Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in acute lung injury to reduce pulmonary dysfunction (HARP-2) trial : study protocol for a randomized controlled trial

Acute lung injury (ALI) is a common devastating clinical syndrome characterized by life-threatening respiratory failure requiring mechanical ventilation and multiple organ failure. There are in vitro, animal studies and pre-clinical data suggesting that statins may be beneficial in ALI. The Hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in Acute lung injury to Reduce Pulmonary dysfunction (HARP-2) trial is a multicenter, prospective, randomized, allocation concealed, double-blind, placebo-controlled clinical trial which aims to test the hypothesis that treatment with simvastatin will improve clinical outcomes in patients with ALI

Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe?

Osteoarthritis of the hip is a significant source of morbidity in the elderly. Treatment guidelines are available for the management of hip osteoarthritis, but these do not address the application of intraarticular corticosteroid injection. The intraarticular injection of corticosteroid is used in the management of other large joint osteoarthritic diseases and is well studied in the knee, however, this data cannot be used to make sound clinical decisions regarding its use for hip osteoarthritis. There are also concerns regarding the safety of this modality. Review of the published literature reveals that there are eight trials examining the efficacy of intraarticular corticosteroid injection for hip osteoarthritis and of these only four are randomized controlled trials. In general, the available literature demonstrates a short-term reduction of pain with corticosteroid injection and is indicated for patients refractory to non-pharmacologic or analgesic and NSAID therapy. The use of radiologic-guidance is recommended and, with proper sterile technique, the risk of adverse outcomes is very low. Future randomized controlled trials are needed to further examine the efficacy and safety of intraarticular corticosteroid injection for hip osteoarthritis

On the dynamics of persistent states and their secular trends in the waveguides of the Southern Hemisphere troposphere

We identify the dynamical drivers of systematic changes in persistent quasi-stationary states (regimes) of the Southern Hemisphere troposphere and their secular trends. We apply a purely data-driven approach, whereby a multiscale approximation to nonstationary dynamical processes is achieved through optimal sequences of locally stationary fast vector autoregressive factor processes, to examine a high resolution atmospheric reanalysis over the period encompassing 1958–2013. This approach identifies regimes and their secular trends in terms of the predictability of the flow and is Granger causal. A comprehensive set of diagnostics on both isentropic and isobaric surfaces is employed to examine teleconnections over the full hemisphere and for a set of regional domains. Composite states for the hemisphere obtained from nonstationary nonparametric cluster analysis reveal patterns consistent with a circumglobal wave 3 (polar)–wave 5 (subtropical) pattern, while regional composites reveal the Pacific South American pattern and blocking modes. The respective roles of potential vorticity sources, stationary Rossby waves and baroclinic instability on the dynamics of these circulation modes are shown to be reflected by the seasonal variations of the waveguides, where Rossby wave sources and baroclinic disturbances are largely contained within the waveguides and with little direct evidence of sustained remote tropical influences on persistent synoptic features. Warm surface temperature anomalies are strongly connected with regions of upper level divergence and anticyclonic Rossby wave sources. The persistent states identified reveal significant variability on interannual to decadal time scales with large secular trends identified in all sectors apart from a region close to South America