Prospective Randomized Crossover Study Research Articles

Effect of Heated Humidification on CPAP Therapy Adherence in Subjects With Obstructive Sleep Apnea With Nasopharyngeal Symptoms.

The addition of heated humidification to CPAP has been shown to improve nasal adverse effects in subjects with obstructive sleep apnea (OSA). However, current data regarding improvement in CPAP adherence is conflicting. Furthermore, there are no data from a tropical climate area with a high humidity level. In this prospective randomized crossover study conducted in Thailand, subjects with moderate to severe OSA with nasopharyngeal symptoms post-split-night study were enrolled in the study. Subjects were randomly assigned to receive CPAP with or without heated humidification for 4 weeks and then crossed over. Information on CPAP adherence, quality of life assessed by the Functional Outcomes of Sleep Questionnaire, nasopharyngeal symptoms assessed by a modified XERO questionnaire, and bedroom ambient humidity and temperature data were obtained. Data were collected on 20 subjects with OSA during the period of January to December 2014. Although the addition of heated humidification appeared to improve average hours of use for all days when compared with conventional CPAP, the difference was not statistically significant (CPAP with heated humidification = 4.6 ± 1.7 h/night; conventional CPAP = 4.0 ± 1.7 h/night, P = .1). However, the addition of heated humidification improved CPAP adherence on the days of use (5.5 ± 1.5 h/night) compared with conventional CPAP (5.2 ± 1.4 h/night), P = .033. Quality of life was also improved according to the Functional Outcomes of Sleep Questionnaire score (median 17.6 [interquartile range 3.5]) in the heated humidification group compared with conventional CPAP group (median 17.6 [interquartile range 4.5]), P = .046. Significant reduction in the dry throat/sore throat symptom was noted only when CPAP with heated humidification was used. Even in a tropical climate area, CPAP adherence and quality of life appeared to improve when heated humidification was employed in subjects with moderate to severe OSA with nasopharyngeal symptoms post-split-night polysomnography. The improvement may be related to a reduction in the dry throat/sore throat symptom.

A Prospective Randomized Crossover Study on the Comparison of Cotton Versus Waterproof Cast Liners.

Many fractures are treated with casting which can cause complications likely from inability to wash the extremity. Gore-Tex-based waterproof cast liner has been compared with cotton liner and shown to be superior in physician and patient scoring but also has high cost and difficult application. The purpose of this study is to compare newer generation waterproof liners with traditional cotton liner. It is the first study to compare this new waterproof liner and cotton liner in a crossover model, allowing patients to swim in the pool with the cast. Twenty patients (ages 3-30) with upper extremity injuries were randomized to waterproof-liner or cotton-liner casts made of fiberglass. Patients would switch cast liners halfway between their treatments to fulfill crossover criteria. All fractures were within a 2-week period from original incident. At each clinic visit, patients evaluated comfort parameters through questionnaires, and physicians rated skin condition. Patients were also asked which cast liner they preferred at the end of the study. There were no unscheduled cast changes. The waterproof-liner group had better scores for odor (P = .041), sweat (P = .016), and overall physician-rated score (P = .038). There was no significant difference in other patient-rated parameters. Seventy-five percent of patients preferred waterproof casting to the cotton liner. This new waterproof cast liner, compared with cotton cast liner, had better odor, sweat, and overall physician scores. The waterproof liners allow patients to rinse casts daily, and the majority of patients prefer waterproof to cotton liner.

Prospective Randomized and Crossover Comparison of Two Apheresis Machines for Peripheral Blood Stem and Progenitor Cell Collection: A Multicenter Study

Peripheral blood stem and progenitor cell (PBSPC) collection imposes apheresis-related risks including thrombocytopenia, hypocalcemia and thromboembolism in donors for PBSPC transplantation. Efficient PBSC collection with fewer apheresis risks and less contamination in the collected products is crucial and we have shown some distinct characteristics among apheresis devices (Transfusion, 2003, 2007 and 2014). A recently introduced apheresis device for PBSPC collections, Spectra-Optia, has not yet established supremacy in safety and efficiency over other established previous apparatuses/programs. To compare the Optia with the widely used automated program for a former apheresis machine, Spectra-Auto (Software version 6.1), we for the first time carried out a prospective randomized multicenter and crossover study for a total of 233 apheresis done from November 2013 to May 2015 in adult (≥18 years) and G-CSF-given patients/donors. The device for the first-day apheresis was randomly assigned, and a total of 152, consisting of 47 for autologous (auto-) patients and 105 for allogeneic (allo-) donors, were studied (1st-day analysis). Among them, the 81 subjects who required the second-day apheresis to collect more cells, the second-day apheresis was performed with the other machine than the one used in the first day, and apheresis collections for 2 consecutive days using both machines were compared by a paired-t test (crossover analysis). In the both devices, apheresis was performed based on the manufacturer's protocols, with 12:1 to 15:1 ratios of whole blood to acid citrate dextrose without heparin. There was no difference between the Optia (n = 74) and the Spectra-Auto (n = 78) in the pre-apheresis parameters including age, sex, circulating blood volume (CBV), and peripheral complete blood counts (CBCs). In the crossover comparison, age, sex and CBV were technically same and CBCs were similar between the two machines (n = 81 in each). The Spectra-Auto processed larger volumes compared with the Optia [P = .02 (1st-day analysis) and .08 (crossover analysis)], although run time was similar with the two devices [P = .57 (1st-day) and .52 (crossover)]. Mild apheresis-related reactions occurred in both machines with similar frequencies of reactions, and volumes of ACD used were not different between them. Volumes of harvested products were greater in the Optia compared with the Spectra-Auto [158 vs. 95 mL, P < .01 (1st-day) and 137 vs. 86 mL, P < .01 (crossover)]. Yields of mononuclear cells [P = .27 (1st-day) and .22 (crossover)] and CD34+ cells [P = .10 (1st-day) and .19 (crossover)] were not different between them. However, regardless of program, pre-apheresis peripheral CD34+ cell counts strongly correlated with the number of CD34+ cells collected, and collection efficiencies of CD34+ cells were significantly higher in the Optia compared with the Spectra-Auto [82.2% vs. 66.3%, P < .01 (1st-day) and 80.5% vs. 63.1%, P < .01 (crossover)]. The products collected using the Optia contained more contaminating red blood cells [64 vs. 36 x 106 cells, P < .01 (1st-day) and 56 vs. 33 x 106 cells, P < .01 (crossover)], compared with the Spectra-Auto, without corresponding anemia. Only in crossover analysis, there was a trend that contaminated platelets were higher with the Optia compared with the Spectra-Auto (154 vs. 127 x 109 cells, P = .06). In conclusion, the Optia is tolerable, and has no significant inferiority in the yield or adverse events in apheresis collection of PBSPCs compared with Spectra-Auto. This trial was registered at http://www.umin.ac.jp/ctr/index.htm as #UMIN000012095. DisclosuresOhto:Terumo BCT: Research Funding.

Diverse diuretics regimens differentially enhance the antialbuminuric effect of renin–angiotensin blockers in patients with chronic kidney disease

The addition of spironolactone or hydrochlorothiazide enhances the antialbuminuric effect of renin-angiotensin blockers. However, comparative studies on the effect of different diuretics are lacking. We conducted a prospective randomized crossover study to compare the effects of spironolactone (25 mg/day), hydrochlorothiazide (50 mg/day) without/with amiloride (5 mg/day) on top of enalapril treatment in 21 patients with CKD stages 1-3 and a urinary albumin-to-creatinine ratio (UACR) over 300 mg/g. Treatment periods lasted 4 weeks. The UACR showed a significant reduction with the diuretics: spironolactone, -34% or hydrochlorothiazide without/with amiloride -42% or -56%, respectively. Reduction of the UACR was significantly greater with hydrochlorothiazide without/with amiloride when compared with spironolactone. The percentage of patients who achieved UACR reductions greater than 30% and 50% was greater with hydrochlorothiazide without/with amiloride (81% and 57%, and 81% and 66%, respectively) when compared with spironolactone alone (57% and 28%, respectively). Glomerular filtration rate (GFR), blood pressure, and body weight decreased with the three diuretic regimens. A significant correlation was found between the UACR reduction and GFR and blood pressure changes. Thus, diverse diuretic regimens differentially enhance albuminuria reduction, an effect likely associated with the degree of GFR reduction.

Thermal build-up, decay and retention responses to local therapeutic application of 448 kHz capacitive resistive monopolar radiofrequency: A prospective randomised crossover study in healthy adults

Purpose: Radiofrequency-based electrophysical agents are widely used in therapy-related clinical practice for their thermal effects, mainly relieving pain and inflammation and improving tissue extensibility. The most commonly used and researched are shortwave therapies that operate at 27.12 MHz. Although relatively new, electrophysical agents employing much lower frequencies have also emerged. Capacitive resistive monopolar radiofrequency employing 448 kHz is one such therapy. This laboratory-based study was aimed to investigate the skin thermal responses to 448 kHz radiofrequency-based therapy in healthy adults.Methods: In a two-group randomised crossover study, 15 volunteers attended two modes (capacitive and resistive) of 448 kHz radiofrequency-based therapy (using ‘Indiba Activ 902’) administered locally to the lower thigh region. Starting at minimum, the intensity was increased incrementally until thermal discomfort was felt. Participants reported three time points: thermal onset, definite thermal sensation, and onset of thermal discomfort. Local skin temperature was measured before, immediately post-treatment and up to 45 min post-treatment.Results: Both capacitive and resistive modes of therapy significantly increased the skin temperature and sustained it over the 45-min follow-up. There was statistically significant difference between the thermal response patterns produced by the two modes. Peak post-treatment temperatures attained were not significantly different between the two; however, the retention rate at follow-up was significantly higher for the resistive mode.Conclusions: This study confirms that radiofrequency-based therapy at 448 kHz can significantly increase and sustain skin temperature. The study also provides useful baseline data for further research in the low frequency ranges of radiofrequency-based therapy that remain largely unexplored.

381 Prospective Randomized Crossover Study Evaluating the Comparative Effectiveness of Telesimulation versus Standard Simulation for Teaching Medical Students the Assessment and Management of Critically Ill Patients

381 Prospective Randomized Crossover Study Evaluating the Comparative Effectiveness of Telesimulation versus Standard Simulation for Teaching Medical Students the Assessment and Management of Critically Ill Patients

A Preliminary Comparison of Laryngeal Manipulation and Postural Treatment on Voice Quality in a Prospective Randomized Crossover Study

This crossover study compared the effects of two osteopathic treatments specific laryngeal manipulation (SLM) and postural manual therapy (PMT) on voice quality and pitch. Twelve asymptomatic singers were measured acoustically immediately before and immediately after each intervention using a laryngograph. Fundamental frequency and the glottal closing quotient were used to determine any differences between groups before and after. Fundamental frequency showed a statistically significant change following both interventions (combined [P=0.007] and PMT and SLM individually (P=0.0143, P=0.018, respectively). Although the benefit demonstrated using SLM was greater than that with PMT (2.4, 2.02, respectively), following Bonferroni correction there was no statistical significance demonstrated between the two groups. There was no statistically significant change with glottal closing time for any intervention or at any time (P=0.52). This pilot study provides evidence of the benefit for both SLM and PMT in singers. A significant difference was found in the voice quality of the participants involved in both PMT and SLM. These results set the way for further larger scale studies to evaluate group interactions and potential benefits in symptomatic patients.

Proper target depth of an accelerometer-based feedback device during CPR performed on a hospital bed: a randomized simulation study

PurposeFeedback devices are used to improve chest compression (CC) quality related to survival rates in cardiac arrest. However, several studies have shown that feedback devices are not sufficiently reliable to ensure adequate CC depth on soft surfaces. Here, we determined the proper target depth of feedback (TDF) using an accelerometer during cardiopulmonary resuscitation in hospital beds. MethodsIn prospective randomized crossover study, 19 emergency physicians performed CCs for 2 minutes continuously on a manikin in 2 different beds with 3 TDFs (5, 6, and 7 cm). We measured CC depth, the proportion of accurate compression depths, CC rate, the proportion of incomplete chest decompressions, the velocity of CC (CC velocity), the proportion of time spent in CC relative to compression plus decompression (duty cycle), and the time spent in CC (CC time). ResultsMean (SD) CC depths at TDF 5, 6, and 7 were 45.42 (5.79), 52.68 (4.18), and 58.47 (2.48) on one bed and 46.26 (4.49), 53.58 (3.15), and 58.74 (2.10) mm on the other bed (all P < .001), respectively. The proportions of accurate compression depths and CC velocity at TDF 5, 6, and 7 differed significantly according to TDF on both beds (all P < .001).The CC rate, CC time, and proportion of incomplete chest decompression did not differ on both beds (all P > .05). The duty cycle differed significantly on only B2. ConclusionsThe target depth of the real-time feedback device should be at least 6 cm but should not exceed 7 cm for optimal CC on patients on hospital beds.

Effect of Extrinsic and Intrinsic Stressors on Clinical Skills Performance in Third-Year Medical Students.

Both enhancements and impairments of clinical performance due to acute stress have been reported, often as a function of the intensity of an individual's response. According to the broader stress literature, peripheral or extrinsic stressors (ES) and task-contingent or intrinsic stressors (IS) can be distinguished within a stressful situation. The objective of this study was to assess the impact of IS and ES on clinical performance. A prospective randomized crossover study was undertaken with third-year medical students conducting two medical experiences with simulated patients. The effects of severity of the disease (IS) and the patient's aggressiveness (ES) were studied. A total of 109 students were assigned to four groups according to the presence of ES and IS. Subjective stress and anxiety responses were assessed before and after each experience. The students' clinical skills, diagnostic accuracy and argumentation were assessed as clinical performance measures. Sex and student-perceived cognitive difficulty of the task were considered as adjustment variables. Both types of stressors improved clinical performance. IS improved diagnostic accuracy (regression parameter β = 9.7, p = 0.004) and differential argumentation (β = 5.9, p = 0.02), whereas ES improved clinical examination (β = 12.3, p < 0.001) and communication skills (β = 15.4, p < 0.001). The student-perceived cognitive difficulty of the task was a strong deleterious factor on both stress and performance. In simulated consultation, extrinsic and intrinsic stressors both have a positive but different effect on clinical performance.

Efficacy of palonosetron and 1-day dexamethasone in moderately emetogenic chemotherapy compared with fosaprepitant, granisetron, and dexamethasone: a prospective randomized crossover study.

Although palonosetron (PALO) and NK1 receptor antagonist both reduce chemotherapy-induced nausea and vomiting, no comparison trial in moderately emetogenic chemotherapy (MEC) had been reported. The purpose of this study was to find out which drug combinations are preferable for patients receiving MEC. Chemotherapy-naive patients receiving MEC were randomized to two groups; group A first received PALO therapy [PALO plus 1-day dexamethasone (DEX)], and group B first received fosaprepitant (FAPR) therapy [FAPR, granisetron (GRAN), and DEX]. Patients were re-allocated to the other therapy, respectively, for the second cycle of chemotherapy. We administered intravenous PALO (0.75 mg) and DEX (9.9 mg) to the PALO therapy group, and FAPR (150 mg), DEX (4.95 mg), and GRAN (3 mg) to the FAPR therapy group, on Day 1. Complete response (CR) was the primary endpoint; complete control (CC), total control (CT), and the therapy chosen by the patients for their third and following cycles of antiemetic therapy were the secondary endpoints. We evaluated CR, CC, and TC in the acute phase, in the delayed phase, and over the whole period. A total of 35 patients and 70 cycles of therapy was evaluable for analysis. No significant difference was found at all evaluation points. Overall CR rates for PALO and FAPR therapy were 74 vs 69 % (P = 0.567), CC rates 66 vs 69 % (P = 0.521), and TC rates 46 vs 60 % (P = 0.235), respectively. Patients also showed no clear preference for their third and following cycles of chemotherapy, choosing both regimens almost equally often (PALO 10 vs FAPR 13). PALO and 1-day DEX is almost equivalent to FAPR, GRAN, and DEX for MEC.

Effects of a recruitment maneuver on plasma levels of soluble RAGE in patients with diffuse acute respiratory distress syndrome: a prospective randomized crossover study.

The soluble form of the receptor for advanced glycation end-products (sRAGE) is a promising marker for epithelial dysfunction, but it has not been fully characterized as a biomarker of acute respiratory distress syndrome (ARDS). Whether sRAGE could inform on the response to ventilator settings has been poorly investigated, and whether a recruitment maneuver (RM) may influence plasma sRAGE remains unknown. Twenty-four patients with moderate/severe, nonfocal ARDS were enrolled in this prospective monocentric crossover study and randomized into a "RM-SHAM" group when a 6-h-long RM sequence preceded a 6-h-long sham evaluation period, or a "SHAM-RM" group (inverted sequences). Protective ventilation was applied, and RM consisted of the application of 40 cmH2O airway pressure for 40 s. Arterial blood was sampled for gas analyses and sRAGE measurements, 5 min pre-RM (or 40-s-long sham period), 5, 30 min, 1, 4, and 6 h after the RM (or 40-s-long sham period). Mean PaO2/FiO2, tidal volume, PEEP, and plateau pressure were 125 mmHg, 6.8 ml/kg (ideal body weight), and 13 and 26 cmH2O, respectively. Median baseline plasma sRAGE levels were 3,232 pg/ml. RM induced a significant decrease in sRAGE (-1,598 ± 859 pg/ml) in 1 h (p = 0.043). At 4 and 6 h post-RM, sRAGE levels increased back toward baseline values. Pre-RM sRAGE was associated with RM-induced oxygenation improvement (AUC 0.84). We report the first kinetics study of plasma sRAGE after RM in ARDS. Our findings reinforce the value of plasma sRAGE as a biomarker of ARDS.

Relationship Between Sunitinib Pharmacokinetics and Administration Time: Preclinical and Clinical Evidence.

Background and ObjectiveCircadian rhythms may influence the pharmacokinetics of drugs. This study aimed to elucidate whether the pharmacokinetics of the orally administered drug sunitinib are subject to circadian variation.MethodsWe performed studies in male FVB-mice aged 8–12 weeks, treated with single-dose sunitinib at six dosing times. Plasma and tissue samples were obtained for pharmacokinetic analysis and to monitor messenger RNA (mRNA) expression of metabolizing enzymes and drug transporters. A prospective randomized crossover study was performed in which patients took sunitinib once daily at 8 a.m., 1 p.m., and 6 p.m at three subsequent courses. Patients were blindly randomized into two groups, which determined the sequence of the sunitinib dosing time. The primary endpoint in both studies was the difference in plasma area under the concentration–time curve (AUC) of sunitinib and its active metabolite SU12662 between dosing times.ResultsSunitinib and SU12662 plasma AUC in mice followed an ~12-h rhythm as a function of administration time (p ≤ 0.04). The combined AUC from time zero to 10 h (AUC10) was 14–27 % higher when sunitinib was administered at 4 a.m. and 4 p.m. than at 8 a.m. and 8 p.m. Twenty-four-hour rhythms were seen in the mRNA levels of drug transporters and metabolizing enzymes. In 12 patients, sunitinib trough concentrations (C trough) were higher when the drug was taken at 1 p.m. or 6 p.m. than when taken at 8 a.m. (C trough-1 p.m. 66.0 ng/mL; C trough-6 p.m. 58.9 ng/mL; C trough-8 a.m. 50.7 ng/mL; p = 0.006). The AUC was not significantly different between dosing times.ConclusionsOur results indicate that sunitinib pharmacokinetics follow an ~12-h rhythm in mice. In humans, morning dosing resulted in lower C trough values, probably resulting from differences in elimination. This can have implications for therapeutic drug monitoring.Electronic supplementary materialThe online version of this article (doi:10.1007/s40262-015-0239-5) contains supplementary material, which is available to authorized users.

Sacral Nerve Modulation for Fecal Incontinence

Although sacral nerve modulation has become an important tool for the treatment of fecal incontinence, prospective, randomized data are still rare. To determine the effectiveness of sacral nerve modulation in a prospective randomized crossover study : Prospective randomized crossover study : Proctological Office and Department of Surgical Proctology at a private hospital. A total of 31 consecutive patients (31 women) aged 55 ± 12 years (median ± SD) with fecal incontinence were enrolled between February 2012 and December 2012. All patients underwent sacral nerve modulation through a staged implantation procedure between 2009-2011. After a median of 26.8 months following implantation, 16 of the 31 patients agreed to be randomized in a crossover design to stimulation ON or OFF, each for a 3-week period. After the two periods (ie, 6 weeks), while still blinded to the stimulator status, the patients chose which stimulation period (first or second) they preferred. The mode of stimulation corresponding to the selected period was then continued for 3 months (final period). Frequency of bowel movements, frequency of fecal incontinence and urgency episodes, severity scores, preference for ON or OFF. The frequency of fecal incontinence episodes and Cleveland Clinic Incontinence Score (CCIS) were both significantly lower in the ON period than the OFF period (p < 0.005) during the crossover phase of the study. All patients decided to stay in the ON mode for the final period and have continued in the ON mode until now. Small patient numbers. The significant improvement in fecal incontinence during the ON period, as compared to the OFF period, makes it unlikely that the observed benefits of sacral nerve modulation are due to a placebo effect.

Comparisons of the Pentax-AWS, Glidescope, and Macintosh Laryngoscopes for Intubation Performance during Mechanical Chest Compressions in Left Lateral Tilt: A Randomized Simulation Study of Maternal Cardiopulmonary Resuscitation

Purpose. Rapid advanced airway management is important in maternal cardiopulmonary resuscitation (CPR). This study aimed to compare intubation performances among Pentax-AWS (AWS), Glidescope (GVL), and Macintosh laryngoscope (MCL) during mechanical chest compression in 15° and 30° left lateral tilt. Methods. In 19 emergency physicians, a prospective randomized crossover study was conducted to examine the three laryngoscopes. Primary outcomes were the intubation time and the success rate for intubation. Results. The median intubation time using AWS was shorter than that of GVL and MCL in both tilt degrees. The time to visualize the glottic view in GVL and AWS was significantly lower than that of MCL (all P < 0.05), whereas there was no significant difference between the two video laryngoscopes (in 15° tilt, P = 1; in 30° tilt, P = 0.71). The progression of tracheal tube using AWS was faster than that of MCL and GVL in both degrees (all P < 0.001). Intubations using AWS and GVL showed higher success rate than that of Macintosh laryngoscopes. Conclusions. The AWS could be an appropriate laryngoscope for airway management of pregnant women in tilt CPR considering intubation time and success rate.

Evaluation of Analgesic Effect of Caudal Epidural Tramadol, Tramadol-Lidocaine, and Lidocaine in Water Buffalo Calves (Bubalus bubalis).

Aim of this study was to compare the analgesic effect of tramadol and a combination of tramadol-lidocaine with that produced by lidocaine administration in the epidural space in buffalo calves. In a prospective randomized crossover study, ten male buffalo calves were used to compare the epidural analgesic effect of tramadol (1 mg/kg) and tramadol-lidocaine combination (0.5 mg/kg and 0.11 mg/kg, resp.) with that produced by 2% lidocaine (0.22 mg/kg). Loss of sensation was examined by pin-prick test. Onset time, duration, and degree of analgesia and ataxia were recorded after each treatment. Heart rate (HR), respiratory rate (RR), rectal temperature, and haematobiochemical parameters were recorded after all treatments. Time to onset and duration of analgesia, respectively, were as follows: tramadol 11 ± 2 min and 208 ± 15 min; tramadol-lidocaine 6 ± 2 min and 168 ± 9 min; lidocaine 4 ± 1 min and 67 ± 13 min. Onset time and duration were significantly longer with tramadol than the other treatments. Duration was significantly longer with tramadol-lidocaine than lidocaine. Ataxia was mildly observed in tramadol-lidocaine and was moderate in lidocaine. HR, RR, and rectal temperature did not differ significantly from baseline after any treatment. Haematobiochemical parameters returned to basal levels by 24 h after all treatments. This combination might be clinically useful to provide analgesia in buffalo for long-duration surgical procedures.

Effects of a recruitment maneuver on plasma soluble rage in patients with diffuse ARDS: a prospective randomized crossover study

The soluble form of the receptor for advanced glycation endproducts (sRAGE) is a promising marker for epithelial dysfunction, but it has not been fully characterized as a biomarker during ARDS. Whether sRAGE could inform on the response to ventilator settings has been poorly investigated, and whether recruitment maneuver (RM) may influence plasma sRAGE remains unknown.

Significant variation in salivation by short-term suggestive intervention: a randomized controlled cross-over clinical study.

IntroductionMost dental procedures require a dry working environment. Although many evaporative drying methods are available, an additional reduction of salivary flow would often be helpful.MethodsThis prospective randomized cross-over study compares salivary production in 31 volunteers during direct, indirect, and non-suggestive (control group) intervention. Overall, each volunteer underwent four salivation measurements, i.e. two measurements during two different types of hypnotic suggestion (indirect and direct) arranged in random order and two control sections. All four measurements were conducted successively.ResultsBoth suggestive methods significantly reduced salivary production in comparison to the two control sections (direct suggestion Δ = 1.46 grams per 5 min, p < 0.001, indirect suggestion Δ = 0.94 grams per 5 min, p = 0.039). Direct suggestion showed a significantly higher reduction of salivary production than indirect suggestion (Δ = -0.53 grams per 5 min, p = 0.001).ConclusionsHypnotic suggestion represents a simple and inexpensive method to reduce salivation and could thus create a better working environment for more comfortable dental treatments for both patients and dentists.

Neonatal intubation with direct laryngoscopy vs videolaryngoscopy: an extremely premature baboon model.

To compare the ability to successfully intubate extremely preterm baboons using conventional direct laryngoscopy (DL) vs videolaryngoscopy. A prospective randomized crossover study using experienced and inexperienced neonatal intubators. All participants were shown an educational video on intubation with each device, followed by attempt of the procedure. The time for successful intubation was the primary outcome. Seven subjects comprised the experienced group, while 10 individuals were in the inexperienced group. The overall intubation success rate was comparable between both devices (53% vs 26%, P = 0.09); however, mean time to intubate with the conventional laryngoscope was faster (25.5 vs 39.4 s, P = 0.02). Although both groups intubated faster with DL, it only reached statistical significance in the inexperienced group (27.0 vs 48.7 s, P < 0.05). Conventional DL and videolaryngoscopy are suitable modes for intubating extremely preterm baboons. Although experienced intubators prefer DL, intubation success rate and time to intubate with both devices were comparable. In inexperienced intubators, participants preferred and intubated faster with DL.

Fasting Reduces the Incidence of Delayed-Type Vomiting Associated with Doxorubicin Treatment in Dogs with Lymphoma

Fasting reduces gastrointestinal cellular proliferation rates through G1 cycle blockade and can promote cellular protection of normal but not cancer cells through altered cell signaling including down-regulation of insulin-like growth factor 1 (IGF-1). Consequently, the purpose of this study was to determine the effects of fasting on delayed-type chemotherapy-induced nausea and vomiting in dogs receiving doxorubicin. This prospective randomized crossover study involved intended administration of two doses of doxorubicin. Cancer-bearing dogs were randomized to be fasted for 24 hours beginning at 6 P.M. the night before the first or second doxorubicin administration, and all treatments were administered within an hour before or after 12 P.M. Dogs were fed normally before the alternate dose. Circulating IGF-1 concentrations were determined from serum samples obtained immediately before each doxorubicin treatment. Data from 35 doses were available from 20 dogs enrolled. Dogs that were fasted exhibited a significantly lower incidence of vomiting, when compared to fed dogs (10% compared to 67%, P = .020). Furthermore, among the 15 dogs that completed crossover dosing, vomiting was abrogated in four of five dogs that experienced doxorubicin-induced vomiting when fed normally (P = .050). No differences in other gastrointestinal, constitutional, or bone marrow toxicities or serum IGF-1 levels were observed.

Evaluation of hydration status calculated from differences in venous and capillary plasma dilution during stepwise crystalloid infusions: A randomized crossover study in healthy volunteers

Background and objectiveA mini volume loading test (mVLT) was proposed for estimating hydration status and interstitial fluid accumulation during stepwise infusion of crystalloids. The method is based on both the transcapillary reflux model and the hypothesis that when subjects are dehydrated, venous plasma dilution induced by a fluid challenge is higher than in the capillaries, and that difference is diminished when the fluid challenge is given to more hydrated individuals. Our objective was to test that hypothesis by evaluating the veno-capillary dilution difference during mVLT in subjects with different hydration status. Materials and methodsIn a prospective randomized crossover study, three mini fluid challenges were given to 12 healthy volunteers on two occasions. The subjects were either dehydrated or hydrated before the experiments. ResultsIn dehydrated subjects only, capillary plasma dilution was significantly lower than venous (P=0.015, 0.005 and 0.006) after each mini fluid challenge. ConclusionsVeno-capillary dilution difference during mVLT depends on the hydration status. The mVLT method could possibly discriminate between the different states of hydration.