Each study was reconstructed with filtered back projection (FBP), hybrid iterative reconstruction (iDose(4)), and IMR in a diastolic phase. Additional systolic phase reconstructions were obtained for TCM studies. Mean pixel attenuation value and standard deviation (SD) were measured in the left ventricle and left main coronary IPI-549 order artery. Subjective scores were obtained by two independent reviewers on a 5-point scale for definitions of contours of small coronary arteries ( smaller than 3 mm), coronary calcifications,
noncalcified plaque, and overall diagnostic confidence for the presence/absence of stenosis. Results: There was no significant difference in pixel intensity among FBP, iDose(4) and IMR (P bigger than .8). For diastolic phase images, noise amplitude G418 chemical structure in the left main coronary artery was reduced by a factor of 1.3 from FBP to iDose(4) (SD = 99 vs. 74; P = .005) and by a factor of 2.6 from iDose(4) to IMR (SD = 74 vs. 28; P smaller than .001). For systolic phase TCM images, noise amplitude in the left main coronary artery was reduced
by a factor of 2.3 from FBP to iDose(4) (SD = 322 vs. 142; P smaller than .001) and by a factor of 3.0 from iDose(4) to IMR (SD = 142 vs. 48; P smaller than .001). All four subjective image quality scores were significantly better with IMR compared to iDose(4) and FBP (P smaller than .001). The reduction in image noise amplitude and improvement in image quality scores were greatest among obese patients. Conclusions: IMR reduces intravascular noise on cCTA by 86%-88% compared to FBP, and improves image quality at radiation exposure levels 80% below our standard technique.”
“Background & Aims: Multidrug resistance presents a major problem in hepatoblastoma (HB), and new anti-tumor strategies are desperately needed. The substance P (SP)/neurokinin-1 receptor (NK1R) complex has been discovered to be pivotal in the development of a variety of human cancers, and NK1R antagonists, such as the clinical drug aprepitant, are promising future
anticancer agents. AZD3965 Yet, the role of the SP/NK1R complex as a potential anticancer target in HB is unknown. Methods: Human HB cell lines HepT1, HepG2, and HuH6, human tumor samples from 17 children with HB as well as mice xenografted with human HB cell line HuH6 were analyzed regarding the SP/NK1R complex as a potential new anti-tumor target in HB. Results: Therapeutic targeting with the NK1R antagonists aprepitant, L-733,060, and L-732,138 led to growth inhibition and apoptosis in HepT1, HepG2, and HuH6 cells in a dose-dependent manner. Intriguingly, HB cells predominantly expressed the truncated splice variant of NK1R. Human fibroblasts showed only dismal NK1R expression and were significantly more resistant.
A novel Rao
test based detector, which does not require any a priori knowledge about the primary user (PU) signal and channels, is proposed for the detection of a primary user in non-Gaussian noises selleck chemicals llc that are molded by the generalized Gaussian distribution (GGD). The statistic of the proposed Rao detector is derived and its detection performance is analyzed in the low signal-to-noise ratio regime and compared to that of the traditional energy detection. Furthermore, the Rao-based detection is extended to a multi-user cooperative framework by using the “k-out-of-M” decision fusion rule and considering erroneous reporting channels between the secondary users and the fusion center due to Rayleigh fading. The global cooperative detection and false alarm probabilities are derived based on the cooperative sensing scheme. Analytical and computer simulation results show that for a given probability of false alarm, the Rao detector can significantly enhance the spectrum sensing performance over the conventional energy detection and the polarity-coincidence-array (PCA) method in non-Gaussian noises. Furthermore, the proposed cooperative detection Dactolisib scheme has a significantly higher global probability of detection than the non-cooperative scheme. (C) 2013 Elsevier B.V. All rights reserved.”
“Empirical data indicative of the health conditions and medical needs of homeless
persons are scarce in Japan. In this study, with the aim of contributing to the formulation of future healthcare strategies for the homeless, we conducted a self-administered
questionnaire survey and interviews at a park in Shinjuku Ward, Tokyo, to clarify the living conditions of homeless persons and their health conditions and awareness about the availability of medical treatment. Responses from 55 homeless men were recorded (response rate: 36.7%). With the exception of one person, none of them possessed a health insurance certificate. Half of the respondents reported having a current income source, although their modal monthly income was (sic)30,000 ($1 was approximately (sic)90). The number of individuals who responded “yes” to the questions regarding “Consulting a doctor on the basis S63845 concentration of someone’s recommendation” and “Being aware of the location of the nearest hospital or clinic” was significantly higher among those who had someone to consult when they were ill than among those who did not (the odds ratios [95% confidence intervals] were 15.00 [3.05-93.57] and 11.45 [1.42-510.681, respectively). This showed that whether or not a homeless person had a person to consult might influence his healthcareseeking behavior. When queried about the entity they consulted (multiple responses acceptable), respondents mentioned “life support organizations” (61.1%) and “public offices” (33.3%). Overall, 94.5% of the respondents were aware of swine flu (novel influenza A (H1N1)).
“Biostatistics units within the pharmaceutical find more industry are faced with the challenge of increasing productivity, reducing costs, and accelerating timelines while at the same time maintaining high quality. This paper describes how the global biostatistics unit in one company is addressing this challenge by nurturing a “culture of quality” to engage frontline staff responsible for daily deliverables. The approach ties together the measurement, improvement, and maintenance of quality, thus inviting staff to understand their role in achieving quality deliverables. Appointment within the operations unit of a quality lead, who is responsible for quality oversight,
further increases visibility and contributes to the culture. Measurement is addressed through the use of a quarterly quality report card in which quality-related metrics are consolidated and tracked over time. Trends and outliers are explored. Through established process improvement practices,
a Lean Sigma team tackles select high-value processes. Quality is maintained through continuous feedback loops driven by formal quality assurance audits and logs of lessons learned. This paper first considers how to define quality in this context; then addresses the sometimes disjointed areas of measurement, improvement, and maintenance; and ultimately ties them together to drive a culture of quality.”
“Although group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, LY3023414 purchase epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries. To determine the epidemiology of invasive GBS disease among young infants in a setting NU7026 clinical trial with high maternal HIV infection, we conducted hospital-based surveillance during 2004-2008 in Soweto, South Africa. Overall GBS incidence was 2.72 cases/1,000 live births (1.50 and 1.22, respectively, among-infants
with early-onset disease [EOD] and late-onset [LOD] disease). Risk for EOD and LOD was higher for HIV-exposed than HIV-unexposed infants. GBS serotypes Ia and III accounted for 84.0% of cases, and 16.9% of infected infants died. We estimate that use of trivalent GBS vaccine (serotypes Ia, Ib, and III) could prevent 2,105 invasive GBS cases and 278 deaths annually among infants in South Africa; therefore, vaccination of all pregnant women in this country should be explored.”
“Vesicles of L-alpha-dimyristoyl-phosphatidylcholine (DMPC) are known to disintegrate upon treatment with surfactin, a lipoheptapeptide biosurfactant from Bacillus subtilis OKB 105, as was observed by static light scattering (SLS) and cryo-transmission electron microscopy (cryo-TEM) recently. The lysis of DMPC bilayers occurs strongly dependent on the surfactin concentration according to a three-stage model.
Adding Qa to Rap markedly reduced the number of LC3-II-positive autolysosomes. Rap + Qa created a competition between Rap increasing and Qa decreasing LC3-II. Rapamycin + Qa decreased total PrPSc by 56% compared with that of Qa alone, which reduced PrPSc by 37% relative to Rap alone. We conclude that the decrease was dominated by the ability of Qa to decrease the formation of PrPSc. Therefore, BrnAggs provide an efficient in vitro tool for screening drug therapies and studying the complex biology of prions.”
“The objective of this study was to determine the seroprevalence of hepatitis B virus
(HBV) and hepatitis C virus (HCV) infections and the possible risk factors among blood donors in Nyala, South Dar Fur State of western Sudan, which has never been studied before. A total of 400 male blood donors CYT387 purchase were tested for the detection of HBsAg
and anti-HCV antibodies, (6.25%) were found reactive for HBsAg and (0.65%) were reactive for anti-HCV antibodies. The highest seroprevalence (30.8%) was found in those between 19-24 and 37-42 years for HBsAg, whereas it was (50%) in those between 31-36 years for anti-HCV antibodies. Unprotected sexual activities (20%) was the most apparent predisposing risk factor for both HBV and HCV seroreactors, followed by razor sharing (13.3%), parenteral drug injections (10%), history of migration to Egypt and alcoholism (6.6%) for each, tattooing and surgical procedures (3.3%) for each MI-503 mouse and (36.6%) were not aware for their condition. Serum alanine aminotansferase (ALT) was elevated
in (30.7%) of HBV seroreactors and in (50%) of HCV seroreactors. Serum albumin was reduced in (23.1%) HBV and in (50%) HCV seroreactors. The study concluded that the seroprevalence of HBV and HCV was in an intermediate and low rates respectively and unprotected sexual activities was the major risk factor for infection in the population studied.”
“Purulent inflammation caused by Staphylococcus xylosus was S3I-201 in vivo first described at the basis of antler in an 8 years old male fallow deer (Dama dama). The condition of the animal was normal but building of the antler was irregular. On the right side trophy with abnormal antler developed.”
“Objective. To assess the impact of anemia and iron deficiency on health-related quality of life (HRQoL) in women treated for heavy menstrual bleeding (HMB). Design. Secondary analysis of a randomized controlled trial. Setting. Five university hospitals in Finland. Sample. A total of 236 women referred for HMB. Methods. Women were randomized to treatment with hysterectomy or a levonorgestrel-releasing intrauterine system. We defined groups based on women’s pretreatment hemoglobin [hemoglobin smaller than 120 g/L (anemic) vs. hemoglobin bigger than = 120 g/L (nonanemic)] and serum ferritin (ferritin smaller than 15 mu g/L vs. bigger than = 15 mu g/L) concentrations.
These sites may be important for host tropism and characteristic mutations of human
influenza viruses may be required for efficient human-to-human transmission. The catalog can be used for genetic surveillance of zoonotic strains of the influenza A virus to determine their pandemic potential, as well as for basic research on the influenza A virus.”
“A case report and review BTSA1 of literature is reported of a rare case of fungal keratitis from eastern India. A 32-year-old woman with a history of vegetative trauma presented with keratitis in left eye. Microbiological examination of corneal scraping showed refractile hyphae with aseptate branching filaments and black pigmented colonies on multiple solid agar medium. Organism
was identified from culture using D1/D2 region of LSU (Large Sub Unit: 28S rDNA)-based molecular technique. PCR amplified a band with a sequence that was 100 % homologous with Lasiodiplodia theobromae. The organism was susceptible to amphotericin B and voriconazole and demonstrated resistance to itraconazole and fluconazole. A therapeutic keratoplasty was performed following non-responsiveness to initial topical voriconazole (2 %) therapy. Recurrence in graft was controlled with topical voriconazole and intracameral amphotericin B. However, the graft failed at the end of 3 months. L. theobromae is a rare cause of fungal keratitis. Management of these cases is difficult, often involving surgical Fer-1 price procedures.”
“Tetrapheryl iron(III) and manganese(III) porphyrin chloride (FeTPPCl and MnTPPCl) are studied by electrospray ionization tandem mass spectrometry (ESI/MS/MS). Removal of the chloride counter ion from these salts results in intense [FeTPP](+) and [MnTPP](+) ions that lose hydrogen and peripheral phenyl rings upon multi-collision-induced dissociation (CID). Dissociation pathways are probed as a function of collision-offset voltage with onset measurements. Onset voltages generally are higher for [MnTPP](+). While primary
losses of benzene, Pevonedistat cell line biphenyl and hydrogen occur concomitantly at low collision voltages, losses of hydrogen from the secondary and higher-order ions occur at higher collision voltages. Comparisons are made with previous measurements using surface-induced dissociation, photodissociation and electron impact. (C) 2008 Elsevier B.V. All rights reserved.”
“The effect of synthesis conditions on the preparation and properties of three novel zeolites TUN, IMF, and -SVR was investigated and compared with MFI. X-ray powder diffraction, infrared spectroscopy, chemical analysis, sorption measurements, and scanning electron microscopy were employed to characterize the textural and chemical properties of these zeolites. FTIR spectroscopy in combination with pyridine as probe molecule was used to describe the type, concentration and acid strength of these zeolites.
Afterwards several figures of merit have been evaluated. Bearing in mind that triazines are one of the most frequently used group of herbicides in agriculture and atrazine and simazine are included in the list of priority substances in Annex II of Directive 2008/105/EC, in this work, these analytes have been analysed in three natural waters. Prior to determination
by gas chromatography with mass spectrometry detection (GC/MS) a step with solid this website phase extraction (SPE) has been carried out. The calibration set is made up of 40 standards 33 are external standards prepared in acetone and seven matrix matched prepared in deionised water subjected to the SPE procedure. Moreover, each kind of water, stream, well, and river, is analysed both unspiked and spiked. For the triazine determination, the second order PARAFAC advantage allows the use of samples prepared in acetone together with those prepared in deionised water subjected to SPE. The decision limit, CC alpha, and the capability of detection, CC beta, are calculated according to ISO 11843-2, assessing the false positive and false negative.
The m/z ratios chosen fulfils the SANCO identification LY2603618 cell line criteria and also the spectrum obtained in the PARAFAC decomposition, which is common in all samples for each triazine. However, when the same experimental data are used to carry out a univariate calibration with the abundance of the base peak of each triazines, a lot of samples lie outside the permitted tolerances depending on the reference experimental spectra used, despite the fact that all of them have a triazine content above H 89 the detection limit. Also, the PARAFAC calibration allows us to detect the test samples which are not similar to the calibration samples and in this way their mistaken quantification is avoided. (C) 2012 Elsevier B.V. All rights reserved.”
“Dihydrouridine synthase (Dus) is
responsible for catalyzing dihydrouridine formation in RNA by the reduction of uridine. To elucidate its RNA-recognition mechanism, Dus from Thermus thermophilus (TthDus) and its complex with tRNA were crystallized. Diffraction data sets were collected from crystals of native and selenomethionine-substituted TthDus to resolutions of 1.70 and 2.30 angstrom, respectively. These crystals belonged to space group P1. Preliminary X- ray crystallographic analysis showed that two molecules of TthDus were contained in an asymmetric unit. In addition, diffraction data were collected to 3.51 angstrom resolution from a crystal of selenomethionine-substituted TthDus in complex with tRNA, which belonged to space group P4(1)2(1)2. Preliminary structural analysis showed that the asymmetric unit contained two TthDus-tRNA complexes.
Moreover, these effects depend on an individual’s social status, which suggests that there is intraspecific variation in the way that androgens MK-2206 nmr affect marking behaviour on short timescales. This study fills a gap in our understanding about the plasticity of rapid androgenic effects on behaviour, and how these responses can influence adaptive reproductive tactics. (C) 2014 The Association for the Study of Animal Behaviour. Published by Elsevier Ltd. All
“Background: Renal cell carcinoma (RCC) is a histopathologically and molecularly heterogeneous disease with the chromophobe subtype (chRCC) accounting for approximately 5% of all cases. The median overall survival of advanced RCC has improved significantly since the advent of tyrosine kinase inhibitors and mammalian target of rapamycin (mTOR) LY2835219 manufacturer inhibitors. However, high-quality evidence for the use of new generation tyrosine kinase inhibitors in patients with advanced chRCC is lacking. Few published case reports have highlighted the use
of temsirolimus in chRCC.\n\nCase presentation: Here, we report the case of a 36-year-old Caucasian woman with metastatic chRCC with predominantly skeletal metastases who was refractory to sunitinib who demonstrated a durable clinical response to temsirolimus lasting 20 months. We review the available evidence pertaining to the use of new generation molecularly targeted agents, in particular mTOR inhibitors in chRCC and discuss their emerging role in the management of this disease which would aid the oncologists faced with the challenge of treating this rare type of RCC.\n\nConclusion: Conducting randomised clinical trials in this rarer sub-group of patients would be challenging and our case report and the evidence reviewed would guide the physicians to make informed decision regarding the management of these patients.”
“This study evaluated the effect of five methods of solvent volatilization on the degree of conversion (DC) of nine one-bottle adhesive systems using Fourier transform infrared/attenuated total reflectance (FTIR/ATR)
analysis. Nine adhesives were tested: Adper Single Bond 2 (SB), Adper Easy One (EO), One Up Bond F Plus (OUP), One Coat Bond SL (OC), XP Bond (RP), Ambar (AM), Natural Bond (NB), GO, and Stae. The adhesive systems KPT-8602 were applied to a zinc-selenide pellet and 1) cured without solvent volatilization, 2) left undisturbed for 10 seconds before curing, 3) left undisturbed for 60 seconds before curing, 4) air-dried with an air stream for 10 seconds before curing, and 5) air-dried with an air stream for 60 seconds before curing. FTIR/ATR spectra were obtained, and the DC was calculated by comparing the aliphatic bonds/reference peaks before and after light activation for 10 seconds (FlashLite 1401). The DC means of each material were analyzed by one-way analysis of variance and post hoc Tukey test (p<0.05).
We identified 72 samples from
61 patients, aged 3 days to click here 80 years, who had negative staging based on bone marrow examination. Megakaryocyte diameters, as highlighted with anti-CD61, were measured. A scatter plot of megakaryocyte size by age revealed a normal distribution of sizes at the youngest ages, with a shift to multiple peaks starting at 24 months indicating that neonates have megakaryocytes of uniform sizes, which diverge into separate clusters of smaller and larger cells beginning at 2 years; this is followed by an overall shift toward larger megakaryocytes at age 4 years. These observations have direct implications for the evaluation of bone marrow megakaryocytes in young children.”
“Breast cancer is the most frequent cancer in women. Evidence suggests that the polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) affect breast cancer proliferation, differentiation and prognosis. However, the mechanism still remains unclear. In this study, the expression
of transient receptor potential canonical (TRPC)3 was detected throughout the cell cytoplasm and at the cell surface of MCF-7 cells. Ca2+ entry was induced in these buy GM6001 cells via activated TRPC3 by either the diacylglycerol analogue (OAG) or by intracellular Ca2+ store depletion. TRPC-mediated Ca2+ entry was inhibited by PUFAs including arachidonic acid (AA) and linolenic acid (LA) but not saturated fatty acids. Overexpression of the PUFA degradation enzyme, cyclooxygenase 2 (COX2), enhanced capacitative Ca2+ entry. In addition, inhibition of COX2 reduced [Ca2+](i). Nevertheless, inhibition of TRPC reduced the cell cycle S phase and cell migration, implicating a functional role for TRP-mediated Ca2+ entry in cell proliferation and invasion. Exogenous PUFA as well as a TRPC3 antagonist consistently attenuated breast cancer cell proliferation and migration, suggesting a mechanism GSK923295 cost in which PUFA restrains the breast cancer partly via its inhibition of
TRPC channels. Additionally, our results also suggest that TRPC3 appears as a new mediator of breast cancer cell migration/invasion and represents a potential target for a new class of anticancer agent.”
“Tellez LA, Perez IO, Simon SA, Gutierrez R. Transitions between sleep and feeding states in rat ventral striatum neurons. J Neurophysiol 108: 1739-1751, 2012. First published June 27, 2012; doi:10.1152/jn.00394.2012.-Neurons in the nucleus accumbens (NAc) have been shown to participate in several behavioral states, including feeding and sleep. However, it is not known if the same neuron participates in both states and, if so, how similar are the responses. In addition, since the NAc contains several cell types, it is not known if each type participates in the transitions associated with feeding and sleep. Such knowledge is important for understanding the interaction between two different neural networks.
Overall, the MCSD in VAS pain score in the group was 17 mm (95%CI 13.6 mm to 20.6 mm). There were statistically significant differences between the MCSD in VAS
pain score between genders and causes of pain Selleckchem Elafibranor (trauma versus non-trauma). Conclusions: The MCSD in VAS pain scores was found to be 17 mm. There was significant differences in MCSD in VAS pain score in different genders and between trauma and non-trauma cases. (Hong Xong j.emerg.med. 2009; 16:233-236)”
“The aim of this study was two-fold: i) to analyse age-related declines in swimming, cycling, and running performances for Olympic and Ironman triathlons, and ii) to compare age-related changes in these three disciplines between the Olympic and Ironman triathlons. Swimming, cycling, running and total time performances selleck chemicals of the top 10 males between 20 and 70 years of age (in 5 years intervals) were analysed for two consecutive world championships (2006 and 2007) for Olympic and Ironman distances. There was a lesser age-related decline in cycling performance (p < 0.01) compared with running and swimming after 55 years of
age for Olympic distance and after 50 years of age for Ironman distance. With advancing age, the performance decline was less pronounced (p < 0.01) for Olympic than for Ironman triathlon in cycling (> 55 years) and running (>50 years), respectively. In contrast, an age-related decline in swimming performance seemed independent of triathlon distance. The age-related decline in triathlon performance is specific to the discipline, with cycling showing less declines in performance with age than swimming and running. The magnitude of the declines in cycling and running performance at Ironman distance is greater than at Olympic distance, suggesting that task duration exerts an important
influence on the magnitude of the age-associated changes in triathlon performance.”
“There JQ1 supplier is increasing interest in cancer stem cells (CSCs) and their role in cancer progression. Recently, CSCs have been identified in brain, skin, and intestinal tumors and it has been suggested that these CSCs are responsible for tumor growth and metastasis. In breast cancer fatality is often due to the development of metastatic disease (MBC). Almost 30% of early breast cancer patients eventually develop MBC and in 90% of these multi-drug resistance (MDR) occurs. This could be attributed to the presence of breast cancer stem cells (BCSCs). Epithelial-to-mesenchymal transition (EMT) is a process known to contribute to metastasis in cancer and it is mainly characterized by loss of E-cadherin expression. The TGF-beta signaling pathway has an established role in promoting EMT by down-regulating E-cadherin via a number of transcription factors, such as Twist, Snail and Slug. EMT has also been reported to produce cells with stem cell-like properties.
“The extent to which reduced feed intake contributes to decreased growth during heat stress (HS) in the ovine model is not clear. To evaluate the impact of decreased DMI on performance, we conducted an experiment on growing lambs experiencing a cyclical but extensive heat load. Sixteen intact male Afshari lambs
(40.1 +/- 1.9 kg) were used in a completely randomized design in 2 periods. In period 1, all 16 lambs were housed in thermal neutral (TN) conditions (22.2 +/- 3.1 degrees C and a temperature-humidity index [THI] of 67.9 +/- 3.2) and fed at libitum for 8 d. In period 2 (P2), which lasted 9 d, 8 lambs were subjected to a cyclical HS condition (33.0 to 45.0 degrees C and a THI of more than 80 at least for 24 h/d and more than 90 for 8 h/d). The other 8 lambs were maintained in TN conditions but pair-fed (pair-fed Belnacasan thermal neutral [PFTN]) to BI-D1870 inhibitor the HS lambs. During each period, DMI and water intake were measured daily. Respiration rate, rectal temperature, and skin temperature at the shoulder, rump, and front and rear leg were recorded at 0700 and 1400 h daily. Dry matte intake declined (17.5%; P smaller than 0.01) in HS lambs and, by design, the temporal pattern and magnitude of reduced feed
intake was similar in the PFTN controls. Water intake increased (19%; P smaller than 0.05) during P2 in HS but not in the PFTN controls. Heat stress increased the 0700 and 1400 h skin temperature at the shoulder (5 and 9.2%), rump (6.2 and 10.3%), rear (6 and 9.2%), and front leg (6.5 selleck kinase inhibitor and 9.8%) and respiratory rates (84 and 163% [P smaller than 0.01] at 0700 and 1400 h, respectfully), but only the 1400 h rectal temperature was increased (P smaller than 0.01; 0.65 degrees C) in HS lambs. Neither environment nor period affected blood urea nitrogen and glucose concentrations. However, circulating NEFA and insulin were increased and declined (P smaller than 0.01) in PFTN lambs, respectively, but neither variable was altered in the HS lambs. Growth was reduced in P2 for lambs in both treatments, but despite being on a similar reduced plane of nutrition, the HS lambs’
ADG was more than 2-fold greater than the PFTN controls. These results indicate that HS markedly alters the energetics of weight gain during growth and that the effects of HS are dependent on the severity of the heat load.”
“Preclinical and clinical studies have suggested a role of the mineralocorticoid receptor (MR) in the response to antidepressants. We tested in a proof-of-concept study whether adding fludrocortisone (an MR agonist) or spironolactone (an MR antagonist) accelerates onset of action and improves efficacy of escitalopram in patients with major depression.\n\nWe included 64 in- and outpatients with major depression (Hamilton Depression Scale-17 score > 18) in a double-blind, randomized, placebo-controlled trial. Patients were randomized in a 2:2:1 fashion to fludrocortisone (0.