analgesic injections required were recorded for the first 3 days , then 1 week after hemorrhoidectomy . The number of days that intramuscular analgesic injections were required , hospital stay , and patient satisfaction were also assessed . RESULTS On postoperative day ( POD ) 1 , there were no significant differences between the parameters of the two groups , but on PODs 2 and 3 , both the pain score ( P = 0.033 and P = 0.011 , respectively ) and the number of patients who required intramuscular analgesic injections were significantly less in group 1 ( P = 0.022 and P = 0.007 , respectively ) . Moreover , the hospital stay was shorter and patient satisfaction was superior in group 1 ( P = 0.001 and P = 0.001 , respectively ) . After 1 week , the pain score and number of intramuscular analgesic injections given were significantly less in group 1 ( P = 0.001 and P = 0.021 ) . CONCLUSION Using MFF after hemorrhoidectomy reduced the severity of pain and intramuscular analgesic requirement .

Micronized flavonoids

micronized flavonoid fractions ( MFF )

MFF

MFF

The severity of pain

MFF

pain control

pain

number of days that

intramuscular analgesic injections

were required

hospital stay

patient satisfaction

pain score

intramuscular analgesic injections

hospital stay

patient satisfaction

pain score

intramuscular analgesic injections

severity of pain

intramuscular analgesic requirement

after hemorrhoidectomy :


Evaluation of umbilical cord serum therapy for persistent corneal epithelial defects . AIMS To evaluate umbilical cord serum therapy as a means of promoting the healing of persistent corneal epithelial defects . METHODS Umbilical cord serum or autologous serum drops were used to promote the healing of persistent epithelial defects . The study design was a prospective randomised controlled clinical trial . 60 eyes of 59 patients were divided into two groups , 31 in the cord serum group and 29 in the autologous serum control group . Epithelial defects measuring at least 2 mm in linear dimension resistant to conventional medical management were included . Serial measurements of the size of the epithelial defects-namely , two maximum linear dimensions perpendicular to each other , and the area and perimeter was done at start of therapy and follow up days 3 , 7 , 14 , 21 . Rate of healing of the epithelial defects were measured as percentage decrease from the baseline parameter at each subsequent follow up . The data were analysed by the non-parametric Wilcoxon rank sum test using STATA 7.0 . RESULTS The median percentage decrease in the size of the epithelial defect was significantly greater in the cord serum group at days 7 , 14 and 21 ( p < 0.05 ) when measured in terms of the area and perimeter . A greater number of patients showed complete re-epithelialisation with umbilical cord serum ( n = 18 ) than with autologous serum ( n = 11 ) ( Pearson chi = 0.19 ) . None of the patients reported any side effects or discomfort with either treatment . CONCLUSIONS Umbilical cord serum leads to faster healing of the persistent corneal epithelial defects refractory to all medical management compared to autologous serum .

umbilical cord serum therapy

umbilical cord serum therapy

Umbilical cord serum

autologous serum drops

cord serum

autologous serum control

cord serum

cord serum

Umbilical cord serum

autologous serum

persistent corneal epithelial defects

persistent epithelial defects

complete re-epithelialisation

persistent corneal epithelial defects .

persistent corneal epithelial defects .


Mometasone furoate nasal spray improves olfactory performance in seasonal allergic rhinitis .

Mometasone furoate nasal spray

seasonal allergic rhinitis


Esomeprazole resolves chronic heartburn in patients without erosive oesophagitis . BACKGROUND Patients with chronic heartburn but with no endoscopic evidence of erosive oesophagitis require gastric acid suppression to relieve symptoms . AIM To assess the efficacy and safety of esomeprazole in patients with frequent heartburn for > or = 6 months and no evidence of erosive oesophagitis on endoscopy . METHODS Two randomized , double-blind , 4-week , multi-centre trials with identical methodology compared once-daily esomeprazole , 40 mg ( n = 241 ) or 20 mg ( n = 234 ) , with placebo ( n = 242 ) for the rigorous end-point of complete resolution of heartburn . Secondary end-points included the percentage of heartburn-free days and the time to first and sustained resolution of heartburn . RESULTS Patients treated with either dose of esomeprazole were two to three times more likely to achieve complete resolution of heartburn than patients treated with placebo ( P < 0.001 ) . The percentage of heartburn-free days was significantly higher with esomeprazole 40 mg ( 63 % , 66 % ) or 20 mg ( 63 % , 68 % ) than with placebo ( 46 % , 36 % ; P < or = 0.001 ) in each of the two studies . Esomeprazole was associated with a significantly shorter mean time to first ( 6-7 days ) and sustained ( 12-17 days ) resolution of heartburn compared with placebo ( first , 10-12 days ; sustained , 21-22 days ; P < or = 0.008 ) . The spectrum and frequency of adverse events with esomeprazole were similar to those with placebo . CONCLUSIONS Esomeprazole , at daily doses of 40 mg or 20 mg , is effective and safe for the treatment of chronic heartburn in patients without erosive oesophagitis .

Esomeprazole

esomeprazole

esomeprazole

placebo

esomeprazole

esomeprazole

Esomeprazole

esomeprazole

Esomeprazole

chronic heartburn

relieve symptoms

efficacy and safety

frequent heartburn

complete resolution of heartburn

percentage of heartburn-free days

complete resolution of heartburn

percentage of heartburn-free days

resolution of heartburn

effective and safe

chronic heartburn

without erosive oesophagitis

chronic heartburn

frequent heartburn for > or = 6 months


Vaginal electrical stimulation of the pelvic floor : a randomized feasibility study in urinary incontinent elderly women . BACKGROUND To evaluate the effectiveness of intravaginal electrical stimulation ( ES ) of the pelvic floor for urinary incontinence in elderly women , and to determine whether ES of the pelvic floor is a preferable treatment for urinary incontinence in elderly women . METHODS Postmenopausal women ( age 65 years or older ) were enrolled in a randomized clinical trial and underwent every-other-day ES of the pelvic floor , or a daily Kegel exercise ( KE ) program . Objective outcome variables were : ( 1 ) Urinary leakage ( during a standardized PAD test ) , ( 2 ) pelvic muscle strength ( measured by a perineometer ) , and ( 3 ) detrusor instability ( on ambulant urodynamic registration ) . Subjective outcome variables were women 's subjective assessment of change in urinary symptoms based on the PRAFAB score . Twenty-four women treated with ES and 11 women treated with Kegel exercises completed the 8-week study program . The Chi-square test was used for statistical analysis . RESULTS No significant improvement in objective outcome variables was observed in the population treated with ES compared with the population treated with KE ( with 29.2 % vs. 36.4 % of the women showing objective improvement in measured urinary leakage ) . Neither was subjective improvement significant , with 29.2 % vs. 27.3 % of the women reporting improvement in the amount of urinary leakage . CONCLUSIONS Although the number of enrolled women was very small this study shows that : 1 . Treating elderly women with vaginal ES of the pelvic floor has a high physical and emotional cost for the individual . 2 . The effectiveness of ES of the pelvic floor in urinary incontinent elderly women is low . 3 . There is no great discrepancy between objective amelioration ( PAD test ) and subjective amelioration ( PRAFAB score/quantity of urinary leakage ) , if the objective improvement is adequately defined . 4 . It is not reasonable to advise elderly women with urinary incontinence to undertake this treatment procedure . The effectiveness of treatment does not compensate for the long-lasting and intense treatment protocol . 5 . We terminated this study because of the negative outcome with ES .

ES of the pelvic floor

ES of the pelvic floor

daily Kegel exercise ( KE )

program

Urinary leakage

pelvic muscle strength

detrusor instability

ambulant urodynamic registration

measured urinary leakage

urinary leakage

effectiveness


Presentation of allergen in different food preparations affects the nature of the allergic reaction -- a case series . BACKGROUND Characterization of fatal and non-fatal reactions to food indicates that the majority of reactions are due to the ingestion of prepared foods rather than the non-processed allergen . In an ongoing study that used a double-blind placebo-controlled food challenge to investigate peanut allergy and clinical symptoms , the observed reaction severity in four of the first six subjects was greater than anticipated . We hypothesized that this was due to differences in the composition of the challenge vehicle . OBJECTIVE The aim was to investigate whether the severity of observed challenge reactions would be repeated on re-challenge with a lower fat challenge vehicle . METHODS Peanut-allergic subjects were re-challenged with a lower fat recipe after reacting more severely than was anticipated to an initial peanut challenge . Similar challenge vehicle recipes were used , the only difference being the lower fat content ( 22.9 % compared with 31.5 % ) . The peanut content of the two recipes was analysed using RAST inhibition studies and ELISA tests . RESULTS Three of four subjects reacted to much smaller doses of peanut protein on re-challenge ( mean dose equivalence - 23 times less peanut ) with the lower fat recipe . RAST inhibition showed that neither recipe altered epitope recognition . The higher fat recipe required twice as much peanut to cause 50 % inhibition . ELISA detected far lower levels of peanut in the higher fat recipe ( 220 000 parts per million ( p.p.m . ) ) than in the lower fat recipe ( 990 000 p.p.m. ) . CONCLUSION The fat content of a challenge vehicle has a profound effect on the reaction experienced after allergen ingestion . This is another factor to be considered in assessing the risk of certain foods to food-allergic consumers and adds another dimension to clinical , research and regulatory practice .

placebo-controlled

lower fat challenge vehicle

lower fat recipe

peanut

doses of peanut protein on re-challenge

RAST inhibition

epitope recognition

allergic reaction

six

Peanut-allergic

food-allergic


Remifentanil with morphine transitional analgesia shortens neurological recovery compared to fentanyl for supratentorial craniotomy . PURPOSE To compare the recovery profiles , efficacy and safety of remifentanil and morphine for transitional analgesia with fentanyl in patients undergoing elective craniotomy for supratentorial mass lesions . METHODS Ninety-one patients were enrolled in this prospective , randomized , multicentre study . Anesthesia was induced with thiopental and remifentanil ( 1.0 micro g x kg ( -1 ) bolus and a 1 micro g x kg ( -1 ) x min ( -1 ) infusion ) or fentanyl ( 1 micro g x kg ( -1 ) bolus and a 1.0 micro g x kg ( -1 ) x min ( -1 ) infusion ) . The opioid infusion continued until the level of anesthesia was deemed appropriate for intubation . Anesthesia was maintained with N ( 2 ) O/O ( 2 ) , isoflurane 0.5 MAC and remifentanil 0.2 micro g x kg ( -1 ) x min ( -1 ) or fentanyl 0.04 micro g x kg ( -1 ) x min ( -1 ) . At bone flap replacement , either morphine 0.08 mg x kg ( -1 ) ( remifentanil group ) or saline ( fentanyl group ) was given . RESULTS Systolic blood pressure was greater in those receiving fentanyl during induction ( 145.6 +/-17.5 mmHg vs 128.8 +/-18.3 mmHg ; P = 0.006 ) and intubation ( 126.9 +/-17.1 vs 110.9 +/-16.5 mmHg ; P < 0.001 ) . Median time to tracheal extubation was similar but less variable in the remifentanil group ( remifentanil = 8 min : range = 2-44 min ; fentanyl = 8 min : range = 1-732 min ) . The fentanyl patients required a longer time to achieve the first normal neurological score ( fentanyl = 38.0 min ; remifentanil = 26.0 min ; P = 0.035 ) . Both the anesthesiologists and the recovery room nurses rated remifentanil better with respect to level of consciousness . Analgesics were required earlier in patients receiving remifentanil ; median time 0.5 vs 1.08 hr , P < 0.001 . CONCLUSIONS Remifentanil is a suitable alternative to fentanyl in supratentorial craniotomy . Time to preoperative neurological recovery is faster and morphine provides some transitional analgesia without compromising the quality of recovery .

Anesthesia

fentanyl ( 1 micro g x kg ( -1 ) bolus

opioid infusion

anesthesia

Anesthesia

isoflurane 0.5 MAC

At bone flap replacement

either morphine 0.08 mg

remifentanil group )

saline

neurological recovery

recovery profiles

efficacy

safety

Systolic blood pressure

Median time to tracheal extubation

level of consciousness

Analgesics

transitional analgesia

quality of recovery

elective craniotomy

supratentorial mass lesions

Ninety-one


Measuring adherence in a hypertension clinical trial . BACKGROUND Non-adherence in hypertension is a global problem and promoting adherence is necessary to decrease cardiovascular mortality . AIMS The purpose of this paper is to examine the measurement of adherence to medication taking in hypertensive patients . Adherence was evaluated primarily by means of MEMS ( Medication Event Monitoring System , Aprex Corporation , Fremont , California ) an electronic system that records the date and time of opening of the study medication container . Additional measurements such as change in urinary potassium level , capsule count , client self report and physician estimate of adherence were recorded . METHODS A randomised clinical trial was used to assign patients to receive the study medication ( potassium ) or placebo . Descriptive statistics were used to answer the research questions . Frequency and percentage of responses to different measures of adherence were carried out as well as correlation between the measures . RESULTS One hundred and seven subjects between the ages of 26 and 80 participated in the clinical trial . The results showed that adherence measures varied with lowest adherence from two items of self-report related to forgetfulness ( 46 and 55 % ) and stringent electronic monitoring with the MEMS ( 58 % ) to percentages in the 80-90 range for other self-report items and the general adherence scale . Electronic monitoring correlated best with capsule count at visit 5 . Implications for health care providers are discussed .

medication

study medication ( potassium )

placebo

adherence

urinary potassium level

capsule count

adherence

self-report related to forgetfulness

electronic monitoring with the MEMS

capsule count

hypertension

hypertensive

One hundred and seven

26 and 80


Efficacy of azithromycin for the treatment of feline chlamydophilosis . The current recommended treatment for feline chlamydophilosis involves daily oral administration of antimicrobials to all cats within an affected group for a prolonged period of time ( 4-6 weeks ) . Not surprisingly , owner compliance can be poor resulting in apparent treatment failure . Recent anecdotal evidence , supported by its efficacy in the treatment of Chlamydia trachomatis infection in humans , has suggested that azithromycin may offer an alternative by allowing less frequent dosing for a shorter duration . A clinical trial was designed to evaluate the efficacy of azithromycin for the treatment of chlamydia ( Chlamydophila felis ) infection in cats . Whilst azithromycin , given at 10-15 mg/kg daily for 3 days and then twice weekly , provided a similar , rapid resolution of clinical signs and negative isolation scores as doxycycline , C felis was re-isolated in four out of the five cats treated . Furthermore , even daily administration of azithromycin to chronically infected cats was ineffective in clearing infection . The azithromycin protocols used here were therefore found to be unsuccessful in eliminating the carriage of this strain of C felis .

azithromycin

antimicrobials

azithromycin

azithromycin

azithromycin

doxycycline

azithromycin

Efficacy

efficacy

efficacy

ineffective in clearing infection .


Twenty-four vs. forty-eight weeks of re-therapy with interferon alpha 2b and ribavirin in interferon alpha monotherapy relapsers with chronic hepatitis C. BACKGROUND/AIM Roughly 50 % of patients with chronic hepatitis C , who relapsed after a previous monotherapy with interferon alpha , will respond in a sustained fashion to 24 weeks of re-therapy with the combination of interferon alpha plus ribavirin . Whether prolonging treatment duration to 48 weeks will further increase sustained response rates remains ill defined . In this randomised controlled pilot trial we compared the efficacy and tolerability of a 24 week with that of a 48 week course of combination therapy with interferon alpha and ribavirin in interferon monotherapy relapsers with chronic hepatitis C. METHODS Interferon alpha monotherapy relapsers with chronic hepatitis C were randomised to receive interferon alpha 2b ( 3 x 3 MIU sc weekly ) and oral ribavirin ( 1000/1200 mg po daily ) for either 24 weeks or 48 weeks . Virological response was evaluated by HCV RNA PCR at week 10 ( initial response ) , at the end of treatment ( end of- treatment response ) and at the end of 24 weeks follow-up ( sustained response ) . Only patients with negative HCV RNA at week 10 continued treatment . Adverse events were recorded at regular intervals . RESULTS Thirty-seven patients were enrolled , 19 ( 6 females , median age 43 ) in the 24 week and 18 ( 5 females , median age 40 ) in the 48 week treatment arm . Baseline characteristics were similar in both groups . At treatment week 10 , 12/19 ( 63 % ) in the 24 week group and 14/18 ( 78 % ) patients in the 48 week group had lost HCV RNA in serum ( p = 0.33 ) . All initial responders remained HCV RNA negative throughout the treatment period . Sustained response rates were 10/19 ( 53 % ) in the 24 week group and 13/18 ( 72 % ) in the 48 week group ( p = 0.31 ) . Three patients discontinued treatment early ( two due to moderate adverse events , one due to non-compliance ) . Dose modifications were necessary in 9 patients , 4 in the 24 week and 5 in the 48 week group for anaemia , neutropenia , nausea and depression , respectively . CONCLUSION Prolonging interferon / ribavirin combination therapy in interferon alpha monotherapy relapsers with chronic hepatitis C from 24 to 48 weeks may increase sustained response rates . Larger controlled trials using pegylated interferon alpha and ribavirin in relapsers with chronic hepatitis C seem warranted .

interferon alpha 2b

ribavirin

combination of

interferon alpha

plus

ribavirin

interferon alpha 2b

oral ribavirin

efficacy

tolerability

Adverse events

lost

HCV RNA in serum

HCV RNA negative

Sustained response rates

moderate adverse events

anaemia

neutropenia

nausea

depression

sustained response rates

interferon alpha monotherapy relapsers

chronic hepatitis C.

interferon monotherapy relapsers

chronic hepatitis C.

Interferon alpha monotherapy relapsers

chronic hepatitis C

negative HCV RNA

Thirty-seven

females

females

Three

relapsers with chronic hepatitis C


Effects of weight reduction interventions by community pharmacists . OBJECTIVE To compare a meal replacement ( MR ) program with a conventional reduced-calorie diet ( RCD ) for weight management using the pharmacy as the setting and the pharmacist as the point of contact for dietary advice . DESIGN Randomized , controlled , open-label trial . SETTING Travis Pharmacy in Shenandoah , Iowa . PATIENTS Ninety-five patients from southwestern iowa and southeastern Nebraska were enrolled , of whom 88 were considered eligible for comparison ( by continuing through week 2 of the study ) . INTERVENTION Patients were randomized to an MR plan or a traditional RCD plan . Patients were followed for a 3-month period of active weight loss and a 10-week period of weight maintenance . Patients returned every 3 weeks for follow-up with the pharmacist , for a total of 13 visits . MAIN OUTCOME MEASURE Weight changes . RESULTS During the active weight loss phase , the MR ( n = 45 ) and RCD ( n = 43 ) groups lost a significant amount of weight , although no significant difference was found between the groups ( mean +/- standard error = 4.90 +/- 0.30 kg MR versus 4.30 +/- 0.30 kg RCD ; P = .16 ) . In the weight maintenance phase , the MR group lost 0.70 +/- 0.40 kg and the RCD group lost 0.90 +/- 0.40 kg ( P = .60 ) . Significant improvements were observed in waist circumference , systolic and diastolic blood pressure , and triglyceride levels . No significant changes were seen in high-density lipoprotein cholesterol or low-density lipoprotein cholesterol levels in either group . CONCLUSION Successful weight management can be achieved in a pharmacy setting . Both MR and RCD programs were effective .

weight reduction interventions

meal replacement ( MR ) program

dietary advice

MR

RCD

MR

RCD

Weight changes .

significant amount of weight

Ninety-five


Parent-defined target symptoms respond to risperidone in RUPP autism study : customer approach to clinical trials . OBJECTIVE A consumer-oriented efficacy assessment in clinical trials should measure changes in chief complaint and consumer request ( symptoms of most concern to patient/caregiver ) , which may be diluted in change scores of multisymptom scales . METHOD In the Research Units on Pediatric Psychopharmacology ( RUPP ) Autism Network 8-week double-blind trial of risperidone versus placebo , the chief concerns of parents were collected at 0 , 4 , and 8 weeks ( endpoint ) , in addition to standardized primary measures . Blinded clinical judges rated change from baseline to 4 and 8 weeks on a 9-point scale ( 1 = normalized , 5 = unchanged , 9 = disastrous ) ; 94 participants had usable data . RESULTS The most common symptoms identified by parents were tantrums , aggression , and hyperactivity . Interrater reliability was excellent . Mean ratings at endpoint were 2.8 +/- 1.2 on risperidone and 4.5 +/- 1.3 on placebo ( p < .001 ) . Ratings were collinear with Clinical Global Impression-Improvement and Aberrant Behavior Checklist Irritability subscale ( primary dimensional measure ) . Effect size d was 1.4 , compared to 1.2 on the Aberrant Behavior Checklist Irritability subscale . Effect sizes varied twofold by symptom category , largest for self-injury ( 2.11 ) and tantrums ( 1.95 ) . CONCLUSIONS Risperidone was superior to placebo in reducing symptoms of most concern to parents of autistic children with irritable behavior . Rating individualized participant-chosen target symptoms seems a reliable , sensitive , efficient , and consumer-friendly way to assess treatment effect and might have clinical application .

risperidone

risperidone

placebo

risperidone

placebo

Risperidone

placebo

tantrums

aggression

hyperactivity

Interrater reliability

Mean ratings at endpoint

Clinical Global Impression-Improvement

Effect size

Aberrant Behavior Checklist

Effect sizes

symptoms

irritable behavior

RUPP autism

autistic

children

irritable behavior


Removal of hypertrophied anal papillae and fibrous anal polyps increases patient satisfaction after anal fissure surgery . BACKGROUND Hypertrophied anal papillae and fibrous anal polyps are frequently found in association with chronic fissure in ano . Usually , no specific attention is given to them and they are considered normal findings . The present prospective study was aimed at determining whether removal of hypertrophied anal papillae and fibrous anal polyps while dealing with chronic fissure in ano confers long-term benefit to patients . METHODS Between July 1999 and December 2000 , 140 patients undergoing anal sphincterotomy were randomized into two groups to have their fibrous polyps and hypertrophied anal papillae either removed by radiofrequency surgery or left intact . After two years , they underwent a detailed interview by an independent , masked investigator . RESULTS Overall 84 % of patients who had polyp and papilla removal rated the outcome of their surgery as excellent or good in comparison to 58 % of controls . The mean satisfaction grading was 9.2 on a visual analogue scale in the treatment group compared to 8.1 in controls ( p=0.004 ) . CONCLUSION Removal of hypertrophied anal papillae and fibrous anal polyps should be an essential part of treatment of chronic fissure in ano . Persistence of these structures leaves behind a sense of incomplete treatment , reducing the overall satisfaction on the part of the patient . Radiofrequency procedure is useful in eradication of these concomitant pathologies .

radiofrequency surgery

left intact

Radiofrequency procedure

patient satisfaction

long-term benefit

visual analogue scale

overall satisfaction

after anal fissure surgery .


Prophylactic effect of phenytoin in bipolar disorder : a controlled study . OBJECTIVE Phenytoin is an effective anticonvulsant that has not previously been studied prophylactically in bipolar ( BP ) patients . Thus a study of phenytoin prophylaxis was undertaken and is herein reported . METHOD Bipolar patients were studied who had at least one episode per year in the previous 2 years despite ongoing prophylaxis . Patients were stable for a mean of 4 months ( range 1-13 ) before entering the study . Phenytoin or placebo was added to their current therapy in a double-blind cross-over design for 6 months in each phase . Thirty observation periods of 6 months each were studied for 23 patients . RESULTS Three patients had relapse on phenytoin and nine had relapse on placebo . There was a significant prophylactic effect of phenytoin in BP disorder [ Cox 's F-test for comparing survival in two groups : F ( 6 , 18 ) = 3.44 , p = 0.02 ] . CONCLUSIONS This study suggests prophylactic effects of add-on phenytoin in BP illness . However , the number of patients was small and confirmation is necessary .

phenytoin

Phenytoin

phenytoin

Phenytoin

placebo

phenytoin

phenytoin

phenytoin

Prophylactic effect

relapse

prophylactic effect

[ Cox 's F-test

survival in

prophylactic effects

bipolar disorder

bipolar

BP

Bipolar

had at least one episode per year

ongoing prophylaxis


Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy . BACKGROUND AND OBJECTIVE Intraperitoneal administration of a local anaesthetic in combination with an opioid , for the relief of postoperative pain , has already been reported except after laparoscopic cholecystectomy . This study was aimed at assessing the analgesic effect of the intraperitoneal administration of bupivacaine and morphine in patients undergoing laparoscopic cholecystectomy . METHODS At the end of laparoscopic cholecystectomy , in a double-blind , randomized manner , one of the following injections was given intraperitoneally . There were 30 patients in each group : Group 1 , physiological saline 30 mL ; Group 2 , bupivacaine 0.25 % 30 mL ; Group 3 , bupivacaine 0.25 % 30 mL plus morphine 2 mg . In addition , Group 2 received 2 mg intravenous ( i.v . ) morphine in 2 mL saline , and Groups 1 and 3 , 2 mL saline intravenously . Patients ' postoperative pain was evaluated using a visual analogue scale and a verbal rating score . The postoperative analgesic requirement was assessed by the total dose of metamizol administered by an i.v . patient-controlled analgesia ( PCA ) device . Pain , vital signs , supplemental analgesic consumption and side-effects were recorded for all patients for 24 h. RESULTS There were no differences between the three groups regarding pain scores ( at rest and coughing ) during the study except in the first 2 h , when scores were lower for patients receiving intraperitoneal bupivacaine plus i.v . morphine ( P < 0.05 ) . Supplemental consumption of metamizol was significantly lower ( P < 0.05 ) in Group 3 than in Group 1 during the first 6 h after surgery . However , the cumulative doses of metamizol were also lower in Group 2 than in Groups 1 and 3 over the entire study ( 2025 +/- 1044 mg vs. 4925 +/- 1238 and 4125 +/- 1276mg ; P < 0.05 ) . CONCLUSIONS In patients undergoing laparoscopic cholecystectomy , the intraperitoneal administration of morphine plus bupivacaine 0.25 % reduced the analgesic requirements during the first 6 postoperative hours compared with the control group . However , the combination of intraperitoneal bupivacaine 0.25 % and i.v . morphine was more effective for treatment of pain after laparoscopic cholecystectomy .

bupivacaine

morphine

bupivacaine

morphine

physiological saline

bupivacaine

bupivacaine

plus morphine

morphine

saline

bupivacaine

morphine

morphine

bupivacaine

bupivacaine

morphine

pain relief

postoperative pain

postoperative pain

visual analogue scale

verbal rating score

patient-controlled analgesia ( PCA )

Pain

vital signs

supplemental analgesic consumption

side-effects

pain scores

Supplemental consumption of metamizol

cumulative doses

analgesic requirements

pain

laparoscopic cholecystectomy .


Can acupuncture ease the symptoms of menopause ? In a randomized , 2-group clinical study , acupuncture was used for the relief of menopausal hot flushes , sleep disturbances , and mood changes . The experimental acupuncture treatment consisted of specific acupuncture body points related to menopausal symptoms . The comparison acupuncture treatment consisted of a treatment designated as a general tonic specifically designed to benefit the flow of Ch'i ( energy ) . Results from the experimental acupuncture treatment group showed a decrease in mean monthly hot flush severity for site-specific acupuncture . The comparison acupuncture treatment group had no significant change in severity from baseline over the treatment phase . Sleep disturbances in the experimental acupuncture treatment group declined over the study . Mood changes in both the experimental acupuncture treatment group and the comparison acupuncture treatment group showed a significant difference between the baseline and the third month of the study . Acupuncture using menopausal-specific sites holds promise for nonhormonal relief of hot flushes and sleep disturbances .

acupuncture

acupuncture

acupuncture

acupuncture

acupuncture

acupuncture

acupuncture

acupuncture

acupuncture

Acupuncture

symptoms of menopause

menopausal hot flushes

sleep disturbances

mood changes

menopausal symptoms

mean monthly hot flush severity

change in severity

Sleep disturbances

Mood changes

relief of

hot flushes

and

sleep disturbances

menopause

menopausal hot flushes

sleep disturbances

mood changes


Future therapeutic directions for factor Xa inhibition in the prophylaxis and treatment of thrombotic disorders . The targeted mechanism of factor Xa inhibition has been studied extensively , initially as prophylaxis for venous thromboembolism ( VTE ) in the orthopedic surgical setting . Future therapeutic directions for selective factor Xa inhibition in the management of other thrombotic diseases are discussed . Thromboembolic diseases can occur in the venous or arterial sides of the circulatory system . Factor Xa inhibition is a targeted approach to anticoagulation that resulted from significant advances in our understanding of the coagulation cascade . The factor Xa inhibitor fondaparinux has been studied extensively in the orthopedic surgical setting for the prophylaxis of VTE . Current investigations that are under way or completed evaluate the efficacy and safety of fondaparinux for the management of various thrombotic diseases . The future development of fondaparinux resides primarily in three therapeutic areas : prevention of VTE , treatment of VTE , and treatment of acute coronary syndromes . For the prevention of VTE , fondaparinux has been studied as extended prophylaxis following hip fracture surgery ( PENTHIFRA Plus ) , for use in high-risk abdominal surgical patients ( PEGASUS and APOLLO ) , and for use in medical patients ( ARTEMIS ) . Studies evaluating fondaparinux for the treatment of VTE are part of the large MATISSE clinical program ( MATISSE DVT and MATISSE PE ) . Fondaparinux was investigated in phase 2 studies for the treatment of acute coronary syndromes , including acute ST-segment myocardial infarction ( PENTALYSE ) and unstable angina ( PENTUA ) . Encouraging data from these trials are the basis for phase 3 programs in this area ( MICHELANGELO ) . The orthopedic prophylactic and nonorthopedic clinical programs for fondaparinux in the management of thrombosis support the concept that targeted inhibition of coagulation is an effective advance in antithrombotic therapy .

factor Xa inhibitor fondaparinux

fondaparinux

fondaparinux

Fondaparinux

efficacy and safety

acute coronary syndromes

targeted inhibition of coagulation

thrombotic disorders .

venous thromboembolism ( VTE )

acute coronary syndromes


Extracorporeal shock wave therapy ( ESWT ) in patients with chronic proximal plantar fasciitis : a 2-year follow-up . The aim of this study was to compare the effect of extracorporeal shock wave therapy ( ESWT ) in patients with chronically painful proximal plantar fasciitis with a further conventional conservative treatment . Forty-seven patients ( 49 feet ) with a previously unsuccessful nonsurgical treatment of at least 6 months were randomized to two groups . Heel cups had to be worn throughout the study . Group 1 ( 25 heels ) was treated immediately with three sessions of ESWT ( 3000 shock waves/session of 0.2 mJ/mm2 ) at weekly intervals . The patients of group 2 ( 24 heels ) continued nonsurgical treatment ( iontophoresis with diclofenac and an oral nonsteroidal anti-inflammatory drug ) for 12 weeks . After this period they were treated using the protocol of group 1 . No significant difference of pain and walking time after further nonsurgical treatment ( 3 months ) was seen in group 2 . At 12 weeks after ESWT , the pain estimation on the visual analogue scale ( VAS ) for activities of daily living diminished significantly by 62.9 % in group 1 and by 63.0 % in group 2 . The comfortable walking time had increased significantly in both groups . Two years after ESWT , pain during activities of daily living decreased by 94 % in group 1 and by 90 % in group 2 on the VAS and the comfortable walking time had increased significantly in both groups .

extracorporeal shock wave therapy

Heel cups

nonsurgical treatment

iontophoresis with diclofenac

and an

pain and walking time

comfortable walking time

pain during activities of daily living

comfortable walking time


Intraperitoneal cisplatin versus no further treatment : 8-year results of EORTC 55875 , a randomized phase III study in ovarian cancer patients with a pathologically complete remission after platinum-based intravenous chemotherapy . First-line intravenous chemotherapy ( CT ) following debulking surgery is associated with prolonged survival , in particular in patients who achieve a pathological complete remission ( pCR ) at second-look surgery but in whom a high rate of relapses still occurs . Between 1988 and 1997 , 153 patients in pCR following platinum-based intravenous CT were randomized between four courses of intraperitoneal cisplatin ( P ) ( 90 mg/m2 every 3 weeks ) or observation . Overall survival ( OS ) was the primary endpoint , while progression-free survival ( PFS ) was a secondary endpoint . This intent-to-treat analysis includes 16 patients who were not eligible and 17 patients who had protocol violations . The two groups were well balanced in terms of age ( median = 55 years ) , performance status ( 78 % P.S . O ) , FIGO stage ( 96 % stage III ) , histology ( serous in 66 % ) , grade ( 2 or 3 in 80 % ) , and residuum before intravenous CT ( > 1 cm in 40 % ) . Intraperitoneal CT was delivered mainly through intraperitoneal catheters ( Port-a-Cath 61 % and Tenckhoff 25 % ) . Side effects of intraperitoneal cisplatin included vomiting [ > or =grade 2 ( 82 % ) ] , rise in serum creatinine [ > or =grade 2 ( 14 % ) ] , abdominal pain [ grade 1-2 ( 38 % ) ] , and neurotoxicity [ grade 2-3 ( 15 % ) ] . After a median follow-up of 8 years , 80 patients ( 52 % ) have progressed with no difference in the pattern of relapse between the two groups and 75 patients ( 49 % ) have died ; the respective hazard ratios for PFS and OS with 95 % CI are 0.89 ( 0.59-1.33 ) and 0.82 ( 0.52-1.29 ) . These results are suggestive of a treatment benefit but do not support a change in clinical practice . Other randomized clinical trials of intraperitoneal CT are reviewed and briefly discussed .

Intraperitoneal cisplatin

platinum-based intravenous chemotherapy

First-line intravenous chemotherapy

platinum-based intravenous CT

observation

Intraperitoneal CT

intraperitoneal cisplatin

prolonged survival

Overall survival ( OS )

vomiting

rise in serum creatinine

abdominal pain

neurotoxicity

pattern of relapse

died


Nonnucleoside reverse transcriptase inhibitor-containing regimens are associated with increased satisfaction with sexual life .

satisfaction with sexual life


Identification , course , and treatment of depression after admission for a cardiac condition : rationale and patient characteristics for the Identifying Depression As a Comorbid Condition ( IDACC ) project . BACKGROUND Given the prevalence of cardiovascular disease and the high rates of depression among cardiac patients , there is a need to develop practical ways to identify this population and provide pragmatic general-practitioner-based interventions for managing depression as a comorbid condition . METHOD The Identifying Depression As a Comorbid Condition ( IDACC ) study employed a hybrid design , incorporating a randomized controlled trial nested within a prospective cohort study . IDACC screened for depression in patients hospitalized in South Australia for a range of cardiac conditions , with outcome measures monitored for 12 months after discharge . The subgroup identified as depressed was entered into the nested IDACC trial , which tests the hypothesis that identifying depression and offering an evidence-based intervention to general practitioners , incorporating multidisciplinary telephone case conferencing , will reduce levels of depression , improve quality of life , and reduce associated economic costs . RESULTS At baseline , 46.3 % of 1455 participants screened were classified as depression cases on the basis of their score on the Center for Epidemiological Studies Depression Scale ( > or =16 ) or the Hospital Anxiety and Depression Scale ( > or =8 ) . Elevated scores were associated with being younger , female , divorced or separated , not employed , living alone , having a lower level of education , and having poorer health and quality of life . Nearly one fifth ( 19.4 % ) of participants had Center for Epidemiological Studies Depression Scale scores > 27 , which is indicative of major depression . CONCLUSIONS This project confirms , in an Australian setting , the high prevalence of depressive symptoms among hospitalized cardiac patients . Follow-up over 12 months will enhance understanding of the natural history of depression in cardiac patients , while the nested trial will inform on effectiveness of an intervention involving tailored advice and support to general practitioners .

depression

economic costs .

depression

Hospital Anxiety and Depression Scale

depressive symptoms


Early reperfusion and late clinical outcomes in patients presenting with acute myocardial infarction randomly assigned to primary percutaneous coronary intervention or streptokinase . BACKGROUND Primary percutaneous coronary intervention ( PCI ) has become an alternative to thrombolytic therapy as a reperfusion strategy for ST-elevation acute myocardial infarction ( AMI ) . METHODS The main goal of this study was to determine whether PCI and thrombolytic therapy achieve comparable reperfusion rates , as evidenced by ST-segment resolution . Secondary end points included infarct vessel patency rates before hospital discharge and short- and long-term outcomes . Patients with ischemic chest pain with duration < or =12 hours and no contraindication for thrombolytic therapy were included . RESULTS Between October 1993 and August 1995 , 58 patients were randomly assigned to streptokinase ( SK ) and 54 patients to primary PCI . Baseline clinical characteristics and infarct location were well balanced in both groups . Median age ( interquartile range ) was 68 ( 58 , 75 ) years , 29 % were women , and 78 % of the patients met at least one criterion for " not low risk " AMI ( anterior location , age > 70 years old , previous MI , systolic blood pressure < 100 mm Hg , and/or heart rate > 100 bpm ) . The median time from symptom onset to random assignment was 217 ( 139 , 335 ) minutes in the PCI group and 210 ( 145 , 334 ) minutes in the SK group . Median random assignment to balloon time was 82 ( 55 , 100 ) minutes , and median random assignment to needle time was 15 ( 10 , 26 ) minutes ( P < .0001 ) . TIMI grade 3 flow after primary PCI was obtained in 85 % of patients . The proportion of patients with ST-segment resolution > or =50 % at 120 minutes was 80 % in the PCI group and 50 % in the SK group ( P =.001 ) . The predischarge angiogram showed the presence of TIMI 3 flow in 96 % of patients who received PCI and 65 % of patients who received SK ( P < .001 ) . A composite of in-hospital death , reinfarction , severe heart failure , stroke , and major bleeding occurred in 15 % of patients who received PCI and 21 % of patients who received SK ( P =.4 ) . At 3 years , freedom from the composite end point of AMI , postdischarge revascularization , and death was 61 % in the PCI group and 40 % in the SK group ( P =.025 ) . CONCLUSIONS Our study shows that primary PCI , as compared with SK , is associated with more effective ST-segment resolution , higher patency rates in the infarct vessel at 7 days , and more favorable clinical outcomes at 3 years of follow-up .

streptokinase

thrombolytic therapy

PCI

thrombolytic therapy

streptokinase ( SK )

primary PCI

PCI

SK

infarct vessel patency rates

blood pressure

median time from symptom onset

balloon time

needle time

TIMI grade 3 flow

ST-segment resolution

presence of TIMI 3 flow

in-hospital death

reinfarction

severe heart failure

stroke

major bleeding

composite end point of AMI

postdischarge revascularization

ST-segment resolution

patency rates

ischemic chest pain

women

> 70 years


Determination of vital status at the end of the DIG trial . The Digitalis Investigation Group ( DIG ) trial was a randomized , double-blind placebo-controlled trial whose primary objective was to determine whether digoxin had beneficial , harmful , or no effect on total mortality in patients with heart failure who were in sinus rhythm and whose ejection fraction was < /=0.45 . The study was designed as a large simple trial with a large number of centers ( 302 ) in the United States and Canada , many of which were inexperienced in research . To ensure that the results of the trial would be reported accurately without possible bias due to missing data , the study leadership decided that no outcome results would be reported until the vital status at the end of the study was known for at least 97 % of the study participants . Planning for closeout of the study began a year prior to the common end date of December 31 , 1995 and included plans for obtaining vital status on December 31 , 1995 . Participants were given postcards at their final study visit to be completed and mailed on or after January 1 , 1996 . Of 5602 postcards distributed , 5070 ( 90.5 % ) were completed and returned . A contract search agency was hired to locate the remaining participants . Of the total 7788 participants entered into the DIG trial , only 97 participants ( 1.2 % ) could not have their vital status as of December 31 , 1995 determined . It is recommended that investigators having an outcome measure with a common end date include plans in their protocols for obtaining their measures and activate those plans as early as possible during the course of the study .

placebo-controlled

digoxin

vital status


Bupropion SR and counseling for smoking cessation in actual practice : predictors of outcome . To date , only one study has been published on individual characteristics associated with outcome following standard treatment with bupropion SR for smoking cessation . To investigate treatment outcome beyond the 6-week end-of-treatment point , the present study examined characteristics associated with more clinically relevant smoking endpoints following treatment with bupropion SR in a large health care system . A total of 1,524 smokers ( 649 men and 875 women ) of average age 45.1 years were randomized to receive one of four combinations of bupropion SR ( 150 or 300 mg ) and behavioral counseling ( tailored mailings or proactive telephone counseling ) and assessed for point-prevalent smoking status at 3 and 12 months . Multiple logistic regression analyses of potential risk factors for 12-month point-prevalent smoking and for persistent smoking ( point-prevalent smoking at both follow-ups ) following treatment were conducted for men and women combined and separately . Risk factors for smoking at both endpoints in the combined sample included treatment with tailored mailings , female gender , younger age , higher levels of tobacco dependence , shorter previous quit attempts , previous use of nicotine replacement therapy , and report of current depressive symptoms or lifetime depression . Risk factors for smoking following treatment identified in women only included treatment with the lower dose of bupropion SR , younger age , and higher perceived stress , whereas those that were unique to men included the presence of lifetime depression . The results are discussed in terms of their implications for the need for more effective treatments in general , and the role of individual differences in the likelihood of returning to smoking following treatment for quitting .

Bupropion SR

counseling for smoking

standard treatment with bupropion SR

bupropion SR

bupropion SR

bupropion SR

need for more effective treatments

smoking cessation

1,524 smokers

649 men

875 women

average age 45.1 years


Effect of a carbohydrate-protein supplement on endurance performance during exercise of varying intensity . Increasing the plasma glucose and insulin concentrations during prolonged variable intensity exercise by supplementing with carbohydrate has been found to spare muscle glycogen and increase aerobic endurance . Furthermore , the addition of protein to a carbohydrate supplement will enhance the insulin response of a carbohydrate supplement . The purpose of the present study was to compare the effects of a carbohydrate and a carbohydrate-protein supplement on aerobic endurance performance . Nine trained cyclists exercised on 3 separate occasions at intensities that varied between 45 % and 75 % VO2max for 3 h and then at 85 % VO2max until fatigued . Supplements ( 200 ml ) were provided every 20 min and consisted of placebo , a 7.75 % carbohydrate solution , and a 7.75 % carbohydrate/1.94 % protein solution . Treatments were administered using a double-blind randomized design . Carbohydrate supplementation significantly increased time to exhaustion ( carbohydrate 19.7 +/- 4.6 min vs. placebo 12.7 +/- 3.1 min ) , while the addition of protein enhanced the effect of the carbohydrate supplement ( carbohydrate-protein 26.9 +/- 4.5 min , p < .05 ) . Blood glucose and plasma insulin levels were elevated above placebo during carbohydrate and carbohydrate-protein supplementation , but no differences were found between the carbohydrate and carbohydrate-protein treatments . In summary , we found that the addition of protein to a carbohydrate supplement enhanced aerobic endurance performance above that which occurred with carbohydrate alone , but the reason for this improvement in performance was not evident .

carbohydrate-protein supplement

protein to a carbohydrate supplement

carbohydrate

carbohydrate-protein supplement

placebo

carbohydrate solution

protein solution

carbohydrate

carbohydrate-protein supplementation

carbohydrate-protein

carbohydrate supplement

endurance performance

aerobic endurance

aerobic endurance performance

time to exhaustion

Blood glucose and plasma insulin levels

aerobic endurance performance

Nine trained cyclists


The efficacy of sublingual immunotherapy for respiratory allergy is not affected by different dosage regimens in the induction phase . BACKGROUND Sublingual administration of allergens is a safe and effective alternative to subcutaneous immunotherapy in patients with respiratory allergies . A drawback to this therapeutic approach is the relatively long and complex management of the induction phase . AIM OF THE STUDY To determine whether different induction regimens affect the outcome of sublingual immunotherapy . METHODS AND RESULTS Adult and pediatric patients with allergic rhinoconjunctivitis and/or asthma were included in the study . Ten subjects served as controls and received symptomatic treatments . Forty-three subjects were allocated to sublingual immunotherapy , with three different induction protocols ( 8- , 15- and 20-day , respectively ) . Symptom and medication scores , skin test results and ( in asthmatic patients ) FEV1 values were monitored for two years . Adverse effects were recorded . All induction regimens produced a significant improvement in symptom and medication usage ( p < 0.0001 ) ; skin test scores decreased ( p < 0.0001 ) and FEV1 improved ( p < 0.05 ) . In contrast , symptom and skin test scores did not significantly change in controls . No relevant adverse effects were observed with any of the induction regimens . CONCLUSIONS For patients with respiratory allergies , sublingual immunotherapy with an 8-day induction protocol is safe and effective . Our results encourage the usage of shorter induction regimens , which produce better compliance with this therapy .

sublingual immunotherapy

Sublingual administration of allergens

sublingual immunotherapy

symptomatic treatments

sublingual immunotherapy

sublingual immunotherapy

Symptom and medication scores

skin test results

( in asthmatic patients ) FEV1 values

Adverse effects

skin test scores decreased

FEV1 improved

symptom and skin test scores did not

change

adverse effects

patients with respiratory allergies .


Effect of m-chlorophenylpiperazine on plasma homovanillic acid concentrations in healthy subjects . In view of the abundant anatomical and functional interactions between serotonin and dopamine systems , this study examined the effect of the serotonin agonist , m-chlorophenylpiperazine ( mCPP ) on plasma concentrations of the dopamine metabolite , homovanillic acid . Plasma prolactin levels , body temperature , and mCPP blood level were also measured . mCPP ( 0.35 mg/kg ) and placebo were administered orally to 10 healthy men in a randomized double-blind design . Variables were measured for 210 min after administration of capsules . mCPP raised prolactin and temperature as compared to placebo , but did not affect plasma homovanillic acid concentrations . Results suggest that mCPP does not alter dopamine function .

m-chlorophenylpiperazine

m-chlorophenylpiperazine ( mCPP )

mCPP

placebo

mCPP

mCPP does not alter dopamine function .

healthy subjects .


Clinical and radiographic evaluation of guided tissue regeneration in the treatment of class II furcation defects . A randomized clinical trial . PURPOSE To evaluate the treatment outcomes after guided tissue regeneration ( GTR ) with a bioabsorbable membrane in Class II furcation defects in mandibular molars . The open flap debridement ( OFD ) was used as the control . METHODS Nine patients , with two comparable Class II furcation defects were included in the study . After initial preparation , the defects were randomly assigned in each patient to either GTR-group or OFD-group . Clinical parameters and standardized radiographs were obtained at baseline and 6 months after the surgeries . The radiographs were analyzed by subtraction radiography . RESULTS Comparing baseline to 6-month results , both groups showed statistically significant probing depth reduction ( PD ) , horizontal clinical attachment level ( CAL-h ) gain , and increase in gingival recession ( GR ) . The vertical clinical attachment level ( CAL-v ) gain was statistically significant only for the OFD-group . Comparing the two treatments , no statistically significant differences were found in PD reduction ( GTR : 1.67 mm ; OFD : 2.51 mm , P = 0.26 ) , CAL-v gain ( GTR : 0.62 mm ; OFD : 1.16 mm , P= 0.37 ) , and GR increase ( GTR : 1.04 mm ; OFD : 1.24 mm , P = 0.31 ) . GTR provided complete closure of the furcation defect in two sites and superior horizontal clinical attachment level gain ( GTR : 2.27 mm ; OFD : 1.01 mm , P = 0.05 ) . Subtraction radiography showed significant difference in bone height change between GTR-group and OFD-group ( -0.14 mm and 0.86 mm , respectively ; P = 0.028 ) at 6 months .

guided tissue regeneration ( GTR )

GTR-group

OFD-group

radiographs

GTR

probing depth reduction ( PD )

increase in gingival recession ( GR )

PD reduction

CAL-v gain

GR increase

closure of the furcation defect

class II furcation defects

Nine

Class II furcation defects

GTR-group or OFD-group


Prediction of the response to citalopram and reboxetine in post-stroke depressed patients . RATIONALE AND OBJECTIVE Depression is a significant complication of stroke . The effectiveness of antidepressant drugs in the management of post-stroke depression ( PSD ) has been widely investigated . However , the choice of antidepressant drug is critically influenced by its safety and tolerability and by its effect on concurrent pathologies . Here we investigate the efficacy and safety of a selective serotonin reuptake inhibitor ( SSRI ) , citalopram , and a noradrenaline reuptake inhibitor ( NARI ) , reboxetine , in post-stroke patients affected by anxious depression or retarded depression . METHODS This was a randomized double-blind study . Seventy-four post-stroke depressed patients were diagnosed as affected by anxious or retarded depression by using a synoptic table . Randomisation was planned so that 50 % of the patients in each subgroup were assigned for 16 weeks to treatment with citalopram and the remaining 50 % were assigned to treatment with reboxetine . The Beck Depression Inventory ( BDI ) , the Hamilton Depression Rating Scale ( HDRS ) and a synoptic table were used to score depressive symptoms . RESULTS Both citalopram and reboxetine showed good safety and tolerability . Citalopram exhibited greater efficacy in anxious depressed patients , while reboxetine was more effective in retarded depressed patients . CONCLUSIONS Citalopram or other SSRIs and reboxetine may be of first choice treatment in PSD because of their good efficacy and lack of severe side effects . In addition , PSD patients should be classified according to their clinical profile ( similarly to patients affected by primary depression ) for the selection of SSRIs or reboxetine as drugs of choice in particular subgroups of patients .

citalopram and reboxetine

citalopram

reboxetine

citalopram

reboxetine

reboxetine

Citalopram

reboxetine

safety

tolerability

depressive symptoms .

safety and tolerability

greater efficacy

post-stroke depressed patients

anxious depression

retarded depression

Seventy-four

post-stroke depressed

PSD


[ Combined preoperative xeloda and radiotherapy for lower rectal cancer ] . OBJECTIVE To evaluate the effect of combined preoperative xeloda and pelvic radiotherapy on locally advanced lower rectal cancer . METHODS Sixty lower rectal cancer patients were divided randomly into two groups . 30 patients ( Group A ) were treated with operation alone and 30 patients ( Group B ) were treated with xeloda and radiotherapy before operation . RESULTS The operative resection , anal preservation and local recurrence rates were 86.66 % , 33.33 % , 15.38 % in group A and 100 % , 83.33 % , 0 % in group B ( P < 0.05 and P < 0.01 ) . CONCLUSION Combined preoperative xeloda and radiotherapy for lower rectal cancer is able to significantly improve the operative resection , anal preservation and decrease the local recurrence rates .

preoperative xeloda

radiotherapy

operation alone

operative resection ,

anal preservation

and local recurrence rates

lower rectal cancer

locally advanced lower rectal cancer

Sixty


The effect of use of pyridostigmine and requirement of vecuronium in patients with myasthenia gravis . CONTEXT Patients with myasthenia gravis receive pyridostigmine , an anticholinesterase agent , as a part of therapy . These patients demonstrate a heightened sensitivity towards non-depolarising muscle relaxants . Continuing pyridostigmine till the day of the surgery or omitting it on the night before surgery could provide variable results with regards to the effect of vecuronium . AIMS Myographic evaluation of a dose of vecuronium in patients with myasthenia gravis on pyridostigmine therapy . SETTING AND DESIGN A randomised , double-blind , clinical study conducted in a teaching hospital . SUBJECTS AND METHODS Medically ( oral pyridostigmine ) well-controlled adult patients with myasthenia gravis who were posted for thymectomy , were randomly divided into two groups . Patients in Group 1 received their last dose of pyridostigmine on the night before surgery while those in Group 2 received even the morning dose of the drug on the day of surgery . Neostigmine ( 1-2 mg ) intravenously was used as rescue medication . Vecuronium ( 0.01 mg/kg ) was used for intubation and muscle relaxation during trans-sternal thymectomy and its effect was reversed using neostigmine and atropine . RESULTS Fourteen patients ( 7 in each group ) belonging to both sexes were enrolled in the study . The intubating dose of vecuronium showed quicker onset time ( 155 sec or 2.7 min approx . ) and peak effect ( 99 % T1 suppression ) in patients belonging to Group 1 , and 3/7 ( 43 % ) complained of respiratory discomfort while waiting for surgery . By giving the morning dose of pyridostigmine ( Group 2 ) , an identical intubating dose of vecuronium showed relative resistance ( peak effect-97 % T1 suppression ) and delayed onset time ( 198 sec approx. ) . However , the reversal was complete at the end of surgery in both the regimens . CONCLUSIONS Omission of the pyridostigmine dose on the day of surgery predisposed patients with myasthenia gravis to the possibility of respiratory discomfort and sensitivity to vecuronium . Continued administration significantly prolonged the onset time of vecuronium and the patients required a higher dose of vecuronium .

pyridostigmine

vecuronium

pyridostigmine

anticholinesterase agent

pyridostigmine

vecuronium

( oral pyridostigmine

thymectomy

pyridostigmine

Neostigmine

Vecuronium

trans-sternal thymectomy

pyridostigmine

vecuronium

pyridostigmine

vecuronium

vecuronium

vecuronium

onset time

peak effect

relative resistance

delayed onset time

patients with myasthenia gravis .


Randomized Phase II trial assessing estramustine and vinblastine combination chemotherapy vs estramustine alone in patients with progressive hormone-escaped metastatic prostate cancer . Based on the results of combined data from three North American Phase II studies , a randomised Phase II study in the same patient population was performed , using combination chemotherapy with estramustine phosphate ( EMP ) and vinblastine ( VBL ) in hormone refractory prostate cancer patients . In all , 92 patients were randomised into a Phase II study of oral EMP ( 10 mg kg day continuously ) or oral EMP in combination with intravenous VBL ( 4 mg m ( 2 ) week for 6 weeks , followed by 2 weeks rest ) . The end points were toxicity and PSA response in both groups , with the option to continue the trial as a Phase III study with time to progression and survival as end points , if sufficient responses were observed . Toxicity was unexpectedly high in both treatment arms and led to treatment withdrawal or refusal in 49 % of all patients , predominantly already during the first treatment cycle . The mean treatment duration was 10 and 14 weeks , median time to PSA progression was 27.2 and 30.8 weeks , median survival time was 44 and 50.9 weeks , and PSA response rate was only 24.6 and 28.9 % in the EMP/VBL and EMP arms , respectively . There was no correlation between PSA response and survival . While the PSA response in the patients tested was less than half that recorded in the North American studies , the toxicity of EMP monotherapy or in combination with VBL was much higher than expected . Further research on more effective and less toxic treatment strategies for hormone refractory prostate cancer is mandatory .

estramustine alone

EMP/VBL

EMP

EMP

VBL

toxicity

PSA response

time to progression

survival

Toxicity

mean treatment duration

median time to PSA progression

median survival time

PSA response rate

PSA response

survival

PSA response

toxicity of EMP monotherapy

effective

toxic


Effects of low and high doses of atorvastatin on arterial compliance . At the beginning of atherosclerosis before evidence of morphological lesions or plaques , vascular distensibility or arterial compliance decreased gradually . This endothelial dysfunction is regarded as an early feature of atherosclerosis . In a randomized , double-blind study design , group 1 ( 12 patients ; 7 males , 5 females ) with serum LDL-C levels higher than 170 mg/dL and without any other risk factor for atherosclerosis received three months of 20 mg/day atorvastatin treatment while group 11 ( 8 males , 4 females ) with the same characteristics received 80 mg/day . Baseline and posttreatment serum lipid fractions and arterial compliance were measured . Arterial compliance was measured noninvasively in the left common carotid artery with color Doppler ultrasound . Atorvastatin reduced total cholesterol ( TC ) , LDL-C , and triglyceride levels by 32 % ( P < 0.001 ) , 40.8 % ( P < 0.001 ) , and 19 % ( P < 0.001 ) , respectively , and increased HDL-C by 6.9 % , ( P = 0.002 ) in the first group . In the second group these reductions were 38.5 % ( P < 0.001 ) , 46.2 % ( P < 0.001 ) , and 26.78 % ( P < 0.001 ) , respectively , and the increase in HDL was 7.8 % ( P = 0.03 ) . It was observed that the decrease in serum TC , LDL-C and triglyceride levels were significantly higher in the second group than the first group . With atorvastatin , the distensibility coefficient ( DC ) and compliance coefficient ( CC ) increased from 18.7 +/- 3.4 to 21.3 +/- 2.9 10 ( -3 ) x kPa ( -1 ) ( P < 0.001 ) and from 0.69 +/- 0.05 to 0.77 +/- 0.03 mm2 x kPa ( -1 ) ( P < 0.001 ) in the first group while they changed from 18.3 +/- 3.6 to 21.9 +/- 3.0 10 ( -3 ) x kPa ( -1 ) ( P < 0.001 ) and from 0.70 +/- 0.04 to 0.81 +/- 0.01 mm2 x kPa ( -1 ) ( P < 0.001 ) respectively , in the second group . DC and CC increased in both groups , but the differences between the groups were not significant . High doses of atorvastatin reduce blood lipid levels more than conventional doses , however , the change in compliance is not dose-dependent . As endothelial dysfunction is regarded as an early feature of atherosclerosis , there would be no need to administer aggressive doses in a patient without any risk factors other than hyperlipidemia .

atorvastatin

atorvastatin treatment

Atorvastatin

atorvastatin

atorvastatin

morphological lesions or plaques

vascular distensibility

arterial compliance

serum LDL-C levels

serum lipid fractions

arterial compliance

Arterial compliance

reduced total cholesterol ( TC )

LDL-C

triglyceride levels

increased HDL-C

increase in HDL

decrease in serum TC

LDL-C

triglyceride levels

distensibility coefficient ( DC )

compliance coefficient ( CC ) increased

DC

CC

reduce blood lipid levels

7 males

5 females

serum LDL-C levels

atherosclerosis

8 males

4 females


Intervention in children with Developmental Coordination Disorder : the role of parents and teachers . BACKGROUND Children with Developmental Coordination Disorder ( DCD ) are a heterogeneous group who have a marked impairment in the performance of functional skills . Provision for these children is usually made via a paediatrician through occupational or physiotherapy though , with a prevalence rate of 5 % , regular provision is not possible due to limited professional resources . AIMS The study aimed to determine the extent to which parents and teachers , with guidance , can assist in the management of children with DCD ; whether children with DCD are helped in this way and how this may contribute to our understanding of the condition . SAMPLE Thirty-one children with DCD aged 7 to 9 years participated in the study . METHODS Following assessment , individual profiles were developed and each week teachers and parents were given guidelines for working with the children and each child had three to four sessions a week lasting approximately for 20 minutes . In Phase 1 , one group of children worked with teachers and the other group worked with parents . In Phase 2 , the two groups of children swapped over . The children were assessed regularly throughout the project using the Movement ABC , together with diaries and comments from teachers and parents . RESULTS At the end of the 40-week study , 27 children showed significant improvement in their motor skills . CONCLUSIONS Both teachers and parents were able to provide effective intervention for the majority of the children . It is possible that the children who did not improve have difficulties that are of a more complex type which require more specialist therapy to meet their need .

parents and teachers

occupational

physiotherapy

parents and teachers

teachers and parents

teachers and parents

specialist therapy

motor skills

effective intervention

Developmental Coordination Disorder

Thirty-one

7 to 9 years


[ Clinical observation on effect of fuzheng yiliu granule on cell cycle and nuclear transcription factor-kappa B in tissue of esophageal-gastric carcinoma ] . OBJECTIVE To observe the effect of Fuzheng Yiliu Granule ( FZYLG ) on cell cycle and nuclear transcription factor-kappa B ( NF-kappa B ) in tissue of esophageal-gastric carcinoma . METHODS Seventy-six patients with esophageal gastric carcinoma were randomly divided into two groups , the FZYLG group and the control group . FZYLG was given to the former for 15 days . The tumor tissue in both groups was resected and cell cycle and apoptosis rate as well as NF-kappa B were determined by flowcytometry . RESULTS Level of NF-kappa B in the treated group was significantly higher than that in the control group ( P < 0.05 ) . In the treated group , the percentage of G0/G1 stage cells were significantly increased and that of S stage significantly decreased ( both P < 0.05 ) . At the same time , obvious cell apoptosis was found in the treated group , the apoptosis rate of which was significantly higher than that in the control group ( P < 0.01 ) . CONCLUSION FZYLG can increase the NF-kappa B expression , block the proliferation to promote the apoptosis of tumor cells .

fuzheng yiliu granule

Fuzheng Yiliu Granule ( FZYLG )

FZYLG

control group

FZYLG

FZYLG

cell cycle

apoptosis rate

Level of NF-kappa B

percentage of G0/G1 stage cells

S stage

cell apoptosis

apoptosis

apoptosis


Azimilide decreases recurrent ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators . OBJECTIVES This study evaluated the effects of azimilide dihydrochloride ( AZ ) on anti-tachycardia pacing ( ATP ) and shock-terminated events in patients with implantable cardioverter defibrillators ( ICDs ) . BACKGROUND Animal studies have shown the effectiveness of AZ for therapy of supraventricular and ventricular tachycardia ( VT ) . Azimilide dihydrochloride was investigated as adjunctive treatment for reducing the frequency of VT and , thus , the need for ICD therapies , including ATP and cardioversion/defibrillation ( ICD shocks ) in patients with inducible monomorphic VT. METHODS A total of 172 patients were randomized to daily treatment with placebo , 35 mg , 75 mg , or 125 mg of oral AZ in this dose-ranging pilot study of patients with ICDs . The majority of patients had a history of documented remote myocardial infarction and congestive heart failure New York Heart Association class II or III . RESULTS The frequency of appropriate shocks and ATP were significantly decreased among AZ-treated patients compared with placebo patients . The incidence of ICD therapies per patient-year among the placebo group was 36 , and it was 10 , 12 , and 9 among 35 mg , 75 mg , and 125 mg AZ patients , respectively ( hazard ratio = 0.31 , p = 0.0001 ) . Azimilide dihydrochloride was generally well tolerated and did not affect left ventricular ejection fraction or minimal energy requirements for defibrillation or pacing . CONCLUSIONS Azimilide dihydrochloride may be a safe and effective drug for reducing the frequency of VT and ventricular fibrillation in patients with implanted ICDs .

Azimilide

azimilide dihydrochloride ( AZ )

Azimilide dihydrochloride

placebo

oral AZ

Azimilide dihydrochloride

recurrent ventricular tachyarrhythmias

anti-tachycardia pacing ( ATP )

shock-terminated events

frequency of appropriate shocks and ATP

well tolerated

implantable cardioverter defibrillators

implantable cardioverter defibrillators

ICDs


Transcutaneous electrical nerve stimulation for postoperative pain relief after total knee arthroplasty . Transcutaneous electrical nerve stimulation ( TENS ) has been used to treat chronic pain syndromes and has been reported to be of some utility in the treatment of postsurgical pain . A randomized , blinded , placebo-controlled trial was designed to evaluate the utility of TENS after total knee arthroplasty . Patients were randomly enrolled into patient-controlled anesthesia ( PCA ) alone , PCA plus TENS , or PCA plus sham TENS . The cumulative dose of morphine by PCA for each group was used as the end-point of the study . There was no significant reduction in the requirement for patient-controlled analgesia with or without TENS . We conclude that there is no utility for TENS in the postoperative management of pain after knee arthroplasty .

cumulative dose of morphine

postoperative pain

total knee arthroplasty

total knee arthroplasty


Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer 's disease : results of a randomized trial . Behavioral problems are among the most challenging aspects of caring for a person with Alzheimer 's disease . A sample of 406 spouses-caregivers of patients with Alzheimer 's disease was randomized to an active multicomponent counseling and support intervention condition or to a usual care condition . Caregivers reported on the frequency of troublesome patient behaviors and their reactions to them at baseline and at regular follow-up interviews . Random-effects regression models over the first 4 years after randomization revealed that , although the intervention did not affect the frequency of patient behavioral problems , it did significantly reduce caregivers ' reaction ratings . Because caregiver appraisals have been found to mediate the impact of caregiving stress on depression and to predict nursing home placement rates , they deserve greater attention as an important target of intervention services .

caregiver intervention

usual care condition

intervention

caregiver appraisals

caregivers ' reaction ratings .

Alzheimer 's disease

Alzheimer 's disease

Alzheimer 's disease


Outcomes in patients with diabetes mellitus undergoing percutaneous coronary intervention in the current era : a report from the Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO ) trial . BACKGROUND Diabetes portends an adverse prognosis in patients undergoing percutaneous coronary intervention ( PCI ) . Whether improvements in current clinical practice ( stents , IIb/IIIa antagonists ) have resulted in substantial improvement of these outcomes remains an issue . The aim of this study was to determine the influence of diabetes on 9-month outcomes of patients undergoing PCI in the current era . METHODS AND RESULTS The 11 482 patients enrolled in the Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO ) Trial were stratified according to the presence ( n=2694 ) or absence ( n=8798 ) of diabetes . Diabetic patients were older ; were more likely to be female ; had a higher proportion of congestive failure , hypertension , prior CABG , and unstable angina ; and had higher body mass index and lower ejection fraction than nondiabetic patients ( P < 0.01 for all comparisons ) . The degree of multivessel disease was similar between the two groups . American College of Cardiology/American Heart Association type C lesions were more common in diabetic patients ( 17 % versus 15 % , P < 0.01 ) . Angiographic and procedural success rates and in-hospital events were similar between the two groups . The primary end point of death , myocardial infarction , or target vessel revascularization ( TVR ) was analyzed as time-to-first event within 9 months of the index PCI . After adjusting for certain baseline characteristics , diabetes was independently associated with death at 9 months ( relative risk [ RR ] , 1.87 ; 95 % CI , 1.31 to 2.68 , P < 0.01 ) and with an increased likelihood of TVR ( RR , 1.27 ; 95 % CI , 1.14 to 1.42 , P < 0.01 ) , as well as the composite end point of death/myocardial infarction/TVR ( RR , 1.26 ; 95 % CI , 1.13 to 1.40 , P < 0.01 ) . CONCLUSIONS Despite advances in interventional techniques , diabetes remains a significant independent predictor of adverse events in the intermediate term after PCI .

percutaneous coronary intervention

PCI

PCI

PCI

congestive failure

hypertension

prior CABG

unstable angina

body mass index

ejection fraction

degree of multivessel disease

type C lesions

in-hospital events

death

myocardial infarction

target vessel revascularization ( TVR )

death

TVR

death/myocardial infarction/TVR

PCI

undergoing PCI

11 482


Single-needle acupuncture alleviates gag reflex during transesophageal echocardiography : a blinded , randomized , controlled pilot trial . OBJECTIVES To study the effect of single-needle acupuncture in suppressing gag-reflex in transesophageal echocardiography ( TEE ) . DESIGN Prospective , blinded trial . Settings/locations : Patients with ischemic stroke or transient ischemic attack undergoing TEE because of presumed cardioembolic origin in a specialized stroke unit of the Johann Wolfgang Goethe-University , Frankfurt/Main , Germany . Subjects/Study interventions : Forty-one ( 41 ) patients were studied . Patients received single-needle acupuncture with a 0.2 x 13 mm disposable acupuncture needle ( Suzhou Medical Appliances , China ) , 10-mm deep either at Chengjiang ( midline between lower lip and chin ) or superficially at a sham point ( tip of the chin ) during TEE or no acupuncture for alleviating gag reflex . OUTCOME MEASURES Severity of gagging was rated on a visual-analogue scale . RESULTS The acupuncture group experienced significantly less gagging than the sham group ( p = 0.037 ) or the nonacupuncture group ( p = 0.013 ) . CONCLUSIONS Acupuncture of CV24 is an easy to apply and effective method to reduce gag reflex during TEE .

Single-needle acupuncture

single-needle acupuncture

single-needle acupuncture

no acupuncture

Acupuncture of CV24

Severity of gagging

less gagging

gag reflex

Forty-one ( 41 )


Psychoeducational group intervention for wives of men with prostate cancer . OBJECTIVE The effects of a 6-week psychoeducational group intervention on the distress , coping , personal growth , and marital communication of wives of men diagnosed with prostate cancer were evaluated using a randomized clinical trial . METHODS Sixty wives completed measures prior to random assignment to either the psychoeducational group intervention or a no-treatment control group , and 1 month after completion of the group . RESULTS No differences with regard to wives ' general distress or cancer-specific distress were noted . In comparison with the control group , participants receiving the intervention perceived that having a spouse with prostate cancer had made positive contributions to their lives , reported gains in the use of positive reappraisal coping and reductions in denial coping . CONCLUSION Although the psychoeducational intervention did not result in changes in psychological distress , improvements in adaptive coping and indicators of psychological growth were found . The utility of group interventions for spouses of men with prostate cancer is discussed .

Psychoeducational group intervention

psychoeducational group intervention

psychoeducational group intervention

no-treatment control group

psychoeducational intervention

positive reappraisal coping

denial coping .

psychological distress

prostate cancer

men

diagnosed with prostate cancer

Sixty

wives

prostate cancer


The long-term effect of oxandrolone on hepatic acute phase proteins in severely burned children . BACKGROUND Acute phase protein production is a hallmark of severe burns . We wondered whether anabolic treatment with oxandrolone would affect these proteins . METHODS Thirty-five children with > or =40 % total body surface area burns were randomized to receive either placebo or oxandrolone ( 0.1 mg/kg by mouth twice daily ) from postoperative day 5 to 1 year postburn . Levels of constitutive proteins and acute phase proteins were measured at admission ; at discharge ; and at 6 , 9 , and 12 months after burn . Total albumin supplementation and hepatic transaminases were also assessed . RESULTS Constitutive proteins such as albumin , prealbumin , and retinol-binding protein levels increased ( p < 0.05 ) , and acute phase proteins such as alpha 1-acid glycoprotein , C3 complement , alpha 2-macroglobulin , and fibrinogen levels significantly decreased in the oxandrolone group compared with placebo ( p < 0.05 ) . Albumin supplementation during the acute hospitalization was reduced in the oxandrolone group . Hepatic transaminases remained within normal levels . CONCLUSION Treatment with oxandrolone in severe burns significantly increases constitutive protein and reduces acute phase protein levels .

oxandrolone

placebo

oxandrolone

Total albumin supplementation

hepatic transaminases

Hepatic transaminases

constitutive protein

acute phase protein levels

severely burned

children

Thirty-five children


Left internal thoracic artery-radial artery composite grafts as the technique of choice for myocardial revascularization in elderly patients : a prospective randomized evaluation . OBJECTIVES The technique of choice for myocardial revascularization in elderly patients remains a debated issue . We evaluated the potential advantages of the use of left internal thoracic artery-radial artery composite grafts compared with conventional coronary artery bypass grafts in elderly patients . METHODS We prospectively enrolled 160 patients aged more than 70 years scheduled to undergo isolated myocardial revascularization . Patients were assigned at random to group 1 , 80 patients undergoing total arterial revascularization ( left internal thoracic artery on left anterior descending coronary artery plus radial artery ) , or group 2 , 80 patients undergoing standard coronary artery bypass graft surgery ( left internal thoracic artery on left anterior descending coronary artery plus saphenous veins ) . The radial artery was used in all cases as a composite Y-graft . RESULTS Preoperative characteristics and risk factors ( EuroSCORE : group 1 = 7.9 vs group 2 = 8.1 ) , number of grafted coronary vessels ( group 1 = 2.4 vs group 2 = 2.5 ) , aortic crossclamping time ( group 1 = 37 +/- 7 minutes vs group 2 = 38 +/- 7 minutes ) , ventilation time ( group 1 = 22 +/- 12 hours vs group 2 = 23 +/- 11 hours ) , intensive care unit stay ( group 1 = 39 +/- 10 hours vs group 2 = 40 +/- 9 hours ) , and hospital mortality ( group 1 = 3.8 % vs group 2 = 5 % ) were comparable between the groups . Comparison between the 2 groups in terms of early postoperative complications showed a higher incidence of cerebrovascular accidents in group 2 ( group 1 = 0 patients vs group 2 = 4 patients , 5 % ) . At a mean follow-up of 16 +/- 3 months , patients in group 1 showed superior clinical results with a lower incidence of graft occlusion ( group 1 = 2 vs group 2 = 11 ; P =.06 ) and angina recurrence ( group 1 = 2 patients vs group 2 = 12 patients ; P =.03 ) . Multivariate analysis identified saphenous vein grafts as independent predictors for graft occlusion and angina recurrence . CONCLUSIONS Left internal thoracic artery-radial artery composite grafts proved to be a safe procedure in elderly patients . It improved the clinical outcome , providing a significantly higher graft patency rate and a lower incidence of late cardiac events .

isolated myocardial revascularization

composite Y-graft

number of grafted coronary vessels

aortic crossclamping time

ventilation time

intensive care unit stay

hospital mortality

early postoperative complications

cerebrovascular accidents

graft occlusion

angina recurrence

graft occlusion

angina recurrence

elderly patients


Comparison study of venlafaxine and paroxetine for the treatment of depression in elderly Chinese inpatients .

venlafaxine and paroxetine

depression


Prospective , randomized trial of diclofenac and ketorolac after refractive surgery . PURPOSE To compare the effectiveness of diclofenac and ketorolac in relieving corneal pain after refractive surgery , and determine if there is a difference in stinging on instillation . METHODS Thirty patients were randomized prospectively to postoperative diclofenac in one eye and ketorolac in the other . Patients and surgeon did not know which medications were used . Ocular postoperative pain and discomfort on instillation of medication were measured after radial keratotomy with a visual analog scale and a questionnaire . RESULTS Both medications were highly effective in relieving pain . There was no significant difference in pain relief , or stinging on instillation ( P = .29 ) . CONCLUSION There was no statistical difference in the effectiveness of the medications on pain relief , or in stinging on instillation .

diclofenac

diclofenac

ketorolac

postoperative diclofenac

ketorolac in the other

effectiveness

relieving corneal pain

Ocular postoperative pain

visual analog scale

questionnaire

effective in relieving pain

pain relief

stinging on instillation

pain relief

stinging on instillation

refractive surgery

corneal pain

Thirty


Clonidine treatment of hyperactive and impulsive children with autistic disorder . Many autistic children have associated problems of inattention , impulsivity , and hyperactivity that limit the effectiveness of educational and behavioral interventions . Few controlled psychopharmacologic trials have been conducted in autistic children to determine which agents may be effective for these associated features . Eight male children ( 8.1 +/- 2.8 years ) with autistic disorder , diagnosed by DSM-III-R criteria , completed a placebo-controlled , double-blind crossover trial of clonidine . Subjects were included in the study if they had inattention , impulsivity , and hyperactivity that was excessive for their developmental level . Subjects had not tolerated or responded to other psychopharmacologic treatments ( neuroleptics , methylphenidate , or desipramine ) . Teacher ratings on the Aberrant Behavior Checklist irritability , stereotypy , hyperactivity , and inappropriate speech factors were lower during treatment with clonidine than during treatment with placebo . Attention deficit disorder with hyperactivity : Comprehensive Teacher 's Rating Scale ratings were not significantly improved during the study , except for oppositional behavior . Parent Conners Abbreviated Parent-Teacher Questionnaire ratings significantly improved during clonidine treatment . Clonidine led to increased ratings of the side effects of drowsiness and decreased activity . Clinician ratings ( Children 's Psychiatric Rating Scale Autism , Hyperactivity , Anger and Speech Deviance factors ; Children 's Global Assessment Scale ; Clinical Global Impressions efficacy ) of videotaped sessions were not significantly different between clonidine and placebo . Clonidine was modestly effective in the short-term treatment of irritability and hyperactivity in some children with autistic disorder .

Clonidine

placebo-controlled

clonidine

neuroleptics

methylphenidate

desipramine

clonidine

placebo

clonidine

clonidine

placebo

Clonidine

effective

Teacher ratings on the

Children 's Global Assessment Scale

Clinical Global Impressions efficacy

irritability and hyperactivity

children with autistic disorder .


Salmeterol versus slow-release theophylline combined with ketotifen in nocturnal asthma : a multicentre trial . French Multicentre Study Group . We wished to assess the efficacy of inhaled salmeterol ( SML ; 50 micrograms b.i.d . ) compared to a combination of slow-release theophylline and ketotifen p.o . ( TK ; T 300 mg+K 1 mg b.i.d . ) for the treatment of nocturnal asthma . Ninety six patients with nocturnal asthma , ( forced expiratory volume in one second ( FEV1 ) 60-90 % of predicted value , reversibility > or = 15 % , at least two nocturnal awakenings per week ) were eligible for a multicentre , double-blind , double-dummy cross-over study ( 14-day run-in , two successive 28-day treatment periods ) . Efficacy was assessed as success/failure , success being defined as the complete disappearance of nocturnal symptoms/awakening during the last week of each treatment period . There was a statistically significant difference between SML and TK for this criterion : 46 % and 39 % success with SML during periods I ( first 28-day period ) and II ( following the cross-over ) , compared to only 15 % and 26 % with TK , respectively ( p < 0.01 ) . SML was also significantly better for the other criteria ( lung function , rescue salbutamol intake during day and night ) . Side-effects were five times less frequent in SML-treated patients ( p < 0.004 ) . Efficacy and tolerance of SML were obviously far better than those of TK in patients with nocturnal asthma .

Salmeterol

theophylline

ketotifen

salmeterol

theophylline and ketotifen

efficacy

Efficacy

success/failure , success

statistically significant difference

Side-effects

Efficacy and tolerance

nocturnal asthma :


Oscillatory potentials , retinopathy , and long-term glucose control in insulin-dependent diabetes . The main objective of the study was to assess effects of long-term lowering of glucosylated hemoglobin ( HbA1 % ) on neurosensory function in insulin-dependent diabetes . Individual ( OP-1 , OP-2 , OP-3 ) and summed ( OP-sum ) amplitudes of oscillatory potentials ( OPs ) of electroretinography were recorded at study start and 7-years later in 45 patients ( the Oslo study ) . As an overall 7-year change , amplitudes of OP-2 , OP-3 and OP-sum were reduced ( p < 0.0001-0.01 ) , retinopathy worsened ( p = 0.005 ) , intraocular pressure decreased ( p < 0.001 ) , systolic blood pressure increased ( p < 0.0002 ) , and glycemic control improved from HbA1 of 11.2 +/- 2.2 % at study start to a 7-year cumulative mean of 9.5 +/- 1.5 % ( p < 0.0001 ) . Multiple regression analysis did not identify any independent relations between change in OP-1 , OP-2 , OP-3 , OP-sum and change in glycemic control or background variables , including change in age and duration of diabetes . However , cross-sectional observations at 7 years showed negative correlations between all OPs and age ( p < 0.0001-0.003 ) , and between OP-3 and duration ( p = 0.003 ) and counts of microaneurysms ( p = 0.02 ) . The data suggest that various clinical background variables may influence individual and summed amplitudes of OPs differently . Reduced neurosensory retinal function ( OPs ) seemed to appear after 7-years , independently of vascular defects of retinopathy and long-term improvement in glucose control .

glucosylated hemoglobin ( HbA1 % )

glucosylated hemoglobin

amplitudes of OP-2 , OP-3 and OP-sum

retinopathy

intraocular pressure

systolic blood pressure

glycemic control

OP-1 , OP-2 , OP-3 , OP-sum

change in glycemic control

background variables

OPs

duration

counts of microaneurysms

vascular defects of retinopathy

Oscillatory

retinopathy

insulin-dependent diabetes

insulin-dependent diabetes


Effects of a combination of evening primrose oil ( gamma linolenic acid ) and fish oil ( eicosapentaenoic + docahexaenoic acid ) versus magnesium , and versus placebo in preventing pre-eclampsia . In a placebo controlled , partially double-blinded , clinical trial , a combination of evening primrose oil and fish oil was compared to Magnesium Oxide , and to a Placebo in preventing Pre-Eclampsia of Pregnancy . All were given as nutritional supplements for six months to a group of primiparous and multiparous pregnant women . Some of these women had personal or family histories of hypertension ( 21 % ) . Only those patients who received prenatal care at the Central Maternity Hospital for Luanda were included in the study . Compared to the Placebo group ( 29 % ) , the group receiving the mixture of evening primrose oil and fish oil containing Gamma-linolenic acid ( GLA ) , Eicosapentaenoic acid ( EPA ) , and Docosahexaenoic acid ( DHA ) had a significantly lower incidence of edema ( 13 % , p = 0.004 ) . The group receiving Magnesium Oxide had statistically significant fewer subjects who developed hypertension of pregnancy . There were 3 cases of eclampsia , all in the Placebo group .

gamma linolenic acid

eicosapentaenoic + docahexaenoic acid

magnesium

placebo

placebo

Magnesium Oxide

Placebo

Placebo

evening primrose oil

fish oil

Gamma-linolenic acid ( GLA )

Docosahexaenoic acid ( DHA )

Magnesium Oxide

Placebo

pre-eclampsia .

Pre-Eclampsia of Pregnancy .

incidence of

edema

hypertension of pregnancy .

eclampsia

pre-eclampsia .


Reliance on visual information after stroke . Part II : Effectiveness of a balance rehabilitation program with visual cue deprivation after stroke : a randomized controlled trial . OBJECTIVE To test the hypothesis that balance rehabilitation with visual cue deprivation improves balance more effectively than rehabilitation with free vision . DESIGN Single-blind , randomized controlled trial . SETTING Public rehabilitation center in France . PARTICIPANTS Twenty patients with hemiplegia after a single-hemisphere stroke that occurred at least 12 months before the study . INTERVENTION Patients were randomly assigned to 1 of 2 balance rehabilitation programs-with and without visual cue deprivation . In all other respects , the programs were identical . Each lasted for 1 hour and was implemented 5 days a week for 4 weeks . All patients completed the program . Mean outcome measures Balance under 6 sensory conditions was assessed by computerized dynamic posturography ( EquiTest ) , gait velocity , timed stair climbing , and self-assessment of ease of gait before and after program completion . RESULTS After completing the program , balance , gait velocity , and self-assessment of gait improved significantly in all patients . The improvements in gait velocity ( P= .03 ) and timed stair climbing ( P= .01 ) correlated significantly with improved balance . Balance improved more in the vision-deprived group than in the free-vision group . CONCLUSIONS Balance improved more after rehabilitation with visual deprivation than with free vision . Visual overuse may be a compensatory strategy for coping with initial imbalance exacerbated by traditional rehabilitation .

rehabilitation program

visual cue deprivation

rehabilitation with free vision

balance rehabilitation programs-with

and

without visual cue deprivation

visual deprivation

free vision

visual information

balance

Balance

balance

gait velocity

self-assessment of gait

gait velocity

timed stair climbing

Balance

Balance

after stroke :


Injection pain and postinjection pain of the palatal-anterior superior alveolar injection , administered with the Wand Plus system , comparing 2 % lidocaine with 1:100,000 epinephrine to 3 % mepivacaine . PURPOSE The purpose of this prospective , randomized , double-blind study was to compare injection pain and postinjection pain of 2 % lidocaine with 1:100,000 epinephrine and 3 % mepivacaine using the computer-assisted Wand Plus injection system to administer the palatal-anterior superior alveolar ( P-ASA ) injection . Additionally study was done to determine if the use of topical anesthetic decreased the pain of needle insertion with the P-ASA injection . STUDY DESIGN Using a crossover design , 40 subjects randomly received , in a double-blind manner , P-ASA injections of 1.4 mL of 2 % lidocaine with 1:100,000 epinephrine and 1.4 mL of 3 % mepivacaine , at 2 separate appointments . The P-ASA injection was administered , utilizing the Wand Plus system , 6 to 10 mm into the incisive canal located lingual to the central incisors . The pain of needle insertion , needle placement , solution deposition and postinjection pain were recorded on a Heft-Parker visual analog scale for the 2 P-ASA injections . Eighty injections were randomly administered in the study , 40 using topical anesthetic gel and 40 using a placebo gel . RESULTS For needle insertion , 30 % of the subjects reported moderate/severe pain with the lidocaine solution and 43 % reported moderate/severe pain with the mepivacaine solution . There was no significant difference ( P > .05 ) between the topical and placebo groups . For needle placement into the incisive canal , 54 % of the subjects reported moderate/severe pain with the lidocaine solution and 58 % reported moderate/severe pain with the mepivacaine solution . For anesthetic solution deposition , 8 % of the subjects reported moderate pain with the lidocaine solution and 12 % reported moderate pain with the mepivacaine solution . There were no significant differences ( P > .05 ) between the lidocaine and mepivacaine solutions . Regarding postinjection pain , when anesthesia wore off on the day of the injection , 20 % of the subjects reported moderate/severe pain with the lidocaine solution and 14 % reported moderate/severe pain with the mepivacaine solution . Pain ratings decreased over the next 3 days . There were no significant differences ( P > .05 ) between the lidocaine and mepivacaine solutions . Postinjection , 12 % and 18 % of the subjects experienced temporary numbness/paresthesia of the incisive papilla with the lidocaine and mepivacaine solutions , respectively . Twenty percent and 28 % of the subjects had incisive papilla swelling or soreness with the lidocaine and mepivacaine solutions , respectively . There were no significant differences ( P > .05 ) between the lidocaine and mepivacaine solutions . CONCLUSIONS The P-ASA injection of 1.4 mL of 2 % lidocaine with 1:100,000 epinephrine or 3 % mepivacaine , administered with the Wand Plus , has the potential to be a painful injection . The use of topical anesthetic did not significantly reduce pain of needle insertion when compared to a placebo . The incidence of postinjection pain , temporary numbness/paresthesia , and incisive papilla swelling or soreness would indicate that some pain and problems occur with the P-ASA technique , regardless of whether 2 % lidocaine with 1:100,000 epinephrine or 3 % mepivacaine is used .

lidocaine

epinephrine

mepivacaine

topical anesthetic

epinephrine

mepivacaine

topical anesthetic gel

placebo gel

mepivacaine

placebo

lidocaine

lidocaine

mepivacaine

lidocaine

mepivacaine

lidocaine

mepivacaine

lidocaine

mepivacaine

lidocaine

mepivacaine

lidocaine

mepivacaine

lidocaine

mepivacaine

lidocaine

epinephrine

mepivacaine

placebo .

lidocaine

epinephrine

mepivacaine

Injection pain and postinjection pain

injection pain

postinjection pain

pain

moderate/severe pain

moderate/severe pain

moderate/severe pain

moderate/severe pain

moderate pain

moderate pain

postinjection pain

moderate/severe pain

moderate/severe pain

Pain ratings

incisive papilla swelling

soreness

pain

postinjection pain

temporary numbness/paresthesia

incisive papilla swelling

soreness