Does Systematic Preliminar Colour Doppler Study Reduce Kidney Biopsy Complication Incidence?

While ultrasonography is widely performed prior to biopsy, colour Doppler examination is often used only to discover post-biopsy complications. Aim of this paper was to evaluate the usefulness of colour Doppler examination in planning the optimal site of puncture for renal biopsy. Present analysis includes 561 consecutive percutaneous renal biopsies performed from the same operator. Until August 2000 332 biopsies were performed after a preliminary ultrasonography (Group A). From September 2000, 229 patients underwent even a preliminary colour Doppler study (Group B). Postbioptic bleeding were categorized as minor (gross hematuria or subcapsular perinephric hematoma < 4 cmq of greater diameter) or major (hematoma >4 cmq of greater diameter; requiring blood transfusion or invasive procedures; leading to acute renal failure, urine tract obstruction, septicaemia, or death). Major complications were seen in 2.1% in Group A while in Group B only one case was reported (0.43%). Minor clinically significant complications occur in 7.8% in Group A and in 3.4% of cases of Group B. Colour Doppler reduced drastically the incidence of complications observed before the introduction of routine colour Doppler examination prior to biopsy. In our opinion, these data support the use of preliminary colour Doppler study when a biopsy is planned.

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Effect of selective beta-blockade with bisoprolol in the treatment of recent-onset atrial fibrillation

Folia Medica ◽

10.2478/v10153-011-0085-7 ◽

2012 ◽

Vol 54 (2) ◽

pp. 27-31 ◽

Cited By ~ 2

Author(s):

Maria N. Negreva ◽

Atanas P. Penev

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Combined Therapy ◽

Beta Blockade ◽

Recent Onset ◽

Number Of Patients ◽

Group A ◽

Clinically Significant ◽

Group B ◽

Onset Atrial Fibrillation

ABSTRACT The incidence of atrial fibrillation has been rapidly increasing in recent years. The increased tonus of the sympathetic nervous system is related to the development of atrial fibrillation. OBJECTIVE: To study the effect of bisoprolol, a highly selective beta-blocker, on patients with recent-onset atrial fibrillation (< 48 hours) for regularization of the rhythm using propafenone. PATIENTS AND METHODS: The study includes 164 patients (81 women, 83 men, age 59.09 ± 10.81) with successfully restored sinus rhythm in recent-onset atrial fibrillation. The patients received either propafenone (group A, n = 82) or a combination of propafenone and bisoprolol (group B, n = 82). The studied patients were randomly allocated to the groups. Propafenone was administered intravenously as a 2 mg/kg bolus followed by infusion of 0.0078 mg/kg/min for 120 min and orally in dosage of 300 mg three times every 8 hours if arrhythmia persisted. Bisoprolol was administered in a single dose at the very beginning of propafenone treatment and only in patients from group B at a dose of 5 or 10 mg. Regularization of the rhythm was assessed at the 3rd, 6th, 12th and 24th hour. RESULTS: In the initial stages of regularization the combined therapy restored the sinus rhythm in a greater number of patients in comparison with the monotherapy (at the 6th hour 67.07% in group B versus 48.78% in group A, P < 0.05; at the 12th hour it was 87.80% versus 75.60%, respectively, P < 0.05). CONCLUSION: Early regularization of rhythm in patients with recent-onset atrial fibrillation reduces the likelihood of recurrent episodes of arrhythmia. This makes the application of selective beta-blockade clinically significant.

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Effect of Germanium-Embedded Knee Sleeve on Osteoarthritis of the Knee

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119879124 ◽

2019 ◽

Vol 7 (10) ◽

pp. 232596711987912 ◽

Cited By ~ 1

Author(s):

Katherine Marino ◽

Rachel Lee ◽

Paul Lee

Keyword(s):

United Kingdom ◽

Los Angeles ◽

Skin Irritation ◽

Oxford Knee Score ◽

Osteoarthritis Of The Knee ◽

Knee Oa ◽

The United Kingdom ◽

Group A ◽

Clinically Significant ◽

Group B

Background: Knee osteoarthritis (OA) affects an estimated 1 in 5 individuals older than 45 years of age in the United Kingdom. Previous studies have suggested that germanium-infused garments may provide improved clinical outcomes in OA. Germanium-embedded (GE) knee sleeves embrace this fabric technology. Purpose: To assess the outcomes of GE knee sleeves for patients with knee OA. Study Design: Cohort study; Level of evidence, 2. Methods: This study was undertaken at a hospital in the United Kingdom. Patients who had radiographic features of OA, experienced knee pain for at least 6 months, and opted for nonsurgical intervention were included. Patients were recruited over 3 months. The University of California, Los Angeles activity score, Lysholm score, visual analog scale (VAS) score, and Oxford Knee Score (OKS) were collected at monthly intervals for 6 months. Patients were followed to determine their compliance with wearing the knee sleeves at all times, as advised, and whether any adverse effects had occurred. Results: A total of 50 participants were recruited for the study; 4 participants were excluded due to pain and were converted to surgical management. Therefore, 46 patients were analyzed and placed into 2 groups according to severity of OA, as classified by the Kellgren-Lawrence system: group A had grade 1 or 2 OA, and group B had grade 3 or 4 OA. There were 25 patients in group A and 21 in group B. Improvements were seen in OKS, VAS, and Lysholm scores in both groups. Clinically significant improvements were seen in group A only for OKS (mean increase, 14), VAS (mean decrease, 4.1), and Lysholm (mean increase, 17.2) scores. These results were also statistically significant (OKS, P = 5.8 × 10-7; VAS, P = 7.7 × 10-12; Lysholm, P = 4.2 × 10-11). The data from this study demonstrated that GE knee sleeves gave better outcomes for patients with grades 1 and 2 OA compared with patients with more advanced disease, which is consistent with previous studies. A total of 3 patients reported skin irritation, which resolved with simple skin ointment application. No patients reported infection, deep vein thrombosis, or circulation problems. Conclusion: GE knee sleeves could play an important role in optimizing nonsurgical management of patients with knee OA, especially patients with grades 1 and 2 OA, as demonstrated by the clinically significant improvements.

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A Retrospective Audit of Clinically Significant Maternal Bacteraemia in a Specialist Maternity Hospital from 2001 to 2014

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2015/518562 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 12

Author(s):

Richard John Drew ◽

Zara Fonseca-Kelly ◽

Maeve Eogan

Keyword(s):

Blood Culture ◽

Positive Blood Culture ◽

Maternal Blood ◽

Maternity Hospital ◽

E Coli ◽

Live Births ◽

Retrospective Audit ◽

Group A ◽

Clinically Significant ◽

Group B

Maternal sepsis is a significant problem in obstetrics, with almost one in four maternal deaths related to severe sepsis. We carried out a retrospective review of clinically significant bacteraemia in obstetric patients attending Rotunda Hospital over 14 years. From 2001 to 2014, there were 252 clinically significant positive blood culture episodes in obstetric patients. There were 112,361 live births >500 g during the study period giving an overall rate of 2.24 clinically significant positive maternal blood culture episodes per 1000 live births >500 g. The median rate over the 14 years was 2.12 episodes per 1000 live births >500 g, with an interquartile range of 1.74–2.43 per 1000 live births >500 g. There was no discernable increasing or decreasing trend over the 14 years.E. coliwas the most commonly isolated organism (n= 92/252, 37%), followed by group BStreptococcus(n= 64/252, 25%),Staphylococcus aureus(n= 28/252, 11%), and anaerobes (n= 11/252, 4%). These top four organisms represented three-quarters of all positive blood culture episodes (n= 195/252, 77.3%). Of note, there were only five cases of listeriosis, representing a rate of 4.4 cases per 100,000 live births >500 g. The rate of invasive group A streptococcal infection was also very low at 5.3 cases per 100,000 live births >500 g.

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A comparative trial between the therapeutic efficacy of topical 2% sertaconazole cream and 1% terbinafine cream in the treatment of tinea cruris/tinea corporis

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20170082 ◽

2017 ◽

Vol 3 (1) ◽

pp. 59

Author(s):

Sumyuktha J. ◽

Murali Narasimhan ◽

Parveen Basher Ahamed

Keyword(s):

Comparative Trial ◽

Treated Group ◽

Tinea Corporis ◽

Fungal Culture ◽

Tinea Cruris ◽

Complete Cure ◽

Group A ◽

Clinically Significant ◽

Group B ◽

Cure Rates

Background: Skin infections caused by dermatophyte fungi account for 6% of dermatology consultations at our hospital and 3 to 4% worldwide. A variety of antifungal agents are available for topical use. Terbinafine 1% cream is considered the first line topical medication in the treatment of dermatophytosis. Sertaconazole 2% cream is a relatively new drug having antifungal as well as antiflammatory property. In this prospective study we sought to compare the safety and efficacy of topical 2% Sertaconazole and 1% Terbinafine creams in the treatment of localized tinea cruris and/or tinea corporis.Methods: In this study, 80 patients were randomized into two groups of 40 each. Group A received 2% Sertaconazole cream while group B received Terbinafine 1% cream topical application twice daily for 4 weeks. Patients were followed up at the end of 2nd and 4th weeks for clinical, mycological (KOH mount and fungal culture) and complete cure (both clinical and mycological).Results: The mean age of the patients studied was 27.97 years. Complete cure was achieved in 59.5% and 80% in group A and 71.4% and 90.9% in group B at the end of 2nd and 4th weeks respectively. Significant P values were observed if the results were compared within the group, between baseline and 2 weeks, baseline and 4th week and also 2nd and 4th week. Clinically significant side effects were not observed in both the groups. Conclusions: Although higher cure rates were observed in the Terbinafine treated group, the results were not statistically significant. It can be concluded from our study that Sertaconazole 2% cream is similar in efficacy to Terbinafine 1% cream in the treatment of localized tinea cruris and corporis.

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Coagulation effects of mannitol in combination with 0.9% normal saline or hydroxyethyl starch in patients undergoing supratentorial craniotomy: A preliminary report

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.124851 ◽

2014 ◽

Vol 01 (01) ◽

pp. 056-059 ◽

Cited By ~ 1

Author(s):

Hemanshu Prabhakar ◽

Gyaninder Singh ◽

Parmod Bithal ◽

Mani Kalaivani

Keyword(s):

General Anaesthesia ◽

Hydroxyethyl Starch ◽

Normal Saline ◽

In Vitro Study ◽

Coagulation Parameters ◽

Neurosurgical Patients ◽

Group A ◽

Clinically Significant ◽

Group B

Abstract Background: Neurosurgical patients often require administration of both, mannitol and hydroxyethyl starch (HES). A recent in vitro study demonstrated that HES in combination with mannitol could disturb coagulation parameters and should be avoided in neurosurgical practice. The aim of our study was to evaluate coagulation abnormalities due to mannitol when administered alone and in combination with HES in patients undergoing craniotomy for various intracranial brain tumours. Materials and Methods: We enrolled 30 adult patients undergoing craniotomy. Patients were randomised into two groups using a computer generated randomisation chart. Interventions: Group A: Patients received 10 ml/kg 0.9% normal saline and 1 g/kg mannitol and Group B: Patients received 10 ml/kg, HES 130/0.4, and 1 gm/kg mannitol; immediately after induction of general anaesthesia. Rotational thromboelastography was done immediately after induction of general anaesthesia and 5 min after administration of mannitol. Measured parameters of blood coagulation were clotting time (CT) and clot formation time (CFT) with EXTEM and maximum clot firmness (MCF) with EXTEM and (FIBTEM). Results: Fourteen patients in each group completed the study. Insignificant change was noted in CT; CFT altered significantly from the baseline in both the groups (P < 0.05). MCF with FIBTEM did not change significantly from baseline (P > 0.05), but significantly differed between groups (P = 0.001). However, all values were in normal range. Conclusion: Mannitol 1 g/kg and HES 10 ml/kg can be safely administered in patients undergoing craniotomy for supratentorial tumours, without clinically significant changes in coagulation parameters.

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Evaluation of antioxidant potential of melatonin in periodontitis: a prospective clinic-biochemical study

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20192198 ◽

2019 ◽

Vol 8 (6) ◽

pp. 1331

Author(s):

Anagha Marawar ◽

Pramod Marawar ◽

D. H. Nandal ◽

Rahul Kunkulol ◽

Sandeep Narwane

Keyword(s):

Biochemical Study ◽

Systemic Disease ◽

High Serum ◽

Antioxidant Potential ◽

Lactating Mothers ◽

Group A ◽

Clinically Significant ◽

Group B ◽

Root Planning ◽

Positive Effect

Background: The present study was done with an objective to evaluate the effect of melatonin as an antioxidant in patients suffering from periodontitis.Methods: This study was conducted in the Department of Periodontics, Rural Dental College, Loni. Patients of chronic periodontitis, of age between 18 to 65 years of either gender ready to give informed consent to participate in the study were included. Postoperative patients, patients having night duties, drivers and those using heavy machinery, pregnant women, lactating mothers, patients with any clinically significant systemic disease and patients on any other drugs were excluded from the study. Patients were divided into three Groups. Group A included patients who underwent SRP (Scaling and Root Planning) alone, Group B included patients who underwent SRP & supplemented with Vitamin E 200 IU daily at night for 4 weeks. Group C included patients who underwent SRP & supplemented with tablet melatonin 3 mg daily at night for 4 weeks. Estimation of Malondialdehyde (MDA) for serum lipid peroxidation8, Superoxide dismutase (SOD) and Glutathione peroxidase (GPx) was done on day 0, day 30, day 60 and day 90.Results: A total 240 patients were enrolled in the study. It was demonstrated that there was considerable oxidative stress in periodontitis patients, as established by high serum MDA levels, which was reduced significantly by melatonin reflecting its antioxidant potential. Pretreatment levels of SOD and GPx also were low, which were improved with the treatment of melatonin far better than with vitamin E.Conclusions: Melatonin acts as an antioxidant in the patients of periodontitis which has positive effect on biochemical parameters of periodontitis, conferring a new facet to the management of periodontitis and an attempt to impede the disease progression.

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Organizational and technological algorithm of primary specialized health care at cardiovascular diseases

Kazan medical journal ◽

10.17816/kmj2020-394 ◽

2020 ◽

Vol 101 (3) ◽

pp. 394-402

Author(s):

A Yu Abramov ◽

R S Goloshchapov-Aksenov ◽

D I Kicha ◽

O V Rukodayny

Keyword(s):

Russian Federation ◽

Limb Ischemia ◽

Scientific Publications ◽

Quality Healthcare ◽

Significant Atherosclerosis ◽

Group A ◽

The Russian Federation ◽

Clinically Significant ◽

Group B ◽

Cardiovascular Care

Aim. To develop an algorithm for primary specialized cardiovascular care with a priority of endovascular strategy. Methods. The study was conducted in 20182019 based on the Central Clinical Hospital Russian Railways-Medicine and 14 polyclinics in the regions of the Russian Federation. The subject of the study is cardiovascular surgeons (n=2), possessing the skills of endovascular care. The object of the study was patients (n=1018) attended regional polyclinics of the Russian Federation. Patients were divided into two groups: group A consisting of 673 patients with clinically significant atherosclerosis of the coronary, brachiocephalic and peripheral arteries and abdominal aortic aneurysm; group B consisting of 345 patients with chronic lower limb ischemia that does not require surgical treatment. The average age of patients in group A was 696.1 years, in group B 637.2 years. There were 467 men in group A (69.4%), and 339 in group B (98.3%). An organizational and technological algorithm was developed to improve the primary specialized cardiovascular care. The results were assessed by the presence of outcomes (heart attack, stroke, bleeding, death), the availability of endovascular care and patient survival follow up 12 and 24 months. A content analysis of scientific publications on the issue under study has been performed. Results. An organizational and technological algorithm of primary specialized cardiovascular care has been developed, including the activities of the cardiovascular surgeon, who has the skills of endovascular care and a nurse in an outpatient clinic. The implementation of the algorithm ensured continuity, 100% availability, safety and quality of cardiovascular care using endovascular technology. Outcomes are not registered in both groups. Both patient groups showed 100% one and two-year survival. Conclusion. The developed algorithm of primary specialized cardiovascular care has provided high quality healthcare.

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Oxidant Stress as a Cause of Clinically Significant “Functional” Cobalamin (Cbl) Deficiency

Blood ◽

10.1182/blood.v112.11.2877.2877 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2877-2877 ◽

Cited By ~ 2

Author(s):

Lawrence R. Solomon

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Oxidant Stress ◽

Cumulative Effect ◽

Normal Serum ◽

Ambulatory Care Setting ◽

Group A ◽

Clinically Significant ◽

Group B ◽

Deficient Group

Abstract Many patients (pts) with Cbl-responsive disorders identified in the ambulatory care setting have reversible neurologic abnormalities associated with increased levels of the Cbl-dependent metabolites, methylmalonic acid (MMA) and homocysteine (HCys), despite normal serum Cbl values. However, no mechanism to explain these findings has been proposed. Since this picture resembles both the CblC mutation (where reduction of CblCo(III) to CblCo(II) is impaired) and nitrous oxide exposure (which inactivates methionine synthase by oxidation of CblCo(I)), a pathophysiologic role for oxidant stress leading to “Functional” Cbl deficiency was considered. Thus, a retrospective review was performed of 39 pts with Cbl-responsive hematologic or neurologic disorders seen during a 14 yr period for the presence of 6 factors associated with increased oxidant stress: advanced age (>69 yrs); diabetes mellitus; cigarette abuse; alcohol abuse; renal insufficiency; and the presence of active inflammatory disorders. Pts were classified as Cbl-Deficient (Group A: serum Cbl <201 pg/ml; N=9); Possibly Cbl-Deficient (Group B: serum Cbl=201–300 pg/ml with MMA >250 nmol/l; N=12); and “Functional” Cbl Deficiency (Group C: serum Cbl >300 pg/ml with MMA >250 nmol/l; N=18). HCys values were increased (>12.1 μmol/l) in 67%, 75% and 50% of evaluable pts in Groups A, B and C respectively. Reversible neurologic abnormalities occurred in 44% of Group A pts, 67% of Group B pts and 100% of Group C pts. In Group C pts, 83% of cases had at least 2 oxidant risk factors. In contrast, only 22% of Group A pts had 1 risk factor and only 11% had 2 risk factors (p<0.002 vs Group C). Similarly, at least 1 oxidant risk factor was present in 67% of Group B pts (p<0.02 vs Group A) but only 17% had 2 risk factors (p<0.001 vs Group C). Moreover, within Group B, only 1 of 4 pts with serum Cbl values of 201–250 pg/ml had 1 oxidant risk factor (25%), while 7 of 8 pts with serum Cbl values of 251–300 pg/ml had at least 1 risk factor (88%)(p<0.03). Finally, when all 207 pts screened for Cbl deficiency during this period who had serum Cbl values >300 pg/ml were reviewed, MMA values were found to be >250 nmol/l in 81 of them (40%). At least 1 oxidant risk factor was present in 77% of the 81 pts with high MMA values but in only 20% of the 126 pts with normal MMA values (p<0.001). HCys levels were also increased in 42 of the 78 pts with high MMA values studied (54%) and Cbl therapy significantly decreased MMA and HCys values in 83% and 85% respectively of evaluable pts in this population. In contrast, only 11% of the 126 pts with normal MMA values had high HCys levels (p<0.001). It is concluded that “Functional” Cbl-deficiency is associated with disorders known to induce oxidant stress; more commonly encountered as a cause of elevated metabolite levels and neurologic abnormalities than classic Cbl Deficiency; and often responds to Cbl therapy. Taken together, these data suggest a cumulative effect of oxidant risk factors at higher serum Cbl values leading first to increases in MMA and then to clinically significant neurologic abnormalities. Thus, Cbl inactivation may play a role in the development of neuropathy when high risk individuals experience inflammatory illnesses or are exposed to prooxidant drugs and a possible prophylactic or therapeutic role for reduced Cbl vitamers should be considered.

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The Combination of General Anaesthesia and Epidural Block I: The Effects of Sequence of Induction on Haemodynamic Variables and Blood Gas Measurements in Healthy Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x7900700304 ◽

1979 ◽

Vol 7 (3) ◽

pp. 229-238 ◽

Cited By ~ 12

Author(s):

P. A. S. Germann ◽

J. G. Roberts ◽

C. Prys-Roberts

Keyword(s):

General Anaesthesia ◽

Epidural Block ◽

Gynaecological Surgery ◽

Haemodynamic Changes ◽

Group A ◽

Baseline Values ◽

Gas Measurements ◽

Clinically Significant ◽

Group B ◽

Intravenous Atropine

The haemodynamic effects of epidural block, administered before or after general anaesthesia, were investigated in twelve healthy women scheduled for elective gynaecological surgery. The effects of 10° head down tilt and administration of atropine 0.6 mg intravenously were also determined. Haemodynamic measurements included systolic (SAP), diastolic (DAP) and mean (MAP) arterial pressure, heart rate (HR), cardiac output (CO) and systemic vascular resistance (SVR). In those receiving general anaesthesia first (Group A) (thiopentone/suxamethonium/N2O/O2) significant changes occurred only at the time when epidural block and general anaesthesia were both present: SAP, DAP and MAP (-22%, p < 0.001) were reduced compared to awake control values, however changes in HR, CO and SVR were not significant. In those receiving epidural block first (Group B) (1.5% lignocaine, mean dose 270 mg), MAP was reduced by 20% (p < 0.01) from awake control values after epidural block and there was a further reduction to 35% below control (p < 0.001) when general anaesthesia was induced. These changes were accompanied by a significant reduction in SVR. Comparison of all variables between Group A and Group B showed no clinically significant differences, indicating that the order of performance of epidural block (before or after general anaesthesia) did not affect haemodynamic variables. Head down tilt resulted in no haemodynamic changes in the presence of general anaesthesia or epidural block alone and only minimal changes when the two were combined. In contrast, intravenous atropine (0.6 mg) resulted in a return of arterial pressures to essentially baseline values in both Group A and Group B (HR increased 84%, p < 0.001; MAP increased 37%, p < 0.001; CO increased 70%, p < 0.001).

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Stone Cone® in ureteroscopic ballistic lithotripsy of proximal ureteral stones

Urologia Journal ◽

10.1177/039156030807500407 ◽

2008 ◽

Vol 75 (4) ◽

pp. 237-240 ◽

Cited By ~ 2

Author(s):

M. Arancio ◽

S. Guglielmetti ◽

A. Delsignore ◽

A. Landi ◽

C. Marchetti ◽

...

Keyword(s):

The Other ◽

Ureteral Stent ◽

Ureteral Stones ◽

Shockwave Lithotripsy ◽

Boston Scientific ◽

Safety And Efficacy ◽

Group A ◽

Clinically Significant ◽

Group B ◽

The Cost

Stone Cone® (Microvasive-Boston Scientific Corp, USA) is a device which prevents retrograde calculus migration during endoscopic ureterolithotripsy. We have studied the safety and efficacy of this device in endoscopic ureterolithotripsy with ballistic energy in proximal ureteral stones. Materials and Methods. From 01/02/2006 to 01/02/2008 we carried out 36 ureterorenoscopies (URS) for proximal ureteral stones (average age: 46, range: 15–73). A ballistic energy was used for stones fragmentation. In 18 patients (Group A) we carried out URS with the aid of Stone Cone®, which was not used in the other 18 patients (Group B). Semirigid 8 Ch or 10 Ch Storz ureteroscope and ballistic lithotriptor Swiss Lithoclast Master EMS® were used. In cases of migration, edema, and ureteral damage, a ureteral stent was used. Results. In Group B patients (URS performed without Stone Cone®) the migration of the whole stone, or of clinically significant fragments, occurred 8 times (45%). All of these patients underwent external shockwave lithotripsy (ESWL) at a center equipped with a lithotriptor. A ureteral stent was placed in 14 cases (78%). In Group A, the migration of a stone requiring ESWL treatment occurred only once (5%). The ureteral stent was placed 8 times (45%). We had no significant complications during the procedure. Conclusions. The Stone Cone® is a safe and easy-to-use device. The cost of this device can be balanced by the reduction of postoperative ESWL treatments for lithiasic fragments pushing up into the kidneys (p<0.01), and of ureteral stent applications at the end of the procedure (p<0.05).

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