HHAL MEDICAL NEWS JANUARY09
Poor Sleep Patterns May Increase Risk for the
Common
Cold
Abbreviated or disturbed sleep may make you more susceptible
to colds, Archives of Internal Medicine reports.
Some
150 volunteers recorded their sleep duration and sleep efficiency (defined as the percentage of time spent asleep while in
bed) every day for 2 weeks. They were then quarantined and challenged with a rhinovirus.
During the next 5 days, the risk for developing a cold was about three times higher
among participants who'd averaged less than 7 hours' sleep a night (vs. 8 or more), and nearly six times higher for
those with less than 92% sleep efficiency (vs. 98% or more).
Good
night!
http://archinte.ama-assn.org/cgi/content/short/169/1/62
http://www.reuters.com/articlePrint?articleId=USTRE50B6Q120090112
Short Sleep Duration as a Predictor of Cardiovascular Events
Sleeping less than 7.5 hours nightly and having nighttime rises in SBP were associated with excess cardiovascular risk in older patients with hypertension.
Relationship Between Blood Pressure and Outdoor Temperature in a Large Sample of Elderly Individuals
Conclusions Outdoor temperature and blood pressure are
strongly correlated in the elderly, especially in those 80 years or older. During periods of extreme temperatures,
a careful monitoring of blood pressure and antihypertensive treatment could contribute to reducing the
consequences of blood pressure variations in the elderly.
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Weight Loss to Treat Urinary
Incontinence in Overweight and Obese Women
Conclusions A 6-month behavioral intervention targeting weight loss reduced the
frequency of self-reported urinary-incontinence episodes among overweight and obese women as compared with a
control group. A decrease in urinary incontinence may be another benefit
among the extensive health improvements associated with moderate weight reduction. (ClinicalTrials.gov number,
NCT00091988 [ClinicalTrials.gov] .)
http://content.nejm.org/cgi/content/short/360/5/481?query=TOC
BNP-Guided vs Symptom-Guided Heart Failure Therapy
The Trial of Intensified vs Standard Medical Therapy
in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial
Conclusion Heart failure therapy guided by N-terminal BNP did
not improve overall clinical outcomes or quality of life compared with symptom-guided treatment.
http://jama.ama-assn.org/cgi/content/full/301/4/383
Acupuncture treatment for pain: systematic
review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups
Conclusion
We found a small analgesic effect
of acupuncture that seems to lack clinical relevance and cannot be clearly distinguished from bias.
Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact
of the treatment ritual is unclear.
http://www.bmj.com/cgi/content/full/338/jan27_2/a3115
AHA Advisory: 5% to 10% of Calories Should Come from
Omega 6s
The American Heart Association has advised that
people get at least 5% to 10% of their energy from omega-6 polyunsaturated fatty acids — e.g., from corn, sunflower,
safflower, and soybean oils — to reduce their risk for coronary heart disease. The recommendation appears online in
Circulation.
Circulation article (Free PDF)
AHA chart on beneficial vs. harmful fats (Free PDF)
http://www.washingtonpost.com/wp-dyn/content/article/2009/01/26/AR2009012601832.html
http://www.modernmedicine.com/modernmedicine/A-Fatty-Acid-Found-in-Fish-Linked-to-Lower-Dementi/ArticleStandard/Article/detail/538668?searchString=dementia
Rosiglitazone, Pioglitazone, and Fractures: A Meta-Analysis
January
27, 2009
Combined data from 10 trials show that
rosiglitazone and pioglitazone confer significant risk for fractures.
Reviewing: Loke YK et al. CMAJ 2009 Jan 6; 180:32
Efficacy
of pneumococcal vaccination in adults: a meta-analysis.
INTERPRETATION: Pneumococcal vaccination does not appear to be effective in preventing pneumonia, even
in populations for whom the vaccine is currently recommended.
http://www.ncbi.nlm.nih.gov/pubmed/19124790?dopt=Abstract
Early Communication
about an Ongoing Safety Review
of clopidogrel bisulfate (marketed as Plavix)
The FDA is investigating whether the antiplatelet drug clopidogrel is less effective
in people with some genetic factors and when taken with other drugs, including proton pump inhibitors (PPIs).
Studies indicate that certain polymorphisms may cause patients
to metabolize clopidogrel differently.
In
addition, research has shown that PPIs inhibit the enzyme that converts clopidogrel to its active form, potentially rendering
it less effective. (Clopidogrel and PPIs are commonly used in tandem because clopidogrel can irritate the stomach, while PPIs
decrease stomach acid.)
Until the manufacturers have
finished further studies, the FDA recommends that healthcare providers:
http://www.fda.gov/cder/drug/early_comm/clopidogrel_bisulfate.htm
Effects
of Exercise Modality on Insulin Resistance and Functional Limitation in Older Adults
Conclusion The combination of resistance and aerobic exercise
was the optimal exercise strategy for simultaneous reduction in insulin resistance and functional limitation
in previously sedentary, abdominally obese older adults.
http://archinte.ama-assn.org/cgi/content/abstract/169/2/122?ct
Increased
Mortality and Cardiovascular Morbidity Associated With Use of Nonsteroidal Anti-inflammatory Drugs in Chronic Heart Failure
Conclusions NSAIDs are frequently used in patients with
HF and are associated with increased risk of death and cardiovascular morbidity. Inasmuch as even commonly
used NSAIDs exerted increased risk, the balance between risk and benefit requires careful consideration
when any NSAID is given to patients with HF.
http://archinte.ama-assn.org/cgi/content/abstract/169/2/141?ct
Uric
Acid and Insulin Sensitivity and Risk of Incident Hypertension
Conclusions: Differences in
uric acid and insulin levels robustly and substantially affect the risk of hypertension in young women.
Measuring these biomarkers in clinical practice may identify higher-risk individuals.
http://archinte.ama-assn.org/cgi/content/abstract/169/2/155?ct
Loop Diuretic Use and Fracture in Postmenopausal Women
Conclusions: After adjustment
for confounding variables, no significant association was found between ever use of loop diuretics and
changes in BMD, falls, and fractures. Loop diuretics were used by women in poor health who were already at risk
for fractures. However, prolonged use of loop diuretics was associated with higher fracture risk in
postmenopausal women.
http://archinte.ama-assn.org/cgi/content/abstract/169/2/132?ct
Treatment of fibromyalgia syndrome with antidepressants: a meta-analysis.
CONCLUSION: Antidepressant medications
are associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in patients
with FMS.
http://www.ncbi.nlm.nih.gov/pubmed/19141768?dopt=Abstract
The Natural Course of Microalbuminuria among African Americans with
Type 2 Diabetes: A 3-Year Study
Conclusion:
This study suggests
that African Americans with type 2 diabetes and microalbuminuria experience irreversible disease that not infrequently progresses
to overt proteinuria. The degree of microalbuminuria and blood pressure are key determinants in this process and should be
primary targets in treating this population regardless of the antihypertensive class used.
http://www.amjmed.com/article/S0002-9343(08)00850-4/fulltext
Fine-Particulate
Air Pollution and Life Expectancy in the United States
Conclusions: A reduction in exposure to ambient fine-particulate
air pollution contributed to significant and measurable improvements in life expectancy in the United States.
http://content.nejm.org/cgi/content/full/360/4/376?query=TOC
ABSTRACT
Several recent medical articles have described multiple cases
of unusual low-impact subtrochanteric stress fractures or completed fractures of the femur in patients who have been on the
bisphosphonate alendronate for several years for osteoporosis or osteopenia. Some patients have experienced such fractures
in both femurs. The fractures are often preceded by pain in the affected thigh, may have a typical x-ray appearance, and many
have delayed healing. It has been hypothesized that in some patients, long-term alendronate causes oversuppression of bone
turnover, resulting in bones that are brittle despite improved bone density. In patients with atypical or low-impact fractures
of the femoral shaft, consider the possible connection with alendronate use. Some bone specialists now recommend stopping
alendronate in most patients after 5 years.
http://geriatrics.modernmedicine.com/geriatrics/article/articleDetail.jsp?id=575099&pageID=1&sk=&date=
What does antihistamine therapy do to bone density?
Femoral neck bone mineral density may be higher
in histamine 1 receptor antagonist users than nonusers among older adults. Histamine 2 receptor antagonist users with reduced
calcium intake had lower bone mineral density than nonusers. The American
Journal of Medicine (12/2008)
There is increasing scientific evidence suggesting that while the aging process
cannot be stopped, its impact on brain function can be slowed or altered when patients participate in a program that exercises
the largest organ in the human body. The dementia process can be slowed, and possibly prevented when elderly adults adopt
a comprehensive brain wellness program, explains Robert Bender, MD, a geriatrician at the Johnny Orr Memory Center and Healthy
Aging Institute in Des Moines, Iowa.
During
the past 20 years Bender intensely studied dementing disorders and became particularly interested in emerging neuroplasticity
information and- the brain's ability to compensate for injury or disease by forming new neural connections.
Bender also made use of new research in quantum physics pointing
to the importance of conscience attention and motivation in terms of brain health. “We felt strongly that with the Copenhagen
interpretation of shorting the equation at least at the quantum level, with self observation and conscious attention, perhaps
people could change their own brains. Obviously this is a great hope but more and more science seems to support that attitude,”
says Bender.
Three years ago, with a small grant from the
Center for Disease Control (CDC), Bender was able to start a comprehensive brain wellness program with a group of patients
with mild to moderate Alzheimer’s to see if there could be an interventional or preventative approach that would slow
the progression of the disease. Over a six month period, patients were brought together for physical exercise, socialization,
cognitive training via a computer program, and meditation. As part of a multifaceted approach, patients also took aricept,
namenda, vitamins E and C and ginkgo biloba.
The
results of his program were very exciting. “We were able to show improvement based on anecdotal reports from the family
members, neurophysiologic training and indeed PET scan changes,” says Bender.
One patient had remarkable results after completing the brain wellness
program. Bender recounts a conversation he had with the patient’s wife at his last visit, “She was crying and
said Dr. Bender when we started this research project we thought maybe you could slow his progressive loss of memory. He has
done far better than that – we got our dad back.” Bender explains that this anecdotal evidence was confirmed with
positive changes in the patient’s PET scan after strictly following the program.
Based on the findings of his research Bender concludes, “We
can now say that we can do certain things to help our brains be healthier, but also build reserves, so as we get older perhaps
in terms of the aging process it won’t matter at least in terms of functionality.”
Bender has a very comprehensive approach for patients to keep their
brains healthy and fit:
1. Use
your brain to learn new things and strive for some level of mastery
2. Physical exercise
3.
Low fat diet- high in antioxidants and omega 3 fatty acids
4. Socialization
5.
Manage Stress
6. Avoid excess
– tobacco, alcohol and calories
7.
Utilize your talents for self and others because using talents enhances our brain circuitry
8. Avoid head injuries
9. Meditation
10. Maximize a spiritual life
Association
found in elderly subjects with mild or better hypertension
Conclusion: caffeinated coffee consumption was associated with lower risk of CHD mortality and heart valve disease development or progression in older Framingham subjects without moderate
or severe hypertension.
http://www.ajconline.org/article/S0002-9149(08)01271-X/abstract
Activation in additional areas observed in
experienced Internet users
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Internet-Searching-Increases-Brain-Function-in-Eld/ArticleNewsFeed/Article/detail/573180?contextCategoryId=40158
Condition
may increase the risk of non-alcoholic fatty liver disease and type 2 diabetes
Conclusions: Hypoxic stress of sleep apnea
may be implicated in the development of insulin resistance and steatohepatitis in
severe obesity.
http://ajrccm.atsjournals.org/cgi/content/abstract/179/3/228
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Obstructive-Sleep-Apnea-Linked-to-Insulin-Resistan/ArticleNewsFeed/Article/detail/577391?contextCategoryId=40153
Telomerase
activity positively associated with comprehensive interventions on diet and lifestyle. The increases in telomerase activity were significantly associated with decreases in low-density lipoprotein
(LDL) cholesterol (r=−0·36, p=0·041) and decreases in psychological distress (r=−0·35, p=0·047).
http://www.thelancet.com/journals/lanonc/article/PIIS1470204508702341/abstract?isEOP=true
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Lifestyle-Changes-Increase-Telomerase-Activity/ArticleNewsFeed/Article/detail/551105?contextCategoryId=44708&searchString
Higher A1C levels in diabetics associated with poorer scores on four cognitive tests
CONCLUSIONS—Higher A1C levels are associated with lower
cognitive function in individuals with diabetes. The effect of glucose lowering on cognitive function will
be determined by the ongoing ACCORD-MIND trial.
http://care.diabetesjournals.org/cgi/content/abstract/32/2/221
http://www.modernmedicine.com/modernmedicine/Endocrinology/Chronic-Hyperglycemia-Linked-to-Cognitive-Dysfunct/ArticleNewsFeed/Article/detail/577976?contextCategoryId=40137
http://www.modernmedicine.com/modernmedicine/Research+Briefs/Lifestyle-changes-stress-management-can-reverse-an/ArticleStandard/Article/detail/516873?searchString=
Adjusting Warfarin When INR Isn’t in Therapeutic Range
Data
suggest that warfarin dose shouldn’t be changed unless INR is 1.7 or
3.3 (when the target is 2.0–3.0).
Exercise Benefits Patients with Peripheral Arterial Disease
Beneficial,
but modest, effects were noted for both treadmill walking and lower-extremity resistance exercising
Quad Strength and Progression of Knee Osteoarthritis
Quadriceps
strength was associated with preservation of patellofemoral — but not tibiofemoral — cartilage.
ACE Inhibitor Plus Calcium Blocker for Hypertension
This
drug combination bested a diuretic-containing regimen in a trial involving older high-risk
patients.
Resting heart rate: Another mortality predictor
This study concluded that changes in resting heart rate
over 5 years is an independent predictor of mortality in middle-aged men The American Journal of Cardiology (1/15)
Predicting metabolic risk with C-reactive protein variability
The results of this longitudinal
analysis suggest the intraindividual, long-term variability of CRP concentrations is relatively small and predictive of new
diabetes over an intermediate-term of 4 years.
Results: Between the first and second examinations (averaging 16 years
apart), 23% to 47% of men and 27% to 49% of women remained within the same quintile of CRP values. An additional 24% to 51%
of men and 24% to 50% of women occupied an adjacent quintile. Intermediate-term CRP variability (over 4 years) was similar
to long-term variability. Both long- and intermediate-term variability of CRP were significantly less than that of plasma
cholesterol measured in these same groups. Linear regression models for CRP at the intermediate examination demonstrated that
CRP at the initial examination contributed the largest proportion of the variability (partial R-square = 0.27) seen in the
overall model after adjustment for other covariates known to affect CRP concentrations. Although logistic regression models
demonstrated that CRP over the intermediate term did not predict new-onset metabolic syndrome at the final examination, CRP
did predict an increase in glucose and new-onset diabetes.
Conclusion: The results of this longitudinal analysis suggest the intraindividual, long-term
variability of CRP concentrations is relatively small and predictive of new diabetes over an intermediate-term of 4 years.
The American Journal of Medicine (1/2009)
Another
side effect to postmenopausal hormone therapy
These findings suggest an increased risk of urinary incontinence associated with use of postmenopausal hormone
therapy in younger postmenopausal women.
Bottom of Form
Results: Women currently using hormone therapy had 1.39-fold (95% CI, 1.16-1.67)
increased odds of incident UI, compared with women who never used hormone therapy. ORs were similar in current users of oral
estrogen alone (OR, 1.35, 95% CI, 1.03-1.78) and oral estrogen with progestin (OR, 1.37, 95% CI, 1.13-1.67).
Conclusion: These findings suggest an increased risk of UI associated
with use of postmenopausal hormone therapy in younger postmenopausal women.
American Journal of Obstetrics & Gynecology (1/2009)
Metabolic
syndrome linked to depression in adults
Metabolic syndrome
may be a predictor of depression in middle-age adults, according to a study of 5,232 adults ages 41 to 61. The study in Diabetes
Care found central obesity, high triglyceride levels and low HDL were components of metabolic syndrome most often linked to
depression symptoms. Medscape (1/6)
Periodontal
disease and inflammatory markers
Oral health screening
in the context of cardiovascular disease risk assessment represents a potential opportunity to identify persons at risk for
cardiovascular disease. This study found that self-reported periodontal disease is independently associated with inflammation
and common in persons without traditional cardiovascular disease risk factors. The American Journal of Cardiology (12/1)
Exercise,
calcium could reduce risk of metabolic syndrome
A study in the American Journal of Health Promotion of more than 5,000 Illinois adults found those who got recommended levels of exercise and took in enough dietary calcium were less likely to develop
metabolic syndrome. People who didn't get at least 30 minutes of moderate exercise daily were 85% more likely to have
metabolic syndrome. Those who didn't regularly eat calcium-rich foods raised their risk by 61%. Reuters (11/28)
What
role does hypovitaminosis D play in cardiovascular disease?
This study concluded that hypovitaminosis
D is highly prevalent in U.S. adults with cardiovascular diseases, particularly those with both coronary heart disease and
heart failure.
Discussion
In NHANES 2001 to 2004, CVDs were more prevalent in adults with lower
25(OH)D, and hypovitaminosis D was also more common in those with certain CVDs. Although our findings were consistent with
previous reports of the association of hypovitaminosis D with cardiovascular risk factors5 and such CVDs as coronary heart disease,7 heart failure,8 stroke,6 and peripheral arterial disease,5 our study provided
national data about the burden of CVDs by 25(OH)D levels and the prevalence of hypovitaminosis D by age, race, and gender
in adults with CVDs. We also identified that subjects with both coronary heart disease and heart failure had the highest prevalence
of hypovitaminosis D.
Several
lines of evidence suggested that hypovitaminosis D may contribute to CVDs by stimulating renin expression,12 proliferation of cardiomyocytes13 and smooth muscle cells,14 secondary hyperparathyroidism,15 and inflammation.16 Attenuation of the association between hypovitaminosis D and CVDs after controlling for cardiovascular risk
factors suggested that such factors were responsible in part for the observed association. The association of hypovitaminosis
D appeared stronger with CVDs than with risk factors, which was in line with earlier findings that vitamin D supplementation
was associated more with hard endpoints than less hard endpoints.17 In addition, higher prevalence of hypovitaminosis D in those with both coronary heart disease and heart failure
may have been caused by limited physical activity and sunlight exposure as a result of CVDs. However, it has been shown that
patients with heart failure and healthy controls differed in vitamin D–associated lifestyle factors in their earlier
lives, suggesting that hypovitaminosis D may precede CVDs.18 Furthermore, 25(OH)D of 20 to 29 ng/ml (50 to 74.9 nmol/L) was not significantly associated with increased prevalence
of CVDs. Mild hypovitaminosis D was not associated with incident hypertension19 or cardiovascular events20 in recent prospective studies.
A
few limitations should be noted. The causal relation could not be established because of the cross-sectional nature of this
study. Clustered sampling may underestimate SEs, leading to false-positive associations. Although we combined the 2 cycles
of NHANES for adequate sample size, there were small numbers of subjects in certain age, race, and gender-specific groups
and certain combinations of CVDs. Finally, there was a possibility of misclassification because CVDs were self-reported.
Nevertheless, our study provided valuable data about the prevalence
of hypovitaminosis D for clinicians who treat patients at high risk or with CVDs, as well as for researchers who design clinical
trials on the protective effect of vitamin D supplementation against CVDs.
The American Journal of Cardiology (12/1)
Sliding
scale insulin. It's not effective or efficient.
The high prevalence and persistent use of sliding scale insulin is inconsistent with current guidelines
as well as current recommendations. Additional studies are needed to evaluate outcomes associated with prolonged SSI use in
long-term care facilities. Journal of the American Medical Directors Association
Low-glycemic
foods best for lowering blood sugar
A study found
a diet of low-glycemic foods such as beans and pasta is better than a high-cereal-fiber diet for lowering blood sugar in people
with Type 2 diabetes. A separate study also found that people with Type 2 diabetes who are diagnosed with cancer have a greater
risk of death than cancer patients who don't have diabetes. Both studies were published in The Journal of the American
Medical Association. HealthDay News (12/16)
Escitalopram
and Sertraline Top Comparison of 12 Newer Antidepressants
Escitalopram and sertraline
seem the best choices in starting treatment for major depression, according to a meta-analysis published online in Lancet.
Researchers analyzed 117 randomized trials — comprising
some 26,000 patients — of 12 new-generation antidepressants. The drugs were evaluated for efficacy and patient acceptability
at the 8-week mark.
Among the conclusions:
Editorialists conclude that,
especially among children and demented elderly patients for whom there is little evidence of the drugs' efficacy, their
use "should be reduced sharply."
http://content.nejm.org/cgi/content/short/360/3/225
Study: Obese Americans outnumber overweight
U.S. statistics
show more than 34% of U.S. adults were obese in 2005-2006, compared with 32.7% who were overweight and about 6% who were considered
extremely obese. The National Center for Health Statistics study, based on a survey of 4,356
adults, said the prevalence of obesity has more than doubled since 1980 while the prevalence
of overweight has remained stable. MSNBC/Reuters (1/9)
Treadmill Exercise Recommended for Peripheral Arterial Disease
Physicians should prescribe treadmill exercise for patients with peripheral arterial
disease, a JAMA study concludes.
Some
150 patients with peripheral arterial disease, with or without intermittent claudication, were randomized to one of three
groups: treadmill exercise, lower-extremity resistance training, or a control group. (The active treatment groups exercised
three times a week for 6 months under supervision.)
By
the end of the trial, treadmill exercise resulted in greater improvement in the 6-minute-walk test than resistance training,
and it also improved brachial artery flow-mediated dilation. For its part, resistance training improved several measures of
functional performance, such as stair-climbing ability.
The
authors say their results "suggest ... treadmill exercise confers a favorable systemic vascular effect that may reduce
cardiovascular events" in these patients, regardless of the presence of intermittent claudication.
http://jama.ama-assn.org/cgi/content/full/301/2/165
Elevated Sodium-to-Potassium Excretion Ratio Linked to
Greater Risk for CVD
Patients with elevated sodium-to-potassium excretion
ratios may face increased risk for cardiovascular events, reports Archives of Internal Medicine.
In two prospective studies,
some 2300 adults aged 30 to 54 and with prehypertension provided four 24-hour urine samples over 18 to 36 months, and then
were followed for 10 to 15 years.
During follow-up, 8% of the participants experienced major cardiovascular events, including MI, coronary
revascularization, and cardiovascular death. After adjustment for multiple confounders, the risk for cardiovascular events
increased as the sodium-to-potassium excretion ratio increased. Neither sodium nor potassium excretion alone was significantly
associated with cardiovascular risk.
The authors conclude that these results, taken together with previous research, suggest
that "lowering dietary sodium intake, while increasing potassium consumption, at the population level might reduce the
incidence of CVD."
http://archinte.ama-assn.org/cgi/content/short/169/1/32
Drug-Induced Liver Injury in the U.S.
The most commonly implicated single agent was amoxicillin/clavulanate.
In 2003, the NIH established the Drug-Induced Liver Injury Network, a consortium
of five academic medical centers that identifies and follows patients who develop idiosyncratic drug hepatotoxicity. In this
report, the clinical features of the network’s first 300 cases are summarized. Cases of acetaminophen toxicity were
excluded from this database.
The
implicated substance was a single prescription medication in 73% of subjects, a dietary supplement in 9%, and more than one
prescription medication (or a prescription plus a dietary supplement) in 18%. The most commonly implicated drug classes were
antibiotics (46% of cases) and central nervous system agents, such as antiseizure or psychotropic drugs (15%). The most commonly
implicated single agent was amoxicillin/clavulanate (23 cases); nitrofurantoin, isoniazid, and trimethoprim/sulfamethoxazole
were implicated in 13 cases each. As defined by specified patterns of alanine aminotransferase and alkaline phosphatase abnormalities,
57% of cases were hepatocellular, 23% were cholestatic, and 20% were mixed. Sixty-nine percent of patients developed jaundice,
60% were hospitalized, and 8% died within 6 months. In four patients who were initially thought to have drug-induced liver
injury, acute hepatitis C infection eventually was deemed responsible for the presentation.
Comment: Although the specific hepatotoxicity risk
for any single drug cannot be inferred from this report, the findings provide an interesting snapshot of clinically significant
drug-induced liver injury. The investigators plan to present additional analyses after enrollment of more cases in the database.
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