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BACKGROUND: Small bowel neuroendocrine tumors (SB-NET) frequently metastasize to regional lymphatic or distant sites. While most prognostication of SB-NET focuses on lymph node involvement, findings from studies of NETs from other primary sites have suggested that preoperative serum chromogranin-A (CgA) levels may provide a more accurate metric. STUDY DESIGN: Using the National Cancer Database (2004–2016), we analyzed patients with locoregional SB-NET who underwent curative resection including an adequate lymphadenectomy (n = 1,274). A statistically optimized cut-point was used to dichotomize CgA cohort based on preoperative serum CgA levels. RESULTS: We determined that a CgA ≥139ng/mL identified patients with significantly shorter estimated mean overall survival (6.6 years vs. 7.6 years, log-rank p = 0.00001). These patients were also older (63 vs. 57 years, p < 0.001) and more likely to have poorly-differentiated tumors (2.1% vs. 0.7%, p = 0.04) or primary tumors >1cm (88.2% vs. 79.2%, p = 0.001). Clinical features associated with shorter overall survival included preoperative CgA ≥139ng/mL (HR = 2.19, 95% CI 1.22 – 3.92; p = 0.009), age at diagnosis (HR = 1.06, 95% CI 1.03 – 1.09; p < 0.001), Charlson-Deyo score ≥2 (HR = 3.93, 95% CI 1.71 – 9.01; p = 0.001), and poorly-differentiated tumors (HR = 11.22, 95% CI 4.16 – 30.24; p < 0.001). Neither lymph node metastasis nor T-stage were independently associated with shorter overall survival in patients with locoregional SB-NET. CONCLUSIONS: Elevated preoperative serum CgA is an adverse prognostic marker associated with shorter overall survival in patients with locoregional SB-NET.

BACKGROUND: Therapeutic vaccinations against cancer have mainly targeted differentiation antigens, cancer-testis antigens, and overexpressed antigens and have thus far resulted in little clinical benefit. Studies conducted by multiple groups have demonstrated that T cells recognizing neoantigens are present in most cancers and offer a specific and highly immunogenic target for personalized vaccination. METHODS: We recently developed a process using tumor-infiltrating lymphocytes to identify the specific immunogenic mutations expressed in patients’ tumors. Here, validated, defined neoantigens, predicted neoepitopes, and mutations of driver genes were concatenated into a single mRNA construct to vaccinate patients with metastatic gastrointestinal cancer. RESULTS: The vaccine was safe and elicited mutation-specific T cell responses against predicted neoepitopes not detected before vaccination. Furthermore, we were able to isolate and verify T cell receptors targeting KRAS(G12D) mutation. We observed no objective clinical responses in the 4 patients treated in this trial. CONCLUSION: This vaccine was safe, and potential future combination of such vaccines with checkpoint inhibitors or adoptive T cell therapy should be evaluated for possible clinical benefit in patients with common epithelial cancers. TRIAL REGISTRATION: Phase I/II protocol (NCT03480152) was approved by the IRB committee of the NIH and the FDA. FUNDING: Center for Clinical Research, NCI, NIH.

Background Vitamin C is one of the most important micronutrient required for various physiological roles in the human system. Evidences suggest that there is an inadequate status of vitamin C in diabetes mellitus. The objectives of this study is to understand the prevalence of vitamin C deficiency in established type II diabetes mellitus patients and to study the correlation between various variables of diabetes mellitus with serum vitamin C levels. Methods A prospective cross-sectional study to assess the prevalence of vitamin C deficiency was carried out in diabetes patients. Fasting blood sugar levels, glycated hemoglobin, serum malondialdehyde levels, and lipid profile levels were correlated with serum vitamin C levels. Results The prevalence rate of hypovitaminosis C is found to be 55.13% among the enrolled patients. There is a significant increase in the systolic blood pressure levels in patients with inadequate as well as deficient vitamin C levels (p < 0.05). Inverse relationship exists between fasting blood sugar and vitamin C levels (p < 0.001). Similarly total cholesterol levels were also inversely related to the vitamin C levels (p = 0.0031). Body mass index, glycated hemoglobin, and fasting blood sugar levels are important predictors of vitamin C deficiencies. Conclusion Vitamin C deficiency is well established among diabetes mellitus patients. Deficiency of vitamin C levels has an impact on the serum malondialdehyde levels suggesting increased oxidative stress. The higher oxidative stress would have led to increase in glycated hemoglobin. Further research must be carried out to understand the beneficial effects of vitamin C supplementation in diabetes mellitus.

Background: Endodontic treatment involves the removal of the vital and necrotic contents of the root canal through chemo-mechanical means followed by obturation of the prepared root canal to prevent the ingress of fluids and avoid bacterial infection or regrowth. Root canal sealers and core filling materials are used together to fill the irregularities in the root. Penetration into the dentinal tubules also results in the inhibition of bacterial regrowth and increases the success of root canal therapy. Aim: This study aimed to evaluate the penetration depth of various sealers into the dentinal tubules using a confocal microscope. Materials and methods: A total of 65 specimens were decoronated to standardize the root length of 13mm. Working length was determined, and Biomechanical preparation for all the samples was done with a rotary ProTaper file till F4. Samples were randomly divided into five groups containing 13 teeth in each group based on the sealer used, namely Group 1: Endomethasone (n=13), Group 2: AH-Plus (n=13), Group 3: Roekoseal (n=13), Group 4: MTA Fillapex (n=13), Group 5: Endosequence BC (n=13). All the sealers were labelled with Rhodamine-B dye, and samples were obturated using cold lateral compaction technique. The specimens were sectioned orthogonally at coronal, middle, and apical thirds. All the samples were examined with a Zeiss Pascal Laser Scanning Microscope to examine the sealer penetration depth into the dentinal tubules. The data were subjected to statistical analysis using one- way Analysis of Variance (ANOVA) and Tukey's Honest Significant Difference (HSD) tests. Results: Endosequence BC showed the highest penetration into dentinal tubules, followed by MTA Fillapex and Roekoseal, AH-Plus, and Endomethasone exhibited the least penetration. Conclusion: Endosequence BC sealer exhibited maximum penetration. All the groups showed maximum penetration at coronal third, followed by the middle and apical third.

Adoptive cell therapy (ACT) targeting neoantigens can achieve durable clinical responses in patients with cancer. Most neoantigens arise from rare mutations, requiring highly individualized treatments. To broaden the applicability of ACT targeting neoantigens, we focused on TP53 mutations commonly shared across different cancer types. Here, we describe a library of T cell receptors (TCRs) that can target TP53 mutations shared among 7.3% of patients with solid cancers. These TCRs recognized tumor cells in a TP53 mutation- and human leucocyte antigen (HLA)-specific manner both in vitro and in vivo. Patients with chemorefractory epithelial cancers treated with ex vivo-expanded autologous tumor infiltrating lymphocytes (TILs) naturally reactive with mutant p53 experienced limited clinical responses (2 PRs/12 patients), and we detected low frequencies, exhausted phenotypes, and poor persistence of the infused mutant p53-reactive TILs. Alternatively, we treated one patient with a chemorefractory breast cancer with ACT by transducing autologous peripheral blood lymphocytes with an HLA-A*02-restricted anti-p53R175H TCR. The infused cells exhibited an improved immunophenotype and prolonged persistence compared to the TIL ACT and the patient experienced an objective tumor regression (-55%) that lasted 6 months. Collectively, these data demonstrate the feasibility of off-the-shelf TCR-engineered cell therapies targeting shared p53 neoantigens to treat human cancers.

To compare pain control (opioid consumption and postsurgical pain scores) in head and neck (HN) free flap reconstruction patients who undergo traditional means of postoperative analgesia including use of opioids versus a novel protocol that includes ketamine and gabapentin.Single-institution retrospective cohort study.Eighty-six patients who underwent HN free flap reconstruction from 2015 to 2018 were included. Forty-three patients were in the control cohort treated with opioids only, and 43 patients were in the treatment group. There was a statistically significant decrease in opioid consumption in each of the first 5 postoperative days ranging from 80% to 83% in the treatment group. The daily pain scores were significantly lower in the treatment group in the first 2 postoperative days. At the 1-month postoperative visit, there was no significant difference in pain scores between the groups; however, by the 2-month visit, the treatment group reported significantly lower pain scores than the control group (P = 0.001). No adverse outcomes of ketamine or gabapentin were experienced.Ketamine and gabapentin are safe and effective analgesics in HN free flap surgery that significantly decrease opioid use in the acute postoperative setting and may improve pain control.3a Laryngoscope, 130:1686-1691, 2020.

Introduction: Kidneys are vital organ for multiple function in the body. Thereby kidney can be involved in various pathological processes. Nephrectomy is the treatment of choice in extreme and untreatable conditions including malignancies. Aims and Objectives: In this study we aim to analyse the nephrectomy specimen received in terms of the various epidemiological factors and their clinico-histopathological correlation. The study also aims to give an account of currect trend of nephrectomy in the study population. Materials and Methods: This is three year prospective and retrospective analysis of the consecutive nephrectomy specimen received in department of pathology with emphasis on epidemiological and clinic-pathological correlation. Results: A total of 48 nephrectomy specimen received during the study period, 28(58%) were male and 20(42%) were females. We found that 40% of the cases constituted that of chronic pyelonephritis with or without end stage renal disease while renal cell carcinoma of clear cell type constituted 17% of the cases. Conclusion: This study concludes that non neoplastic indications for nephrectomy constitute the major burden in our study population. These conditions if diagnosed in advance can be treated and nephrectomy can be avoided. Keywords: Kidney, Nephrectomy, Epidemiology, Histopathology.

Summary The present research work highlights the benefits of analytical quality-by-design (QbD) approach to optimize high-performance thin-layer chromatography (HPTLC) method for the simultaneous q...

BACKGROUND: Adrenal venous sampling (AVS) is recommended before adrenalectomy for patients with primary aldosteronism (PA) over 35 years old. Literature examining contralateral suppression (CoS) on AVS in predicting surgical outcomes is conflicting. We examined the presence of CoS on patients who underwent adrenalectomy while adjusting for clinical and biochemical factors associated with a clinical cure of hypertension (ccHTN). METHODS: We performed a retrospective review of patients with successful AVS who underwent unilateral adrenalectomy for PA at a quaternary referral center. Patients were excluded if they had overt cortisol co-secretion, or inadequate follow-up. We first evaluated the aldosterone resolution score (ARS) in predicting ccHTN in our cohort. Next, the receiver-operator characteristic analysis (ROC) was used to determine the optimal Contralateral Suppression Index (CSI) cutoff to define CoS. We performed univariable and multivariable analyses of factors associated with ccHTN. The primary outcome was ccHTN defined as blood pressure less than 140/90 mmHg, and off blood pressure medications. RESULTS: Of the 102 patients, on bivariable analysis, age, sex, duration of HTN, number of medications, preoperative systolic blood pressure, and creatinine level were associated with ccHTN. ROC analysis of ARS had an AUC of 0.850 (p

The primary objective of robot manipulators is to achieve the desired orientation and point of end effector in order to accomplish the pre-established task. Inverse kinematic analysis will be used in the pioneer 2 robot to obtain a successful solution to design and operate the arm. This paper considers a 5-dof revolute Pioneer2 manipulator which is compact, low cost and lightweight. When the DOF of the robot increases, the inverse kinematic problem becomes more and more complex and gives n number of joint configurations for the same position. This results in making the standard solution for this problem becomes trickier. To overcome the computational complexity of kinematic analysis of Pioneer 2 robot, the objective of this study is to perform intelligent computation of inverse kinematics with the use of machine learning techniques that consists of linear regression, K-Nearest Neighbor algorithm and Artificial Neural Network. By comparing three algorithms R-square values and RMSE values, it is observed that KNN algorithm is giving better results. Therefore, KNN can be used for better solution of inverse kinematics with fast results and high accuracy. Then the smooth trajectory is achieved using cubic spline interpolation.

In this paper an algorithm is developed for smooth trajectory with minimum jerk using Cubic-B spline and intelligent computation of inverse kinematics using different machine learning algorithms for a SCARA robot for performing pick &; place/ assembly operations. Static Obstacle is considered in the robot environment. Machine Learning Algorithms like Linear Regression (LR), K-Nearest Neighbors (KNN), and Artificial Neural Networks (ANN) are used to prevent the difficulty in computing inverse kinematics in trajectory planning. It is observed that K-Nearest Neighbor (KNN) algorithm residuals plots have better fit by comparing with linear regression and ANN. The difference between actual and predictions of KNN, gives best results as compared to LR and ANN. Therefore, KNN can be used for inverse kinematics of SCARA robot for high accuracy and fast solutions. Cubic Spline functions are used to obtain the minimum jerk for the robot path.

Recently, robot manipulators plays very important role in manufacturing industry automation especially in assembly, pick and place operations and their performance will be improved by leveraging a proper trajectory planning. Non-linearity of the robot manipulator variables is one of the major challenges faced by the robot manipulator, which leads to more vibrations and jerk in the robot. So, in this paper, an algorithm is developed to obtain an optimal trajectory planning for robot manipulator with minimal jerk. A pick and place industrial robot PUMA-560 with six degrees of freedom is considered in this study for implementing optimization algorithm. The computational complexity of inverse kinematics in trajectory planning can be solved by using artificial neural network. To achieve the smooth trajectory, synchronizedS-curve is used in this work.

Pancreatic neuroendocrine tumors (PNETs) are classified based on their histologic differentiation and proliferative indices, which have been used extensively to determine prognosis. Advances in next-generation sequencing and other high-throughput techniques have allowed researchers to objectively explore tumor specimens and learn about the genetic alterations associated with malignant transformation in PNETs. As a result, targeted, pathway-specific therapies have been emerging for the treatment of unresectable and metastatic disease. As we continue to trial various pharmaceutical products, evidence from studies using multi-omics approaches indicates that clinical aggressiveness stratifies along other genotypic and phenotypic demarcations, as well. In this review, we explore the clinically relevant and potentially targetable molecular signatures of PNETs, their associated trials, and the overall differences in reported prognoses and responses to existing therapies.

Background Given the lack of consensus in the surgical treatment of anal adenocarcinoma, practice-patterns demonstrate utilization of organ-preserving techniques. The adequacy of local excision compared to abdominoperineal resection (APR) as a surgical approach for stage II disease is unknown. Our study examines the utilization of local excision in the treatment of stage II anal adenocarcinoma, rates of R0 resection, and differences in overall survival compared to APR. Materials and methods Using the National Cancer Database (2004–2016), we retrospectively analyzed patients diagnosed with clinical stage II anal adenocarcinoma who received chemoradiation and surgery. Patient cohorts were assigned based on the surgical procedure they received. Propensity score matching was used to offset selection bias and confounding factors. Treatment approach, pathologic margin status, and overall survival were assessed. Results Overall, 359 patients underwent resection of clinical stage II anal adenocarcinoma and received chemoradiation therapy. Of these patients, 87 (24%) underwent local excision, whereas 272 (76%) received an abdominoperineal resection. In a propensity score-matched cohort, patients who underwent local excision were less likely to achieve an R0 resection (40% vs 90%), and more likely to receive adjuvant instead of neoadjuvant chemoradiation. Overall survival was not significantly different between the propensity-matched groups. Surgical approach and pathologic margin status were not independently associated with overall survival. Conclusions Among patients with clinical stage II anal adenocarcinoma who received chemotherapy and radiation, complete resection was significantly less likely with local excision compared to abdominoperineal resection, however, overall survival was not affected. Prospective studies of neoadjuvant chemoradiation followed by local excision are warranted.

Background According to a 2017 Centers for Disease Control and Prevention (CDC) report, there were 23.1 million Americans living with diagnosed diabetes. Diabetes-related complications in pregnancy are spontaneous abortion, preterm delivery, preeclampsia, fetal malformations, altered fetal growth, polyhydramnios, and unexplained fetal demise. Continuous insulin delivery through insulin pump is used for effective management of type 1 diabetes (T1DM). Case presentation We present case reports of four patients who were on insulin pump for at least 1 year prior to pregnancy and continued throughout their pregnancy. Although these case reports demonstrated overall good pregnancy outcomes, it did not show how well their blood glucose was controlled during pregnancy. Conclusion Standard of care in diabetic management during pregnancy using insulin pump in the presented case reports supports the American Association of Clinical Endocrinologists recommendation that insulin pump should be used for women with preexisting T1DM during pregnancy.

Aim To present the clinicopathological profile, surgical management, and the outcome of parapharyngeal space (PPS) neoplasms in 14 patients. Materials and methods This is a retrospective review of the clinical records of 14 patients treated for PPS tumors. The age of patients ranged from 24 to 54 years, with female to male ratio of 1.3:1. The commonest clinical presentation was a slowgrowing, painless neck swelling. The preoperative protocol was based on: (1) imaging study to establish site, size, and anatomical relationships. (2) Fine-needle aspiration cytology (FNAC) was performed to determine the nature of the mass. Details of the management, morbidity, and outcome of these patients are presented. Results A total of 85.7% of the PPS neoplasms were benign and 14.2% were malignant. Majority of the benign tumors were of neurogenic origin. The histocytopathology confirmed 12 (85.7%) of these diagnoses (2 patients were with “nondiagnostic” result). The positive predictive value of the FNAC was 83.3% for benign tumors and 100% for malignant tumors. In 6 patients (60%), a transcervical surgery was performed. Three patients (30%) underwent transparotid–transcervical surgery for a pleomorphic adenoma of the deep lobe of the parotid gland in the prestyloid space and transcervical–transmandibular approach was taken in 1 case (10%). Postoperative complications occurred in 3 out of 10 patients (33.3%). Conclusion The results of our study are in agreement with other studies reported in the literature and confirm the need to follow a careful preoperative diagnostic protocol that must take advantage of imaging studies (computed tomography, magnetic resonance imaging) and of cytology FNAC, in order to plan surgical treatment with a safe approach and that reduces complications, esthetic and functional damage, and the risk of recurrence. How to cite this article Shivanandappa PD, Doddamane VP, Munish KS, Yogeesha BS, Shivakumar AM. A Clinical Approach to the Parapharyngeal Space. Int J Head Neck Surg 2017;8(1):1-4.

Introduction: Red cell antibodies that are found normally in human serum are considered naturally occurring and those are anti A and anti B. All other antibodies directed against RBC antigens are considered “unexpected or irregular". Aim: This study is aimed to evaluate the prevalence of the anti-red blood cell antibodies among healthy blood donors. Material and Methods: Antibody screening and identification was done using commercially available 3 cell and 11 cell reagent cells (0.8% Surgiscreen, Ortho Clinical Diagnostics Limited, USA and Low ionic Strength Saline Ortho Bliss with AHG Cassettes) in antihuman globulin phase. Results: A total of 36,684 donors were screened for the presence of irregular erythrocyte antibodies. Among these donors, twenty donors showed presence of alloantibodies in their serum (0.054%). Most frequent alloantibodies identified were from Lewis blood group system. The results showed statistically a higher prevalence of RBC alloantibodies in males than in females. Conclusion: Screening for presence of alloantibodies in donor blood is important to provide compatible blood products and to avoid transfusion reactions.

Background. Anesthesia machines are known reservoirs of bacterial species, potentially contributing to healthcare associated infections (HAIs). An inexpensive, disposable, nonpermeable, transparent anesthesia machine wrap (AMW) may reduce microbial contamination of the anesthesia machine. This study quantified the density and diversity of bacterial species found on anesthesia machines after terminal cleaning and between cases during actual anesthesia care to assess the impact of the AMW. We hypothesized reduced bioburden with the use of the AMW. Methods. In a prospective, experimental research design, the AMW was used in 11 surgical cases (intervention group) and not used in 11 control surgical cases. Cases were consecutively assigned to general surgical operating rooms. Seven frequently touched and difficult to disinfect “hot spots” were cultured on each machine preceding and following each case. The density and diversity of cultured colony forming units (CFUs) between the covered and uncovered machines were compared using Wilcoxon signed-rank test and Student’s t-tests. Results. There was a statistically significant reduction in CFU density and diversity when the AMW was employed. Conclusion. The protective effect of the AMW during regular anesthetic care provides a reliable and low-cost method to minimize the transmission of pathogens across patients and potentially reduces HAIs.

12 p., Background: The imperative to improve global health has prompted transnational research partnerships to investigate common health issues on a larger scale. The Global Alliance for Chronic Diseases (GACD) is an alliance of national research funding agencies. To enhance research funded by GACD members, this study aimed to standardise data collection methods across the 15 GACD hypertension research teams and evaluate the uptake of these standardised measurements. Furthermore we describe concerns and difficulties associated with the data harmonisation process highlighted and debated during annual meetings of the GACD funded investigators. With these concerns and issues in mind, a working group comprising representatives from the 15 studies iteratively identified and proposed a set of common measures for inclusion in each of the teams’ data collection plans. One year later all teams were asked which consensus measures had been implemented. Results: Important issues were identified during the data harmonisation process relating to data ownership, sharing methodologies and ethical concerns. Measures were assessed across eight domains; demographic; dietary; clinical and anthropometric; medical history; hypertension knowledge; physical activity; behavioural (smoking and alcohol); and biochemical domains. Identifying validated measures relevant across a variety of settings presented some difficulties. The resulting GACD hypertension data dictionary comprises 67 consensus measures. Of the 14 responding teams, only two teams were including more than 50 consensus variables, five teams were including between 25 and 50 consensus variables and four teams were including between 6 and 24 consensus variables, one team did not provide details of the variables collected and two teams did not include any of the consensus variables as the project had already commenced or the measures were not relevant to their study. Conclusions: Deriving consensus measures across diverse research projects and contexts was challenging. The major barrier to their implementation was related to the time taken to develop and present these measures. Inclusion of consensus measures into future funding announcements would facilitate researchers integrating these measures within application protocols. We suggest that adoption of consensus measures developed here, across the field of hypertension, would help advance the science in this area, allowing for more comparable data sets and generalizable inferences.

Vibrational contrast imaging of the distribution of complex biological molecules requires the use of techniques that provide broadband spectra with sufficient resolution. Coherent anti-Stokes Raman scattering (CARS) microscopy is currently limited in meeting these requirements due to the presence of a nonresonant background and its inability to target multiple resonances simultaneously. We present nonlinear interferometric vibrational imaging (NIVI), a technique based on CARS that uses femtosecond pump and Stokes pulses to retrieve broadband vibrational spectra over 200 cm(-1) (full-width at half maximum). By chirping the pump and performing spectral interferometric detection, the anti-Stokes pulses are resolved in time. This phase-sensitive detection allows suppression of not only the nonresonant background, but also of the real part of the nonlinear susceptibility χ((3)), improving the spectral resolution and features to make them comparable to those acquired with spontaneous Raman microscopy, as shown for a material sample and mammary tissue.

Nat. Methods 14, 160–166 (2017); published online 12 December 2016; corrected after print 10 April 2017 In the version of this article initially published, the middle cerebral artery was incorrectly referred to as the middle carotid artery. The error has been corrected in the HTML and PDF versions of the article as of 10 April 2017.

It is clear now that laser therapy cannot be considered separately from physiotherapeutic methods that use such physical factors as low-frequency pulsed electromagnetic elds; microwaves; time-varying, static, and combined magnetic elds; focused ultrasound; and direct-current electricity. Some common features of biological responses to physical factors have been briey analyzed (Karu 1998).

It has been observed that adoption of different possible switching patterns/schemes affects the transient behaviours such as phase current and torque of a PMBLDC motor. Four possible switching patterns are achieved by modulating only upper/lower switches and incoming/outgoing phase switches. For the purpose of control of PMBLDC motor low cost ATMEGA 32 micro-controller is used to generate all the four possible switching schemes. Use of dummy hall sensor is a near ideal and cheaper approach to prepare micro-controller for the control of PMBLDC motor. Dummy Hall sensor signals where generated for variable speed reference with the help of micro-controller to analyse inverter voltages. Provision is made to bypass the generated dummy hall sensor signal with actual hall sensor signal from the motor for the control purposes.

India is a country where automobile industry is governed by macroeconomics like GDP but making or breaking a success of the brand is directly in the hands of appointed dealers in that particular territory. This paper tries to identify and evaluate the importance of family owned dealers, so called mom-and-pop firm, how they contribute to their success by being most of the times unorganized still resilient, maintain corporate identity of manufacturers brand and also how they adopt different downturn strategies and same is used in different ways for customer capitalization and sustain from non-family firms through fund management, with less ambitious plans, trading mentality, frugal need for quick and fast money, retaining well-deserved key employees.

Objective: The gold standard method for measuring population sodium intake is based on a 24 h urine collection carried out in a random population sample. However, because participant burden is high, response rates are typically low with less than one in four agreeing to provide specimens. At this low level of response it is possible that simply asking for volunteers would produce the same results. Conclusions: The estimated salt consumption derived from the two samples was comparable and was not substantively different to estimates obtained from other surveys. In countries where salt is pervasive and cannot easily be avoided, estimates of consumption obtained from volunteer samples may be valid and less costly. Participants: We randomly selected 2152 adults and obtained usable 24 h urine samples from 306 (response rate 16%). Specimens were also collected from a further 113 volunteers. Estimated salt consumption and the costs for each strategy were compared. Results: The characteristics of the 'random' and 'volunteer' samples were moderately different in mean age 58 (SD 14.6 vs 49(17.7) years, respectively; p