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0
PMC3002766
S45
['3a']
[0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study design
this double-blind, randomised, parallel-group, placebo-controlled study consisted of a ≤2-week screening period, a 24-week treatment period and an 8-week post-treatment follow-up period.
1
PMC3002766
S46
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study design
the study was approved by local ethics committees and conducted in accordance with the amended declaration of helsinki.
2
PMC3002766
S47
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study design
all patients gave written informed consent.
3
PMC3002766
S49
['4b']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0]
Settings and participants
the study was conducted from october 2003 to may 2005 at 41 centres in europe and north america.
4
PMC3002766
S50
['4a']
[0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Settings and participants
recruited patients were ≥18 years old, with ssc as defined by the preliminary classification criteria of the american college of rheumatology (acr)17 and at least one active du (onset between 1 week and 3 months prior to randomisation) that was selected by the investigator and termed the ‘cardinal ulcer’ (painful area,...
5
PMC3002766
S51
['4a']
[0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Settings and participants
patients were excluded if they had received intravenous prostanoids within the previous 3 months, had used phosphodiesterase inhibitors other than for intermittent treatment of male erectile dysfunction, or had received inhaled or oral prostanoids or injected botulinum toxin in an affected finger within 1 month.
6
PMC3002766
S52
['4a']
[0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Settings and participants
patients were also excluded if they received systemic antibiotics to treat infected dus within 2 weeks prior to randomisation.
7
PMC3002766
S53
['4a']
[0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Settings and participants
also excluded were patients with body weight <40 kg, severe pah (who class iii/iv), moderate to severe hepatic impairment or serum aminotransferase levels >3 times the upper limit of the normal range (uln).
8
PMC3002766
S54
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Settings and participants
contraceptive measures and monthly pregnancy testing were required during and for 3 months after the end of study treatment.
9
PMC3002766
S56
['8a', '8b']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 1, 0]
Randomisation and interventions
after screening, patients were randomised to bosentan or placebo (1:1 ratio) by sequential allocation of randomisation numbers distributed to each centre in blocks of four.
10
PMC3002766
S57
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Randomisation and interventions
patients received bosentan 62.5 mg twice daily for 4 weeks and then 125 mg twice daily for the remainder of the treatment period or matching placebo.
11
PMC3002766
S58
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Randomisation and interventions
the dose could remain at or be decreased to the starting dose due to intolerance, with possible subsequent increase to the target dose.
12
PMC3002766
S59
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Randomisation and interventions
concomitant use of systemic antibiotics, analgaesics and topical treatments for wound care were allowed, and randomised treatment was administered in addition to the usual, stable (over the previous month) treatment for raynaud's phenomenon.
13
PMC3002766
S60
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Randomisation and interventions
patients who required parenteral, oral or inhaled prostanoid treatment during the study were first discontinued from study treatment.
14
PMC3002766
S61
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Randomisation and interventions
use of glibenclamide, fluconazole, calcineurin inhibitors or ciclosporin a was not allowed due to potential drug interactions.
15
PMC3002766
S63
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outcomes
the two primary end points were (1) the mean number of new dus per patient assessed by the investigator up to week 24 and (2) the time to healing of the cardinal ulcer up to week 24 in patients with cardinal ulcer healing maintained for 12 or more weeks.
16
PMC3002766
S64
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outcomes
healing was defined as complete epithelialisation, regardless of residual pain.
17
PMC3002766
S65
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outcomes
maintenance of cardinal ulcer healing required no recurrence at or contiguous to the original location at week 24 (if healing occurred before or at week 12) or during 12 weeks of observation with permissible extension of the treatment period (if healing occurred after week 12).
18
PMC3002766
S66
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outcomes
to verify that the effect of treatment would not vary substantially across relevant baseline subgroups, the number of new dus up to week 24 was additionally analysed in subgroups based on predefined baseline factors associated with disease severity.
19
PMC3002766
S67
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outcomes
secondary and exploratory end points included: (1) reduction of new dus and overall du number (proportions of patients with no new dus and with each number of new dus up to week 24, time to onset of each number of new dus up to week 24 and change from baseline to week 24 in total number of all dus), (2) healing (time t...
20
PMC3002766
S68
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outcomes
post hoc analyses included: (1) the number of new dus up to week 12 in the overall patient population and in subgroups defined by randomisation month (october–february or autumn–winter and march–september or spring–summer) and (2) number of new dus, time to each successive new du and total number of dus through week 24...
21
PMC3002766
S69
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Outcomes
patients were evaluated at randomisation/baseline and every 4 weeks during treatment (or premature withdrawal, week 24 and, if applicable, 12 weeks after healing of the cardinal ulcer), with dus assessed at each study visit.
22
PMC3002766
S70
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Outcomes
safety was continually monitored.
23
PMC3002766
S72
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
efficacy analyses were performed on all treated patients using sas software (sas institute, cary, north carolina, usa).
24
PMC3002766
S73
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
means±ses are presented for numerical variables and kaplan–meier estimates for time-to-event variables.
25
PMC3002766
S74
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
treatment effects for the primary end points were evaluated using the pitman permutation (new dus) and log-rank test with asymptotic approximation (time to healing of the cardinal ulcer).
26
PMC3002766
S75
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
missing data on new dus were imputed using extrapolation, with the incidence rate of new dus at the last assessment corrected for the missing time period.
27
PMC3002766
S76
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
the worst of either the calculated number or observed values at week 24 was used for patients who prematurely discontinued study treatment.
28
PMC3002766
S77
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
patients with no valid assessment post baseline (three patients on bosentan, one on placebo) were excluded from the main analysis.
29
PMC3002766
S78
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
treatment effects for new dus in predefined subgroups were presented as point estimates and 95% two-sided cis.
30
PMC3002766
S79
['12a', '12b']
[0, 0, 0, 0, 1, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
for exploratory purposes, statistical tests of treatment difference were provided for planned secondary/exploratory and unplanned post hoc efficacy analyses and included the pitman permutation (for changes from baseline), the fisher exact test (for proportions) and the log-rank test (for times to event), each performed...
31
PMC3002766
S80
['12a', '12b']
[0, 0, 0, 0, 1, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
placebo-corrected changes from baseline, rr and hrs from cox modelling were each reported with 95% cis where appropriate.
32
PMC3002766
S81
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical methods
safety and baseline data were summarised descriptively, with no statistical testing planned or given.
33
PMC3002834
S49
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study subjects
we studied a subgroup of crs patients from the epocares trial (clinicaltrials.gov, nct00356733), and healthy controls of comparable age and gender.
34
PMC3002834
S50
['4a']
[0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study subjects
a detailed description with inclusion and exclusion criteria of the study has previously been published.14
35
PMC3002834
S51
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study subjects
the protocol was approved by the medical ethics committee and all patients gave informed consent.
36
PMC3002834
S52
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study subjects
procedures were in accordance with the helsinki declaration.
37
PMC3002834
S53
['4a']
[0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study subjects
patients with mild anaemia (women: 6.4–7.4 mmol/l; men: 6.4–7.8 mmol/l), moderate ckd (estimated creatinine clearance 20–70 ml/min, cockcroft–gault formula) and chf (functional nyha class ii–iv, based on symptoms, signs and objective abnormality on echocardiography,15 reduced ejection fraction (<50%) or left ventricula...
38
PMC3002834
S55
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Study design
epc levels and function were compared between 45 crs patients at baseline and 20 healthy controls.
39
PMC3002834
S56
['3a']
[0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study design
the effects of epo treatment were evaluated in an open-label, randomised design.
40
PMC3002834
S57
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study design
patients received epo treatment (50 iu/kg/week; neorecormon, roche pharmaceuticals, woerden, netherlands) or standard treatment without epo for one year.
41
PMC3002834
S58
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Study design
short-term effects of epo (n =30) versus no epo (n =15) were evaluated after 18 days (3 days after third epo injection), when epo treatment was not yet expected to result in a haematopoietic response.
42
PMC3002834
S59
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Study design
long-term (52 week) effects of epo were assessed in a subgroup of epo-treated patients, who were allowed to increase haemoglobin (hb) levels up to 8.5 mmol/l for men and 8.3 mmol/l for women (n =13), and a non epo-treated group (n =13).
43
PMC3002834
S61
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Plasma measurements
serum epo levels were measured by sandwich chemiluminescent immunoassay (immulite 2000 platform, siemens healthcare diagnostics, breda, netherlands).
44
PMC3002834
S62
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Plasma measurements
endothelial dysfunction, epc mobilising factors and inflammation markers were measured using elisa (e-selectin, vascular cell adhesion molecule-1 (vcam-1), interleukin (il)-6, vegf, sdf-1α (r&d systems, minneapolis, minnesota, usa) and thrombomodulin (diaclone, stamford, connecticut, usa)) or multiplex immunoassay17 (i...
45
PMC3002834
S63
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Plasma measurements
high sensitivity c reactive protein (hscrp) was determined by particle-enhanced immunonephelometry (standard cardio-phase hscrp for bnii, dade behring holding, liederbach, germany).
46
PMC3002834
S64
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Plasma measurements
n-terminal prohormone of brain natriuretic peptide (nt-probnp) was measured using electrochemiluminescense immunoassay (cobas ca6000, roche, mannheim, germany).
47
PMC3002834
S65
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Plasma measurements
samples were measured in duplicate and averaged for analysis.
48
PMC3002834
S67
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Circulating EPC levels
circulating epc were defined as cells positive for haematopoietic stem cell marker cd34 and endothelial marker kinase insert domain receptor (kdr; ie, vegf receptor-2).
49
PMC3002834
S68
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Circulating EPC levels
this cd34+kdr+-epc has previously shown clinical importance by predicting cardiovascular events and death in cardiovascular risk populations.18 19
50
PMC3002834
S69
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Circulating EPC levels
blood (100 μl) was incubated with anti-cd34-fitc (bd pharmingen, california, usa), anti-kdr-pe (r&d systems) and anti-cd45-pe-cy7 (bd pharmingen) antibodies for 45 min. erythrocytes were lysed and analysed by flow cytometry (beckman coulter, california, usa).
51
PMC3002834
S70
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Circulating EPC levels
circulating hsc and epc were identified as cd34+ and cd34+kdr+ cells in the lymphocyte region of the forward/sideward scatter plot.
52
PMC3002834
S71
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Circulating EPC levels
cell numbers were quantified relative to 105 granulocytes, identified as cd45+ cells with a typical granulocyte distribution.
53
PMC3002834
S72
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Circulating EPC levels
measurements were performed in duplicate and results were averaged.
54
PMC3002834
S73
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Circulating EPC levels
isotype-stained samples served as negative controls.
55
PMC3002834
S75
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outgrowth of EPC in culture
epc outgrowth from mononuclear cells (mnc) was assessed as described previously.3
56
PMC3002834
S76
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outgrowth of EPC in culture
in brief, mnc were isolated from blood using ficoll density gradient separation (histopaque 1077, sigma, st louis, missouri, usa).
57
PMC3002834
S77
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outgrowth of EPC in culture
to evaluate epc outgrowth in culture, 107 mnc/well were seeded on a human fibronectin (sigma) coated 6-well plate in egm-2 (cambrex, baltimore, maryland, usa), supplemented with accompanying aliquots, 20% fetal calf serum (invitrogen, carlsbad, california, usa), 100 ng/ml recombinant vegf-165 (r&d systems) and antibiot...
58
PMC3002834
S78
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outgrowth of EPC in culture
medium was changed after 4 days to wash non-adherent cells away.
59
PMC3002834
S79
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outgrowth of EPC in culture
after 7 days, cultured epc in selected wells were placed on serum free medium (ebm-2 with hegf, hydrocortisone, ga-1000, r3-igf-1, ascorbic acid, heparin and antibiotics) overnight.
60
PMC3002834
S80
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outgrowth of EPC in culture
conditioned medium was stored for functional experiments and cultured epc were detached by trypsin and cell scraping, and automatically counted using a haemocytometer.
61
PMC3002834
S82
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
In vitro scratch wound assay
the potential of epc outgrowth to excrete paracrine factors that stimulate endothelial cell migration was assessed by in vitro scratch wound assay.20
62
PMC3002834
S83
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
In vitro scratch wound assay
in brief, epc outgrowth medium was placed on a mechanically scratched confluent human microvascular endothelial cell layer.
63
PMC3002834
S84
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
In vitro scratch wound assay
after 6 h, the extent of scratch closure relative to the starting width was compared between study groups using light photography.
64
PMC3002834
S85
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
In vitro scratch wound assay
each sample was measured in two separate wells and two picture fields per well were examined.
65
PMC3002834
S86
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
In vitro scratch wound assay
results were averaged for data analysis.
66
PMC3002834
S88
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
data analysis was performed using spss v.15.0 for windows.
67
PMC3002834
S89
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
data distribution was tested by the kolmogorov–smirnov test.
68
PMC3002834
S90
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
data are expressed as mean ± sd for parametric data and as median (iqr) for non-parametric data.
69
PMC3002834
S91
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
differences between groups were analysed using student's t test or the mann–whitney test.
70
PMC3002834
S92
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
fisher's exact test was used to analyse whether proportions of categories varied by group.
71
PMC3002834
S93
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
multiple group comparisons were performed using anova with lsd post-hoc testing for which non-parametric data were log-transformed.
72
PMC3002834
S94
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
correlations were measured by pearson's or spearman's correlation coefficient where appropriate.
73
PMC3002834
S95
['12a']
[0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
multivariate determinants of log-transformed progenitor cell counts were identified by stepwise multiple linear regression analysis.
74
PMC3002834
S96
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Statistical analysis
a value of p <0.05 was considered statistically significant.
75
PMC3016167
S100
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study treatments
mesobuthus tamulus is not the only venomous scorpion in the state of western maharashtra, but it may be the only dangerously venomous scorpion in the mahad area.24 25
76
PMC3016167
S101
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study treatments
haffkine biopharma (mumbai) has been manufacturing monovalent anti-scorpion venom serum f(ab)2 against mesobuthus tamulus since 1997 and it has been available for clinical use in a rural setting since 2002.
77
PMC3016167
S102
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study treatments
studies conducted at different times show that the antivenom is potent; 1 ml of reconstituted anti-scorpion venom serum neutralised 1.2 mg of indian red scorpion venom by intravenous route in an in vivo study in mice.35
78
PMC3016167
S103
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Study treatments
the maximum volume of venom injected in one sting by the indian red scorpion is 1.5 mg, and each ml of antivenom is capable of neutralising 1.2 to 1.5 mg of venom.36
79
PMC3016167
S104
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
a single 30 ml dose of haffkine biopharma monovalent antivenom (batch no ss811001, manufacturing date november 2008, expiry date april 2013) was added to 100 ml of normal saline, which was infused intravenously over 30 minutes irrespective of patient’s age.
80
PMC3016167
S105
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
during infusion the patient was closely observed for reaction to the serum in the form of sudden onset of vomiting, urticaria, hypotension, tachycardia, bronchospasm, angioneurotic oedema, or anaphylaxis.
81
PMC3016167
S106
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
oral prazosin (batch no ml.nh 138 batch no gk 60372 manufactured 04/2006, expiry 03/2011, and ml.nh 138 batch no gk 80282 manufactured 02/2008, expiry 01/2013) was given at a dose of 250 µg in children up age 18 years and 500 µg in adults.
82
PMC3016167
S107
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
the same dose was repeated at intervals of 3 hours until the extremities were cold.
83
PMC3016167
S108
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
similar doses were administered in both randomisation groups.
84
PMC3016167
S109
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
dehydration owing to vomiting and sweating was corrected by intravenous crystalloid solution.
85
PMC3016167
S110
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
the prazosin treated group required longer duration and larger volumes of intravenous crystalloid solution than the antivenom plus prazosin group.
86
PMC3016167
S111
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
patients who developed grade 3 and 4 symptoms were transferred to the intensive care unit.
87
PMC3016167
S112
['5']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0]
Study treatments
before discharge all participants were immunised for tetanus.
88
PMC3016167
S114
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outcomes
the primary end point was the proportion of patients achieving resolution of the grade 2 clinical syndrome at the end of 10 hours after administration of the study drugs and prevention of deterioration to grade 3 and 4.18 21 37
89
PMC3016167
S115
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Outcomes
secondary end points were time required for complete resolution of clinical syndrome, prevention of deterioration to higher grade, doses of prazosin required within 10 hours and overall, and adverse events.
90
PMC3016167
S46
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Trial design
this study and trial were done without the help of any funding agency.
91
PMC3016167
S47
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Trial design
anti-scorpion antivenom was purchased from haffkine biopharma mumbai and given to participants in this trial.
92
PMC3016167
S48
['4a']
[0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Trial design
we proposed to include people admitted with scorpion sting over one year, between march 2009 and february 2010.
93
PMC3016167
S49
['3a', '4b']
[0, 0, 0, 0, 0, 0, 1, 0, 0, 1, 0, 0, 0, 0, 0, 0, 0, 0]
Trial design
this was a randomised (1:1 allocation ratio), parallel group, open label, controlled trial conducted at bawaskar hospital in mahad, a region of india with a population of 20 000, situated 180 km south of mumbai on the mumbai-goa highway.
94
PMC3016167
S50
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Trial design
an independent data and safety monitoring board monitored the trial and had access to the all data.
95
PMC3016167
S51
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Trial design
statistical analysis was done by a statistician in collaboration with the investigators.
96
PMC3016167
S52
['0']
[1, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0]
Trial design
the study design was approved by the independent ethics committee of byl medical college mumbai (iec/08/39) and all participants provided written informed consent.
97
PMC3016167
S54
['6a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0, 0, 0]
Sample size
the primary efficacy variable was the time required for recovery after venomous scorpion sting.
98
PMC3016167
S55
['7a']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 0, 0, 0, 0]
Sample size
we estimated that 35 patients in each group would be required to achieve 80% power; α=0.05 to detect a mean difference of four hours in the recovery time between the groups, assuming a mean recovery time of 10 hours (sd 2.5 hours) in the antivenom plus prazosin group and 14 (sd 3) hours for the prazosin alone group.
99
PMC3016167
S57
['8a', '8b']
[0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1, 1, 0]
Randomisation
a statistician generated the sequentially numbered randomisation list with random block sizes of 4 4 2 4 4 6 2 4 6 6 6 8 4 8 2 using www.randomisation.com.
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