Perfectly implemented randomized clinical trials, particularly of complex interventions, are extremely rare. Almost always they are characterized by imperfect adherence to the randomly allocated treatment and variable amounts of missing outcome data. Here we start by describing a wide variety of examples and then introduce instrumental variable methods for the analysis of such trials. We concentrate mainly on situations in which compliance is all or nothing (either the patient receives the allocated treatment or they do not - in the latter case they may receive no treatment or a treatment other than the one allocated). The main purpose of the review is to illustrate the use of latent class (finite mixture) models, using maximum likelihood, for complier-average causal effect estimation under varying assumptions concerning the mechanism of the missing outcome data.

Background The Outcomes of Depression International Network (ODIN) trial evaluated the effect of two psychological interventions for the treatment of depression in primary care. Only about half of the patients in the treatment arm complied with the offer of treatment, prompting the question: ‘what was the effect of treatment in those patients who actually received it?’ Aims To illustrate the estimation of the effect of receipt of treatment in a randomised controlled trial subject to non-compliance and loss to follow-up. Method We estimated the complier average causal effect (CACE) of treatment. Results In the ODIN trial the effect of receipt of psychological intervention (an average of about 4 points on the Beck Depression Inventory) is about twice that of offering it. Conclusions The statistical analysis of the results of a clinical trial subject to noncompliance to allocated treatment is now reasonably straightforward through estimation of a CACE and investigators should be encouraged to present the results of analyses of this type as a routine component of a trial report.

Additional oxygen consumption during intense exercises may lead to oxidative stress and contribute to muscular fatigue. Green tea and sour tea (Hibiscus sabdariffa L.), which contain various flavonoids and polyphenols, have many healthful properties such as anticarcinogenic, anti-inflammatory, and heart protecting effects. The aim of the present study was to assess the effects of green tea and sour tea supplementation on oxidative stress and muscle damage in soccer athletes. This randomized, double-blind control trial was conducted on 54 male soccer players. Participants were randomly assigned to three groups to receive: 450 mg/d green tea extract (GTE) in the first group (n = 18), 450 mg/d sour tea extract (STE) in the second group (n = 18) and 450 mg/d maltodextrin in the control group (n = 18). Fasting whole blood samples were taken under resting conditions at the beginning and the end of the study to quantify the serum levels of muscle damage indices, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), and oxidative stress biomarkers, malondialdehyde (MDA), and total antioxidant capacity (TAC). After six weeks intervention, athletes who received GTE and STE supplements compared with the placebo had a significantly decreased MDA level (P = 0.008). Furthermore, STE supplementation resulted in a significant increase in TAC level compared with GTE and placebo groups (P = 0.01). However, supplementation with GTE and STE had no significant effects on muscle damage indices. GTE and STE supplementation have beneficial effects on oxidative stress status in male athletes. However, both kinds of tea extract did not affect muscle damage status.

Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature. A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05. Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115). According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of this study with the clinical outcomes.