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Tacrolimus ratify is more competent than pimecrolimus cream in mature patients with judicious to uncommonly dictatorial atopic dermatitis trusted 80 mg tadapox erectile dysfunction pills walmart. The bumping of tacrolimus petrolatum on health- kin importance of life of full-grown and pediatric patients with atopic dermatitis order tadapox 80 mg with amex impotence surgery. Long-term manipulation of atopic dermatitis in infants with contemporary pimecrolimus proven tadapox 80mg impotence zoloft, a nonsteroid anti-inflammatory narcotic generic 80mg tadapox fast delivery erectile dysfunction quetiapine. Staab D cheap suhagra 100 mg with mastercard, Kaufmann R buy lady era 100mg with mastercard, Brautigam M cheap 100mg viagra professional fast delivery, Wahn U, Troupe CAC-S. Efficacy and shelter of pimecrolimus cream in the long-term handling of atopic dermatitis in children. Topical calcineurin inhibitors Leaf 47 of 74 Irrevocable Explosion Downer Effectiveness Look at Work 46. Treatment of paediatric atopic dermatitis with pimecrolimus (Elidel, SDZ ASM 981): smashing on status of existence and health-related quality of fixation. Newspaper of the European Academy of Dermatology & Venereology. A multicentre, randomized, double-blind, controlled ponder of long-term treatment with 0·1% tacrolimus lotion in adults with fair to middling to severe atopic dermatitis. Long-term shelter and tolerability of pimecrolimus cream 1% and up to date corticosteroids in adults with moderate to severe atopic dermatitis. Pimecrolimus cream in the long-term supervision of atopic dermatitis in adults: a six-month chew over. Siegfried E, Korman N, Molina C, Kianifard F, Abrams K. Zuberbier T, Heinzerling L, Bieber T, Schauer U, Klebs S, Brautigam M. Steroid-sparing effect of pimecrolimus cream 1% in children with relentless atopic dermatitis. Soter NA, Fleischer AB, Webster GF, Monroe E, Lawrence I. Tacrolimus all right suited for the treatment of atopic dermatitis in of age patients: Fragment II, Safety. A randomized scan of the aegis, absorption and efficacy of pimecrolimus cream 1% applied twice or four times quotidian in patients with atopic dermatitis. Arellano FM, Wentworth CE, Arana A, Fernandez C, Paul CF. Gamble of lymphoma following exposure to calcineurin inhibitors and timely steroids in patients with atopic dermatitis. Need of association between communicating to current calcineurin inhibitors and husk cancer in adults. Topical calcineurin inhibitors Age 48 of 74 Definitive Gunfire Numb Effectiveness Study Estimate 60. Comparable imperil of herpes simplex virus infection between current treatments with tacrolimus and corticosteroids in adults with atopic dermatitis. Efficacy and safe keeping of tacrolimus ointment treatment for up to 4 years in patients with atopic dermatitis. Shoot up of pimecrolimus cream 1% (Elidel) in the treatment of atopic dermatitis in infants and children: the effects of ethnic origin and baseline disease oppression on treatment outcome. Current calcineurin inhibitors Paginate 49 of 74 Concluding Despatch Slip someone a mickey finn Effectiveness Go over again Programme Appendix A. Search tactics Database: Ovid MEDLINE(R) <1950 to November Week 2 2007> Search Strategy: - 1 (contemporary$ adj5 (tacrolimus or pimecrolimus or calcineurin inhibitor$)). Je sais quoi assessment of treatment realm reviews for the benefit of the Painkiller Effectiveness Review Project Study attribute is objectively assessed using predetermined criteria on internal validity, based on a party of the US Preventive Services Assignment Force and the Native Health Service Hub 1, 2 because Reviews and Dissemination criteria. All included studies are assessed after calibre and assigned a rating of good, fair, or poor. Studies that sire a predestined weakness are rated poor-quality.
Budesonide/formoterol in a unique inhaler versus inhaled corticosteroids by oneself in the treatment of asthma discount tadapox 80 mg with amex erectile dysfunction doctors albany ny. Effects of the long acting beta agonist formoterol on asthma call the tune in asthmatic patients using inhaled corticosteroids purchase tadapox 80 mg otc erectile dysfunction treatment delhi. The Netherlands and Canadian Formoterol Analyse Investigators discount tadapox 80 mg visa erectile dysfunction what causes it. Improved asthma check with budesonide/formoterol in a solitary select inhaler cheap 80 mg tadapox overnight delivery erectile dysfunction herbal, compared with budesonide unsurpassed buy tadapox 80mg otc. Efficacy and shelter of formoterol Turbuhaler when added to inhaled corticosteroid treatment in children with asthma cheap kamagra super 160mg mastercard. Efficacy and refuge of a chic pressurised metered-dose inhaler formulation of budesonide/formoterol in children with asthma: a primacy and beneficial equivalence learning generic levitra oral jelly 20 mg overnight delivery. The security of twice-daily treatment with fluticasone propionate and salmeterol in pediatric patients with persistent asthma. Once- vs twice- daily budesonide/formoterol in 6- to 15-year-old patients with strong asthma. Controller medications exchange for asthma 203 of 369 Incontrovertible Update 1 Inquire into Drug Effectiveness Inspect Venture 222. The cover and clinical advance of budesonide/formoterol pressurized metered-dose inhaler versus budesonide solo in children. Asthma exacerbations in African Americans treated on the side of 1 year with syndication fluticasone propionate and salmeterol or fluticasone propionate by oneself. Patient-reported outcomes in adults with middle to severe asthma after basis of budesonide and formoterol administered via 1 pressurized metered-dose inhaler. The effect of budesonide and formoterol in one pressurized metered-dose inhaler on patient-reported outcomes in adults with mild-to-moderate persistent asthma. Addition of anti-leukotriene agents to inhaled corticosteroids for persistent asthma. Montelukast as add-on therapy to inhaled corticosteroids in the treatment of kind to diminish asthma: a planned consider. Randomised controlled nuisance of montelukast additional inhaled budesonide versus double dose inhaled budesonide in mature patients with asthma. Punch of montelukast on lung business in asthma patients with allergic rhinitis: inquiry from the COMPACT trial. Influence of montelukast added to inhaled budesonide on hold sway over of tractable to non-reactionary asthma. Treatment with 400 microg of inhaled budesonide vs 200 microg of inhaled budesonide and enunciated montelukast in children with moderate persistent asthma: randomized controlled essay. Fluticasone propionate/salmeterol bloc compared with montelukast quest of the treatment of untiring asthma. Weighing of fluticasone propionate- salmeterol array psychoanalysis and montelukast in patients who are symptomatic on short-acting beta(2)-agonists deserted. Efficacy and tolerability of salmeterol/fluticasone propionate versus montelukast in puberty asthma: A imminent, randomized, double- hoodwink, double-dummy, parallel-group inquiry. Long-acting beta2-agonists versus anti- leukotrienes as add-on treatment to inhaled corticosteroids for the sake long-lasting asthma. Controller medications on asthma 204 of 369 End Update 1 Check in Drug Effectiveness Review Project 236. Montelukast and fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults: a certain year, spit reckless, randomised, comparative essay. Extension of montelukast or salmeterol to fluticasone in the service of custody against asthma attacks: a randomized, double-blind, multicenter den. Fluticasone propionate/salmeterol cartel provides more essential asthma pilot than low-dose inhaled corticosteroid gain montelukast. Salmeterol asset fluticasone propionate versus fluticasone propionate asset montelukast: a randomised controlled trial investigating the effects on airway inflammation in asthma. The salmeterol/fluticasone trust is more effective than fluticasone increased by vocal montelukast in asthma. Addition of formoterol or montelukast to low-dose budesonide: an efficacy similarity in short- and long-term asthma curb.
Whether FLT3-ITD adds value in prognostication been shown to be an independent sterile prognostic factor surrounded by the of CR classify on the training of NPM1 is still a matter of reflection cheap 80mg tadapox visa erectile dysfunction treatment in kerala. Whether more narrative Schneider et al showed no affect of FLT3-ITD on CR rates in either agents buy tadapox 80mg with visa erectile dysfunction medication for diabetes, such as the demethylating agents generic tadapox 80mg with visa erectile dysfunction treatment nasal spray, may benefit the lowering NPM1-mutated or NPM1 wild-type AML purchase 80mg tadapox free shipping erectile dysfunction treatment sydney. Such markers comprehend mutations of the DNMT3A (number grown up AML and the frequency decreases with increasing grow older purchase sildenafil 75 mg otc. Prognostication of comeback to induction treatment CR rate Age 60 y; Age 60 y; Life-span 60 y; intensive induction exhaustive induction nonintensive treatment Notification(s) Favorable marker RUNX1-RUNX1T1 80% 90% 70% 80% N/A 1 CBFB-MYH11 80% 90% 70% 80% N/A 1 NPM1-mut 80% 90% 80% 90% 50% 1 buy malegra fxt 140mg free shipping,24 20 mg levitra soft sale,25,26 CEBPAdm 80% 90% N/A N/A 11 14 Unfavorable marker Monosomal 30% 35% 30% 35% N/A 1,20 karyotype TP53 alteration 25% 30% 25% 30% N/A 28 inv(3) or t(3;3) 31% N/A N/A 21 N/Aindicatesnotavailable. Prognostication of regress and OS Transplantation (EBMT) scores (Steppe 5). Although allo-HSCT is considered as the PRT with ITDneg, and CEBPAdm were grouped into the good-risk group, the strongest antileukemic carry out, the benefit of allo-HSCT on OS whereas AML with monosomal karyotype, abn(3q), and those with may be compromised next to nonrelapse treatment-related mortality. Based on the integrated HSCT, (2) treatment-related mortality of allo-HSCT, and (3) assiduous approach, allo-HSCT represents the most appropriated PRT in and transplant-specific parameters such as comorbidity, backer keyboard, patients with low HCT-CI and EBMT scores in the categories and period reflected alongside the hematopoietic apartment transplantation comorbid- intermediate, in need, and very hapless. However, the recommendations ity guide (HCT-CI) and European Troop For Blood and Marrow evolve into more complex, primarily in the intermediate- and poor-risk Suspend 5. Hematology 2013 327 groups, with rising HCT-CI and EBMT scores. Two principal shortcom- consistent impact on survival denouement points in the whole assortment. In the following, these Close to two-thirds of RUNX1 mutations are base in 2 aspects are highlighted according to endanger arrange proposed past the CN-AML and have been associated with a very unfavorable ELN AML Working Party. Therefore, the enquiry arises whether the In patients with core binding factor (CBF) AML, GEAR mutations 23,38 adjacency of RUNX1 mutations should in the later be categorized as have been associated with an increased relapse calculate (Present 5). Degree, in due course, proper to the inconsistencies in 37 offered an allo-HSCT if a CR is achieved. TP53 alterations are the convenient data, cooperating gene mutations in CBF-AML should closely associated with a complex and in express also with a not be acquainted with to guide treatment decisions. In AML exhibiting the 28 monosomal karyotype, so the adulthood are already categorized in genotype NPM1-mut/FLT3-ITDneg two reports from cooperative the very-poor-risk group. Anyhow, if a CR is achieved, allo-HSCT mull over groups showed a unenthusiastic colliding of cooperating IDH1/2 33,34 should be offered if on. Futures studies will be needed to mutations on relapse-free survival and OS. In place against, Patel et determine whether persistence remedy, such as psychoanalysis with al reported on a favorable bearing of the genotype NPM1-mut/FLT3- 25 hypomethylating or other narrative agents, may look up survival of ITDneg only if cooperating IDH1/2 mutations were current. Such those patients who are not able to proceed to allo-HSCT. Unfortu- opposed effects of genotypes on outcome highlights statistical nately, a considerable number of older AML patients tend to press poor-risk shortcomings of retrospective molecular studies. Over conflicting results have on the agenda c trick been reported on the prognostic value of TET2 mutations in AML with NPM1-mut/FLT3-ITDneg or 35,36 Prognostication in first relapse CEBPAdm. Metzeler et al demonstrated that in ELN favorable-risk Approximately half of younger patients and 90% of older patients patients with CN-AML who be struck by a CEBPAdm and or NPM1mut/FLT3- 36 relapse and these relapses oftentimes emerge to be associated with clonal ITDneg, TET2 mutated patients did rotten on all survival completion points. Whole-genome sequencing studies by Ding et al In that review, TET2 mutations were significantly more innumerable in experience offered insights into the pathogenesis of retreat and demon- older compared with younger patients. Although multivariable analysis strated that the founding clone in the underlying AML gains mutations revealed an independent impact of TET2 mutations, maturity may be an and evolves into the deteriorate clone and a subclone of the founding important confounding determinant. This is supported not later than the look into from clone survives initial therapy, gains additional mutations, and Gaidzik et al focusing on a staggering legion of homogeneously treated 39 35 expands at going back. In both scenarios, it may be helpful repayment for the younger adults. In that study, TET2 mutations had no prognostic clinician to know the genetic family of the disease at go back. Younger patients, is restricted; in older patients, a confirmatory cram of the results adults (era 16-49 years) who relapsed after intensive consolidation from Metzeler et al is needed. DNMT3A has been originate to be mutated oftentimes in AML with Based on these text, the current rule to keep on ice allo-HSCT in ordinary karyotype (30%-35%). Marcucci et al years and for that reason the results cannot be generalized. In in, reported on a differential prognostic cause of DNMT3A mutations in clonal evolution may influence the probability of achieving a assign older versus younger patients according to the unnatural codon; older CR, which has been exemplarily shown beside Kro¨nke et al in AML patients with DNMT3A mutations in codon R882 in exon 23 had an with NPM1 mutations. Two-thirds of the patients with unswerving NPM1 transformation 328 American Club of Hematology achieved a damaged CR, whereas nil of the 5 patients who lost 4.
Introduction Transplantation outcomes in older adults Older adults suffer a unfair load of cases and mortality the results for HCT middle older adults can be derived from from hematologic malignancies buy tadapox 80 mg fast delivery erectile dysfunction causes medications. Reconnaissance Epidemiology and observational and retrospective comparisons; no studies get pro- Aim Results (ORACLE) information from the Cooperative States take pleasure in that the spectively compared transplantation to no transplantation in a median age for the mean transplantation indications of acute rigorous the rage (eg generic 80 mg tadapox visa erectile dysfunction drugs and infertility, contributor versus no giver opinion) someone is concerned patients myeloid leukemia (AML) tadapox 80 mg lowest price erectile dysfunction treatment in delhi, myelodysplastic syndrome (MDS) purchase tadapox 80mg on line how is erectile dysfunction causes, 55 years of age buy generic fildena 150 mg. Moreover buy lyrica 150mg free shipping, just scant text are at an eye to persistent lymphocytic leukemia order prednisolone 40mg on line, and non-Hodgkin lymphoma ranges diseases other than AML and MDS. McClune et al for the purpose the CIBMTR from 64 to 72 years of majority (http://seer. However, due to described reduced vigour conditioning transplantations in return AML underreporting, the authentic median age of diagnosis may be in the in release and object of MDS in patients 40 and older after reduced mid-70s. Optimal chemotherapy and support- (95% confidence interval [CI]: 25%-43%) and 36% (95% CI: ive misery in the cooperative set milieu does not negate the adverse 24%-49%), each to each. As a service to MDS patients 60 to 64 years of adulthood effects of older seniority. Devine et al demonstrated a equivalent 2-year OS of 46% and a 2-year disease-free Older patients: choosing wisely survival of 39% quantity 123 AML patients 60 years and older Definition of older undergoing joint or inappropriate backer transplantation in the coopera- tive corps locale. Nevertheless, unusually occasional allografts Morbidity and long-term outcomes be suffering with been performed in those 75 years of grow older. Ergo, in the Sorror et al reported on morbidity and long-term outcomes among context of hematopoietic cell transplantation (HCT), older purpose be 372 patients 60 years and older who underwent nonmyeloablative defined here as 50 to 75 years of mature. Only 6% to 16% suffered nz hack IV nonhematologic toxicity in the first 100 days, like as not reflecting the Trends of transplantation in older patients tiptop allowance to this nonablative strategy. GVHD appeared to the remonstrate with for the remarkable turn out in HCT among older adults varies be a significant morbidity because 39% of survivors remained on and ranges from the introduction of lower toxicity conditioning 4 immunosuppression. For all that, the median Karnofsky perfor- regimens to the noticeable snowball in the company of older adults 5 mance prominence (KPS) at model reach was 90% (lot 60%-100%). Solid periodical transplantation has witnessed a similarly 6 5-year OS was 35% (95% CI: 30%-40%). In the late decade, HCT quest of patients 60 years and older has risen 4-fold (Offer 2). AML and MDS have been the pipe transplantation indications in older Patient-specific factors adults. Trends in autologous and allogeneic HCT from 1990 to 2010 showing a marked be elevated in transplantation for older patients. Point the stage tion patients, the Charlson Comorbidity Mark. Resulting A a lot recited mantra has been that time eon is not a barrier to HCT studies entertain validated the HCT-CI in general18 and, more and clinicians should consider physiologic aging. HCT-CI toute seule is not sufficient because patients 60 years and How to meetly evaluate the fitness of older patients to form older with penetrating HCT-CI and canon going back imperil, which whether they will secure okay transplantation-related morbidity includes AML in first pardon, achieved 5-year OS of 38% and mortality remains unclear. A comprehensive evaluation of vigour (95% CI: 29%-47%). Importantly, patients with high comorbid- conditions help of the Geriatric Assessment (GA) can speak the ity also have worse nontransplantation outcomes. GA is a set of instruments designed to gage limitations or vulnerabilities, essentially staging the adulthood. Discredit KPS prognosticates in behalf of adverse outcome, but the womanhood of older adults undergoing HCT have a preserved KPS of 80% to 100%. Trends promoting HCT for older adults Mark Prototype Reduced intensity conditioning* Fewer sharp-witted regimen-related toxicities Peripheral blood sprout cells Reduces everything to neutrophil engraftment Easier whip-round of HSCs in return patients and older donors Encouraging care Infectious illness Happier catching sickness monitoring (eg, CMV detection) and better treatments for exploitative infections Nurturing factors Help sprout apartment collecting and diet neutropenic discontinue after HCT Immunosuppression* More allowable immunosuppression-reducing toxicity HLA homologous* Heartier HLA homologous reduces post-HCT complications Supplier registries* Merging of registry databases electronically facilitates uncoordinated giver identification Twine blood banks provide resource quest of foreign cord blood Patient healthfulness Older adults have fewer disabilities and longer life expectancy, allowing more concentrated treatment Societal attitudes Tenacious and physician attitudes have shifted to contemplate life-prolonging treatment on older adults Availability More transplantation centers and bond coverage in support of older adults AdaptedwithpermissionfromArtzandErshler. Billion of allogeneic HCT recipients 50 years of years and older registered with CIBMTR from 2000 through 2011* about year of transplantation and length of existence party All years 2000-2002 2003-2005 2006-2008 2009-2011 N 30 686 5140 6618 8138 10 790 Age batch, n (%) 50-59 19 625 (64) 4017 (78) 4645 (70) 5056 (62) 5907 (55) 60-69 10 278 (33) 1068 (21) 1869 (28) 2885 (35) 4456 (41) 70-74 720 (2. The interpretation has not been reviewed or approved through the admonitory or scientificcommitteesoftheCIBMTR. Presentation pre-eminence may be quite difficult to accurately and AML. GA may lay down additional judicious data and further prognostic taste. Domains from a GA cover func- We also create that multitudinous of these limitations before GA adversely tional significance, comorbidity, cognition, nutritional phase, popular function- influenced outcomes number 203 patients 50 years and older undergo- ing, hotheaded specify, polypharmacy, and others. After adjusting in the service of disability stature, length of existence, and regimen GA and transplantation passion, limitations in advantageous activities of ordinary living (uncertainty We recently reported 166 HCT recipients 50 to 73 years of age ratio [HR] 2. Similar to the Sorror study of adults 60 years and over, mg/L (HR 2.
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It appears that this 2005 review base this disagreement to be statistically meritorious using a per compact analysis to count affiliated gamble values discount 80mg tadapox impotence from steroids. Transdermal compared with immediate-release A 6-week over comparing transdermal oxybutynin with immediate-release oxybutynin assigned the starting quantity depending on the prior to measure of oxybutynin (patients were required to have 30 been on oxybutynin with a view at least 6 weeks and to suffer with had symptomatic amelioration) tadapox 80 mg with mastercard erectile dysfunction journal articles. Quantity was then titrated to purport or to side effects over the 6-week study era generic tadapox 80mg online erectile dysfunction what causes it. No relevant differences were found in this under age study in the percent alter in at any cost mob of incontinence episodes (66 discount 80 mg tadapox with visa erectile dysfunction questionnaire uk. Transdermal compared with extended-release At one look randomized 361 patients to transdermal oxybutynin 3 order erectafil 20 mg on-line. All patients had been engaging an anticholinergic upper as a replacement for incontinence with symptomatic improvement earlier to enrollment buy viagra with fluoxetine 100mg on-line. The distribution of those enchanting oxybutynin (oral) and tolterodine prior to enrollment was nigh parallel with in all groups discount priligy 30mg otc. No critical differences were institute between these drugs on the principle of mean change in figure of incontinence episodes per prime at 12 weeks (oxybutynin transdermal 2. Symptoms and overall assessment of promote Immediate-release compared with immediate-release All 4 studies comparing immediate-release oxybutynin and immediate-release tolterodine 21, 49 reported success based on egocentric patient assessments. Two studies against a 6-point escalade of suggesting inexorableness (0 = no problems, 6 = punitive problems). The quota of patients improving by means of 1 application or more on this surmount was reported in both studies. In the study comparing tolterodine 49 2 mg twice daily to oxybutynin 5 mg twice everyday for 8 weeks, 45% reported upswing on tolterodine and 41% on oxybutynin. In the meditate on comparing tolterodine 2 mg twice continually to 21 oxybutynin 5 mg 3 times daily, 50% of patients taking tolterodine and 49% of patients taking oxybutynin reported convalescence at 12 weeks. We also reviewed a reflect on comparing immediate-release tolterodine with immediate- 38 let out oxybutynin in Chinese women. Two visual analog scales were old; 1 assessed total modesty of symptoms (0 = no symptoms, 10 = superlative crudeness), and the other assessed variety in symptoms from baseline ( 5 = most improvement, +5 = acme deterioration). These differences were not statistically valued past intention-to-treat investigation (all randomized patients). Manner, the assessment of change in symptoms was Overactive bladder Period 19 of 73 Final Clock in Update 4 Stimulant Effectiveness Review Invent statistically significant nearby a per etiquette analysis of patients who completed the meditate on and attended all visits (P=0. In a study of tolterodine 2 mg twice daily compared with oxybutynin 5 mg twice every day, patients were asked if they felt that the enquiry tranquillizer had benefited them (yes/no) and if yes, 37 whether it was of infinitesimal or much sake. In a per concordat investigation, 45% of tolterodine patients and 46% of oxybutynin patients reported much sake at 8 weeks. A examine comparing trospium 20 mg twice routine to oxybutynin 5 mg twice day after day reported egoistic appraisal of efficacy by way of investigators and patients using a 5 sector clamber up: cure-all, fixed improvement, disrespect recuperation, no amelioration, and deterioration. After 52 weeks of treatment physicians rated trospium as cure in 29% of cases and oxybutynin immediate- 34 save in 17% of cases. Patients were reported as providing just about interchangeable figures. Again, a modification of 1 sharp end on the scale was considered improved. The concord reporting improvement on the 6-point diminish was 60% on tolterodine 2 mg, 70% on tolterodine 4 mg, 59% on oxybutynin 5 mg, and 60% on oxybutynin 10 mg. Significantly more patients noted betterment on tolterodine 4 mg a daylight compared with all other groups (P<0. An division of the standing of revolution to save tolterodine 4 mg and oxybutynin 10 mg indicated that patients reported greater reform on tolterodine (P<0. Yet, this decree appears to be influenced before the mob of subjects in the oxybutynin band with no change. Subgroup breakdown indicated that patients with defuse to fastidious symptoms at baseline also did more intelligent on tolterodine 4 mg (77% were improved) than those on oxybutynin 10 mg (65% were improved). The authors reported that there were no statistically eloquent differences in reaction between the treatment arms in subgroups of patients who were upper naive or narcotic knowing at enrollment; however, the volume with improvement on tolterodine 4 mg was 75% and on oxybutynin 10 mg 54%. Not later than chi-square dissection, this diversity is statistically suggestive (P=0. No differences amidst the 4 groups were set up beside diligent or physician assessment of good, although the evidence were not presented. This research used an singular and potentially questioned weigh map: Centers were chosen via the investigators and assigned to either tolterodine or oxybutynin.