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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_438"
                     title="Rituximab Shows Promise in Scleroderma (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/tb/18352?impressionId=1265771773065"
                     
      &lt;p&gt;Rituximab (Rituxan) improved lung function in patients with scleroderma, a small proof-of-principle study found.&lt;/p&gt;
&lt;p&gt;At one year, patients randomized to receive rituximab had a median 10.25% increase in forced vital capacity (FVC) compared with baseline, while those who received standard treatment had a deterioration of 5.04% (&lt;em&gt;P&lt;/em&gt;=0.002), according to Dimitrios Daoussis, MD, and colleagues from the University of Patras in Greece.&lt;/p&gt;
&lt;p&gt;There also was a significant 19.46% increase in diffusing capacity of carbon monoxide (DL&lt;sub&gt;co&lt;/sub&gt;) in the rituximab-treated patients, while the controls showed deterioration of 7.5% (&lt;em&gt;P&lt;/em&gt;=0.023), the researchers reported in the February issue of &lt;em&gt;Rheumatology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Interstitial lung disease is a common manifestation of diffuse scleroderma and represents the disease component that dictates prognosis because it can be progressive and typically responds poorly to treatment. Animal and human studies have suggested a possible pathogenic role for B cells in the disease.&lt;/p&gt;
&lt;p&gt;There have been a few reports of clinical and histologic improvements in scleroderma and in graft-versus-host disease (which shares some features with scleroderma) after treatment with the B-cell depleting monoclonal antibody rituximab.&lt;/p&gt;
&lt;p&gt;These encouraging early findings led Daoussis and colleagues to undertake an open-label, controlled study that included 14 patients with diffuse disease.&lt;/p&gt;
&lt;p&gt;Median age was 55 and mean disease duration was seven years.&lt;/p&gt;
&lt;p&gt;All patients continued their standard medications, which included various agents such as prednisone, bosentan (Tracleer), mycophenolate mofetil (CellCept), and cyclophosphamide.&lt;/p&gt;
&lt;p&gt;Those randomized to rituximab treatment also underwent four weekly pulses of the drug (375 mg/m&lt;sup&gt;2&lt;/sup&gt;) at baseline and six months later.&lt;/p&gt;
&lt;p&gt;By one year, the mean FVC in the rituximab group had risen from 68.13% of normal predicted value based on age, sex, and height, to 75.63% (&lt;em&gt;P&lt;/em&gt;=0.0018), while FVC in the control group fell nonsignificantly from 86% of normal to 81.67%.&lt;/p&gt;
&lt;p&gt;In the rituximab group, DL&lt;sub&gt;co&lt;/sub&gt; increased from a mean of 52.25% of normal at baseline to 62% (&lt;em&gt;P&lt;/em&gt;=0.017) at one year, while the controls decreased nonsignificantly from 65.33% to 60.17%.&lt;/p&gt;
&lt;p&gt;None of the patients treated with rituximab experienced worsening of FVC or DL&lt;sub&gt;co&lt;/sub&gt;, whereas lung function deteriorated in five controls.&lt;/p&gt;
&lt;p&gt;&quot;We should note, however, that patients in the control group tended to have more early disease and better lung function parameters (although not statistically different from the [rituximab] group) making them more likely to deteriorate over the time of the study,&quot; the investigators commented.&lt;/p&gt;
&lt;p&gt;Skin manifestations of the disease also showed improvements in the rituximab group. Skin thickening, as measured by the Modified Rodnan Skin Score, improved by 39.25% in the rituximab group and by 20.80% in the control group, a difference that was not statistically significant.&lt;/p&gt;
&lt;p&gt;Skin fibrosis also improved by a median of 38.33%, while it worsened by 5.23% in controls.&lt;/p&gt;
&lt;p&gt;Histologic improvement was seen in four of the rituximab-treated patients, corresponding with clinical benefits. One patient in the active treatment group had a significant reduction of fibrosis in both the papillary and reticular dermis, accompanied by an almost complete resolution of skin lesions.&lt;/p&gt;
&lt;p&gt;Improvement in skin fibrosis was most common in patients who had evidence of B-cell depletion in the skin.&lt;/p&gt;
&lt;p&gt;Overall function, as evaluated by the Health Assessment Questionnaire, improved from a median baseline score of 0.687 to 0.312 at one year (&lt;em&gt;P&lt;/em&gt;=0.03), while no change was seen in controls.&lt;/p&gt;
&lt;p&gt;The pathogenesis of scleroderma is poorly understood, according to the authors, but this study adds support to a possible role for B cells.&lt;/p&gt;
&lt;p&gt;In addition, rituximab indirectly targets T cells, which also are thought to be implicated.&lt;/p&gt;
&lt;p&gt;The authors noted potential limitations, including the study&apos;s small size and the fact that most patients had longstanding disease, had been treated with multiple immunosuppressive agents in the past, and were receiving concurrent therapies during the study.&lt;/p&gt;
&lt;p&gt;&quot;This is a proof-of-principle study that was performed in order to obtain preliminary data regarding the effect of [rituximab] on a limited number of patients,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Our data could serve as a good starting point for the design of larger scale, multicenter studies with longer evaluation periods and especially in earlier stages of the disease,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Robert W. Simms, MD, and Robert Lafyatis, MD, of Boston University, echoed concerns about the small number of patients and the lack of blinding in the study.&lt;/p&gt;
&lt;p&gt;&quot;One cannot...on the basis of this study, recommend rituximab in the routine clinical care of patients with scleroderma,&quot; the editorialists wrote.&lt;/p&gt;
&lt;p&gt;The findings will need to be replicated in a multicenter randomized trial, but &quot;do provide some hope that B-cell depletion might enhance the currently restricted therapeutic armamentarium of this disease.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the Hellenic Rheumatology Society.&lt;/p&gt;&lt;p&gt;Funding to pay Open Access publication charges was provided by Roche Hellas.&lt;/p&gt;&lt;p&gt;Authors and editorialists declared to conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_261"
                     title="Scrubbing Away Germs Can Backfire on Backsides (CME/CE)"
                     score="-0"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/18121?impressionId=1265771773065"
                     
      Rashes from toilet seats are once again afflicting American children, and the rare condition is often misdiagnosed, which may delay proper treatment.&lt;br&gt;
&lt;br&gt;That&apos;s the conclusion from a report based of five-cases of toilet-seat contact dermatitis investigated by researchers at Johns Hopkins University School of Medicine and reported in the Jan. 25 issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;While toilet-seat dermatitis is commonly thought to result from allergies to wooden seats, the report concludes that another source is plastic toilet seats cleaned with harsh detergents.&lt;/p&gt;
&lt;p&gt;&quot;This case series and previous reports have documented that toilet-seat dermatitis is much more common than previously recognized in the U.S. and around the world,&quot; Bernard A. Cohen, MD, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Furthermore, the incidence of this condition is rising in North America because of a resurgent popularity of exotic-wood toilet seats and frequent use of detergents that contain highly irritant/sensitizing compounds such as quaternary ammonium compounds, phenol, formaldehyde, etc. in public restrooms.&quot;&lt;/p&gt;
&lt;p&gt;Of the cases analyzed by the authors, two occurred in the U.S. and the other three occurred in India.&lt;/p&gt;
&lt;p&gt;Both U.S. cases were girls, a 6-year-old who had a rash for over two years before it was correctly diagnosed and a 10-year-old whose rash lasted for a year. In both cases, the rashes seemed to worsen during the school year when the girls were using school restrooms. The younger girl&apos;s dermatitis twice became infected with methicillin-resistant &lt;em&gt;Staphylococcus aureus &lt;/em&gt;and required treatment with antibiotics.&lt;/p&gt;
&lt;p&gt;After doctors determined the rashes were the result of contact with toilet seats and instructed the girls to use toilet-seat covers and apply moisturizers and topical steroids to the affected areas, the eruptions cleared up within a few weeks.&lt;/p&gt;
&lt;p&gt;The cases in India included a 14-month old boy and two girls, 12 and 10.&lt;/p&gt;
&lt;p&gt;The boy and the 12-year-old girl were both initially misdiagnosed with ringworm and unsuccessfully treated with clotrimazole cream. The other girl was unsuccessfully treated with ayurvedic and homeopathic topical medications before doctors diagnosed toilet-seat dermatitis. Two of the children were instructed to use soaps that only exacerbated the problem.&lt;/p&gt;
&lt;p&gt;In all three cases, the rashes cleared up with some combination of topical steroids, using toilet-seat covers, replacing the household toilet seat, and limiting time on the toilet.&lt;/p&gt;
&lt;p&gt;The authors distinguished between two types of toilet-seat dermatitis: allergic contact dermatitis, the better described form of the condition, in which a patient develops allergy to wooden toilet seats, and irritant contact dermatitis, in which the rashes result from contact with harsh detergents used on plastic toilet seats.&lt;/p&gt;
&lt;p&gt;They noted that detergents used in public restrooms and in hospitals are potentially more irritating to the skin than those used at home and that alkaline detergents are more likely to cause skin irritation than acidic detergents, because they perturb the body&apos;s natural acidic environment.&lt;/p&gt;
&lt;p&gt;Toilet-seat dermatitis was first identified as an external skin rash in 1927. Exposure to wooden toilet seats and associated varnish, lacquers, and paints led to sensitization and development of an allergic contact dermatitis.&lt;/p&gt;
&lt;p&gt;The condition nearly disappeared in the U.S. in 1980s and 1990s, after public facilities and homeowners in the U.S. changed from wooden to plastic toilet seats and sanitary seat covers became readily available.&lt;/p&gt;
&lt;p&gt;However, in recent years the number of cases has grown as a result of homeowners installing toilet seats made of exotic woods and the increased use of harsh toilet seat detergents.&lt;/p&gt;
&lt;p&gt;Most reports have focused on adults with rashes, but little previous attention has focused on the condition in children. &quot;In this case series we describe toilet-seat contact dermatitis in children and underscore a typical history and physical findings that we hope will aid clinicians in recognizing this disease,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;It is important to underscore that regular use of toilet-seat covers is the key to success in treatment,&quot; the authors wrote. &quot;Such seat covers can be purchased at any major retailer such as Walmart or online.&lt;/p&gt;
&lt;p&gt;As an alternative, newspaper cutouts could be used to provide barrier protection. Although it is possible to develop an allergy to toilet-seat covers, none have been reported thus far in the literature.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors reported no sources of funding or financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1601"
                     title="ICD: Hands Down -- Oral Retiniod Trumps Topical Steroids"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14337?impressionId=1265771773065"
                     
      PRAGUE, May 22 -- Almost half of patients with steroid-resistant hand eczema had complete or near-complete clearance when treated with the oral vitamin D analog alitretinoin, according to data from two randomized clinical trials. 
              &lt;br&gt;&lt;br&gt;Almost 80% of patients who relapsed after alitretinoin withdrawal regained disease control when treated again with the 9-cis retinoic acid agent, Uwe Hillen, M.D., of University Clinic in Essen, Germany, reported here at the International Congress of Dermatology. 
              &lt;br&gt;&lt;br&gt;&quot;Alitretinoin produced improvement in all of the individual signs and symptoms of chronic hand eczema,&quot; said Dr. Hillen. &quot;Patients who relapse after initial treatment can be effectively retreated with alitretinoin, suggesting it is a suitable, intermittent treatment option for the long-term management of this chronic, relapsing disease.&quot; 
              &lt;p&gt;
              &lt;p&gt;In a substantial proportion of patients, hand eczema evolves into a chronic condition, even with strict avoidance of triggers. 
              &lt;p&gt;
              &lt;p&gt;Standard therapy for chronic hand eczema is topical corticosteroids, but patients have had few alternatives if the combination of emollients and topical steroids fails to control the disease. 
              &lt;p&gt;
              &lt;p&gt;Typically, alitretinoin is used to treat cutaneous, AIDS-related Kaposi&apos;s sarcoma, but researchers have been investigating its use orally as a last-resort in those eczema cases. 
              &lt;p&gt;
              &lt;p&gt;Dr. Hillen summarized data from three phase III clinical trials showing that alitretinoin induces clinically significant responses in a substantial proportion of patients. 
              &lt;p&gt;
              &lt;p&gt;The largest of the three trials involved 1,032 patients enrolled at 111 sites in Europe and Canada. The patients were randomized to alitretinoin 10 mg or 30 mg once daily, or to matching placebo for 12 or 24 weeks. 
              &lt;p&gt;
              &lt;p&gt;All patients were advised to avoid known irritants and allergens that could trigger or exacerbate eczema. 
              &lt;p&gt;
              &lt;p&gt;The primary efficacy endpoint was the proportion of patients who had a Physician Global Assessment rating of &quot;clear&quot; or &quot;almost clear&quot; at the end of treatment. 
              &lt;p&gt;
              &lt;p&gt;Dr. Hillen reported that 48% of patients treated with the higher dose of alitretinoin had complete responses, as did 28% of patients treated with the lower dose. 
              &lt;p&gt;
              &lt;p&gt;In contrast, 17% of placebo-treated patients had complete or almost complete clearance of eczema (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001, &lt;em&gt;P&lt;/em&gt;=0.004 versus high- and low-dose alitretinoin, respectively). 
              &lt;p&gt;
              &lt;p&gt;The second study involved 249 patients from 37 centers in Europe and Canada. All had chronic hand eczema unresponsive to topical steroids, and they received open-label alitretinoin 30 mg daily for as long as 24 weeks. 
              &lt;p&gt;
              &lt;p&gt;The primary objective of the study was to accumulate additional safety data in patients with severe hand eczema that was unresponsive to topical corticosteroids. 
              &lt;p&gt;
              &lt;p&gt;Dr. Hillen said that 46.6% of patients in the alitretinoin group had complete responses. When response criteria were expanded to include &quot;mild disease,&quot; the response rate increased to 63.9%. 
              &lt;p&gt;
              &lt;p&gt;The third trial included two cohorts of patients from the first study: 117 patients who initially responded to alitretinoin but relapsed within 24 weeks and 243 patients who previously had not responded to initial treatment. 
              &lt;p&gt;
              &lt;p&gt;Patients in the relapse group were randomized to receive their initial dose of alitretinoin or placebo. Patients in the second cohort received open-label alitretinoin 30 mg. The primary endpoint for both cohorts was Physician Global Assessment of clear or almost clear. 
              &lt;p&gt;
              &lt;p&gt;In the relapse cohort, 79.6% of patients randomized a second time to alitretinoin 30 mg had clear or almost clear hands at the end of the study, compared with 8.3% of placebo-treated patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). 
              &lt;p&gt;
              &lt;p&gt;Patients retreated with alitretinoin 10 mg had a response rate of 47.6% compared with 10% in the placebo patients. 
              &lt;p&gt;
              &lt;p&gt;Dr. Hillen said that almost half of the patients in the open-label study responded to treatment with alitretinoin. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Hillen reported no disclosures.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
    <recommendedItem id="20090101_19_1611"
                     title="ICD: Silica Spheres Enhance Acne Drug"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14350?impressionId=1265771773065"
                     
       PRAGUE, May 22 -- Silica-encapsulated benzoyl peroxide improved acne more with less skin irritation than a conventional form of the medication, according to results of a randomized clinical trial. 
              &lt;p&gt;&lt;p&gt;Two different strengths of silica-encapsulated drug significantly reduced lesion counts compared with nonencapsulated therapy, Daniela Mavor, of Sol Gel Technologies in Ness Ziona, Israel, reported at the International Congress of Dermatology. 
              &lt;p&gt;Differences in efficacy and tolerability emerged early and persisted through the study. 
              &lt;p&gt;&quot;As early as week two, we noted a reduction of acne lesions, which was significantly superior to leading commercial products,&quot; Stanley Shapiro, Ph.D., also of Sol Gel, said in a statement. &quot;At week four, a 75% improvement was achieved. 
              &lt;p&gt;&quot;Throughout the study, the high-strength acne kits were significantly better tolerated than the two commercial products,&quot; he said. 
              &lt;p&gt;Benzoyl peroxide is an established therapy for acne, but the compound often causes burning and irritation that ranges from mild to severe. 
              &lt;p&gt;Sol Gel Technologies has developed a proprietary delivery vehicle consisting of silica microspheres that form a barrier between the skin and the medication inside the spheres. 
              &lt;p&gt;The microencapsulating process also leads to a continuous release of the active ingredient, Mavor and colleagues explained in a poster presentation. 
              &lt;p&gt;Investigators evaluated the safety and efficacy of silica-encapsulated benzoyl peroxide in a clinical trial involving 78 patients, ages 16 to 35, with mild or moderate acne vulgaris. 
              &lt;p&gt;Disease activity required included at least three comedones (noninflammatory lesions), six or more papules or pustules (inflammatory lesions), no more than 25 lesions of either type, and fewer than four nodulocystic acne lesions. 
              &lt;p&gt;The patients were randomized to one of four treatment groups: 4% or 7% silica-encapsulated benzoyl peroxide, or a 2.5% or 7% commercially available, nonencapsulated formulation of the acne medication. 
              &lt;p&gt;Study participants were asked to apply assigned medication twice daily for four weeks. Medication came in a kit that included a cleanser, a toner, and a lotion, applied in sequence according to instructions. 
              &lt;p&gt;The primary outcome measures were change in number, type, and severity of lesions; safety and tolerability; and change in images obtained at each clinic visit. 
              &lt;p&gt;By week two, the 7% silica-encapsulated treatment had reduced the total lesion count significantly more than either of the two conventional therapies. The percent reduction from baseline also was significantly greater with the high-dose encapsulated formulation (&lt;em&gt;P&lt;/em&gt;=0.016 to &lt;em&gt;P&lt;/em&gt;=0.033). 
              &lt;p&gt;Over the four weeks of the study, the 7% encapsulated formulation led to significantly more improvement compared with the two nonencapsulated formulations (&lt;em&gt;P&lt;/em&gt;=0.010, &lt;em&gt;P&lt;/em&gt;=0.021). 
              &lt;p&gt;By Investigator Global Assessment, patients using either strength of encapsulated benzoyl peroxide improved by 40% to 50% from week one to week two. In contrast, little change was noted in patients assigned to the conventional acne therapy. 
              &lt;p&gt;At weeks three and four, patients using the 4% silica-encapsulated formulation had 75% and 82% improvement, respectively, compared with weeks two and three, Mavor reported. 
              &lt;p&gt;Patients in the 7% silica-encapsulated arm had improvement of 56% and 75% at weeks three and four, respectively. 
              &lt;p&gt;A combination of physician- and patient-assessed tolerance showed no difference among the four groups after one week. 
              &lt;p&gt;By week two, both silica-encapsulated formulations were associated with lower cumulative irritation scores. At weeks three and four, differences between groups reached statistical significance for the encapsulated formulations (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.008 for all comparisons). 
              &lt;p&gt;The lowest dropout rate (5.3%) was noted for patients on 7% silica encapsulated BPO treatment. The highest dropout rate (35.7%) was noted for patients on 2.5% commercial treatment.  
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The study was funded by Sol Gel Technologies. 
              &lt;p&gt;Investigators in the study included employees of Sol Gel Technologies.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1672"
                     title="ICD: Topical Therapies, Cosmetics Eyed in Skin Reactions"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14430?impressionId=1265771773065"
                     
      PRAGUE, May 29 -- Ingredients commonly used in topical pharmaceuticals and cosmetics may be sources of contact hypersensitivity in patients with chronic eczema, according to findings from a large patch-test study. 
              &lt;p&gt;
              &lt;p&gt;The frequency of sensitization to certain adjuvant ingredients exceeded 10% in both men and women, Eliska Dastychova, M.D., of Masaryk University in Brno, Czech Republic, reported at the International Congress of Dermatology. 
              &lt;p&gt;
              &lt;p&gt;The biggest offender was the preservative thimerosal, as 11% of the patients demonstrated sensitization to the substance. 
              &lt;p&gt;
              &lt;p&gt;&quot;When identifying the causes of contact eczema in chronic eczematics, testing of the adjuvants of pharmaceutical and cosmetic preparations possibly involved in the chronicity or relapses of eczema is advisable,&quot; said Dr. Dastychova. 
              &lt;p&gt;
              &lt;p&gt;Patients with chronic eczema have an inherently greater potential for contact sensitivity, which occurs as a result of damage to the skin barrier and long-term or repeated application of topical agents, she said. 
              &lt;p&gt;
              &lt;p&gt;To identify some of the key sources of contact sensitivity, investigators conducted patch tests in 2,218 patients with chronic eczema, 1,531 of whom were women. The tests determined the patients&apos; sensitivity to 29 ingredients (including preservatives, antioxidants, and emulsifiers) often found in topical pharmaceutical and cosmetic compounds. 
              &lt;p&gt;
              &lt;p&gt;Testing consisted of 48-hour exposure to test strips, followed by reaction-assessment at 48, 72, and 96 hours. 
              &lt;p&gt;
              &lt;p&gt;Dr. Dastychova reported that 11.5% of women and 10% of men demonstrated sensitivity to thimerosal. Wood alcohols came in second, affecting 3.5% of men and 3.7% of women. 
              &lt;p&gt;
              &lt;p&gt;Other sources of sensitization in men included formaldehyde (3.2%), dodecyl gallate (2.9%), phenylmercuric acetate (2.3%), chloracetamide (1.9%), and chlorhexidine (1.6%). 
              &lt;p&gt;
              &lt;p&gt;In women, the leading offenders included phenylmercuric acetate (2.8%), formaldehyde (2.0%), bronopol and kathon CG (1.9%), dibromodicyanobutane/phenoxyethanol 1:4 (1.8%), and chloracetamide, chlorhexidine, and dodecyl gallate (1.2% each). 
              &lt;p&gt;
              &lt;p&gt;The overall rate of sensitivity did not differ significantly between men and women. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was supported by a government grant from the Czech Republic. 
              &lt;p&gt;The authors reported no competing interests. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
</recommendedContent>