Increasing the reach of health sponsorship : using a " sponsorship kit " to promote health . In Australia , a tobacco tax provides funding for Healthway , the Western Australian Health Promotion Foundation . Healthway provides sponsorships for the arts and racing and sporting events to replace funds previously provided by tobacco companies . These sponsorships provide visibility for Healthway and positive health messages . Normally , Healthway staff attends these events to help promote health messages . To reduce Healthway staff time spent helping event organizers promote health messages , Healthway developed a sponsor kit of promotional materials which communicate health messages without requiring Healthway staff to attend events . Recognition , awareness , comprehension , and acceptance of health messages was comparable at events that featured Healthway staff versus the sponsor kits , but the average cost of the sponsorship kits was only 40 % of the cost when Healthway staff was featured .

sponsor kit of promotional materials

sponsorship kits

health


Spatial orientation adjustments in children with autism in Hong Kong . Abnormal spatial orientation and body postures in children with autism often interfere with visual abilities to attend tasks and social interactions . Twenty-four children diagnosed with autism from Kowloon , Hong Kong were assessed for spatial orientation and spatial management abilities . Positive changes in spatial orientation were evident when the children wore ambient prism lenses and included changes in posture from slanted to erect . Adjustments in spatial management were evident in improved ball catching ability , a task requiring visual tracking and eye-hand coordination . The findings suggest that alterations to the sensory systems may lead to behavioral change in some children .

Spatial orientation adjustments

wore

ambient prism lenses

alterations to the sensory systems

spatial orientation and body postures

spatial orientation

spatial management

Positive changes

spatial orientation

changes in posture

spatial management

catching ability

children

autism

children

autism

Twenty-four

children

autism


Comparison of the efficacy of fluoxetine alone vs. fluoxetine plus local lidocaine ointment in the treatment of premature ejaculation . OBJECTIVE The present study compares the efficacy and side effects of fluoxetine alone vs. fluoxetine plus local lidocaine ointment in the treatment of premature ejaculation . METHODS Forty-three patients suffering from premature ejaculation were studied . The exclusion criteria were erectile dysfunction , loss of libido , alcohol and substance abuse , mental retardation , diabetes mellitus , thyroid disease , hypotension , previous use of these drugs and urogenital infections . The patients ' ages ranged from 19 to 48 years ( mean age 28 +/- 1.6 ) . They had regular sexual lives . They had normal psychiatric consultation and the Glombock Rast Sexual Satisfactory Test ( GRISS ) psychiatric test were in accordance with premature ejaculation . RESULTS The patients were assigned to two groups . Twenty-six patients , aged 21 to 36 years ( mean age 27 ) , received only fluoxetine 20 mg/day ( 1 capsule ) for a week which was later increased to 40 mg/day ( 2 capsules ) . Seventeen patients , aged 19 to 48 years ( mean age 31 ) , were given fluoxetine 20 mg/day plus local application of lidocaine ointment . The patients and partners were re-evaluated 8 weeks after the treatment . The results were classified as unsuccessful , improvement and cure . The chi-square test was used for statistical analysis . In the fluoxetine group , 8 ( 30.8 % ) patients cured , 11 ( 42.2 % ) showed improvement and there were 7 failures ( 26.9 % ) . In the combination treatment group , 9 ( 52.9 % ) patients cured , improvement was observed in 5 ( 29.4 % ) and failure in 3 ( 17.6 % ) . Side effects in group I were observed in 6 patients ( 23 % ) and in 5 ( 29.4 % ) in group II . There were no statistical differences between the two groups according to the side effects ( p > 0.01 ) . No patients were excluded from the study due to side effects . CONCLUSION The combination of fluoxetine plus local application of lidocaine ointment was found to be more effective than fluoxetine alone in the treatment of premature ejaculation . However , the results should be confirmed in further studies with a placebo group to rule out the placebo effect .

fluoxetine alone

fluoxetine

local lidocaine ointment

fluoxetine alone

fluoxetine

local lidocaine ointment

fluoxetine

fluoxetine

lidocaine ointment

fluoxetine

lidocaine

fluoxetine

unsuccessful

improvement

cure

chi-square test

cured

improvement

failures

premature ejaculation

premature ejaculation

Forty-three

19 to 48 years

28 +/- 1.6


The injured colon : therapeutic considerations . A prospective randomized study was carried out at the Detroit General Hospital over a two year period to evaluate methods of management in 165 patients with colonic injuries . Results of the study show that primary closure is a safe and reiable method of management when rigid criteria are incorporated in an ongoing protocol . Moreover , the technic of exteriorization is a safe adjunct to management and is recommended in any patient with a colonic injury above 18 cm in which one suture line is required and in which the additional operating time of twenty minutes will not compromise the management of secondary injuries . Patients not fulfilling these criteria should have primary colostomy . These principles make it possible to reduce the need for primary colostomy to approximately 50 per cent in a large ongoing group of patients with colonic injury .

colonic injuries

primary closure

exteriorization

primary colostomy

primary colostomy

safe

reiable

safe

primary colostomy .

primary colostomy

injured colon :

colonic injuries

patients with colonic injury


Is hands-on experience more effective than didactic workshops in postgraduate cancer pain education ? BACKGROUND This study examined the nurse outcomes of a cancer pain education program for nurses of patients from 11 different ethnic groups . METHODS Four hundred ninety six home , hospital , and hospice nurses participated in a one-day workshop or two half-day workshops on cancer pain assessment and management . Of these , 116 were randomized to participate in a bedside-precepted visit with an oncology nurse specialist with pain specialization and a focus group to discuss attitudinal issues . Eighty-six nurses served as controls . Pre- , post- and one-year follow-up tests were administered . RESULTS Attitudes , knowledge , and application skills significantly improved for workshop-only and enriched-model nurses relative to controls . CONCLUSION For postgraduate nurses , daylong cancer pain education workshops were , in the group studied , as effective as hands-on experience in improving cancer pain knowledge and changing attitudes . Both the workshop-only and the enriched-model nurses relative to controls had significantly improved knowledge and changed attitudes towards optimal pain management .

cancer pain assessment and management

nurse outcomes

cancer

cancer

11 different ethnic groups

Four hundred ninety six

cancer pain assessment and management

Eighty-six


Cognitive performance and serotonergic function in users of ecstasy . RATIONALE ( +/- ) 3,4-Methylenedioxymethamphetamine ( MDMA or " ecstasy " ) has been shown to cause long term damage to serotonergic cerebral neurons in animals . The neurotoxic effects in humans are less clear and little is known about the functional consequences , although some studies suggest memory impairment . Given the widespread use of MDMA , our lack of knowledge raises concerns . OBJECTIVE We investigated , in humans , the relation between past use of ecstasy and cognitive performance as well as serotonergic function . METHODS Two groups of 21 males with moderate and heavy recreational use of MDMA , respectively , and a control group of 20 males without use of MDMA were compared . All were from the same subculture . Reaction time , direct recall , and recognition were assessed . Serotonergic function was measured by the neuro-endocrine response to a placebo-controlled , crossover challenge with dexfenfluramine . RESULTS Ecstasy users showed a broad pattern of statistically significant , but clinically small , impairment of memory and prolonged reaction times . Heavy users were affected stronger than moderate users . Release of cortisol but not of prolactin after dexfenfluramine administration was significantly reduced in both groups of ecstasy users compared with the controls . Analyses of covariance showed that likely confounding variables including recent exposure to ecstasy , psychosocial profiles and use of other drugs did not explain the differences found between the groups . CONCLUSIONS These results provide further evidence that use of ecstasy may be associated with impairment of memory and of serotonergic function . These findings are compatible with neurotoxicity of ecstasy as shown in animals .

MDMA

MDMA

MDMA

placebo-controlled

dexfenfluramine

dexfenfluramine

Cognitive performance

serotonergic function

neurotoxic effects

Reaction time , direct recall

recognition

Serotonergic function

Release of cortisol

prolactin

neurotoxicity

ecstasy

males


The effect of aging on circulating levels of proinflammatory cytokines during septic shock . Norasept II Study Investigators . BACKGROUND As the proportion of the population that is older continues to rise , infection in older people has become an important healthcare problem . Although aging is associated with multiple abnormalities in immune function , the effect of aging on the production of proinflammatory cytokines has not been well studied under conditions of clinical stress . OBJECTIVES The aim of this study was to examine the effect of aging on circulating levels of the proinflammatory cytokines in a large cohort of septic shock patients . We hypothesized that aging would be associated with a diminished proinflammatory cytokine response to sepsis . DESIGN Patients with septic shock who were enrolled in the placebo limb of the North American Sepsis Trial ( NORASEPT II ) study were analyzed . SETTING The intensive care units of 105 hospitals in the United States and Canada . PARTICIPANTS Nine hundred and thirty patients presenting to hospital within 12 hours of the onset of septic shock . MEASUREMENTS Interleukin-6 ( IL-6 ) , tumor necrosis factor-alpha ( TNF-alpha ) , soluble tumor necrosis factor-receptor-55 ( sTNF-R55 ) , and soluble tumor necrosis factor-receptor-75 ( sTNF-R75 ) concentrations were measured at enrollment . The study population was broken down into five age groups as follows : less than 50 years ( group one ) , 50 to 64 years ( group two ) , 65 to 74 years ( group three ) , 75 to 84 years ( group four ) , and 85 or older ( group five ) . Clinical , demographic , and cytokine data were extracted to describe each age group . RESULTS Data were available for 930 patients . The patients ' mean age ( +/- SD ) was 59 +/- 17 years ( range , 18 to 102 ) . There were 280 patients in group one , 242 in group two , 210 in group three , 150 in group four , and 48 in group five . The primary diagnoses ; clinical characteristics ; and IL-6 , sTNF-R55 , and sTNF-R75 levels were similar among the five age groups . The TNF-alpha levels were significantly higher , however , in the oldest group of patients ( group five ) . The 28-day survival was 49 % in patients over the age of 75 and 58 % in those under 75 years ( P = .03 ) . There was no gender difference in survival or cytokine levels . CONCLUSIONS Contrary to our expectations , we found that aging was not associated with a decline in the circulating levels of proinflammatory cytokines .

Norasept II

placebo

proinflammatory

Interleukin-6 ( IL-6

primary diagnoses

clinical characteristics

sTNF-R75 levels

TNF-alpha levels

28-day survival

gender difference

survival

cytokine levels

septic shock

older

septic shock

septic shock

Nine hundred and thirty

septic shock

less than 50 years

50 to 64 years

65 to 74 years

75 to 84 years

85 or older

59 +/- 17 years


Effect of surgical technique in subtotal and bilateral thyroidectomy on risk of postoperative parathyroid insufficiency development -- our experience . One of the postoperative complications after strumectomy is hypoparathyroidism . Therefore , the purpose of our study was to evaluate the effect of the surgical technique on the development of parathyroid gland insufficiency in our group of patients . Subtotal , bilateral strumectomies were performed according to Rothmund 's suggestions . Randomized controlled trial was performed in two groups . In the first group of 19 patients , main trunk of the inferior thyroid artery was ligated and in the second one consisting of 18 patients , only the branches of this artery were ligated . Total calcium and PTH levels were evaluated pre- and postoperatively . Based on the biochemical and clinical data , no statistically significant differences in the development of postoperative hypoparathyroidism in relation to performed surgical techniques were observed .

surgical technique

subtotal and bilateral thyroidectomy

surgical technique

bilateral strumectomies

surgical techniques

Total calcium and PTH levels

parathyroid gland insufficiency

19 patients

18 patients


Alternative voice after laryngectomy using a sound-producing voice prosthesis . OBJECTIVE To improve the voice quality of female laryngectomees and/or laryngectomees with a hypotonic pharyngoesophageal ( PE ) segment by means of a pneumatic artificial source of voice incorporated in a regular tracheoesophageal ( TE ) shunt valve . STUDY DESIGN Experimental , randomized , crossover trial . METHODS The new sound source consists of a single silicone lip , which performs an oscillatory movement driven by expired pulmonary air flowing along the outward-striking lip through the TE shunt valve . A prototype of this pneumatic sound source is evaluated in vitro and in six laryngectomees . In vivo evaluation includes speech rate , maximal phonation time , perceptual voice evaluation of read-aloud prose by an expert listener , speech intelligibility measurements with 12 listeners , and self-assessment by the patients . Moreover , extensive acoustical and aerodynamic in vivo registrations are performed using a newly developed data acquisition system . RESULTS The current prototype seems beneficial in female laryngectomees with a hypotonic PE segment only . For them the sound-producing voice prosthesis improves voice quality and increases the average pitch of voice , without decreasing intelligibility or necessitating other pressure and airflow rates than regular TE shunt speech . Pitch regulation of this prosthetic voice is possible , yet limited . CONCLUSIONS The mechanism is feasible and does not result in unacceptable airflow resistance . For this new mechanism of alaryngeal voice to become an established technique for postlaryngectomy voice restoration , a voice suitably pitched for male laryngectomees has to be generated and a large part of the melodic and dynamic range of the sound source has to be attainable within physiological airflow rates .

laryngectomy

sound-producing voice prosthesis

pneumatic sound source

sound-producing voice prosthesis

improve the voice quality

extensive acoustical and

aerodynamic in vivo registrations

feasible

laryngectomy

female

laryngectomees

six

laryngectomees

speech intelligibility measurements

female

male

laryngectomees


Beneficial effects of a soy-based dietary supplement on lipid levels and cardiovascular risk markers in type 2 diabetic subjects . OBJECTIVE Consumption of soy protein has recently been shown to improve the blood lipid levels in nondiabetic subjects . The purpose of this study was to evaluate if a dietary supplement of soy protein , isoflavones , and cotyledon fiber ( Abalon ) affects cardiovascular risk markers , blood glucose , and insulin levels in type 2 diabetic subjects . RESEARCH DESIGN AND METHODS Twenty type 2 diabetic subjects participated in a crossover trial . They were randomized to double-blind supplementation for 6 weeks with Abalon ( soy protein [ 50 g/day ] with high levels of isoflavones [ minimum 165 mg/day ] and cotyledon fiber [ 20 g/day ] ) or placebo ( casein [ 50 g/day ] and cellulose [ 20 g/day ] ) , separated by a 3-week wash-out period . RESULTS The results are expressed as means +/- SD . The percentage mean treatment difference between Abalon and placebo demonstrated significantly lower mean values after Abalon for LDL cholesterol ( 10 +/- 15 % , P < 0.05 ) , LDL/UHDL ratio ( 12 +/- 18 % , P < 0.05 ) , apolipoprotein ( apo ) B100 ( 30 +/- 38 % , P < 0.01 ) , triglycerides ( 22 +/- 10 % , P < 0.05 ) , and homocysteine ( 14 +/- 21 % , P < 0.01 ) , whereas the total cholesterol value tended to be less significant but still lower ( 8 +/- 15 % , P < 0.08 ) . No change occurred in HDL cholesterol , apo B100/apo A1 ratio , plasminogen activator inhibitor 1 , factor VIIc , von Willebrand factor , fibrinogen , lipoprotein ( a ) , glucose , HbA1c , or 24-h blood pressure . CONCLUSIONS These results indicate beneficial effects of dietary supplementation with Abalon on cardiovascular risk markers in type 2 diabetic subjects . This improvement is seen even in individuals with near-normal lipid values .

soy-based dietary supplement

soy protein

isoflavones

cotyledon fiber ( Abalon )

6 weeks with Abalon ( soy protein

isoflavones

cotyledon fiber

placebo

Abalon

placebo

Abalon

Abalon

lipid levels

cardiovascular risk markers

blood lipid levels

cardiovascular risk markers

blood glucose

insulin levels

LDL cholesterol

LDL/UHDL ratio

apolipoprotein

triglycerides

homocysteine

total cholesterol value

HDL cholesterol

apo B100/apo A1 ratio

plasminogen activator inhibitor 1

factor VIIc

von Willebrand factor

fibrinogen

lipoprotein ( a )

glucose

24-h blood pressure

cardiovascular risk markers

type 2 diabetic subjects .

Twenty

type 2 diabetic


Effect of allopurinol on myocardial oxygen free radical production in coronary bypass surgery . OBJECTIVES Allopurinol protects the heart from reperfusion injury . The aim of this study was to investigate myocardial free radical production during reperfusion with and without allopurinol treatment in coronary artery bypass grafting patients randomized into allopurinol ( n = 14 ) or placebo ( n = 13 ) groups . DESIGN Allopurinol ( 1 g ) was given blind prior to cardiopulmonary bypass and prior to opening the aorta . Oxygen free radicals were measured before anesthesia in arterial blood , before cross-clamping and 1 and 10 min after reperfusion in arterial and coronary sinus blood . Levels were measured as relative concentrations by the electron spin resonance method . RESULTS One minute after reperfusion the level of spin-trapped radicals in arterial blood was elevated significantly ( p = 0.016 ) in the allopurinol group , from 7.7 ( SE : 0.8 ) to 8.6 ( 1.4 ) and non-significantly ( p = 0.074 ) in the placebo group , from 7.3 ( 0.7 ) to 8.3 ( 0.8 ) . Ten minutes after reperfusion the arterial values were 8.6 ( 1.5 ) in the allopurinol and 7.6 ( 0.7 ) in the placebo group , the sinus values being 7.6 ( 1.3 ) and 8.3 ( 0.8 ) , respectively . Myocardial free radical production was -0.94 ( 1.21 ) in the allopurinol and +0.79 ( 0.96 ) in the placebo group after 10 min reperfusion , the difference being significant ( p = 0.043 ) . CONCLUSIONS All patients in both groups had an increasing tendency to free radical production during early reperfusion . Patients treated with allopurinol showed less myocardial production of free radicals , indicating that its protective effect may be due to its antioxidative properties .

allopurinol

Allopurinol

allopurinol

placebo

Allopurinol ( 1 g )

oxygen free radical production

myocardial free radical production

Oxygen free radicals

spin-trapped radicals in arterial blood

arterial values were

the sinus values

myocardial production of free radicals

coronary artery bypass grafting


The effect of splinting of teeth in combination with reconstructive periodontal surgery in humans . The purpose of this study was to evaluate the effect of splinting teeth on the results of periodontal reconstructive surgery using a specific carbonate bone replacement graft ( BRG ) material . Forty-five patients were randomly treated with a periodontal surgery approach . Natural coral calcium BRG was utilised in 33 patients . This 33-patient group was divided into three equal groups . In the presplint group , teeth were splinted to at least two rigid teeth before surgery , in the postsplint group , teeth were splinted at suture removal , and in the nonsplint group , the treated teeth were not splinted at all . In 12 patients , teeth were treated with surgical debridement ( DEBR ) alone and not splinted . Periodontal probing depth ( PPD ) , clinical probing attachment level ( CPAL ) , and tooth mobility were measured using desmodontometry ( DDM ) and periotest ( PTV ) with reproducible methods before surgery and at various periods up to 1 year afterwards . A decrease in PPD ( 5.4 mm , SD 1.4 mm ) and tooth mobility ( DDM-horizontal 257 microns , SD 60 microns ) and a gain of CPAL ( 5.1 mm , SD 1.4 mm ) were seen following the use of BRG in presplint teeth . In the same group , PPD and tooth mobility were significantly reduced compared to nonsplint teeth . DEBR alone showed reductions in tooth mobility and PPD and a significantly smaller gain in CPAL than in presplint teeth treated with BRG . The less favourable improvement in periodontal function of postsplint or nonsplint teeth seemed to be due to the loss of BRG material caused by tooth mobility . These results indicate that an undisturbed wound healing process using BRG together with tooth stability is beneficial to overall clinical success .

splinting of teeth

reconstructive periodontal surgery

splinting teeth

periodontal reconstructive surgery

periodontal surgery

splinted at suture removal

treated teeth were not splinted at all

decrease in PPD

tooth mobility

gain of CPAL

PPD

tooth mobility

tooth mobility

PPD

CPAL

loss of BRG material

tooth mobility

overall clinical success .

reconstructive periodontal surgery

humans

Forty-five

periodontal surgery


Simplified subjective workload assessment technique . Although the subjective workload assessment technique ( SWAT ) has been widely used , it has two main problems : it is not very sensitive for low mental workloads and it requires a time-consuming card sorting pretask procedure . In this study are presented five variations of SWAT in an effort to overcome the limitations . Four of the variants used the continuous SWAT subscales while one used the discrete SWAT subscale . Fifteen subjects participated in the experiment . The scales were compared with the original SWAT scale in terms of sensitivity and pretask procedure completion time when performing arithmetic tasks . The results show that all four variants are more sensitive than the conventional SWAT scale and that the pairwise comparison procedure takes significantly less pretask completion time compared with the original SWAT scale . Thus , the conventional pretask procedure can be replaced by a simple unweighted averaging to yield a scale of high sensitivity .

five variations of SWAT

continuous SWAT subscales

discrete SWAT subscale .

SWAT

conventional SWAT scale

original SWAT scale .

conventional pretask procedure

sensitivity

sensitive

conventional SWAT scale

pretask completion time

Fifteen


Effect of acarbose on additional insulin therapy in type 2 diabetic patients with late failure of sulphonylurea therapy . AIM The present study investigated the effect of acarbose on insulin requirements and glycaemic control in patients with type 2 diabetes receiving exogenous insulin due to secondary failure of maximum dose sulphonylurea therapy . METHODS A single-centre , double-blind , randomized , placebo-controlled study was performed in 48 type 2 diabetic patients with late-term failure following at least 3 years of sulphonylurea therapy requiring additional insulin therapy to determine the impact of acarbose on glycaemic control and insulin requirements . The primary end points were glycaemic response rate ( responders being predefined as patients who achieve a decrease in HbA1c to less than 8 % or a reduction by at least 15 % as compared to the baseline values ) and the daily insulin dose at 6 months . Secondary parameters assessed included postprandial changes in blood glucose , serum insulin and C-peptide during the treatment period . RESULTS There were significantly more responders in the acarbose-treated group compared with the placebo group ( 20/24 patients vs. 10/19 patients ; p < 0.05 ) . The mean daily insulin dose after 24 weeks of treatment was 16.4 +/- 10.1 IU in the acarbose group and 22.4 +/- 12.2 IU in the placebo group ( mean +/- s.d . ; p < 0.07 ) . Postprandial increases in blood glucose , insulin and C-peptide were consistently lower in the acarbose-treated group than in the placebo group . For example , the mean increase in 2-h postprandial serum insulin remained almost unchanged in the acarbose group at the end of 24 weeks of treatment compared to an increase to 43 +/- 29 microU/ml ( mean +/- s.d . ) at the end of the study period for the placebo group . CONCLUSIONS The findings of this study suggest that the addition of acarbose to sulphonylurea/insulin combination therapy can improve glycaemic control in type 2 diabetic patients . Acarbose may also reduce insulin resistance and hyperinsulinaemia .

acarbose

insulin therapy

acarbose

insulin

placebo-controlled

sulphonylurea

insulin

acarbose

insulin

insulin

insulin

acarbose

placebo

placebo

insulin

placebo

acarbose

sulphonylurea/insulin

Acarbose

insulin requirements

glycaemic control

glycaemic response rate

daily insulin dose

mean daily insulin dose

Postprandial increases in blood glucose

insulin

C-peptide

glycaemic control

type 2 diabetic

late failure

sulphonylurea therapy

type 2 diabetes

exogenous insulin

failure

sulphonylurea therapy

type 2 diabetic

late-term failure

sulphonylurea therapy

insulin therapy

type 2 diabetic


Phase-dependent modulation of the soleus H-reflex during rhythmical arm swing in humans . The purpose of this study is to investigate modulation of the soleus H-reflex during rhythmic arm swing in humans . Significant depression of the soleus H-reflex was observed when subjects swung their ipsilateral arms or both arms reciprocally during testing . The degree of soleus H-reflex depression appeared directly proportional to the speed of the arm swing . This depression was observed in the conditioning-testing intervals of 400 , 500 , and 600 msec during the ipsilateral backward arm swing and at the onset of the ipsilateral arm forward swing . This phase of depression partially overlapped the phase of depression of the soleus H-reflex during walking . However , the pattern of modulation during arm swing was not exactly the same as that during walking . Therefore , we concluded that the ipsilateral arm swing may partially affect the depression of the soleus H-reflex during the arm swing phase of walking but is not responsible for depression of the soleus H-reflex throughout the entire walking cycle .

rhythmical arm swing

soleus H-reflex

rhythmic arm swing

soleus H-reflex

ipsilateral backward arm swing

ipsilateral arm forward swing

ipsilateral arm swing

soleus H-reflex

modulation of the soleus H-reflex

H-reflex

soleus H-reflex depression

depression

depression

depression of the soleus H-reflex

arm swing

arm swing

ipsilateral


Comparison of provocative tests for unexplained syncope : isoprenaline and glyceryl trinitrate for diagnosing vasovagal syncope . AIMS To compare the sensitivity , specificity and adverse event profile of glyceryl trinitrate head-up tilt with isoprenaline head-up tilt in the diagnosis of vasovagal syncope in patients with unexplained syncope and healthy controls . METHODS AND RESULTS Forty-eight patients with unexplained syncope and negative passive head-up tilt at 70 degrees for 40 min , and 14 healthy controls underwent glyceryl trinitrate head-up tilt and isoprenaline head-up tilt ( maximum dose 5 microg x min ( -1 ) ) one week apart in random order . Outcome measures were production of symptoms ( syncope , pre-syncope ) with development of hypotension . In those with negative passive head-up tilt , the sensitivity of glyceryl trinitrate for diagnosing vasovagal syncope was 48 % and the specificity was 71 % . Glyceryl trinitrate was well tolerated . Isoprenaline sensitivity was 21 % with specificity 64 % . Side-effects prevented completion of the test in 68 % . Commonest adverse events were the development of hypertension or tachycardia and intolerable flushing or nausea . CONCLUSIONS Glyceryl trinitrate head-up tilt is as effective as isoprenaline head-up tilt as a provocative agent for vasovagal syncope and has a lower incidence of adverse events .

isoprenaline

glyceryl trinitrate

glyceryl trinitrate

isoprenaline

glyceryl trinitrate head-up tilt

isoprenaline head-up tilt

glyceryl trinitrate

Isoprenaline

Glyceryl trinitrate head-up tilt

isoprenaline head-up tilt

vasovagal syncope .

sensitivity of glyceryl trinitrate

vasovagal syncope

tolerated

Isoprenaline sensitivity

Side-effects

development of hypertension

or

tachycardia

and

intolerable flushing

or

nausea

effective


Effect of protein ingestion on the glucose appearance rate in people with type 2 diabetes . Amino acids derived from ingested protein are potential substrates for gluconeogenesis . However , several laboratories have reported that protein ingestion does not result in an increase in the circulating glucose concentration in people with or without type 2 diabetes . The reason for this has remained unclear . In people without diabetes it seems to be due to less glucose being produced and entering the circulation than the calculated theoretical amount . Therefore , we were interested in determining whether this also was the case in people with type 2 diabetes . Ten male subjects with untreated type 2 diabetes were given , in random sequence , 50 g protein in the form of very lean beef or only water at 0800 h and studied over the subsequent 8 h. Protein ingestion resulted in an increase in circulating insulin , C-peptide , glucagon , alpha amino and urea nitrogen , and triglycerides ; a decrease in nonesterified fatty acids ; and a modest increase in respiratory quotient . The total amount of protein deaminated and the amino groups incorporated into urea was calculated to be approximately 20-23 g. The net amount of glucose estimated to be produced , based on the quantity of amino acids deaminated , was approximately 11-13 g. However , the amount of glucose appearing in the circulation was only approximately 2 g. The peripheral plasma glucose concentration decreased by approximately 1 mM after ingestion of either protein or water , confirming that ingested protein does not result in a net increase in glucose concentration , and results in only a modest increase in the rate of glucose disappearance .

protein ingestion

50 g

protein

in the form of very lean beef

only water

Protein

glucose appearance rate

circulating glucose concentration

circulating insulin

C-peptide

glucagon

alpha amino and urea nitrogen

triglycerides

nonesterified fatty acids

respiratory quotient

glucose

peripheral plasma glucose concentration

glucose concentration

rate of glucose disappearance

people with type 2 diabetes .

type 2 diabetes .

Ten


Work-related stress and early atherosclerosis . The purpose of this study was to examine the link between work-related stress and early atherosclerosis as measured by common carotid artery intima-media thickness and focal lesions in the common carotid artery and bifurcation . Four hundred sixty-seven members of an occupational cohort ( total N = 573 ) were examined via questionnaires and B-mode ultrasound . We used multiple linear and logistic models to regress lesion risk and intima-media thickness on work-related stress scores from a questionnaire administered at an 18-month follow-up examination . In an age-adjusted model , the prevalence of carotid lesions among men scoring in the highest stress quintile was 36 % compared with 21 % among men in the lowest quintile . We also observed an increase in intima-media thickness in the highest quintile relative to the lowest ( difference = 0.048 +/- 0.025 mm ) among men . Among women , stress was not related to the prevalence of lesions or intima-media thickness . These findings suggest that men with greater work-related stress are at increased risk for atherosclerotic disease . Women in this age group may be protected from such effects , or current work-place questionnaires may not accurately assess stress in women .

questionnaires

B-mode ultrasound

work-related stress scores

prevalence of carotid lesions

intima-media thickness

stress

work-related stress

atherosclerotic disease

early atherosclerosis

Four hundred sixty-seven

women ,

men

work-related stress


Sun protection behaviors and stages of change for the primary prevention of skin cancers among beachgoers in southeastern New England . Sun exposure is the most important avoidable cause of skin cancers . We report characteristics of a representative sample ( N = 2,324 ) of beachgoers in Southeastern New England during the summer of 1995 . This sample was not employing adequate sun protection behaviors ( 83 % did not often avoid the sun during midday and only 45 % often used sunscreen ) . Important demographic and skin cancer risk factor differences in sun protective behaviors and stages of change for sun protection were found , especially differences based on age , gender , and degree of sun sensitivity . Consistent with previous research , increased age , female gender , and greater sun sensitivity were each independently associated with more sun protective behaviors . These findings underscore the need for interventions targeting high-risk populations , such as those receiving high-intensity sun exposures at the beach .

Sun protection behaviors

sun protection behaviors

avoid the sun during midday

sunscreen

sun protective behaviors

sun protective behaviors

skin cancers


RAB-plate versus sliding hip screw for unstable trochanteric hip fractures : stability of the fixation and modes of failure -- radiographic analysis of 218 fractures . BACKGROUND The sliding hip screw has gained considerable acceptance in the treatment of unstable trochanteric fractures . However , the new type of 120 degrees fixed angle blade-plate with a buttress rod ( RAB-plate ) showed encouraging clinical results . The purpose of this study was to assess stability of fixation and analyze modes of failure in unstable trochanteric hip fractures treated with these devices . METHODS A retrospective radiographic review of 218 unstable fractures was performed . Linear and angular displacements of the major fragments and implant migration into the femoral head during healing were assessed . Additionally , adequacy of the reduction and the location of the implant within the femoral head as predictors of fixation failure were evaluated . RESULTS The postreduction neck-shaft angle was maintained in the majority of the fractures in both groups . However , there was a significantly higher incidence of varus angulation by 10 degrees or more by the completion of healing among fractures treated with the sliding hip screw ( p = 0.04 ) . There was no statistically significant difference in vertical migration of the device into the femoral head between the implants used ( p = 0.3 ) . There was a significant relationship between failure of the fixation and varus reduction ( p = 0.04 ) as well as screw/neck angle deviation more than 20 degrees in the lateral projection ( p = 0.005 ) or if the implant was in a superior or posterior position ( p = 0.02 ) . CONCLUSION The RAB-plate provided a more stable fixation , especially with regard to maintained postoperative alignment . However , positive predictors for fixation failure were identical for both devices . Here , the screw/neck angle deviation has had the strongest significance for prediction of fixation failure .

RAB-plate

sliding hip screw

sliding hip screw

sliding hip screw

RAB-plate

implant migration into the femoral head

fixation failure


A single-center open label randomized trial of the safety and efficacy of the use of sirolimus versus azathioprine in one-haplotype living related kidney transplant recipients-preliminary results .

sirolimus versus azathioprine

safety and efficacy


Oral rizatriptan versus oral sumatriptan : a direct comparative study in the acute treatment of migraine . Rizatriptan 030 Study Group . Rizatriptan is a potent , oral , 5-HT1B/1D agonist with more rapid absorption and higher bioavailability than oral sumatriptan . It was postulated that this would result in more rapid onset of effect . This randomized , double-blind , triple-dummy , parallel-groups study compared rizatriptan 5 mg , rizatriptan 10 mg , sumatriptan 100 mg , and placebo in 1268 outpatients treating a single migraine attack . Headache relief rates after rizatriptan 10 mg were consistently higher than sumatriptan at all time points up to 2 hours , with significance at 1 hour ( 37 % versus 28 % , P = 0.010 ) . All active agents were significantly superior to placebo with regard to headache relief and pain freedom at 2 hours ( P < or = 0.001 ) . The primary efficacy endpoint of time to pain relief through 2 hours demonstrated that , after adjustment for age imbalance , rizatriptan 10 mg had earlier onset than sumatriptan 100 mg ( P = 0.032 ; hazard ratio 1.21 ) . Rizatriptan 10 mg was also superior to sumatriptan on pain-free response ( P = 0.032 ) , reduction in functional disability ( P = 0.015 ) , and relief of nausea at 2 hours ( P = 0.010 ) . Significantly fewer drug-related clinical adverse events were reported after rizatriptan 10 mg ( 33 % , P = 0.014 ) compared with sumatriptan 100 mg ( 41 % ) . We conclude that rizatriptan 10 mg has a rapid onset of action and relieves headache and associated symptoms more effectively than sumatriptan 100 mg .

placebo

Headache relief rates

headache relief

pain freedom

time to pain relief through 2

reduction in functional disability

relief of nausea

drug-related clinical adverse events

acute treatment of migraine .


Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program . OBJECTIVE The objective of this secondary analysis was to examine the relationships between a reduction in psychological distress and long-term cardiac and psychological outcomes in post-myocardial infarction patients who participated in a randomized trial of home-based psychosocial nursing interventions ( the Montreal Heart Attack Readjustment Trial [ M-HART ] ) . Gender differences were considered . METHODS We studied 433 patients ( 36.0 % women ) from the M-HART treatment group who received two home visits after achieving a high psychological distress score ( ie , > or =5 ) on the General Health Questionnaire ( GHQ ) . Short-term GHQ success was determined by a return to a normal GHQ score ( < 5 ) or a reduction of > or =50 % after the two visits . Patients with short-term successful and unsuccessful GHQ outcomes were compared for mid-term maintenance of success , 1-year death and readmission rates , and 1-year depression and anxiety symptoms . RESULTS Patients with short-term GHQ success were more likely to show mid-term GHQ success ( p < .001 ) , marginally less likely to die of any causes ( p = .087 ) , less likely to die of cardiac causes ( p = .043 ) , less likely to be readmitted for any reason ( p < .001 ) and for cardiac reasons ( p < .001 ) , and less likely to have high depression ( p < .001 ) and anxiety ( p < .001 ) at 1-year than patients with short-term unsuccessful GHQ outcomes . Results held for men and women and were not altered by controlling for potential confounders . However , the number of deaths prevented analysis with statistical controls . CONCLUSIONS Post-myocardial infarction interventions that reduce psychological distress have the potential to improve long-term prognosis and psychological status for both men and women .

psychosocial intervention program

GHQ success

GHQ score

mid-term GHQ success

die of any causes

die of cardiac causes

readmitted

high

depression

anxiety

GHQ outcomes

deaths

long-term prognosis

psychological status

psychosocial intervention program

post-myocardial infarction

Montreal Heart Attack

women

men

women

men

women


Central nervous system serotonin function and cardiovascular responses to stress . OBJECTIVE The objective of this study was to evaluate the impact of indices of central nervous system ( CNS ) serotonin function on cardiovascular reactivity to mental stress . METHODS Lumbar puncture was performed on 54 healthy volunteers to obtain cerebrospinal fluid ( CSF ) for determination of 5-hydroxyindoleacetic acid ( 5HIAA ) levels . Genotypes were determined with respect to a functional polymorphism of the serotonin transporter gene promoter region ( 5HTTLPR ) . Subjects then underwent mental stress testing . RESULTS Persons with one or two long ( l ) 5HTTLPR alleles had CSF levels of the major serotonin metabolite , 5HIAA , that were 50 % higher than those of persons with the s/s 5HTTLPR genotype . Persons with one or two l alleles or higher CSF 5HIAA levels also exhibited greater blood pressure and heart rate responses to a mental stress protocol . CONCLUSIONS These findings suggest the 5HTTLPR polymorphism affects CNS serotonin function , and they are consistent with the general hypothesis that CNS serotonin function is involved in the regulation of potentially health-damaging biobehavioral characteristics . In particular , the l allele could contribute , through its association with increased cardiovascular reactivity to stress , to increased risk of cardiovascular disease .

Lumbar puncture

cardiovascular responses

cardiovascular reactivity

CSF levels

CSF 5HIAA levels

blood pressure and heart rate responses

cardiovascular reactivity

5HTTLPR alleles

5HTTLPR genotype


Interferential therapy electrode placement technique in acute low back pain : a preliminary investigation . OBJECTIVE To determine the efficacy of interferential therapy ( IFT ) electrode placement technique compared with a control treatment in subjects with acute low back pain ( LBP ) . DESIGN Single-blind , randomized , controlled trial with a 3-month follow-up . SETTING Outpatient physiotherapy departments in hospital and university settings . PATIENTS A random sample of 60 eligible patients with back pain ( 28 men , 32 women ) were recruited by general practitioners and self-referral for physiotherapy treatment and randomly assigned to 1 of 3 groups . INTERVENTIONS ( 1 ) " IFT painful area " and The Back Book , ( 2 ) " IFT spinal nerve " and The Back Book , and ( 3 ) " Control , " The Back Book only . Standardized IFT stimulation parameters were used : carrier frequency 3.85 kHz ; 140 Hz constant ; pulse duration 130 micros ; 30 minutes ' duration . MAIN OUTCOME MEASURES Pain Rating Index , Roland-Morris Disability Questionnaire ( RMDQ ) , and EuroQol were completed by subjects pretreatment , at discharge , and 3-month follow-up . RESULTS All groups had significant improvements in all outcomes at follow-up . Subjects managed by IFT spinal nerve and The Back Book displayed both a statistically significant ( p = .030 ) and clinically meaningful reduction in functional disability ( RMDQ ) , compared with management via IFT painful area and The Back Book combined or The Back Book alone . CONCLUSIONS The findings showed that IFT electrode placement technique affects LBP-specific functional disability , providing preliminary implications for future clinical studies .

control treatment

IFT painful area " and The Back Book

" IFT spinal nerve "

and

The Back Book

" Control , " The Back Book

IFT

IFT electrode placement technique

acute low back pain :


Double-blind placebo-controlled administration of fluoxetine in restricting- and restricting-purging-type anorexia nervosa . BACKGROUND Anorexia nervosa is an often chronic disorder with high morbidity and mortality . Many people relapse after weight restoration . This study was designed to determine whether a selective serotonin reuptake inhibitor would improve outcome and reduce relapse after weight restoration by contributing to maintenance of a healthy normal weight and a reduction of symptoms . METHODS We administered a double-blind placebo-controlled trial of fluoxetine to 35 patients with restricting-type anorexia nervosa . Anorexics were randomly assigned to fluoxetine ( n = 16 ) or a placebo ( n = 19 ) after inpatient weight gain and then were observed as outpatients for 1 year . RESULTS Ten of 16 ( 63 % ) subjects remained on fluoxetine for a year , whereas only three of 19 ( 16 % ) remained on the placebo for a year ( p =.006 ) . Those subjects remaining on fluoxetine for a year had reduced relapse as determined by a significant increase in weight and reduction in symptoms . CONCLUSIONS This study offers preliminary evidence that fluoxetine may be useful in improving outcome and preventing relapse of patients with anorexia nervosa after weight restoration .

placebo-controlled

fluoxetine

selective serotonin reuptake inhibitor

placebo-controlled

fluoxetine

fluoxetine

placebo

fluoxetine

placebo

fluoxetine

fluoxetine

reduced relapse

relapse

patients with anorexia nervosa


Effectiveness of the school dental screening programme in stimulating dental attendance for children in need of treatment in Northern Ireland . UNLABELLED The school dental screening programme has been in existence from the beginning of the 20th century yet its value in encouraging attendance among children with a dental health need is not fully established . OBJECTIVE To evaluate the effectiveness of school dental screening in promoting dental attendance among children with a treatment need and to examine the relative importance of screening , social class and other factors in dental attendance . METHODS Sixty-four participating schools were assigned to study and control groups using a stratified , blocked randomisation technique . The study group children received the standard school dental screening and the dental attendance of those with a positive screening result was assessed after 2 months by means of a questionnaire issued to the children 's parents . The control group children were not , at this stage , screened , yet their parents received the same questionnaire assessing dental attendance over the 2-month period . However , only questionnaires from control group children who had a positive result at a subsequent screening were retained for analysis . RESULTS A total of 2,321 children were screened , with 980 having a positive result . The mean dmft of those screening positive was 4.85 . In all , 664 completed questionnaires were returned , giving a response rate of 67.8 % . Dental attendance was reported among 45.5 % of the study group ( n=352 ) in the 2 months following screening . In the same period , 27.6 % of the control group ( n=312 ) claimed attendance . The effect was found to be significant among the high employed group ( P < 0.01 ) and the unemployed group ( P < 0.05 ) . CONCLUSION School dental screening was capable of stimulating dental attendance . The strong effect among the lowest socio-economic group shows that school dental screening may be used to decrease dental health inequalities .

school dental screening programme

school dental screening

standard school dental screening

Effectiveness

stimulating dental attendance

dental attendance

dental attendance

dental attendance

dental attendance

Dental attendance

dental attendance

dental health inequalities

children

dental health

children

Sixty-four

2,321 children


Psychosocial nursing therapy following sudden cardiac arrest : impact on two-year survival . BACKGROUND Although psychosocial therapy has been shown to reduce mortality after myocardial infarction , it is unknown whether the benefits of psychosocial therapy on mortality reduction extend to out-of-hospital sudden cardiac arrest , a main cause of cardiovascular mortality . OBJECTIVE Describe efficacy of psychosocial therapy on two-year cardiovascular mortality in sudden cardiac arrest survivors . METHOD Survivors of out-of-hospital ventricular fibrillation or asystole ( N = 129 ) , documented by electrocardiograms from registries of a citywide Medic One unit and two countywide emergency units , were randomized into a two group , experimental , longitudinal design . The intervention consisted of 11 individual sessions , implementing three components : physiologic relaxation with biofeedback training focused on altering autonomic tone ; cognitive behavioral therapy aimed at self-management and coping strategies for depression , anxiety , and anger ; and cardiovascular health education . The primary outcome measure was cardiovascular mortality . RESULTS Risk of cardiovascular death was significantly reduced 86 % by psychosocial therapy , p = .03 . Six of the seven cardiovascular deaths in the control group were caused by ventricular arrhythmias . The cardiovascular death in the therapy group was due to stroke . Controlling for depression , previous myocardial infarction , low ejection fraction , decreased heart rate variability , and ventricular ectopic beats had little impact on estimated treatment effect . The risk of all-cause mortality was reduced by 62 % in the therapy group , p = .13 . There were a total of three deaths in the therapy group and eight deaths in the control group . CONCLUSIONS Psychosocial therapy significantly reduced the risk of cardiovascular death in sudden cardiac arrest survivors .

Psychosocial nursing therapy

psychosocial therapy

psychosocial therapy

psychosocial therapy

cognitive behavioral therapy

control

Psychosocial therapy

two-year survival

mortality

mortality reduction

cardiovascular mortality

cardiovascular mortality

cardiovascular mortality

Risk of cardiovascular death

cardiovascular deaths

The cardiovascular death

risk of all-cause mortality

deaths

deaths

cardiovascular death

following sudden cardiac arrest :

sudden cardiac arrest survivors .


Effectiveness of N , N-dimethylglycine in autism and pervasive developmental disorder . N , N-dimethylglycine , a dietary supplement , has been reported to be beneficial in children with autism and pervasive developmental disorder . We examined the effectiveness of dimethylglycine in children with autism and pervasive developmental disorder in a double-blind , placebo-controlled study . Thirty-seven children between 3 and 11 years of age with a diagnosis of autism and/or pervasive developmental disorder were gender and age matched and randomly assigned to receive either placebo or dimethylglycine for 4 weeks . All children were assessed before and after treatment on two behavioral measures , the Vineland Maladaptive Behavior Domain and the Aberrant Behavior Checklist . Standardized neurologic examinations before and after treatment on 33 children showed no change . An overall improvement on all behavioral measures was observed for both the placebo and the dimethylglycine groups . However , the improvement among the children who received dimethylglycine was not statistically different from the improvement observed among the children who received the placebo . The children who participated in this study were a heterogeneous group , and their apparent responses to the dimethylglycine varied . Some children appeared to respond positively to the dimethylglycine , and there was a smaller proportion of negative changes in the dimethylglycine group , but the quantitative changes in the dimethylglycine behavioral assessments were not significantly different from what was observed among children who received placebo .

N , N-dimethylglycine

receive either placebo

dimethylglycine for 4 weeks

Effectiveness

Vineland Maladaptive Behavior Domain

Aberrant Behavior Checklist

behavioral measures


Children with persistent conduct problems who dropout of treatment . Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service . We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service , using a prospective design . The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach . The overall dropout rate was 36 % . Dropout occurred significantly less frequently in the CBT group . The dropout group was associated with mothers who were younger and less educated , a poorer rating by the clinicians at the last meeting , parental dissatisfaction with the treatment service and perception that the treatment was less organised and having less behavioural tasks . In the second study we used a naturalistic follow-up design . Forty-six children were included . The overall dropout rate was 48 % . Again , the children who defaulted were rated by clinicians as less likely to have improved and dropout was also significantly associated with parental perception of a less organised treatment . In both studies dropout usually occurred after assessment and at the early phase of treatment .

CBT

naturalistic follow-up

Dropout

dropout rate of children

overall dropout rate

Dropout

overall dropout rate

dropout

Children

Forty-six


Double hearing protection and speech intelligibility-room for improvement . INTRODUCTION Double hearing protection is used in many air forces around the world for protection in noisy aircraft environments , particularly in helicopters . The usual combination is foam ear plugs under headset or helmet muffs . Much of the research that spurred the introduction of foam earplugs indicated little change in speech intelligibility in persons with normal hearing . However , aircrew often complain about having to maximize intercom volume for speech understanding , causing a situation with no reserve volume and bad sound quality . In recent years , further developments have included so-called hi-fi plugs and custom made ear plugs which are claimed to improve speech communication . The aim of the present project was to investigate different types of ear plugs and their effect on speech intelligibility in helicopter noise . METHODS Each of nine normal-hearing pilot subjects were placed in an environment of recorded helicopter noise from a BO-105 helicopter . Speech audiometry was performed under four different conditions : headset only , and three different ear plugs worn under the headset . Fitting of the ear plugs was performed by an ear , nose and throat specialist to ensure similar conditions . The sequence of test conditions was randomized and double-blind . In addition , a subjective rating scale was used . RESULTS Wearing foam ear plugs under the headset decreased speech intelligibility dramatically . The " hi-fi " plug was somewhat better than foam plugs , and the custom made ear plug provided a speech intelligibility close to the headset-only situation . Subjective rating scores coincided with these findings . DISCUSSION In helicopter noise , custom made ear plugs may provide a much improved speech intelligibility over conventional plugs when worn under a headset , while maintaining improved noise protection over the headset-alone situation . Custom made ear plugs might therefore be a good alternative to other forms of enhanced noise protection in helicopters .

subjective rating scale

speech intelligibility

speech intelligibility

Subjective rating scores

speech intelligibility

noise protection

enhanced noise protection


Variability in isochronous tapping : higher order dependencies as a function of intertap interval . Isochronous serial interval production ( ISIP ) data , as from unpaced finger tapping , exhibit higher order dependencies ( drift ) . This fact has largely been ignored by the timing literature , one reason probably being that influential timing models assume random variability . Men and women , 22-36 years old , performed a synchronization-continuation task with intertap intervals ( ITI ) from 0.4 s to 2.2 s. ISIP variability was partitioned into components attributable to drift and 1st-order serial correlation , and the results indicate that ( a ) drift contributes substantially to the dispersion for longer ITIs , ( b ) drift and 1st-order correlation are different functions of the ITI , and ( c ) drift exhibits break close to 1.0 s and 1.4 s ITI . These breaks correspond to qualitative changes in performance for other temporal tasks , which suggests common timing processes across modalities and tasks .

isochronous tapping

unpaced finger tapping

isochronous tapping

Men

women

22-36 years


Physiologic modeling of the intravenous glucose tolerance test in type 2 diabetes : a new approach to the insulin compartment . The minimal model of Bergman et al has been used to yield estimates of insulin sensitivity ( Si ) and glucose effectiveness ( Sg ) in type 2 diabetes by incorporating exogenous insulin protocols into the regular intravenous glucose tolerance test ( IVGTT ) . These estimates , however , are influenced by the degree to which the dose of exogenous insulin is greater than the physiologic response to a glucose load . Moreover , most studies have related to type 2 diabetes subjects whose diabetes was relatively mild in terms of therapeutic requirements . To develop a " minimal disturbance " approach in estimating Si and Sg in type 2 diabetes , we have used a reduced glucose load ( 200 mg/kg ) and a " physiologic " insulin infusion throughout the IVGTT in a series of 8 patients , 5 of whom were insulin-requiring . Data from this approach were analyzed using the modelling program CONSAM to apply the Bergman model , either unmodified ( BMM ) , or incorporating an additional delay element between the plasma and " remote " insulin compartments ( MMD ) . Application of the MMD and extension of the IVGTT from 3 to 5 hours improved successful resolution of Si and Sg from 37.5 % ( BMM , 3-hour IVGTT ) to 100 % ( MMD , 5-hour IVGTT ) . Si was reduced in these type 2 diabetes patients compared with normal subjects ( 1.86 +/- 0.60 v. 8.65 +/- 2.27 min ( -1 ) x microU ( -1 ) x mL x 10 ( 4 ) P < .01 ) . The results were validated in the type 2 diabetes group using a 2-stage euglycemic clamp ( ( Si ) CLAMP = 2.02 +/- 0.42 min ( -1 ) x microU ( -1 ) x mL x 10 ( 4 ) P > .4 ) . Sg was not significantly reduced ( 2.00 +/- 0.25 type 2 diabetes v. 1.55 +/- 0.26 normal min ( -1 ) x 10 ( 2 ) ) . Data from a group of normal nondiabetic subjects was then analyzed using the MMD , but this approach did not enhance the fit of the model compared with the BMM . This result indicates that the delay in insulin action in type 2 diabetes represents an abnormality whereby the onset of insulin action can not be described as a single phase in the transfer of insulin from plasma to the remote compartment . It is postulated that the physiologic basis for this delayed action may relate to transcapillary endothelial transfer of insulin , this process limiting the rate of onset of insulin action .

exogenous insulin protocols

exogenous insulin

reduced glucose load

" physiologic " insulin infusion

intravenous glucose tolerance test

insulin sensitivity ( Si )

glucose effectiveness ( Sg )

Si

Sg

resolution of Si and Sg

Si

Sg

type 2 diabetes :

type 2 diabetes subjects


A pharmacy discharge plan for hospitalized elderly patients -- a randomized controlled trial . OBJECTIVES to investigate the effectiveness of a pharmacy discharge plan in elderly hospitalized patients . DESIGN randomized controlled trial . SUBJECTS AND SETTINGS we randomized patients aged 75 years and older on four or more medicines who had been discharged from three acute general and one long-stay hospital to a pharmacy intervention or usual care . INTERVENTIONS the hospital pharmacist developed discharge plans which gave details of medication and support required by the patient . A copy was given to the patient and to all relevant professionals and carers . This was followed by a domiciliary assessment by a community pharmacist . In the control group , patients were discharged from hospital following standard procedures that included a discharge letter to the general practitioner listing current medications . OUTCOMES the primary outcome was re-admission to hospital within 6 months . Secondary outcomes included the number of deaths , attendance at hospital outpatient clinics and general practice and proportion of days in hospital over the follow-up period , together with patients ' general well-being , satisfaction with the service and knowledge of and adherence to prescribed medication . RESULTS we recruited 362 patients , of whom 181 were randomized to each group . We collected hospital and general practice data on at least 91 and 72 % of patients respectively at each follow-up point and interviewed between 43 and 90 % of the study subjects . There were no significant differences between the groups in the proportion of patients re-admitted to hospital between baseline and 3 months or 3 and 6 months . There were no significant differences in any of the secondary outcomes . CONCLUSIONS we found no evidence to suggest that the co-ordinated hospital and community pharmacy care discharge plans in elderly patients in this study influence outcomes .

pharmacy discharge plan

pharmacy discharge

community pharmacy care discharge plans

number of deaths

general well-being

satisfaction with the service

knowledge

adherence to prescribed medication

elderly patients

elderly

75 years and older

362 patients

181 were randomized to each group

at least 91

72 % of patients

between 43

90 % of the study subjects


Comparative evaluation of calcium hydroxide and zinc oxide eugenol as root canal filling materials for primary molars : a clinical and radiographic study . Calcium hydroxide , a material widely used for the treatment of permanent teeth has not been used frequently for pulpectomy in primary teeth . A comparative evaluation of calcium hydroxide and zinc oxide eugenol used as root canal filling materials in primary molars is presented .

calcium hydroxide

zinc oxide eugenol

root canal filling

Calcium hydroxide

calcium hydroxide

zinc oxide eugenol

root canal filling materials

root canal filling materials

root canal filling materials

root canal filling

primary molars

primary molars


A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care : an urban versus rural perspective . A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas . One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s . Over two years , 274 patients required a hospital outpatient dermatology referral -- 126 patients ( 46 % ) were randomized to a telemedicine consultation and 148 ( 54 % ) to a conventional hospital outpatient consultation . Of those seen by telemedicine , 61 % were registered with an urban practice , compared with 71 % of those seen conventionally . The clinical outcomes of the two types of consultation were similar -- almost half the patients were managed after a single consultation with the dermatologist . The observed marginal cost per patient of the initial realtime teledermatology consultation was 52.85 Pounds for those in urban areas and 59.93 Pounds per patient for those from rural areas . The observed marginal cost of the initial conventional consultation was 47.13 Pounds for urban patients and 48.77 Pounds for rural patients . The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas , mainly because of the fixed equipment costs . Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal , while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation .

realtime teledermatology

conventional care

realtime teledermatology

telemedicine consultation

telemedicine

conventionally

realtime teledermatology consultation

conventional consultation

teledermatology

conventional care

telemedicine

conventional consultations

telemedicine consultation

conventional consultation

clinical outcomes

consultation

observed marginal cost per patient

observed marginal cost

total observed costs

average costs


Repeated doses of porcine secretin in the treatment of autism : a randomized , placebo-controlled trial . BACKGROUND AND OBJECTIVES Anecdotal reports on the efficacy of secretin in autism raised great hopes for the treatment of children with this disorder . Initial single-dose , randomized , controlled trials failed to demonstrate any therapeutic effects of secretin . The present study is the first to test the outcome of repeated doses and to examine whether there is a subgroup of children who are more likely to achieve positive effects . METHOD Sixty-four children with autism ( ages 2-7 years ; 55 boys and 9 girls ) with a range of intelligence quotient and verbal ability were randomly assigned , in a double-blind manner , to secretin or placebo groups . Children received 2 doses of placebo or porcine secretin , 6 weeks apart . Assessments were performed at baseline and 3 weeks after each injection using several outcome measures . RESULTS There were no group differences on formal measures of language , cognition , or autistic symptomatology . Subgroupings based on cognitive level , the presence or absence of diarrhea , or a history of regression failed to show any significant therapeutic effects of secretin . CONCLUSION No evidence is provided for the efficacy of repeated doses of porcine secretin in the treatment of children with autism . The possible relationship between relief of biological symptoms and enhanced skill performance is discussed .

porcine secretin

secretin

secretin

secretin

placebo

placebo

porcine secretin

secretin

porcine secretin

cognitive level

presence or absence of diarrhea

regression

efficacy

biological symptoms

skill performance

autism

children

Sixty-four

boys

girls


Comments on " Comparison of gastrointestinal tolerance feeding proctocols in critically ill patients : a prospective , randomized controlled clinical trial " .

tolerance feeding proctocols

gastrointestinal tolerance

critically ill patients :

randomized controlled clinical trial "


A randomized , double-blind , placebo-controlled trial of single-dose intravenous secretin as treatment for children with autism . OBJECTIVE To determine whether a single injection of intravenous secretin results in measurable improvements in socialization and/or communication skills in children with autism . STUDY DESIGN Sixty subjects with autism were randomly selected and assigned to either treatment or placebo group . Subjects in the treatment group received 2.0 clinical units of secretin per kilogram of body weight as a single intravenous dose . Subjects in the placebo group received normal saline solution . Neurodevelopmental and behavioral assessments were performed for all subjects before injection and at 3 and 6 weeks after injection . RESULTS Assessment of language skills and parents ' behavioral assessments revealed no significant differences between the treatment and placebo groups . Raters ' assessments of severity of autistic symptoms did not differ for the 2 groups at 6 weeks after injection . A marginally statistically significant improvement in autistic behaviors was seen in the treatment group at 3 weeks after injection ( P =.051 ) . CONCLUSIONS A single dose of intravenous secretin does not appear to have significant effects on either parents ' perception of autistic behaviors or language skills at 6 weeks after injection . Transient , marginally significant improvements in autistic behaviors may occur in some children .

secretin

secretin

placebo

placebo

normal saline solution

secretin

Raters ' assessments of

severity of autistic symptoms

children

autism

children

autism .

Sixty

autism


Clinical and microbial evaluation of a histatin-containing mouthrinse in humans with experimental gingivitis . OBJECTIVE P-113 , a 12 amino acid histatin-based peptide , was evaluated in a mouthrinse formulation for safety , prevention of the development of experimental gingivitis , and for its effects on periodontal flora . METHOD 159 periodontally healthy subjects abstained from oral hygiene procedures and self-administered either 0.005 % , 0.01 % , 0.05 % P-113 or placebo mouthrinse formulations twice daily over a four week treatment period . During this time , the safety , anti-plaque , and anti-gingivitis effects of P-113 were evaluated . RESULTS There was a significant reduction in plaque ( p=0.046 ) and a reduction in gingivitis ( p=0.086 ) for subjects using 0.01 % P-113 mouthrinse . Significantly more subjects in the 0.01 % and 0.05 % treatment groups showed a small increase in plaque index of < 0.25 as compared to the placebo group ( p < 0.05 ) . Similar trends were noted for changes in the % of sites with bleeding on probing in the 0.01 % P-113 group . There were no treatment-related adverse events , and there were no adverse shifts in supragingival microflora during the study . CONCLUSION These data suggest that P-113 mouthrinse is safe and reduces plaque , gingivitis and gingival bleeding in the human experimental gingivitis model .

histatin-containing mouthrinse

mouthrinse formulation

placebo

P-113 mouthrinse

P-113 mouthrinse

plaque

reduction in gingivitis

plaque

bleeding on probing

adverse events

shifts in supragingival microflora


L-arginine and S-nitrosoglutathione reduce embolization in humans . BACKGROUND L-Arginine reduces platelet aggregation and adhesion in ex vivo studies , but there is no evidence as yet that it has a therapeutic effect on clinical end points . Doppler ultrasound can detect cerebral emboli noninvasively . Such embolic signals are common after carotid endarterectomy , and their frequency predicts risk of stroke recurrence . We used this situation to determine the antiplatelet efficacy of L-arginine and S-nitrosoglutathione ( GSNO ) , a physiological nitric oxide donor with possible platelet specificity . METHODS AND RESULTS Patients undergoing carotid endarterectomy were randomized in a double-blind manner between L-arginine ( n=14 ) , GSNO ( n=14 ) , or placebo ( n=14 ) administered intravenously for 90 minutes , starting 30 minutes after skin closure . All patients were pretreated with aspirin and given heparin during surgery . Transcranial Doppler recordings were made from the ipsilateral middle cerebral artery for 4 hours after surgery , beginning 30 minutes after skin closure , and also at 6 and 24 hours . There were highly significant reductions in the number of Doppler embolic signals in the L-arginine and GSNO groups ; first 4 hours , median ( range ) number of embolic signals , placebo 44.7 ( 6 to 778 ) , L-arginine 9.5 ( 0 to 225 ) , and GSNO 0.8 ( 0 to 8 ) , both P < 0.001 versus control values . The reduction in the signals persisted at the 24-hour recording . CONCLUSIONS Intravenous L-arginine and GSNO attenuate Doppler embolic signals in humans . Modulation of the NO system with these agents may have applications in the treatment of thromboembolic disease . This study demonstrates the potential application of ultrasonic embolic signal detection to examine the efficacy of new antiplatelet agents in relatively small numbers of patients .

L-arginine

S-nitrosoglutathione

L-Arginine

L-arginine

S-nitrosoglutathione ( GSNO )

L-arginine

GSNO

placebo

aspirin

heparin

L-arginine

GSNO

L-arginine

GSNO

L-arginine

GSNO

embolization

platelet aggregation and adhesion

antiplatelet efficacy

number of embolic signals

reduction in the signals

attenuate Doppler embolic signals

undergoing carotid endarterectomy


[ Clinical and experimental research of Epimedium brevicornum in relieving neuroendocrino-immunological effect inhibited by exogenous glucocorticoid ] . OBJECTIVE To study protective effect of Epimedium brevicornum ( EB ) on hypothalamus-pituitary-adrenal-thymus ( HPAT ) axis inhibited by exogenous glucocorticoid . METHODS In clinical research , variation of cortisol , adrenocorticotrophin ( ACTH ) , lymphocyte proliferative reaction were observed before and after medication in 65 patients took prednisone , and were randomly divided into Fufang prednisone group ( mixture of prednisone and EB ) and prednisone group . An experimental model of HPAT axis inhibited by corticosterone ( CORT ) was established to observe the effect of EB on relevant indices of HPAT axis . RESULTS The level of ACTH and CORT in plasma decreased and lymphocyte proliferative reaction reduced in patients ( P < 0.05 ) . In experimental study , monoaminic transmitters activated in hypothalamus ; weight of pituitary , adrenal and thymus decreased ; number of CRH positive neurons in hypothalamic paraventricular nucleus , CRH positive neurofibrilin median eminence and anterior pituitary ACTH positive secretory cells decreased ; adrenal fasciculate zone and thymus cortex atrophies ; NK cell cytotoxicity and the level of IL-2 and gamma-IFN which were produced by lymphocytes reduced in CORT-rats ( P < 0.05 ) . There were significant difference between Fufang prednisone group ( clinical research ) or EB group ( experimental research ) and CORT control groups , P < 0.05 . CONCLUSION EB could relieve neuroendocrino-immunological effect inhibited by exogenous glucocorticoid .

Epimedium brevicornum

Epimedium brevicornum ( EB )

prednisone

prednisone group

neuroendocrino-immunological effect

level of ACTH and CORT in plasma

lymphocyte proliferative reaction

monoaminic transmitters

neuroendocrino-immunological effect

neuroendocrino-immunological effect


Thalidomide : an alternative therapy for treatment of apthous ulcers ( canker sores ) .

Thalidomide

treatment of apthous ulcers


" Confirmatory " trials : symptom reduction as efficacy measure .

symptom reduction

symptom reduction

efficacy


Peptide T : negative trial result .

Peptide T

Peptide T : negative trial result


Immune reconstitution after allogeneic marrow transplantation compared with blood stem cell transplantation . Allogeneic peripheral blood stem cell grafts contain about 10 times more T and B cells than marrow grafts . Because these cells may survive in transplant recipients for a long time , recipients of blood stem cells may be less immunocompromised than recipients of marrow . Immune reconstitution was studied in 115 patients randomly assigned to receive either allogeneic marrow or filgrastim-mobilized blood stem cell transplantation . Between day 30 and 365 after transplantation , counts of most lymphocyte subsets were higher in the blood stem cell recipients . The difference was most striking for CD4 T cells ( about 4-fold higher counts for CD45RA ( high ) CD4 T cells and about 2-fold higher counts for CD45RA ( low/- ) CD4 T cells ; P < .05 ) . On assessment using phytohemagglutinin and herpesvirus antigen-stimulated proliferation , T cells in the 2 groups of patients appeared equally functional . Median serum IgG levels were similar in the 2 groups . The rate of definite infections after engraftment was 1.7-fold higher in marrow recipients ( P =.001 ) . The rate of severe ( inpatient treatment required ) definite infections after engraftment was 2.4-fold higher in marrow recipients ( P =.002 ) . The difference in the rates of definite infections was greatest for fungal infections , intermediate for bacterial infections , and lowest for viral infections . Death associated with a fungal or bacterial infection occurred between day 30 and day 365 after transplantation in 9 marrow recipients and no blood stem cell recipients ( P =.008 ) . In conclusion , blood stem cell recipients have higher lymphocyte-subset counts and this appears to result in fewer infections . ( Blood . 2001 ; 97:3380-3389 )

allogeneic marrow transplantation

blood stem cell transplantation .

transplantation

transplantation

marrow

blood stem cell

counts of most lymphocyte subsets

CD4 T cells

CD4 T cells

T cells

appeared equally functional

Median serum IgG levels

Death

lymphocyte-subset counts


[ Advantages of video assisted thoracic surgery in the treatment of spontaneous pneumothorax ] . Spontaneous pneumothorax ( SP ) is a disabling condition mostly affecting young , thin and otherwise healthy males . It is usually caused by ruptured pleural blebs . The first treatment is the insertion of a chest tube ( ICT ) but in a great number of patients there is recurrence of the disease . We believe that the video assisted thoracoscopy ( VATS ) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence . In order to prove it , 40 patients admitted in a five-year period , with a SP , were randomly assigned to be treated by ICT or VATS . The ICT patients were in the hospital a mean time of 7.5 ( 4 to 15 ) days and the VATS patients , 5.3 ( 2 to 7 ) days ( P < .05 ) . ICT patients required analgesic drugs during 76.8 +/- 31 hours and VATS patients 38.4 +/- 13 hours ( p < .05 ) . From the ICT group , 8 ( 53 % ) patients had recurrence of the disease and 6 ( 40 % ) had a prolonged air leak , while none of the patients of the VATS group had any complication ( < .001 ) . Cost of ICT and VATS were $ 850 and $ 1730 , respectively . According to these results , VATS should be the treatment of choice in SP patients . It treats the cause of the disease . It also reduces the hospitalization time , the use of analgesic drugs post surgery , decreases recurrence of the disease and the cost of the treatment . Moreover , the patients were back to work in less than 10 days .

video assisted thoracic surgery

insertion of a chest tube ( ICT )

video assisted thoracoscopy ( VATS )

ICT

VATS

ICT

VATS

ICT

VATS

ICT

VATS

ICT

VATS

VATS

mean time

analgesic drugs

recurrence of the disease

air leak

complication

Cost of ICT and VATS

hospitalization time

recurrence of the disease

cost of the treatment

spontaneous pneumothorax ]


Effects of irrigation fluid temperature on core body temperature during transurethral resection of the prostate . OBJECTIVES To determine the effect irrigation fluid temperature has on core body temperature changes in patients undergoing transurethral resection of the prostate ( TURP ) . METHODS Fifty-six male patients ( mean age 71.2 +/- 8.2 years ) scheduled for TURP were enrolled in the study . Patients were randomized to one of two groups . Group 1 consisted of 27 patients who received room temperature irrigation fluid ( 70 degrees F ) throughout TURP ; group 2 consisted of 29 patients whose procedure was performed with warmed irrigation fluid ( 91.5 degrees F ) . The irrigation fluid used for both groups was glycine . The baseline temperature , final temperature , total time in the operating room , and amount of irrigation fluid used during the procedure were recorded for each patient . RESULTS No significant difference in the average time spent in the operating room or in the total irrigation fluid used between the two groups was observed . Of the 27 patients who received room temperature irrigation fluid , 15 ( 55.6 % ) had a decrease in body temperature . A decrease in temperature was observed in 21 ( 72.4 % ) of the 29 patients who received warm irrigation fluid . Groups 1 and 2 had 12 ( 44.4 % ) of 27 and 8 ( 27.6 % ) of 29 patients , respectively , who demonstrated an elevation in their core body temperature . CONCLUSIONS The results of our study suggest that irrigation fluid temperature is not a factor responsible for altering the core body temperature in patients undergoing TURP .

transurethral resection

TURP

warmed irrigation fluid

room temperature irrigation fluid

warm irrigation fluid

the total irrigation fluid

room temperature irrigation fluid

body temperature

temperature

irrigation fluid

core body temperature

body temperature

transurethral resection of the prostate

TURP

Fifty-six

male

71.2 +/- 8.2

TURP


Carvedilol increases plasma vascular endothelial growth factor ( VEGF ) in patients with chronic heart failure .

Carvedilol

patients with chronic heart failure


Dose response effect of cyclical medroxyprogesterone on blood pressure in postmenopausal women . OBJECTIVE This study was designed to compare with placebo the dose-response effect of cyclical doses of the C21 progestogen , medroxyprogesterone acetate ( MPA ) on blood pressure ( BP ) when administered to normotensive postmenopausal women receiving a fixed mid-range daily dose of conjugated equine oestrogen ( CEE ) . MATERIALS AND METHODS Twenty normotensive postmenopausal women ( median age 53 years ) participated in the study which used a double-blind crossover design . There were four randomised treatment phases , each of 4 weeks duration . The four blinded treatments were MPA 2.5 mg , MPA 5 mg , MPA 10 mg and matching placebo , taken for the last 14 days of each 28 day treatment cycle . CEE 0.625 mg was also administered once daily as open labelled tablets to all subjects throughout the study . Clinic BP was measured weekly with the mean values of weeks 3 and 4 of each phase used for analysis . Ambulatory BP was performed in the final week of each phase . RESULTS Compared with the placebo phase , end of phase clinic BP was unchanged by any of the progestogen treatments . There was a dose-dependent decrease in ambulatory daytime diastolic and mean arterial BP with the progestogen treatments compared with placebo ( P < 0.05 ) . CONCLUSION In a regimen of postmenopausal hormone replacement therapy with a fixed mid-range daily dose of CEE combined with a cyclical regimen of a C21 progestogen spanning the current clinical dose range , the progestogen has either no effect or a small dose-dependent reduction in clinic and ambulatory BPs over one treatment cycle .

cyclical medroxyprogesterone

placebo

C21 progestogen

medroxyprogesterone acetate

conjugated equine oestrogen ( CEE

MPA 2.5 mg , MPA 5 mg , MPA 10 mg

placebo

CEE

progestogen

blood pressure

Clinic BP

Ambulatory BP

clinic BP

clinic and ambulatory BPs

postmenopausal

women

normotensive postmenopausal

women

normotensive postmenopausal

median age 53 years


Efficacy and tolerability of antibiotics in patients undergoing H. pylori eradication . BACKGROUND/AIMS Helicobacter pylori ( H. pylori ) infection is one of the most common gastrointestinal diseases . An increasing number of people undergo different treatment options . Unfortunately , H. pylori therapy may be troublesome for drug side effects and inefficacious for resistance to antibiotics . METHODOLOGY One hundred and ninety-three ( 193 ) H. pylori-positive patients were randomly assigned to one of the following 7-day treatments : Group A ( N = 64 ) : amoxicillin , clarithromycin and rabeprazole ; Group B ( N = 64 ) : tinidazole , clarithromycin and ranitidine bismuth citrate ; Group C ( N = 65 ) : tinidazole , clarithromycin and rabeprazole Eradication was assessed by 13C-Urea Breath Test 6-8 weeks after the end of the therapy . Not-eradicated patients underwent a second cycle with tinidazole , tetracycline , bismuth and rabeprazole . All patients were asked to complete a validated questionnaire regarding presence and intensity of drug side effects . RESULTS One hundred and eighty-eight out of the 193 H. pylori-positive patients ( 96 % ) completed therapy . No significant difference in eradication rates was observed among the three groups both in intention to treat analysis and in per protocol analysis . No significant difference in incidence of side effects occurred among groups after the first-line regimens : 48 % in group A , 44 % in group B and 46 % in group C. Twenty-two out of the 193 enrolled subjects ( 11 % ) were not eradicated after the first-line therapy . Among them , 86 % were successfully eradicated by the tinidazole , tetracycline , bismuth and rabeprazole therapy . Moreover , during quadruple therapy , a higher prevalence and intensity of side effects than in each one of the groups submitted to the first-line triple therapy was observed . CONCLUSIONS This study shows that triple rabeprazole-based eradicating regimens are effective and safe . Incidence of side effects seems low and similar in different three-drug regimens used . Quadruple therapy , which appear highly efficacious as a second line therapy , is associated with a significantly higher incidence of side effects when compared to first-line treatment .

antibiotics

antibiotics

tinidazole , tetracycline , bismuth

rabeprazole

Quadruple therapy

Efficacy and tolerability

eradication rates

incidence of side effects

eradicated

eradicated

effective and safe .

side effects

One hundred and ninety-three ( 193 )

H. pylori-positive patients

Group A

Group B

64 )

Group C


Rehabilitation outcomes following percutaneous coronary interventions ( PCI ) . This prospective study evaluated the effect of an individualized , comprehensive , home-based cardiac rehabilitation program combining exercise training with risk factor modification and psychosocial counseling on risk factors , psychological well-being , functional capacity , and work resumption in 99 post-percutaneous coronary interventions ( PCI ) patients randomized to control ( standard care plus telephone follow-up , n=49 ) or intervention ( individualized , comprehensive , home-based cardiac rehabilitation , n=50 ) groups . Data were collected at time 1 ( T ( 1 ) ) during hospital admission , time 2 ( T ( 2 ) ) approximately 2 months post-PCI , and time 3 ( T ( 3 ) ) approximately 12 months post-PCI . Results suggest that the allocation to an individualized , comprehensive , home-based cardiac rehabilitation program provided more advantageous outcomes . At both follow-ups , the intervention group showed within-group improvement in serum cholesterol levels ( P < 0.02 ; P < 0.01 ) and exercise participation ( P < 0.001 ; P < 0.001 ) with differences in exercise participation favoring the intervention group ( P < 0.01 ) at T ( 2 ) . Repeated measures ANOVA showed significant improvements over time in body mass index ( BMI ) ( P < 0.01 ) , psychological well-being ( P < 0.001 ) , and functional capacity ( P < 0.001 ) for both groups . More patients in the intervention group had returned to work at T ( 2 ) ( P < 0.001 ) and did so more quickly ( P < 0.01 ) . These findings suggest that an individualized , comprehensive , home-based cardiac rehabilitation program improves risk factor profiles and work resumption patterns for patients following PCI .

intervention

post-PCI

Rehabilitation outcomes

risk factors

psychological well-being

functional capacity

work resumption

serum cholesterol levels

exercise participation

exercise participation

body mass index ( BMI )

psychological well-being

functional capacity

returned to work


Double-blind , placebo-controlled study of amantadine hydrochloride in the treatment of children with autistic disorder . OBJECTIVE To test the hypothesis that amantadine hydrochloride is a safe and effective treatment for behavioral disturbances -- for example , hyperactivity and irritability -- in children with autism . METHOD Thirty-nine subjects ( intent to treat ; 5-19 years old ; IQ > 35 ) had autism diagnosed according to DSM-IV and ICD-10 criteria using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule-Generic . The Aberrant Behavior Checklist-Community Version ( ABC-CV ) and Clinical Global Impressions ( CGI ) scale were used as outcome variables . After a 1-week , single-blind placebo run-in , patients received a single daily dose of amantadine ( 2.5 mg/kg per day ) or placebo for the next week , and then bid dosing ( 5.0 mg/kg per day ) for the subsequent 3 weeks . RESULTS When assessed on the basis of parent-rated ABC-CV ratings of irritability and hyperactivity , the mean placebo response rate was 37 % versus amantadine at 47 % ( not significant ) . However , in the amantadine-treated group there were statistically significant improvements in absolute changes in clinician-rated ABC-CVs for hyperactivity ( amantadine -6.4 versus placebo -2.1 ; p = .046 ) and inappropriate speech ( -1.9 versus 0.4 ; p = .008 ) . CGI scale ratings were higher in the amantadine group : 53 % improved versus 25 % ( p = .076 ) . Amantadine was well tolerated . CONCLUSIONS Parents did not report statistically significant behavioral change with amantadine . However , clinician-rated improvements in behavioral ratings following treatment with amantadine suggest that further studies with this or other drugs acting on the glutamatergic system are warranted . The design of these and similar drug trials in children with autistic disorder must take into account the possibility of a large placebo response .

placebo-controlled

amantadine hydrochloride

amantadine

amantadine

placebo

amantadine-treated

Amantadine

amantadine

behavioral disturbances

hyperactivity and irritability

irritability

hyperactivity

hyperactivity

inappropriate speech

CGI scale ratings

behavioral change

behavioral ratings

autistic disorder

autism

Thirty-nine subjects

autistic disorder


Laparoscopic vs open appendectomy in overweight patients . BACKGROUND Laparoscopic appendectomy ( LA ) has been associated with a faster recovery and less postoperative pain than the open technique . However , few data are available on the clinical outcome of LA in overweight patients . METHODS A group of 106 patients with a body mass index ( BMI ) > 26.4 , representing the upper quintile of 500 prospectively randomized patients , were included in the study . They were randomized to undergo either laparoscopic or open appendectomy ( OA ) . Operating and anesthesia times , postoperative pain , complications , hospital stay , functional index ( 1 week postoperatively ) , sick leave , and time to full recovery were documented . RESULTS In OA , the operating time for overweight patients was significantly longer than that for patients in the normal weight range ( 40 vs 35 min , p < 0.05 ) . In LA , there was no difference in operating time between the normal and overweight patients . Overweight patients who underwent LA had longer operating and anesthesia times than their OA counterparts ( 55 vs 40 min , p < 0.001 ; and 125 vs 100 min , p < 0.001 , respectively ) . Postoperative pain was significantly greater in overweight patients who underwent OA than in those treated with the laparoscopic technique . Postoperative pain was also significantly greater in overweight patients subjected to OA than in patients of normal weight after 4 weeks ; the clinical significance may , however , be of less importance since the values are low ( 0.26 vs 0.09 , p < 0.05 ) . There were no significant differences between the two operating techniques in terms of complications . Hospital stay was longer for overweight patients than for normal-weight patients undergoing OA ( 3.0 vs 2.0 , p < 0.01 ) . The functional index did not differ between any group of patients . Sick leave was longer for overweight patients who underwent OA than for normal-weight patients treated with the same technique ( 17 vs 13 days , p < 0.01 ) . In the laparoscopic group , however , there were no differences between the overweight and normal-weight patients . Time to full recovery was greater in overweight patients subjected to OA than in the overweight patients in the LA group ( 22 vs 15 days , p < 0.001 ) . CONCLUSION In this study , overweight patients who were submitted to LA had less postoperative pain and a faster postoperative recovery than overweight patients who had OA . LA also abolished some of the negative effects that overweight had on operating time , hospital stay , and sick leave with the open technique . However , anesthesia and operating times were significantly longer in LA for both overweight patients and those with a normal BMI .

Laparoscopic

open appendectomy

Laparoscopic appendectomy ( LA )

LA

OA

LA

OA

OA

laparoscopic technique

Operating and anesthesia times

postoperative pain

complications

hospital stay

functional index

sick leave

time to full recovery

operating time

operating time

operating and anesthesia times

Postoperative pain

Postoperative pain

Hospital stay

Sick leave

Time to full recovery

postoperative pain

postoperative recovery

operating time

hospital stay

sick leave

overweight


A comparative study of caudal bupivacaine and midazolam-bupivacaine mixture for post-operative analgesia in children undergoing genitourinary surgery . OBJECTIVE This study was designed to evaluate the analgesic efficacy of caudal midazolam-bupivacaine combination in providing post-operative pain relief in children undergoing genitourinary surgery and to study the occurrence of adverse effects . SUBJECTS AND METHODS Thirty children , aged 2 to 8 years , scheduled for genitourinary surgery were allocated randomly to receive either 0.25 % bupivacaine 0.5 ml/kg ( group B ; n = 15 ) or 0.25 % bupivacaine 0.5 ml/kg with 50 microg/kg midazolam ( group BM ; n = 15 ) by the caudal route immediately after induction of general anesthesia . Heart rate , arterial blood pressure and oxygen saturation were monitored throughout the study period . Postoperative pain was assessed at regular intervals for 12 hours using an objective pain score . Analgesia was supplemented whenever the pain score was > or = 4 . Duration of analgesia , as well as the requirement of additional analgesics , were noted . RESULTS Lowest pain scores were observed with the addition of midazolam to caudal bupivacaine ( p < 0.01 ) . Duration of analgesia was longer in group BM ( 11 +/- 0.5 h ) as compared to group B ( 7.4 +/- 2.1 hours ) ( p < 0.05 ) . Fewer children ( 26.6 % ) required additional analgesia in the combination group whereas in group B , 60 % of the children received analgesic supplements within 6 hours after surgery ( p < 0.05 ) . There were no significant changes in heart rate , blood pressure and oxygen saturation in both groups . We observed no untoward event in either of the groups . CONCLUSION Caudal administration of bupivacaine-midazolam mixture prolongs post-operative analgesia compared to bupivacaine alone without causing any adverse effects .

bupivacaine

midazolam to caudal bupivacaine

bupivacaine

Heart rate

arterial blood pressure

oxygen saturation

Postoperative pain

pain score

Analgesia

pain score

Duration of analgesia

pain scores

Duration of analgesia

additional analgesia

analgesic supplements

heart rate

blood pressure

oxygen saturation

untoward event


In vivo effect of clarithromycin on multiple cytochrome P450s . The in vivo effects of oral clarithromycin administration on the in vivo activity of cytochrome P450 1A2 , 2C9 , and 2D6 were determined . The cytochrome P450 probes caffeine ( CYP1A2 ) , tolbutamide ( CYP2C9 ) , and dextromethorphan ( CYP2D6 ) were administered as an oral cocktail prior to and 7 days after oral clarithromycin ( 500 mg twice daily ) administration to 12 healthy male subjects . Blood and urine samples were collected and assayed for each of the compounds and their metabolites using high-performance liquid chromatography . The CYP1A2 indices , oral caffeine clearance ( 6.2 +/- 3.3 l/h before and 5.7 +/- 4.2 l/h after , p > 0.05 ) and the 6-h paraxanthine to caffeine serum concentration ratio ( 0.49 +/- 0.3 before and 0.44 +/- 0.3 after , p > 0.05 ) , were unchanged following clarithromycin dosing . Neither the tolbutamide oral clearance ( 0.77 +/- 0.28 l/h before and 0.72 +/-0.24 l/h after , p > 0.05 ) nor the tolbutamide urinary metabolic ratio ( 779 +/- 294 before and 681 +/- 416 after , p > 0.05 ) indices of CYP2C9 were altered by clarithromycin administration . In the case of CYP2D6 , the dextromethorphan to dextrorphan urinary ratio was not significantly different before ( 0.021 +/- 0.04 ) and after ( 0.024 +/- 0.06 ) clarithromycin dosing . In conclusion , clarithromycin does not appear to alter the in vivo catalytic activity of CYP1A2 , CYP2C9 , and CYP2D6 in healthy individuals as assessed by caffeine , tolbutamide , and dextromethorphan , respectively .

clarithromycin

clarithromycin

caffeine

tolbutamide

dextromethorphan

clarithromycin

tolbutamide

tolbutamide

clarithromycin

dextromethorphan

clarithromycin

clarithromycin

Blood and urine samples

CYP1A2 indices

oral caffeine clearance

tolbutamide oral clearance

tolbutamide urinary metabolic ratio

dextromethorphan

dextrorphan urinary ratio

significantly different

vivo catalytic activity

healthy

male