Application of high-performance liquid chromatography in determining saturates and aromatic hydrocarbons along with polars/additives in automotive finished and used lubricating oils.

Lubricating oils help an internal combustion engine function effectively by reducing friction and wear on the engine's moving parts. They typically consist of petroleum-derived base oil and various additives to achieve the desired characteristics in automotive engine oils. Determination of aromatics and polar additives in the finished and used lubricating oils is not possible with existing methods hence their development is significant from the perspectives of environment and reuse/re-refining of used lubricating oils. This study reports the development of a new HPLC method to determine additives in the finished lubricating oils and/or polars in the used engine oils. The proposed method is simple, fast (runtime of 13 min), does not require sample pre-treatment, and exhibits high precision and superior limits of detection and quantification. The method demonstrated good linear response ranging from 0.1 to 30 mass for total aromatics and 0.1 to 20 % for additives. The method validation was carried out by analyzing brand-new commercial two and four-wheeler lubricants with used automotive lubricants. Based on the proposed method, the aromatics and additives concentration ranges in the studied finished lubricants were estimated between 0.20-1.70 % (mass) and 0.20-3.50 % (mass), respectively. Similarly, for used lubricants, the aromatics and additives were estimated to be 1.00-6.10 % and 0.60-2.40 % (mass), respectively.

Electronic and optical properties of boron-based hybrid monolayers.

Anisotropic 2D Dirac cone materials are important for the fabrication of nanodevices having direction-dependent characteristics since the anisotropic Dirac cones lead to different values of Fermi velocities yielding variable carrier concentrations. In this work, the feasibility of the B-based hybrid monolayers BX (X = As, Sb, and Bi), as anisotropic Dirac cone materials is investigated. Calculations based on density functional theory and molecular dynamics method find the stability of these monolayers exhibiting unique electronic properties. For example, the BAs monolayer possesses a robust self-doping feature, whereas the BSb monolayer carries the intrinsic charge carrier concentration of the order of 1012cm-2which is comparable to that of graphene. Moreover, the direction-dependent optical response is predicted in these B-based monolayers; a high IR response in thex-direction is accompanied with that in the visible region along they-direction. The results are, therefore, expected to help in realizing the B-based devices for nanoscale applications.

Determination of biodiesel and used cooking oil in automotive diesel/green diesel fuels through high-performance liquid chromatography.

This study reports a simple and convenient analytical method for the simultaneous determination of biodiesel and vegetable oils or used cooking oils in petrodiesel and green diesel (hydrotreated vegetable oils or paraffinic diesel). The approach is based on normal-phase high-performance liquid chromatography with refractive index detection. It employed silica stationary phase, n-hexane mobile phase with isopropanol modifier to achieve optimum separation between hydrocarbons (petrodiesel or green diesel), fatty acid methyl esters (biodiesel) and triglycerides (vegetable oils and used cooking oil). In addition to determining vegetable oils or used cooking oils as adulterants in diesel, this method is also proposed as a better alternative to the standard method ASTM D7371, which is currently recommended for determining fatty acid methyl esters in petrodiesel. The method development involved screening of various stationary and mobile phases, with and without modifiers, to achieve acceptable chromatographic resolutions between analytes. Under the optimized method conditions, silica column, and n-hexane containing 0.6% isopropanol as the mobile phase provided the best results. The real-world scenario was simulated for the method validation carried out by fortifying Jatropha seed oil, soybean oil, and used cooking oil in the biodiesel blended petrodiesel and green diesel. Measurement of all analytes was accompanied by high precision, low limit of detection/quantification and linear response range of 0.05 to 50% for biodiesel, and 0.05 to 30% for vegetable oils. The proposed method is simple, fast (runtime 7 min), and does not require sample pre-treatment and backflushing.

HLA-B27-related uveitis and seasonal variation-an Indian perspective.

Purpose: To study seasonal variation and systemic associations in HLA-B27 related uveitis (HBU). Methods: This was a retrospective, observational chart review conducted in a single, tertiary eye care hospital, from January 2015 to December 2019. New cases presented from January 2017 to December 2019 were studied for incidence patterns (Group X). Cases with ≥1-year follow-up were studied for systemic association (Group Y) and cases with ≥4 episodes of active uveitis were studied for recurrence pattern (Group Z). A year was divided into 3 segments of the year (SoY): 1. November-February, 2. March-June, 3. July-October. Results: We found 157 cases of HBU from January 2015 to December 2019. The incidence in Group X (n = 105) was found to be least in SoY 2 in all 3 years (2017-2019). In Group Y (n = 85), 39 cases (45.88%) were diagnosed as spondyloarthropathies, among which 20 were of ankylosing spondylitis (23.52%). More than 1/2 the total number of episodes occurring in the same SoY (SoY Max), in Group Z (n = 25), was seen in 14 (56%) cases. SoY Max was the first segment (SoY 1) for most of these cases (n = 7). In Group Z, 8 (32%) patients were on immunomodulatory therapy at presentation. Conclusion: Our study confirms seasonal variation in HBU patients by documenting the least incidence from March to June and identifies 56% of patients that can have a maximum number of recurrences in a specific season of the year. Outcomes of surgical interventions planned accordingly, and responsible environmental factors for HBU should be studied further.

Supraclavicular or infraclavicular subclavian vein: Which way to go- A prospective randomized controlled trial comparing catheterization dynamics using ultrasound guidance.

BACKGROUND AND AIMS: Subclavian vein (SCV) catheterization via the supraclavicular (SSV) or infraclavicular (ISV) approaches under real time ultrasonographic (USG) guidance is being performed routinely in critically ill patients in ICU.The aim of this study is comparative evaluation of SSV and ISV approaches in terms of success rate, time taken and incidence of complications. SETTINGS AND DESIGN: In this prospective study, 110 critically ill patients were randomly divided into two groups of 55 each. Right SCV catheterization was performed using real time USG by single experienced operator. METHODS: Success rate, first attempt success rate, time taken for venous visualization, puncture, catheterization, total procedure, incidence of mechanical, and infectious complications were variables used for comparison among groups. STATISTICAL ANALYSIS USED: Normality tests were performed using the Kolmogorov-Smirnov test. All data are expressed as the mean (SD), number (%), or median [interquartile range (IQR)] as indicated. Data were compared using the χ2 test, the Mann-Whitney U-test, Fisher's exact test and Student's t-test as appropriate. RESULTS: Total procedural time was significantly lesser in SSV group than ISV group (P < 0.0001). Time for visualization, puncture and catheterization were significantly higher in ISV group (P < 0.001). Success rate was 100% in both groups. First attempt success rate was more in SSV (P = 0.171).Two incidence of malposition was found in ISV group. Infectious complications were comparable in both groups. CONCLUSIONS: Real time USG-guided supraclavicular subclavian approach is a viable and preferable alternative with significantly lesser total procedural time, similar success rate, fewer attempts, faster and lesser complication rates as compared with infraclavicular approach.

Assessment of chromium phytotoxicity, phytoremediation and tolerance potential of Sesbania sesban and Brachiaria mutica grown on chromite mine overburden dumps and garden soil.

The addition of toxic chromium in agrarian soils from mine overburden dump is of serious concern. To combat the toxicity of chromium an experiment was carried out at the Department of Botany, Utkal University, India by taking the chromium rich overburden dump (OBD) from Sukinda chromite mine, India. Different proportions of chromium rich OBD (10%, 20%, 30%, 40%, 50%, 70% and 100% OBD) were supplied to garden soil and plants of legume and non-legume categories (Sesbania sesban L. and Brachiaria mutica L.) were grown for assessment of phytoaccumulation ability of chromium, tolerance index, chlorophyll, protein and proline and the activity of oxidative inhibitors enzymes. After 60 days of experimentation, Cr phytotoxicity on physiological and biochemical parameters were assessed. The outcome of the results showed that the activity of antioxidant enzymes enhanced considerably in roots as compared to shoots with enhancing concentration of chromium. To compare the phytoaccumulation ability, the tolerance index (TI), bio-concentration factor (BCF) and transportation index (Ti) were measured in two different species. The results showed that at 100% OBD the TI, BCF and Ti of S. sesban have 22.30, 0.45 and 71.06 and B. mutica have 20.83, 0.43 and 42.45 respectively. The result showed that S. sesban not only had the highest bioaccumulation capacity of chromium but also have high tolerance index and transportation index as compared to B. mutica. Hence S. sesban can be recommended for phytostabilization programme to alleviate toxic chromium from chromite overburden mining sites.

Sarcopenia: Ammonia metabolism and hepatic encephalopathy

Sarcopenia (loss of muscle mass and/or strength) frequently complicates liver cirrhosis and adversely affects the quality of life; cirrhosis related liver decompensation and significantly decreases wait-list and post-liver transplantation survival. The main therapeutic strategies to improve or reverse sarcopenia include dietary interventions (supplemental calorie and protein intake), increased physical activity (supervised resistance and endurance exercises), hormonal therapy (testosterone), and ammonia lowering agents (L-ornithine L-aspartate, branch chain amino acids) as well as mechanistic approaches that target underlying molecular and metabolic abnormalities. Besides other factors, hyperammonemia has recently gained attention and increase sarcopenia by various mechanisms including increased expression of myostatin, increased phosphorylation of eukaryotic initiation factor 2a, cataplerosis of α ketoglutarate, mitochondrial dysfunction, increased reactive oxygen species that decrease protein synthesis and increased autophagy-mediated proteolysis. Sarcopenia contributes to frailty and increases the risk of minimal and overt hepatic encephalopathy.

Correction: Evaluation of 19,460 Wheat Accessions Conserved in the Indian National Genebank to Identify New Sources of Resistance to Rust and Spot Blotch Diseases.

[This corrects the article DOI: 10.1371/journal.pone.0167702.].

Chemical Modifications of Ketoprofen (NSAID) in Search of Better Lead Compounds: A Review of Literature From 2004-2016.

BACKGROUND: Ketoprofen, a potent anti-inflammatory, analgesic and anti-pyretic drug belonging to the propionic acid class was synthesized in 1968. Rapid absorption, simple metabolism, faster blood brain barrier crossing and high antinociceptive activity are the features responsible for its high use. But, free acidic moiety present in its structure is the major factor that declines its popularity by causing various gastric side effects. Many researchers have chemically modified this drug with the aim to discover an improved and safe NSAID candidate or a new drug with altered activity. We thoroughly searched the literature and found that during the period 2004-2016, more than fifty reports are available on chemical modification of ketoprofen. Along with this, many patents involving chemical modification of ketoprofen have also been reported. However, it was very surprising to note that there are only a few review articles available covering only its pharmacological and clinical properties. There is no review article available covering the chemistry part of ketoprofen. This motivated us to compile the information available on ketoprofen and its derivatives. The purpose of this article is to present an updated review about this topic. METHODS: We thoroughly searched the peer reviewed research literature and compiled all such reportings (2004 onwards) for the benefit of researchers who further want to work on ketoprofen or other NSAIDs. RESULTS: Studies have been conducted to invent strategies to reduce the ulcerogenic properties of ketoprofen and in the course of time, its modified and improved derivatives have been synthesized in search of safer NSAIDs. Along with the aim of reducing the gastric side-effects, researchers have also done chemical modifications in the structure of ketoprofen to improve its solubility, to alter its blood brain-barrierr permeability, to improve its pharmacodynamic profile and to get derivatives possessing antioxidant, antiviral, anticancer and immunomodulatory activities. CONCLUSION: The findings of the review confirm that chemical modifications of ketoprofen decrease ulcer producing side effect while maintaining its desirable actions. Some derivatives were also found to possess better activity profile compared to the parent drug.

Evaluation of 19,460 Wheat Accessions Conserved in the Indian National Genebank to Identify New Sources of Resistance to Rust and Spot Blotch Diseases.

A comprehensive germplasm evaluation study of wheat accessions conserved in the Indian National Genebank was conducted to identify sources of rust and spot blotch resistance. Genebank accessions comprising three species of wheat-Triticum aestivum, T. durum and T. dicoccum were screened sequentially at multiple disease hotspots, during the 2011-14 crop seasons, carrying only resistant accessions to the next step of evaluation. Wheat accessions which were found to be resistant in the field were then assayed for seedling resistance and profiled using molecular markers. In the primary evaluation, 19,460 accessions were screened at Wellington (Tamil Nadu), a hotspot for wheat rusts. We identified 4925 accessions to be resistant and these were further evaluated at Gurdaspur (Punjab), a hotspot for stripe rust and at Cooch Behar (West Bengal), a hotspot for spot blotch. The second round evaluation identified 498 accessions potentially resistant to multiple rusts and 868 accessions potentially resistant to spot blotch. Evaluation of rust resistant accessions for seedling resistance against seven virulent pathotypes of three rusts under artificial epiphytotic conditions identified 137 accessions potentially resistant to multiple rusts. Molecular analysis to identify different combinations of genetic loci imparting resistance to leaf rust, stem rust, stripe rust and spot blotch using linked molecular markers, identified 45 wheat accessions containing known resistance genes against all three rusts as well as a QTL for spot blotch resistance. The resistant germplasm accessions, particularly against stripe rust, identified in this study can be excellent potential candidates to be employed for breeding resistance into the background of high yielding wheat cultivars through conventional or molecular breeding approaches, and are expected to contribute toward food security at national and global levels.

Exploiting Phenylpropanoid Derivatives to Enhance the Nutraceutical Values of Cereals and Legumes.

Phenylpropanoids are a diverse chemical class with immense health benefits that are biosynthesized from the aromatic amino acid L-phenylalanine. This article reviews the progress for accessing variation in phenylpropanoids in germplasm collections, the genetic and molecular basis of phenylpropanoid biosynthesis, and the development of cultivars dense in seed-phenylpropanoids. Progress is also reviewed on high-throughput assays, factors that influence phenylpropanoids, the site of phenylpropanoids accumulation in seed, Genotype × Environment interactions, and on consumer attitudes for the acceptance of staple foods rich in phenylpropanoids. A paradigm shift was noted in barley, maize, rice, sorghum, soybean, and wheat, wherein cultivars rich in phenylpropanoids are grown in Europe and North and Central America. Studies have highlighted some biological constraints that need to be addressed for development of high-yielding cultivars that are rich in phenylpropanoids. Genomics-assisted breeding is expected to facilitate rapid introgression into improved genetic backgrounds by minimizing linkage drag. More research is needed to systematically characterize germplasm pools for assessing variation to support crop genetic enhancement, and assess consumer attitudes to foods rich in phenylpropanoids.

A qualitative investigation of non-response in NHS health checks.

BACKGROUND: Improving uptake of NHS Health Checks has become a priority in England, but there is a lack of data on the perceptions of programme non-attenders. This study aimed to explore how non-attenders of NHS Health Checks perceive the programme, identify reasons for non-attendance and inform strategies to improve uptake. METHOD: This qualitative study involved individuals registered at four general practices in Stoke-on-Trent, UK, who had not taken up their invitation to a NHS Health Check. Semi-structured face-to-face and telephone interviews were audio-recorded and transcribed verbatim for Thematic Analysis. RESULTS: Interviews were completed with 19 males and 22 females (mean age 52.9 ± 8.5 years), who were socio-demographically representative of the non-attender population. Four main themes identified related to: the positive perception of the Health Check concept among non-attenders; the perceived lack of personal relevance; ineffective invitation method and appointment inconvenience were common barriers; previous experience of primary care can influence uptake. CONCLUSIONS: Fundamental requirements for improving uptake are that individuals recognise the personal relevance of Health Checks and that attendance is convenient. Incorporating more sophisticated and personalised risk communication as part of the invitation could increase impact and promote candidacy. Flexibility and convenience of appointments should be considered by participating general practices.

Method of invitation and geographical proximity as predictors of NHS Health Check uptake.

BACKGROUND: Uptake of NHS Health Checks remains below the national target. Better understanding of predictors of uptake can inform targeting and delivery. We explored invitation method and geographical proximity as predictors of uptake in deprived urban communities. METHODS: This observational cohort study used data from all 4855 individuals invited for an NHS Health Check (September 2010-February 2014) at five general practices in Stoke-on-Trent, UK. Attendance/non-attendance was the binary outcome variable. Predictor variables included the method of invitation, general practice, demographics, deprivation and distance to Health Check location. RESULTS: Mean attendance (61.6%) was above the city and national average, but varied by practice (47.5-83.3%; P < 0.001). Telephone/verbal invitations were associated with higher uptake than postal invitations (OR = 2.87, 95% CI = 2.26-3.64), yet significant practice-level variation remained. Distance to Health Check was not associated with attendance. Increasing age (OR = 1.04, 95% CI = 1.03-1.04), female gender (OR = 1.48, 95% CI = 1.30-1.68) and living in the least deprived areas (OR = 1.59, 95% CI = 1.23-2.05) were all independent positive predictors of attendance. CONCLUSIONS: Using verbal or telephone invitations should be considered to improve Health Check uptake. Other differences in recruitment and delivery that might explain remaining practice-level variation in uptake warrant further exploration. Geographical proximity may not be an important predictor of uptake in urban populations.

Contribution of individual risk factor changes to reductions in population absolute cardiovascular risk.

BACKGROUND: Few studies have investigated individual risk factor contributions to absolute cardiovascular disease (CVD) risk. Even fewer have examined changes in individual risk factors as components of overall modifiable risk change following a CVD prevention intervention. DESIGN: Longitudinal study of population CVD risk factor changes following a health screening and enhanced support programme. METHODS: The contribution of individual risk factors to the estimated absolute CVD risk in a population of high risk patients identified from general practice records was evaluated. Further, the proportion of the modifiable risk attributable to each factor that was removed following one year of enhanced support was estimated. RESULTS: Mean age of patients (533 males, 68 females) was 63.7 (6.4) years. High cholesterol (57%) was most prevalent, followed by smoking (53%) and high blood pressure (26%). Smoking (57%) made the greatest contribution to the modifiable population CVD risk, followed by raised blood pressure (26%) and raised cholesterol (17%). After one year of enhanced support, the modifiable population risk attributed to smoking (56%), high blood pressure (68%), and high cholesterol (53%) was removed. CONCLUSION: Approximately 59% of the modifiable risk attributable to the combination of high blood pressure, high cholesterol, and current smoking was removed after intervention.

Crouzon syndrome with bony upper airway obstruction: case report and review literature.

Crouzon syndrome is a rare genetic disorder. It is inherited as an autosomal dominant pattern. Mutations in the FGFR2 gene are known to cause Crouzon syndrome. Craniofacial abnormalities are common at birth and may progress with time. The severity of these signs and symptoms varies among affected children. A full term, large for date, male baby was delivered to a gravida 2 mother by cesarean section having facial dimorphism suggestive of Crouzon syndrome. Genetic team confirmed the diagnosis. Baby had severe respiratory distress. On work up, upper bony airway narrowing was found (diameter 3 mm). Later on, baby was operated for the same. Baby is asymptomatic now and doing well up to 2 months of follow-up. Management of Crouzon disease is multidisciplinary and early diagnosis has prime importance. Follow-up must ensure late features like hearing problems, vision problems, dental problems, intelligence, cranial synostosis, and upper airway problems.

One-year cardiovascular risk and quality of life changes in participants of a health trainer service.

AIMS: To explore 12-month changes in cardiovascular disease (CVD) risk and health-related quality of life (HRQoL) in participants of a health trainer (HT) programme. METHODS: Participants were 994 adults with at least one established CVD risk factor who were referred to a HT programme. The primary outcome was 12-month change in Framingham 10 year CVD risk score. Secondary outcomes included change in individual risk factors and HRQoL. Intention to treat analysis was used to explore 12-month changes for the overall population and those classified 'high risk' (≥20% CVD risk) at baseline. RESULTS: At baseline, 33.6% of participants were classified as 'high CVD risk' and 95.7% were overweight or obese. There were modest 12-month improvements in most modifiable CVD risk factors, but not overall CVD risk (-0.25±6.50%). In 'high-risk' participants significant reductions were evident for overall CVD risk (-2.34±8.13%) and individual risk factors. Small, significant 12-month HRQoL improvements were observed, but these were not associated with CVD risk change. CONCLUSIONS: Significant CVD risk reductions in participants in this HT programme with high baseline CVD risk (.20%) in HRQoL in the population as a whole indicated that the programme in its current form should target high-risk patients.

Randomized controlled trial of topical EMLA and breastfeeding for reducing pain during wDPT vaccination.

UNLABELLED: The primary objective was to evaluate the analgesic effect of a eutectic mixture of local anesthetics (EMLA) during whole cell DPT vaccination. The secondary objective was to evaluate if the analgesic effect of EMLA was synergistic to breastfeeding. A randomized, placebo-controlled trial was done to include infants of up to 3 months of age who came for their first DPT vaccination. The outcome variables were duration of cry, latency of onset of cry, and Modified Facial Coding Score. Thirty babies were enrolled in each of three groups. The groups did not differ significantly in baseline characteristics. Median (interquartile range) of duration of cry was least [34.6 (24.1-72.2) s] in babies receiving EMLA cream with breastfeeding (EB group), followed by 94.2 (46.1-180) s in babies receiving EMLA cream with oral distilled water (EW group), as compared to 180.0 (180-180) s in babies receiving placebo cream with oral distilled water (PCW group) (p < 0.05). Mean (SD) of latency of cry was significantly greater in EB group [2.4 (1.14) s] and EW group [1.9 (0.62) s] as compared to babies in PCW group [1.5 (0.47) s] (p < 0.05), but the difference between EB and EW groups was not significant. Modified Facial Coding Score was significantly lower in EB group as compared to the other groups (p < 0.05). CONCLUSIONS: Topical EMLA is effective in reducing pain and has a synergistic effect in analgesia when combined with breastfeeding during vaccination in infants.

Effect of oil massage on growth in preterm neonates less than 1800 g: a randomized control trial.

OBJECTIVE: To study the effect of oil massage on growth in preterm babies less than 1800 g. METHODS: This randomised controlled trial was conducted in Neonatal intensive care unit of a level II hospital. Neonates with birth weight < 1800 g, gestation < 35 wk and < 48 h of age at enrolment were included in the studies. Eligible neonates were randomized to one of the two groups (a) Oil massage along with standard care of low birth weight (b) Standard care of low birth weight without massage. Weight, length and head circumference was measured in the two groups at 7 d intervals. Serum triglyceride levels were measured at enrolment and at completion of study. Primary outcome variable was weight gain at 28 d after enrolment. RESULTS: A total of forty-eight neonates were randomisd to either oil massage group (n = 25) or standard care of low birth weight without massage group (n = 23). Mean (SD) weight of babies in the two groups was 1466.4 ± 226.8 g in oil massage group and 1416.6 ± 229.9 g in the control group. At 28 d, weight gain in the oil massage group (476.76 ± 47.9 g) was higher compared to the control group (334.96 ± 46.4 g) (p < 0.05). At 7 d, less weight loss (7.80 ± 9.8 g) was observed in babies in oil massage group compared to control group (21.52 ± 19.4 g) (p = 0.003). However, there was no significant difference in serum triglycerides and other anthropometric parameters. CONCLUSIONS: Oil application has a potential to improve weight gain and cause less weight loss in first 7 d in low birth weight neonates.

Cross-sectional review of the response and treatment uptake from the NHS Health Checks programme in Stoke on Trent.

BACKGROUND: As part of national policy to manage the increasing burden of chronic diseases, the Department of Health in England has launched the NHS Health Checks programme, which aims to reduce the burden of the major vascular diseases on the health service. METHODS: A cross-sectional review of response, attendance and treatment uptake over the first year of the programme in Stoke on Trent was carried out. Patients aged between 32 and 74 years and estimated to be at ≥20% risk of developing cardiovascular disease were identified from electronic medical records. Multi-level regression modelling was used to evaluate the influence of individual- and practice-level factors on health check outcomes. RESULTS: Overall 63.3% of patients responded, 43.7% attended and 29.8% took up a treatment following their health check invitation. The response was higher for older age and more affluent areas; attendance and treatment uptake were higher for males and older age. Variance between practices was significant (P < 0.001) for response (13.4%), attendance (12.7%) and uptake (23%). CONCLUSIONS: The attendance rate of 43.7% following invitation to a health check was considerably lower than the benchmark of 75%. The lack of public interest and the prevalence of significant comorbidity are challenges to this national policy innovation.

NHS health checks through general practice: randomised trial of population cardiovascular risk reduction.

BACKGROUND: The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD) risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services. METHODS: Randomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support) patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking. RESULTS: Average population CVD risk decreased from 32.9% to 29.4% (p <0.001) in the NHS Health Check only group and from 31.9% to 29.2% (p <0.001) in the NHS Health Check plus additional lifestyle support group. There was no significant difference between the two groups at either measurement point. Prevalence of high blood pressure, high cholesterol and smoking were reduced significantly (p <0.01) in both groups. Prevalence of central obesity was reduced significantly (p <0.01) in the group receiving additional lifestyle support but not in the NHS Health Check only group. CONCLUSIONS: The NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.