Randomized controlled trial of nasogastric tube use after esophagectomy: study protocol for the kinetic trial.

Esophagectomy is a complex and complication laden procedure. Despite centralization, variations in perioparative strategies reflect a paucity of evidence regarding optimal routines. The use of nasogastric (NG) tubes post esophagectomy is typically associated with significant discomfort for the patients. We hypothesize that immediate postoperative removal of the NG tube is non-inferior to current routines. All Nordic Upper Gastrointestinal Cancer centers were invited to participate in this open-label pragmatic randomized controlled trial (RCT). Inclusion criteria include resection for locally advanced esophageal cancer with gastric tube reconstruction. A pretrial survey was undertaken and was the foundation for a consensus process resulting in the Kinetic trial, an RCT allocating patients to either no use of a NG tube (intervention) or 5 days of postoperative NG tube use (control) with anastomotic leakage as primary endpoint. Secondary endpoints include pulmonary complications, overall complications, length of stay, health related quality of life. A sample size of 450 patients is planned (Kinetic trial: https://www.isrctn.com/ISRCTN39935085). Thirteen Nordic centers with a combined catchment area of 17 million inhabitants have entered the trial and ethical approval was granted in Sweden, Norway, Finland, and Denmark. All centers routinely use NG tube and all but one center use total or hybrid minimally invasive-surgical approach. Inclusion began in January 2022 and the first annual safety board assessment has deemed the trial safe and recommended continuation. We have launched the first adequately powered multi-center pragmatic controlled randomized clinical trial regarding NG tube use after esophagectomy with gastric conduit reconstruction.

An anisotropic parameterization scheme for longwave irradiance and its impact on radiant load in urban outdoor settings.

A robust representation of the radiative properties in complex urban settings is important for accurate estimations of radiant load. Here, we present a new parameterization scheme in the SOlar and LongWave Environmental Irradiance Geometry (SOLWEIG) model that partitions the upper hemisphere into 153 patches. Partitioning of the upper hemisphere enables determination if longwave irradiance originates from the sky, vegetation, sunlit building surfaces, or shaded building surfaces from each patch. Furthermore, a model for anisotropic sky longwave irradiance where emissivity increases with zenith angle is included. Comparisons between observations and simulations show high correlation, with R2 and RMSE for Tmrt of 0.94 and 4.6 °C, respectively, and R2 and RMSE for longwave radiation of 0.89 and 14.1 Wm-2, respectively. Simulations show that mean radiant temperature (Tmrt) can be up to 1.5 °C higher with an anisotropic sky compared to a uniform sky as an effect of higher radiant load on the vertical of a human when sky longwave irradiance increases with zenith angle. In comparisons of simulated Tmrt with the new parameterization and old parameterization schemes, previously overestimated Tmrt under trees (high sky obstruction, sky view factor (SVF) < 0.3) can be decreased by up to 3 °C from more realistic estimations using the patches. Moreover, Tmrt close to sunlit walls (SVF ~ 0.5) is increased by up to 2-3 °C from increased exposure to sunlit surfaces. Concluding, anisotropic sky longwave radiation and directionality of longwave radiation from different sources are important in estimations of Tmrt of humans in outdoor settings.

The effects of warm weather on children's outdoor heat stress and physical activity in a preschool yard in Gothenburg, Sweden.

Hot weather conditions can have negative impacts on the thermal comfort and physical activity of vulnerable groups such as children. The aim of this study is to analyze the effects of warm weather on 5-year-old children's thermal comfort and physical activity in a preschool yard in Gothenburg, Sweden. In situ measurements were conducted for 1-1.5 h in the early afternoon on 8 days in May, June, and August of 2022. The thermal comfort and physical activity was estimated with GPS-tracks, heart rate monitors, and step counts and compared to observed weather conditions. Results show that physical activity decreases under warmer weather conditions, depicted by a decrease in distance moved, step counts, and highest registered pulse. Moreover, on warm days, the children avoid sunlit areas. For 50% or more of the time spent in sunlit areas, the children are exposed to cautious levels of heat. In shaded areas, on the other hand, the children are less exposed, with five out of 8 days having 50% or more of the time at neutral levels. The study demonstrates the importance of access to shaded areas in preschool yards where children can continue their active play while simultaneously maintaining a safe thermal status.

Inactivation of SARS-CoV-2 and HCoV-229E in vitro by ColdZyme® a medical device mouth spray against the common cold.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic calls for effective and safe treatments. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 actively replicates in the throat, unlike SARS-CoV, and shows high pharyngeal viral shedding even in patients with mild symptoms of the disease. HCoV-229E is one of four coronaviruses causing the common cold. In this study, the efficacy of ColdZyme® (CZ-MD), a medical device mouth spray, was tested against SARS-CoV-2 and HCoV-229E in vitro. The CZ-MD provides a protective glycerol barrier containing cod trypsin as an ancillary component. Combined, these ingredients can inactivate common cold viruses in the throat and mouth. The CZ-MD is believed to act on the viral surface proteins that would perturb their entry pathway into cells. The efficacy and safety of the CZ-MD have been demonstrated in clinical trials on the common cold. METHOD OF STUDY: The ability of the CZ-MD to inactivate SARS-CoV-2 and HCoV-229E was tested using an in vitro virucidal suspension test (ASTM E1052). RESULTS: CZ-MD inactivated SARS-CoV-2 by 98.3% and HCoV-229E by 99.9%. CONCLUSION: CZ-MD mouth spray can inactivate the respiratory coronaviruses SARS-CoV-2 and HCoV-229E in vitro. Although the in vitro results presented cannot be directly translated into clinical efficacy, the study indicates that CZ-MD might offer a protective barrier against SARS-CoV-2 and a decreased risk of COVID-19 transmission.

A Plasma Protein Biomarker Strategy for Detection of Small Intestinal Neuroendocrine Tumors.

BACKGROUND: Small intestinal neuroendocrine tumors (SI-NETs) are difficult to diagnose in the early stage of disease. Current blood biomarkers such as chromogranin A (CgA) and 5-hydroxyindolacetic acid have low sensitivity (SEN) and specificity (SPE). This is a first preplanned interim analysis (Nordic non-interventional, prospective, exploratory, EXPLAIN study [NCT02630654]). Its objective is to investigate if a plasma protein multi-biomarker strategy can improve diagnostic accuracy (ACC) in SI-NETs. METHODS: At the time of diagnosis, before any disease-specific treatment was initiated, blood was collected from patients with advanced SI-NETs and 92 putative cancer-related plasma proteins from 135 patients were analyzed and compared with the results of age- and sex-matched controls (n = 143), using multiplex proximity extension assay and machine learning techniques. RESULTS: Using a random forest model including 12 top ranked plasma proteins in patients with SI-NETs, the multi-biomarker strategy showed SEN and SPE of 89 and 91%, respectively, with negative predictive value (NPV) and positive predictive value (PPV) of 90 and 91%, respectively, to identify patients with regional or metastatic disease with an area under the receiver operator characteristic curve (AUROC) of 99%. In 30 patients with normal CgA concentrations, the model provided a diagnostic SPE of 98%, SEN of 56%, and NPV 90%, PPV of 90%, and AUROC 97%, regardless of proton pump inhibitor intake. CONCLUSION: This interim analysis demonstrates that a multi-biomarker/machine learning strategy improves diagnostic ACC of patients with SI-NET at the time of diagnosis, especially in patients with normal CgA levels. The results indicate that this multi-biomarker strategy can be useful for early detection of SI-NETs at presentation and conceivably detect recurrence after radical primary resection.

Is Physiological Equivalent Temperature (PET) a superior screening tool for heat stress risk than Wet-Bulb Globe Temperature (WBGT) index? Eight years of data from the Gothenburg half marathon.

BACKGROUND: The Wet-Bulb Globe Temperature (WBGT) index is a common tool to screen for heat stress for sporting events. However, the index has a number of limitations. Rational indices, such as the physiological equivalent temperature (PET) and Universal Thermal Climate Index (UTCI), are potential alternatives. AIM: To identify the thermal index that best predicts ambulance-required assistances and collapses during a city half marathon. METHODS: Eight years (2010-2017) of meteorological and ambulance transport data, including medical records, from Gothenburg's half-marathon were used to analyse associations between WBGT, PET and UTCI and the rates of ambulance-required assistances and collapses. All associations were evaluated by Monte-Carlo simulations and leave-one-out-cross-validation. RESULTS: The PET index showed the strongest correlation with both the rate of ambulance-required assistances (R2=0.72, p=0.008) and collapses (R2=0.71, p=0.008), followed by the UTCI (R2=0.64, p=0.017; R2=0.64, p=0.017) whereas the WBGT index showed substantially poorer correlations (R2=0.56, p=0.031; R2=0.56, p=0.033). PET stages of stress, match the rates of collapses better that the WBGT flag colour warning. Compared with the PET, the WBGT underestimates heat stress, especially at high radiant heat load. The rate of collapses increases with increasing heat stress; large increase from the day before the race seems to have an impact of the rate of collapses. CONCLUSION: We contend that the PET is a better predictor of collapses during a half marathon than the WBGT. We call for further investigation of PET as a screening tool alongside WBGT.

Coupling of urban energy balance model with 3-D radiation model to derive human thermal (dis)comfort.

While capabilities in urban climate modeling have substantially increased in recent decades, the interdependency of changes in environmental surface properties and human (dis)comfort have only recently received attention. The open-source solar long-wave environmental irradiance geometry (SOLWEIG) model is one of the state-of-the-art models frequently used for urban (micro-)climatic studies. Here, we present updated calculation schemes for SOLWEIG allowing the improved prediction of surface temperatures (wall and ground). We illustrate that parameterizations based on measurements of global radiation on a south-facing vertical plane obtain better results compared to those based on solar elevation. Due to the limited number of ground surface temperature parameterizations in SOLWEIG, we implement the two-layer force-restore method for calculating ground temperature for various soil conditions. To characterize changes in urban canyon air temperature (Tcan), we couple the calculation method as used in the Town Energy Balance (TEB) model. Comparison of model results and observations (obtained during field campaigns) indicates a good agreement between modeled and measured Tcan, with an explained variance of R2 = 0.99. Finally, we implement an energy balance model for vertically mounted PV modules to contrast different urban surface properties. Specifically, we consider (i) an environment comprising dark asphalt and a glass facade and (ii) an environment comprising bright concrete and a PV facade. The model results show a substantially decreased Tcan (by up to - 1.65°C) for the latter case, indicating the potential of partially reducing/mitigating urban heat island effects.

Medical Emergencies During a Half Marathon Race - The Influence of Weather.

The aim was to analyze the influence of weather conditions on medical emergencies in a half-marathon, specifically by evaluating its relation to the number of non-finishers, ambulance-required assistances, and collapses in need of ambulance as well as looking at the location of such emergencies on the race course. Seven years of data from the world's largest half marathon were used. Meteorological data were obtained from a nearby weather station, and the Physiological Equivalent Temperature (PET) index was used as a measure of general weather conditions. Of the 315,919 race starters, 104 runners out of the 140 ambulance-required assistances needed ambulance services due to collapses. Maximum air temperature and PET significantly co-variated with ambulance-required assistances, collapses, and non-finishers (R2=0.65-0.92; p=0.001-0.03). When air temperatures vary between 15-29°C, an increase of 1°C results in an increase of 2.5 (0.008/1000) ambulance-required assistances, 2.5 (0.008/1000) collapses (needing ambulance services), and 107 (0.34/1000) non-finishers. The results also indicate that when the daily maximum PET varies between 18-35°C, an increase of 1°C PET results in an increase of 1.8 collapses (0.006/1000) needing ambulance services and 66 non-finishers (0.21/1000).

Can participants predict where ambulance-requiring cases occur at a half marathon?

OBJECTIVES: Despite endurance races leading to a substantial number of ambulance-requiring cases (ARC), little is known regarding where they occur, meaning that knowing where to place medical teams, ambulance pick-up points, etc, is difficult. This article investigates whether the location of ARCs can be identified by race participants. METHODS: Using the world's largest half marathon (Gothenburg half marathon) as a case, 237 runners were asked, post-race, to mark on a map which geographical point of the race was most exhausting. Using the level of agreement tests, these geographical points were then compared with the GPS positions of ARCs. RESULTS: According to the level of agreement tests, the most exhausting positions (MEP), as identified by participants, seem to be highly correlated to the location of ARCs. This study can also show that ambulance-requiring cases seem to be more prevalent towards the end of the race and in uphill sections. CONCLUSIONS: By asking participants where they found the race most exhausting it seems possible to identify high-risk places for an ARC. From a practical perspective, using this method could considerably increase the safety of competitors as well as improving the cost-effectiveness of safety interventions at endurance races. Further studies are needed to understand the specific risk factors of the high-risk areas as well as characteristics of collapsed runners.

Effect of urban design on microclimate and thermal comfort outdoors in warm-humid Dar es Salaam, Tanzania.

Due to the complexity of built environment, urban design patterns considerably affect the microclimate and outdoor thermal comfort in a given urban morphology. Variables such as building heights and orientations, spaces between buildings, plot coverage alter solar access, wind speed and direction at street level. To improve microclimate and comfort conditions urban design elements including vegetation and shading devices can be used. In warm-humid Dar es Salaam, the climate consideration in urban design has received little attention although the urban planning authorities try to develop the quality of planning and design. The main aim of this study is to investigate the relationship between urban design, urban microclimate, and outdoor comfort in four built-up areas with different morphologies including low-, medium-, and high-rise buildings. The study mainly concentrates on the warm season but a comparison with the thermal comfort conditions in the cool season is made for one of the areas. Air temperature, wind speed, mean radiant temperature (MRT), and the physiologically equivalent temperature (PET) are simulated using ENVI-met to highlight the strengths and weaknesses of the existing urban design. An analysis of the distribution of MRT in the areas showed that the area with low-rise buildings had the highest frequency of high MRTs and the lowest frequency of low MRTs. The study illustrates that areas with low-rise buildings lead to more stressful urban spaces than areas with high-rise buildings. It is also shown that the use of dense trees helps to enhance the thermal comfort conditions, i.e., reduce heat stress. However, vegetation might negatively affect the wind ventilation. Nevertheless, a sensitivity analysis shows that the provision of shade is a more efficient way to reduce PET than increases in wind speed, given the prevailing sun and wind conditions in Dar es Salaam. To mitigate heat stress in Dar es Salaam, a set of recommendations and guidelines on how to develop the existing situation from microclimate and thermal comfort perspectives is outlined. Such recommendations will help architects and urban designers to increase the quality of the outdoor environment and demonstrate the need to create better urban spaces in harmony with microclimate and thermal comfort.

A framework for assessing urban greenery's effects and valuing its ecosystem services.

Ongoing urban exploitation is increasing pressure to transform urban green spaces, while there is increasing awareness that greenery provides a range of important benefits to city residents. In efforts to help resolve associated problems we have developed a framework for integrated assessments of ecosystem service (ES) benefits and values provided by urban greenery, based on the ecosystem service cascade model. The aim is to provide a method for assessing the contribution to, and valuing, multiple ES provided by urban greenery that can be readily applied in routine planning processes. The framework is unique as it recognizes that an urban greenery comprises several components and functions that can contribute to multiple ecosystem services in one or more ways via different functional traits (e.g. foliage characteristics) for which readily measured indicators have been identified. The framework consists of five steps including compilation of an inventory of indicator; application of effectivity factors to rate indicators' effectiveness; estimation of effects; estimation of benefits for each ES; estimation of the total ES value of the ecosystem. The framework was applied to assess ecosystem services provided by trees, shrubs, herbs, birds, and bees, in green areas spanning an urban gradient in Gothenburg, Sweden. Estimates of perceived values of ecosystem services were obtained from interviews with the public and workshop activities with civil servants. The framework is systematic and transparent at all stages and appears to have potential utility in the existing spatial planning processes.

Costs and quality of life of small-incision open cholecystectomy and laparoscopic cholecystectomy - an expertise-based randomised controlled trial.

BACKGROUND: Health care providers need solid evidence based data on cost differences between alternative surgical procedures for common surgical disorders. We aimed to compare small-incision open cholecystectomy (SIOC) and laparoscopic cholecystectomy (LC) concerning costs and health-related quality of life using data from an expertise-based randomised controlled trial. METHODS: Patients scheduled for cholecystectomy were assigned to undergo LC or SIOC performed by surgeons in two different expert groups. Total costs were calculated in USD. Reusable instruments were assumed for the cost analysis. Quality of life was measured using the EuroQol 5-D 3-L (EQ 5-D-3L), at five postoperative time points and calculated to Area Under Curve (AUC) for 1 year postoperatively. Two hospitals participated in the trial, which included both emergency and elective surgery. RESULTS: Of 477 patients that underwent a cholecystectomy during the study period, 355 (74.9%) were randomised and 323 analysed, 172 LC and 151 SIOC patients. Both direct and total costs were less for SIOC than for LC patients. The total costs were 5429 (4293-6932) USD for LC and 4636 (3905-5746) USD for SIOC, P = 0.001. The quality of life index did not differ between the LC and SIOC groups at any time. Median values (25th and 75th percentiles (p25-p75)) for AUC at 1 year were as follows: 349 (337-351) for LC and 349 (338-350) for SIOC. CONCLUSIONS: In this expertise-based randomised controlled trial LC was a more costly procedure and quality of life did not differ after SIOC and LC. (ClinicalTrials.gov Identifier: NCT00370344, August 30, 2006).

Present and projected future mean radiant temperature for three European cities.

Present-day and projected future changes in mean radiant temperature, T mrt in one northern, one mid-, and one southern European city (represented by Gothenburg, Frankfurt, and Porto), are presented, and the concept of hot spots is adopted. Air temperature, T a , increased in all cities by 2100, but changes in solar radiation due to changes in cloudiness counterbalanced or exacerbated the effects on T mrt. The number of days with high T mrt in Gothenburg was relatively unchanged at the end of the century (+1 day), whereas it more than doubled in Frankfurt and tripled in Porto. The use of street trees to reduce daytime radiant heat load was analyzed using hot spots to identify where trees could be most beneficial. Hot spots, although varying in intensity and frequency, were generally confined to near sunlit southeast-southwest facing walls, in northeast corner of courtyards, and in open spaces in all three cities. By adding trees in these spaces, the radiant heat load can be reduced, especially in spaces with no or few trees. A set of design principles for reducing the radiant heat load is outlined based on these findings and existing literature.

Influence of ground surface characteristics on the mean radiant temperature in urban areas.

The effect of variations in land cover on mean radiant temperature (T mrt ) is explored through a simple scheme developed within the radiation model SOLWEIG. Outgoing longwave radiation is parameterised using surface temperature observations on a grass and an asphalt surface, whereas outgoing shortwave radiation is modelled through variations in albedo for the different surfaces. The influence of ground surface materials on T mrt is small compared to the effects of shadowing. Nevertheless, altering ground surface materials could contribute to a reduction in T mrt to reduce the radiant load during heat-wave episodes in locations where shadowing is not an option. Evaluation of the new scheme suggests that despite its simplicity it can simulate the outgoing fluxes well, especially during sunny conditions. However, it underestimates at night and in shadowed locations. One grass surface used to develop the parameterisation, with very different characteristics compared to an evaluation grass site, caused T mrt to be underestimated. The implications of using high temporal resolution (e.g. 15 minutes) meteorological forcing data under partly cloudy conditions are demonstrated even for fairly proximal sites.

Transpiration of urban trees and its cooling effect in a high latitude city.

An important ecosystem service provided by urban trees is the cooling effect caused by their transpiration. The aim of this study was to quantify the magnitude of daytime and night-time transpiration of common urban tree species in a high latitude city (Gothenburg, Sweden), to analyse the influence of weather conditions and surface permeability on the tree transpiration, and to find out whether tree transpiration contributed to daytime or nocturnal cooling. Stomatal conductance and leaf transpiration at day and night were measured on mature street and park trees of seven common tree species in Gothenburg: Tilia europaea, Quercus robur, Betula pendula, Acer platanoides, Aesculus hippocastanum, Fagus sylvatica and Prunus serrulata. Transpiration increased with vapour pressure deficit and photosynthetically active radiation. Midday rates of sunlit leaves ranged from less than 1 mmol m(-2) s(-1) (B. pendula) to over 3 mmol m(-2) s(-1) (Q. robur). Daytime stomatal conductance was positively related to the fraction of permeable surfaces within the vertically projected crown area. A simple estimate of available rainwater, comprising of precipitation sum and fractional surface permeability within the crown area, was found to explain 68% of variation in midday stomatal conductance. Night-time transpiration was observed in all studied species and amounted to 7 and 20% of midday transpiration of sunlit and shaded leaves, respectively. With an estimated night-time latent heat flux of 24 W m(-2), tree transpiration significantly increased the cooling rate around and shortly after sunset, but not later in the night. Despite a strong midday latent heat flux of 206 W m(-2), a cooling effect of tree transpiration was not observed during the day.

The effect of urban geometry on mean radiant temperature under future climate change: a study of three European cities.

Future anthropogenic climate change is likely to increase the air temperature (T(a)) across Europe and increase the frequency, duration and magnitude of severe heat stress events. Heat stress events are generally associated with clear-sky conditions and high T(a), which give rise to high radiant heat load, i.e. mean radiant temperature (T(mrt)). In urban environments, T mrt is strongly influenced by urban geometry. The present study examines the effect of urban geometry on daytime heat stress in three European cities (Gothenburg in Sweden, Frankfurt in Germany and Porto in Portugal) under present and future climates, using T(mrt) as an indicator of heat stress. It is found that severe heat stress occurs in all three cities. Similar maximum daytime T(mrt) is found in open areas in all three cities despite of the latitudinal differences in average daytime T(mrt). In contrast, dense urban structures like narrow street canyons are able to mitigate heat stress in the summer, without causing substantial changes in T(mrt) in the winter. Although the T(mrt) averages are similar for the north-south and east-west street canyons in each city, the number of hours when T(mrt) exceeds the threshold values of 55.5 and 59.4 °C-used as indicators of moderate and severe heat stress-in the north-south canyons is much higher than that in the east-west canyons. Using statistically downscaled data from a regional climate model, it is found that the study sites were generally warmer in the future scenario, especially Porto, which would further exacerbate heat stress in urban areas. However, a decrease in solar radiation in Gothenburg and Frankfurt reduces T(mrt) in the spring, while the reduction in T(mrt) is somewhat offset by increasing T(a) in other seasons. It suggests that changes in the T(mrt) under the future scenario are dominated by variations in T(a). Nonetheless, the intra-urban differences remain relatively stable in the future. These findings suggest that dense urban structure can reduce daytime heat stress since it reduces the number of hours of high T(mrt) in the summer and does not cause substantial changes in average and minimum T(mrt) in the winter. In dense urban settings, a more diverse urban thermal environment is also preferred to compensate for reduced solar access in the winter. The extent to which the urban geometry can be optimized for the future climate is also influenced by local urban characteristics.

Characteristics of the mean radiant temperature in high latitude cities--implications for sensitive climate planning applications.

Knowledge of how the mean radiant temperature (T mrt ) is affected by factors such as location, climate and urban setting contributes to the practice of climate sensitive planning. This paper examines how T mrt varies within an urban setting and how it is influenced by cloudiness. In addition, variations of T mrt in three high latitude cities are investigated in order to analyse the impact of geographical context and climate conditions. Results showed large spatial variations between sunlit and shaded areas during clear weather conditions, with the highest values of T mrt close to sunlit walls and the lowest values in the areas shaded by buildings and vegetation. As cloudiness increases, the spatial pattern is altered and the differences are reduced. The highest T mrt under cloudy conditions is instead found in open areas where the proportion of shortwave diffuse radiation from the sky vault is high. A regional comparison between three Swedish coastal cities showed that T mrt during summer is similar regardless of latitudinal location. On the other hand, large differences in T mrt during winter were found. Shadows, both from buildings and vegetation are the most effective measure to reduce extreme values of T mrt. However, extensive areas of shadow are usually not desired within outdoor urban environments at high latitude cities. One solution is to create diverse outdoor urban spaces in terms of shadow and also ventilation. This would provide individuals with access to a choice of thermal environments which they can use to assist their thermal regulation, based on personal needs and desires.

Mandibular trabecular bone structure in adults with Crohn's disease.

OBJECTIVES: Crohn's disease (CD) is associated with reduced bone mineral density. The main objective of the present study was to assess the mandibular trabecular bone quality and to compare our findings with those among sex- and age-matched controls. Furthermore, background variables known to be significant for bone density were compared. MATERIALS AND METHODS: Intraoral radiographs of 49 Crohn's patients (23-61 years old) and 49 age- and sex-matched controls were evaluated. Mandibular trabecular pattern was classified as either sparse, mixed dense plus sparse, or dense. Furthermore, two computer-based methods analyzed the transitions from trabecula to intertrabecular spaces and the size and number of these spaces. Differences in continuous background variables were tested with Student's two-sample t test and ordinal variables with Mann-Whitney U test or Kruskal-Wallis nonparametric tests. RESULTS: All three methods to evaluate bone structure seen on dental radiographs showed significantly sparser trabeculation in Crohn's patients than in the control group. The Crohn's patients were heavier, more often smokers, and more frequently had mothers who developed fragility fractures. Furthermore, the Crohn's patients, especially smokers, had a significantly higher fracture rate than the matched control group but no significant relationship was found between trabeculation pattern and fracture. CONCLUSIONS: The results of this investigations indicated that trabecular bone is significantly sparser in subjects with Crohn's disease compared to a matched control group. CLINICAL RELEVANCE: An early identification of CD patients with sparse trabeculation and appropriate advice concerning nutrition and exercise may lead to less fractures and medication in the future.

Early intervention with a glycerol throat spray containing cold-adapted cod trypsin after self-diagnosis of common cold: A randomised trial.

BACKGROUND: A glycerol throat spray containing cold-adapted cod trypsin (GCTS) deactivates common cold virus in vitro and decreases pharyngeal rhinovirus load after inoculation in humans. We relied on early self-diagnosis and evaluated two different scales to detect a treatment effect in naturally occurring common colds. METHODS: Adults were enrolled in this randomised, prospective, parallel group, single-blind study to begin treatment six times daily at first sign of a common cold or were assigned to a non-treated group. Jackson's symptom scale and the 9-item Wisconsin Upper Respiratory Symptom Survey (WURSS)-21 quality of life (QoL) domain were recorded daily by subjects and area under the curve over 12 days (AUC1-12) calculated. RESULTS: Treatment resulted in reduced symptoms with an AUC1-12 of 45.1 ± 32.5 for Jackson scores compared to 53.8 ± 35.7 in the controls (p = 0.023). AUC1-12 for the 9-item WURSS-21 QoL domain was likewise improved, 113.6 ± 107.7 and 152.7 ± 126.3 (p = 0.006), respectively. During the first four days fewer of the treated subjects (35.3%) used rescue medication than did the control group (50.4%, p = 0.014). CONCLUSIONS: Reduction in common cold symptoms was seen with treatment with a glycerol throat spray containing cold-adapted cod trypsin. This effect was best detected with the 9-item WURSS-21 QoL domain.