Skip to main content
Top
Published in: Trials 1/2013

Open Access 01-12-2013 | Study protocol

Vitamin D to prevent acute lung injury following oesophagectomy (VINDALOO): study protocol for a randomised placebo controlled trial

Authors: Dhruv Parekh, Rachel C A Dancer, Sian Lax, Mark S Cooper, Adrian R Martineau, William D Fraser, Olga Tucker, Derek Alderson, Gavin D Perkins, Fang Gao-Smith, David R Thickett

Published in: Trials | Issue 1/2013

Login to get access

Abstract

Background

Acute lung injury occurs in approximately 25% to 30% of subjects undergoing oesophagectomy. Experimental studies suggest that treatment with vitamin D may prevent the development of acute lung injury by decreasing inflammatory cytokine release, enhancing lung epithelial repair and protecting alveolar capillary barrier function.

Methods/Design

The ‘Vitamin D to prevent lung injury following oesophagectomy trial’ is a multi-centre, randomised, double-blind, placebo-controlled trial. The aim of the trial is to determine in patients undergoing elective transthoracic oesophagectomy, if pre-treatment with a single oral dose of vitamin D3 (300,000 IU (7.5 mg) cholecalciferol in oily solution administered seven days pre-operatively) compared to placebo affects biomarkers of early acute lung injury and other clinical outcomes. The primary outcome will be change in extravascular lung water index measured by PiCCO® transpulmonary thermodilution catheter at the end of the oesophagectomy. The trial secondary outcomes are clinical markers indicative of lung injury: PaO2:FiO2 ratio, oxygenation index; development of acute lung injury to day 28; duration of ventilation and organ failure; survival; safety and tolerability of vitamin D supplementation; plasma indices of endothelial and alveolar epithelial function/injury, plasma inflammatory response and plasma vitamin D status. The study aims to recruit 80 patients from three UK centres.

Discussion

This study will ascertain whether vitamin D replacement alters biomarkers of lung damage following oesophagectomy.

Trial registration

Current Controlled Trials ISRCTN27673620
Literature
1.
go back to reference Lewandowski K, Lewandowski M: Epidemiology of ARDS. Minerva Anestesiol. 2006, 72: 473-477.PubMed Lewandowski K, Lewandowski M: Epidemiology of ARDS. Minerva Anestesiol. 2006, 72: 473-477.PubMed
2.
go back to reference Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD: Incidence and outcomes of acute lung injury. N Engl J Med. 2005, 353: 1685-1693. 10.1056/NEJMoa050333.CrossRefPubMed Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD: Incidence and outcomes of acute lung injury. N Engl J Med. 2005, 353: 1685-1693. 10.1056/NEJMoa050333.CrossRefPubMed
3.
go back to reference Tandon S, Batchelor A, Bullock R, Gascoigne A, Griffin M, Hayes N, Hing J, Shaw I, Warnell I, Baudouin S: Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth. 2001, 86: 633-638. 10.1093/bja/86.5.633.CrossRefPubMed Tandon S, Batchelor A, Bullock R, Gascoigne A, Griffin M, Hayes N, Hing J, Shaw I, Warnell I, Baudouin S: Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth. 2001, 86: 633-638. 10.1093/bja/86.5.633.CrossRefPubMed
4.
go back to reference Schilling M, Gassmann N, Sigurdsson G, Regli B, Stoupis C, Furrer M, Signer C, Redaelli C, Büchler M: Role of thromboxane and leukotriene B4 in patients with acute respiratory distress syndrome after oesophagectomy. Br J Anaesth. 1998, 80: 36-40. 10.1093/bja/80.1.36.CrossRefPubMed Schilling M, Gassmann N, Sigurdsson G, Regli B, Stoupis C, Furrer M, Signer C, Redaelli C, Büchler M: Role of thromboxane and leukotriene B4 in patients with acute respiratory distress syndrome after oesophagectomy. Br J Anaesth. 1998, 80: 36-40. 10.1093/bja/80.1.36.CrossRefPubMed
5.
go back to reference Schilling M, Eichenberger M, Maurer C, Sigurdsson G, Büchler M: Ketoconazole and pulmonary failure after esophagectomy: a prospective clinical trial. Dis Esophagus. 2001, 14: 37-40. 10.1111/j.1442-2050.2001.00158.x.CrossRefPubMed Schilling M, Eichenberger M, Maurer C, Sigurdsson G, Büchler M: Ketoconazole and pulmonary failure after esophagectomy: a prospective clinical trial. Dis Esophagus. 2001, 14: 37-40. 10.1111/j.1442-2050.2001.00158.x.CrossRefPubMed
6.
go back to reference Kuwano H, Sumiyoshi K, Sonoda K, Kitamura K, Tsutsui S, Toh Y, Kitamura M, Sugimachi K: Relationship between preoperative assessment of organ function and postoperative morbidity in patients with oesophageal cancer. Eur J Surg. 1998, 164: 581-586.CrossRefPubMed Kuwano H, Sumiyoshi K, Sonoda K, Kitamura K, Tsutsui S, Toh Y, Kitamura M, Sugimachi K: Relationship between preoperative assessment of organ function and postoperative morbidity in patients with oesophageal cancer. Eur J Surg. 1998, 164: 581-586.CrossRefPubMed
7.
go back to reference Ferguson M, Durkin A: Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002, 123: 661-669. 10.1067/mtc.2002.120350.CrossRefPubMed Ferguson M, Durkin A: Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002, 123: 661-669. 10.1067/mtc.2002.120350.CrossRefPubMed
8.
go back to reference Law S, Wong K, Kwok K, Chu K, Wong J: Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004, 240: 791-800. 10.1097/01.sla.0000143123.24556.1c.CrossRefPubMedPubMedCentral Law S, Wong K, Kwok K, Chu K, Wong J: Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004, 240: 791-800. 10.1097/01.sla.0000143123.24556.1c.CrossRefPubMedPubMedCentral
9.
10.
go back to reference Ware LB, Matthay MA: The acute respiratory distress syndrome. N Engl J Med. 2000, 342: 1334-1349. 10.1056/NEJM200005043421806.CrossRefPubMed Ware LB, Matthay MA: The acute respiratory distress syndrome. N Engl J Med. 2000, 342: 1334-1349. 10.1056/NEJM200005043421806.CrossRefPubMed
11.
go back to reference Perkins GD, Park D, Alderson D, Cooke MW, Gao F, Gates S, Lamb SE, Mistry D, Thickett DR: The Beta Agonist Lung Injury TrIal (BALTI) - prevention trial protocol. Trials. 2011, 12: 79-10.1186/1745-6215-12-79.CrossRefPubMedPubMedCentral Perkins GD, Park D, Alderson D, Cooke MW, Gao F, Gates S, Lamb SE, Mistry D, Thickett DR: The Beta Agonist Lung Injury TrIal (BALTI) - prevention trial protocol. Trials. 2011, 12: 79-10.1186/1745-6215-12-79.CrossRefPubMedPubMedCentral
12.
go back to reference Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E: Epidemic influenza and vitamin D. Epidemiol Infect. 2006, 134: 1129-1140. 10.1017/S0950268806007175.CrossRefPubMedPubMedCentral Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E: Epidemic influenza and vitamin D. Epidemiol Infect. 2006, 134: 1129-1140. 10.1017/S0950268806007175.CrossRefPubMedPubMedCentral
13.
go back to reference Muhe L, Lulseged S, Mason KE, Simoes EA: Case–control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet. 1997, 349: 1801-1804. 10.1016/S0140-6736(96)12098-5.CrossRefPubMed Muhe L, Lulseged S, Mason KE, Simoes EA: Case–control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet. 1997, 349: 1801-1804. 10.1016/S0140-6736(96)12098-5.CrossRefPubMed
14.
go back to reference Coussens AK, Wilkinson RJ, Hanifa Y, Nikolayevskyy V, Elkington PT, Islam K, Timms PM, Venton TR, Bothamley GH, Packe GE, Darmalingam M, Davidson RN, Milburn HJ, Baker LV, Barker RD, Mein CA, Bhaw-Rosun L, Nuamah R, Young DB, Drobniewski FA, Griffiths CJ, Martineau AR: Vitamin D accelerates resolution of inflammatory responses during tuberculosis treatment. Proc Natl Acad Sci U S A. 2012, 109: 15449-15454. 10.1073/pnas.1200072109.CrossRefPubMedPubMedCentral Coussens AK, Wilkinson RJ, Hanifa Y, Nikolayevskyy V, Elkington PT, Islam K, Timms PM, Venton TR, Bothamley GH, Packe GE, Darmalingam M, Davidson RN, Milburn HJ, Baker LV, Barker RD, Mein CA, Bhaw-Rosun L, Nuamah R, Young DB, Drobniewski FA, Griffiths CJ, Martineau AR: Vitamin D accelerates resolution of inflammatory responses during tuberculosis treatment. Proc Natl Acad Sci U S A. 2012, 109: 15449-15454. 10.1073/pnas.1200072109.CrossRefPubMedPubMedCentral
15.
go back to reference Lee P, Eisman JA, Center JR: Vitamin D deficiency in critically ill patients. N Engl J Med. 2009, 360: 1912-1914. 10.1056/NEJMc0809996.CrossRefPubMed Lee P, Eisman JA, Center JR: Vitamin D deficiency in critically ill patients. N Engl J Med. 2009, 360: 1912-1914. 10.1056/NEJMc0809996.CrossRefPubMed
16.
go back to reference Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, Christopher KB: Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med. 2011, 39: 671-677. 10.1097/CCM.0b013e318206ccdf.CrossRefPubMedPubMedCentral Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, Christopher KB: Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med. 2011, 39: 671-677. 10.1097/CCM.0b013e318206ccdf.CrossRefPubMedPubMedCentral
17.
go back to reference Braun AB, Gibbons FK, Litonjua AA, Giovannucci E, Christopher KB: Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Crit Care Med. 2012, 40: 63-72. 10.1097/CCM.0b013e31822d74f3.CrossRefPubMedPubMedCentral Braun AB, Gibbons FK, Litonjua AA, Giovannucci E, Christopher KB: Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Crit Care Med. 2012, 40: 63-72. 10.1097/CCM.0b013e31822d74f3.CrossRefPubMedPubMedCentral
18.
go back to reference Amrein K, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH, Stojakovic T, Schnedl C, Dobnig H: Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011, 15: R104-10.1186/cc10120.CrossRefPubMedPubMedCentral Amrein K, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH, Stojakovic T, Schnedl C, Dobnig H: Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011, 15: R104-10.1186/cc10120.CrossRefPubMedPubMedCentral
20.
go back to reference Zanetti M: Cathelicidins, multifunctional peptides of the innate immunity. J Leukoc Biol. 2004, 75: 39-48.CrossRefPubMed Zanetti M: Cathelicidins, multifunctional peptides of the innate immunity. J Leukoc Biol. 2004, 75: 39-48.CrossRefPubMed
21.
go back to reference Hansdottir S, Monick MM, Lovan N, Powers L, Gerke A, Hunninghake GW: Vitamin D decreases respiratory syncytial virus induction of NF-kappaB-linked chemokines and cytokines in airway epithelium while maintaining the antiviral state. J Immunol. 2010, 184: 965-974. 10.4049/jimmunol.0902840.CrossRefPubMed Hansdottir S, Monick MM, Lovan N, Powers L, Gerke A, Hunninghake GW: Vitamin D decreases respiratory syncytial virus induction of NF-kappaB-linked chemokines and cytokines in airway epithelium while maintaining the antiviral state. J Immunol. 2010, 184: 965-974. 10.4049/jimmunol.0902840.CrossRefPubMed
22.
go back to reference Shaykhiev R, Beisswenger C, Kandler K, Senske J, Puchner A, Damm T, Behr J, Bals R: Human endogenous antibiotic LL-37 stimulates airway epithelial cell proliferation and wound closure. Am J Physiol Lung Cell Mol Physiol. 2005, 289: L842-L848. 10.1152/ajplung.00286.2004.CrossRefPubMed Shaykhiev R, Beisswenger C, Kandler K, Senske J, Puchner A, Damm T, Behr J, Bals R: Human endogenous antibiotic LL-37 stimulates airway epithelial cell proliferation and wound closure. Am J Physiol Lung Cell Mol Physiol. 2005, 289: L842-L848. 10.1152/ajplung.00286.2004.CrossRefPubMed
23.
go back to reference Alalwani SM, Sierigk J, Herr C, Pinkenburg O, Gallo R, Vogelmeier C, Bals R: The antimicrobial peptide LL-37 modulates the inflammatory and host defense response of human neutrophils. Eur J Immunol. 2010, 40: 1118-1126. 10.1002/eji.200939275.CrossRefPubMedPubMedCentral Alalwani SM, Sierigk J, Herr C, Pinkenburg O, Gallo R, Vogelmeier C, Bals R: The antimicrobial peptide LL-37 modulates the inflammatory and host defense response of human neutrophils. Eur J Immunol. 2010, 40: 1118-1126. 10.1002/eji.200939275.CrossRefPubMedPubMedCentral
24.
go back to reference Sun J, Kong J, Duan Y, Szeto FL, Liao A, Madara JL, Li YC: Increased NF-kappaB activity in fibroblasts lacking the vitamin D receptor. Am J Physiol Endocrinol Metab. 2006, 291: E315-E322. 10.1152/ajpendo.00590.2005.CrossRefPubMed Sun J, Kong J, Duan Y, Szeto FL, Liao A, Madara JL, Li YC: Increased NF-kappaB activity in fibroblasts lacking the vitamin D receptor. Am J Physiol Endocrinol Metab. 2006, 291: E315-E322. 10.1152/ajpendo.00590.2005.CrossRefPubMed
25.
go back to reference Sadeghi K, Wessner B, Laggner U, Ploder M, Tamandl D, Friedl J, Zugel U, Steinmeyer A, Pollak A, Roth E, Boltz-Nitulescu G, Spittler A: Vitamin D3 down-regulates monocyte TLR expression and triggers hyporesponsiveness to pathogen-associated molecular patterns. Eur J Immunol. 2006, 36: 361-370. 10.1002/eji.200425995.CrossRefPubMed Sadeghi K, Wessner B, Laggner U, Ploder M, Tamandl D, Friedl J, Zugel U, Steinmeyer A, Pollak A, Roth E, Boltz-Nitulescu G, Spittler A: Vitamin D3 down-regulates monocyte TLR expression and triggers hyporesponsiveness to pathogen-associated molecular patterns. Eur J Immunol. 2006, 36: 361-370. 10.1002/eji.200425995.CrossRefPubMed
26.
go back to reference Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V: Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med. 2009, 7: 28-10.1186/1479-5876-7-28.CrossRefPubMedPubMedCentral Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V: Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med. 2009, 7: 28-10.1186/1479-5876-7-28.CrossRefPubMedPubMedCentral
27.
go back to reference Herr C, Branschied M, Vogelmeier C, Bals R: Influence of Vitamin D on the innate immune response in cigarette smoke exposed macrophages. Eur Respir Soc Barcelona meet. 2010, A4349- Herr C, Branschied M, Vogelmeier C, Bals R: Influence of Vitamin D on the innate immune response in cigarette smoke exposed macrophages. Eur Respir Soc Barcelona meet. 2010, A4349-
28.
go back to reference Zhou X, Bailey-Bucktrout S, Jeker LT, Bluestone JA: Plasticity of CD4(+) FoxP3(+) T cells. Curr Opin Immunol. 2009, 21: 281-285. 10.1016/j.coi.2009.05.007.CrossRefPubMedPubMedCentral Zhou X, Bailey-Bucktrout S, Jeker LT, Bluestone JA: Plasticity of CD4(+) FoxP3(+) T cells. Curr Opin Immunol. 2009, 21: 281-285. 10.1016/j.coi.2009.05.007.CrossRefPubMedPubMedCentral
29.
go back to reference Zhou L, Chong MM, Littman DR: Plasticity of CD4+ T cell lineage differentiation. Immunity. 2009, 30: 646-655. 10.1016/j.immuni.2009.05.001.CrossRefPubMed Zhou L, Chong MM, Littman DR: Plasticity of CD4+ T cell lineage differentiation. Immunity. 2009, 30: 646-655. 10.1016/j.immuni.2009.05.001.CrossRefPubMed
30.
go back to reference Jeffery LE, Burke F, Mura M, Zheng Y, Qureshi OS, Hewison M, Walker LS, Lammas DA, Raza K, Sansom DM: 1,25-Dihydroxyvitamin D(3) and IL-2 combine to inhibit T cell production of inflammatory cytokines and promote development of regulatory T cells expressing CTLA-4 and FoxP3. J Immunol. 2009, 183: 5458-5467. 10.4049/jimmunol.0803217.CrossRefPubMedPubMedCentral Jeffery LE, Burke F, Mura M, Zheng Y, Qureshi OS, Hewison M, Walker LS, Lammas DA, Raza K, Sansom DM: 1,25-Dihydroxyvitamin D(3) and IL-2 combine to inhibit T cell production of inflammatory cytokines and promote development of regulatory T cells expressing CTLA-4 and FoxP3. J Immunol. 2009, 183: 5458-5467. 10.4049/jimmunol.0803217.CrossRefPubMedPubMedCentral
31.
go back to reference Schulz KF, Altman DG, Moher D: CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010, 1: 100-107. 10.4103/0976-500X.72352.CrossRefPubMedPubMedCentral Schulz KF, Altman DG, Moher D: CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010, 1: 100-107. 10.4103/0976-500X.72352.CrossRefPubMedPubMedCentral
32.
go back to reference Perkins GD, McAuley DF, Thickett DR, Gao F: The beta-agonist lung injury trial (BALTI): a randomized placebo-controlled clinical trial. Am J Respir Crit Care Med. 2006, 173: 281-287. 10.1164/rccm.200508-1302OC.CrossRefPubMed Perkins GD, McAuley DF, Thickett DR, Gao F: The beta-agonist lung injury trial (BALTI): a randomized placebo-controlled clinical trial. Am J Respir Crit Care Med. 2006, 173: 281-287. 10.1164/rccm.200508-1302OC.CrossRefPubMed
33.
go back to reference Craig TR, Duffy MJ, Shyamsundar M, McDowell C, O'Kane CM, Elborn JS, McAuley DF: A randomized clinical trial of hydroxymethylglutaryl- coenzyme a reductase inhibition for acute lung injury (The HARP Study). Am J Respir Crit Care Med. 2011, 183: 620-626. 10.1164/rccm.201003-0423OC.CrossRefPubMed Craig TR, Duffy MJ, Shyamsundar M, McDowell C, O'Kane CM, Elborn JS, McAuley DF: A randomized clinical trial of hydroxymethylglutaryl- coenzyme a reductase inhibition for acute lung injury (The HARP Study). Am J Respir Crit Care Med. 2011, 183: 620-626. 10.1164/rccm.201003-0423OC.CrossRefPubMed
34.
go back to reference Licker M, Tschopp JM, Robert J, Frey JG, Diaper J, Ellenberger C: Aerosolized salbutamol accelerates the resolution of pulmonary edema after lung resection. Chest. 2008, 133: 845-852. 10.1378/chest.07-1710.CrossRefPubMed Licker M, Tschopp JM, Robert J, Frey JG, Diaper J, Ellenberger C: Aerosolized salbutamol accelerates the resolution of pulmonary edema after lung resection. Chest. 2008, 133: 845-852. 10.1378/chest.07-1710.CrossRefPubMed
35.
go back to reference Artigas A, Bernard GR, Carlet J, Dreyfuss D, Gattinoni L, Hudson L, Lamy M, Marini JJ, Matthay MA, Pinsky MR, Spragg R, Suter PM: The American-European Consensus Conference on ARDS, part 2. Ventilatory, pharmacologic, supportive therapy, study design strategies and issues related to recovery and remodeling. Intensive Care Med. 1998, 24: 378-398. 10.1007/s001340050585.CrossRefPubMed Artigas A, Bernard GR, Carlet J, Dreyfuss D, Gattinoni L, Hudson L, Lamy M, Marini JJ, Matthay MA, Pinsky MR, Spragg R, Suter PM: The American-European Consensus Conference on ARDS, part 2. Ventilatory, pharmacologic, supportive therapy, study design strategies and issues related to recovery and remodeling. Intensive Care Med. 1998, 24: 378-398. 10.1007/s001340050585.CrossRefPubMed
36.
go back to reference Artigas A, Bernard GR, Carlet J, Dreyfuss D, Gattinoni L, Hudson L, Lamy M, Marini JJ, Matthay MA, Pinsky MR, Spragg R, Suter PM: The American-European Consensus Conference on ARDS, part 2: Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute respiratory distress syndrome. Am J Respir Crit Care Med. 1998, 157: 1332-1347. 10.1164/ajrccm.157.4.ats2-98.CrossRefPubMed Artigas A, Bernard GR, Carlet J, Dreyfuss D, Gattinoni L, Hudson L, Lamy M, Marini JJ, Matthay MA, Pinsky MR, Spragg R, Suter PM: The American-European Consensus Conference on ARDS, part 2: Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute respiratory distress syndrome. Am J Respir Crit Care Med. 1998, 157: 1332-1347. 10.1164/ajrccm.157.4.ats2-98.CrossRefPubMed
37.
go back to reference Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL: Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001, 286: 1754-1758. 10.1001/jama.286.14.1754.CrossRefPubMed Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL: Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001, 286: 1754-1758. 10.1001/jama.286.14.1754.CrossRefPubMed
Metadata
Title
Vitamin D to prevent acute lung injury following oesophagectomy (VINDALOO): study protocol for a randomised placebo controlled trial
Authors
Dhruv Parekh
Rachel C A Dancer
Sian Lax
Mark S Cooper
Adrian R Martineau
William D Fraser
Olga Tucker
Derek Alderson
Gavin D Perkins
Fang Gao-Smith
David R Thickett
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Trials / Issue 1/2013
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-14-100

Other articles of this Issue 1/2013

Trials 1/2013 Go to the issue