Children learn more with one or more signs or symptoms of the a priori criteria were examined by a pediatrician, referred to a pediatric surgeon and admitted to hospital, as necessary. An intususception case adjudication committee consisting of a pediatric surgeon, a pediatrician, and a radiologist reviewed all investigator-diagnosed cases of intussusception using the Brighton criteria level 1 to provide the final diagnosis [14].

Analyses were done by Quintiles using SAS® Version 9.2. Efficacy analysis is presented for the per-protocol (PP) population. The PP population included all subjects who received the same treatment for all three doses of vaccine orplacebo within the a priori defined windows and who reported episodes of diarrhea occurring more than 14 days after the third dose. For each endpoint within the three age windows (from more than 14 days after third dose to the end of age 1 and 2 years and for age 1–2 year period), only the first event was counted for each subject. The

follow up period associated with each event was calculated as time to occurrence of that event or date of dropout or the date of completion of follow up. Efficacy estimates for first year of life include events that occurred till one year of age and efficacy for the second year includes events occurring between 1 and 2 years. Vaccine efficacy was calculated as 100 × (1 − [nv/Fv]/[np/Fp]) person time incidence rate, where nv and np were the number of subjects with at least one episode in the relevant Resveratrol groups (vaccine or placebo) and Fv and Fp are the total

length of follow up in the relevant treatment group. p values and confidence intervals for vaccine efficacy were computed buy UMI-77 using exact binomial methods [15]. Efficacy outcomes are also displayed as a forest plot of incidence rate ratios on a log scale in the two groups. The time to event analysis by groups are presented as Kaplan–Meier curves. The Department of Biotechnology, and Biotechnology Industry Research Assistance Council, Government of India, New Delhi, India; the Bill & Melinda Gates Foundation (#52714) to PATH, USA; Research Council of Norway; Department for International Development, United Kingdom; National Institutes of Health, Bethesda, USA; Bharat Biotech International Limited, Hyderabad, India provided funding. The funders had no influence on how the data was collected; analyses were done by Quintiles. Of the 7848 infants screened, we enrolled 6799 subjects: 4532 subjects received the vaccine and 2267 subjects the placebo. A total of 4419 in the vaccine group and 2191 in the placebo group completed follow up till 2 years of age. In the PP analyses, 4354 in the vaccine group and 2187 in the placebo group were included for the overall analyses (Fig. 1). The total follow up time in the PP population was 7066.4 and 3482.3 years in the vaccine and placebo groups, respectively. The mean (SD) ages at the time of receiving dose one, two and three were 6.8 (0.6), 11.7 (2.4) and 16.3 (2.

stutzeri and its

pH was maintained at 4.0, at temperature 70 °C. Since, the effluent’s initial pH is 6.0, when effluent was inoculated with the identified organism P. stutzeri, the strain starts producing hydrogen immediately. The influence of pH change on hydrogen production was observed to find the maximum hydrogen production. Ulixertinib mw The hydrogen produced was measured by simple water displacement method for a period of 5 days. 21 P. stutzeri SSKVM 2012 is found to be thermophilic, rod shaped, gram negative, anaerobic with an optimum growth at 70 °C. The strain is alkaliphilic and able to grow at wide range of pH from 5.5 to 9.0. There was no growth observed at pH 4.0–pH 5.0 or below. Further pH in the range of 6.5–8.5 was found to be a favourable for the strain to produce hydrogen. The strain hydrolyses starch and found to produce hydrogen sulphide. The 16S rRNA gene sequence of isolate confirms that the organism isolated was P. stutzeri. The sequence of P. stutzeri (HM209781.1) had 99% identity to Pseudomonas xanthomarina (HQ848111.1) and Pseudomonas knackmussii (JN646015.1) and these two sequences grouped together in a phylogenetic tree ( Fig. 1). The sequence reported in this paper has been deposited in the genbank under the accession number JX442762 and the strain identified from the thermal soil sample was named Vorinostat mouse as SSKVM 2012. The hydrogen

production from starch, sucrose measured by water displacement method is shown in Table 1. Initial pH of the soluble starch, sucrose medium was maintained at pH 4.0 and at 70 °C. No hydrogen SB-3CT production was observed

at initial pH 4.0 to pH 5.0. The maximum hydrogen production observed for starch was 255.98 ± 0.76 ml, 195.87 ± 0.82 ml, 176.84 ± 0.64 ml, 125.83 ± 0.64 ml. Similarly, the sucrose showed 212.82 ± 0.57 ml, 194.85 ± 0.69 ml, 191.85 ± 0.76 ml, 177.92 ± 0.78 in 7.5 g/1500 ml, 5.0 g/1000 ml, 3.75 g/750 ml, 2.5 g/500 ml respectively. Among the different concentrations used 7.5 g starch showed highest hydrogen production. The hydrogen production from effluent is shown in Table 2. The initial pH of the mango juice effluent was found to be pH 6.0. The effluent was inoculated with culture P. stutzeri and the study was performed at 70 °C. The maximum hydrogen production observed was 190.03 ± 0.81 ml, 186.13 ± 0.57 ml, 144.96 ± 0.72 ml, 104.93 ± 0.64 ml in 1500 ml, 1000 ml, 750 ml, 500 ml mango juice effluent at pH 8.0. The hydrogen production was found to be low when compared to starch and sucrose but the effluent is recycled to an useful product and signifies eco-friendly environment. Water displacement methods can be more effective as pressure is released, but gases can disproportionally dissolve based on their different solubilities in the solution, making it difficult to determine the produced gas composition. Biological H2 production is the most challenging area of biotechnology with respect to environmental problems.

14 HPLC has preferred analytical tool for fingerprints and quantification of marker

compounds in herbal drugs because of its simplicity, sensitivity, accuracy, suitability for thorough screening etc.15 Lumacaftor cell line RP-HPLC-PDA has been used in published studies to quantify and characterise of Stigmasterol.10 HPLC analysis was conducted to quantitatively estimate the content of Stigmasterol in the methanolic leaves extract of D. patulus at a detection wavelength of 205 nm. The quantity of Stigmasterol was calculated from the respective peak areas according to individual standard curves. Fig. 1 and Table 3 shows the retention times and peak area of the standard. Fig. 2 and Table 3 indicates the retention times and peak area of the sample and the content of the compound was 0.22 mg/g dry weight (0.022%) ( Table 4). The results of present study

confirm the data BKM120 nmr previously reported on the identification and quantification of Stigmasterol in plant extract.16 Oxidative stress is marked by elevated tissue lipid peroxidation that in turn leads to cellular damage. This is believed to be a major cause for various diseases including cancer, cardiac problems and diabetes. Antioxidants are also used for the amelioration of different pathological conditions. The lipid peroxidation inhibiting property observed earlier with the whole plant extract of Butea monosperma might be the result of stigmasterol. 17 Stigmasterols or generally Rolziracetam phytosterols were hypothesized to exert their anticancer properties through multiple pathways inclusive of modulations of signal transduction pathways and apoptosis. Phytosterols were found to inhibit tumour growth of non-hormone dependent breast cancer cells via the sphingomyelin pathway. Stigmasterol was reported to induce four to six fold increases in apoptotic death in MDA-MB-231 cells as evidenced by measuring the release of nucleosomes into the cytoplasm. The molecular targets in apoptosis induction by stigmasterols were found to involve down regulation of oncogene c-myc and transcription factor p53.18 Physiochemical analyses have shown the purity and quality of crude drug. The medicinal property of this plant may be

related to their bioactive compounds. Quantitative estimation by HPLC-PDA revealed the presence of good percentage of stigmasterol in D. patulus. This study has grasped the importance since stigmasterol possesses lipid peroxidation inhibitory action and anticancer activity. These features make this plant a promising candidate for the further studies on isolation and pharmacological studies of this compound from D. patulus. All authors have none to declare. “
“Diabetes mellitus (DM) is characterized by abnormal insulin secretion, derangements in carbohydrate/lipid metabolism and is diagnosed by hyperglycaemia.1 and 2 The world prevalence of diabetes among adults is expected to be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7% i.e.

mIL-10 (accession no. NP_034678) cDNA that was amplified with a pair of NotI-tagged primers, 5′-ACTTGCGGCCGCCAAAGTTCAATGCCTGGCTCAGCACTGCTATGCTGCCTG-3′ and 5′-ATCCGCGGCCGCGATAACTTTCACCCTAAGTTTTTCTTACTACG GTTAGCTTTTCATTTTGATCATCATGTATGCTTC-3′, was subcloned into the F gene-deleted site of the LitmusSalINheIhfrag-TSΔF carrying the SalI and NheI digested fragment containing M and HN genes from pSeV18+/TSΔF find more in LITMUS38 (NEB) [27]. The

SalI and NheI digested fragment of pSeV18+Aβ1–43/TSΔF was substituted with the corresponding fragment of the mIL10 gene-introduced LitmusSalINheIhfrag-TSΔF. The cDNA of SeV18+LacZ/TSΔF (pSeV18+lacZ/TSΔF) was constructed in similar manner using an amplified fragment of LacZ [26]. pSeV18+Aβ1–43/TSΔF-mIL10 or pSeV18+LacZ/TSΔF was transfected into 293T cells with T7-expressing plasmid. The T7-driven recombinant SeV18+Aβ1–43/TSΔF-mIL10 and SeV18+LacZ/TSΔF RNA genomes were encapsulated by NP, P, and L proteins, which were derived

from their respective co-transfected plasmids. The recovered SeV vectors were propagated using F protein-expressing packaging cell line [23]. The virus titers were determined using infectivity and were expressed in cell infectious units (CIU). The SeV vectors were stored at −80 °C until use. rSeV was diluted with PBS to give 5 × 106 CIU/head in a final volume of 0.02 ml, and was administered once nasally or intramuscularly (left TGF-beta inhibitor quadriceps) to 12-month-old Tg2576 mice for analysis of cognitive functions and body weight, or to 24-month-old Tg2576 mice for evaluation of amyloid burdens and Aβ contents in the brain. Control Tg2576 mice received rSeV-LacZ and were

analyzed in the same way. Tg2576 mice received the vaccine nasally or intramuscularly at the age of 24 months and were sacrificed 8 weeks after by CO2 asphyxiation. Their brains were removed and cut in half sagittally. Anti-human Aβ antibody titers in the serum of nasally or intramuscularly vaccinated mice with rSeV-Aβ or rSeV-LacZ (n = 4 each) were quantified by a sandwich ELISA. Microtiter ELISA plates were coated 17-DMAG (Alvespimycin) HCl overnight at 4°C with 2 μg/ml of synthetic human Aβ1–42 in 0.1 M NaHCO3, pH 8.3, washed twice with washing buffer, blocked with 1% BSA and 2% normal goat serum in PBS for 2 h at room temperature (RT), washed twice and incubated with mouse serum samples diluted 1:500 in blocking buffer for 2 h at RT while shaking, washed × 4 and incubated horseradish peroxidase-conjugated goat-anti-mouse IgG for 2 h at RT, washed × 4 and analyzed colorimetrically after incubation with the chromogen substrate 3,3′,5,5′-tetramethylbenzidine (Kirkegaard & Perry Laboratories, Gaithersburg) at RT. Using highly specific antibodies and a sensitive sandwich ELISA, we quantified insoluble Aβ40 and Aβ42 in brain homogenates extracted with TBS, 2% SDS and 70% formic acid according to the method described [28].

megaterium was found to be resistant against Ceftazidime and Cloxacillin Afatinib clinical trial ( Table 1). The λmax value at 432 nm indicates the formation of citrate stabilized AgNPs and the size was found to be 120 nm ( Figs. 1 and 2). The λmax value was found to be 431 nm for the AgNPs synthesized by aqueous extract of O. sanctum and the size was found to be 157.2 nm ( Figs. 3 and 4). The MIC and MBC values of citrate

stabilized AgNPs were found to be 60, 160 μg/mL and 80, 160 μg/mL respectively against S. aureus and B. megaterium. The MIC and MBC values of AgNPs synthesized by the aqueous extract of O. sanctum were found to be 40, 120 μg/mL and 80, 140 μg/mL respectively against S. aureus and B. megaterium ( Fig. 5). The presence of multidrug resistant bacteria in hospital wastes throughout the world has been documented.16 The frequent use of antibiotics in medicine and veterinary Selleck Panobinostat practice has aroused some concern about the incidence and spread of antibiotic resistance among bacterial populations. As a result of the massive usage of antibiotics in medical practices, these bacteria inevitably enter the natural environment. In the current study, we found S. aureus and B. megaterium showing resistance against Ampicillin, Penicillin, Cloxacillin, Ceftazidime, Methicillin and Ceftazidime, Cloxacillin respectively. But both the

isolates were found to be sensitive against antimicrobial AgNPs synthesized by the chemical as well as the green method. The MIC is the lowest concentration 4-Aminobutyrate aminotransferase of antimicrobial agents that completely inhibits the growth of the microorganisms.

The MBC is defined as the lowest concentration of antimicrobial agent that kills 99.9% of the initial bacterial population. In the current study, both the MIC and MBC values obtained by adding AgNPs synthesized by aqueous extract of O sanctum, against both the MDR bacterial isolates were found to be encouraging compared to the values obtained by using citrate stabilized AgNPs, irrespective to their size. It is well known that silver-based compounds have antibacterial activities and many investigators have worked out their applications in different fields of science because of their potent biocidal activities against multidrug resistant bacteria. 15, 17 and 18 The difference in the results may be due to the role played by the alkaloids present in the aqueous extract of O. sanctum reported in many literature along with the AgNPs synthesized. 19 We have studied the effect of antimicrobial AgNPs synthesized by both chemical and green method against MDR isolates and found the AgNPs synthesized by the extract of O. sanctum more effective. We have developed a very convenient green method of synthesizing antimicrobial AgNPs with an average size of 157.2 nm having better antimicrobial activities compared to citrate stabilized AgNPs against both gram positive and negative MDR isolates, which encourages more research in the field of green synthesis of antimicrobial AgNPs. All authors have none to declare.

We used multivariate analyses to mathematically simplify a set of 10 factors to two predictors of shoulder pain. The multivariate model had a good level of accuracy, and explained 63% of the variance in the dataset. Additional factors, such as age and altered tone, did not enhance the model, which suggests that the fit of the model was good. Nevertheless, given that any model is highly dependent upon its derived dataset (Tabachnick and Fiddell 2001), the findings should be replicated in other samples before being recommended see more for wider use. Our findings support that shoulder pain post-stroke is heterogeneous in nature (Price 2002). Level of risk and underlying mechanisms

are likely to vary according to the type and severity of impairments, and personal (eg, age and premorbid shoulder problems) and environmental factors (eg,

trauma) (Ratnasabapathy et al 2003). It therefore seems important to develop clearer diagnostic classifications in order to direct clinical management. Our findings indicate that the Motor Assessment Scale Upper Arm item selleck chemicals llc score may be helpful for this issue. For instance, a score of < 4 indicates a high risk of developing shoulder pain, as proposed in the Management Tool for Acute Hemiplegic Shoulder (Nicks et al 2007). For this group of patients, who are also more likely to have shoulder subluxation, clinical management including use of arm support, electrical stimulation, education, and active motor training to promote shoulder girdle control, as outlined by Nicks and colleagues, seems highly appropriate. However, despite the lower odds, patients admitted with a score of 4 or 5 in our study also had shoulder pain. Physiotherapists would need to employ other approaches to manage these people as different mechanisms for pain, such as shoulder

impingement, are likely (Bender and McKenna 2001, Blennerhassett et al 2009). Despite the observed association with pain, reduced passive range and motor control at the shoulder cannot be considered the cause of post-stroke Cediranib (AZD2171) shoulder pain. Nevertheless, the findings suggest that clinical attention could be directed to improving pain free shoulder joint range, or promoting active shoulder girdle control to align the glenohumeral joint and enable arm elevation. Training should be carefully structured and monitored, given the importance of highly co-ordinated muscular control within the shoulder girdle (Dontalelli 2004), and the potential for impingement, wear and tear, inflammation, and subsequent pain at the shoulder – particularly when the muscles are weak or fatigued, or while performing overhead activities (Ludewig and Reynolds 2009). Education and training of staff, carers, and patients in how to care for the arm are also warranted (Nicks et al 2007, Turner-Stokes and Jackson 2002), given the vulnerability of a weak shoulder and the events described that may have contributed to the development of shoulder pain.

They found that the experimental group had significantly more lengthening of the silent period, increase learn more in resting motor threshold and gait speed than the sham group. These findings suggest that both functional improvement and possible cortico-motor plastic changes occur after combined

rTMS and task-specific training. While the positive results from Yang et al (2013) and previous studies seem promising, the optimal dosage and stimulation protocol of rTMS are yet to be determined. Yang et al (2013) used high frequency rTMS of 5 Hz and stimulated the more affected side of the brain for 12 sessions. Previous studies employed high frequency rTMS stimulation ranging from 5 Hz to 25 Selleckchem EX527 Hz, and stimulated both hemispheres for a total of 8–15 sessions (Gonzalez-Garcia 2011, Khedr et al 2003, Lomarev et al 2006). Two studies reported that the improvement in gait performance lasted for 1 month (Khedr et al 2003, Lomarev et al 2006), hence the treatment effect beyond 1 month is not known. Although meta-analysis reported a positive trend of high frequency rTMS on reducing PD-specific impairment and disability level (Elahi et al 2009), most of the studies had a small sample size (n = 10–36). It is time to carry out large scale randomised controlled trials to determine the stimulation frequency, stimulation

site and total pulse, and the number of treatment sessions. Further study is also needed to examine the long-term effect of rTMS in enhancing motor function and electro-physiological changes

in PD. “
“Summary of: Dinesen B, et al (2012) Using preventative home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive and pulmonary disease patients. J Telemed Telecare 18: 22–225. [Prepared by Kylie Hill, CAP Editor.] Question: Does telehealth reduce the hospital admission rate and cost for people with chronic obstructive pulmonary disease (COPD)? Design: Randomised controlled trial with concealed allocation. Setting: The participants’ homes in Aalborg, Denmark. Participants were linked with healthcare professionals at primary and secondary healthcare facilities using telehealth technology. Participants: Adults were included if they had severe or very severe COPD, lived in Aalborg, and were free from other diseases that limited function (eg, heart disease). Randomisation allocated 60 to the intervention group and 51 to the control group. Interventions: Participants in the intervention group had a telehealth monitoring device installed in their home for four months and were taught how to monitor their symptoms, measure clinical data (eg, spirometry), use a step counter, and given instructions about home exercise. Healthcare professionals accessed the data to monitor their disease and provide advice.

1 and 6 The view of stem cells of origin can explain why the neuroendocrine and non-neuroendocrine components can be simultaneously observed in neuroendocrine

carcinomas. For example, GPCR Compound Library the neuroendocrine component of lung and gastrointestinal tract commonly appear in combination with squamous cell carcinoma or adenocarcinoma, the neuroendocrine component of renal pelvis is frequently accompanied with transitional cell carcinoma (TCC). However, the present case we reported showed squamous metaplasia component, which is extremely rare. Generally, TCC is the most common type in renal pelvis neoplasmas, whereas the type of squamous cell carcinoma or TCC with squamous

metaplasia in renal pelvis is often accompanied with incentive factors such as pyelonephritis, kidney stones, and renal pelvis leukoplakia. In this case, we consider that the kidney stones induce the squamous metaplasia component located within the tumor. Although neuroendocrine carcinoma has typical Hydroxychloroquine in vitro morphologic features including highly cellular atypia, high mitotic/proliferative indices, and extensive necrosis, sometimes it is difficult to make a rapid and definite diagnosis by conventional histologic preparations. The differential diagnoses include malignant lymphoma, lymphoepithelioma such as carcinoma, plasmacytoid carcinoma, poorly differentiated urothelial carcinoma,

and primitive neuroectodermal tumor. For this case, the primary diagnosis of nephroscopy biopsy was urothelial carcinoma with necrosis. However, the resected tumor was confirmed to be a high-grade neuroendocrine Fossariinae carcinoma with focal squamous metaplasia by immunohistochemical markers, including synaptophysin, neuron-specific enolase, CD56, and P63 (Fig. 3). As neuroendocrine carcinoma frequently occurs in lung and gastrointestinal and rarely arises from urogenital system, the confirmation of the primary site is important. However, no neuroendocrine carcinomas were found in other anatomic sites before surgery, indicating this rare neuroendocrine carcinoma might originate from urothelial epithelium of the renal pelvis. Hematuria and flank discomfort or pain were the most frequent clinical symptoms in the cases of renal pelvis high-grade neuroendocrine carcinomas. Surprisingly, no endocrine syndromes were described in these cases. This type of tumor is characterized by an aggressive clinical course with early metastasis, and the usual sites of metastasis are lymph nodes and bone. It has been reported that patients with urologic poorly differentiated neuroendocrine carcinomas treated with chemotherapy independently showed a better survival than patients treated with surgery or combination therapy of surgery and chemotherapy.

An 80-year-old man was referred for a small pus-draining cutaneous opening on the lower part of the scrotum. The patients presented with intermittent gross painful hematuria, partial urinary retention, and dysuria. The Pifithrin-�� research buy past history showed that the patients had received urethral catheterization because of voiding difficulty 5

years before visiting our clinic. The walnut-sized mass was palpated hard in the middle of the scrotum, and pus was drained through a 2-mm-sized opening on the scrotum. He had been treated with intravenous antibiotics and fluid for 16 days, but there was no interval improvement. Under the impression of any fistula from urethra, a retrograde urethrography (RGU) was done. When performing the RGU, we encountered a catheter shadow in the bladder and the urethra (Fig. 1). Distal tip of the catheter was lying outside of the urethral course, heading down toward the scrotum. But there was no evidence of contrast

leak on RGU. The cystoscopy was performed Smad inhibitor to confirm the catheter in the urethra (Fig. 2) and possibly to remove the catheter without open surgery. There was a Foley catheter stuck outside of the bulbous urethra. With the aid of foreign body forceps, the catheter, which was about 18F in size, could be barely grabbed and pushed back toward proximal urethra to make the buried tip of the catheter free. Then it was smoothly removed out of the body along the urethral course (Fig. 3). The removed catheter was a broken one with its balloon deflated, but there was no remaining piece of catheter within the urinary

bladder. After removal of the retained catheter, the patients received further treatment with intravenous fluid and antibiotics for another 3 days. The patient was discharged home with a new urethral catheter and oral antibiotics. A week later, the fistula opening was closed spontaneously. One month later, RGU showed no leakage out of urethral lumen, and the scrotum returned to a normal condition without any fistulous opening or mass. A neglected or lost urethral Adenosine catheter can result in some complications requiring surgical procedures. Bendana et al3 showed a case of a straight catheter lost in the urethra and forgotten for 20 years and its safe surgical removal. In their report, the urethral catheter with stone formation was removed through a perineal urethrotomy and incision at the meatus and fossa navicularis. In contrast to the previous report, there was no significant catheter encrustation in our case; therefore, we could remove the retained catheter via natural urethra with cystourethroscopy. However, it was reported that up to 50% of patients undergoing long-term catheterization would experience catheter encrustation, which stemmed from the infection of urease producing bacteria.

The risks of mortality and re-hospitalisation are difficult to Selleckchem EX527 predict with precision in the population of people with heart failure. Most tests aimed at determining factors that could be used as predictors of morbidity and mortality in this group of patients are complicated and expensive, which prevent them from being cost effective. A marked reduction in the capacity to undertake

physical activity is one of the principal symptoms of heart failure. Therefore, potential associations have been investigated between various methods of assessing physical exercise capacity and prognosis (Sarullo et al 2010, Poggio et al 2010). Many predictor variables from formal cardiopulmonary exercise testing have been proposed, including peak oxygen consumption as a percentage of the predicted value, the chronotropic index, and ventilatory efficiency (Poggio et al 2010). When multiple predictors are available, conflicting predictions can make interpretation difficult (Poggi et al 2010). The 6-minute walk test is a simple and inexpensive method of indirectly assessing physical capacity that is widely available and commonly used (Bellet et al 2011, Rostagno et al 2008,

Faggiano et al 2004). Most previous studies have What is already known on this topic: selleck products The 6-minute walk test is a simple and inexpensive method of indirectly assessing exercise tolerance. The distance covered by hospitalised patients during the test is predictive of the 1-year risk of cardiovascular death. What this study adds: Among men with chronic heart failure, the 1- and 3-year mortality risk are greater among those who cover less than 468 m on the 6-minute walk test. The specific research questions for this study were: 1. Are there relationships

between the distance covered during the 6-minute walk test and the clinical characteristics of men with stable heart failure? This was a prospective, longitudinal, observational study in which the predictive ability of the 6-minute Methisazone walk test distance was assessed in men with stable heart failure. Participants were followed up for a minimum of three years. The clinical outcomes assessed were mortality and hospitalisation for cardiovascular reasons. Participants were recruited from the Heart Failure Outpatient Clinic of the Center for Heart Disease in Wroclaw, Poland. Male clinic attendees with stable systolic heart failure were approached consecutively and informed about what participation in the study would entail. Those who expressed interest in participation underwent a cardiac evaluation and this was used to assess whether they met the eligibility criteria.