Lancet
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Clinical Trial Controlled Clinical Trial
Interferon induction and increased natural killer-cell activity in influenza infections in man.
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Lymphocyte transformation, production of neutralising antibody, and the development of antirabies IgG antibody were studied in ten healthy volunteers in response to 0.8 ml of human diploid-cell strain (HDCS) rabies vaccine administered on one occasion in divided doses in 8 intradermal (i.d.) sites. All ten volunteers rapidly developed substantial titres of rabies antibody, and eight of the ten had T lymphocytes that were immunologically stimulated by HDCS rabies-virus antigen. Postexposure treatment with 0.8 ml of HDCS vaccine given at 4 i.d. sites completely protected fourteen rabbits from death by street virus. The results suggest that in developing countries patients could be protected with small volumes of potent tissue-culture vaccine administered intradermally shortly after exposure.
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Randomized Controlled Trial Clinical Trial
Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial.
The effect of metoprolol on mortality was compared with that of placebo in a double blind randomised trial in patients with definite or suspected acute myocardial infarction. Treatment with metoprolol or placebo started as soon as possible after the patient's arrival in hospital and was continued for 90 days. Metoprolol was given as a 15 mg intravenous dose followed by oral administration of 100 mg twice daily. 1395 patients (697 on placebo and 698 on metoprolol) were included in the trial. ⋯ Patients were allocated to various risk groups and within each group patients were randomly assigned to treatment with metoprolol or placebo. There were 62 deaths in the placebo group (8.9%) and 40 deaths in the metoprolol group (5.7%), a reduction of 36% (p less than 0.03). Mortality rates are given according to the treatment group to which the patients were initially randomly allocated.
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Drugs with anticholinegic effects are often used in surgical procedures and may impair higher cognitive functions and produce delirious states. This prospective study examined the relation between serum levels of anticholinergic drugs, measured by a radioreceptor assay, and the development of delirium in patients undergoing cardiac surgery. Most patients who had postoperative delirium had high serum levels of anticholinergic drugs, whereas those who remained cognitively intact had low levels; and impairment in cortical function correlated with serum levels of anticholinergic drugs (p less than 0.001). Raised serum levels of drugs with anticholinergic effects may contribute to the development of delirium, and to the increase in risk of morbidity following cardiac surgery.