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In this study it was found that the use of intravenous methylprednisolone followed by oral prednisone did indeed speed the recovery from visual loss, although at 6 months there was little difference between patients treated in this way and those treated with placebo They reported that treatment with oral prednisone alone slightly increased the risk of new episodes of optic neuritis In a subsequent randomized trial conducted by Sellebjerg and colleagues, it was found that methylprednisolone 500 mg orally for 5 days had a bene cial effect on visual function at 1 and 3 weeks However, at 8 weeks, no effect could be shown (compared with the placebotreated group), nor was there an effect on the subsequent relapse rate Interferon Beta and Copolymer I These forms of treatment for patients with relapsing-remitting MS modestly alter the natural history of the disease.

IFN- 1b (Betaseron), a nonglycosylated bacterial cell product with an amino acid sequence identical to that of natural IFN- , was the rst of these agents to be tested (see Arnason) Several trials have now shown that the subcutaneous injection of this agent every second day for up to 5 years decreases the frequency and severity of relapses by almost one-third and also the number of new or enlarging lesions ( lesion burden ) in serial MRIs A large-scale trial (European Study Group) has extended the observations with IFN- 1b to patients with the secondarily progressive type of MS; progression of the disease was delayed for 9 to 12 months in a study period of 2 to 3 years.

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The heel strikes the ground rst, and inspection of the shoes will show that this part is most subject to wear The muscles of greatest importance in maintaining the erect posture are the erector spinae and the extensors of the hips and knees The normal gait cycle, de ned as the period between successive points at which the heel of the same foot strikes the ground, is illustrated in Fig 7-1; it is based on the studies of Murray and coworkers and of Olsson In this gure, the cycle is initiated by the heel strike of the right foot The stance phase, during which the foot is in contact with the ground, occupies 60 to 65 percent of the cycle The swing phase begins when the right toes leave the ground.

The treatment of relapsing-remitting MS with IFN- 1a (a glycosylated mammalian-cell product, Avonex) is equally effective and has the advantage that it may be taken once weekly as an intramuscular injection (PRISMS Study Group) The dose currently used is 30 mg, or 66 million units Copolymer I (glatiramer acetate; Copaxone), which was synthesized to mimic the actions of myelin basic protein, a putative autoantigen in MS, is given daily in subcutaneous doses of 20 mg Glatiramer acetate may be particularly useful in patients who become resistant, ie, develop serum antibodies to IFN- (Rudick et al) The rate of such antibody emergence varies directly with the frequency of use of interferon: after a period of years, 30 percent of patients demonstrate antibodies with daily administration, 18 percent with alternate-day use, and less than 5 percent with weekly use.

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More recent changes in the preparation of interferon have led to reported rates of only 2 percent with antibodies after 1 year of use There is some evidence that the presence of these antidrug antibodies diminishes the effectiveness of interferon Antibodies do not develop to glatiramer acetate, and this has been emphasized as a relative advantage of the latter drug Overall, the side effects of these interferon agents are modest, consisting mainly of u-like symptoms, sweating, and malaise beginning several hours after the injection and persisting for up to 14 h; they are reduced by nonsteroidal anti-in ammatory drugs and tend to abate with continued use of the agents Nevertheless, some.

When you pass parameters like this, you must pass the same number of parameters and pass them in the same order as the subroutine is expecting them. Separate the parameters with commas.

1. In AppleScript Editor, press z-N or choose File | New to create a new script. 2. Start a tell block to iTunes, identifying it formally:

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