University Hospital, Rigshospitalet, Denmark. We established the prevalences of HD and OA in adults according to qualified radiographic discriminators Applying a CE cut-off value of 20 degrees for designation of definite hip dysplasia, we found a prevalence of hip dysplasia of 3. We found significant relationships between radiographic OA discriminators and the CE The FLASSH study: protocol for a randomised controlled trial evaluating falls prevention after stroke and two sub-studies. Full Text Available Abstract Background Falls are common in stroke survivors returning home after rehabilitation, however there is currently a lack of evidence about preventing falls in this population.
Methods and design This randomised controlled trial aims to evaluate the effectiveness of a multi-factorial falls prevention program for stroke survivors who are at high risk of falling when they return home after rehabilitation. Intervention will consist of a home exercise program as well as individualised falls prevention and injury minimisation strategies based on identified risk factors for falls.
Additionally, two sub-studies will be implemented in order to explore other key areas related to falls in this population. The first of these is a longitudinal study evaluating the relationship between fear of falling, falls and function over twelve months, and the second evaluates residual impairment in gait stability and obstacle crossing twelve months after discharge from rehabilitation.
If the falls prevention program is shown to be effective, low cost strategies to prevent falls can be implemented for those at risk around the time of discharge from rehabilitation, thus improving safety and quality of life for stroke survivors. The two sub-studies will contribute to the overall understanding and management of falls risk in stroke survivors. The primary use of magnetic resonance imaging MRI in the evaluation of children with short stature SS is to discover lesions in the central nervous system CNS , particularly tumors that may require intervention.
MRI has a secondary role in identifying structural abnormalities responsible for growth hormone deficiency GHD. We conclude that MRI provides significant value in the evaluation of children with SS, by identifying CNS tumors associated with growth failure as well as anatomical abnormalities of the pituitary. These findings are useful in confirming the diagnosis of GHD in children and identifying potential candidates for continued GH replacement in adulthood.
Adherence to antiretroviral prophylaxis for HIV prevention: a substudy cohort within a clinical trial of serodiscordant couples in East Africa. These discrepancies are likely due to differences in adherence. Study limitations include potential shortcomings of the adherence measures and use of a convenience sample within the substudy cohort.
The high PrEP adherence achieved in the setting of active adherence monitoring and counseling support was associated with a high degree of protection from HIV acquisition by the HIV-uninfected partner in heterosexual serodiscordant couples. Please see later in the article for the Editors' Summary. Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy. Background: Due to scarce resources in health care, staff deployment has to meet the demands.
To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion.
Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. First generation 1st-gen drug-eluting stents DES induce persistent vasomotor dysfunction in the treated coronary artery.
It is unknown whether and to what extent the implantation of an absorbable polymer DES impairs coronary vasomotion. Incremental atrial pacing and quantitative coronary angiography were used to assess vasomotion proximal and distal to the stent and in a reference segment at 9 months after implantation. Percent changes in vessel diameter with pacing versus baseline were calculated and compared. Vasomotor response of the APSES group was also compared with changes observed in a historical group of 17 patients implanted with a 1st-gen sirolimus-eluting stent SES.
Participants received individual and couples-based adherence counseling at PrEP initiation and throughout the study; counseling was intensified if unannounced pill count adherence fell to counseling, and HIV testing. The relationship of hip joint space to self reported hip pain. A survey of 4. An inclusion criteria of minimum JSW. Meulenbroek, O. A preplanned substudy was conducted to provide insight into mechanistic changes underlying the observed effects of ASV, including assessment of changes in left ventricular function, ventricular remodelling, and cardiac, renal and inflammatory biomarkers.
In secondary analyses, data for patients with baseline and month values were evaluated; patients participated in the substudy. There were also no significant between-group differences for changes in left ventricular dimensions, wall thickness, diastolic function or right ventricular dimensions and ejection fraction echocardiography , and on cMRI in small patient numbers. There were no significant between-group differences in changes in cardiac, renal and systemic inflammation biomarkers.
Tranexamic acid prevents blood clots from breaking down and reduces bleeding. However, it is uncertain whether tranexamic acid is effective in traumatic brain injury. The CRASH-3 trial is a randomised controlled trial that will examine the effect of tranexamic acid versus placebo on death and disability in 13, patients with traumatic brain injury. The CRASH-3 trial hypothesizes that tranexamic acid will reduce intracranial haemorrhage, which will reduce the risk of death.
Although it is possible that tranexamic acid will reduce intracranial bleeding, there is also a potential for harm. In particular, tranexamic acid may increase the risk of cerebral thrombosis and ischaemia. This mechanistic sub-study aims to examine the effect of tranexamic acid versus placebo on intracranial bleeding and cerebral ischaemia. In the CRASH-3 IBMS, brain scans acquired before and after randomisation are examined, using validated methods, for evidence of intracranial bleeding and cerebral ischaemia. The primary outcome is the total volume of intracranial bleeding measured on computed tomography after randomisation, adjusting for baseline bleeding volume.
Secondary outcomes include progression of intracranial haemorrhage from pre- to post-randomisation scans , new intracranial haemorrhage seen on post- but not pre-randomisation scans , intracranial haemorrhage following neurosurgery, and new focal ischaemic lesions seen on post-but not pre-randomisation scans. A linear regression model will examine whether receipt of the trial treatment can predict haemorrhage. Full Text Available Background: When safe to do so, avoiding blood transfusions in cardiac surgery can avoid the risk of transfusion-related infections and other complications while protecting a scarce resource and reducing costs.
This protocol describes a kidney substudy of the Transfusion Requirements in Cardiac Surgery III TRICS-III trial, a multinational noninferiority randomized controlled trial to determine whether the risk of major clinical outcomes in patients undergoing planned cardiac surgery with cardiopulmonary bypass is no greater with a restrictive versus liberal approach to red blood cell transfusion. Objective: The objective of this substudy is to determine whether the risk of acute kidney injury is no greater with a restrictive versus liberal approach to red blood cell transfusion, and whether this holds true in patients with and without preexisting chronic kidney disease.
Design and Setting: Multinational noninferiority randomized controlled trial conducted in 73 centers in 19 countries We will repeat the primary analysis using alternative definitions of acute kidney injury, including staging definitions, and will examine effect modification by preexisting chronic kidney disease defined as a preoperative estimated glomerular filtration rate [eGFR] Higher Protein Intake Is Not Associated with Decreased Kidney Function in Pre-Diabetic Older Adults Following a One-Year Intervention—A Preview Sub-Study.
Full Text Available Concerns about detrimental renal effects of a high-protein intake have been raised due to an induced glomerular hyperfiltration, since this may accelerate the progression of kidney disease. The aim of this sub-study was to assess the effect of a higher intake of protein on kidney function in pre-diabetic men and women, aged 55 years and older. Protein intake was estimated from four-day dietary records and hour urinary urea excretion. We found no indication of impaired kidney function after one year with a higher protein intake in pre-diabetic older adults.
High density lipoprotein structural changes and drug response in lipidomic profiles following the long-term fenofibrate therapy in the FIELD substudy. Full Text Available In a recent FIELD study the fenofibrate therapy surprisingly failed to achieve significant benefit over placebo in the primary endpoint of coronary heart disease events.
Increased levels of atherogenic homocysteine were observed in some patients assigned to fenofibrate therapy but the molecular mechanisms behind this are poorly understood. We found that fenofibrate leads to complex HDL compositional changes including increased apoA-II, diminishment of lysophosphatidylcholines and increase of sphingomyelins. Ethanolamine plasmalogens were diminished only in a subgroup of fenofibrate-treated patients with elevated homocysteine levels. Finally we performed molecular dynamics simulations to qualitatively reconstitute HDL particles in silico.
In conclusion, a detailed molecular characterization of HDL may provide surrogates for predictors of drug response and thus help identify the patients who might benefit from fenofibrate treatment. Prospective validation of immunological infiltrate for prediction of response to neoadjuvant chemotherapy in HER2-negative breast cancer--a substudy of the neoadjuvant GeparQuinto trial. Intratumoral lymphocytes iTuLy , stromal lymphocytes strLy as well as lymphocyte-predominant breast cancer LPBC were evaluated by histopathological assessment.
Pathological complete response pCR rates were analyzed and compared between the defined subgroups using the exact test of Fisher. The lymphocytic infiltrate is a promising additional parameter for histopathological evaluation of breast cancer core biopsies. We assessed the efficacy and safety of ibrutinib in a population with rituximab-refractory disease. Disease refractory to the last rituximab-containing therapy was defined as either relapse less than 12 months since last dose of rituximab or failure to achieve at least a minor response.
Key exclusion criteria included: CNS involvement, a stroke or intracranial haemorrhage less than 12 months before enrolment, clinically significant cardiovascular disease, hepatitis B or hepatitis C viral infection, and a known bleeding disorder. Patients received oral ibrutinib mg once daily until progression or unacceptable toxicity. The substudy was not prospectively powered for statistical comparisons, and as such, all the analyses are descriptive in nature.
This study objectives were the proportion of patients with an overall response, progression-free survival, overall survival, haematological improvement measured by haemoglobin, time to next treatment, and patient-reported outcomes according to the Functional Assessment of Cancer Therapy-Anemia FACT-An and the Euro Qol 5 Dimension Questionnaire EQ-5D-5L.
All analyses were per protocol. The study is registered at ClinicalTrials. Between Aug 18, , and Feb 18, , 31 patients were enrolled. Motivation to physical activity among adults with high risk of type 2 diabetes who participated in the Oulu substudy of the Finnish Diabetes Prevention Study. Type 2 diabetes can be prevented by lifestyle changes such as sufficient level of physical activity. The number of persons at high risk of or diagnosed with type 2 diabetes is increasing all over the world. In order to prevent type 2 diabetes and develop exercise counselling, more studies on motivators and barriers to physical activity are needed.
Thus, the aim of this qualitative study was to describe the motivators and barriers to physical activity among individuals with high risk of type 2 diabetes who participated in a substudy of the Finnish Diabetes Prevention Study in Oulu and to consider whether the motivators or barriers changed during the follow-up from to The study was conducted in the city of Oulu in Finland. The results of this study showed that motivators to physical activity included weight management, feelings of physical and mental well being. In addition, social relationships associated with exercise were also motivators.
In conclusion, we present that regular counselling is important in order to promote exercise among older people, and that motivators to exercise are strengthened by positive experiences of exercise as one grows older. Help seeking behavior and onset-to-alarm time in patients with acute stroke: sub-study of the preventive antibiotics in stroke study. Patients with acute stroke often do not seek immediate medical help, which is assumed to be driven by lack of knowledge of stroke symptoms. We explored the process of help seeking behavior in patients with acute stroke, evaluating knowledge about stroke symptoms, socio-demographic and clinical characteristics, and onset-to-alarm time OAT.
A semi-structured questionnaire was used to assess knowledge, recognition and interpretation of stroke symptoms. With in-depth interviews, response actions and reasons were explored. OAT was recorded and associations with socio-demographic, clinical parameters were assessed.
Knowledge about stroke symptoms does not always result in correct recognition of own stroke symptoms, neither into correct interpretation of the situation and subsequent action.
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Help seeking behavior after acute stroke is a complex process. Follow-up OCT was performed at 3 months or prior to revascularisation when occurring before the 3-month window. The substudy was designed for non-inferiority of the primary endpoint of neointimal thickness. When safe to do so, avoiding blood transfusions in cardiac surgery can avoid the risk of transfusion-related infections and other complications while protecting a scarce resource and reducing costs. The objective of this substudy is to determine whether the risk of acute kidney injury is no greater with a restrictive versus liberal approach to red blood cell transfusion, and whether this holds true in patients with and without preexisting chronic kidney disease.
Multinational noninferiority randomized controlled trial conducted in 73 centers in 19 countries We will repeat the primary analysis using alternative definitions of acute kidney injury, including staging definitions, and will examine effect modification by preexisting chronic kidney disease defined as a preoperative estimated glomerular filtration rate [eGFR] blood cell transfusion in the presence of anemia during cardiac surgery done with cardiopulmonary bypass.
Although cardiac troponin is associated with outcomes in atrial fibrillation AF , the complementary prognostic information provided by cardiac troponin I cTnI and cTnT is unknown. This study investigated the distribution, determinants, and prognostic value of cTnI and cTnT concentrations in patients with AF. Samples were collected. Correlations Spearman , determinants multivariable linear regression , and outcomes adjusted Cox models and c-statistics were investigated.
Renal impairment was the most important factor affecting the concentrations of both troponins. Over a median 1. Prevention of haematoma progression by tranexamic acid in intracerebral haemorrhage patients with and without spot sign on admission scan: a statistical analysis plan of a pre-specified sub-study of the TICH-2 trial.
We present the statistical analysis plan of a prespecified Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage TICH -2 sub-study aiming to investigate, if tranexamic acid has a different effect in intracerebral haemorrhage patients with the spot sign on admission compared to spot sign negative patients. They were included irrespective of radiological signs of on-going haematoma expansion. Participants were randomised to tranexamic acid versus matching placebo. In this subgroup analysis, we will include all participants in TICH-2 with a computed tomography angiography on admission allowing adjudication of the participants' spot sign status.
This sub-study will investigate the important clinical hypothesis that spot sign positive patients might benefit more from administration of tranexamic acid compared to spot sign negative patients. Atherosclerosis is one of the main mechanisms of stroke and cardiovascular diseases and is associated with increased risk of recurrent stroke and cardiovascular events. Intima-medial thickness IMT is a well-known surrogate marker of atherosclerosis and has been used to predict stroke and cardiovascular events. However, the clinical significance of IMT and IMT change in stroke has not been investigated in well-designed studies.
The primary outcome is the change in mean carotid IMT, which is defined as the mean of the far-wall IMTs of the right and left common carotid arteries, between baseline and 13 months after randomization. Published by Elsevier Inc. Practice of mechanical ventilation in cardiac arrest patients and effects of targeted temperature management: A substudy of the targeted temperature management trial. Mechanical ventilation practices in patients with cardiac arrest are not well described.
Also, the effect of temperature on mechanical ventilation settings is not known. Mechanical ventilation data were obtained at three time points: 1 before TTM; 2 at the end of TTM before rewarming and 3 after rewarming. Logistic regression was used to determine an association between mechanical ventilation variables and outcome. Repeated-measures mixed modelling was performed to determine the effect of TTM on ventilation settings.
Mechanical ventilation data was available for of the TTM patients. At the end of TTM median tidal volume was 7. Median PEEP was 7. The median FiO 2 fraction was 0. Multivariate analysis showed an independent relationship between increased respiratory rate and day mortality. In the majority of the cardiac arrest patients, protective ventilation settings are applied, including low tidal volumes and driving pressures. High respiratory rate was associated with mortality. TTM33 results in lower end-tidal CO 2 levels and a higher alveolar dead. Affected patients have chronic leg pain and swelling and may develop ulcers.
Venous valve disruption from the thrombus itself or thrombus-associated mediators of inflammation is considered to be a key initiating event for the development of venous hypertension that often underlies PTS. As existing treatments for PTS are extremely limited, strategies that focus on preventing the development of PTS in patients with DVT are more likely to be effective and cost-effective in reducing its burden. Elastic compression stockings ECS could be helpful in preventing PTS; however, data on their effectiveness are scarce and conflicting.
A total of patients with proximal DVT will be randomized to one of 2 treatment groups: ECS or placebo inactive stockings worn on the DVT-affected leg daily for 2 years. The primary outcome is the incidence of PTS during follow-up. Outcomes will be evaluated during 6 clinic visits and 2 telephone follow ups.
At baseline, 1 and 6 months, blood samples will be obtained to evaluate the role of inflammatory mediators and genetic markers of thrombophilia in the development of PTS Bio-SOX substudy. It is designed to provide definitive data on the effects of ECS on the occurrence and severity of PTS, as well as DVT recurrence, cost-effectiveness and quality of life.
This study will also. Value of the lead electrocardiogram to define the level of obstruction in acute anterior wall myocardial infarction: correlation to coronary angiography and clinical outcome in the DANAMI - 2 trial. FeAST, a prospective, randomized, single-blind clinical trial, tested the hypothesis that reduction of iron stores using phlebotomy would influence clinical outcomes in PAD patients randomized to iron reduction or control groups.
The effects of statin administration were also examined in the Sierra Nevada Health Care SNHC cohort by measuring serum ferritin levels at entry and during the 6-year study period. No difference was documented between treatment groups in all-cause mortality and secondary outcomes of death plus nonfatal myocardial infarction and stroke.
Iron reduction in the main study caused a significant age-related improvement in cardiovascular disease outcomes, new cancer diagnoses, and cancer-specific death. Average levels of ferritin and lipids at entry and at the end of the study were compared. The clinical course and ferritin levels of 23 participants who died during the study were reviewed. At baseline, 53 participants on statins had slightly lower mean entry-level ferritin values Longitudinal analysis of follow-up data, after adjusting for the phlebotomy treatment effect, showed that statin use was associated with.
Outcomes were assessed using Cox proportional hazard models and area under the curve using receiver operating characteristics. In total, patients were included. Within 30 days 23 patients One blood sample was collected for pharmacogenetic testing from each patient who elected to participate in the substudy.
Random assignment of patients to treatment groups was not stratified according to genotypes. Our primary endpoint was the risk of a first exacerbation of COPD based on time to first exacerbation data. An exacerbation of COPD was defined as the increase or new onset of more than one symptom of COPD cough, sputum, wheezing, dyspnoea, or chest tightness , with at least one of the symptoms lasting for 3 days or more and needing treatment with antibiotics or systemic glucocorticoids moderate exacerbations , or admission to hospital severe exacerbations.
The distributions of ADRB2 genotypes were well matched among groups. Polymorphisms at aminoacid 27 did not affect exacerbation outcomes. In the salmeterol group, patients with Arg16Arg genotype had a significantly reduced. DNA-thioguanine nucleotide concentration and relapse-free survival during maintenance therapy of childhood acute lymphoblastic leukaemia NOPHO ALL : a prospective substudy of a phase 3 trial.
Adjustment of mercaptopurine and methotrexate maintenance therapy of acute lymphoblastic leukaemia by leucocyte count is confounded by natural variations. The aim of this study was to establish whether DNA-TGN concentrations in blood leucocytes during maintenance therapy are associated with relapse-free survival.
In this substudy of the NOPHO ALL phase 3 trial done in 23 hospitals in seven European countries Denmark, Estonia, Finland, Iceland, Lithuania, Norway, and Sweden , we analysed data from centralised and blinded analyses of 6-mercaptopurine and methotrexate metabolites in blood samples from patients with non-high-risk childhood acute lymphoblastic leukaemia.
The primary objective was the association of DNA-TGN concentrations and 6-mercaptopurine and methotrexate metabolites with relapse-free survival. The secondary endpoint was the assessment of DNA-TGN concentration and 6-mercaptopurine and methotrexate metabolites during maintenance therapy phase 2. Relapse-free survival was. Myocardial reperfusion after primary percutaneous coronary intervention PCI can be assessed by the extent of post-procedural ST-segment resolution. This nested substudy was performed in centres routinely using pre-hospital GPI in order to compare the impact of randomized treatments on ST-resolution after primary PCI.
Residual cumulative ST-segment deviation on the single one hour post-procedure electrocardiogram ECG was assessed by an independent core laboratory and was the primary endpoint. Overall, there were no differences between randomized treatments in any measures of ST-segment resolution either before or after the index procedure. Osteopenia, osteoporosis, and low bone mineral density are frequent in patients with HIV. We assessed the 96 week loss of bone mineral density associated with a nucleoside or nucleotide reverse transcriptase inhibitor NtRTI -sparing regimen.
Exclusion criteria included treatment for malignant disease, testing positive for hepatitis B virus surface antigen, pregnancy, creatinine clearance less than 60 mL per min, treatment for osteoporosis, systemic steroids, or oestrogen-replacement therapy. The two primary endpoints were the mean percentage changes in lumbar spine and total hip bone mineral density at week 48, assessed by dual energy x-ray absorptiometry DXA scans. We did the analysis with an intention-to-treat-exposed approach with antiretroviral modifications ignored. The parent trial is registered with ClinicalTrials.
Between Aug 2, , and April 18, , we recruited patients to the substudy , 70 assigned to the NtRTI-sparing regimen and 76 to the standard regimen. DXA data were available for , and patients at baseline, 48 and 96 weeks respectively. At week 48, the mean percentage loss in bone mineral density in the. Elevated concentrations of homocysteine are associated with cerebral small vessel disease CSVD. B-vitamin supplementation with folate and vitamins B12 and B6 reduces homocysteine concentrations.
A total of patients with recent stroke or transient ischemic attack, who were randomly allocated to double-blind treatment with placebo or b vitamins, underwent brain MRI at randomization and after 2 years of B-vitamin supplementation. MR images were analyzed blinded to treatment allocation. Outcomes related to the prespecified hypothesis were progression of white matter hyperintensities and incident lacunes. We also explored the effect of B-vitamin supplementation on the incidence of other ischemic abnormalities. After 2 years of treatment with b vitamins or placebo, there was no significant difference in white matter hyperintensities volume change 0.
In a subanalysis of patients with MRI evidence of severe CSVD at baseline, b-vitamin supplementation was associated with a significant reduction in white matter hyperintensities volume change 0. Daily B-vitamin supplementation for 2 years did not significantly reduce the progression of brain lesions resulting from presumed CSVD in all patients with recent stroke or transient ischemic attack but may do so in the subgroup of patients with recent stroke or transient ischemic attack and severe CSVD.
The study sought to evaluate the efficacy and safety of the Absorb everolimus-eluting bioresorbable vascular scaffold BVS Abbott Vascular, Abbott Park, Illinois in patients with diabetes mellitus. Randomized, controlled trials have demonstrated comparable clinical outcomes following percutaneous coronary intervention with either Absorb BVS or metallic Xience everolimus-eluting stent.
However, these trials lack power required to provide reliable treatment effect estimates in this high-risk population. Among diabetic patients included in analysis The Absorb diabetic substudy suggests efficacy and safety of the Absorb BVS for treatment of patients with diabetes mellitus. Data were available for patients ivabradine and placebo. There were improvements in QoL in both treatment groups. The primary outcome of change in physical limitation score at 12 months was 4. The effect on QoL was maintained over the study duration, and ivabradine patients had better scores on angina frequency at every visit to 36 months.
Treatment with ivabradine did not affect the primary outcome of change in physical limitation score at 12 months. It did produce consistent improvements in other self-reported QoL parameters related to angina pectoris, notably in terms of angina frequency and disease perception. Patients with cardiovascular diseases managed by a person-centered care PCC approach have been observed to have better treatment outcomes and satisfaction than with traditional care.
Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases. The objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome ACS. This was a substudy of a randomized controlled trial investigating the effects of PCC in patients hospitalized with ACS. In total, patients with ACS aged eHealth tool, or both, for at least 2 months after hospital discharge.
The primary end point was a composite score of changes in general self-efficacy, return to work or prior activity level, and rehospitalization or death 6 months after discharge. Patients used the eHealth tool a mean of 38 times during the first 8 weeks range , SD 33 and 64 times over a 6-month period range , SD Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group odds ratio 4.
Patients in the PCC group who did not use the eHealth tool. Results: The baseline clinical, angiographic and procedural characteristics were similar between two groups. At 24 months, TLF occurred in 6. There were no significant differences in cardiac death, myocardial infarction and stent thrombosis rate. This finding is hypothesis-generating and needs to be confirmed in larger trials with longer follow-up.
Standardization of imaging procedures is a prerequisite, especially in multicentre clinical trials. Forty-four cancer patients were enrolled in an imaging sub-study of a randomized international multicentre trial. FDG scan had to be performed at baseline and days after treatment start. Variability substantially increased for the subjects with unacceptable UT 11 patients : 2. The high attrition number of patients due to low compliance with the IG compromised the quantitative assessment of the predictive value for early response monitoring.
This emphasizes the need for better regulated procedures in imaging departments, which may be achieved by education of involved personnel or efforts towards regulations. Exercise capacity and N-terminal pro-brain natriuretic peptide levels with biventricular vs. Previous studies showed unfavourable effects of right ventricular RV pacing.
Ventricular pacing VP , however, is required in many patients with atrioventricular AV block. Our study suggests that BIV pacing produces better exercise capacity over 1 year compared with RV pacing in patients without advanced heart failure and AV block. Body composition and metabolic outcomes after 96 weeks of treatment with ritonavir-boosted lopinavir plus either nucleoside or nucleotide reverse transcriptase inhibitors or raltegravir in patients with HIV with virological failure of a standard first-line antiretroviral therapy regimen: a substudy of the randomised, open-label, non-inferiority SECOND-LINE study.
Lipoatrophy is one of the most feared complications associated with the use of nucleoside or nucleotide reverse transcriptase inhibitors N[t]RTIs. We aimed to assess soft-tissue changes in participants with HIV who had virological failure of a first-line antiretroviral ART regimen containing a non-nucleoside reverse transcriptase inhibitor plus two N t RTIs and were randomly assigned to receive a second-line regimen containing a boosted protease inhibitor given with either N t RTIs or raltegravir.
Participants were randomly assigned , via a computer-generated allocation schedule, to receive either ritonavir-boosted lopinavir plus raltegravir raltegravir group or ritonavir-boosted lopinavir plus two or three N t RTIs N[t]RTI group. Participants and investigators were not masked to group assignment, but allocation was concealed until after interventions were assigned.
DXA scans were done at weeks 0, 48, and The primary endpoint was mean percentage and absolute change in peripheral limb fat from baseline to week We did intention-to-treat analyses of available data. This substudy is registered with ClinicalTrials. Between Aug 1, , and July 10, , we recruited participants into the substudy. The intention-to-treat population comprised participants in the N t RTI group and participants in the raltegravir group, of whom 91 and participants, respectively, reached 96 weeks.
Inhibition of platelet aggregation by AZD, a reversible oral P2Y12 receptor antagonist, compared with clopidogrel in patients with acute coronary syndromes. The approval of the use of dabiatran in stroke prevention in patients with nonvalvular atrial fibrilation NVAF is based on the results of the RE-LY Randomized Evaluation of Long-Term Anticoagulation Therapy trial, one of the largest studies to date in this entity. In this trial, dabigatran showed similar safety and efficacy to warfarin in primary and secondary prevention of stroke in patients with AF.
At a dose of mg twice daily, dabigatran was superior to warfarin in the prevention of stroke or systemic embolism and the mg dose twice daily showed similar efficacy and greater safety, given the lower incidence of hemorrhage. These results were consistently found in the various subanalyses, with some slight differences of interest for clinical practice.
Studies of the long-term safety of this drug, pharmacoeconomic analyses in Spain and post-commercialization pharmacovigilance data are required before the definitive uses of this drug can be established. Aortic root geometry in aortic stenosis patients a SEAS substudy. The ratio of sinus of Valsalva height to sinus width was In multivariate linear regression analysis, larger sinus of Valsalva height was associated with older age, larger sinus of Valsalva diameter Overall, annular dimension feasible for TAVI using any available prosthesis was found Heparin-induced thrombocytopenia HIT type II is an acquired thrombophylic state and life-threatening immune complication of a heparin treatment mainly clinically manifested by marked thrombocytopenia, frequently by arterial and venous thrombosis, and sometimes by skin changes.
Functional assay as heparin aggregation test and 14C-serotonin release assays are used in diagnostics as well as antigen assays of which detection tests for heparin-platelet factor 4 antibodies are most frequently used. Considering the fact that there is no single reliable assays for HIT II detection available, sometimes it is necessary to combine both of the above-mentioned types of assays. The diagnosis was confirmed by the heparin aggregation test.
In both patients, the disease had a lethal outcome despite all then available therapeutic measures applied. Further on we discuss advantages of certain types of tests, a therapy doctrine, need for urgent therapeutic measures, inclusive of the administration of antithrombins, avoidance of harmful procedures like low-molecular-weight heparins administration and prophylactic platelet transfusion as well as preventive measures. In an era when the length of hospitalization has a major impact on health care costs, the determination of the optimal duration of the infusion of these drugs after PCI is of great relevance.
Define the levels by commodity as appropriate. The effects of heart failure HF severity on risk of inappropriate implantable cardioverter-defibrillator ICD therapy have not been thoroughly investigated. Incorporate behavioral, emotional, educational, and contextual consequences to enable a complete assessment of In this Full Text Available Intramyocellular triacylglycerol IMTG is utilized as metabolic fuel during exercise and is linked to insulin resistance, but the long-term effect of weight loss strategies on IMTG among participants with abdominal fat, remain unclear.
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At baseline, women had higher IMTG than men 3. Intramyocellular triacylglycerol IMTG is utilized as metabolic fuel during exercise and is linked to insulin resistance, but the long-term effect of weight loss strategies on IMTG among participants with abdominal fat, remain unclear. Trada, Yuvnik, E-mail: yuvnik gmail.
Quality assurance in RAVES required each clinician and site to submit a credentialing dummy run DR and for each patient's radiation therapy plan to undergo external RTR before treatment. Prospectively defined major violations from trial protocol required remedy and resubmission. Results: Data were collected from consecutive patients, treated by 46 clinicians at 32 hospitals. The majority of resubmissions were due to contouring violations 39 of 65 and dosimetric violations 22 of For each additional patient accrued, significant decreases in RTR resubmission were seen at both clinician level OR 0.
The rate of resubmission due to dosimetric violations was only 1. Use of IMRT was associated with lower rates of resubmission compared with 3-dimensional conformal radiation therapy OR 0. Conclusion: Several low- and high-risk factors that may assist with tailoring future clinical trial QA were identified. Because the real-time resubmission rate was largely independent of the credentialing exercise, some form of RTR QA is recommended.
The greatest benefit from QA was derived early in trial activation and clinician experience. This study sought to compare the diagnostic accuracy of visual and quantitative analyses of myocardial perfusion cardiovascular magnetic resonance against a reference standard of quantitative coronary angiography. Visual analysis of perfusion cardiovascular magnetic resonance studies for assessing myocardial perfusion has been shown to have high diagnostic accuracy for coronary artery disease.
However, only a few small studies have assessed the diagnostic accuracy of quantitative myocardial perfusion. This retrospective study included patients randomly selected from the CE-MARC Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease study population such that the distribution of risk factors and disease status was proportionate to the full population. Visual analysis results of cardiovascular magnetic resonance perfusion images, by consensus of 2 expert readers, were taken from the original study reports.
Quantitative myocardial blood flow estimates were obtained using Fermi-constrained deconvolution. Diagnostic performance was calculated using receiver-operating characteristic curve analysis. The area under the curve for visual analysis was 0. For quantitative stress myocardial blood flow the area under the curve was 0.
Quantitative perfusion has a high diagnostic accuracy for detecting coronary artery disease but is not superior to visual analysis. The incorporation of rest perfusion imaging does not improve diagnostic accuracy in quantitative perfusion analysis. Atrial tachycardia AT and atrial fibrillation AF are common in pacemaker patients and are associated with bad prognoses. Influence of non-steady state during isoglycemic hyperinsulinemic clamp in hypertension.
A LIFE substudy. We performed a 2-h oral glucose tolerance test and a 3-h isoglycemic However, a 2-h clamp results in lower insulin sensitivity values in elderly, hypertensive patients due to the fact that steady state is not reached Human papillomavirus HPV -based screening needs triage. Cytological slides taken at the first colposcopy were retrieved and independently interpreted by an external laboratory, which was only aware of patients' HPV positivity. All statistical tests were two-sided. Cytology informed of HPV positivity is more sensitive than blind cytology and could allow longer intervals before retesting HPV-positive, cytology-negative women.
Published by Oxford University Press. Introduction The myocardium at risk MaR represents the quantitative ischemic area destined to myocardial infarction MI if no reperfusion therapy is initiated. Different ECG scores for MaR have been developed, but there is no consensus as to which should be preferred. Objective Comparisons The Hasche score is based on the maximal possible Dexamethasone for the prevention of postpericardiotomy syndrome: A DExamethasone for Cardiac Surgery substudy. Bunge, Jeroen J. The postpericardiotomy syndrome PPS is a common complication following cardiac surgery.
The pathophysiology remains unclear, although evidence exists that surgical trauma and the use of cardiopulmonary bypass provoke an immune response leading to PPS. We hypothesized that an intraoperative dose of. Aims Microalbuminuria frequently clusters with the metabolic syndrome and may identify subjects at increased coronary risk. Statin treatment may reduce the incidence of major adverse cardiac events in subjects with the metabolic syndrome, but evidence is limited. We evaluated the impact of. Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery.
The importance of perioperative cognitive decline has long been debated. We recently demonstrated a significant correlation between perioperative cognitive decline and long-term cognitive dysfunction. Despite this association, some still question the importance of these changes in cognitive function to the quality of life of patients and their families. The purpose of our investigation was to determine the association between cognitive dysfunction and long-term quality of life after cardiac surgery. After institutional review board approval and patient informed consent, patients undergoing cardiac surgery with cardiopulmonary bypass were enrolled and followed for 5 years.
Cognitive function was measured with a battery of tests at baseline, discharge, and 6 weeks and 5 years postoperatively. Quality of life was assessed with well-validated, standardized assessments at the 5-year end point. Our results demonstrate significant correlations between cognitive function and quality of life in patients after cardiac surgery. Lower 5-year overall cognitive function scores were associated with lower general health and a less productive working status. Multivariable logistic and linear regression controlling for age, sex, education, and diabetes confirmed this strong association in the majority of areas of quality of life.
Five years after cardiac surgery, there is a strong relationship between neurocognitive functioning and quality of life. This has important social and financial implications for preoperative evaluation and postoperative care of patients undergoing cardiac surgery. Informed consent during the clinical emergency of acute myocardial infarction HERO-2 consent substudy : a prospective observational study. Anxiety, fear, pain, and treatment with morphine might compromise the ability of patients to comprehend information about, and give informed consent for, participation in clinical trials.
We aimed to assess whether patients with acute myocardial infarction could understand written and verbal information and whether they were competent to give autonomous informed consent to participate in a clinical trial. We prospectively studied patients with acute myocardial infarction in 16 hospitals in New Zealand and Australia who were eligible for participation in the Hirulog and Early Reperfusion or Occlusion HERO -2 trial.
We assessed readability of patient information sheets, patients' educational status, their views of the consent process, comprehension of verbal and written information, and competence to give consent. Although the consent process for HERO-2 met regulatory requirements for clinical trials, it was inappropriate for the needs of most patients. The patients' comprehension of the information provided and their competence to autonomously give consent was less than optimum.
Cardiac resynchronization with defibrillators CRT-D reduces heart failure and mortality compared with defibrillators alone. Whether this applies to all ages is unclear. Different age groups age groups, there were , , and patients, respectively. We compared events with the use of a multivariate regression model. CRT-D reduced mortality only in the year age group.
Assassination Of Heart (for The Poet / Gamal Elbialy) por The Poet / Gamal Elbialy
Dietary pattern is central in the prevention of hypertension and blood pressure BP -related diseases. A diet based on healthy Nordic foods may have a favourable impact on BP. The objective was to clarify whether a Nordic alternative for a healthy food pattern would have beneficial effects on ambulatory BP in subjects with metabolic syndrome MetS. In total, 37 subjects were randomized to either a healthy Nordic diet or a control diet. A healthy Nordic diet embraced whole grains, rapeseed oil, berries, fruits, vegetables, fish, nuts and low-fat dairy products of Nordic origin.
The mean nutrient intake in the Nordic countries formed the control diet, embracing wheat products, dairy fat-based spread and a lower intake of fruits, vegetables and fish. Diets were isoenergetic. Ambulatory BP was monitored and h urine was collected before and after 12 weeks of intervention. After 12 weeks, ambulatory diastolic BP Urinary sodium and potassium excretions were unaffected by diets and consequently not associated with the healthy Nordic diet-induced lowering of BP. Consumption of Nordic varieties of health-enhancing foods for 12 weeks decreased diastolic ambulatory BP and mean arterial pressure in subjects with features of MetS during weight-stable condition, suggesting beneficial effects of a healthy Nordic dietary pattern on ambulatory BP.
Based on controlled 36 h experiments a higher dietary protein intake causes a positive protein balance and a negative fat balance. A positive net protein balance may support fat free mass accrual. However, few data are available on the impact of more prolonged changes in habitual protein intake on whole-body protein metabolism and basal muscle protein synthesis rates.
To assess changes in whole-body protein turnover and basal muscle protein synthesis rates following 12 weeks of adaptation to a low versus high dietary protein intake. A randomized parallel study was performed in 40 subjects who followed either a high protein 2. A subgroup of 7 men and 8 women body mass index: After the diet, subjects received continuous infusions with L-[ring-2H5]phenylalanine and L-[ring-2H2]tyrosine in an overnight fasted state, with blood samples and muscle biopsies being collected to assess post-absorptive whole-body protein turnover and muscle protein synthesis rates in vivo in humans.
After 12 weeks of intervention, whole-body protein balance in the fasted state was more negative in the high protein treatment when compared with the low protein treatment Basal muscle protein synthesis rates were maintained on a low vs high protein diet 0. In the overnight fasted state, adaptation to a low-protein intake 0. We hypothesized that treatment with losartan as compared to atenolol would improve In recent years, virtual reality VR therapy systems for upper limb training after stroke have been increasingly used in clinical practice.
Therapy systems employing VR technology can enhance the intensity of training and can also boost patients' motivation by adding a playful element to therapy. However, reports on user experiences are still scarce. A qualitative investigation of patients' and therapists' perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention.
The interviews were analyzed from a phenomenological perspective emphasizing the participants' perceptions and interpretations. Five key themes were identified from the patients' perspectives: i motivational factors, ii engagement, iii perceived improvements, iv individualization, and v device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. Patients and therapists mainly valued the intensive and motivational character of VR training.
The playful nature of the training appeared to have a significant influence on the patients' moods and engagement and seemed to promote a "gung-ho" spirit, so they felt that they could perform more repetitions. Conclusion: This paper outlines an ethical framework for the conduct of population-based genetics and genomics research in Trinidad and Tobago; highlights common issues arising in the field and strategies to address these.
Full Text Available Based on controlled 36 h experiments a higher dietary protein intake causes a positive protein balance and a negative fat balance. CMR was performed in patients to evaluate infarct size and myocardial salvage. In a multivariable analysis Impact of hypertension on left ventricular structure in patients with asymptomatic aortic valve stenosis a SEAS substudy. Both hypertension and aortic valve stenosis induce left ventricular hypertrophy. However, less is known about the influence of concomitant hypertension on left ventricular structure in patients with aortic valve stenosis Full Text Available Background.
Accelerated collagen turnover in women with angina pectoris without obstructive coronary artery disease: An iPOWER substudy. Aim Collagens are major cardiac extracellular matrix components, known to be actively remodelled and accumulated during diffuse myocardial fibrosis. We evaluated whether accelerated collagen turnover described by neo-epitope biomarkers reflecting collagen formation and degradation separates patients with diffuse myocardial fibrosis from asymptomatic controls. Methods and results Seventy-one women with angina pectoris without significant coronary artery disease assessed by invasive coronary angiogram were included.
Serum samples from 32 age-matched asymptomatic women were included as controls. The examined biomarkers are tools to monitor active collagen remodelling in patients with angina pectoris, in risk of developing myocardial fibrosis. Methods and results: Seventy-one women with angina pectoris without significant coronary artery disease assessed by invasive coronary angiogram were included.
Cardiac magnetic resonance T1 mapping was performed to determine extracellular volume fraction and thus diffuse myocardial fibrosis. Conclusion: Women with angina pectoris The examined biomarkers are tools to monitor active collagen remodelling in patients with angina pectoris, in risk of developing myocardial fibrosis Due to the prevalence of the westernized dietary pattern and lack of physical activity, the numbers of overweight or obese individuals are increasing, resulting in a growing health burden because of various related diseases.
A lifestyle modification approach has additional advantages compared with pharmacological therapies or bariatric surgery. In our randomized controlled trial conducted in , we successfully used a ubiquitous health care SmartCare service for patients with metabolic syndrome to achieve a significant weight loss effect. Various useful apps have been developed for the SmartCare Service, which involves using a mobile phone to manage chronic diseases, minimizing time and space restrictions.
Many studies have demonstrated weight loss effects using a SmartCare service, but limited data are available regarding the effect of active participation in relation to weight loss. We aimed to assess the weight loss effect achieved after using the SmartCare service in terms of adherence and participation.
Widerlegung der Rezension des Prof. Zwischenzeit PhD diss. A socio-cultural and religious investigation," Thesis, University of Birmingham, Essays in Honor of David B. O'Connor, Volume II , I II III IV Campagnes ," Karnak 13 : Leroux, Book of Proceedings , Season BM EA and P. Ward Providence: , Brogger, Brill, with M. Wypyski and contributions by H. Shirahata, R. Koestler, and R. Vocke, Jr. Hoch and A. Peter Munro 8. Januar — 2.
Mystical Twilight: A Poetry Book por Khayal Al Allaq
Januar , Direktor am Kestner-Museum, Hannover. Ein Nachruf Die Entdeckung von Berenike Pancrisia. DM ,. Kampagne ", Der antike Sudan. Juni Dynastie", in Studien zum antiken Sudan. Akten der 7. September in Gosen, ed. Steffen Wenig Berlin , Juli Wiesbaden; Harrassowitz XX, S. Zu den Tiermotiven auf einem napatanischen Amulett", Der antike Sudan 13 : Hildesheim: Gerstenberg Verlag.
Khayal Al Allaq con Mystical Twilight: A Poetry Book
Pelizaeus-Museum VIII, S. Eggebrecht und B. Schmitz, Orientalistische Literaturzeitung 91 , An Alphabetical List Leiden: Lutz, Henry F. Hinrichs'sche Buchhandlung, Stech, J. Muhly, and E. Sopranos, OIMP 27 Alster and P. Frandsen Copenhagen, : Past, Present and Fuutre, ed. Strudwick and J. Taylor London, : Virgili Barcelona : Tefnin Bruxelles, : Gamal Moukhtar, Cairo, : Studies in Honour of Naguib Kanawati, ed.
Woods, A. MacFarlane and S. Binder, Cairo, II , Angenot Brepols, Essays Presented to Leonard H. Studies in Honor of Edward Brovarski Cairo: , Geburtstag am Juli , Reisner," KMT 7. Le Grande Piramide di Cheope. Haynes and Rita E. VI Paris: Tome premier. Appleton and Co. Prescendi, F.
infarction-2 danami-2 substudy: Topics by ynykyvykeb.tk
Belayche, N. Paris: PUPS, : Heidorn, W. Kagel, and T. Excavations — Chicago: Oriental Institute, Coxe Junior Expedition to Nubia, Vol. Archi and R. Francia Studi Micenei ed Egeo-Anatolici 49 , April Vor- u. Posluschny, K. Lambers, and I. Herzog Bonn, , I-IV Leipzig: I Leipzig: II Leipzig: Monson, Andrew, and John Taie, "Putting papyri into archaeological context: new insights from Tebtunis, Egypt," Archaeology International 5 : Dynastie Dynastie und den Stufenpyramiden der 5.
Codierung von Totenbuch-Vignetten Link to PDF file. Link to web page. Kahl, Jochem, "Hannig, Rainer.