Evaluation of prostaglandin E1 for prevention of respiratory failure in high risk trauma patients : a prospective clinical trial and correlation with plasma suppressive factors for neutrophil activation . A group of 48 critically injured patients were entered into a prospective , double-blind , placebo-controlled trial to evaluate the efficacy of early infusion of PGE1 for reducing the incidence of severe respiratory failure and mortality . Secondary assessments examined the effects of the PGE1 infusion on plasma mediated suppression of PMN superoxide production and loss of PMN granule enzyme content . The incidence of severe respiratory failure was lower in the PGE1 group -- 13 % versus 32 % , but this did not reach significance . The overall morality was equivalent between the two groups -- 26 % ( PGE1 ) versus 28 % ( placebo ) . The suppressive activity of the patient plasma was assayed by measurement of normal PMN superoxide production relative to normal control plasma ( ratio P : C ) . The baseline ratio P : C was 62 +/- 5 % in the PGE1 group versus 60 +/- 5 % in the placebo group . The day 1 plasma samples showed significant reversal of plasma suppressive activity in the PGE1 group -- ratio P : C 88 +/- 5 % versus 67 +/- 5 % in the placebo group ( P less than 0.02 ) . In patients who received the full 7 days of infusion , the plasma suppressive activity remained significantly diminished in the PGE1 group -- ratio P : C 77 +/- 4 % versus 61 +/- 5 % ( P less than 0.04 ) . The baseline lysozyme content of patient PMN 's relative to that of normal control PMNs ( ratio P : C ) was 119 +/- 14 % in the PGE1 group . A significant loss of lysozyme content was observed in the PGE1 group on day 1 of the infusion -- ratio P : C 79 +/- 8 % ( P less than 0.03 ) , and was associated with a reduction in the plasma suppressive activity . ( ABSTRACT TRUNCATED AT 250 WORDS )

prostaglandin E1

placebo-controlled

early infusion of PGE1

placebo

severe respiratory failure

plasma suppressive activity

plasma suppressive activity

high risk trauma

critically injured


Endurance training has little effect on active muscle free fatty acid , lipoprotein cholesterol , or triglyceride net balances . We evaluated the hypothesis that net leg total FFA , LDL-C , and TG uptake and HDL-C release during moderate-intensity cycling exercise would be increased following endurance training . Eight sedentary men ( 26 +/- 1 yr , 77.4 +/- 3.7 kg ) were studied in the postprandial state during 90 min of rest and 60 min of exercise twice before ( 45 % and 65 % V ( O2 peak ) ) and twice after 9 wk of endurance training ( 55 % and 65 % posttraining V ( O2 peak ) ) . Measurements across an exercising leg were taken to be a surrogate for active skeletal muscle . To determine limb lipid exchange , femoral arterial and venous blood samples drawn simultaneously at rest and during exercise were analyzed for total and individual FFA ( e.g. , palmitate , oleate ) , LDL-C , HDL-C , and TG concentrations , and limb blood flow was determined by thermodilution . The transition from rest to exercise resulted in a shift from net leg total FFA release ( -44 +/- 16 micromol/min ) to uptake ( 193 +/- 49 micromol/min ) that was unaffected by either exercise intensity or endurance training . The relative net leg release and uptake of individual FFA closely resembled their relative abundances in the plasma with approximately 21 and 41 % of net leg total FFA uptake during exercise accounted for by palmitate and oleate , respectively . Endurance training resulted in significant changes in arterial concentrations of HDL-C ( 49 +/- 5 vs. 52 +/- 5 mg/dl , pre vs. post ) and LDL-C ( 82 +/- 9 vs. 76 +/- 9 mg/dl , pre vs. post ) , but there was no net TG or LDL-C uptake or HDL-C release across the resting or active leg before or after endurance training . In conclusion , endurance training favorably affects blood lipoprotein profiles , even in young , healthy normolipidemic men , but muscle contractions per se have little effect on net leg LDL-C , or TG uptake or HDL-C release during moderate-intensity cycling exercise . Therefore , the favorable effects of physical activity on the lipid profiles of young , healthy normolipidemic men in the postprandial state are not attributable to changes in HDL-C or LDL-C exchange across active skeletal muscle .

9 wk of endurance training

Endurance training

free fatty acid

lipoprotein cholesterol

triglyceride

net leg total FFA

LDL-C

TG uptake

HDL-C release

limb lipid exchange

LDL-C

HDL-C

TG concentrations

limb blood flow

total FFA release

arterial concentrations of HDL-C

LDL-C

net TG or LDL-C uptake

HDL-C release

blood lipoprotein profiles

leg LDL-C

TG uptake

HDL-C release

HDL-C

LDL-C

Eight

men

26 +/- 1 yr ,

young

men

young

normolipidemic

men


Effect of step aerobics training on anaerobic performance of men and women . The purpose of this study was to investigate the effects of 10 weeks of step aerobics training on anaerobic performance of men and women . College-age volunteers ( 64 women and 54 men ) were divided into step aerobics ( 33 women , 27 men ) and control ( 31 women , 27 men ) groups . Before and after the 10-week period , the subjects ' body composition , muscular strength , Wingate anaerobic performance , and vertical jump anaerobic performance were determined . The step aerobics group participated in step aerobics sessions of 50 minutes per day , 3 days per week for 10 weeks , at 60-80 % of their heart rate reserve . Results of 2 x 2 analysis of covariance with repeated measures indicated significant sex differences in percentage body fat , lean body mass , muscular strength , and in all of the measured indices of the Wingate Anaerobic Test . The step aerobics group showed significant improvement only in mean power relative to body weight compared with the control group and women showed significant improvement only in anaerobic power of vertical jump when compared with men . It can be concluded that 10 weeks of step aerobics was not effective in improving all of the measured anaerobic indices in men and women .

step aerobics training

step aerobics training

step aerobics

control

step aerobics

step aerobics

aerobics

men and women .

men and women .


Safety and acceptability of cellulose sulfate as a vaginal microbicide in HIV-infected women . OBJECTIVES Few studies of topical microbicides have assessed their safety in HIV-infected women . We conducted this study to evaluate the safety and acceptability of 6 % cellulose sulfate ( CS ) gel as a vaginal microbicide in sexually abstinent and active HIV-infected women . METHODS Fifty-nine HIV-infected women were enrolled in a randomized double-blind placebo-controlled study comparing 6 % CS to placebo gel used for 14 days . Sexually abstinent women applied gel once or twice daily and sexually active women used gel once daily . RESULTS CS gel was safe with no reported severe or life-threatening adverse events ( AE ) . Thirty-nine ( 66 % ) of the participants experienced urogenital AE judged as probably or possibly related to gel . The majority ( 51 % ) of these participants reported only mild events . Fewer women ( 62 % ) who used CS experienced urogenital AE than those assigned to placebo gel ( 70 % ) ( P = 0.59 ) . Eleven ( 19 % ) women experienced intermenstrual bleeding judged to be probably or possibly related to gel use ( four in the CS and seven in the placebo gel group ) . There was no increase in AE by frequency of gel use or sexual activity with the exception of abdominal/pelvic pain which was noted more frequently with twice daily use among sexually abstinent women . Women and men found the gel highly acceptable . CONCLUSIONS This Phase I study demonstrated that CS vaginal gel was safe , well tolerated and acceptable by HIV-infected women and their male partners . Thus , further development of CS is warranted as a potential method to prevent HIV transmission and acquisition .

cellulose sulfate

cellulose sulfate ( CS )

placebo-controlled

CS

placebo gel

placebo

CS vaginal gel

safety in HIV-infected women

safety and acceptability

urogenital AE

mild events

urogenital AE

intermenstrual bleeding

AE

abdominal/pelvic pain

safe , well tolerated and acceptable

HIV transmission and acquisition


Eberconazole 1 % cream is an effective and safe alternative for dermatophytosis treatment : multicenter , randomized , double-blind , comparative trial with miconazole 2 % cream . BACKGROUND Eberconazole is a topical , broad-spectrum imidazole derivative , effective in dermatophytoses , candidiasis , and pityriasis treatment . In previous trials , it showed a higher efficacy than clotrimazole in the treatment of dermatophytoses . The purpose of this trial was to evaluate the efficacy of eberconazole 1 % cream compared with miconazole 2 % cream in the treatment of dermatophytoses . METHODS A multicenter , double-blind , randomized trial was performed in 653 patients with dermatophytoses , randomized to eberconazole 1 % cream every 12 h or miconazole 2 % cream every 12 h for 4 weeks . Treatment efficacy was assessed on the basis of the percentage of effective response after 4 weeks through mycologic and clinical assessment . RESULTS Of the 653 patients included in the trial , 360 produced positive baseline mycologic cultures and were included in the efficacy assessment . Clinical efficacy was shown in 76.1 % of patients receiving eberconazole and in 75.0 % of patients receiving miconazole . The incidence of adverse events related to treatment was 0.91 % for eberconazole and 0.92 % for miconazole , none being serious , and all being local and transient . CONCLUSIONS Eberconazole 1 % cream is an effective treatment for fungal infections produced by dermatophytes , with a good safety and tolerability profile , and can be considered a good alternative for the treatment of dermatophytoses .

Eberconazole

miconazole

Eberconazole

eberconazole

miconazole

eberconazole

miconazole

effective and safe

Treatment efficacy

adverse events

safety and tolerability


Thromboprophylaxis by low-molecular-weight heparin in elective hip surgery . A placebo controlled study . In a double-blind , randomised study of thromboprophylaxis in patients undergoing total hip replacement , we compared a low-molecular-weight heparin with a placebo . Of the 120 patients enrolled , 112 completed the trial ; 58 in the treatment group and 54 in the placebo group . Nine ( 16 % ) patients in the treatment group and 19 ( 35 % ) in the placebo group developed deep venous thrombosis , diagnosed by the 125I-fibrinogen uptake test ( p < 0.02 ) . Verification was obtained by phlebography in 86 % of the patients . Prolonged surgery increased the risk of thrombosis in the placebo group but not in the treatment group ( p < 0.05 ) . There were significantly more cases of deep venous thrombosis in the placebo group during the first four postoperative days ( p < 0.02 ) . The groups did not differ with respect to peroperative and postoperative bleeding . Low-molecular-weight heparin offers safe and easily administered thromboprophylaxis in total hip replacement .

low-molecular-weight heparin

placebo

low-molecular-weight heparin

placebo

placebo

Low-molecular-weight heparin

deep venous thrombosis

risk of thrombosis

cases of deep venous thrombosis

peroperative and postoperative bleeding

elective hip surgery

total hip replacement


A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams : results at 2 years . OBJECTIVE To compare holmium laser enucleation of the prostate ( HoLEP ) with transurethral resection of the prostate ( TURP ) for treatment of men with bladder outflow obstruction ( BOO ) secondary to benign prostatic hyperplasia with a minimum of 24-month follow-up . PATIENTS AND METHODS Sixty-one patients were randomised to either HoLEP or TURP . All patients had BOO proven on urodynamic studies pre-operatively ( prostate size 40-200 g ) . One patient died before treatment , which left 30 patients in each group . Perioperative data , as well as symptom scores , Quality of Life ( QoL ) scores , and maximum urinary flow rates ( Qmax ) were obtained at one , three , six,12 , and 24 months . Post-void residual volumes , transrectal ultrasound ( TRUS ) volumes , and pressure flow studies were obtained six months post-operatively . Continence and potency data were also recorded . RESULTS There were no significant differences between the two surgical groups pre-operatively . Mean pre-operative TRUS volume was 77.8+/-5.6 g ( 42-152 ) in the HoLEP group and 70.0+/-5.0 g ( 46-156 ) in the TURP group . Patients in the HoLEP group had shorter catheter times and hospital stays . More prostate tissue was retrieved in the HoLEP group . At six months , HoLEP was urodynamically superior to TURP in relieving BOO . At 24 months , there was no significant difference between the two surgical groups with respect to American Urology Association scores , QoL scores , or Qmax values ; however , two patients in the TURP group required re-operation . CONCLUSIONS HoLEP has less perioperative morbidity and produces superior urodynamic outcomes than TURP , when treating prostates > 40 g. At 24 months of follow-up , HoLEP is equivalent to TURP .

holmium laser enucleation

transurethral resection

HoLEP

TURP

TURP

HoLEP

HoLEP

HoLEP

TURP

HoLEP

TURP

HoLEP

TURP

Continence and potency data

Mean pre-operative TRUS volume

catheter times

hospital stays

prostate tissue

urodynamically

urodynamic outcomes

prostates larger than 40 grams

men

bladder outflow obstruction ( BOO )

benign prostatic hyperplasia

BOO

prostate size 40-200 g


Joint attention and symbolic play in young children with autism : a randomized controlled intervention study . BACKGROUND Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism . These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts ( see Kasari , Freeman , & Paparella , 2001 ) . In this study , we examine the efficacy of targeted interventions of joint attention and symbolic play . METHODS Participants were 58 children with autism aged 3 and 4 years ( 46 boys ) . Children were randomized to a joint attention intervention , a symbolic play intervention , or control group . Interventions were conducted 30 minutes daily for 5-6 weeks . Both structured assessments of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors . RESULTS Results indicate that both intervention groups improved significantly over the control group on certain behaviors . Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction . The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers . CONCLUSIONS This randomized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism . Future studies need to examine the long-term effects of these early interventions on children 's development .

joint attention

symbolic play

joint attention intervention

symbolic play intervention

or

control group

showing

responsiveness to joint attention

structured joint attention assessment

child-initiated joint attention

mother-child interaction .

types of symbolic play

play levels

play assessment

interaction with their mothers .

young children

autism

young children

autism

children

autism

3 and 4 years

boys


Confidential registration in health services : randomised controlled trial . BACKGROUND Human rights legislation safeguards the privacy and dignity of patients . OBJECTIVE To assess the effectiveness in terms of patient assessed privacy of confidential registration . DESIGN Randomised controlled trial . SETTING Emergency Department , University Hospital of Wales . PARTICIPANTS A total of 302 patients aged over 15 years . MAIN OUTCOME MEASURES Binary choices and ordinal visual analogue scores from a validated questionnaire on self reported measures : patient ability and preference to speak to receptionists and disclose confidential information without being overhead and concern about disclosure of items of confidential personal information . RESULTS Patients who registered in a screened area felt significantly more able to tell receptionists things they did not want others to hear . Control patients were significantly more concerned than intervention patients that others heard their name , address , date of birth , reason for emergency department attendance , and telephone number , but not their marital status . Overall , intervention patients were less concerned about disclosure of information and that they had been overheard . CONCLUSIONS Patients value privacy when they register and are concerned if others can hear them tell receptionists who they are , how to contact them , and why they are there . Confidential registration should be instituted in health services . Confidential registration increased patient privacy and should be instituted in health services .

Confidential registration

confidential registration

Binary choices

ordinal visual analogue

screened area

Confidential registration

Confidential registration

patient ability


Tradeoffs and theory : the double-mediation model . Most theories of decision making suggest that , when options imply tradeoffs between their attributes , conflict increases as tradeoff size increases , because greater sacrifices are to be incurred in choosing one option instead of another . An alternative view is that conflict decreases as tradeoff size increases , because stronger arguments can be made for any decision . The authors propose a unified model , the double-mediation model , which combines the mediating effects of sacrifice and argumentation . Our model generally predicts an inverse U-shaped relation between tradeoff size and conflict . Results support this prediction . Also , when the decision situation increases the mediating effect of sacrifice relative to that of argumentation , the relation between tradeoff size and conflict changes in an upward direction ; conversely , when the decision situation increases the mediating effect of argumentation relative to that of sacrifice , the relation changes in a downward direction . Results support these predictions as well . Commonalities and differences between our model and other formulations are discussed .

double-mediation model .

double-mediation model ,

double-mediation model


Nitroglycerin , nitroprusside , or both , in preventing radial artery spasm during transradial artery catheterization . OBJECTIVE Radial artery spasm remains a major complication of transradial coronary interventions . The aim of this study was to compare the efficacy of three different intra-arterial vasodilating cocktails in reducing the incidence of radial artery spasm in patients undergoing transradial coronary angiography . The secondary goal was to assess the predictors of arterial spasm in this large group of patients . METHODS A total of 379 patients undergoing the procedure were randomly enrolled in 1 of 3 groups . Every patient in each of the 3 groups received intra-arterial heparin , lidocaine and diltiazem . Along with that , patients in Group A received nitroglycerin ; patients in Group B received nitroprusside instead of nitroglycerin ; and patients in Group C received both nitroglycerin and nitroprusside . A single experienced operator , blinded to the study drug , subjectively determined the presence of spasm . RESULTS Of 379 patients , a total of 44 patients ( 11.6 % ) experienced spasm . The occurrence of spasm was similar , independent of the vasodilator cocktail used ( Group A : 12.2 % , Group B : 13.4 % , Group C : 9.5 % ; p = 0.597 ) . After multivariate analysis , the following variables were found to be independent predictors of spasm : radial artery diameter ( RD ) /height index ( p = 0.005 ) , RD/BSA index ( p = 0.012 ) , and sheath outer diameter ( OD ) /RD index ( p = 0.024 ) . CONCLUSION In this prospective , randomized trial , the addition of a direct nitric oxide donor to nitroglycerin in an antispastic cocktail did not reduce the risk of spasm , and the use of nitroglycerin was found to be as effective as nitroprusside . Also , morphometric and mechanical factors play a significant role in predicting the occurrence of radial spasm . The sex of the patient , presence of diabetes , body surface area and smoking history appeared to play no role in predicting the occurrence of radial spasm .

Nitroglycerin

nitroprusside

vasodilating cocktails

heparin

lidocaine

diltiazem

nitroglycerin

nitroprusside

nitroglycerin

nitroglycerin

nitroprusside

nitric oxide

nitroglycerin

nitroglycerin

nitroprusside

radial artery spasm

radial artery spasm

predictors of arterial spasm

spasm

spasm

reduce the risk of spasm

effective

transradial artery catheterization

transradial coronary angiography

379 patients


Effects of short- and long-term risperidone treatment on prolactin levels in children with autism . BACKGROUND The effects of short- and long-term risperidone treatment on serum prolactin were assessed in children and adolescents with autism . METHODS Patients with autism ( N = 101 , 5-17 years of age ) were randomized to an 8-week trial of risperidone or placebo and 63 then took part in a 4-month open-label follow-up phase . Serum samples were obtained at Baseline and Week-8 ( N = 78 ) , and at 6-month ( N = 43 ) and 22-month ( N = 30 ) follow-up . Serum prolactin was determined by immunoradiometric assay ; dopamine type-2 receptor ( DRD2 ) polymorphisms were genotyped . RESULTS Baseline prolactin levels were similar in the risperidone ( N = 42 ) and placebo ( N = 36 ) groups ( 9.3 +/- 7.5 and 9.3 +/- 7.6 ng/ml , respectively ) . After 8 weeks of risperidone , prolactin increased to 39.0 +/- 19.2 ng/ml , compared with 10.1 +/- 8.8 ng/ml for placebo ( p < .0001 ) . Prolactin levels were also significantly increased at 6 months ( 32.4 +/- 17.8 ng/ml ; N = 43 , p < .0001 ) and at 22 months ( N = 30 , 25.3 +/- 15.6 ng/ml , p < .0001 ) . Prolactin levels were not associated with adverse effects and DRD2 alleles ( Taq1A , -141C Ins/Del , C957T ) did not significantly influence baseline levels or risperidone-induced increases in prolactin . CONCLUSIONS Risperidone treatment was associated with two- to four-fold mean increases in serum prolactin in children with autism . Although risperidone-induced increases tended to diminish with time , further research on the consequences of long-term prolactin elevations in children and adolescents is needed .

risperidone

risperidone

risperidone

placebo

risperidone

placebo

risperidone

Risperidone

prolactin levels

Baseline prolactin levels

prolactin

Prolactin levels

Prolactin levels


Thermal welding versus bipolar tonsillectomy : a comparative study . OBJECTIVE To compare thermal welding tonsillectomy ( TWT ) with bipolar electrocautery tonsillectomy ( BET ) procedure . STUDY DESIGN AND SETTING A prospective randomized study was conducted on 150 consecutive adult patients undergoing tonsillectomy . Indications included chronic tonsillitis and obstructive sleep apnea syndrome . Exclusion criteria included peritonsillar abscess history , bleeding disorders , and any other procedure together with tonsillectomy . Patients were randomly assigned to TWT or BET groups . Intraoperative bleeding , operative time , postoperative pain , complication rates , and return to normal diet were evaluated . RESULTS In the TWT group there was no measurable intraoperative bleeding , while mean bleeding for BET group was 16 mL . No significant difference regarding mean operative time was noticed . Mean postoperative pain score and mean time for return to normal diet were significantly lower in the TWT group . Primary hemorrhage occurred in 1 subject of the BET group . Secondary postoperative hemorrhage was noticed in 1 subject of the TWT group and 3 subjects of the BET group . CONCLUSION Thermal welding tonsillectomy procedure provides sufficient hemostasis , lower postoperative pain , and quick return to normal diet . EBM RATING A-1b .

Thermal welding

bipolar tonsillectomy

thermal welding tonsillectomy

( TWT )

tonsillectomy

TWT

BET

TWT

BET

TWT

BET

TWT

BET

Thermal welding tonsillectomy procedure

Intraoperative bleeding

operative time

postoperative pain

complication rates

return to normal diet

intraoperative bleeding

mean bleeding

mean operative time

Mean postoperative pain score

mean time for return to normal diet

Primary hemorrhage

Secondary postoperative hemorrhage

hemostasis

postoperative pain

quick return to normal diet

chronic tonsillitis

obstructive sleep apnea syndrome .

peritonsillar abscess

bleeding disorders

tonsillectomy


Neurocognitive outcomes in off-pump versus on-pump bypass surgery : a randomized controlled trial . BACKGROUND Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass . However , the cognitive benefit of off-pump surgery remains unclear . METHODS Consecutively listed candidates for elective bypass were randomly assigned to either off-pump or on-pump techniques ( n = 107 ) . A battery of 11 standardized neuropsychological tests was administered before surgery , and again at 2 and 6 months after surgery . The two groups were compared using a range of statistical procedures , including growth modeling . RESULTS There were no significant differences in cognitive test scores between the off-pump and on-pump groups using t tests at any of the time points . There were no differences between off-pump and on-pump groups in the incidence of cognitive deficits at 2 months or 6 months , with the exception that fewer off-pump patients showed impairment on one test of verbal fluency at 6 months . When the pattern of cognitive change over time between the two groups was compared using sophisticated modeling techniques , the two groups were again comparable , except for results on the test of verbal fluency , in which the off-pump group showed more rapid postsurgical cognitive gains than the on-pump group . CONCLUSIONS The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes .

off-pump

on-pump bypass surgery

cardiopulmonary bypass

off-pump

on-pump

off-pump

on-pump

off-pump

on-pump

off-pump

off-pump

on-pump

off-pump

on-pump

Neurocognitive outcomes

growth modeling

cognitive test scores

incidence of cognitive deficits

verbal fluency

pattern of cognitive change over time

verbal fluency

cognitive gains

( n = 107 )


Outcomes in a nursing home transition case-management program targeting new admissions . PURPOSE The Providing Assistance to Caregivers in Transition ( PACT ) program offers nursing home discharge planning and case management for individuals in the transitional period following a return to the community . The PACT program targeted individuals newly admitted to nursing homes and worked with a family caregiver to develop and implement a nursing home discharge plan . DESIGN AND METHOD Reported are the results of a randomized control design evaluating the program 's effectiveness . Those individuals randomly assigned to the intervention group ( n = 33 ) received PACT case management in addition to their usual medical and nursing home care . The individuals in the control group ( n = 29 ) continued their usual care . RESULT There were no statistical differences in the discharge rate ( 84 % treatment vs 76 % controls ) or in the median length of stay ( 42 days vs 55 days ) between the two groups of individuals . IMPLICATIONS Replications or extensions of a PACT-type intervention might consider a broader mix of nursing homes , working directly with the nursing home 's admission Minimum Data Set coordinator in patient selection , or working with Medicare or Medicaid HMO plans .

PACT program

usual care

PACT-type intervention

effectiveness

differences in the discharge rate

in the median length of stay

newly admitted to nursing homes

n = 33

n = 29


Deliberate hypotension in patients with intracranial arteriovenous malformations : esmolol compared with isoflurane and sodium nitroprusside . Thirty patients undergoing resection of arteriovenous malformations with deliberate hypotension were randomized to receive 1 of 3 hypotensive agents . Anesthesia was maintained with isoflurane and nitrous oxide in all patients . Mean arterial pressure was reduced 20 % to 60-65 mm Hg with use of either isoflurane ( less than or equal to 4 % ) , sodium nitroprusside ( less than or equal to 8 micrograms.kg-1.min-1 ) , or esmolol ( less than or equal to 24 mg/min ) . Esmolol was associated with a decrease in cardiac output from 6.2 +/- 1.3 to 3.8 +/- 0.8 L/min , which , because of a 22 % increase in systemic vascular resistance , far exceeded the reduction in mean arterial pressure . Systemic vascular resistance increased despite a 32 % decrease in plasma renin activity . In contrast , with sodium nitroprusside or isoflurane , the decrease in mean arterial pressure was associated with decreases in systemic vascular resistance of similar magnitude , with no change in cardiac output . Plasma renin activity levels increased 48 % with sodium nitroprusside and 126 % with isoflurane . Heart rate increased 13 % with sodium nitroprusside , remained unchanged with isoflurane , and decreased 23 % with esmolol . Although esmolol may be used as a primary hypotensive agent , the potential for marked myocardial depression must be recognized . The differences in pharmacologic properties for the different hypotensive agents suggest that combinations of these agents may provide a pharmacologic profile superior to either agent alone .

esmolol

isoflurane

sodium nitroprusside

isoflurane and nitrous oxide

isoflurane

sodium nitroprusside

esmolol

Esmolol

sodium nitroprusside

isoflurane

sodium nitroprusside

isoflurane

sodium nitroprusside

esmolol

esmolol

Deliberate hypotension

cardiac output

systemic vascular resistance

arterial pressure

Systemic vascular resistance

plasma renin activity

mean arterial pressure

systemic vascular resistance

cardiac output

Plasma renin activity levels

Heart rate

marked myocardial depression

Thirty

arteriovenous malformations


[ Profiles of irregular bleeding induced by low-dose hormone therapy and Chinese formulated herbs products ] . OBJECTIVE To compare profiles and related factors of irregular bleeding induced by different types of low-dose hormone therapy ( HT ) and a Chinese formulated herbs products . METHODS Applied with open-labeled , randomized , and clinical trial design , 136 postmenopausal women were assigned into four groups : group A : estradiol valerate ( E2 V ) 1 mg/d + medroxyprogesterone acetate ( MPA ) 2 mg/d ; group B : conjugated equine estrogen 0.45 mg/d + MPA 2 mg/d ; group C : tibolone 1.25 mg/d ; group D : a Chinese formulated herbs product ( Kuntai ) 4 # tid . Each subject took element calcium 400 mg/d and vitamin D 200 IU/d concomitantly . Modified Kupperman scores were assessed on baseline and every 3 months thereafter and irregular bleeding was recorded on menopausal diary every day . The duration of this study was 1 year . Results The efficacies were similar in three HT-managed groups , but was better than in group D , although the latter was also effective in alleviating menopausal symptoms . Hazard ratio ( HR ) of irregular bleeding was 1.00 in group C , 2.43 in group A ( 95 % CI : 1.08-5.46 ) , 3.12 in group B ( 95 % CI : 1.42-6.88 ) , and 0.73 in group D ( 95 % CI : 0.26-2.04 ) . Most cases initially experienced bleeding in the first 3 months but such initiation was a bit later in group C. Endometrium , as detected by B-mode ultrasound , increased approximately 1 mm in HT groups , while it was a bit thicker in group C. Long periods in reproductive age and short time since menopause were high risk factors for irregular bleeding . CONCLUSION Profiles of irregular bleeding in 3 commonly used types of low-dose HT are different and some factors such as long period in reproductive age and short time since menopause may contribute to bleeding initiation .

low-dose hormone therapy

Chinese formulated herbs products

low-dose hormone therapy ( HT )

Chinese formulated herbs products

estradiol valerate ( E2 V ) 1 mg/d

conjugated equine estrogen 0.45 mg/d

MPA 2

tibolone

calcium

vitamin D

low-dose HT

irregular bleeding

irregular bleeding

irregular bleeding

efficacies

effective

bleeding

initiation

Endometrium

irregular bleeding

irregular bleeding

postmenopausal

women


[ Rapidity of pain relief , medication requirement and patient satisfaction with reflux treatment in the physician 's office ] . Treatment of gastroesophageal reflux disease ( GERD ) with proton pump inhibitors was investigated in three controlled prospective , randomized open studies . Lansoprazole , omeprazole MUPS and esomeprazole were compared under doctor 's office conditions . The outcomes of interest were the rapidity of pain relief achieved with a single dose , effectiveness and patient satisfaction with on demand therapy . In the first study , 180 patients with chronic and prolonged episodes of reflux were investigated . Time to pain relief following a single dose was 1.1 +/- 0.8 hours with 30 mg lansoprazole , 3.0 +/- 2.5 hours with 20 mgomeprazole MUPS and 2.1 +/- 1.2 hours with 40 mg esomeprazole . Studies 2 and 3 were designed as cross-over studies intended to investigate drug consumption . In study 2 , the amount of lansoprazole consumed was approximately 50 % less than that of omeprazole , and this translated to 81 % patient satisfaction with lansoprazole compared with only 9.5 % for omeprazole . In study 3 comparing lansoprazole and esomeprazole , consumption of the former was 85 % that of the latter . 58 % of the patients opted to continuetreatment with lansoprazole , compared with only 25 % in the case of esomeprazole . The appreciably greater patient satisfaction with lansoprazole was due tothe faster pain relief achieved with this drug .

proton pump inhibitors

Lansoprazole

omeprazole MUPS

esomeprazole

lansoprazole

mgomeprazole

esomeprazole

lansoprazole

omeprazole

lansoprazole

omeprazole

esomeprazole

lansoprazole

esomeprazole

lansoprazole

Rapidity of pain relief

medication requirement

patient satisfaction

rapidity of pain relief

single dose

effectiveness

patient satisfaction

pain relief

drug consumption

amount of lansoprazole consumed

patient satisfaction

consumption

continuetreatment

patient satisfaction

faster pain relief

gastroesophageal reflux disease

GERD


A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma . CONTEXT Barriers impede translating recommendations for asthma treatment into practice , particularly in inner cities where asthma morbidity is highest . METHODS The purpose of this study was to test the effectiveness of timely patient feedback in the form of a letter providing recent patient-specific symptoms , medication , and health service use combined with guideline-based recommendations for changes in therapy on improving the quality of asthma care by inner-city primary care providers and on resultant asthma morbidity . This was a randomized , controlled clinical trial in 5- to 11-year-old children ( n = 937 ) with moderate to severe asthma receiving health care in hospital- and community-based clinics and private practices in 7 inner-city urban areas . The caretaker of each child received a bimonthly telephone call to collect clinical information about the child 's asthma . For a full year , the providers of intervention group children received bimonthly computer-generated letters based on these calls summarizing the child 's asthma symptoms , health service use , and medication use with a corresponding recommendation to step up or step down medications . We measured the number and proportion of scheduled visits resulting in stepping up of medications , asthma symptoms ( 2-week recall ) , and health care use ( 2-month recall ) . RESULTS In this population , only a modest proportion of children whose symptoms warranted a medication increase actually had a scheduled visit to reevaluate their asthma treatment . However , in the 2-month interval after receipt of a step-up letter , 17.1 % of the letters were followed by scheduled visits in the intervention group compared with scheduled visits 12.3 % of the time by the control children with comparable clinical symptoms . Asthma medications were stepped up when indicated after 46.0 % of these visits in the intervention group compared with 35.6 % in the control group , and when asthma symptoms warranted a step up in therapy , medication changes occurred earlier among the intervention children . Among children whose medications were stepped up at any time during the 12-month study period , those in the intervention group experienced 22.1 % fewer symptom days and 37.9 % fewer school days missed . The intention-to-treat analysis showed no difference over the intervention year in the number of symptom days , yet there was a trend toward fewer days of limited activity and a significant decrease in emergency department visits by the intervention group compared with controls . This 24 % drop in emergency department visits resulted in an intervention that was cost saving in its first year . CONCLUSIONS Patient-specific feedback to inner-city providers increased scheduled asthma visits , increased asthma visits in which medications were stepped up when clinically indicated , and reduced emergency department visits .

clinician feedback

patient feedback

a letter

bimonthly computer-generated letters

Asthma medications

control

Patient-specific feedback

number of symptom days

emergency department visits

emergency department visits

asthma

5- to 11-year-old


Fifteen-year results of a randomized prospective trial of hyperfractionated chest wall irradiation versus once-daily chest wall irradiation after chemotherapy and mastectomy for patients with locally advanced noninflammatory breast cancer . PURPOSE To analyze the results of a Phase III clinical trial that investigated whether a hyperfractionated radiotherapy ( RT ) schedule could reduce the risk of locoregional recurrence in patients with locally advanced breast cancer treated with chemotherapy and mastectomy . METHODS AND MATERIALS Between 1985 and 1989 , 200 patients with clinical Stage III noninflammatory breast cancer were enrolled in a prospective study investigating neoadjuvant and adjuvant chemotherapy . Of the 179 patients treated with mastectomy after neoadjuvant chemotherapy , 108 participated in a randomized component of the trial that compared a dose-escalated , hyperfractionated ( twice-daily , b.i.d . ) chest wall RT schedule ( 72 Gy in 1.2-Gy b.i.d . fractions ) with a once-daily ( q.d . ) schedule ( 60 Gy in 2-Gy q.d . fractions ) . In both arms of the study , the supraclavicular fossa and axillary apex were treated once daily to 50 Gy . The median follow-up period was 15 years . RESULTS The 15-year actuarial locoregional recurrence rate was 7 % for the q.d . arm and 12 % for the b.i.d . arm ( p=0.36 ) . The rates of severe acute toxicity were similar ( 4 % for q.d . vs. 5 % for b.i.d . ) , but moist desquamation developed in 42 % of patients in the b.i.d . arm compared with 28 % of the patients in the q.d . arm ( p=0.16 ) . The 15-year actuarial rate of severe late RT complications did not differ between the two arms ( 6 % for q.d . vs. 11 % for b.i.d. , p=0.54 ) . CONCLUSION Although the sample size of this study was small , we found no evidence that this hyperfractionation schedule of postmastectomy RT offered a clinical advantage . Therefore , we have concluded that it should not be further studied in this cohort of patients .

once-daily chest wall irradiation after

chemotherapy

hyperfractionated radiotherapy ( RT )

mastectomy after

neoadjuvant chemotherapy

q.d . arm

b.i.d . arm

b.i.d . arm

q.d . arm

postmastectomy RT

rates of severe acute toxicity

locally advanced breast cancer

Stage III noninflammatory breast cancer


Different loss of BMD using uncemented press-fit and whole polyethylene cups fixed with cement : repeated DXA studies in 96 hips randomized to 3 types of fixation . BACKGROUND In cemented THA , aseptic loosening of the cup is more common than loosening of the stem , while periprosthetic osteolysis of the socket resulting in difficult reconstruction problems has emerged as the most significant problem with cementless cup fixation . PATIENTS AND METHODS 90 patients ( 96 hips ) scheduled for THA were stratified in three groups according to the method of fixation of the acetabular component : acrylic bone cement with fluoride ( Cemex-F ) , porous-coated press-fit cup with ceramic coating ( Trilogy , uncemented ) and acrylic cement with gentamicin ( Palacos ) . All patients received the Spectron EF stem . Acetabular bone mineral density was measured with dual-energy X-ray absorptiometry ( DXA ) 1 week postoperatively , and after 12 and 24 months . The periprosthetic BMD was evaluated in 5 ROIs positioned around the acetabular component . RESULTS In the uncemented sockets , the BMD had decreased proximally and medially to the cup after 2 years . The difference was significant in the proximal region as compared to the control group ( Palacos ) . No difference was noted between the 2 groups with cemented components after 2 years . Stepwise linear regression analysis showed that loss of periprosthetic BMD in the proximal high-pressure region after 2 years increased with higher postoperative BMD and when the uncemented design had been used . INTERPRETATION Contrary to previous studies of cemented stems , the use of fluoride cement did not influence the periprosthetic BMD 2 years after the examination . Increased loss of BMD with use of uncemented press-fit cups in the region in which osteolytic lesions are commonly found suggests that stress shielding may initiate the development of this complication . Longer follow-up will , however , be necessary to substantiate this hypothesis .

Spectron EF stem

control group ( Palacos

fluoride cement

Different loss of BMD

Acetabular bone mineral density

periprosthetic BMD

BMD

BMD

postoperative BMD


Greater knowledge gain with structured than student-directed learning in Child Health : cluster randomized trial . The aim of this study was to detect a difference in knowledge gain between students receiving structured versus student-directed learning for the two-week Child Health outpatient module . A total of 138 phase 3 ( year 4 ) medical students in 10 two-week paediatric outpatient blocks at the Department of Child Health , University of Dundee , Scotland , were randomized to student-directed or structured learning between January and December 2002 . Pre- and post-course tests were administered at the start and the end of the attachment ; 129 students sat both tests . Results are presented as mean scores with standard deviations or 95 % confidence intervals ( CI ) in parentheses . The primary outcome measure was gain in knowledge of the Child Health core curriculum that is covered in the outpatient setting . Although pre-course scores were similar ( student-directed 25.3 ( 7.3 ) ; structured 24.8 ( 7.5 ) ) the structured approach resulted in higher post-course scores in comparison with the student-directed approach ( student-directed 41.8 ( 9.4 ) ; structured 53.8 ( 8.8 ) ; p < 0.01 ) . Knowledge gain showed significant differences between the two learning approaches ( student-directed 16.5 ( 3.7 ) ; structured 29.1 ( 3.8 ) , difference = 12.6 ( 95 % CI 11.3 to 13.9 ) ) . Low pre-course scores or gender did not affect knowledge gain . In the Child Health outpatient setting , the 'traditional ' structured approach led to significantly greater knowledge gain in comparison with the 'novel ' student-directed approach . The findings emphasize the importance of careful evaluation of novel medical education strategies before their implementation in medical schools , and the need for further research to define the effective methods for delivering medical education in Child Health .

structured

student-directed learning

structured

versus

student-directed learning

student-directed

structured learning

knowledge gain

knowledge gain

Pre- and post-course tests

gain in knowledge

pre-course scores

post-course scores

Knowledge gain

pre-course scores

knowledge gain

knowledge gain

Health

students


Clinical evaluation of the intraoral fluoride releasing system in radiation-induced xerostomic subjects . Part 2 : Phase I study . Radiation-induced xerostomia can result in the rapid onset and progression of dental caries in head and neck cancer patients . Topically applied fluorides have been successfully used to inhibit the formation of dental caries in this population . However , because intensive daily self-application is required , compliance is an issue . The intraoral fluoride-releasing system ( IFRS ) containing a sodium fluoride core is a newly developed , sustained-release , passive drug delivery system that does not require patient involvement except for periodic replacement , thus reducing the effect of patient compliance on its effectiveness in dental caries prevention . Twenty-two head and neck cancer patients from U. T. M. D. Anderson Cancer Center , with radiation-induced xerostomia , were entered into a pilot study to contrast the daily home use of a 0.4 % stannous fluoride-gel-containing tray ( control group ) to IFRS ( study group ) with respect to tolerability and adherence , and to obtain information on relative caries preventive efficacy . Participants were stratified on the basis of radiation exposure and randomly assigned to treatment with either IFRS or stannous fluoride gel . Patients in both groups were fitted with two IFRS retainers and also were instructed to use a 1100-ppm fluoride conventional sodium fluoride dentifrice twice daily . The study was conducted as a single-blinded , parallel-cell trial . Pre-existing carious lesions were restored prior to the beginning of the study . The efficacy variable was determined by the mean number of new or recurrent decayed surfaces . Patients were examined for caries 4 , 8 , 12 , 24 , 36 , and 48 weeks after initiation of treatment . Reports of adverse reactions were based on information volunteered by patients and that were elicited during interviews . At baseline , the resting and stimulated salivary flow rates ( g/5min ) were significantly greater in the control group than in the study group ( p < 0.05 ) . Patients in the control group had received significantly more radiation than those in the test group ( 68Gy vs. 60Gy ; p=0.047 ) . No marked differences in follow-up new and recurrent caries were found between the stannous fluoride gel control and IFRS groups during the study period . The rate of new or recurrent carious lesions in the group treated with the fluoride gel was slightly lower than in the IFRS group , based on carious lesions at the baseline examination ( Poisson mean number of new or recurrent carious lesions for the control group=0.55 per year vs. 0.83 per year for the study group , p=0.705 ; odds ratio of the occurrence of any new or recurrent caries during follow-up for control group vs. the study group=0.80 ; p=0.781 ) . This pilot study revealed that the IFRS was well-tolerated and safe in this study population associated with minimal complications during the duration of this study and was comparable in efficacy to a SnF ( 2 ) gel in preventing caries development . The IFRS provided similar rates of control for caries formation to a fluoride-gel-containing tray . The IFRS is designed to release a daily dose of 0.12mg of sodium fluoride , which can be evenly distributed throughout the oral cavity for a single application of 4 months . It would be more convenient than the daily home application of a tray of 0.4 % stannous fluoride or 1.1 % sodium fluoride gel , and avoids the problem of variable patient compliance .

intraoral fluoride releasing system

fluoride-gel-containing tray

sodium fluoride

recurrent caries

well-tolerated and safe

complications

efficacy to a SnF ( 2 ) gel

rates of control

radiation-induced xerostomic subjects .

Patients in both groups

Patients in the control group


Dexamethasone effectively reduces postoperative nausea and vomiting in a general surgical adult patient population . BACKGROUND Postoperative nausea and vomiting ( PONV ) is still a common and major complication for surgical patients , which may delay post-anesthetic care unit discharge , prolong hospital stay and thus increase the cost of hospitalization . It is understood that PONV is a multi-factorial outcome and occurs more often with general anesthesia than with other anesthetic methods . Prophylactic administration of antihistamines , antidopaminergics , anticholinergics , phenothiazines , serotonin antagonist , steroids and even acupuncture has been shown to be effective . However , expenses and side effects of these agents have also been a concern for clinical doctors . The aim for this prospective study was to find an agent that is cost effective and side effect free ( or at least with a low incidence of side effects ) for the prevention of PONV . METHODS A total of 700 adult surgical patients who planned to have surgery under general anesthesia were enrolled in this double-blinded , randomized and placebo-controlled study . Group P received the placebo ( 0.9 % normal saline 2 ml ) and Group D received 10 mg dexamethasone intravenously right before the induction of anesthesia . RESULTS We found that during the postoperative period of 1-8 h , patients in Group D reported a lower incidence of PONV ( 24 % ) than those in Group P ( 39 % , p < 0.001 ) . Patients in Group D also requested less rescue anti-emetic ( 17 % ) than those in Group P ( 30 % , p < 0.05 ) . The same phenomenon was also noted in the 8-to-24-hour interval ( PONV 4 % vs. 12 % , p < 0.05 and rescue anti-emetic 3 % vs. 9 % , p < 0.05 in Group D vs. Group P , respectively . ) CONCLUSIONS We conclude that the prophylactic intravenous administration of 10 mg dexamethasone immediately before the induction of anesthesia is effective in preventing PONV in the general surgical adult patient population .

Dexamethasone

placebo

normal saline

dexamethasone

PONV


Milk production of dairy cows fed wet corn gluten feed during the dry period and lactation . An experiment was conducted with 36 primiparous and 40 multiparous Holstein cows to examine the effects of feeding wet corn gluten feed ( WCGF ) on 305-d milk production , dry matter ( DM ) intake , body condition score ( BCS ) , and health . The experimental treatments included : 1 ) control -- WCGF not fed ( n = 27 ) ; 2 ) WCGF-L-cows received diets containing WCGF ( 38 % DM basis ) during lactation ( n = 23 ) ; and 3 ) WCGF-DL -- cows received diets containing WCGF ( 38 % DM basis ) during the dry period and lactation ( n = 26 ) . During the dry period , cows consuming WCGF were observed to have a significant gain in BCS ( 0.07 +/- 0.06 ) compared with a loss in BCS in cows fed the control diet ( control = -0.11 +/- 0.06 and WCGF-L = -0.04 +/- 0.06 ) . During lactation , there were no differences by treatment on BCS . Cows consuming WCGF during lactation consumed more feed compared with the control : 25.4 , 23.8 , and 21.2 +/- 0.76 kg/d for WCGF-L , WCGF-DL , and the control , respectively . Milk production was higher for cows consuming WCGF : 35.0 , 34.7 , and 31.1 +/- 2.1 kg/d for WCGF-L , WCGF-DL , and the control , respectively . No differences were found in either DM intake or actual milk yield between the WCGF-L and WCGF-DL treatments , indicating that prepartum diets did not influence lactational performance . The WCGF diets resulted in significant reductions in the concentration of milk fat ( 3.94 , 3.74 , and 4.15 +/- 0.08 % for WCGF-L , WCGF-DL , and the control , respectively ) , but because total milk yield was increased , there were no differences in total milk fat yield . In addition , 3.5 % of fat-corrected milk tended to be affected by diet : 38.9 , 36.3 , and 34.7 +/- 1.93 kg/d for WCGF-L , WCGF-DL , and the control , respectively . The increasing effect of DM intake and milk yield in cows consuming WCGF resulted in a similar efficiency of 3.5 % fat-corrected milk production for all treatments , averaging 1.5 +/- 0.09 . Total protein yields were significantly higher for cows consuming WCGF diets during lactation : 1.15 , 1.10 , 1.00 +/- 0.06 kg/d for WCGF-L , WCGF-DL , and the control , respectively . These results indicate that diets may be formulated to contain as much as 37.5 % WCGF ( DM basis ) .

wet corn gluten feed ( WCGF )

diets containing WCGF

diets containing WCGF

Milk production

feed

actual milk yield

concentration of milk fat

total milk yield

Total protein yields

36 primiparous

40 multiparous


Intermittent recombinant growth hormone treatment in short children born small for gestational age : four-year results of a randomized trial of two different treatment regimens . BACKGROUND Treatment of short children born small for gestational age SGA with recombinant human growth hormone r-hGH increases growth velocity during childhood . As in other indications , the growth velocity in these patients is more marked during the first year of treatment and then decreases . This study was undertaken to evaluate the efficacy of different r-hGH treatment schedules ( 67 microg/kg/day in a discontinuous or continuous regimen ) during the second year of r-hGH treatment by comparing height velocity changes and total gain of height over a 4-year period . METHODS 58 growth-retarded SGA children aged 2-5 years were randomized to a TOTO regimen ( 4 years alternating treatment ( T ) and observation ( O ) , n = 30 ) or a TTOO regimen ( 2 years ' treatment , followed by 2 years ' observation , n = 28 ) . Height velocity HV and total height gain were assessed during the 4-year study . RESULTS In both groups , HV and HV standard deviation score HV-SDSCA increased during treatment and decreased during observation periods . Interruption of treatment in the TOTO group did not result in a better gain in height standard deviation score H-SDSCA when compared with the TTOO group . After 4 years of study , the gain in H-SDSCA was 1.4 + or - 01 in the TOTO group and 1.6 + or - 0.2 in the TTOO group leading to a mean height of -2.0 + or - 1.0 SDS and -2.0 + or - 0.8 SDS , respectively . The rate of bone maturation was similar in the two groups . CONCLUSIONS In short SGA children , TOTO and TTOO regimens produced significant improvements in growth during r-hGH treatment . However , treatment interruption after 1 year did not influence the overall gain in height SDS when compared with 2 years ' continuous treatment .

recombinant human growth hormone r-hGH

TOTO regimen

TOTO

TTOO

r-hGH treatment

growth velocity

growth velocity

height velocity

total gain of height

Height velocity HV

total height gain

HV

HV standard deviation score HV-SDSCA

gain in H-SDSCA

height

rate of bone maturation

growth

overall gain in height SDS


Effects of levosimendan versus dobutamine on inflammatory and apoptotic pathways in acutely decompensated chronic heart failure . A single levosimendan administration has recently been shown to result in clinical and hemodynamic improvement in patients with decompensated heart failure ( HF ) , but without survival benefits . In this study , the effects of levosimendan and dobutamine on plasma levels of proinflammatory and proapoptotic mediators in decompensated HF were compared and correlated with the concomitant effects on cardiac function and prognosis . Sixty-nine patients were randomized to received 24-hour intravenous infusions of levosimendan ( n = 23 ) , dobutamine ( n = 23 ) , or placebo ( n = 23 ) . Echocardiographic , hemodynamic , and biochemical assessments were performed at baseline , immediately after treatment , and 48 hours later . Patients were subsequently followed for 4 months for disease progression . End-systolic wall stress , the left ventricular ejection fraction , pulmonary capillary wedge pressure , and cardiac index were significantly improved in the levosimendan group but remained practically unaffected in the other groups . Plasma N-terminal-pro-B-type natriuretic peptide , tumor necrosis factor-alpha , and soluble Fas ligand levels were significantly decreased only in the levosimendan group ( from 1,900 +/- 223 to 1,378 +/- 170 pg/ml , 13.4 +/- 1.0 to 12.3 +/- 1.2 pg/ml , and 68.2 +/- 3.7 to 59.8 +/- 3.6 pg/ml , respectively ; p < 0.05 for all ) ; interleukin-6 was also borderline reduced ( p = 0.051 ) . Levosimendan-induced reduction in end-systolic wall stress was significantly correlated with respective decreases in N-terminal-pro-B-type natriuretic peptide ( r = 0.671 , p < 0.01 ) , tumor necrosis factor-alpha ( r = 0.586 , p < 0.01 ) , soluble Fas ( r = 0.441 , p < 0.05 ) , and soluble Fas ligand ( r = 0.614 , p < 0.01 ) . Event-free survival was significantly longer in the levosimendan group ( p < 0.05 ) . In conclusion , the superiority of levosimendan over dobutamine in improving central hemodynamics and left ventricular performance in decompensated HF seems to be related to its anti-inflammatory and antiapoptotic effects .

levosimendan

dobutamine

levosimendan

levosimendan

dobutamine

levosimendan

dobutamine

placebo

levosimendan

levosimendan

levosimendan

dobutamine

tumor necrosis factor-alpha

soluble Fas

soluble Fas ligand

Event-free survival

central hemodynamics

left ventricular performance


The safety and efficacy of terazosin in the treatment of essential hypertension in blacks . Terazosin , a new selective alpha 1-adrenergic receptor antagonist , has been found to be an effective antihypertensive agent . In a series of studies , the safety and efficacy of terazosin , alone and in combination with other antihypertensive agents , were evaluated in 1180 black patients with mild to moderate essential hypertension . Terazosin was effective in lowering blood pressure when administered alone ( in dosages of 1 to 80 mg/day ) and when prescribed ( in dosages of 1 to 20 mg/day ) in combination with other antihypertensive agents . In elderly black patients , terazosin , 1 to 10 mg daily , was as effective in lowering blood pressure as propranolol ( 40 to 120 mg twice daily ) . Changes ( mean +/- SE ) in sitting diastolic blood pressure from baseline were -8.1 +/- 1.4 mm Hg for terazosin and -5.0 +/- 1.5 mm Hg for propranolol . Terazosin ( 5 mg ) combined with methyclothiazide ( 2.5 to 5 mg ) produced a significantly greater ( p less than 0.01 ) antihypertensive effect than that of terazosin alone . Changes ( mean +/- SE ) in standing diastolic blood pressure from baseline were -7.9 +/- 2.0 mm Hg for terazosin alone , -15.1 +/- 2.1 mm Hg for terazosin plus 2.5 mg of methyclothiazide , and -15.0 +/- 2.0 mm Hg for terazosin plus 5 mg of methyclothiazide . Terazosin had a favorable effect on serum lipid levels and appeared to compensate for the negative lipid effects associated with diuretics and beta-blockers when used in combination with these agents . Terazosin , alone and combined with other antihypertensive agents , was well tolerated with minimal side effects in black hypertensive patients .

terazosin

Terazosin

terazosin

antihypertensive agents

Terazosin

antihypertensive agents

propranolol

propranolol

Terazosin

terazosin

terazosin

terazosin

2.5 mg of methyclothiazide

terazosin

methyclothiazide

blood pressure

antihypertensive effect

serum lipid levels

tolerated

essential hypertension in blacks .

mild to moderate essential hypertension

elderly

hypertensive


International Czech and Slovak cooperation in the treatment of patients with differentiated thyroid cancer . BACKGROUND The aim of this paper is to present our experience concerning cooperation in the treatment of Slovak patients with differentiated thyroid cancer in Slovak and Czech hospitals . The objectives of this study were to demonstrate the means of this cooperation and the results of therapy . MATERIAL AND METHODS From September 1991 to October 2005 in the Department of Nuclear Medicine in Ostrava 357 patients from the Slovak Republic with differentiated thyroid cancers ( follicular and papillary ) underwent complex therapy . They were diagnosed and operated due to the cancer ( near-total thyroidectomy and removal of lymph node metastases ) in Slovak hospitals . Then they were sent to the Department of Nuclear Medicine in Ostrava in the Czech Republic . In this department a radioiodine ablation of thyroid remnants , by means of the treatment amount of radioiodine of a standard activity of 3.7 GBq , was performed , and then a suppression and substitution therapy of thyroid hormones was started . After 3-6 months some patients were examined by means of diagnostic whole body scintigraphy after application of 300 MBq 131I . Some patients were treated by means of a standard activity of 7.4 GBq 131I and after 5 days whole body scintigraphy ( WBS ) was performed . In both of these groups of patients the diagnostic or therapeutic radioiodine application was done after withdrawal of thyroid hormone treatment . If thyroglobulin levels were low and WBSs were negative , patients were followed up in the Department of Nuclear Medicine in Martin . Patients with radioiodine accumulated metastases were again treated with radioiodine in Ostrava . If indicated , external radiation therapy targeted on the neck and upper mediastinum was performed in the Slovak Republic , in the University Hospital in Martin . Newly formed lymph node metastases were surgically treated in Slovakia , too . Generally we have very good treatment results . Also , economically our partnership is cost effective . Our collaboration also successfully continues after entrance of the Slovak Republic and the Czech Republic to the European Union in 2004 . CONCLUSIONS The results of this multi-centre study show that international Czech and Slovak cooperation in the complex therapy of patients with differentiated thyroid cancers is successful , with high efficacy . The treatment results were very similar to therapeutic results in our patients from the Czech Republic .

Czech and Slovak cooperation

cooperation

complex therapy

radioiodine

radioiodine

substitution therapy

radioiodine

radioiodine

radiation therapy

cooperation

means of this cooperation

diagnostic whole body scintigraphy

thyroglobulin levels

WBSs

good treatment results

cost effective

differentiated thyroid cancer

differentiated thyroid cancer


Paraesthesia during the needle-through-needle and the double segment technique for combined spinal epidural anaesthesia . Paraesthesia during regional anaesthesia is an unpleasant sensation for patients and , more importantly , in some cases it is related to neurological injury . Relatively few studies have been conducted on the frequency of paraesthesia during combined spinal epidural anaesthesia . We compared two combined spinal epidural anaesthesia techniques : the needle-through-needle technique and the double segment technique in this respect . We randomly allocated 116 parturients undergoing elective Caesarean section to receive anaesthesia using one of these techniques . Both techniques were performed using a 27G pencil point needle , an 18G Tuohy needle , and a 20G multiport epidural catheter from the same manufacturer . The overall frequency of paraesthesia was higher in the needle-through-needle technique group ( 56.9 % vs. 31.6 % , p = 0.011 ) . The frequency of paraesthesia at spinal needle insertion was 20.7 % in the needle-through-needle technique group and 8.8 % in the double segment technique group ; whereas the frequency of paraesthesia at epidural catheter insertion was 46.6 % in the needle-through-needle technique group and 24.6 % in the double segment technique group .

needle-through-needle

double segment technique

spinal epidural anaesthesia

anaesthesia

needle-through-needle technique

needle-through-needle

double segment

needle-through-needle technique

double segment

overall frequency of paraesthesia

frequency of paraesthesia

frequency of paraesthesia


POG 8625 : a randomized trial comparing chemotherapy with chemoradiotherapy for children and adolescents with Stages I , IIA , IIIA1 Hodgkin Disease : a report from the Children 's Oncology Group . To determine if 6 courses of chemotherapy alone could achieve the same or better outcome than 4 courses of chemotherapy followed by radiation therapy ( chemoradiotherapy ) in pediatric and adolescent patients with Hodgkin disease . Children < or =21 years old with biopsy-proven , pathologically staged I , IIA , or IIIA1 Hodgkin disease were randomly assigned 6 courses of alternating nitrogen mustard , oncovin , prednisone , and procarbazine/doxorubicin , bleomycin , vinblastine , and dacarbazine ( treatment 1 ) or 4 courses of alternating nitrogen mustard , oncovin , prednisone , and procarbazine/doxorubicin , bleomycin , vinblastine , and dacarbazine +2550 cGy involved-field radiotherapy ( treatment 2 ) . The complete response rate was 89 % , with a complete response and partial response rate of 99.4 % . There was no statistically significant difference in event-free survival ( EFS ) or overall survival between arms . The EFS for those who achieved an early complete response was significantly higher than for those who did not . For pediatric patients with asymptomatic low-stage and intermediate-stage Hodgkin disease , chemotherapy and chemoradiotherapy both resulted in 3-year EFS of approximately 90 % and statistically indistinguishable 8-year EFS and overall survival , without significant long-term toxicity . Early response to therapy was associated with higher EFS , a concept that has led to the Children 's Oncology Group paradigm of response-based risk-adapted therapy for pediatric Hodgkin disease .

chemotherapy

chemoradiotherapy

chemotherapy

chemotherapy

radiation therapy ( chemoradiotherapy )

nitrogen mustard

oncovin

prednisone

procarbazine/doxorubicin

bleomycin

vinblastine

dacarbazine +2550 cGy

radiotherapy ( treatment 2 ) .

chemotherapy

chemoradiotherapy

EFS

complete response

3-year EFS

8-year EFS

overall survival

long-term toxicity .

response to therapy

EFS

Stages I , IIA , IIIA1 Hodgkin Disease

pediatric

adolescent

Hodgkin disease

Children

pediatric


Modulation of human motor cortex excitability by single doses of amantadine . Amantadine-sulfate has been used for several decades to treat acute influenza A , Parkinson 's disease ( PD ) , and acute or chronic drug-induced dyskinesia . Several mechanisms of actions detected in vivo/in vitro including N-methyl-D-aspartate ( NMDA ) -receptor antagonism , blockage of potassium channels , dopamine receptor agonism , enhancement of noradrenergic release , and anticholinergic effects have been described . We used transcranial magnetic stimulation ( TMS ) to evaluate the effect of single doses of amantadine on human motor cortex excitability in normal subjects . Using a double-blind , placebo-controlled , crossover study design , motor thresholds , recruitment curves , cortical stimulation-induced silent period ( CSP ) , short intracortical inhibition ( ICI ) , intracortical facilitation ( ICF ) , and late inhibition ( L-ICI ) in 14 healthy subjects were investigated after oral doses of 50 and 100 mg amantadine with single and paired pulse TMS paradigms . Spinal cord excitability was investigated by distal latencies and M-amplitudes of the abductor digiti minimi muscle . After intake of amantadine , a significant dose-dependent decrease of ICF was noticed as well as a significant increase of L-ICI as compared to placebo . The effect on ICF and L-ICI significantly correlated with amantadine serum levels . ICI was slightly increased after amantadine intake , but the effect failed to be significant . Furthermore , amantadine had no significant effects on motor thresholds , MEP recruitment curves , CSP , or peripheral excitability . In conclusion , a low dose of amantadine is sufficient in modulating human motor cortex excitability . The decrease of ICF and increase of L-ICI may reflect glutamatergic modulation or a polysynaptic interaction of glutamatergic and GABA-ergic circuits . Although amantadine has several mechanisms of action , the NMDA-receptor antagonism seems to be the most relevant effect on cortical excitability . As L-ICI can be influenced by this type of drug , it may be an interesting parameter for studies of motor learning and use-dependent plasticity .

amantadine

Amantadine-sulfate

amantadine

placebo-controlled

oral doses of 50 and 100 mg amantadine

single and paired pulse TMS paradigms

amantadine

amantadine

amantadine

amantadine

amantadine

amantadine

N-methyl-D-aspartate

antagonism

cortex

Spinal cord excitability

M-amplitudes

ICF

L-ICI

ICF

L-ICI

ICI

motor thresholds

MEP recruitment curves

CSP

peripheral excitability .

ICF

L-ICI

cortical excitability

L-ICI

normal

healthy


The impact of daily sodium intake on posttransplant hypertension in kidney allograft recipients . INTRODUCTION Posttransplant hypertension is a well-known risk factor for long-term allograft failure and mortality in kidney recipients . Although dietary sodium restriction is a widely recommended nonpharmacological measure for control of blood pressure ( BP ) , no detailed investigation has been conducted regarding the impact of dietary sodium restriction on this condition . METHODS Thirty-two patients on antihypertensive treatment completed the study . They were randomly divided into two groups : controls ( group 1 ) versus strict sodium diet ( group 2 ; 80 to 100 mmol sodium daily ) . After randomization , 24-hour urine for sodium measurement , BP , and allograft functions were recorded at baseline and after 3 months . BP treatment was reevaluated at each visit throughout the study . RESULTS At baseline , there was no significant difference in age , sex , serum creatinine , systolic and diastolic BP , antihypertensive drugs , or 24-hour urinary sodium levels between the groups . After 3 months , daily urinary sodium excretion ( from 190+/-75 to 106+/-48 mEq/d , P < .0001 ) , systolic BP ( from 146+/-21 to 116+/-11 mm Hg ) , and diastolic BP ( from 89+/-8 to 72+/-10 mm Hg ) had significantly decreased in group 2 , while no significant changes were observed in group 1 . CONCLUSION Low sodium intake in combination with antihypertensive treatment appears to efficiently control BP in kidney allograft recipients with hypertension . Twenty-four-hour urinary sodium excretion should be checked regularly in these patients as a useful marker to indicate whether the patient complies with low sodium intake .

sodium

controls

strict sodium diet

sodium

posttransplant hypertension

Posttransplant hypertension

blood pressure ( BP )

serum creatinine

systolic

diastolic BP

antihypertensive drugs

24-hour urinary sodium levels

daily urinary sodium excretion

systolic BP

diastolic BP

control BP

kidney recipients .

kidney allograft recipients


Factors that influence cancer patients ' anxiety following a medical consultation : impact of a communication skills training programme for physicians . BACKGROUND No study has yet assessed the impact of physicians ' skills acquisition after a communication skills training programme on the evolution of patients ' anxiety following a medical consultation . This study aimed to compare the impact , on patients ' anxiety , of a basic communication skills training programme ( BT ) and the same programme consolidated by consolidation workshops ( CW ) , and to investigate physicians ' communication variables associated with patients ' anxiety . PATIENTS AND METHODS Physicians , after attending the BT , were randomly assigned to CW or to a waiting list . The control group was not a non-intervention group . Consultations with a cancer patient were recorded . Patients ' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation . Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual . RESULTS No statistically significant change over time and between groups was observed . Mixed-effects modelling showed that a decrease in patients ' anxiety was linked with screening questions ( P = 0.045 ) , physicians ' satisfaction about support given ( P = 0.004 ) and with patients ' distress ( P < 0.001 ) . An increase in anxiety was linked with breaking bad news ( P = 0.050 ) and with supportive skills ( P = 0.013 ) . No impact of the training programme was observed . CONCLUSIONS This study shows the influence of some communication skills on the evolution of patients ' anxiety . Physicians should be aware of these influences .

communication skills training programme

communication skills training programme

consolidation workshops

BT

CW

waiting list

anxiety

anxiety

State Trait Anxiety Inventory

Communication skills

time

physicians ' satisfaction

patients ' anxiety

cancer patients ' anxiety

Physicians


Recovery after prolonged anaesthesia for acoustic neuroma surgery : desflurane versus isoflurane . In this study , 33 patients were randomly assigned to receive desflurane ( D ) or isoflurane ( I ) for acoustic neuroma surgery . The time from end of the procedure to spontaneous breathing , extubation , eye-opening , hand-squeezing to command , and ability to state name , birthdate and phone number were recorded . The Steward recovery score was also recorded every five minutes during the first 20 minutes postoperatively and then every 10 to 15 minutes . Groups were similar regarding patient characteristics , depth of anaesthesia , sufentanil total dose , anaesthesia duration ( D : 349.1 +/- 19.1 min ; I : 349.2 +/- 22.9 min ) , haemodynamic/respiratory parameters , and surgical conditions ( assessed by a bleeding score ) . The emergence time in the D group was significantly faster than the I group ( D : 14.9 +/- 2.4 min vs I : 29.2 +/- 2.4 min for eye-opening ) . Full recovery also occurred earlier in the D group ( D : 22.1 +/- 3.1 min vs I : 37.6 +/- 4.0 min , P < 0.005 for stating name ) . Steward recovery scores were also better during the first postoperative hour in the D group ( D : 40 min vs I : 90 min , P < 0.005 for 100 % of patients with Steward score of 6 ) . The results indicate that desflurane is associated with similar operating conditions and faster postoperative recovery following acoustic neuroma surgery . The faster recovery following desflurane may be desirable after long surgical procedures , enabling the patient 's full cooperation and facilitating early diagnosis of any potential neurological deficit .

desflurane

isoflurane

desflurane

isoflurane

acoustic neuroma surgery

Recovery

emergence time

Full recovery

Steward recovery scores

postoperative recovery

recovery

prolonged anaesthesia

acoustic neuroma surgery

acoustic neuroma surgery

acoustic neuroma


Psychological well-being correlates with free thyroxine but not free 3,5,3'-triiodothyronine levels in patients on thyroid hormone replacement . CONTEXT AND OBJECTIVE An association between mood disorders and overt thyroid dysfunction is well established , but there are few data on the potential for thyroid hormone levels closer to the reference range to correlate with psychological well-being . DESIGN , SETTING , AND PATIENTS We analyzed the relationship between psychological well-being and free T ( 4 ) ( fT4 ) , free T ( 3 ) ( fT3 ) , TSH , and total rT ( 3 ) in 697 patients on thyroid hormone replacement therapy at entry to a randomized , controlled trial of combined T ( 4 ) and T ( 3 ) replacement therapy . All patients were on 100 mug or more T ( 4 ) . INTERVENTIONS AND MAIN OUTCOME MEASURES Psychological well-being was assessed with General Health Questionnaire-12 ( GHQ-12 ) , Thyroid Symptom Questionnaire , and Hospital Anxiety and Depression Scale . RESULTS fT ( 4 ) and TSH showed a strong correlation with GHQ-12 scores ( fT4 - b : -0.16 , P = 0.005 ; TSH - b : 0.663 , P = 0.04 ) . No correlations were seen between the GHQ scores and fT3 ( b : 0.318 , P = 0.275 ) , rT ( 3 ) ( b : 0.095 , P = 0.95 ) , rT ( 3 ) to fT4 ratio ( b : 71.83 , P = 0.09 ) or fT3 to rT ( 3 ) ratio ( b : 0.05 , P = 0.32 ) . The correlations remained when the data set was limited to patients with TSH in the range 0.3-4.0 mIU/liter . Similar correlations were seen with the Thyroid Symptom Questionnaire , although not with the Hospital Anxiety and Depression Scale scores . CONCLUSIONS Differences in fT4 and TSH concentration , even within the reference range , may be a determinant of psychological well-being in treated hypothyroid patients although not necessarily with symptoms typical of anxiety or depression .

thyroid hormone replacement therapy

Psychological well-being

Thyroid Symptom Questionnaire

Hospital Anxiety

Depression Scale

Thyroid Symptom Questionnaire

thyroid hormone replacement

thyroid hormone replacement therapy

hypothyroid


Pelvic lymphadenectomy for cervical carcinoma : laparotomy extraperitoneal , transperitoneal or laparoscopic approach ? A randomized study . OBJECTIVE To compare transperitoneal , extraperitoneal and laparoscopic pelvic lymphadenectomy in terms of feasibility and morbidity in patients affected by cervical cancer undergoing radical hysterectomy . METHODS Consecutive patients affected by stage IB-IIB cervical carcinoma scheduled for radical surgery entered the study . Patients were randomly assigned to transperitoneal ( TPL ) , extraperitoneal ( EPL ) or laparoscopic pelvic lymphadenectomy ( LPL ) . All patients underwent classical radical hysterectomy . Perioperative data were recorded . Follow up examinations were performed at the 15th , 30th and 60th day after surgery . RESULTS 168 patients entered the study . The mean operative times were : 63+/-7.6 , 54+/-6.7 and 75+/-8.4 min ( TPL vs EPL P < 0.001 ; EPL vs LPL P < 0.001 ; TPL vs LPL P < 0.001 ) for TPL , EPL and LPL respectively . The feasibility of the procedures , analyzed on an intention-to-treat basis , was 96 % , 93 % and 95 % for TPL , EPL and LPL group respectively ( P=ns ) . The average hospitalizations were : 5.6+/-0.9 , 3.2+/-0.4 and 3.1+/-0.3 days ( TPL vs EPL P < 0.001 ; TPL vs LPL P < 0.001 ) for TPL , EPL and LPL respectively . CONCLUSIONS EPL and LPL are as feasible and effective as TPL and can be adequately performed with a reasonable complication rate . LPL showed a statistically significant longer operative time . However , both EPL and LPL can minimize some postoperative complications reducing length of stay .

radical surgery

transperitoneal ( TPL )

extraperitoneal ( EPL )

classical radical hysterectomy

TPL

EPL

TPL

LPL

TPL

EPL

LPL

TPL

EPL

LPL

TPL

EPL

TPL

LPL

TPL

EPL

LPL

EPL

LPL

TPL

LPL

EPL

LPL

feasibility and morbidity

examinations

mean operative times

feasibility of the procedures

average hospitalizations

feasible

effective

operative time

length of stay

cervical carcinoma


Randomized comparison of two communication interventions for preschoolers with autism spectrum disorders . This randomized group experiment compared the efficacy of 2 communication interventions ( Responsive Education and Prelinguistic Milieu Teaching [ RPMT ] and the Picture Exchange Communication System [ PECS ] ) in 36 preschoolers with autism spectrum disorders . Each treatment was delivered 3 times per week , in 20-min sessions , for 6 months . The results revealed that the RPMT facilitated the frequency of generalized turn taking and generalized initiating joint attention more than did the PECS . The latter effect occurred only for children who began treatment with at least some initiating joint attention . In contrast , the PECS facilitated generalized requests more than the RPMT in children with very little initiating joint attention prior to treatment . These effect sizes were large .

RPMT

PECS

frequency of generalized turn taking

generalized initiating joint attention

initiating joint attention

generalized requests

initiating joint attention

effect sizes

large

preschoolers

autism spectrum disorders

autism spectrum disorders .


Analysis of face gaze in autism using " Bubbles " . One of the components of abnormal social functioning in autism is an impaired ability to direct eye gaze onto other people 's faces in social situations . Here , we investigated the relationship between gaze onto the eye and mouth regions of faces , and the visual information that was present within those regions . We used the " Bubbles " method to vary the facial information available on any given trial by revealing only small parts of the face , and measured the eye movements made as participants viewed these stimuli . Compared to ten IQ- and age-matched healthy controls , eight participants with autism showed less fixation specificity to the eyes and mouth , a greater tendency to saccade away from the eyes when information was present in those regions , and abnormal directionality of saccades . The findings provide novel detail to the abnormal way in which people with autism look at faces , an impairment that likely influences all subsequent face processing .

face gaze

Bubbles " method

eye movements

fixation specificity

autism

autism


Effects of two different short-term training programs on the physical and technical abilities of adolescent basketball players . This study evaluated and compared the effectiveness of two different off-season , short-term basketball training programs on physical and technical abilities of young basketball players . Twenty-seven adolescent basketball players ( 14.7+/-0.5 years ; Tanner stage : 3.5+/-0.5 ) were randomly divided into a specialized basketball training group ( SP , n=10 ) , a mixed basketball plus conditioning training group ( MX , n=10 ) and a control group ( n=7 ) . Training included five sessions per week ( 100-120 min each ) and was performed for 4 weeks . Maximal oxygen uptake was similarly improved after SP ( 4.9+/-1.8 % ) and MX ( 4.9+/-1.4 % ) , but there was no effect on ventilatory threshold . Peak and mean power output measured during the Wingate test were also improved by a similar magnitude after SP ( 21+/-5 % ) and MX ( 15+/-6 % ) . Trunk muscle endurance was equally increased ( SP : 23+/-4 % , MX : 25+/-5 % ) , but arms endurance was improved significantly more after MX ( 50+/-11 % ) compared to SP ( 11+/-14 % , p < 0.05 ) . Performance in four basketball technical skills was similarly increased ( by 17-27 % ) in both groups , with a tendency for greater improvement of the SP groups in the technical skills of shooting and passing . These results indicate that a SP basketball training program , performed exclusively on-court was as effective as a MX training program in terms of aerobic and anaerobic fitness improvement . Furthermore , the decrease of the total on-court training time in the MX group resulted in a tendency for a smaller improvement of basketball technical skills . In conclusion , both SP and MX training are equally effective in order to limit and/or reverse the detraining effects that occur during the off-season in basketball .

short-term training programs

specialized basketball training group

control group

Training

Maximal oxygen uptake

ventilatory threshold

Peak and mean power output

Trunk muscle endurance

arms endurance

Performance

basketball technical skills

shooting and passing

young basketball players .


Specific immunoglobulin for treatment of whooping cough . Immunoglobulin treatment for whooping cough ( pertussis ) is widely believed to be ineffective although there are sound reasons for regarding the condition as a toxin-induced disease . We wondered whether the lack of success with pertussis immunoglobulins might be attributable to inadequate dose , so we designed a randomised , double-blind , placebo-controlled trial of two immunoglobulin preparations . The study was conducted at three Swedish hospitals . We enrolled 73 children aged less than 36 months who were admitted with a clinical diagnosis of whooping cough . On admission they were assigned to one of three groups : ( a ) monocomponent pertussis toxoid vaccine ; ( b ) two-component acellular vaccine also containing filamentous haemagglutinin ; or ( c ) 20 % albumin solution ( placebo ) . The immunoglobulins had a high antitoxin content and had been raised with acellular pertussis vaccines . Diagnosis of pertussis was confirmed by laboratory tests and the follow-up was completed in 67 children . The main study group consisted of 47 children with less than or equal to 14 days of disease before therapy . Duration of whoops post-treatment was 8.7 days ( 95 % Cl 4.8 , 12.6 ) in the 33 children receiving immunoglobulin vs 20.6 ( 95 % Cl 11.9 , 29.3 ) in the 14 receiving placebo ( p = 0.0041 ) . Mean number of whoops during the first week of follow-up was also significantly reduced ( p = 0.0196 ) . We found that early treatment was important , since the effect on duration of whoops was most pronounced when disease duration before treatment was less than or equal to 7 days . There were no significant differences between the two immunoglobulin preparations . High-dose specific pertussis immunoglobulin with a high antitoxin concentration has a beneficial effect in the treatment of whooping cough .

Specific immunoglobulin

Immunoglobulin

immunoglobulins

placebo-controlled

monocomponent pertussis toxoid vaccine

20 %

albumin solution

( placebo )

immunoglobulins

immunoglobulin

placebo

immunoglobulin

ineffective

lack of success

Duration of whoops post-treatment

Mean number of whoops

beneficial effect

whooping cough

children aged less than 36 months

whooping cough

children


The efficacy of early continuous positive airway pressure therapy in patients with acute cardiogenic pulmonary edema . Although continuous positive airway pressure ( CPAP ) therapy using a face mask is known to improve oxygenation , the intrapulmonary shunt reduction remains unsettled . Our study was designed to explore this issue . From 1985 to 1987 80 patients with acute cardiogenic pulmonary edema were randomly chosen to receive either serial CPAP therapy or high-flow face mask oxygen therapy without CPAP ( control ) for the purpose of evaluating the efficacy of CPAP therapy . After screening for exclusion , only 55 patients were included in the first 3-hour investigation period . PaO2 in the CPAP group showed a significant increase by the end of the initial study ; whereas intrapulmonary shunt and alveolar-arterial oxygen tension gradient AaDO2 revealed simultaneously a significant reduction . Conversely , neither PaO2 nor intrapulmonary shunt ( or AaDO2 ) in the control group demonstrated any significant beneficial changes . As for cardiovascular function , only the CPAP therapy achieved a significant reduction in rate pressure product in contrast to the control ( face mask ) therapy alone . In terms of therapeutic failure , 10 patients in the control group failed . However , in the CPAP group only 5 patients had failed at the end of the first 3-hour study period . Overall , the cumulative therapeutic failure rate was 28 % in the CPAP group and 60 % in the control group during a 6-hour observation study . However , there was no significant difference between the two groups in 24-hour hospital mortality . ( ABSTRACT TRUNCATED AT 250 WORDS )

serial CPAP therapy

intrapulmonary shunt

rate pressure product

therapeutic failure

cumulative therapeutic failure rate

acute cardiogenic pulmonary edema .

acute cardiogenic pulmonary edema


Resistance training increases basal limb blood flow and vascular conductance in aging humans . Age-related reductions in basal limb blood flow and vascular conductance are associated with the metabolic syndrome , functional impairments , and osteoporosis . We tested the hypothesis that a strength training program would increase basal femoral blood flow in aging adults . Twenty-six sedentary but healthy middle-aged and older subjects were randomly assigned to either a whole body strength training intervention group ( 52 +/- 2 yr , 3 men , 10 women ) who underwent three supervised resistance training sessions per week for 13 wk or a control group ( 53 +/- 2 yr , 4 men , 9 women ) who participated in a supervised stretching program . At baseline , there were no significant differences in blood pressure , cardiac output , basal femoral blood flow ( via Doppler ultrasound ) , vascular conductance , and vascular resistance between the two groups . The strength training group increased maximal strength in all the major muscle groups tested ( P < 0.05 ) . Whole body lean body mass increased ( P < 0.05 ) with strength training , but leg fat-free mass did not . Basal femoral blood flow and vascular conductance increased by 55-60 % after strength training ( both P < 0.05 ) . No such changes were observed in the control group . In both groups , there were no significant changes in brachial blood pressure , plasma endothelin-1 and angiotensin II concentrations , femoral artery wall thickness , cardiac output , and systemic vascular resistance . Our results indicate that short-term strength training increases basal femoral blood flow and vascular conductance in healthy middle-aged and older adults .

Resistance training

strength training program

whole body strength training

resistance training

strength training group

strength training

short-term strength training

basal femoral blood flow

blood pressure

cardiac output

vascular conductance

vascular resistance

maximal strength

Whole body lean body mass

leg fat-free mass

brachial blood pressure

femoral artery wall thickness

cardiac output

systemic vascular resistance

healthy middle-aged and older adults .


Teaching young nonverbal children with autism useful speech : a pilot study of the Denver Model and PROMPT interventions . This single subject design study examined two models of intervention : Denver Model ( which merges behavioral , developmental , and relationship-oriented intervention ) , and PROMPT ( a neuro-developmental approach for speech production disorders ) . Ten young , nonverbal children with autism were matched in pairs and randomized to treatment . They received 12 1-h weekly sessions of therapy and daily 1-h home intervention delivered by parents . Fidelity criteria were maintained throughout . Eight of the ten children used five or more novel , functional words spontaneously and spoke multiple times per hour by the conclusion of treatment . There were no differences in acquired language skills by intervention group . Initial characteristics of the best responders were mild to moderate symptoms of autism , better motor imitation skills , and emerging joint attention skills .

Denver Model

PROMPT

interventions

Denver Model

relationship-oriented

intervention

PROMPT

a

neuro-developmental approach

for speech production disorders

functional

multiple times per hour

acquired language skills

nonverbal

children

autism

Ten

nonverbal

children

autism

mild to moderate symptoms of autism

motor imitation skills

joint attention skills


Gemcitabine and split-dose paclitaxel or docetaxel in metastatic breast cancer : a randomised phase II study . PURPOSE The purpose was to evaluate the activity and toxicity of split-dose paclitaxel or docetaxel in combination with gemcitabine in patients with metastatic breast cancer ( MBC ) who had previously received anthracyclines . PATIENTS AND METHODS A total of 210 patients were randomly assigned to one of three treatment arms : gemcitabine 1,250 mg/m ( 2 ) Days 1 and 8 and paclitaxel 175 mg/m ( 2 ) as a 3-h infusion on Day 1 ( GP1 ) ; gemcitabine 1,000 mg/m ( 2 ) Days 1 and 8 and paclitaxel 100 mg/m ( 2 ) as a 1-h infusion on Days 1 and 8 ( GP2 ) ; gemcitabine 1,000 mg/m ( 2 ) Days 1 and 8 and docetaxel 40 mg/m ( 2 ) as a 1-h infusion on Days 1 and 8 ( GD ) . Cycles were repeated every 3 weeks . RESULTS For the 204 patients evaluable for response assessment , the response rates were 48.6 % for GP1 , 52.2 % for GP2 , and 52.3 % for GD . Median response duration , time to treatment failure , and time to progression ( TTP ) were similar in each arm . Median TTP for GP1 , GP2 and GD was 7.5 , 7.0 and 7.4 months , respectively . For the 208 patients evaluable for safety , the most common grade 3/4 toxicity for each regimen was neutropaenia , with 64 % , 57 % , and 68 % for GP1 , GP2 , and GD , respectively . Grade 4 neutropaenia , grade 3/4 anaemia , febrile neutropaenia , and diarrhoea were more common in the docetaxel arm , as was the use of intravenous antibiotics and blood transfusions . CONCLUSION The study confirmed the high activity of gemcitabine-taxane combinations in MBC . Split-dose paclitaxel had similar activity and toxicity to the 3-weekly administration . The split-dose docetaxel regimen had similar activity to the paclitaxel combinations though associated with higher toxicity .

Gemcitabine

paclitaxel

docetaxel

split-dose paclitaxel

docetaxel

combination with gemcitabine

gemcitabine-taxane combinations

paclitaxel

docetaxel

paclitaxel combinations

activity and toxicity

response rates

Median response duration

time to treatment failure

time to progression ( TTP )

safety

toxicity

neutropaenia

neutropaenia

anaemia

febrile neutropaenia

diarrhoea

toxicity

metastatic breast cancer


Effects of single doses of rabeprazole 20 mg and esomeprazole 40 mg on 24-h intragastric pH in healthy subjects . OBJECTIVE To compare antisecretory effects of single doses of rabeprazole and esomeprazole . METHODS Open , randomised , 2-way crossover , clinical pharmacology study . 24 healthy subjects ( 10 men ; mean age 26.2 y ) received a single dose of rabeprazole 20 mg or esomeprazole 40 mg , with a 14-day 'washout ' . Intragastric pH was recorded continuously from 24 h before to 24 h after dosing . RESULTS Mean intragastric pH was higher after esomeprazole than rabeprazole during 0-5 h after dosing ( P=0.0001 ) ; the reverse was true from 14-24 h ( P=0.0002 ) . Mean % time pH > 3 and > 4 was greater after esomeprazole than rabeprazole during 0-14 h ( P=0.041 and 0.044 ) , but the reverse was true during 14-24 h ( P=0.0005 and 0.001 ) . In the 0-24 h interval as a whole , there was no difference between treatments in mean pH or % time pH > 3 or > 4 . CONCLUSION Single-dose rabeprazole 20 mg was as effective as esomeprazole 40 mg in increasing intragastric pH and maintaining pH > 3 and > 4 , despite the 2-fold difference in dose .

rabeprazole

esomeprazole

rabeprazole

esomeprazole .

rabeprazole 20 mg or esomeprazole 40 mg

esomeprazole

rabeprazole

esomeprazole

rabeprazole

rabeprazole

esomeprazole

24-h intragastric pH

Intragastric pH

Mean intragastric pH

Mean % time pH > 3 and > 4

mean pH or % time pH > 3 or > 4 .

intragastric pH

pH > 3 and > 4

24 healthy subjects

men

; mean age 26.2 y )


Rotigotine transdermal patch enables rapid titration to effective doses in advanced-stage idiopathic Parkinson disease : subanalysis of a parallel group , open-label , dose-escalation study . OBJECTIVE Rotigotine ( Neupro ) is formulated as a transdermal delivery system designed to provide a selective , non-ergot D3/D2/D1 agonist to the systemic blood flow over a 24-hour period . In clinical trials , patches were applied once daily and uptitrated to the individual effective dose in increments of 2 mg/24 h every week . The aim of this analysis was to determine the safety of a more rapid titration of rotigotine by assessing the tolerability of escalating transdermal doses of rotigotine given in 2 different titration schemes . METHODS We analyzed the safety of rotigotine in 2 groups of patients with advanced stage Parkinson Disease . The starting dose of 4 mg/24 h was increased every week by 2 mg/24 h in the slow-titration group and 4 mg/24 h in the fast-titration group . The primary focus of this subanalysis was the separate tolerability of rotigotine in each randomized treatment arm , during the dose-escalation period . However , the 2 titration schemes were also compared with each other . RESULTS The dose of first reported nausea and/or vomiting was 8 mg/24 h for the fast-titration group and 4 mg/ 24 h for the slow-titration group . There were no remarkable differences concerning the side-effect profile between the 2 different titration schemes . CONCLUSIONS The fast-titration regimen had a similar adverse event profile to slower titration , and allowed rotigotine to be introduced quickly . This subanalysis suggests that rotigotine may be uptitrated more rapidly .

Rotigotine transdermal patch

Rotigotine ( Neupro )

patches

rotigotine

rotigotine

rotigotine

rotigotine

rotigotine

rotigotine

safety

safety

tolerability of rotigotine

nausea and/or vomiting

side-effect profile

adverse event profile

advanced stage Parkinson Disease


Divalproex versus placebo for the prevention of irritability associated with fluoxetine treatment in autism spectrum disorder .

Divalproex

placebo

fluoxetine

irritability

autism spectrum disorder .