Continuous event recorders did not affect anxiety or quality of life in patients with palpitations . OBJECTIVES Palpitations can generate feelings of anxiety and decrease quality of life ( QoL ) due to fear of a cardiac abnormality . Continuous event recorders ( CERs ) have proven to be successful in diagnosing causes of palpitations but may affect patient QoL and anxiety . The aim is to determine anxiety and health-related ( HR ) -QoL and evaluate the burden of carrying a CER in general practice populations . STUDY DESIGN AND SETTING Patients ( n=244 ) participated in a randomized trial . One group ( n=127 ) carried a CER during 4 weeks . One hundred and seventeen patients formed the usual care ( UC ) group . State-Trait Anxiety Inventory ( STAI ) and the Short Form-36 ( SF-36 ) were administered at study inclusion , after 1 , 6 months . RESULTS At baseline , patients reported greater anxiety and lower QoL than healthy populations . The CER group had three times more cardiac diagnoses than the UC group . No differences were found between CER group and UC group at 6 weeks . At 6 months , the UC group showed QoL improvement and less anxiety compared to the CER group . Type of diagnosis had influence , but did not fully explain these differences . CONCLUSION A CER does not negatively influence anxiety or QoL . Better outcomes in the UC group might be attributed to less cardiac diagnosis and more emphasis on psychological well-being .

Continuous event recorders ( CERs )

CER

CER

usual care ( UC )

CER

UC

CER

UC

UC

CER

CER

UC

anxiety

quality of life

anxiety

quality of life ( QoL )

QoL

anxiety

anxiety

health-related ( HR ) -QoL

State-Trait Anxiety Inventory ( STAI )

Short Form-36 ( SF-36 )

anxiety

QoL

cardiac diagnoses

QoL improvement

anxiety

Type of diagnosis

anxiety

QoL

cardiac diagnosis

psychological well-being

palpitations

One hundred and seventeen


[ Effects of hetero-thermal water administration on leg vein hemodynamics , skin microcirculation and O2 tension in chronic venous insufficiency ] .

hetero-thermal water administration

chronic venous insufficiency ]


How can we help witnesses to remember more ? It 's an ( eyes ) open and shut case . Five experiments tested the idea that instructing a witness to close their eyes during retrieval might increase retrieval success . In Experiment 1 participants watched a video , before a cued-recall test for which they were either instructed to close their eyes , or received no-instructions . Eye-closure led to an increase in correct cued-recall , with no increase in incorrect responses . Experiments 2-5 sought to test the generality of this effect over variations in study material ( video or live interaction ) , test format ( cued- or free-recall ) and information modality ( visual or auditory details recalled ) . Overall , eye-closure increased recall of both visual detail and auditory details , with no accompanying increase in recall of false details . Collectively , these data convincingly demonstrate the benefits of eye-closure as an aid to retrieval , and offer insight into why hypnosis , which usually involves eye-closure , may facilitate eyewitness recall .

watched a video

no-instructions .

( video or live interaction )

( cued- or free-recall )

( visual or auditory details recalled )

retrieval success .

incorrect responses

recall of false details .

witnesses


Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke . BACKGROUND AND PURPOSE Previous studies have shown that repeated sensory inputs could enhance brain plasticity and cortical motor output . The purpose of this study was to investigate whether combining electrically induced sensory inputs through transcutaneous electrical nerve stimulation ( TENS ) with task-related training ( TRT ) in a home-based program would augment voluntary motor output in chronic stroke survivors better than either treatment alone or no treatment . METHODS Eighty-eight patients with stroke were assigned randomly to receive a home-based program of ( 1 ) TENS , ( 2 ) TENS+TRT , ( 3 ) placebo TENS+TRT , or ( 4 ) no treatment ( control ) 5 days a week for 4 weeks . Outcome measurements included Composite Spasticity Scale , peak torques generated during maximum isometric voluntary contraction of ankle dorsiflexors and plantarflexors , and gait velocity recorded at baseline , after 2 and 4 weeks of treatment , and 4 weeks after treatment ended . RESULTS When compared with TENS , the combined TENS+TRT group showed significantly greater improvement in ankle dorsiflexion torque at follow-up and in ankle plantarflexion torque at week 2 and follow-up ( P < 0.01 ) . When compared with placebo+TRT , the TENS+TRT group produced earlier and greater reduction of plantarflexor spasticity and improvement in ankle dorsiflexion torque at week 2 ( P < 0.01 ) . When compared with all 3 groups , the TENS+TRT group showed significantly greater improvement in gait velocity ( P < 0.01 ) . CONCLUSIONS In patients with chronic stroke , 20 sessions of a combined TENS+TRT home-based program decreased plantarflexor spasticity , improved dorsiflexor and plantarflexor strength , and increased gait velocity significantly more than TENS alone , placebo+TRT , or no treatment . Such improvements can even be maintained 4 weeks after treatment ended .

combined with task-related training

with task-related training ( TRT )

TENS , ( 2 ) TENS+TRT , ( 3 )

placebo TENS+TRT

, or ( 4 )

no treatment ( control )

TENS

TENS+TRT

placebo+TRT

TENS+TRT

combined TENS+TRT home-based

TENS

lower limb functions

brain plasticity

cortical motor output .

voluntary motor output

Composite Spasticity Scale

ankle dorsiflexion torque

ankle plantarflexion torque

plantarflexor spasticity

gait velocity

decreased plantarflexor spasticity

increased gait velocity


The logMAR Kay picture test and the logMAR acuity test : a comparative study . PURPOSE To compare the level of visual acuity with crowded and uncrowded versions of the logMAR acuity test and the Kay picture test in amblyopia . METHODS A prospective study was carried out on 51 participants with amblyopia ( strabismic n=17 ; anisometropic n=10 ; combined n=24 ) , mean age 10 years 8 months . The amblyopia was defined as severe/moderate ( < 0.250 logMAR ) , n=41 or mild ( > or = 0.250 logMAR ) , n=10 . Visual acuity was assessed uniocularly using the crowded and uncrowded logMAR acuity tests and the logMAR crowded and uncrowded Kay picture tests in random orders . RESULTS The mean visual acuity outcome using the logMAR crowded Kay picture test ( 0.343+/-0.150 ) was comparable ( P=0.084 ) with the mean outcome using the crowded logMAR acuity test ( 0.402+/-0.188 ) . However , the mean acuity difference between these two tests in the subgroup with severe/moderate amblyopia ( 0.074+/-0.036 ) was statistically significant ( P=0.0382 ) . The uncrowded logMAR acuity test significantly overestimated visual acuity when compared with the logMAR crowded Kay picture test ( P < 0.005 ) by a mean of 0.088+/-0.008 . CONCLUSION The logMAR crowded Kay picture test is a useful tool in clinical practice . The test design takes the crowding phenomenon into account . It provides visual acuity measures more comparable with the gold standard crowded logMAR acuity test than the uncrowded logMAR acuity test . However , the outcomes in poorer acuities should still be viewed with caution .

logMAR Kay picture test

logMAR acuity test

crowded and uncrowded versions

logMAR acuity test

Kay picture test

logMAR crowded Kay picture test

crowded logMAR acuity test

uncrowded logMAR acuity test

logMAR crowded Kay picture test

logMAR crowded Kay picture test

crowded logMAR acuity test

visual acuity

Visual acuity

mean visual acuity outcome

mean acuity difference

logMAR acuity

visual acuity

logMAR crowded Kay picture

visual acuity


A double-blind , randomised trial of tesaglitazar versus pioglitazone in patients with type 2 diabetes mellitus . The efficacy and safety of tesaglitazar ( 0.5 and 1 mg ) and pioglitazone ( 15 , 30 and 45 mg ) were compared in a 24-week , randomised , double-blind study in 1,707 patients with type 2 diabetes mellitus . Tesaglitazar 1 mg was non-inferior to pioglitazone 45 mg for change from baseline in glycosylated haemoglobin ( HbA1C ) at 24 weeks ( difference : -0.056 [ 95 % confidence intervals -0.161 , 0.049 ] , pNI < 0.001 for non-inferiority hypothesis ) . Tesaglitazar 1 mg improved triglyceride ( TG ) , high-density lipoprotein cholesterol ( HDL-C ) and non-HDL-C levels compared with all pioglitazone doses at 24 weeks ( p < 0.001 ) . Low-density lipoprotein cholesterol ( LDL-C ) was lower with tesaglitazar for all pioglitazone comparisons ( p < 0.05 ) , except for tesaglitazar 0.5 mg versus pioglitazone 15 mg. Tesaglitazar 1 mg decreased LDL particle number , when compared with all pioglitazone doses ( p < 0.01 ) . Both agents increased body weight and peripheral oedema in a dose-dependent manner , but only tesaglitazar increased serum creatinine . In summary , tesaglitazar provided similar glycaemic control to pioglitazone , was associated with significant improvement in lipid and lipoprotein variables , and increased serum creatinine in a dose-dependent manner .

tesaglitazar

pioglitazone

tesaglitazar

pioglitazone

Tesaglitazar

pioglitazone

Tesaglitazar

tesaglitazar

pioglitazone

tesaglitazar

pioglitazone

Tesaglitazar

pioglitazone

tesaglitazar

tesaglitazar

pioglitazone

LDL particle number

body weight and peripheral oedema

serum creatinine .

glycaemic control

lipid and lipoprotein variables

type 2 diabetes mellitus

type 2 diabetes mellitus


Phase II study of efficacy and safety of bevacizumab in combination with chemotherapy or erlotinib compared with chemotherapy alone for treatment of recurrent or refractory non small-cell lung cancer . PURPOSE Bevacizumab , a humanized anti-vascular endothelial growth factor monoclonal antibody , and erlotinib , a reversible , orally available epidermal growth factor receptor tyrosine kinase inhibitor , have demonstrated evidence of a survival benefit in the treatment of non-small-cell lung cancer ( NSCLC ) . A single-arm phase I and II study of bevacizumab plus erlotinib demonstrated encouraging efficacy , with a favorable safety profile . PATIENTS AND METHODS A multicenter , randomized phase II trial evaluated the safety of combining bevacizumab with either chemotherapy ( docetaxel or pemetrexed ) or erlotinib and preliminarily assessed these combinations versus chemotherapy alone , as measured by progression-free survival ( PFS ) . All patients had histologically confirmed nonsquamous NSCLC that had progressed during or after one platinum-based regimen . RESULTS One hundred twenty patients were randomly assigned and treated . No unexpected adverse events were noted . Fewer patients ( 13 % ) in the bevacizumab-erlotinib arm discontinued treatment as a result of adverse events than in the chemotherapy alone ( 24 % ) or bevacizumab-chemotherapy ( 28 % ) arms . The incidence of grade 5 hemorrhage in patients receiving bevacizumab was 5.1 % . Although not statistically significant , relative to chemotherapy alone , the risk of disease progression or death was 0.66 ( 95 % CI , 0.38 to 1.16 ) among patients treated with bevacizumab-chemotherapy and 0.72 ( 95 % CI , 0.42 to 1.23 ) among patients treated with bevacizumab-erlotinib . One-year survival rate was 57.4 % for bevacizumab-erlotinib and 53.8 % for bevacizumab-chemotherapy compared with 33.1 % for chemotherapy alone . CONCLUSION Results for PFS and overall survival favor combination of bevacizumab with either chemotherapy or erlotinib over chemotherapy alone in the second-line setting . No unexpected safety signals were noted . The rate of fatal pulmonary hemorrhage was consistent with previous bevacizumab trials . The toxicity profile of the bevacizumab-erlotinib combination is favorable compared with either chemotherapy-containing group .

erlotinib

chemotherapy alone

Bevacizumab

erlotinib

bevacizumab

erlotinib

bevacizumab

chemotherapy ( docetaxel or pemetrexed

erlotinib

chemotherapy

bevacizumab-erlotinib

chemotherapy

bevacizumab-chemotherapy

bevacizumab

bevacizumab-chemotherapy

bevacizumab-erlotinib .

bevacizumab-erlotinib

bevacizumab-chemotherapy

chemotherapy

bevacizumab

chemotherapy

chemotherapy

bevacizumab

bevacizumab-erlotinib combination

chemotherapy-containing

efficacy

safety

progression-free survival ( PFS )

adverse events

result of

adverse events

grade 5 hemorrhage

risk of disease progression or

death

One-year survival rate

PFS

overall survival

safety signals

fatal pulmonary hemorrhage

toxicity

One hundred twenty patients


Letrozole in the neoadjuvant setting : the P024 trial . Neoadjuvant chemotherapy trials have consistently reported lower response rates in hormone receptor-positive ( HR+ ) breast cancer when compared with HR- cases . Preoperative endocrine therapy has therefore become a logical alternative and has gained considerable momentum from the finding that aromatase inhibitors ( AIs ) are more effective than tamoxifen for HR+ breast cancer in both the neoadjuvant and adjuvant settings . The most convincing neoadjuvant trial to demonstrate the superiority of an AI versus tamoxifen was the P024 study , a large multinational double-blind trial in postmenopausal women with HR+ breast cancer ineligible for breast-conserving surgery . The overall response rate ( ORR ) was 55 % for letrozole and 36 % for tamoxifen ( P < 0.001 ) . Significantly more letrozole-treated patients underwent breast-conserving surgery ( 45 vs. 35 % , respectively ; P=0.022 ) . In addition , ORR was significantly higher with letrozole than tamoxifen in the human epidermal growth factor receptor HER1/HER2+ subgroup ( P=0.0004 ) . The clinical efficacy of letrozole in HER2+ breast cancer was confirmed by fluorescent in situ hybridization analysis and was found to be comparable to that of HER2- cases ( ORR 71 % in both subsets ) . Biomarker studies confirmed the superiority of letrozole in centrally assessed estrogen receptor-positive ( ER+ ) tumors and found a strong relationship with the degree of ER positivity for both agents . Interestingly , letrozole was effective even in marginally ER+ tumors and , unlike tamoxifen , consistently reduced the expression from estrogen-regulated genes ( progesterone receptor and trefoil factor 1 ) . Furthermore , when analyzed by Ki67 immunohistochemistry , letrozole was significantly more effective than tamoxifen in reducing tumor proliferation ( P=0.0009 ) . Thus , neoadjuvant letrozole is safe and superior to tamoxifen in the treatment of postmenopausal women with HR+ locally advanced breast cancer .

Letrozole

Neoadjuvant chemotherapy

Preoperative endocrine therapy

aromatase inhibitors

tamoxifen

AI

tamoxifen

breast-conserving surgery

letrozole

tamoxifen

breast-conserving surgery

tamoxifen

letrozole

letrozole

letrozole

letrozole

tamoxifen

response rates

overall response rate ( ORR )

underwent breast-conserving surgery

ORR

clinical efficacy

Biomarker studies

degree of ER positivity

tumor proliferation

multinational


A randomized parallel study to assess the safety and efficacy of two different dosing regimens of 5 % imiquimod in the treatment of superficial basal cell carcinoma . OBJECTIVES This study was designed to compare the safety and efficacy of two cycled dosing regimens of imiquimod 5 % cream for treatment of superficial basal cell carcinoma ( sBCC ) . METHODS Patients ( n = 32 ) were randomized to receive one of two treatment regimens : 8 weeks of treatment with once-daily dosing for alternate weeks ( R1 ) and 5 weeks of once-daily dosing with a 1-week interval in the middle of the course ( R2 ) . Efficacy measures were tumour clearance at weeks 19 and 52 and measures of patients ' acceptability . RESULTS Data from 30 patients ( 13 females ) , 14 on R1 and 16 on R2 , were analysed . The results revealed an initial clearance rate of 64 % at week 19 for R1 and 81 % for R2 ( 95 % CI for difference : -14 % to 45 % , p = 0.21 ) . However , clearance rates at week 52 were significantly different : 43 % for R1 and 88 % for R2 ( 95 % CI for difference : 11 % to 68 % , p = 0.02 ) . There was no difference in acceptability of treatment as measured by composite median visual analogue scores at week 8 . CONCLUSION Five weeks of 5 % imiquimod cream once daily with a 1-week interval was more effective but as well tolerated as the 8-week alternate week regimen for sBCC .

imiquimod

imiquimod

imiquimod

safety and efficacy

safety and efficacy

tumour clearance

measures of patients ' acceptability

clearance rate

clearance rates

acceptability of treatment

effective

well tolerated


[ Effects of electroacupuncture combined with behavior therapy on intelligence and behavior of children of autism ] . OBJECTIVE To find out an effective therapy for autism . METHODS Sixty children of autism were randomly divided into an electroacupuncture ( EA ) plus behavior therapy group and a behavior therapy group , 30 cases in each group . The patients in the two groups were treated with routine behavior , with EA at Baihui ( GV 20 ) , Sishencong ( EX-HN 1 ) , Shenting ( GV 24 ) , Benshen ( GB 13 ) , Yintang ( EX-HN 3 ) , Naohu ( GV 17 ) , Naokong ( GB 19 ) , Neiguan ( PC 6 ) and scalp acupuncture at Speech Areas I , II , III added for the EA plus behavior therapy group . Their therapeutic effects were observed , and the picture and vocabulary scale ( PPVT ) and behavior ability were detected . RESULTS The total effective rate was 86.7 % in the EA plus behavior therapy group which was better than 56.7 % of the behavior therapy group , and had significant enhancement in sensation , association , body , and ability of self-care ( P < 0.05 ) and was better than the behavior therapy group in sensation , body and self-care factors , with no significantly improvement in the scores of PPVT in the two groups ( P > 0.05 ) . CONCLUSION EA combined with behavior therapy can significantly improve clinical symptoms of autism , but does not improve intelligence .

group and a behavior therapy group

routine behavior

EA

scalp acupuncture

EA plus behavior therapy

EA

behavior therapy

EA combined with behavior therapy

picture and vocabulary scale ( PPVT )

behavior ability

total effective rate

sensation , body and self-care factors

PPVT

children

autism

Sixty

children

autism


A double-blind placebo controlled trial of piracetam added to risperidone in patients with autistic disorder . It has been reported that autism is a hypoglutamatergic disorder . Therefore , it was of interest to assess the efficacy of piracetam , a positive modulator of AMPA-sensitive glutamate receptors in autistic disorder . About 40 children between the ages three and 11 years ( inclusive ) with a DSM IV clinical diagnosis of autism and who were outpatients from a specialty clinic for children were recruited . The children presented with a chief complaint of severely disruptive symptoms related to autistic disorder . Patients were randomly allocated to piracetam + risperidone ( Group A ) or placebo + risperidone ( Group B ) for a 10-week , double-blind , placebo-controlled study . The dose of risperidone was titrated up to 2 mg/day for children between 10 and 40 kg and 3 mg/day for children weighting above 40 kg . The dose of piracetam was titrated up to 800 mg/day . Patients were assessed at baseline and after 2 , 4 , 6 , 8 and 10 weeks of starting medication . The measure of the outcome was the Aberrant Behavior Checklist-Community ( ABC-C ) Rating Scale ( total score ) . The ABC-C Rating Scale scores improved with piracetam . The difference between the two protocols was significant as indicated by the effect of group , the between subjects factor ( F = 5.85 , d.f . = 1 , P = 0.02 ) . The changes at the endpoint compared with baseline were : -11.90 +/- 3.79 ( mean +/- SD ) and -5.15 +/- 3.04 for group A and B respectively . A significant difference was observed on the change in scores in the ABC-C Rating Scale in week 10 compared with baseline in the two groups ( t = 6.017 , d.f . = 38 , P < 0.0001 ) . The results suggest that a combination of atypical antipsychotic medications and a glutamate agent such as piracetam , might have increase synergistic effects in the treatment of autism .

placebo

piracetam

risperidone

piracetam

piracetam

risperidone

placebo

risperidone

risperidone

piracetam

efficacy

( total score )

ABC-C Rating Scale scores

scores in the ABC-C Rating Scale

autistic disorder

children

three and 11 years

autism

children

children

autistic disorder


A study on the effect of the duration of subcutaneous heparin injection on bruising and pain . AIM This study was carried out to determine the effect of injection duration on bruising and pain following the administration of the subcutaneous injection of heparin . BACKGROUND Although different methods to prevent bruising and pain following the subcutaneous injection of heparin have been widely studied and described , the effect of injection duration on the occurrence of bruising and pain is little documented . DESIGN This study was designed as within-subject , quasi-experimental research . METHOD The sample for the study consisted of 50 patients to whom subcutaneous heparin was administered . Heparin was injected over 10 seconds on the right abdominal site and 30 seconds on the left abdominal site . Injections areas were assessed for the presence of bruising at 48 and 72 hours after each injection . Dimensions of the bruising on the heparin applied areas were measured using transparent millimetric measuring paper . The visual analog scale ( VAS ) was used to measure pain intensity and a stop-watch was used to time the pain period . Data were analysed using chi-square test , Mann-Whitney U , Wilcoxon signed ranks tests and correlation . RESULTS The percentage of bruising occurrence was 64 % with the injection of 10 seconds duration and 42 % in the 30-second injection . It was determined that the size of the bruising was smaller in the 30-second injection . Pain intensity and pain period were statistically significantly lower for the 30-second injection than for the 10-second injection . CONCLUSIONS It was determined that injection duration had an effect on bruising and pain following the subcutaneous administration of heparin . This study should be repeated on a larger sample . RELEVANCE TO CLINICAL PRACTICE When administering subcutaneous heparin injections , it is important to extend the duration of the injection .

subcutaneous heparin injection

heparin

heparin

heparin

Heparin

heparin

heparin

bruising

visual analog scale ( VAS )

percentage of bruising occurrence

size of the bruising

Pain intensity and pain period

bruising and pain

subcutaneous heparin was administered


Rehabilitation of therapy-related cognitive deficits in patients after hematopoietic stem cell transplantation . Neuropsychological deficits are potential side effects of hematopoietic stem cell therapy ( HSCT ) . Systematic data on the long-term course of and therapeutic options for these consequences are limited . One hundred fifty-seven patients were screened for cognitive deficits following HSCT for malignant diseases at an in-patient oncologic rehabilitation clinic . Patients showing evidence of impairment were randomly assigned to one of two training groups : individualized PC-supported training or neuropsychological group therapy . The control group consisted of patients who received no specific training . During in-patient rehabilitation , the results of a comprehensive neuropsychological test battery improved significantly in all three groups , and no specific intervention effects were identified . Neuropsychological deficits were still evident in a subgroup of patients 6 months later . Correlation between neuropsychological testing and patients ' self-evaluation of cognitive functioning in daily life was generally low . Sustained attention and verbal-semantic memory played the main role for self-appraisal and in the designation as 'neuropsychologically impaired ' . In conclusion , a substantial number of patients revealed evidence of cognitive deficits a long time after HSCT . There is a need for more studies and for the development of differentiated rehabilitative measures for such therapeutic consequences .

Rehabilitation

HSCT

no specific training

HSCT

Neuropsychological deficits

Sustained attention

verbal-semantic memory

One hundred fifty-seven patients

impairment


An exploratory , pragmatic , cluster randomised trial of practice nurse training in the use of asthma action plans . INTRODUCTION To investigate the feasibility of improving asthma management - in particular , the implementation of individualised asthma action plans ( AAPs ) for poorly-controlled adult asthma patients - by providing training in asthma-focused clinical and communication skills for practice nurses who deliver asthma clinics . METHODS A pragmatic , cluster randomised trial with an intervention ( an interactive seminar ) delivered at practice level ( n=13 practices ; 6=intervention , 7=control ) . The impact of the intervention was assessed against patient outcomes : routinely available asthma outcome measures ( beta2-agonist prescription rate and number of oral steroid courses ) for asthma patients identified as being poorly-controlled from practice records ; and questionnaire data - Mini Asthma Quality of Life Questionnaire ( AQLQ ) and the Asthma Control Questionnaire ( ACQ ) - from a subset of consenting patients . Data was collected at baseline and at 6-month follow-up . ANALYSISs : Routine data was analysed for 629 patients . 236 ( 37 % ) of these patients consented to provide questionnaire data at baseline , with 75 % returning questionnaires at follow-up . After adjustment for baseline and practice , there was a significant difference at followup between intervention and control practices on the Mini AQLQ only ( p=0.03 ) . Estimates for subsequent sample sizes to inform future trials of asthma training were identified . CONCLUSION Training designed to support practice nurses in implementing individualised AAPs impacted on one patient outcome only . This disappointing outcome may have been due to many different factors such as outcome measure limitations , data collection problems , and underestimating the complexity of supporting practice nurses in behaviour change .

practice nurse training

feasibility

beta2-agonist prescription rate

and

number of oral steroid courses

questionnaire data

Mini AQLQ

asthma

adult

asthma

asthma


Supportive-expressive group therapy for primary breast cancer patients : a randomized prospective multicenter trial . OBJECTIVE The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community settings , to determine whether highly distressed patients were most likely to benefit and whether therapist 's training or experience was related to outcome . METHOD Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were randomly assigned to receive supportive-expressive group therapy or to an education control condition . Participants were recruited from two academic centers and nine oncology practices , which were members of NCI 's Community Clinical Oncology Program ( CCOP ) and were followed over 2 years . RESULTS A 2x2x19 analysis of variance was conducted with main effects of treatment condition , cohort , and baseline distress and their interactions . There was no main effect for treatment condition after removing one subject with an extreme score . Highly distressed women did not derive a greater benefit from treatment . Therapist training and psychotherapy experience were not associated with a treatment effect . CONCLUSIONS This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer . Future studies might productively focus on women with higher initial levels of distress .

Supportive-expressive group therapy

supportive-expressive group therapy

education control condition

supportive-expressive intervention

breast cancer

breast cancer

effects of treatment condition

treatment condition

distressed

greater benefit

distress

breast cancer

distress .

primary breast cancer patients :

Highly distressed women

primary


Midazolam as a main anesthesia induction agent -- a comparison with thiopental and diazepam . A clinical randomized investigation was undertaken to determine the value of midazolam as a narcotic adjuvant for anesthetic induction . Thirty ASA I-II adult patients undergoing selective surgery were allocated randomly into two groups to receive one of the following agents : midazolam 0.3 mg/kg , thiopental 5 mg/kg , or diazepam 0.4 mg/kg . The induction time as measured from the onset of injection to loss of the eyelash reflex was shortest in the case of thiopental ; while a lower frequency of apnea , lesser suppression of circulation , and lack of venous irritation were points favoring midazolam . However , further study is needed to clarify the moderate cardiovascular response seen during intubation in some cases as well as to elucidate any patient population differences .

Midazolam

thiopental and diazepam .

midazolam

value

lack of venous irritation

moderate cardiovascular response

Thirty

ASA I-II


Intravenous sodium valproate versus diazepam infusion for the control of refractory status epilepticus in children : a randomized controlled trial . An open-label , randomized controlled study was conducted at a tertiary care teaching hospital to compare efficacy and safety of intravenous sodium valproate versus diazepam infusion for control of refractory status epilepticus . Forty children with refractory status epilepticus were randomized to receive either intravenous sodium valproate or diazepam infusion . Refractory status epilepticus was controlled in 80 % of the valproate and 85 % of the diazepam patients . The median time to control refractory status epilepticus was less in the valproate group ( 5 minutes ) than the diazepam group ( 17 minutes ; P < .001 ) . None of the patients in the valproate group required ventilation or developed hypotension , whereas in the diazepam group 60 % required ventilation and 50 % developed hypotension after starting diazepam infusion . No adverse effects on liver functions were seen with valproate . It is concluded that intravenous sodium valproate is an effective alternative to diazepam infusion in controlling refractory status epilepticus in children and is free of respiratory depression and hypotension .

Intravenous sodium valproate

diazepam infusion

intravenous sodium valproate

diazepam infusion

Refractory status epilepticus

ventilation or developed hypotension

ventilation

hypotension

adverse effects on liver functions

refractory status epilepticus

children

Forty

refractory status epilepticus

children


Tubeless percutaneous nephrolithotomy : safe even in supracostal access . PURPOSE This study was designed to determine the outcome and safety of tubeless percutaneous nephrolithotomy ( PCNL ) in the treatment of renal calculi . PATIENTS AND METHODS Between November 2005 and March 2006 , 48 patients were randomized to either an 18F Re-entry nephrostomy tube ( group 1 ) or a 6F Double-J stent ( group 2 ) . The two groups were well matched for age , sex , stone size , stone laterality , and number of previous renal procedures . All PCNL procedures were performed by the same surgeon . Postoperative visual analog pain scale ( VAS ) scores at 8 and 24 hours and 14 days after surgery , in-hospital analgesic use , length of hospital stay , success rate , blood transfusion rate , and postoperative complications were compared for the two groups . RESULTS The mean hospital stays in groups 1 and 2 were 3.1 and 1.6 days , respectively ( P = 0.003 ) . The mean VAS scores 8 and 24 hours after surgery were significantly lower in group 2 than in group 1 ( P = 0.001 ) . The postoperative analgesic requirement ( diclofenac sodium ) was significantly higher in group 1 ( 263 mg ) than in group 2 ( 120 mg ; P = 0.02 ) . The rate of blood transfusion in the two groups was similar ( P = NS ) . There was no difference between the groups in VAS scores on postoperative day 14 . The number of supracostal accesses was significantly higher in group 2 than in group 1 ( P = 0.02 ) . The stone-free rates and the numbers of patients with insignificant residual fragments were similar in the two groups . There was no urine leakage or formation of urinoma in patients with Double-J stents . CONCLUSION Tubeless PCNL is safe and effective even after supracostal access and is associated with less postoperative pain and a shorter hospital stay .

Tubeless percutaneous nephrolithotomy

18F Re-entry nephrostomy tube

6F Double-J stent

( diclofenac sodium )

Tubeless PCNL

outcome

safety

success rate

blood transfusion rate

postoperative complications

mean hospital stays

mean VAS scores

postoperative analgesic requirement

rate of blood transfusion

VAS scores

number of supracostal accesses

stone-free rates

insignificant residual fragments

postoperative pain

shorter hospital stay

renal calculi


Maternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic disease . BACKGROUND The sources and the impact of maternal bacteria on the initial inoculum of the intestinal microflora of newborn infants remain elusive . OBJECTIVE To assess the association between maternal breast-milk and fecal bifidobacteria and infants ' fecal bifidobacteria . METHODS Sixty-one mother-infant pairs were included , special emphasis being placed on the maternal allergic status . Bifidobacteria were analysed by a direct PCR method in fecal samples from mothers at 30-35 weeks of gestation and from infants at 1 month of age and from breast-milk samples 1 month post-partum . RESULTS Fecal Bifidobacterium adolescentis and Bifidobacterium bifidum colonization frequencies and counts among mother-infant pairs correlated significantly ( P=0.005 and 0.02 for frequencies , respectively , and P=0.002 and 0.01 for counts , respectively ) . Only infants of allergic , atopic mothers were colonized with B. adolescentis . Each of the breast-milk samples contained bifidobacteria [ median 1.4 x 10 ( 3 ) bacterial cells/mL ; interquartile range ( IQR ) 48.7-3.8 x 10 ( 3 ) ] . Bifidobacterium longum was the most frequently detected species in breast-milk . Allergic mothers had significantly lower amounts of bifidobacteria in breast-milk compared with non-allergic mothers [ median 1.3 x 10 ( 3 ) bacterial cells/mL ( IQR 22.4-3.0 x 10 ( 3 ) ) vs. 5.6 x 10 ( 3 ) bacterial cells/mL ( 1.8 x 10 ( 3 ) -1.8 x 10 ( 4 ) ) , respectively , ( P=0.004 ) ] , and their infants had concurrently lower counts of bifidobacteria in feces [ 3.9 x 10 ( 8 ) bacterial cells/g ( IQR 6.5 x 10 ( 6 ) -1.5 x 10 ( 9 ) ) in infants of allergic mothers , vs. 2.5 x 10 ( 9 ) bacterial cells/g ( 6.5 x 10 ( 8 ) -3.2 x 10 ( 10 ) ) in infants of non-allergic mothers , P=0.013 ] . CONCLUSIONS Breast-milk contains significant numbers of bifidobacteria and the maternal allergic status further deranges the counts of bifidobacteria in breast-milk . Maternal fecal and breast-milk bifidobacterial counts impacted on the infants ' fecal Bifidobacterium levels . Breast-milk bacteria should thus be considered an important source of bacteria in the establishment of infantile intestinal microbiota .

direct PCR

Bifidobacteria

Bifidobacterium longum

bifidobacteria

bifidobacteria in feces


Human papillomavirus and Papanicolaou tests to screen for cervical cancer . BACKGROUND Screening for cervical cancer based on testing for human papillomavirus ( HPV ) increases the sensitivity of detection of high-grade ( grade 2 or 3 ) cervical intraepithelial neoplasia , but whether this gain represents overdiagnosis or protection against future high-grade cervical epithelial neoplasia or cervical cancer is unknown . METHODS In a population-based screening program in Sweden , 12,527 women 32 to 38 years of age were randomly assigned at a 1:1 ratio to have an HPV test plus a Papanicolaou ( Pap ) test ( intervention group ) or a Pap test alone ( control group ) . Women with a positive HPV test and a normal Pap test result were offered a second HPV test at least 1 year later , and those who were found to be persistently infected with the same high-risk type of HPV were then offered colposcopy with cervical biopsy . A similar number of double-blinded Pap smears and colposcopies with biopsy were performed in randomly selected women in the control group . Comprehensive registry data were used to follow the women for a mean of 4.1 years . The relative rates of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected at enrollment and at subsequent screening examinations were calculated . RESULTS At enrollment , the proportion of women in the intervention group who were found to have lesions of grade 2 or 3 cervical intraepithelial neoplasia or cancer was 51 % greater ( 95 % confidence interval [ CI ] , 13 to 102 ) than the proportion of women in the control group who were found to have such lesions . At subsequent screening examinations , the proportion of women in the intervention group who were found to have grade 2 or 3 lesions or cancer was 42 % less ( 95 % CI , 4 to 64 ) and the proportion with grade 3 lesions or cancer was 47 % less ( 95 % CI , 2 to 71 ) than the proportions of control women who were found to have such lesions . Women with persistent HPV infection remained at high risk for grade 2 or 3 lesions or cancer after referral for colposcopy . CONCLUSIONS The addition of an HPV test to the Pap test to screen women in their mid-30s for cervical cancer reduces the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations . ( ClinicalTrials.gov number , NCT00479375 [ ClinicalTrials.gov ] . ) .

Human papillomavirus

Papanicolaou tests

HPV test

Papanicolaou ( Pap ) test

Pap test

HPV test

Pap test

HPV test

Pap smears

and colposcopies with biopsy

intervention

control

intervention

control

HPV test

Pap test

double-blinded Pap smears

and colposcopies with biopsy

or cancer detected

or

cancer

2 or 3 lesions or cancer

women

32 to 38 years of age

women


Effects of vacuum-compression therapy on healing of diabetic foot ulcers : randomized controlled trial . A single-blind , randomized controlled trial was conducted to evaluate vacuum-compression therapy ( VCT ) for the healing of diabetic foot ulcers . Eighteen diabetic patients with foot ulcers were recruited through simple nonprobability sampling . Subjects were randomly assigned to either an experimental or a control group . Before and after intervention , the foot ulcer surface area was estimated stereologically , based on Cavalieri 's principle . The experimental group was treated with VCT in addition to conventional therapy for 10 sessions . The control group received only conventional therapy , including debridement , blood glucose control agents , systemic antibiotics , wound cleaning with normal saline , offloading ( pressure relief ) , and daily wound dressings . The mean foot ulcer surface area decreased from 46.88 +/- 9.28 mm ( 2 ) to 35.09 +/- 4.09 mm ( 2 ) in the experimental group ( p = 0.006 ) and from 46.62 +/- 10.03 mm ( 2 ) to 42.89 +/- 8.1 mm ( 2 ) in the control group ( p = 0.01 ) . After treatment , the experimental group significantly improved in measures of foot ulcer surface area compared with the control group ( p = 0.024 ) . VCT enhances diabetic foot ulcer healing when combined with appropriate wound care .

vacuum-compression therapy

vacuum-compression therapy ( VCT )

control

VCT in addition to conventional therapy

offloading ( pressure relief )

, and

daily wound dressings

VCT

vacuum-compression therapy

diabetic foot ulcers

vacuum-compression therapy ( VCT )

diabetic foot ulcers

foot ulcers

foot ulcer surface area

VCT

conventional therapy

conventional therapy

systemic antibiotics

wound cleaning with normal saline

offloading

daily wound dressings

foot ulcer surface area

measures of foot ulcer surface area

VCT

diabetic foot ulcer healing

diabetic foot ulcers

diabetic foot ulcers

Eighteen

diabetic

foot ulcers


Children with autism 's response to novel stimuli while participating in interventions targeting joint attention or symbolic play skills . Thirty-five children diagnosed with autism were randomly assigned to either a joint attention or a symbolic play intervention . During the 5-8 week treatment , three novel probes were administered to determine mastery of joint attention skills . The probes consisted of auditory and visual stimuli , such as a loud spider crawling or a musical ball bouncing . The current study examined affect , gaze , joint attention behaviors , and verbalizations at three different time points of intervention . Results revealed that children randomized to the joint attention group were more likely to acknowledge the probe and engage in shared interactions between intervener and probe upon termination of intervention . Additionally , the joint attention group improved in the proportion of time spent sharing coordinated joint looks between intervener and probe . These results suggest that generalization of joint attention skills to a novel probe did occur for the group targeting joint attention and provides further evidence of the effectiveness of the joint attention intervention .

novel stimuli

joint attention

symbolic play

joint attention

response to novel stimuli

mastery of joint attention skills .

verbalizations

Children with autism 's

Thirty-five children

autism


Comparison of menopausal symptoms during the first year of adjuvant therapy with either exemestane or tamoxifen in early breast cancer : report of a Tamoxifen Exemestane Adjuvant Multicenter trial substudy . PURPOSE Hormonal breast cancer treatment increases menopausal symptoms in women . This study investigated differences between the symptoms associated with either adjuvant tamoxifen or exemestane . PATIENTS AND METHODS Ten common symptoms were assessed by self-report questionnaire administered to 1,614 consecutive patients at baseline and every 3 months during the first year of a double-blind , randomized trial of postmenopausal women with early hormone receptor-positive breast cancer . Symptoms were categorized as none , mild , moderate , or severe . A hot flash score was calculated at each time point . Symptoms were analyzed by repeated-measures analysis of variance . Each time period was tested repeatedly against the baseline ; an overall P value was assigned for each reported symptom . RESULTS Compliance was excellent , with 7,286 questionnaires analyzed . Baseline symptom prevalence ranged from 2 % ( vaginal bleeding ) to 60 % to 70 % ( bone/muscle aches and low energy ) . There were no significant differences in vaginal bleeding , mood alteration , or low energy . Patients receiving tamoxifen had significantly more vaginal discharge ( P < .0001 ) . Exemestane patients reported more bone/muscle aches ( P < .0001 ) , vaginal dryness ( P = .0004 ) , and difficulty sleeping ( P = .03 ) . In both groups , the hot flash score peaked at 3 months and decreased thereafter . At 12 months , patients receiving tamoxifen had a significantly higher mean hot flash score ( P = .03 ) , with daily hot flashes increasing from baseline by 33 % compared with a 7 % increase from baseline with exemestane . CONCLUSION At 12 months , exemestane was associated with fewer hot flashes and less vaginal discharge than tamoxifen , but with more vaginal dryness , bone/muscle aches , and difficulty sleeping . Symptoms were common in both groups .

exemestane or tamoxifen

adjuvant tamoxifen or exemestane

menopausal symptoms

hot flash score

symptom

bone/muscle aches

low energy

vaginal bleeding ,

mood alteration

, or low energy

vaginal discharge

bone/muscle aches

vaginal dryness

difficulty sleeping

hot flash score

hot flash score

hot flashes

hot flashes

vaginal discharge

vaginal dryness

bone/muscle aches

difficulty sleeping

breast cancer

women

postmenopausal

women


Covariation of adolescent physical activity and dietary behaviors over 12 months . PURPOSE This study examined covariation among changes in dietary , physical activity , and sedentary behaviors over 12 months among adolescents participating in a health behavior intervention . Evidence of covariation among behaviors would suggest multi-behavior interventions could have synergistic effects . METHODS Prospective analyses were conducted with baseline and 12-month assessments from a randomized controlled trial to promote improved diet , physical activity , and sedentary behaviors ( experimental condition ) or SUN protection behaviors ( comparison condition ) . Participants were adolescent girls and boys ( N = 878 ) aged 11-15 years on entry . The main outcomes were : diet , based on multiple 24-hour recalls ( total fat , grams of fiber , servings of fruit and vegetables , total calories ) ; average daily energy expenditure ( kcals/kg ) based on 7-day physical activity recall interviews ; daily minutes of moderate-vigorous physical activity minutes from accelerometery ; and self-reported daily hours of sedentary behavior . RESULTS Covariation was found between fat and calories ( r = .16 ) , fiber and calories ( r = .53 ) , fiber and fruit/vegetables ( r = .53 ) , calories and fruit/vegetables ( r = .34 ) , and fruit and vegetables and sedentary behavior ( r = -.12 ) for the total sample ( all p values < .01 ) . The pattern of findings was similar for most subgroups defined by gender and study condition . CONCLUSIONS The strongest covariation was observed for diet variables that are inherently related ( calories and fat , fiber , and fruit/vegetables ) . Little covariation was detected within or between other diet , physical activity and sedentary behavior domains suggesting that interventions to improve these behaviors in adolescents need to include specific program components for each target behavior of interest .

adolescent physical activity

dietary behaviors

dietary

physical activity

sedentary behaviors

SUN protection behaviors

adolescent physical activity

dietary behaviors

diet

physical activity

sedentary behaviors

SUN protection behaviors

diet

average daily energy expenditure

fiber and fruit/vegetables

calories and fruit/vegetables

fruit and vegetables

sedentary behavior

diet variables

diet

physical activity

sedentary behavior

adolescent

health behavior intervention

girls

boys


Lactoferrin supplementation to Holstein calves during the preweaning and postweaning phases . Sixty Holstein calves ( 30 bulls , 30 heifers ) were used to examine the effects of supplemental lactoferrin on feed intake , growth , and health during the preweaning and postweaning periods . One of 3 levels of lactoferrin was supplemented from 3 to 56 d in either whole milk or water to produce 3 dietary treatments : 1 ) 0 g/d , 2 ) 0.5 g/d , and 3 ) 1 g/d . Whole milk ( 3.8 L/d ) containing lactoferrin supplements was fed from bottles until weaning at 35 d. From d 36 to 56 , lactoferrin supplements were added to water ( 15 to 25 mL ) and fed from bottles . Lactoferrin supplementation had no effect on feed intake , body weight , average daily gain , heart girth , body temperature , fecal scores , respiratory scores , or haptoglobin concentrations . Calves were housed in individual pens in either an open-sided barn or hutches . Calves raised in the barn consumed more calf starter and therefore grew better than calves raised in hutches . Under the conditions of this study , lactoferrin supplementation was not beneficial . Further research is needed to fully elucidate the role of lactoferrin , and possible benefits during different feeding conditions or milk sources .

Lactoferrin supplementation

supplemental lactoferrin

lactoferrin

lactoferrin supplements

lactoferrin supplements

Lactoferrin supplementation

lactoferrin supplementation

lactoferrin

feed intake , growth , and health

feed intake

( 30 bulls , 30 heifers )


Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care . BACKGROUND Although chlorhexidine-based solutions and alcohol-based povidone-iodine have been shown to be more efficient than aqueous povidone-iodine for skin disinfection at catheter insertion sites , their abilities to reduce catheter-related infection have never been compared . METHODS Consecutively scheduled central venous catheters inserted into jugular or subclavian veins were randomly assigned to be disinfected with 5 % povidone-iodine in 70 % ethanol or with a combination of 0.25 % chlorhexidine gluconate , 0.025 % benzalkonium chloride , and 4 % benzylic alcohol . Solutions were used for skin disinfection before catheter insertion ( 2 consecutive 30-second applications separated by a period sufficiently long to allow for dryness ) and then as single applications during subsequent dressing changes ( every 72 hours , or earlier if soiled or wet ) . RESULTS Of 538 catheters randomized , 481 ( 89.4 % ) produced evaluable culture results . Compared with povidone-iodine , the chlorhexidine-based solution was associated with a 50 % decrease in the incidence of catheter colonization ( 11.6 % vs 22.2 % [ P = .002 ] ; incidence density , 9.7 vs 18.3 per 1000 catheter-days ) and with a trend toward lower rates of catheter-related bloodstream infection ( 1.7 % vs 4.2 % [ P = .09 ] ; incidence density , 1.4 vs 3.4 per 1000 catheter-days ) . Independent risk factors for catheter colonization were catheter insertion into the jugular vein ( adjusted relative risk , 2.01 ; 95 % confidence interval , 1.24-3.24 ) and use of povidone-iodine ( adjusted relative risk , 1.87 ; 95 % confidence interval , 1.18-2.96 ) . CONCLUSION Chlorhexidine-based solutions should be considered as a replacement for povidone-iodine ( including alcohol-based ) formulations in efforts to prevent catheter-related infection .

Chlorhexidine-based antiseptic solution

alcohol-based povidone-iodine

chlorhexidine-based solutions

alcohol-based povidone-iodine

povidone-iodine

chlorhexidine-based solution

povidone-iodine

Chlorhexidine-based solutions

catheter-related infection

culture results

incidence of catheter colonization

incidence density

catheter-related bloodstream infection

incidence density

catheter colonization

catheter-related infection

catheter insertion sites

central venous catheters


Oral amoxicillin vs. oral erythromycin in the treatment of pyoderma in Bamako , Mali : an open randomized trial . BACKGROUND Pyoderma ( bacterial superficial skin infection ) is an extremely common disorder in tropical developing countries . In these settings , Streptococcus pyogenes is considered to be the main etiological agent . Apart from epidemics of poststreptococcal glomerulonephritis where mass treatment with intramuscular benzathine-penicillin is recommended , no recommendation exists for the treatment of pyoderma in this setting . The aim of this study was to evaluate the efficacy of oral amoxicillin in the treatment of pyoderma in Mali , by comparison with oral erythromycin . METHODS In Bamako , 132 patients with pyoderma , diagnosed and graded as " severe " on clinical grounds , were randomly assigned to an oral treatment by either amoxicillin ( 50 mg/kg per day ) or erythromycin ; infections of the follicular appendage were excluded . Both drugs were associated with the topical application of povidone iodine . The patients were evaluated openly at the seventh day of treatment for cure or marked improvement of the clinical features , indicating successful treatment . RESULTS Three patients were lost to follow-up . Treatment was successful in 57 of 64 patients treated with amoxicillin vs. 58 of 65 patients treated with erythromycin ( P = 0.00 ) . CONCLUSIONS Amoxicillin was as efficacious as erythromycin in the treatment of severe pyoderma in Mali . Owing to its efficacy , added to high availability and low cost , this compound should be considered a first-line treatment of this disorder in this country , and perhaps in other countries where this condition presents in a similar way .

amoxicillin

erythromycin

benzathine-penicillin

amoxicillin

erythromycin .

amoxicillin

erythromycin ;

treatment of pyoderma

clinical features

successful treatment

Treatment was successful

Amoxicillin was as efficacious

treatment of severe pyoderma

tropical developing countries .

severe pyoderma in Mali .


Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain . BACKGROUND Different methods and propofol formulations have been used to decrease propofol injection pain , but it remains an unresolved problem . We aimed to investigate the effect of i.v . acetaminophen pretreatment on the propofol injection pain . METHODS One hundred and fifty ASA I-II patients undergoing general anaesthesia were randomly allocated into three groups . A 20-gauge catheter was inserted into a superficial radial vein of the left hand , and after the occlusion of venous drainage , Groups I , II , and III were pretreated with 40 mg of lidocaine in saline , 50 mg of i.v . acetaminophen , and 5 ml of saline , respectively . The occlusion was released after 2 min and one-fourth of the total propofol dose was injected into the vein over a period of 5 s. During the injection of both pretreatment solution and propofol , patients ' pain was assessed and recorded as 0-3 , corresponding to no , mild , moderate or severe pain , respectively . Chi2 and Kruskal-Wallis tests were used for the statistical analysis . For all analyses , differences were considered to be significant at P < 0.05 . RESULTS Patient characteristics were similar among the groups . Incidence of pain on injection of propofol in control , i.v . acetaminophen , and lidocaine groups was 64 % , 22 % and 8 % , respectively ( P < 0.05 ) . CONCLUSIONS Pretreatment with i.v . acetaminophen seems to be effective in attenuating pain during i.v . injection of propofol .

acetaminophen

lidocaine

lidocaine

acetaminophen

saline

propofol

propofol

acetaminophen

lidocaine

acetaminophen

propofol .

Efficacy

propofol injection pain

injection pain

pain

Incidence of pain on injection

pain


Low-dose intravenous midazolam reduces etomidate-induced myoclonus : a prospective , randomized study in patients undergoing elective cardioversion . BACKGROUND Myoclonic movements are a common problem in unpremedicated patients during induction of anesthesia with etomidate . METHODS In a double-blind fashion , 40 patients ( ASA physical status III-IV ) scheduled for elective cardioversion were randomly assigned to receive either 0.015 mg/kg midazolam or placebo 90 s before the injection of 0.3 mg/kg etomidate . Myoclonic movements and sedation were recorded on a scale between 0 and 3 . Pulse oximetry , noninvasive arterial blood pressure , and heart rate were recorded during the study period . RESULTS Two patients ( 10 % ) in the midazolam group had myoclonic movements after the administration of etomidate , whereas 10 of the 20 patients ( 50 % ) receiving placebo experienced such movements ( P = 0.006 ) . No other differences were found between the groups ; in particular , there was no difference in recovery 5 min after the administration of etomidate . CONCLUSIONS IV midazolam 0.015 mg/kg administered 90 s before induction of anesthesia with etomidate is effective in reducing myoclonic movements and does not prolong recovery in unpremedicated patients after short procedures .

midazolam

midazolam

placebo

etomidate

midazolam

etomidate

placebo

midazolam

Myoclonic movements and sedation

myoclonic movements


How well do blood folate concentrations predict dietary folate intakes in a sample of Canadian lactating women exposed to high levels of folate ? An observational study . BACKGROUND In 1998 , mandatory folic acid fortification of white flour and select cereal grain products was implemented in Canada with the intention to increase dietary folate intakes of reproducing women . Folic acid fortification has produced a dramatic increase in blood folate concentrations among reproductive age women , and a reduction in neural tube defect ( NTD ) -affected pregnancies . In response to improved blood folate concentrations , many health care professionals are asking whether a folic acid supplement is necessary for NTD prevention among women with high blood folate values , and how reliably high RBC folate concentrations predict folate intakes shown in randomized controlled trials to be protective against NTDs . The objective of this study was to determine how predictive blood folate concentrations and folate intakes are of each other in a sample of well-educated lactating Canadian women exposed to high levels of synthetic folate . METHODS The relationship between blood folate concentrations and dietary folate intakes , determined by weighed food records , were assessed in a sample of predominantly university-educated lactating women ( 32 +/- 4 yr ) at 4- ( n = 53 ) and 16-wk postpartum ( n = 55 ) . RESULTS Median blood folate concentrations of all participants were well above plasma and RBC folate cut-off levels indicative of deficiency ( 6.7 and 317 nmol/L , respectively ) and all , except for 2 subjects , were above the cut-off for NTD-risk reduction ( > 906 nmol/L ) . Only modest associations existed between total folate intakes and plasma ( r = 0.46 , P < 0.001 ) and RBC ( r = 0.36 , P < 0.01 ) folate concentrations at 16-wk postpartum . Plasma and RBC folate values at 16-wk postpartum correctly identified the quartile of folate intake of only 26 of 55 ( 47 % ) and 18 of 55 ( 33 % ) of subjects , respectively . The mean RBC folate concentration of women consuming 151-410 microg/d of synthetic folate ( 2nd quartile of intake ) did not differ from that of women consuming > 410 microg/d ( 3rd and 4th quartile ) . CONCLUSION Folate intakes , estimated by food composition tables , and blood folate concentrations are not predictive of each other in Canadian lactating women exposed to high levels of folate . Synthetic intakes > 151-410 microg/d in these women produced little additional benefit in terms of maximizing RBC content . More studies are needed to examine the relationship between blood folate concentration and NTD risk . Until data from such studies are available , women planning a pregnancy should continue to consume a daily folic acid supplement of 400 microg .

blood folate

dietary folate intakes

folic acid supplement

blood folate

blood folate

blood folate

total folate intakes

Folate intakes

blood folate

folic acid supplement

blood folate concentrations

blood folate concentrations

folate intakes

blood folate concentrations

dietary folate intakes

blood folate concentrations

total folate intakes

plasma

folate concentrations

Plasma and RBC folate values

RBC folate concentration

Folate intakes

blood folate concentrations

folate

blood folate concentration

women

folate

reproducing

women

women

high blood folate values

women

synthetic folate

women

( 32 +/- 4 yr )


Effects of gabapentin on experimental somatic pain and temporal summation . BACKGROUND AND OBJECTIVES Gabapentin is used for treatment of neuropathic pain , but its effect on different somatic pain modalities and integrative mechanisms are not completely understood . The aim of this double-blind , placebo-controlled experimental pain study , conducted on 20 healthy volunteers , was to examine the effect of a single dose of 1200 mg gabapentin on multi-modal experimental cutaneous and muscle pain models . METHODS The following pain models were applied : ( 1 ) pain thresholds to single and repeated cutaneous and intramuscular electrical stimulation ( temporal summation to 5 stimuli delivered at 2 Hz ) ; ( 2 ) stimulus-response function relating pain intensity scores ( visual analog scale , VAS ) to increasing current intensities for electrical skin and muscle stimuli ( single and repeated , determined at baseline ) ; and ( 3 ) the pain intensity ( VAS ) and pain areas after intramuscular injection of hypertonic saline . Pain assessments were performed prior to , and at 4 , 6 , and 8 hours after medication . RESULTS When responses were averaged across the post-dose times , gabapentin : ( 1 ) significantly increased the temporal summation pain threshold in skin compared with placebo ( P = .03 ) ; ( 2 ) significantly reduced the area under the pain intensity curve to hypertonic saline injections in the muscle ( P = .02 ) ; and ( 3 ) significantly reduced the area of pain evoked by hypertonic saline ( P = .03 ) . CONCLUSIONS Gabapentin reduces temporal summation of skin stimuli at pain threshold intensities ; this may have potential as a biomarker for drugs with efficacy on neurogenic pain . The data also suggest that tonic muscle pain is responsive to gabapentin treatment and suggest further clinical studies .

gabapentin

Gabapentin

placebo-controlled

pain intensity ( VAS )

pain areas

gabapentin

Gabapentin

somatic pain

temporal summation

Pain

temporal summation pain threshold

tonic muscle pain

healthy


Mode of ventilation during cardiopulmonary bypass does not affect immediate postbypass oxygenation in pediatric cardiac patients . STUDY OBJECTIVE To investigate the impact of different modes of ventilation during cardiopulmonary bypass ( CPB ) on immediate postbypass oxygenation in pediatric cardiac surgery . DESIGN Prospective , randomized clinical trial . SETTING University hospital . PATIENTS 50 pediatric patients ( 18 girls , 32 boys ) , aged 4 months to 15 years , undergoing elective repair of congenital heart disease . INTERVENTIONS Patients were randomized to receive one of 5 modes of ventilation during bypass . Groups 1 and 2 received high-frequency/low-volume ventilation with 100 % ( group 1 ) or 21 % oxygen ( group 2 ) . Groups 3 and 4 received continuous positive airway pressure of 5 cm H ( 2 ) O with 100 % ( group 3 ) or 21 % oxygen ( group 4 ) ; and in group 5 , each patient 's airway was disconnected from the ventilator ( passive deflation ) . MEASUREMENTS Blood gas analysis and spirometry data were recorded 5 minutes before chest opening , 5 minutes before inducing bypass , 5 minutes after weaning from bypass , and 5 minutes after chest closure . MAIN RESULTS There were no differences in Pao ( 2 ) values among the 5 groups studied and at the different time points . Lung compliance was higher 5 minutes before bypass in group 1 versus group 5 ( 34 +/- 13 mL/cm H ( 2 ) O vs 20 +/- 9 mL/cm H ( 2 ) O ; P = 0.048 ) . CONCLUSIONS Mode of ventilation during CPB did not affect immediate postbypass oxygenation .

Mode of ventilation during

cardiopulmonary bypass

modes of ventilation during

cardiopulmonary bypass ( CPB )

one of 5 modes of ventilation during

bypass

21 % oxygen

Mode of

ventilation

Blood gas analysis and spirometry data

Pao ( 2 ) values

Lung compliance

pediatric cardiac patients .


Long-term psychosocial and health economy consequences of ADHD , autism , and reading-writing disorder : a prospective service evaluation project . OBJECTIVE The study aims to evaluate psychosocial , societal , and family cost consequences of a psychoeducational intervention program . METHODS Sixty boys with ADHD , Asperger syndrome/high-functioning autism ( AS/HFA ) , and reading and writing disorder ( RD/WD ) were allocated to participate in a service evaluation project . Every other boy in each diagnostic group was randomly allocated to receive either ( a ) a special education program ( clinical index group ) or ( b ) follow-up without the special education program ( clinical comparison group ) . Nine years after initial assessments the stability of the psychosocial and economic resource consequences over time was studied . RESULTS ADHD , AS/HFA , and RD/WD all had severe impact on family life quality . The societal costs were high , but no significant differences in resource use or in total costs were found between the clinical index and the comparison groups . CONCLUSIONS The results underscore the very long-term need for support including individually tailored reevaluations and carefully monitored intervention programs adapted to family needs and severity of child disorder .

family life quality .

resource use or in total costs

ADHD

autism

reading-writing disorder

Sixty

boys

ADHD

reading and writing disorder ( RD/WD )


Assessment of response to induction therapy and its influence on 5-year failure-free survival in group III rhabdomyosarcoma : the Intergroup Rhabdomyosarcoma Study-IV experience -- a report from the Soft Tissue Sarcoma Committee of the Children 's Oncology Group . PURPOSE Initial response to induction chemotherapy predicts failure-free survival ( FFS ) in osteosarcoma and Ewing 's sarcoma . For Intergroup Rhabdomyosarcoma Study ( IRS ) IV patients with group III rhabdomyosarcoma , we assessed whether reported response assessed by anatomic imaging at week 8 predicted FFS . PATIENTS AND METHODS We studied 444 group III patients who received induction therapy , had response assessed at week 8 by anatomic imaging , and continued with protocol therapy . Induction chemotherapy was generally followed by radiation therapy ( RT ) starting after week 9 . Response to induction therapy was determined at weeks 0 and 8 . Local institutions coded response . RESULTS Response rate for the entire cohort at week 8 was 77 % ( 95 % CI , 73 % to 81 % ; complete response [ CR ] , 21 % ; partial response [ PR ] , 56 % ) but response had no influence on FFS ( P = .57 ) . Two hundred seventy-two patients received standard-timing RT at week 9 and thus only chemotherapy during induction . Response rate was 81 % ( 95 % CI , 76 % to 86 % ; CR , 22 % ; PR , 59 % ) . In these patients , response did not influence FFS except for those with alveolar histology . One hundred thirty-two other patients received chemotherapy and RT during induction ( up-front RT ) . Response rate was 65 % ( 95 % CI , 57 % to 73 % ; CR , 12 % ; PR , 53 % ) , but response had no influence on FFS ( P = .69 ) . Forty patients received no RT at all ( protocol violation ) and response to induction therapy had no effect on FFS . CONCLUSION In IRS-IV , response rate to induction therapy was 77 % in group III patients , was independent of histology , and had no influence on FFS overall .

induction chemotherapy

induction therapy

anatomic imaging

continued with protocol therapy

Induction chemotherapy

radiation therapy ( RT )

5-year failure-free survival

failure-free survival ( FFS )

Response rate

complete response [ CR ]

partial response [ PR ]

FFS

Response rate

CR

PR

did not influence FFS

Response rate

CR

PR

FFS

FFS

response rate

FFS


Robotic therapy : a novel approach in upper-limb neurorehabilitation after stroke .

Robotic therapy

upper-limb neurorehabilitation

stroke .


Hitting the target : relatively easy , yet absolutely difficult . It is generally agreed that absolute-direction judgments require information about eye position , whereas relative-direction judgments do not . The source of this eye-position information , particularly during monocular viewing , is a matter of debate . It may be either binocular eye position , or the position of the viewing-eye only , that is crucial . Using more ecologically valid stimulus situations than the traditional LED in the dark , we performed two experiments . In experiment 1 , observers threw darts at targets that were fixated either monocularly or binocularly . In experiment 2 , observers aimed a laser gun at targets while fixating either the rear or the front gunsight monocularly , or the target either monocularly or binocularly . We measured the accuracy and precision of the observers ' absolute- and relative-direction judgments . We found that ( a ) relative-direction judgments were precise and independent of phoria , and ( b ) monocular absolute-direction judgments were inaccurate , and the magnitude of the inaccuracy was predictable from the magnitude of phoria . These results confirm that relative-direction judgments do not require information about eye position . Moreover , they show that binocular eye-position information is crucial when judging the absolute direction of both monocular and binocular targets .

accuracy

and

precision

inaccurate

inaccuracy

absolute-direction judgments

monocularly or binocularly


Sivelestat sodium hydrate improves septic acute lung injury by reducing alveolar dysfunction . Sivelestat sodium hydrate ( sivelestat ) is a selective inhibitor of polymorphonuclear leukocyte elastase ( PMN-E ) . We administered sivelestat to patients with septic acute lung injury ( ALI ) to examine its usefulness . The primary endpoints in the study were the duration of artificial ventilation and pulmonary oxygenation ability , and the secondary endpoints were mortality and the concentrations of PMN-E , SP-D , TNF-alpha and IL-8 in blood . In the sivelestat group , the duration of artificial ventilation , pulmonary oxygenation ability , and the blood PMN-E , SP-D , TNF-alpha and IL-8 concentrations decreased significantly . Administration of sivelestat was found to reduce alveolar dysfunction and improve respiratory function , and it was suggested that early administration might be useful .

Sivelestat sodium hydrate

sivelestat

sivelestat

sivelestat

duration of artificial ventilation

pulmonary oxygenation ability

mortality

duration of artificial ventilation

pulmonary oxygenation ability

alveolar dysfunction

respiratory function

septic acute lung injury

septic acute lung injury ( ALI )


Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence . PURPOSE To investigate and compare the effects of a dental cream containing complexes of casein phosphoprotein-amorphous calcium phosphate ( CPP-ACP ) and fluoride mouthwashes on the regression of white spot lesions ( WSL ) . MATERIALS AND METHODS The study group consisted of 26 healthy adolescents ( mean age 14.6 years ) exhibiting 60 teeth with 152 visible WSL sites on incisors and canines immediately after debonding of fixed orthodontic appliances . After bracket removal , professional tooth cleaning and drying , a visual scoring ( 0-4 ) and laser fluorescence ( LF ) readings were carried out . The patients were randomly assigned to two different treatment protocols with the aim of remineralising the lesions : A ) daily topical applications of a dental cream containing CPP-ACP ( Topacal ) for 3 months followed by a 3-month period of daily toothbrushing with fluoridated dentifrice , or B ) daily 0.05 % sodium fluoride mouthwash combined with fluoridated dentifrice for 6 months . The registrations were repeated after 1 , 3 , 6 and 12 months and follow-up data were compared with baseline with aid of chi-square and paired t-tests . RESULTS A significant improvement of the clinical WSL-scores was found over time in both groups , but there was a statistically significant difference ( p < 0.01 ) concerning the number of sites that totally disappeared after 12 months in favour of the CPP-ACP regime , 63 % compared with 25 % respectively . The clinical registrations were mirrored by a statistically significant decrease ( p < 0.05 ) in the LF readings at the 6- and 12-month follow-ups compared with baseline . No significant differences were displayed between the groups . CONCLUSIONS Clinical scoring and LF assessment suggested that both regimens could promote regression of WSL after debonding of fixed orthodontic appliances . The visual evaluation suggested an aesthetically more favourable outcome of the amorphous calcium phosphate treatments .

amorphous cream phosphate complexes

fluoride

bracket removal

professional tooth cleaning and drying

amorphous calcium phosphate treatments

clinical WSL-scores

LF readings


Exploring effects of different treadmill interventions on walking onset and gait patterns in infants with Down syndrome . Two cohorts of participants were included to investigate the effects of different treadmill interventions on walking onset and gait patterns in infants with Down syndrome ( DS ) . The first cohort included 30 infants with DS ( 17 males , 13 females ; mean age 10 mo [ SD 1.9 mo ] ) who were randomly assigned to either a lower-intensity-generalized ( LG ) training group , or a higher-intensity-individualized ( HI ) training group . A control ( C ) group from another study , who did not receive treadmill training , served as the control ( eight males , seven females ; mean age 10.4 mo [ SD 2.2 mo ] ) . Mean age at walking onset was 19.2 , 21.4 , and 23.9 months for the HI , LG , and C groups respectively . At walking onset the HI group was significantly younger than the C group ( p=0.011 ) . At the gait follow-up that was conducted between 1 and 3 months after walking onset , three groups significantly different in overall gait patterns ( p=0.037 ) were examined by six basic gait parameters including average velocity , stride length , step width , stride time , stance time , and dynamic base . Post-hoc analyses demonstrated that stride length was the gait parameter largely contributing to this overall group difference ( p=0.033 ) , and the HI group produced a significantly longer stride length than the C group ( p=0.030 ) . In conclusion , the HI treadmill intervention significantly promoted earlier walking onset and elicited more advanced gait patterns ( particularly in stride length ) in infants with DS .

treadmill interventions

treadmill interventions

control ( C )

not receive treadmill training

walking onset

gait patterns

walking onset

gait patterns

Mean age at walking onset

walking onset

stride length

stride length

walking onset

gait patterns

infants

Down syndrome

infants

Down syndrome

DS

infants

DS

males

females

10 mo

control ( C ) group

eight

males

seven

females

10.4 mo

infants

DS


Home blood pressure monitoring : advantages and limitations . Home blood pressure monitoring is a useful tool for clinical management of patients with hypertension . Its major advantages are the ease with which the techniques can be learned , reproducibility of values , sensitivity of measurement and availability of normotensive data . In spite of the ability to tell whether a subject has normal or abnormal values , because of the lack of prospective mortality/morbidity data , home blood pressure monitoring can not be used to decide whether treatment is indicated . The treatment decision must be based on repeated clinic blood pressure readings . After that the home blood pressure monitoring can be used to exclude individuals who are at risk for side effects due to low out-of-office blood pressure readings and to precisely monitor the blood pressure response to therapy . Home blood pressure monitoring is frequently used to find subjects with 'white-coat ' hypertension . In our study of borderline hypertension in Tecumseh , white-coat hypertension is present in 7.1 % of the whole population and in 58 % of all subjects with elevated blood pressures in the clinic . Subjects with white-coat hypertension in Tecumseh appear to be at an increased risk for coronary heart disease : they show repeated elevated clinic readings throughout their life time , their parents have higher blood pressure , their high-density lipoprotein is decreased and insulin , cholesterol and triglycerides are elevated . Whereas subjects with white-coat hypertension should not be treated with antihypertensive agents , they must be followed and managed through non-pharmacologic means .

Home blood pressure monitoring

Home blood pressure monitoring

home blood pressure monitoring

clinic blood pressure

home blood pressure monitoring

Home blood pressure monitoring

non-pharmacologic means

blood pressure

clinical management

clinic blood pressure readings

blood pressure

blood pressure

blood pressure response

'white-coat ' hypertension .

blood pressures

coronary heart disease

clinic readings

blood pressure

high-density lipoprotein

insulin

cholesterol

triglycerides

hypertension

borderline hypertension


The value-congruence model of memory for emotional experiences : an explanation for cultural differences in emotional self-reports . In 3 studies , the authors found support for the value-congruence model that accounts for cultural variations in memory for emotional experiences . In Study 1 , the authors found that in the made-in-the-U.S. scenario condition , European Americans were more accurate than were Asian Americans in their retrospective frequency judgments of emotions . However , in the made-in-Japan scenario condition , European Americans were less accurate than were Asian Americans . In Study 2 , the authors demonstrated that value orientation mediates the CulturexType of Event congruence effect . In Study 3 ( a daily event sampling study ) , the authors showed that the congruence effect was explained by the importance of parental approval . In sum , emotional events congruent with personal values remain in memory longer and influence retrospective frequency judgments of emotion more than do incongruent events .

made-in-the-U.S. scenario

made-in-Japan scenario

daily event sampling study

memory for emotional experiences

memory for emotional experiences

CulturexType of Event congruence effect

congruence effect

personal values


Effects of resistance versus endurance training on serum adiponectin and insulin resistance index . PURPOSE The purpose of the present study was to investigate the effects of resistance and endurance training on serum adiponectin and insulin resistance index ( SI ) in healthy men . METHODS Twenty-four healthy males ( age , 35-48 years ) participated in the study . The subjects were randomly assigned to one of three groups : endurance training group ( n=8 ) , resistance training group ( n=8 ) and control group ( n=8 ) . Blood samples were taken in fasting state from all subjects . The experimental groups performed either endurance or resistance training 3 days a week for 12 weeks . The endurance training programme included continuous running at an intensity corresponding to 75-85 % of maximal heart rate , while resistance training consisted of four sets of circuit weight training for 11 stations and at an intensity corresponding to 50-60 % of one-repetition maximum . The maximum numbers of repetitions in each station was 12 . RESULTS There were significant negative correlations between serum adiponectin and body fat percentage , waist-to-hip ratio , body mass index and the insulin resistance index at baseline , whereas changes in response to training were not significantly correlated . Both endurance and resistance training resulted in a significant decrease in the SI in comparison with the control group . However , serum adiponectin did not change significantly in response to resistance and endurance training . CONCLUSION Endurance and resistance training caused an improvement in insulin resistance in healthy men , but this improvement was not accompanied by increased adiponectin levels .

resistance versus endurance training

resistance and endurance training

endurance training

group ( n=8 ) ,

resistance training

group ( n=8 ) and

control

group ( n=8 )

endurance

resistance training

endurance training programme

resistance training

Blood samples

SI

serum adiponectin

healthy

men

Twenty-four

males

age , 35-48 years

healthy

men


Cost-effectiveness of clopidogrel in acute coronary syndromes in Canada : a long-term analysis based on the CURE trial . BACKGROUND Cardiovascular diseases account for nearly 20 % of all hospitalizations in Canada and consume 12 % of the total cost of all illnesses . With increasing trends of cardiovascular disease and increasing costs of care , development of cost-effective strategies is vital . The Clopidogrel in Unstable angina to prevent Recurrent Events ( CURE ) trial demonstrated the effectiveness of clopidogrel plus acetylsalicylic acid ( ASA ) compared with ASA alone in reducing cardiovascular events in patients with acute coronary syndromes and , in addition , patients undergoing percutaneous coronary intervention in the Percutaneous Coronary Intervention in CURE ( PCI-CURE ) trial . OBJECTIVE To assess the cost-effectiveness of clopidogrel in the Canadian health care system . METHODS Estimates of hospitalization costs were based on the 2003 cost schedules released by the Health Funding and Costing Branch of the Alberta Health and Wellness , as well as on the Case Mix Group classification system . Life expectancy beyond the trial was estimated from the Saskatchewan Health Database . Cost-effectiveness was expressed as the incremental cost-effectiveness ratio , and bootstrap methods were used to estimate the joint distribution of costs and effectiveness . RESULTS Clopidogrel was shown to be cost-effective , with incremental cost-effectiveness ratios less than $ 10,000 per event prevented and less than $ 4,000 per life-year gained . The probability of clopidogrel resulting in cost per life-year gained of less than $ 20,000 was 0.975 for CURE patients and 0.904 for PCI-CURE patients . CONCLUSIONS The economic analysis demonstrated that clopidogrel combination therapy is not only cost-effective as antiplatelet therapy compared with ASA alone , but it is also cost-effective compared with other commonly used and openly reimbursed cardiovascular therapies in the Canadian health care system .

clopidogrel

Clopidogrel

ASA alone

clopidogrel

Clopidogrel

clopidogrel combination therapy

ASA

cost-effective

cost-effectiveness ratios

gained .

cost per life-year gained

acute coronary syndromes

coronary intervention


Intra-operative antibiotic prophylaxis in neurosurgery . A prospective , randomized , controlled study on cefotiam . In this prospective , randomized and controlled study the effect of cefotiam for the prevention of wound infections following trepanations was investigated . The main interest was centered on the rate of post-operative bone flap infections requiring operative revision . Administration of cefotiam was randomized for patients undergoing major craniotomies . The antibiotic was administered intravenously in a single dose of 2 g with induction of anaesthesia . Only clean or clean contaminated cases were included . Excluded were contaminated cases , operations with a transnasal-transsphenoidal approach , shunt-operations and patients with any other preoperative infection or antibiotic therapy . Outpatients were excluded due to difficulties in obtaining sufficient clinical information . From originally 918 consecutive patients operated on 711 fulfilled the entry criteria . With regard to age , sex , diagnosis and the site of te trepanation , control patients ( n = 355 ) and cefotiam treated patients ( n = 356 ) were shown to be comparable . In the various subgroups formed for different primary diagnoses , concomitant steroidal therapy and concomitant severe internal medical diseases cefotiam treated patients and controls were comparable as well . A highly significant difference for bone flap infection could be shown with 0.3 % in the cefotiam group versus 5.1 % in the control group ( p less than 0.001 ) . The overall rate of post-operative deep wound infections including meningitis and abscesses was also significantly ( p less than 0.005 ) different with 3.1 % in the cefotiam versus 9.0 % in the control group . Thus it was concluded that a single dose of cefotiam significantly reduces post-operative deep wound infection .

antibiotic

cefotiam

cefotiam

antibiotic

anaesthesia

antibiotic therapy

control patients

concomitant steroidal therapy

cefotiam

bone flap infection

post-operative deep wound infection


Randomized study of chlorambucil ( CB ) compared to interferon ( alfa-2b ) combined with CB in low-grade non-Hodgkin 's lymphoma : an interim report of a randomized study . Non-Hodgkin 's Lymphoma Cooperative Study Group . Alpha interferon has shown initial promise in the treatment of low-grade non-Hodgkin 's lymphoma ( NHL ) , especially with the nodular form of the disease . The present study enrolled 70 NHL patients who received either chlorambucil ( CB ; 10 mg/day ) or CB plus interferon alfa-2b ( 5 million units ( MU ) /m2 subcutaneously three times a week ) . Among 63 evaluable patients , similar response rates ( 62.1 % and 64.7 % respectively ) were recorded for the treatment arms . In patients receiving no maintenance therapy , those who received interferon alfa-2b during the induction phase showed a favourable trend in terms of incidence of relapse compared to those who had received chlorambucil alone . During maintenance therapy with interferon alfa-2b , no significant differences in the occurrence of relapse have yet been seen compared to patients on no maintenance therapy . A longer observation period is needed to make a definitive conclusion about the usefulness of interferon maintenance therapy and to evaluate further the effects of the combined schedule of chlorambucil and interferon induction on the duration of remission .

chlorambucil

interferon

CB

Alpha interferon

chlorambucil

CB plus interferon alfa-2b

interferon alfa-2b

interferon maintenance therapy

chlorambucil

interferon

incidence of relapse

occurrence of relapse

non-Hodgkin 's lymphoma

Non-Hodgkin 's Lymphoma

no maintenance therapy

no maintenance therapy


A prospective randomized treatment study comparing three treatment options for chalazia : triamcinolone acetonide injections , incision and curettage and treatment with hot compresses . BACKGROUND Three methods of treating chalazia were compared : intralesional triamcinolone acetonide injections ( 0.2 mL of 10 mg/mL ) , incision and curettage and advice regarding the application of hot compresses to the affected eyelid . METHODS This was a single centre randomized treatment study . Patients with a chalazion underwent either of the three treatment options . Chalazion resolution , pain , satisfaction and inconvenience experienced because of treatments were the outcomes assessed via a telephone interview at 3 weeks . RESULTS 136 consecutive patients were enrolled into the study . At the 3-week follow up , the resolution rates in the triamcinolone acetonide injection and surgical treatment groups were not significantly different from each other at 84 % ( 47/56 ) and 87 % ( 39/45 ) , respectively ( P < 0.001 ) , but was significantly lower in the conservative treatment group at 46 % ( 16/35 ) ( P < 0.001 ) . Pain scores were higher in the surgical treatment group compared with the triamcinolone injection group ( P < 0.003 ) . Inconvenience experienced by patients was reported as significantly less in the triamcinolone group compared with the conservative and surgical treatment groups ( P < 0.001 ) . Patient satisfaction scores were lower in the conservative treatment group compared with each of the other two groups which in turn , were no different from each other regarding this outcome ( P < 0.001 ) . CONCLUSIONS To our knowledge , this is the first prospective randomized study comparing the three methods of chalazia treatment . Results suggest that a single triamcinolone acetonide injection followed by lid massage is almost as effective as incision and curettage in the treatment of chalazia and with similar patient satisfaction and less pain and patient inconvenience .

triamcinolone acetonide injections

incision

curettage

hot compresses

incision and curettage

hot compresses

triamcinolone acetonide

triamcinolone acetonide

Chalazion resolution

pain

satisfaction

resolution rates

Pain scores

Inconvenience experienced by patients

Patient satisfaction scores

patient satisfaction

pain

patient inconvenience


Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women . BACKGROUND There is a paucity of data on the efficacy of nitrofurantoin for the treatment of acute uncomplicated cystitis in regimens shorter than 7 days . Evidence-based use of this drug is increasingly important as trimethoprim-sulfamethoxazole resistance among uropathogens increases . METHODS To assess the efficacy of nitrofurantoin vs trimethoprim-sulfamethoxazole , 338 women aged 18 to 45 years with acute uncomplicated cystitis were randomized to open-label treatment with either trimethoprim-sulfamethoxazole , 1 double-strength tablet twice daily for 3 days , or nitrofurantoin , 100 mg twice daily for 5 days . Clinical cure 30 days after therapy was the main outcome measure . Secondary outcomes included clinical and microbiological cure rates 5 to 9 days after therapy and , for trimethoprim-sulfamethoxazole-treated women , clinical cure stratified by the trimethoprim-sulfamethoxazole susceptibility of the uropathogen . RESULTS Clinical cure was achieved in 79 % of the trimethoprim-sulfamethoxazole group and in 84 % of the nitrofurantoin group , for a difference of -5 % ( 95 % confidence interval , -13 % to 4 % ) . Clinical and microbiological cure rates at the first follow-up visit were also equivalent between the 2 groups . In the trimethoprim-sulfamethoxazole arm , 7 of 17 women ( 41 % ) with a trimethoprim-sulfamethoxazole-nonsusceptible isolate had a clinical cure compared with 84 % of women with a trimethoprim-sulfamethoxazole-susceptible isolate ( P < .001 ) . CONCLUSION A 5-day course of nitrofurantoin is equivalent clinically and microbiologically to a 3-day course of trimethoprim-sulfamethoxazole and should be considered an effective fluoroquinolone-sparing alternative for the treatment of acute cystitis in women .

nitrofurantoin

nitrofurantoin

trimethoprim-sulfamethoxazole

nitrofurantoin

trimethoprim-sulfamethoxazole

trimethoprim-sulfamethoxazole

nitrofurantoin

trimethoprim-sulfamethoxazole-treated

trimethoprim-sulfamethoxazole

trimethoprim-sulfamethoxazole

Clinical cure 30 days after therapy

clinical and microbiological cure rates

clinical cure

Clinical cure

Clinical and microbiological cure rates

acute uncomplicated cystitis

women

women

aged 18 to 45 years

acute uncomplicated cystitis

acute cystitis

women


Obesity and mortality in men with locally advanced prostate cancer : analysis of RTOG 85-31 . BACKGROUND Greater body mass index ( BMI ) is associated with shorter time to prostate-specific antigen ( PSA ) failure following radical prostatectomy and radiation therapy ( RT ) . Whether BMI is associated with prostate cancer-specific mortality ( PCSM ) was investigated in a large randomized trial of men treated with RT and androgen deprivation therapy ( ADT ) for locally advanced prostate cancer . METHODS Between 1987 and 1992 , 945 eligible men with locally advanced prostate cancer were enrolled in a phase 3 trial ( RTOG 85-31 ) and randomized to RT and immediate goserelin or RT alone followed by goserelin at recurrence . Height and weight data were available at baseline for 788 ( 83 % ) subjects . Cox regression analyses were performed to evaluate the relations between BMI and all-cause mortality , PCSM , and nonprostate cancer mortality . Covariates included age , race , treatment arm , history of prostatectomy , nodal involvement , Gleason score , clinical stage , and BMI . RESULTS The 5-year PCSM rate for men with BMI < 25 kg/m ( 2 ) was 6.5 % , compared with 13.1 % and 12.2 % in men with BMI > or =25 to < 30 and BMI > or =30 , respectively ( Gray 's P = .005 ) . In multivariate analyses , greater BMI was significantly associated with higher PCSM ( for BMI > or =25 to < 30 , hazard ratio [ HR ] 1.52 , 95 % confidence interval [ CI ] , 1.02-2.27 , P = .04 ; for BMI > or =30 , HR 1.64 , 95 % CI , 1.01-2.66 , P = .04 ) . BMI was not associated with nonprostate cancer or all-cause mortality . CONCLUSIONS Greater baseline BMI is independently associated with higher PCSM in men with locally advanced prostate cancer . Further studies are warranted to evaluate the mechanism ( s ) for increased cancer-specific mortality and to assess whether weight loss after prostate cancer diagnosis alters disease course .

radical prostatectomy

radiation therapy

RT and immediate goserelin

RT alone followed by goserelin

body mass index ( BMI )

BMI

all-cause mortality

PCSM

nonprostate cancer mortality

5-year PCSM rate

BMI

higher PCSM

BMI

nonprostate cancer

all-cause mortality

baseline BMI

PCSM

cancer-specific mortality

weight loss

locally advanced prostate cancer :

men


A systems analysis of obstetric triage . OBJECTIVE The purpose of this study is to examine some of the variables involved in obstetric triage in an effort to develop a more efficient patient care delivery system in a high-volume obstetric unit . An efficient triage system is essential to a busy labor and delivery unit for the evaluation of unscheduled patient visits . In hospitals that lack an efficient obstetric triage system , it is very difficult to regulate patient flow and wait times . METHOD The study was designed to determine whether a triage room and/or standing orders decreased length of stay as compared to the existing system of evaluating women in labor rooms . In 2 separate phases , women who met triage criteria were randomly assigned to either the triage room or the standard care labor room . During phase 1 , the effect of room assignment was evaluated . During phase 2 , the effect of room assignment and the intervention of standing orders in common obstetric problems were utilized . The total sample size was 398 patients . The study took place on a midsize labor and delivery unit , in an academic medical center averaging 3600 births per year . RESULTS Results showed that using a triage room and/or standing orders did not significantly decrease length of stay . CONCLUSION The results of this study suggest that the triage process in this setting is strongly dependent on the provider 's availability to assess , triage , and discharge patients .

length of stay

length of stay .

obstetric triage

women in labor rooms .

women who met triage criteria


Comparison of long-term efficacy and safety of risperidone and haloperidol in children and adolescents with autistic disorder . An open label maintenance study . BACKGROUND The aim of the study was to investigate safety , efficacy and tolerability of risperidone in comparison with haloperidol in the long-term treatment of autistic disorder . METHODS This was an open-label continuation study of the randomized , double-blind , controlled trial of risperidone and haloperidol study for 12 week in autistic children and adolescents . A total of 28 subjects between 8 and 18 ages with autistic disorder were enrolled to the open label phase of the study . Behavioral rating scales ( Clinical Global Impression Scale [ CGI-I ] , Ritvo-Freeman Real Life Rating Scale [ RF-RLRS ] ) , Aberrant Behavior Checklist [ ABC ] , Turgay DSM-IV Pervasive Developmental Disorder Rating Scale [ TPDDRS ] ) and safety assessment scales ( Extrapyramidal Symptoms Rating Scale [ ESRS ] , UKU-Side Effect Rating Scale ) were performed at 12 , 16 , 20 and 24 weeks , following the 12 week double-blind phase . Risperidone and haloperidol treatments were applied with a once daily dosage regimen as 0.01-0.08 mg/kg/day . RESULTS Risperidone led to a significant greater reduction on CGI scale . There was significant improvement on RF-RLRS sensory motor and language subscale and ABC scores in risperidone group . Weight gain was observed more frequently in the haloperidol group at week 24 . CONCLUSIONS These results demonstrate that risperidone is more efficacious and well tolerated than haloperidol in the long-term maintenance treatment of autistic disorder .

risperidone

haloperidol

risperidone

haloperidol

risperidone

haloperidol

Risperidone

haloperidol

long-term efficacy and safety

safety , efficacy and tolerability

Behavioral rating scales

Aberrant Behavior Checklist [ ABC ]

reduction

CGI scale

ABC scores

Weight gain

children

adolescents

autistic disorder

autistic disorder

autistic

children

adolescents

28 subjects

8 and 18 ages

autistic disorder


Several indicators of oxidative stress , immunity , and illness improved in trained men consuming an encapsulated juice powder concentrate for 28 weeks . Phytonutrients from plant foods provide numerous antioxidants . We hypothesized that supplementation for 28 wk with a commercially available encapsulated juice powder concentrate ( JPC ) could influence indicators of oxidative stress , immunity , and illness . Trained men ( n = 41 ; 34 +/- 5 y ; maximum oxygen uptake = 55 +/- 7 mL x kg ( -1 ) x min ( -1 ) ) from a homogenous police Special Forces unit were randomly assigned in a double blind manner to either JPC ( n = 21 ) or placebo ( n = 20 ) . We used multiple 7-d food records to assess dietary intake and found inadequate mean daily fruit and vegetable consumption ( 3.2 +/- 1.2 servings ) . The group physician documented all duty days lost due to illness . We collected plasma at baseline and study wk 4 , 8 , 16 , and 28 for analysis of carbonyl groups on protein ( CP ) and TNFalpha . Over the 28-wk investigation , CP was lower in the JPC group , with both a treatment and a time x treatment interaction ( P < 0.05 ) . Concentrations of both CP and TNFalpha at 16 and 28 wk were lower in the JPC than in the placebo group ( P < 0.001 ) . TNFalpha increased during the first 8 wk followed by a decrease in both groups for the following 20 wk ( P < 0.001 ) . Over the final 20 wk of the study , the placebo group tended to have more days of illness than the JPC group ( P = 0.068 ) . These data suggest beneficial JPC effects with regard to reduction of duty days lost due to illness and reduction of CP and TNFalpha concentrations in this group of trained men over 28 wk .

encapsulated juice powder concentrate

Phytonutrients from plant foods

JPC

or placebo

JPC

JPC

placebo

placebo

JPC

JPC

oxidative stress

immunity

illness

illness

carbonyl groups on

protein ( CP ) and TNFalpha

CP

CP

TNFalpha

TNFalpha

illness

illness

CP

TNFalpha concentrations