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|000004f0| 00 00 00 00 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |....$Uni|que_ID{Y|
|00000500| 52 42 30 38 35 30 30 7d | 0d 0a 24 54 69 74 6c 65 |RB08500}|..$Title|
|00000510| 7b 41 20 43 6f 6e 74 72 | 6f 6c 6c 65 64 20 43 6c |{A Contr|olled Cl|
|00000520| 69 6e 69 63 61 6c 20 54 | 72 69 61 6c 20 6f 66 20 |inical T|rial of |
|00000530| 48 69 67 68 2d 44 6f 73 | 65 20 4d 65 74 68 79 6c |High-Dos|e Methyl|
|00000540| 70 72 65 64 6e 69 73 6f | 6c 6f 6e 65 20 69 6e 20 |predniso|lone in |
|00000550| 74 68 65 20 54 72 65 61 | 74 6d 65 6e 74 20 6f 66 |the Trea|tment of|
|00000560| 20 53 65 76 65 72 65 20 | 53 65 70 73 69 73 20 61 | Severe |Sepsis a|
|00000570| 6e 64 20 53 65 70 74 69 | 63 20 53 68 6f 63 6b 7d |nd Septi|c Shock}|
|00000580| 0d 0a 24 41 75 74 68 6f | 72 7b 42 6f 6e 65 2c 20 |..$Autho|r{Bone, |
|00000590| 52 43 0d 0a 46 69 73 68 | 65 72 2c 20 43 4a 20 4a |RC..Fish|er, CJ J|
|000005a0| 72 0d 0a 43 6c 65 6d 6d | 65 72 2c 20 54 50 0d 0a |r..Clemm|er, TP..|
|000005b0| 53 6c 6f 74 6d 61 6e 2c | 20 47 4a 0d 0a 4d 65 74 |Slotman,| GJ..Met|
|000005c0| 7a 2c 20 43 41 0d 0a 42 | 61 6c 6b 2c 20 52 41 0d |z, CA..B|alk, RA.|
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|000005f0| 65 70 73 69 73 20 53 74 | 75 64 79 20 47 72 6f 75 |epsis St|udy Grou|
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|00000610| 7b 7d 0d 0a 24 53 75 62 | 6a 65 63 74 7b 53 68 6f |{}..$Sub|ject{Sho|
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|00000650| 6d 65 74 68 79 6c 70 72 | 65 64 6e 69 73 6f 6c 6f |methylpr|ednisolo|
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|00000690| 74 68 79 6c 70 72 65 64 | 6e 69 73 6f 6c 6f 6e 65 |thylpred|nisolone|
|000006a0| 20 69 6e 20 73 65 70 73 | 69 73 20 61 6e 64 0d 0a | in seps|is and..|
|000006b0| 73 65 70 74 69 63 20 73 | 68 6f 63 6b 7d 0d 0a 24 |septic s|hock}..$|
|000006c0| 4a 6f 75 72 6e 61 6c 7b | 4e 20 45 6e 67 6c 20 4a |Journal{|N Engl J|
|000006d0| 20 4d 65 64 7d 0d 0a 24 | 56 6f 6c 75 6d 65 7b 33 | Med}..$|Volume{3|
|000006e0| 31 37 7d 0d 0a 24 50 61 | 67 65 7b 36 35 33 2d 36 |17}..$Pa|ge{653-6|
|000006f0| 35 38 7d 0d 0a 24 44 61 | 74 65 7b 53 65 70 74 20 |58}..$Da|te{Sept |
|00000700| 31 30 2c 20 31 39 38 37 | 7d 0d 0a 24 59 42 56 6f |10, 1987|}..$YBVo|
|00000710| 6c 7b 31 39 38 39 20 59 | 65 61 72 20 42 6f 6f 6b |l{1989 Y|ear Book|
|00000720| 20 6f 66 20 49 6e 66 65 | 63 74 69 6f 75 73 20 44 | of Infe|ctious D|
|00000730| 69 73 65 61 73 65 73 7d | 0d 0a 24 43 68 61 70 74 |iseases}|..$Chapt|
|00000740| 65 72 7b 31 2d 31 7d 0d | 0a 24 59 42 45 64 69 74 |er{1-1}.|.$YBEdit|
|00000750| 6f 72 7b 44 72 73 2e 20 | 57 6f 6c 66 66 2c 20 42 |or{Drs. |Wolff, B|
|00000760| 61 72 7a 61 2c 20 4b 65 | 75 73 63 68 2c 20 4b 6c |arza, Ke|usch, Kl|
|00000770| 65 6d 70 6e 65 72 2c 20 | 61 6e 64 20 53 6e 79 64 |empner, |and Snyd|
|00000780| 6d 61 6e 7d 0d 0a 24 54 | 61 62 6c 65 7b 7d 0d 0a |man}..$T|able{}..|
|00000790| 24 43 6f 6d 6d 65 6e 74 | 61 74 6f 72 7b 7d 0d 0a |$Comment|ator{}..|
|000007a0| 0d 0a 43 6f 70 79 72 69 | 67 68 74 20 28 63 29 20 |..Copyri|ght (c) |
|000007b0| 59 65 61 72 20 42 6f 6f | 6b 20 4d 65 64 69 63 61 |Year Boo|k Medica|
|000007c0| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|000007d0| 63 2e 2c 20 31 39 38 39 | 0d 0a 0d 0a 31 39 38 39 |c., 1989|....1989|
|000007e0| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 49 6e | Year Bo|ok of In|
|000007f0| 66 65 63 74 69 6f 75 73 | 20 44 69 73 65 61 73 65 |fectious| Disease|
|00000800| 73 20 28 52 29 0d 0a 0d | 0a 43 68 61 70 74 65 72 |s (R)...|.Chapter|
|00000810| 20 31 2d 2d 42 61 63 74 | 65 72 69 61 6c 20 49 6e | 1--Bact|erial In|
|00000820| 66 65 63 74 69 6f 6e 73 | 0d 0a 0d 0a 2d 2d 2d 2d |fections|....----|
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|00000840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 41 20 |--------|----..A |
|00000880| 43 6f 6e 74 72 6f 6c 6c | 65 64 20 43 6c 69 6e 69 |Controll|ed Clini|
|00000890| 63 61 6c 20 54 72 69 61 | 6c 20 6f 66 20 48 69 67 |cal Tria|l of Hig|
|000008a0| 68 2d 44 6f 73 65 20 4d | 65 74 68 79 6c 70 72 65 |h-Dose M|ethylpre|
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|000008c0| 20 54 72 65 61 74 6d 65 | 6e 74 20 6f 66 0d 0a 53 | Treatme|nt of..S|
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|000008f0| 0a 42 6f 6e 65 20 52 43 | 3b 20 46 69 73 68 65 72 |.Bone RC|; Fisher|
|00000900| 20 43 4a 20 4a 72 3b 20 | 43 6c 65 6d 6d 65 72 20 | CJ Jr; |Clemmer |
|00000910| 54 50 3b 20 53 6c 6f 74 | 6d 61 6e 20 47 4a 3b 20 |TP; Slot|man GJ; |
|00000920| 4d 65 74 7a 20 43 41 3b | 20 42 61 6c 6b 20 52 41 |Metz CA;| Balk RA|
|00000930| 3b 20 74 68 65 0d 0a 4d | 65 74 68 79 6c 70 72 65 |; the..M|ethylpre|
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|00000950| 20 53 65 70 73 69 73 20 | 53 74 75 64 79 20 47 72 | Sepsis |Study Gr|
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|00000980| 65 70 74 20 31 30 2c 20 | 31 39 38 37 0d 0a 2d 2d |ept 10, |1987..--|
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|000009e0| 0d 0a 41 62 73 74 72 61 | 63 74 0d 0a 0d 0a 20 20 |..Abstra|ct....  |
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|00000f50| 20 54 68 65 20 75 73 65 | 20 6f 66 20 68 69 67 68 | The use| of high|
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|00000fc0| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 38 |$Unique_|ID{YRB08|
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|00001110| 67 6c 75 63 6f 63 6f 72 | 74 69 63 6f 69 64 73 3b |glucocor|ticoids;|
|00001120| 20 47 6c 75 63 6f 63 6f | 72 74 69 63 6f 69 64 73 | Glucoco|rticoids|
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|00001140| 65 6d 69 63 2c 0d 0a 6d | 6f 72 74 61 6c 69 74 79 |emic,..m|ortality|
|00001150| 20 61 66 74 65 72 7d 0d | 0a 24 4a 6f 75 72 6e 61 | after}.|.$Journa|
|00001160| 6c 7b 4e 20 45 6e 67 6c | 20 4a 20 4d 65 64 7d 0d |l{N Engl| J Med}.|
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|00001180| 50 61 67 65 7b 36 35 39 | 2d 36 36 35 7d 0d 0a 24 |Page{659|-665}..$|
|00001190| 44 61 74 65 7b 53 65 70 | 74 20 31 30 2c 20 31 39 |Date{Sep|t 10, 19|
|000011a0| 38 37 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 38 39 |87}..$YB|Vol{1989|
|000011b0| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 49 6e | Year Bo|ok of In|
|000011c0| 66 65 63 74 69 6f 75 73 | 20 44 69 73 65 61 73 65 |fectious| Disease|
|000011d0| 73 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 31 2d 32 |s}..$Cha|pter{1-2|
|000011e0| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|000011f0| 2e 20 57 6f 6c 66 66 2c | 20 42 61 72 7a 61 2c 20 |. Wolff,| Barza, |
|00001200| 4b 65 75 73 63 68 2c 20 | 4b 6c 65 6d 70 6e 65 72 |Keusch, |Klempner|
|00001210| 2c 20 61 6e 64 20 53 6e | 79 64 6d 61 6e 7d 0d 0a |, and Sn|ydman}..|
|00001220| 24 54 61 62 6c 65 7b 7d | 0d 0a 24 43 6f 6d 6d 65 |$Table{}|..$Comme|
|00001230| 6e 74 61 74 6f 72 7b 53 | 2e 4d 2e 20 57 6f 6c 66 |ntator{S|.M. Wolf|
|00001240| 66 2c 20 4d 2e 44 2e 7d | 0d 0a 0d 0a 43 6f 70 79 |f, M.D.}|....Copy|
|00001250| 72 69 67 68 74 20 28 63 | 29 20 59 65 61 72 20 42 |right (c|) Year B|
|00001260| 6f 6f 6b 20 4d 65 64 69 | 63 61 6c 20 50 75 62 6c |ook Medi|cal Publ|
|00001270| 69 73 68 65 72 73 2c 20 | 49 6e 63 2e 2c 20 31 39 |ishers, |Inc., 19|
|00001280| 38 39 0d 0a 0d 0a 31 39 | 38 39 20 59 65 61 72 20 |89....19|89 Year |
|00001290| 42 6f 6f 6b 20 6f 66 20 | 49 6e 66 65 63 74 69 6f |Book of |Infectio|
|000012a0| 75 73 20 44 69 73 65 61 | 73 65 73 20 28 52 29 0d |us Disea|ses (R).|
|000012b0| 0a 0d 0a 43 68 61 70 74 | 65 72 20 31 2d 2d 42 61 |...Chapt|er 1--Ba|
|000012c0| 63 74 65 72 69 61 6c 20 | 49 6e 66 65 63 74 69 6f |cterial |Infectio|
|000012d0| 6e 73 0d 0a 0d 0a 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |ns....--|--------|
|000012e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000012f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001300| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001310| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001320| 2d 2d 2d 2d 2d 2d 0d 0a | 45 66 66 65 63 74 20 6f |------..|Effect o|
|00001330| 66 20 48 69 67 68 2d 44 | 6f 73 65 20 47 6c 75 63 |f High-D|ose Gluc|
|00001340| 6f 63 6f 72 74 69 63 6f | 69 64 20 54 68 65 72 61 |ocortico|id Thera|
|00001350| 70 79 20 6f 6e 20 4d 6f | 72 74 61 6c 69 74 79 20 |py on Mo|rtality |
|00001360| 69 6e 20 50 61 74 69 65 | 6e 74 73 20 57 69 74 68 |in Patie|nts With|
|00001370| 0d 0a 43 6c 69 6e 69 63 | 61 6c 20 53 69 67 6e 73 |..Clinic|al Signs|
|00001380| 20 6f 66 20 53 79 73 74 | 65 6d 69 63 20 53 65 70 | of Syst|emic Sep|
|00001390| 73 69 73 0d 0a 0d 0a 56 | 41 20 53 79 73 74 65 6d |sis....V|A System|
|000013a0| 69 63 20 53 65 70 73 69 | 73 20 43 6f 6f 70 65 72 |ic Sepsi|s Cooper|
|000013b0| 61 74 69 76 65 20 53 74 | 75 64 79 20 47 72 6f 75 |ative St|udy Grou|
|000013c0| 70 0d 0a 28 56 41 20 4d | 65 64 20 43 74 72 2c 20 |p..(VA M|ed Ctr, |
|000013d0| 57 65 73 74 20 48 61 76 | 65 6e 2c 20 43 6f 6e 6e |West Hav|en, Conn|
|000013e0| 29 0d 0a 4e 20 45 6e 67 | 6c 20 4a 20 4d 65 64 20 |)..N Eng|l J Med |
|000013f0| 33 31 37 3a 36 35 39 2d | 36 36 35 2c 20 53 65 70 |317:659-|665, Sep|
|00001400| 74 20 31 30 2c 20 31 39 | 38 37 0d 0a 2d 2d 2d 2d |t 10, 19|87..----|
|00001410| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001420| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001430| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001440| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001450| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00001460| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|....    |
|00001470| 20 41 6c 74 68 6f 75 67 | 68 20 69 6d 70 72 6f 76 | Althoug|h improv|
|00001480| 65 6d 65 6e 74 73 20 68 | 61 76 65 20 73 74 65 61 |ements h|ave stea|
|00001490| 64 69 6c 79 20 62 65 65 | 6e 20 6d 61 64 65 20 69 |dily bee|n made i|
|000014a0| 6e 20 61 6e 74 69 62 69 | 6f 74 69 63 20 74 68 65 |n antibi|otic the|
|000014b0| 72 61 70 79 20 61 6e 64 | 0d 0a 69 6e 74 65 6e 73 |rapy and|..intens|
|000014c0| 69 76 65 20 63 61 72 65 | 2c 20 6d 6f 72 74 61 6c |ive care|, mortal|
|000014d0| 69 74 79 20 66 72 6f 6d | 20 66 75 6c 6d 69 6e 61 |ity from| fulmina|
|000014e0| 6e 74 20 73 65 70 73 69 | 73 20 72 65 6d 61 69 6e |nt sepsi|s remain|
|000014f0| 73 20 75 6e 61 63 63 65 | 70 74 61 62 6c 79 20 68 |s unacce|ptably h|
|00001500| 69 67 68 2e 20 20 4f 66 | 0d 0a 74 68 65 20 6d 61 |igh.  Of|..the ma|
|00001510| 6e 79 20 61 64 6a 75 6e | 63 74 69 76 65 20 74 68 |ny adjun|ctive th|
|00001520| 65 72 61 70 69 65 73 20 | 70 72 6f 70 6f 73 65 64 |erapies |proposed|
|00001530| 2c 20 6e 6f 6e 65 20 69 | 73 20 61 73 20 63 6f 6e |, none i|s as con|
|00001540| 74 72 6f 76 65 72 73 69 | 61 6c 20 61 73 0d 0a 67 |troversi|al as..g|
|00001550| 6c 75 63 6f 63 6f 72 74 | 69 63 6f 69 64 73 2e 20 |lucocort|icoids. |
|00001560| 20 53 74 75 64 69 65 73 | 20 77 69 74 68 20 61 6e | Studies| with an|
|00001570| 69 6d 61 6c 73 20 68 61 | 76 65 20 73 68 6f 77 6e |imals ha|ve shown|
|00001580| 20 74 68 61 74 20 74 68 | 65 73 65 20 64 72 75 67 | that th|ese drug|
|00001590| 73 20 64 65 63 72 65 61 | 73 65 0d 0a 6d 6f 72 62 |s decrea|se..morb|
|000015a0| 69 64 69 74 79 20 61 6e | 64 20 6d 6f 72 74 61 6c |idity an|d mortal|
|000015b0| 69 74 79 3b 20 68 6f 77 | 65 76 65 72 2c 20 72 65 |ity; how|ever, re|
|000015c0| 73 75 6c 74 73 20 66 72 | 6f 6d 20 68 75 6d 61 6e |sults fr|om human|
|000015d0| 20 73 74 75 64 69 65 73 | 20 61 72 65 20 6c 65 73 | studies| are les|
|000015e0| 73 0d 0a 63 6f 6e 76 69 | 6e 63 69 6e 67 2e 20 20 |s..convi|ncing.  |
|000015f0| 54 6f 20 63 6c 61 72 69 | 66 79 20 74 68 65 20 72 |To clari|fy the r|
|00001600| 6f 6c 65 20 6f 66 20 61 | 64 6a 75 6e 63 74 69 76 |ole of a|djunctiv|
|00001610| 65 20 67 6c 75 63 6f 63 | 6f 72 74 69 63 6f 69 64 |e glucoc|orticoid|
|00001620| 20 74 68 65 72 61 70 79 | 20 69 6e 0d 0a 70 61 74 | therapy| in..pat|
|00001630| 69 65 6e 74 73 20 74 72 | 65 61 74 65 64 20 61 73 |ients tr|eated as|
|00001640| 20 65 61 72 6c 79 20 61 | 73 20 70 6f 73 73 69 62 | early a|s possib|
|00001650| 6c 65 20 61 66 74 65 72 | 20 73 79 73 74 65 6d 69 |le after| systemi|
|00001660| 63 20 73 65 70 73 69 73 | 20 69 73 20 72 65 63 6f |c sepsis| is reco|
|00001670| 67 6e 69 7a 65 64 2c 20 | 61 0d 0a 6d 75 6c 74 69 |gnized, |a..multi|
|00001680| 63 65 6e 74 65 72 2c 20 | 72 61 6e 64 6f 6d 69 7a |center, |randomiz|
|00001690| 65 64 2c 20 64 6f 75 62 | 6c 65 2d 62 6c 69 6e 64 |ed, doub|le-blind|
|000016a0| 2c 20 70 6c 61 63 65 62 | 6f 2d 63 6f 6e 74 72 6f |, placeb|o-contro|
|000016b0| 6c 6c 65 64 20 74 72 69 | 61 6c 20 6f 66 20 65 61 |lled tri|al of ea|
|000016c0| 72 6c 79 0d 0a 73 68 6f | 72 74 2d 74 65 72 6d 2c |rly..sho|rt-term,|
|000016d0| 20 68 69 67 68 2d 64 6f | 73 65 20 6d 65 74 68 79 | high-do|se methy|
|000016e0| 6c 70 72 65 64 6e 69 73 | 6f 6c 6f 6e 65 20 73 6f |lprednis|olone so|
|000016f0| 64 69 75 6d 20 73 75 63 | 63 69 6e 61 74 65 20 77 |dium suc|cinate w|
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|00001710| 20 20 20 20 54 68 65 20 | 32 32 33 20 70 61 74 69 |    The |223 pati|
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|00001760| 65 6e 73 6f 72 69 75 6d | 73 2e 20 20 4f 6e 65 20 |ensorium|s.  One |
|00001770| 68 75 6e 64 72 65 64 20 | 74 77 65 6c 76 65 20 72 |hundred |twelve r|
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|000017a0| 72 65 63 65 69 76 65 64 | 0d 0a 70 6c 61 63 65 62 |received|..placeb|
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|000017d0| 66 6c 75 69 64 73 20 77 | 65 72 65 20 61 6c 73 6f |fluids w|ere also|
|000017e0| 20 61 64 6d 69 6e 69 73 | 74 65 72 65 64 2e 0d 0a | adminis|tered...|
|000017f0| 47 6c 75 63 6f 63 6f 72 | 74 69 63 6f 69 64 20 6f |Glucocor|ticoid o|
|00001800| 72 20 70 6c 61 63 65 62 | 6f 20 77 61 73 20 67 69 |r placeb|o was gi|
|00001810| 76 65 6e 20 69 6e 74 72 | 61 76 65 6e 6f 75 73 6c |ven intr|avenousl|
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|00001830| 61 20 64 6f 73 65 20 6f | 66 20 33 30 0d 0a 6d 67 |a dose o|f 30..mg|
|00001840| 2f 6b 67 20 62 6f 64 79 | 20 77 65 69 67 68 74 20 |/kg body| weight |
|00001850| 6f 76 65 72 20 31 35 20 | 6d 69 6e 75 74 65 73 2e |over 15 |minutes.|
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|00001880| 6f 66 0d 0a 35 20 6d 67 | 2f 6b 67 2f 68 6f 75 72 |of..5 mg|/kg/hour|
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|000018c0| 73 20 6f 66 20 73 65 70 | 73 69 73 20 61 6e 64 20 |s of sep|sis and |
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|000018f0| 32 2e 38 20 68 6f 75 72 | 73 2e 0d 0a 20 20 20 20 |2.8 hour|s...    |
|00001900| 20 54 68 65 20 31 34 2d | 64 61 79 20 6d 6f 72 74 | The 14-|day mort|
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|00001980| 6f 63 6f 72 74 69 63 6f | 69 64 20 67 72 6f 75 70 |ocortico|id group|
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|00002130| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002140| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002150| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002160| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002170| 2d 2d 2d 2d 2d 2d 0d 0a | 41 64 75 6c 74 20 53 75 |------..|Adult Su|
|00002180| 70 72 61 67 6c 6f 74 74 | 69 74 69 73 3a 20 20 41 |praglott|itis:  A|
|00002190| 20 50 72 6f 73 70 65 63 | 74 69 76 65 20 41 6e 61 | Prospec|tive Ana|
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|000021b0| 20 4a 3b 20 45 61 76 65 | 79 20 52 44 3b 20 53 75 | J; Eave|y RD; Su|
|000021c0| 6c 6c 69 76 61 6e 20 42 | 61 6b 65 72 20 41 0d 0a |llivan B|aker A..|
|000021d0| 28 4d 61 73 73 61 63 68 | 75 73 65 74 74 73 20 45 |(Massach|usetts E|
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|00002200| 73 73 61 63 68 75 73 65 | 74 74 73 20 47 65 6e 20 |ssachuse|tts Gen |
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|00002220| 61 72 76 61 72 64 20 4d | 65 64 20 53 63 68 6f 6f |arvard M|ed Schoo|
|00002230| 6c 29 0d 0a 4a 41 4d 41 | 20 32 35 39 3a 35 36 33 |l)..JAMA| 259:563|
|00002240| 2d 35 36 37 2c 20 4a 61 | 6e 20 32 32 2d 32 39 2c |-567, Ja|n 22-29,|
|00002250| 20 31 39 38 38 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d | 1988..-|--------|
|00002260| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002270| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002280| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002290| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|00002bb0| 0a 53 77 69 74 7a 65 72 | 6c 61 6e 64 7d 0d 0a 24 |.Switzer|land}..$|
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|00002ea0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002eb0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002ec0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002ed0| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 50 72 6f 74 65 63 |--------|..Protec|
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|00003000| 20 4d 61 79 20 31 32 2c | 20 31 39 38 38 0d 0a 2d | May 12,| 1988..-|
|00003010| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003020| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003030| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003040| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003050| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|00003060| 0a 0d 0a 41 62 73 74 72 | 61 63 74 0d 0a 0d 0a 20 |...Abstr|act.... |
|00003070| 20 20 20 20 42 65 63 61 | 75 73 65 20 64 69 61 72 |    Beca|use diar|
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|00004130| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004140| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004150| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|000042f0| 2c 20 44 65 63 20 31 30 | 2c 20 31 39 38 37 0d 0a |, Dec 10|, 1987..|
|00004300| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004310| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004320| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004330| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004340| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004350| 0d 0a 0d 0a 41 62 73 74 | 72 61 63 74 0d 0a 0d 0a |....Abst|ract....|
|00004360| 20 20 20 20 20 54 68 65 | 20 76 65 72 6f 74 6f 78 |     The| verotox|
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|000057b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000057c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000057d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|00005980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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