Evaluating the Impact of a Training Program in Shared Decision-Making for Neurologists Treating People with Migraine.

INTRODUCTION: Migraine symptoms vary significantly between patients and within the same patient. Currently, an increasing number of therapeutic options are available for symptomatic and preventive treatment. Guidelines encourage physicians to use shared decision-making (SDM) in their practice, listening to patients' treatment preferences in order to select the most suitable and effective therapy. Although training for healthcare professionals could increase their awareness of SDM, results concerning its effectiveness are inconclusive. This study aimed to analyze the impact of a training activity to promote SDM in the context of migraine care. This was addressed by evaluating the impact on patients' decisional conflict (main objective), patient-physician relationship, neurologists' perceptions of the training and patient's perception of SDM. METHODS: A multicenter observational study was conducted in four highly specialized headache units. The participating neurologists received SDM training targeting people with migraine in clinical practice to provide techniques and tools to optimize physician-patient interactions and encourage patient involvement in SDM. The study was set up in three consecutive phases: control phase, in which neurologists were blind to the training activity and performed the consultation with the control group under routine clinical practice; training phase, when the same neurologists participated in the SDM training; and SDM phase, in which these neurologists performed the consultation with the intervention group after the training. Patients in both groups with a change of treatment assessment during the visit completed the Decisional conflict scale (DCS) after the consultation to measure the patient's decisional conflict. Also, patients answered the patient-doctor relationship questionnaire (CREM-P) and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). The mean ± SD scores obtained from the study questionnaires were calculated for both groups and compared to determine whether there were significant differences (p < 0.05). RESULTS: A total of 180 migraine patients (86.7% female, mean age of 38.5 ± 12.3 years) were included, of which 128 required a migraine treatment change assessment during the consultation (control group, n = 68; intervention group, n = 60). A low decisional conflict was found without significant differences between the intervention (25.6 ± 23.4) and control group (22.1 ± 17.9; p = 0.5597). No significant differences in the CREM-P and SDM-Q-9 scores were observed between groups. Physicians were satisfied with the training and showed greater agreement with the clarity, quality and selection of the contents. Moreover, physicians felt confident communicating with patients after the training, and they applied the techniques and SDM strategies learned. CONCLUSION: SDM is a model currently being actively used in clinical practice for headache consultation, with high patient involvement in the process. This SDM training, while useful from the physician's perspective, may be more effective at other levels of care where there is still room for optimization of patient involvement in decision-making.

Physical analysis of a processive molecular motor: the conventional kinesin.

We present a model that allows for the derivation of the experimentally accessible observables: spatial steps, mean velocity, stall force, useful power, efficiency and randomness, etc. as a function of the [adenosine triphosphate] concentration and an external load F. The model presents a minimum of adjustable parameters and the theoretical predictions compare well with the available experimental results.

Efecto del conflicto decisional sobre el control del asma en escolares de 10 a 14 años / Effect of decisional conflict on the control of asthma in scholars from 10 to 14 years old

INTRODUCCIÓN: La cantidad de pacientes asmáticos que asisten al sistema público de salud es cada vez mayor, no obstante, la tasa de adherencia al tratamiento es muy baja, siendo los adolescentes quienes presentan mayor porcentaje de abandono al tratamiento, inasistencia a sus controles y gran conflicto decisional (CD). El OBJETIVO de este estudio fue evaluar el efecto de la aplicación de consejerías sobre el CD en relación al tratamiento del asma y el nivel de control de su enfermedad. MATERIALES Y MÉTODOS: Estudio pre-experimental que reclutó a 32 niños asmáticos entre 10 a 14 años de edad del policlínico respiratorio infantil del hospital Carlos Van Buren de Valparaíso. Solo 15 niños estuvieron dispuestos a participar en el estudio quienes completaron la totalidad de las sesiones de consejería. Para determinar el grado de CD de su patología, se aplicó la Escala de Conflicto Decisional de Ottawa; y para el nivel del control del asma, se usó la Escala Global Initiative for Asthma (GINA). RESULTADOS: La edad media del grupo de niños fue de 12,06 ± 1,16 años. Finalizada la intervención, el nivel de control de asma se mantuvo y la media del CD disminuyó de 34,05 ± 4,59 a 18,02 ± 3,01 puntos (p < 0,05; t de Student para muestras pareadas). Un 73,3% de los pacientes disminuyó su nivel de conflicto decisional. CONCLUSIÓN: Las consejerías de apoyo decisional demostraron tener efectos positivos en la población estudiada.

INTRODUCTION: The number of asthmatic patients attending the public health system is increasing. However, the rate of adherence to treatment is very low. Adolescents have the largest percentage of abandonment to treatment, lack of control and a great decisional conflict (DC). The OBJECTIVE of this study was to evaluate the effect of the application of counseling on the DC in relation to asthma treatment and the level of control of their disease. MATERIALS AND METHODS: Pre-experimental study that recruited 32 asthmatic children from 10 to 14 years-old, from the children's respiratory outpatients clinic of Carlos Van Buren hospital in Valparaíso, Chile. Only 15 children were willing to participate in the study and completed all of the counseling sessions. To determine the degree of DC of its pathology, the Ottawa Decision Conflict Scale was applied; and for the Asthma Control level, the Global Initiative for Asthma Scale (GINA) was used. RESULTS: Mean children age was 12.06 ± 1.16 years-old. After the intervention, the level of Asthma Control was maintained and the mean of the DC decrease from 34.05 ± 4.59 to 18.02 ± 3.01 points (p < 0.05; paired Student's t-test). 73.3% of the patients lowered their level of decisional conflict. CONCLUSION: The counseling of decision support proved to have positive effects on the population studied.

First Report of Choke Disease Caused by Epichloë baconii in the Grass Agrostis castellana.

Agrostis castellana is common in semiarid natural grasslands of the province of Salamanca, Spain. In this area, plants showing fungal stromata in their stems were observed in July of 2001. These symptoms are typical of choke disease, caused by Epichloë species in several grasses (3). In this disease, external fungal stromata develop around the leaf sheath of the flag leaf during the reproductive cycle of the plant host. As a result, the inflorescence does not emerge. In natural populations of A. castellana, less than 1% of plants showed disease symptoms, and all the stems of infected plants were sterilized by stromata. Intercellular endophytic mycelium was observed by microscopy in stem pith of diseased plants, but not on samples of 30 apparently healthy plants (1). Ergovaline, a fungal alkaloid, was not detected in lyophilized samples of infected plant tissue (2). In a fungal culture obtained from surface-disinfected leaf sheaths of a diseased plant (1), reniform conidia and conidiophores characteristic of the genus Epichloë were observed (4). To determine the fungal species, the nucleotide sequence of the ITS1-5.8SrRNA-ITS2 region and the three first introns of the beta-tubulin gene were obtained (EMBL Accession Nos. AJ490938 and AJ490939). When compared to those of other Epichloë species, these sequences identified the fungus from A. castellana as E. baconii (3). This fungus has been previously described as a pathogenic fungal endophyte in other Agrostis and Calamagrostis species (3,4). The fact that all stems of infected plants were diseased, infection incidence was low, and no alkaloids were detected in plants suggests that this grass-endophyte interaction is pathogenic and not mixed or mutualistic. References: (1) E. Clark et al. J. Microbiol. Methods 1:149, 1983. (2) N. Hill et al. Crop Sci. 33:331, 1993. (3) A. Leuchtmann et al. Mycol. Res. 102:1169, 1998. (4) J. White Jr. Mycologia 85:444, 1993.

[An analysis of calcium pidolate absorption and a comparison with that of a salt in common use, gluconate-lactate-carbonate, in postmenopausal osteoporosis]. / Análisis de la absorción del pidolato de calcio y comparación con la da una sal de uso común, el glucono-lactato-carbonato, en la osteoporosis postmenopáusica.

The absorption of calcium pidolate is studied in 10 females suffering from osteoporosis by oral overload compared to the results of the glucono-lactate-carbonate. 405 mq of Ca pidolate produced a higher excretion of calcium by urine and an increase of Ca levels in blood than that produced by 1000 mq of Ca glucono-lactate-carbonate. The tolerance and the lack of side effects were the common feature in both salts. There were no effects on parathyroid glands nor bone resorption. We concluded that calcium pidolate is a safe and efficient treatment for osteoporosis because of easy absorption, which is very helpful in maintaining the calcium balance.

Prueba de caminata de carga progresiva (Incremental Shuttle Walking Test) en niños sanos / Incremental shuttle walking test: In healthy children

Resumen Introducción: La prueba de caminata de carga progresiva (PCCP) es una prueba incremental que permite la evaluación funcional de las enfermedades respiratorias. Esta prueba muestra una mayor correlación entre la distancia recorrida y el consumo máximo de O2 comparada con la prueba de marcha de seis minutos. En la actualidad, no contamos con valores de referencia en la población pediátrica nacional. Objetivo: Conocer la distancia recorrida en niños en la prueba. Material y Método: Estudio descriptivo correlacional. La muestra final fue de 60 sujetos (35 niños y 25 niñas) elegidos al azar en un rango de edad de 10 a 14 años. Durante la prueba se registró la distancia recorrida (DR) en metros, frecuencia cardíaca basal y final (FC), disnea, sensación subjetiva de fatiga (SSF), género, peso (kg), talla (m) y respuesta cardíaca al ejercicio (RCE). Se realizó estadística descriptiva en ambos grupos seguida de una prueba "t" para analizar las diferencias entre género. Se aplicó el coeficiente de correlación de Pearson para verificar la correlación entre las variables. Los resultados fueron expresados en medias ± desviación estándar (DE). Resultados: El promedio de la DR del conjunto de los 60 menores fue 596,2 ± 178,7 m; para la DR en las niñas el promedio fue de 531,6 ± 136,4 m y la DR promedio en los niños de 642,3 ± 192,4 m (p = 0,017). El promedio de la talla para los niños fue de 1,50 ± 0,08 m y para las niñas de 1,53 ± 0,08 m. El coeficiente de correlación de Pearson fue de 0,570 (p < 0,001) entre el promedio de DR para ambos géneros y la RCE. Conclusiones: Los niños alcanzan una mayor DR que las niñas en la PCCP. No se encontró influencia de la edad, peso, estatura o IMC en la distancia recorrida para la PCCP. En el conjunto de los 60 niños se observó una correlación positiva entre la DR y la RCE.

Background: The "incremental shuttle walking test" (ISWT) is an incremental test that allows the functional evaluation of respiratory diseases. It shows a greater correlation between distance walked and the maximum O2 uptake compared to the six-minute walking test. Presently we do not have reference values in Chilean pediatric population. Objective: To know the distance walked by children in the test. Material and Method: This was a correlational descriptive study. The final sample consisted of 60 subjects (35 boys and 25 girls) randomly selected from an age range from 10 to 14 years-old. During the test, walked distance (WD) in meters, basal and final heart rate (HR), dyspnea, subjective sensation of fatigue (SSF), gender, weight (kg), height (m) and cardiac response to exercise (CRE) were recorded. Descriptive statistics were performed in both series followed by a t-test to look for differences among genders. Pearson's correlation coefficient was used to verify the correlation between variables. Results were expressed as mean ± SD. Results: Mean of WD in all the 60 children together was 596.2 ± 178.7 m; in average WD in girls series was 531.6 ± 136.5 m and in boys series was 642.3 ± 192.4 m (p = 0.017). The average height for boys was 1.50 ± 0.08 m and for girls was 1.53 ± 0.08 m (p = 0.245). The average BMI for boys was 18.3 ± 1.6 kg/m2 and for girls was 19.3 ± 2.2 kg/m2 (p = 0.041). Pearson's correlation coefficient between the average of meters walked for all the 60 children together and CRE was 0.570 (p < 0.001). Conclusions: Boys showed a greater WD than girls in ISWT. There was no influence of age, weight, height or BMI on distance walked on the ISWT A positive correlation is shown between the WD and the CRE.

[Development and validation of the Social Functioning Scale, short version, in schizophrenia for its use in the clinical practice]. / Desarrollo y validación de la versión corta de la Escala de Funcionamiento Social en esquizofrenia para su uso enla práctica clínica.

INTRODUCTION: The Social Functioning Scale (SFS) was designed to evaluate social functioning essential to schizophrenic patients. Its length may be difficult to use in clinical practice. The objective of this study was to develop and validate a short version of the SFS. METHODS: Data from 445 patients with schizophrenia who came from two separate studies, one longitudinal (n=250) and one cross-sectional (n=195), were used to produce and validate the short form of the SFS. The two samples were combined and then randomly split into two subsamples. In the first subsample (n = 223), items were eliminated using classical, modern (item response theory) psychometric criteria, as well as clinimetric criteria. The short version was independently validated using data from the other subsample (n = 222), by comparing the level of association (correlation and Area Under the ROC Curve [AUC]) with the EQ-5D VAS and the Clinical Global Impression (CGI), with the original scale. RESULTS: The original 78 items were reduced initially to 19 and 13 items (respectively using classic and modern psychometric criteria) and then to 15, since 2 items related with the employment capacity were added for clinometric criteria. The short form of the SFS had a Cronbach's alpha of 0.76. Spearman correlation coefficients with the EQ-5D VAS and with the CGI score (0.46 and 0.42, respectively) were similar or even higher for the short version than for the original version. The AUC of the SFS and the dichotomous CGI were practically the same for both the original (AUC: 0.74) and the short (AUC: 0.73) versions. CONCLUSIONS: The short version of the SFS proved to be reliable and valid. It could be adequate for use in clinical practice.

[Remission and relapse in the outpatient treatment of patients with schizophrenia. Outcomes at 3 years]. / Remisión y recaída en el tratamiento ambulatorio de los pacientes con esquizofrenia. Resultados a 3 años.

INTRODUCTION: Three year data collected in the frame of the SOHO study within Spain were used to evaluate antipsychotic treatment outcomes by analyzing remission and relapse as well as the factors influencing them. METHODS: The SOHO was a prospective, long-term, observational study of the outcomes of schizophrenia treatment in ambulatoty who initiated therapy or who changed to a new antipsychotic drug performed in 10 European countries, with a focus on olanzapine. This article reports the attainment of international schizophrenia clinical remission and relapse criteria and the associated correlates in these patients. RESULTS AND CONCLUSIONS: A total of 2,020 patients were recruited in Spain. Almost 2/3 (60.1%) of the patients met the criteria for clinical remission. Factors that influence the likelihood of remission were identified, such as gender, baseline clinical and/or functional status, time since treatment initiation, treatment with olanzapine versus oral typical antipsychotics, duration of treatment, gender or the need for concomitant anxiolytics. Relapse occurred in 18.7% of patients. Treatment with quetiapine or the prescription of anticholinergics was associated with a greater risk of relapse. CONCLUSIONS: These results highlight some prognostic factors of the course of schizophrenia and underscore the importance of the antipsychotic choice and its maintenance to achieve favorable long-term clinical outcomes in routine practice.

[Safety and tolerability of olanzapine versus risperidone: a one-year randomized study in outpatients with schizophrenia with prominent negative symptoms]. / Seguridad y tolerabilidad de olanzapina y risperidona: un estudio aleatorizado de 1 año de duración en pacientes con esquizofrenia y sintomatologia negativa prominente tratados de manera ambulatoria.

OBJECTIVE: To evaluate the safety and tolerability of long-term treatment with olanzapine versus risperidone in schizophrenic outpatients with prominent negative symptoms. METHODS: This was a multi-center, randomised, open-label, parallel, dose-flexible, 1 year study of outpatients with schizophrenia (DSM-IV criteria) with prominent negative symptoms (SANS Global score > or =10). Safety was evaluated by recording treatment-emergent adverse events, vital signs, body weight and, when available, laboratory parameters. Extrapyramidal symptoms (EPS) were evaluated by a questionnaire based on the UKU scale, and sexual dysfunction by the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ). RESULTS: The mean (+/- SD) modal dose throughout the study was 12.3 (+/- 6.3) mg/day for olanzapine and 5.2 (+/- 2.5) mg/day for risperidone. EPS were significantly more frequent in the risperidone-treated patients 50.4 % versus 28.9 % for olanzapine (p = 0.0006). Olanzapine patients showed significantly greater reductions (improvement) from baseline in the PRSexDQ score (p=0.0292) and risperidone patients reported significantly more sexual adverse events (21.1% versus 7.3% for olanzapine; p=0.0018). Mean body weight gain was not significantly different at endpoint (3.5 kg gained with olanzapine versus 1.9 kg gained with risperidone; p=0.3522), but the proportion of patients showing a body weight increase > or =7% was higher among the olanzapine-treated patients (37.8% versus 16.8%; p=0.0012). CONCLUSIONS: Significantly less treatment-emergent extrapyramidal and sexual adverse events were observed in patients treated with olanzapine compared to those treated with risperidone. Mean body weight increases with both drugs were not significantly different after one year. Olanzapine patients presented a significantly higher incidence of clinically important body weight increase when compared with patients treated with risperidone.

Kinesin as an electrostatic machine.

Kinesin and related motor proteins utilize ATP fuel to propel themselves along the external surface of microtubules in a processive and directional fashion. We show that the observed step-like motion is possible through time-varying charge distributions furnished by the ATP hydrolysis cycle while the static charge configuration on the microtubule provides the guide for motion. Thus, while the chemical hydrolysis energy induces appropriate local conformational changes, the motor translational energy is fundamentally electrostatic. Numerical simulations of the mechanical equations of motion show that processivity and directionality are direct consequences of the ATP-dependent electrostatic interaction between the different charge distributions of kinesin and the microtubule.

Near-infrared reflectance spectroscopy as a fast and non-destructive tool to predict foliar organic constituents of several woody species.

Near-infrared reflectance spectroscopy (NIRS) was used to estimate N, neutral detergent fibre (NDF), acid detergent fibre (ADF), lignin and cellulose contents in leaves of a heterogeneous group of 17 woody species from the Central Western region of the Iberian Peninsula. The sample set consisted of 182 samples of leaves of deciduous and evergreen species, showing a wide range of concentrations determined by reference methods: 6.60-35.2 g kg-1 (N), 15.5-66.0% (NDF), 10.2-57.3% (ADF), 3.45-27.4% (lignin) and 5.79-31.3% (cellulose). Reflectance spectra, obtained for samples of dried and ground leaves, were recorded as log1/R (R=reflectance) from 1,100 to 2,500 nm. NIRS calibrations were developed using multiple linear (MLR) and partial least-squares (PLSR) regressions, and tested by external validation. Spectral data were transformed to the first and second derivative (1D, 2D). The PLSR method and derivative transformations provided the best statistics and showed lower standard errors of calibration (SEC) and higher coefficients of multiple determination (R2). In the external validation the standard errors of prediction (SEP) were 0.76 g kg-1 (N), 2.11% (NDF), 1.47% (ADF), 0.85% (lignin) and 0.86% (cellulose). The results obtained show that NIRS is very effective for the estimation of these organic constituents in leaf tissue of woody species. This technique can be used in ecological or ecophysiological studies as an alternative to the more time-consuming standard methods.

Use of near-infrared reflectance spectroscopy in predicting nitrogen, phosphorus and calcium contents in heterogeneous woody plant species.

Near-infrared reflectance spectroscopy was applied to determine nitrogen (N), phosphorus (P) and calcium (Ca) content in leaf samples of 18 woody species. A total of 183 samples from mountain, riparian and dry areas from the Central-Western Iberian Peninsula were collected for this purpose. The wide intervals of variation observed in nutrient concentrations (6.6-45.0 g kg(-1) for N, 0.24-2.97 g kg(-1) for P, and 1.00-20.06 g kg(-1) for Ca) were due to the great heterogeneity of the samples. To develop calibration equations, multiple linear regression, and partial least-squares regression (PLSR) were used. In both cases, three mathematical transformations of the data were applied: log1/R and first and second derivatives. The best calibration statistics were obtained using PLSR and derivative transformations (second derivative for N and first derivative for P and Ca). The following coefficients of multiple determination (R2) and standard errors of cross validation were obtained: 0.99 and 0.93 for N, 0.94 and 0.15 for P, and 0.95 and 0.88 for Ca. In the external validation the standard errors of prediction obtained were 0.76 (N), 0.11 (P) and 0.60 (Ca).

[Economic analyses of olanzapine in the treatment of schizophrenia and bipolar disorder]. / Análisis económico de la olanzapina en el tratamiento de la esquizofrenia y el trastorno bipolar.

Schizophrenia generates important costs for society both direct, as a consequence of hospitalization and outpatient treatment, and indirect; related to loss of productivity. The atypical antipsychotics, such as olanzapine, have supposed an important advance in the treatment of schizophrenia. The greater cost of atypical antipsychotics with respect to conventional drugs has led to the conduction of pharmacoeconomic studies to determine its efficiency. This article reviews the complete pharmacoeconomic studies that compare olanzapine with haloperidol and risperidone in the treatment of schizophrenia. Cost analyses comparing olanzapine and haloperidol show that the former drug does not add increased cost to therapy, and even contributes to lessen expenses fundamentally as a result of a decrease in hospitalizations. In the economic evaluations comparing olanzapine and risperidone, the results are not conclusive, and in general, the total costs associated with both treatments were similar. In the treatment of bipolar disorder, although few studies have estimated the economic impact of olanzapine, it has been observed a reduction of hospitalization costs associated to the treatment with olanzapine.

Cell cycle regulation of a DNA ligase-encoding gene (CaLIG4) from Candida albicans.

A DNA ligase (CaLIG4) (formerly CaCDC9) of the human pathogen, Candida albicans, has been characterized. The encoded protein displayed a significant similarity to ligase IV from both Saccharomyces cerevisiae and humans. In addition, whereas CaLIG4 did not complement a S. cerevisiae cdc9 mutant, it re-established non-homologous end-joining of DNA double-strand breaks in a S. cerevisiae lig4 deletant. CaLIG4 was assigned to chromosome 2. Several cis-acting effector sequences were identified in the promoter region of the CaLIG4, including the DNA sequence element ACGNG, which is required for periodic transcription of several DNA-replicating genes in S. cerevisiae. The level of transcription of CaLIG4 in C. albicans varies during the yeast cell cycle. Newly formed cells contained basal levels of transcript which increased to a maximum level when cells were in late G(1). Thereafter, levels of transcript dropped as DNA replication was initiated. Our results suggest that CaLIG4 may perform an important role during the mitotic cycle of C. albicans.

[The European schizophrenia outpatient health outcomes (SOHO) study: baseline findings of the Spanish sample]. / Estudio observacional paneuropeo de la efectividad de la olanzapina frente a otros antipsicóticos (SOHO): resultados basales de la muestra española.

INTRODUCTION: To describe the baseline findings and study population of the Spanish sample of the Schizophrenia Outpatient Health Outcomes (SOHO) Study. METHOD: The SOHO study is an ongoing, large, prospective, long-term observational study of schizophrenia treatment in 10 European countries. The study population consists of outpatients who initiate therapy or change to a new antipsychotic. RESULTS: A total of 86 investigators enrolled 2,020 in Spain (10,972 patients in Europe). 64 % of patients were men and the mean age was 38.7 years. The Spanish SOHO study sample had considerable functional impairment at baseline. The main reason for change of therapy was lack effectiveness followed by intolerability. Patients included in the study and those receiving their first antipsychotic for schizophrenia are most likely to receive an atypical agent. CONCLUSION: The Spanish SOHO study population appears to represent the Spanish outpatients with schizophrenia in whom a treatment decision is required. Baseline findings reflect Spanish clinical practice with respect to patients treated with individual antipsychotics.

[Weaning from mechanical ventilation. The aim of nursing research]. / El destete del ventilador, objeto de investigación enfermera.

Management of patients difficult to wean from the ventilator is a practical challenge in which professional nurses are deeply involved.The clinical research applied over the last years has tried to describe the characteristics of weaning phenomenon and the associated factors, to find predictive outcomes to guide clinical decisions, to search new strategies to conduct the protocols and to identify the most effective modes of weaning. In this paper a critical review of the current knowledge from a nursing perspective is done. The weaning conceptual model proposed by the American Association of Critical Care Nurses (AACN) group has been used as a theoretical framework.

Phase III randomized pilot study comparing interferon alpha-2b in combination with radiation therapy versus radiation therapy alone in patients with stage III-B carcinoma of the cervix.

This randomized pilot study was designed to determine whether the addition of interferon alpha-2b to standard radiation therapy offered an advantage in loco-regional control and survival over radiation therapy alone in a homogeneous group of patients with stage IIIB carcinoma of the cervix. Thirty-six patients were treated with a combination of interferon alpha-2b plus radiation therapy, and 38 patients were treated with radiation therapy alone. Patients with evidence of ureteral obstruction were excluded from the study. Evaluation of loco-regional response was determined by pelvic examination, cervical cytology, biopsies and CT scans when indicated. Survival time was measured from initiation of treatment to date of death or last follow-up. Patient characteristics were comparable between both study arms. The objective complete response rate was 67% in the combined therapy group and 55% in the radiation alone group (P = 0.454). With a median follow-up of 17 months for all patients and 31 months for live patients, 50% of the combined group survived vs. 39.5% of the radiation alone group (P = 0.424). We conclude that the addition of interferon alpha-2b to standard radiation therapy did not significantly improve loco-regional response or survival, although such a trend was noted. We encourage the design of a larger randomized study with sufficient power to detect meaningful differences to prove whether the tendency observed in the present investigation holds any promise to improve the outcome of these patients.

Duloxetina en el tratamiento de los síntomas somáticos dolorosos asociados a la depresión / Duloxetine in the treatment of somatic pain symptoms associated with depression

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