Data are critically important to good decision-making. In an increasingly complex economy, conventional data collecting schemes are no longer sufficient. To deal with the challenge of maintaining its statistics releva...Data are critically important to good decision-making. In an increasingly complex economy, conventional data collecting schemes are no longer sufficient. To deal with the challenge of maintaining its statistics relevant to the users in an ever-shifting environment, the Banco de Portugal decided to explore the largely unused statistical potential of the available micro-databases and to integrate the existing administrative and survey data, thus enhancing the basic information infrastructure while protecting confidentiality. This presentation will address the benefits and problems to be dealt with when two or more data-sources are to be integrated.展开更多
Developing nations, like Nigeria, whose financial systems and infrastructural base are not yet fully developed face data rendition challenges which may hamper the representativeness of their interest rate statistics.A...Developing nations, like Nigeria, whose financial systems and infrastructural base are not yet fully developed face data rendition challenges which may hamper the representativeness of their interest rate statistics.A critical component of any credible interest rate data compilation framework relates to the sampling procedure.In Nigeria, no work has been done with regards to employing alternatives sampling techniques in the computation of interest rate statistics largely because of the small number of deposit money banks in the country. Leveraging on existing literature and established statistical methods, the study examines two sampling techniques for generating credible and reliable interest rates in Nigeria. The current interest rate compilation framework in the country is presented and alternative sampling procedures were explored with a view to investigating their appropriateness for Nigeria＇s interest rate computation. The interest rates generated based on the current population-based compilation method is compared with those of the alternative approaches. This paper recommends the use of purposive sampling method that covers Deposit Money Banks （DMBs） which account for about 70.0 per cent of the banking sector total assets as an appropriatealternative.展开更多
Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical expe...Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical experience and recovery.This mini review aims to evaluate the impact of preoperative anxiety in children,identify contributing factors,and explore effective strategies to manage this anxiety during day surgery.Methods:A literature review was conducted,focusing on studies that assess anxiety levels in pediatric patients before day surgery and the interventions designed to alleviate this anxiety.The review included both psychological and procedural strategies.Results:Preoperative anxiety in children can be influenced by a variety of factors,including age,previous medical experiences,parental anxiety,and the hospital environment.Untreated anxiety may lead to increased postoperative pain,behavioral changes,and extended recovery times.Several strategies,including psychological preparation,family centered approaches,and the involvement of child life specialists,have been shown to effectively reduce anxiety.Conclusions:Managing anxiety in pediatric day surgery is vital to improving both surgical outcomes and the overall experience for children and their families.Healthcare professionals can play a key role in reducing anxiety through targeted interventions and supportive care.展开更多
This study is to determine age-specific prostate-specific antigen （PSA） distributions in Chinese men without prostate cancer （PC） and to recommend reference ranges for this population after comparison with other s...This study is to determine age-specific prostate-specific antigen （PSA） distributions in Chinese men without prostate cancer （PC） and to recommend reference ranges for this population after comparison with other studies. From September 2003 to December 2006, 9 374 adult men aged from 18 to 96 years agreed to participate in the study. After all cases of PC were excluded, 8 422 adult men participated in statistical analysis and were divided into five age groups. Simple descriptive statistical analyses were carried out and quartiles and 95th percentiles were calculated for each age group. The age-specific PSA reference ranges are as follows： 4049 years, 2.15 ng mLl; 50-59 years, 3.20 ng mLl; 60-9 years, 4.10 ng mL^-1; 70-79 years, 5.37 ng mL^-1. The results indicate that the ethnic differences in PSA levels are obvious. The currently adopted Oesterling＇s age-specific PSA reference ranges are not appropriate for Chinese men. The reference ranges of this study should be more suitable to Chinese men.展开更多
AIM： To assess whether the effectiveness of a combination of transarterial chemoembolization （TACE） and percutaneous ethanol injection （PEI） in the treatment of unresectable hepatocellular carcinoma （HCC） is su...AIM： To assess whether the effectiveness of a combination of transarterial chemoembolization （TACE） and percutaneous ethanol injection （PEI） in the treatment of unresectable hepatocellular carcinoma （HCC） is superior to TACE alone a randomized controlled trial was performed. METHODS： The effect of combination therapy on longterm survival rates and duration of hospitalization was evaluated in 52 previously untreated HCCs, randomly allocated to TACE-PEI （27 pts） or TACE alone （25 pts）. RESULTS： The cumulative survival rate of the TACE group was 75.8% at 6 mo, 62.9% at 12 mo, and 18.0% at 24 mo and of the TACE-PEI group 76.9%, 61.5%, and 38.7%, respectively. Comparison of overall survival in both groups showed no statistically significant difference. Regarding the patients with HCCs Okuda stage I （n = 26）, the median survival of the TACE-PEI group was significantly longer （〉24 mo, median not yet reached in the study period） compared to the TACE group （18.4 mo [range 11.6-21.7 mo]; P = 0.04）. TACE-PEI reduced the relative risk for mortality to 0.4 （95% CI 0.15-0.96） compared to patients who received TACE alone. Median survival in patients with HCCs Okuda stage Ⅱ or Ⅲ was 5.0 mo in the TACE group （1.7 rno-not defined） compared to 10.4 mo in the TACE-PEI group. CONCLUSION： The combination TACE-PEI improved survival time compared to TACE alone. Our study revealed a statistically significant improved survival in HCCs Okuda stage I. Side effects were minor and the combination therapy did not prolong duration of hospitalization considerably.展开更多
Objective:To detect the anticandidal activity of nine toothpastes containing sodium fluoride, sodium monofluorophosphate and herbal extracts as an active ingredients against 45 oral and non oral Candida albicans(C.alb...Objective:To detect the anticandidal activity of nine toothpastes containing sodium fluoride, sodium monofluorophosphate and herbal extracts as an active ingredients against 45 oral and non oral Candida albicans(C.albicans) isolates.Methods:The antifungal activity of these toothpaste formulations was determined using a standard agar well diffusion method.Statistical analysis was performed using a statistical package,SPSS windows version 15,by applying mean values using one-way ANOVA with post-hoc least square differences(LSD) method.A P value of less than 0.05 was considered significant.Results:All toothpastes studied in our experiments were effective in inhibiting the growth of all C.albicans isolates.The highest anticandidal activity was obtained from toothpaste that containing both herbal extracts and sodium fluoride as active ingredients, while the lowest activity was obtained from toothpaste containing sodium monofluorophosphate as an active ingredient.Antifungal activity of Parodontax toothpaste showed a significant difference(P<0.001) against C.albicans isolates compared to toothpastes containing sodium fluoride or herbal products.Conclusions:In the present study,it has been demonstrated that toothpaste containing both herbal extracts and sodium fluoride as active ingredients are more effective in control of C.albicans,while toothpaste that containing monofluorophosphate as an active ingredient is less effective against C.albicans.Some herbal toothpaste formulations studied in our experiments,appear to be equally effective as the fluoride dental formulations and it can be used as an alternative to conventional formulations for individuals who have an interest in naturally-based products.Our results may provide invaluable information for dental professionals.展开更多
Objective:Yes associated protein 1(YAP1)is a member of the Hippo pathway,acting as a transcriptional coactivator.To elucidate the role of YAP1 and phosphorylated(p)YAP1 in prostate cancer(PCa)tumorigenesis,we investig...Objective:Yes associated protein 1(YAP1)is a member of the Hippo pathway,acting as a transcriptional coactivator.To elucidate the role of YAP1 and phosphorylated(p)YAP1 in prostate cancer(PCa)tumorigenesis,we investigated their expression in clinical samples of PCa and cell lines.Methods:Fifty-four tumor,adjacent nontumor,and prostate intraepithelial neoplasia(PIN)tissues from patients with PCa after radical prostatectomy were selected from a retrospective cohort and studied using immunohistochemistry(IHC).Protein and m RNA expression levels of YAP1 were evaluated by Western blot analysis and quantitative real-time reverse transcription PCR,respectively,in cancer cell lines.Publicly available gene expression datasets were downloaded to analyze YAP1 m RNA and protein levels in PCa tissue samples.Results:IHC analysis of PCa tissues revealed that YAP1 staining intensities were moderate to weak in the nucleus and cytoplasm of tumor cells,whereas adjacent normal epithelia showed strong staining.We observed that benign prostates were characterized by higher expression levels of both nuclear(P=0.004)and cytosolic(P=0.005)YAP1.p YAP1 staining was weak in the cytoplasm and absent in the nucleus of all the tissues investigated.YAP1 expression was an indicator of extraprostatic extension(EPE).The level of YAP1 was negatively correlated with the level of the androgen receptor(AR)in The Cancer Genome Atlas dataset and Western blot analysis of cell lines.Conclusions:Our study suggested that YAP1 expression is heterogeneous in PCa tissue samples;therefore,YAP1 might play different roles in different aspects of PCa progression.This might involve AR–YAP1 interplay in PCa.展开更多
This study is to assess the potential factors that could affect the serum prostate-specific antigen （PSA） level in healthy younger men. We evaluated the associations of age, body mass index （BMI） and serum lipid p...This study is to assess the potential factors that could affect the serum prostate-specific antigen （PSA） level in healthy younger men. We evaluated the associations of age, body mass index （BMI） and serum lipid profile with serum PSA level in 6774 Chinese men （aged 20-49 years） who received a routine health examination. Eligible men were classified into 10-year age groups, BMI was categorized as underweight （〈18.5）, normal （18.5-22.9）, overweight （23.0-24.9）, obese （25.0-29,9） and very obese （〉30） according to the redefined World Health Organization （WHO） criteria for the Asia-Pacific region. PSA levels were compared among groups as well, In multiple linear regression analysis, PSA was positively correlated with age （P〈0.0001）. Negative correlations existed between PSA and BMI （P〈0.0001） and triglyceride level （P=0.01）. No relationship could be found between PSA and serum cholesterol （P=0.711） or high-density lipoprotein （HDL; P =0.665）. In addition, we found that serum PSA levels increased with age and decreased with BMI. Our study demonstrates that age, BMI and triglyceride levels influence the PSA level in men 〈50 years of age.展开更多
BACKGROUND Acute liver failure(ALF)can be a primary presentation of Wilson disease(WD).Mortality rates are high in WD with ALF(WDALF).Predictions of mortality in WDALF vary by model and are sometimes contradictory,per...BACKGROUND Acute liver failure(ALF)can be a primary presentation of Wilson disease(WD).Mortality rates are high in WD with ALF(WDALF).Predictions of mortality in WDALF vary by model and are sometimes contradictory,perhaps because few patients are studied or WD diagnoses are questionable.AIM To determine the outcomes among well-documented WDALF patients and assess mortality model performance in this cohort.METHODS We reviewed the medical records of our pediatric WDALF patients(n=41 over 6-years-old,single-center retrospective study)and compared seven prognostic models(King’s College Hospital Criteria,model for end-stage liver disease/pediatric end-stage liver disease scoring systems,Liver Injury Unit[LIU]using prothrombin time[PT]or international normalized ratio[INR],admission LIU using PT or INR,and Devarbhavi model)with one another.RESULTS Among the 41 Han Chinese patients with ALF,WD was established by demonstrating ATP7B variants in 36.In 5 others,Kayser-Fleischer rings and Coombs-negative hemolytic anemia permitted diagnosis.Three died during hospitalization and three underwent liver transplantation(LT)within 1 mo of presentation and survived(7.3%each);35(85.4%)survived without LT when given enteral D-penicillamine and zinc-salt therapy with or without urgent plasmapheresis.Parameters significantly correlated with mortality included encephalopathy,coagulopathy,and gamma-glutamyl transpeptidase activity,bilirubin,ammonia,and serum sodium levels.Area under the receiver operating curves varied among seven prognostic models from 0.981 to 0.748 with positive predictive values from 0.214 to 0.429.CONCLUSION WDALF children can survive and recover without LT when given D-penicillamine and Zn with or without plasmapheresis,even after enlisting for LT.展开更多
Background:Fuzheng Huayu tablet is a traditional Chinese medicine(TCM)used for the treatment of liver fibrosis and cirrhosis.However,whether the combination with Fuzheng Huayu tablet could affect the antiviral efflcac...Background:Fuzheng Huayu tablet is a traditional Chinese medicine(TCM)used for the treatment of liver fibrosis and cirrhosis.However,whether the combination with Fuzheng Huayu tablet could affect the antiviral efflcacy of nucleos(t)ide remains a concern.The objective of this trial was to explore the impact of Fuzheng Huayu tablet on antiviral effect of entecavir in patients with hepatitis B cirrhosis.Methods:A prospective,randomized control trial was conducted.Patients with compensated hepatitis B cirrhosis were randomly divided into the treatment group(entecavir capsule plus Fuzheng Huayu tablet)and the control group(entecavir capsule plus simulant of Fuzheng Huayu),and followed up for 48 weeks.The dynamic changes of HBV DNA load,the rate of serological conversion of HBeAg,liver function,renal function and liver stiffness measurement(LSM)were monitored.The general clinical data and adverse events were also recorded.Results:There was no significant difference in the rate of virological response and cumulative virological response between the treatment group and the control group(P>0.05).After 48 weeks of treatment,the HBeAg seroconversion rate,biochemical response rate and LSM value were 21.05%and 4.76%(P=0.164),86.96%and 65.96%(P=0.017),9.5 kpa and 10.6 kpa(P=0.827)in the treatment group and the control group,respectively.No serious adverse events related to the study therapy occurred during the trial.Conclusions:The antiviral entecavir combined with Fuzheng Huayu tablet did not affect the antiviral efflcacy of entecavir,but could improve the rate of biochemical response,and had a tendency to improve the rate of serological conversion of HBeAg and liver fibrosis in patients with hepatitis B cirrhosis.Fuzheng Huayu tablet is clinically safe for patients with hepatitis B cirrhosis.展开更多
Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States ...Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1<sup>+</sup> or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.展开更多
Rock slope hazard assessment is an important part of risk analysis for open pit mines.The main parameters that can lead to rock slope failures are the parameters traditionally used in geomechanical classifications,the...Rock slope hazard assessment is an important part of risk analysis for open pit mines.The main parameters that can lead to rock slope failures are the parameters traditionally used in geomechanical classifications,the slope geometrical parameters and external factors like rainfall and blasting.This paper presents a methodology for a hazard assessment system for open pit mine slopes based on 88 cases collated around the world using principal components analysis,discriminant analysis and confidence ellipses.The historical cases used in this study included copper,gold,iron,diamond,lead and zinc,platinum and claystone mines.The variables used in the assessment methodology are uniaxial compressive strength of intact rock;spacing,persistence,opening,roughness,infilling and orientation of the main discontinuity set;weathering of the rock mass;groundwater;blasting method;and height and inclination of the pit.While principal component analysis was used to quantify the data,the discriminant analysis was used to establish a rule to classify new slopes about its stability condition.To provide a practical hazard assessment system,confidence ellipses were used to propose a hazard graph and generate the HAS-Q.The discriminant rule developed in this research has a high discrimination capacity with an error rate of 11.36%.展开更多
Peristaltic motion induced by a surface acoustic wave of a viscous, compressible and electrically conducting Maxwell fluid in a confined parallel-plane microchannel through a porous medium is investigated in the prese...Peristaltic motion induced by a surface acoustic wave of a viscous, compressible and electrically conducting Maxwell fluid in a confined parallel-plane microchannel through a porous medium is investigated in the presence of a constant magnetic field. The slip velocity is considered and the problem is discussed only for the free pumping case. A perturbation technique is employed to analyze the problem in terms of a small amplitude ratio. The phenomenon of a “backward flow” is found to exist in the center and at the boundaries of the channel. In the second order approximation, the net axial velocity is calculated for various values of the fluid parameters. Finally, the effects of the parameters of interest on the mean axial velocity, the reversal flow, and the perturbation function are discussed and shown graphically. We find that in the non-Newtonian regime, there is a possibility of a fluid flow in the direction opposite to the propagation of the traveling wave. This work is the most general model of peristalsis created to date with wide-ranging applications in biological, geophysical and industrial fluid dynamics.展开更多
This study focuses on the transitions in flow states around two-, three-and four-inline square cylinders under the effect of Reynolds numbers at two different gap spacing values using the lattice Boltzmann method. For...This study focuses on the transitions in flow states around two-, three-and four-inline square cylinders under the effect of Reynolds numbers at two different gap spacing values using the lattice Boltzmann method. For this purpose, Reynolds number is varied in the range 1–130 while two different values of spacing taken into account are gap spacing =2 and 5. Before going to actual problem, the code is tested for flow around a single square cylinder by comparing the results with experimental and numerical results of other researchers, and good agreement is found.The current numerical computations yield that for both spacing values and all combinations of cylinders there exist three different sates of flow depending on Reynolds numbers: steady state, transitional state and unsteady state. It is found that the range of Reynolds numbers for these flow states is different for both spacing values. At gap spacing =2 the range of Reynolds numbers for each flow state decreases by increasing the number of cylinders while at gap spacing =5 opposite trend is observed. The results also show that at gap spacing =2 the reduction in drag force is greater than the corresponding reduction at gap spacing =5. The maximum reduction in drag force is observed at Reynolds numbers =1 at both spacing values. Similarly, at both spacing values and all Reynolds numbers, the maximum reduction in drag force is observed for the case of four-inline square cylinders.展开更多
BACKGROUND There is scarce data on the long-term mortality and associated prognostic factors in patients with dilated car-diomyopathy(DCM).The study aimed to investigate the all-cause mortality up to 15 years(mean 7.9...BACKGROUND There is scarce data on the long-term mortality and associated prognostic factors in patients with dilated car-diomyopathy(DCM).The study aimed to investigate the all-cause mortality up to 15 years(mean 7.9±5.7 years)in such patients,and the independent prognostic factors influencing their long-term mortality.METHODS One hundred and sixty-six consecutive patients with DCM were prospectively enrolled from 2002 to 2003.The mean age of patients was 59.5±10.4 years,and approximately 57%were male.They were followed up by telephone or outpa-tient visit at least every three months until 2019 or all-cause death occurred.Predictors of mortality were identified using mul-tivariate logistic regression analysis.RESULTS During the 15 years of follow-up,five patients were lost to follow-up,and the complete data records of 161 patients were included in the analysis.Patients were treated with angiotensin-converting-enzyme inhibitors(ACEI)or angiotensin-recept-or blocker(ARB),β-blockers,mineralocorticoid receptor antagonist(MRA),diuretics and digitalis from 2002 to 2004,and main-tained at the maximum tolerated doses between 2004 and 2019.Our safety targets to maintain heart rate and blood pressure at 60-80 beats/min and 90-120/60-80 mmHg,respectively.All-cause mortality in the first five years was 55.9%.The independent risk factors for the 5-year mortality were age≥70 years old(OR=5.45,P=0.006),systolic blood pressure(SBP)>120 mmHg(OR=3.63,P=0.004),6-minute walk distance(6MWD)<450 m(OR=3.84,P=0.001).15-year all-cause mortality was 65.8%.The inde-pendent risk factors for 15-year mortality were age≥70 years old(OR=16.07,P=0.009),LVEF≤35%(OR=5.69,P=0.003),and SBP>120 mmHg(OR=9.56,P<0.001).CONCLUSIONS This study was the first to demonstrate the 15-year survival rate of 34%in DCM patients.The DCM patients’first five-year all-cause mortality decreased significantly after continuous standardized treatment and intensive management.The mortality then plateaued in the following 10 years.Age≥70 years,LVEF≤35%,and SBP>120 mmHg were independent predict-ors of 15-year all-cause mortality.展开更多
Angiosarcoma is a rare primary malignant neoplasm of the liver with a poor prognosis. Here, we report a case of a patient with a ruptured hepatic angiosarcoma which was treated by emergency catheter-directed embolizat...Angiosarcoma is a rare primary malignant neoplasm of the liver with a poor prognosis. Here, we report a case of a patient with a ruptured hepatic angiosarcoma which was treated by emergency catheter-directed embolization, followed by leflc-sided hemihepatectomy.展开更多
OBJECTIVE:H1N1 was a new and potentially serious infectious disease,in human,the severity of influenza can vary from mild to severe,thus to find an effective and safety way to control the influenza pandemic is of cruc...OBJECTIVE:H1N1 was a new and potentially serious infectious disease,in human,the severity of influenza can vary from mild to severe,thus to find an effective and safety way to control the influenza pandemic is of crucial importance.This retrospective study describes the duration of viral shedding in H1N1 patients that were hospitalized and treated in China.METHODS:Clinical data were collected from May to July,2009 in China for 963 patients with influenza A(H1N1) virus infection.Patients were treated based on the guidelines issued by the Chinese Ministry of Health.The primary outcome was duration of viral shedding and statistical comparisons were performed.RESULTS:In the patients with body temperature greater than 38.0℃,there were no differences in virus shedding duration among the patients taking oseltamivir within two days,patients undergoing Traditional Chinese Medicine(TCM) therapy or those receiving no drug therapy.In patients with body temperature 338.1℃,TCM therapy reduced the viral shedding duration(P<0.05,vs.oseltamivir therapy).Furthermore,taking oseltamivir two days after onset of symptoms might prolong the virus shedding duration(P<0.05,vs.taking oseltamivir less than 2 days of onset).CONCLUSION:TCM therapy is effective for reducing the length of virus shedding in patients with body temperature 338.0℃.Oseltamivir used for reducing virus shedding duration should be taken within two days of onset.展开更多
OBJECTIVE: To assess the efficacy and safety in patients with chronic heart failure(CHF) of Western medication plus Traditional Chinese Medicine(TCM) preparations.METHODS: This prospective, single-blind, randomized, c...OBJECTIVE: To assess the efficacy and safety in patients with chronic heart failure(CHF) of Western medication plus Traditional Chinese Medicine(TCM) preparations.METHODS: This prospective, single-blind, randomized, controlled, and multicenter clinical trial began on September 17, 2008, and was completed on June 25, 2011. A total of 340 inpatients, aged 40-79 years, with exacerbating CHF from 10 hospitals were enrolled and randomly allocated within 24 h of admission. The trial included three intervention periods. During hospitalization, the control group received western medication for CHF and the treatment group received Danhong injection with Shenfu injection or Shenmai injection. After discharge,all patients were treated with Qiliqiangxin capsules and Buyiqiangxin tablets or a placebo for 6 months. After the 6-month intervention, both groups received only continuous western medication. The primary endpoint was all-cause mortality.The efficacy assessments were as follows: B-type natriuretic peptide(BNP), Lee's HF score, the 6-minute walking test(6 MWT), left ventricular ejection fraction(LVEF), and the Minnesota Living with Heart Failure Questionnaire(MLHFQ). The safety assessments were as follows: blood and urine routine examination, hepatic and renal function, electrolytes in blood and adverse events.RESULTS: Compared with the control group, the treatment group showed a 30.99% reduction in all-cause mortality and an improved survival rate.The treatment group showed greater improvement in 6 MWT(P = 0.02) than the control group on discharge, after 12-month follow-up, there was a time-group interaction for MLHFQ(P = 0.03). Incidence rate of adverse events and other relevant safety indexes were not statistically significant between the two groups.CONCLUSION: Western medication plus TCM treatment can increase 6-minute walking distance(improve exercise tolerance) and quality of life with heart failure patients.展开更多
文摘Data are critically important to good decision-making. In an increasingly complex economy, conventional data collecting schemes are no longer sufficient. To deal with the challenge of maintaining its statistics relevant to the users in an ever-shifting environment, the Banco de Portugal decided to explore the largely unused statistical potential of the available micro-databases and to integrate the existing administrative and survey data, thus enhancing the basic information infrastructure while protecting confidentiality. This presentation will address the benefits and problems to be dealt with when two or more data-sources are to be integrated.
文摘Developing nations, like Nigeria, whose financial systems and infrastructural base are not yet fully developed face data rendition challenges which may hamper the representativeness of their interest rate statistics.A critical component of any credible interest rate data compilation framework relates to the sampling procedure.In Nigeria, no work has been done with regards to employing alternatives sampling techniques in the computation of interest rate statistics largely because of the small number of deposit money banks in the country. Leveraging on existing literature and established statistical methods, the study examines two sampling techniques for generating credible and reliable interest rates in Nigeria. The current interest rate compilation framework in the country is presented and alternative sampling procedures were explored with a view to investigating their appropriateness for Nigeria＇s interest rate computation. The interest rates generated based on the current population-based compilation method is compared with those of the alternative approaches. This paper recommends the use of purposive sampling method that covers Deposit Money Banks （DMBs） which account for about 70.0 per cent of the banking sector total assets as an appropriatealternative.
文摘Objective:Pediatric patients undergoing day surgery often experience significant anxiety,which can negatively impact both the child and their parents.Addressing this anxiety is crucial to ensure a smooth surgical experience and recovery.This mini review aims to evaluate the impact of preoperative anxiety in children,identify contributing factors,and explore effective strategies to manage this anxiety during day surgery.Methods:A literature review was conducted,focusing on studies that assess anxiety levels in pediatric patients before day surgery and the interventions designed to alleviate this anxiety.The review included both psychological and procedural strategies.Results:Preoperative anxiety in children can be influenced by a variety of factors,including age,previous medical experiences,parental anxiety,and the hospital environment.Untreated anxiety may lead to increased postoperative pain,behavioral changes,and extended recovery times.Several strategies,including psychological preparation,family centered approaches,and the involvement of child life specialists,have been shown to effectively reduce anxiety.Conclusions:Managing anxiety in pediatric day surgery is vital to improving both surgical outcomes and the overall experience for children and their families.Healthcare professionals can play a key role in reducing anxiety through targeted interventions and supportive care.
文摘This study is to determine age-specific prostate-specific antigen （PSA） distributions in Chinese men without prostate cancer （PC） and to recommend reference ranges for this population after comparison with other studies. From September 2003 to December 2006, 9 374 adult men aged from 18 to 96 years agreed to participate in the study. After all cases of PC were excluded, 8 422 adult men participated in statistical analysis and were divided into five age groups. Simple descriptive statistical analyses were carried out and quartiles and 95th percentiles were calculated for each age group. The age-specific PSA reference ranges are as follows： 4049 years, 2.15 ng mLl; 50-59 years, 3.20 ng mLl; 60-9 years, 4.10 ng mL^-1; 70-79 years, 5.37 ng mL^-1. The results indicate that the ethnic differences in PSA levels are obvious. The currently adopted Oesterling＇s age-specific PSA reference ranges are not appropriate for Chinese men. The reference ranges of this study should be more suitable to Chinese men.
文摘AIM： To assess whether the effectiveness of a combination of transarterial chemoembolization （TACE） and percutaneous ethanol injection （PEI） in the treatment of unresectable hepatocellular carcinoma （HCC） is superior to TACE alone a randomized controlled trial was performed. METHODS： The effect of combination therapy on longterm survival rates and duration of hospitalization was evaluated in 52 previously untreated HCCs, randomly allocated to TACE-PEI （27 pts） or TACE alone （25 pts）. RESULTS： The cumulative survival rate of the TACE group was 75.8% at 6 mo, 62.9% at 12 mo, and 18.0% at 24 mo and of the TACE-PEI group 76.9%, 61.5%, and 38.7%, respectively. Comparison of overall survival in both groups showed no statistically significant difference. Regarding the patients with HCCs Okuda stage I （n = 26）, the median survival of the TACE-PEI group was significantly longer （〉24 mo, median not yet reached in the study period） compared to the TACE group （18.4 mo [range 11.6-21.7 mo]; P = 0.04）. TACE-PEI reduced the relative risk for mortality to 0.4 （95% CI 0.15-0.96） compared to patients who received TACE alone. Median survival in patients with HCCs Okuda stage Ⅱ or Ⅲ was 5.0 mo in the TACE group （1.7 rno-not defined） compared to 10.4 mo in the TACE-PEI group. CONCLUSION： The combination TACE-PEI improved survival time compared to TACE alone. Our study revealed a statistically significant improved survival in HCCs Okuda stage I. Side effects were minor and the combination therapy did not prolong duration of hospitalization considerably.
基金Supported by the Deanship of Scientific Research of Najah N.University
文摘Objective:To detect the anticandidal activity of nine toothpastes containing sodium fluoride, sodium monofluorophosphate and herbal extracts as an active ingredients against 45 oral and non oral Candida albicans(C.albicans) isolates.Methods:The antifungal activity of these toothpaste formulations was determined using a standard agar well diffusion method.Statistical analysis was performed using a statistical package,SPSS windows version 15,by applying mean values using one-way ANOVA with post-hoc least square differences(LSD) method.A P value of less than 0.05 was considered significant.Results:All toothpastes studied in our experiments were effective in inhibiting the growth of all C.albicans isolates.The highest anticandidal activity was obtained from toothpaste that containing both herbal extracts and sodium fluoride as active ingredients, while the lowest activity was obtained from toothpaste containing sodium monofluorophosphate as an active ingredient.Antifungal activity of Parodontax toothpaste showed a significant difference(P<0.001) against C.albicans isolates compared to toothpastes containing sodium fluoride or herbal products.Conclusions:In the present study,it has been demonstrated that toothpaste containing both herbal extracts and sodium fluoride as active ingredients are more effective in control of C.albicans,while toothpaste that containing monofluorophosphate as an active ingredient is less effective against C.albicans.Some herbal toothpaste formulations studied in our experiments,appear to be equally effective as the fluoride dental formulations and it can be used as an alternative to conventional formulations for individuals who have an interest in naturally-based products.Our results may provide invaluable information for dental professionals.
基金financially supported by the The Scientific and Technological Research Council of Turkey(TUBITAK,Grant No.114S419)Istanbul Medeniyet University Scientific Research Grants(Grant No.FBA-2014-293)
文摘Objective:Yes associated protein 1(YAP1)is a member of the Hippo pathway,acting as a transcriptional coactivator.To elucidate the role of YAP1 and phosphorylated(p)YAP1 in prostate cancer(PCa)tumorigenesis,we investigated their expression in clinical samples of PCa and cell lines.Methods:Fifty-four tumor,adjacent nontumor,and prostate intraepithelial neoplasia(PIN)tissues from patients with PCa after radical prostatectomy were selected from a retrospective cohort and studied using immunohistochemistry(IHC).Protein and m RNA expression levels of YAP1 were evaluated by Western blot analysis and quantitative real-time reverse transcription PCR,respectively,in cancer cell lines.Publicly available gene expression datasets were downloaded to analyze YAP1 m RNA and protein levels in PCa tissue samples.Results:IHC analysis of PCa tissues revealed that YAP1 staining intensities were moderate to weak in the nucleus and cytoplasm of tumor cells,whereas adjacent normal epithelia showed strong staining.We observed that benign prostates were characterized by higher expression levels of both nuclear(P=0.004)and cytosolic(P=0.005)YAP1.p YAP1 staining was weak in the cytoplasm and absent in the nucleus of all the tissues investigated.YAP1 expression was an indicator of extraprostatic extension(EPE).The level of YAP1 was negatively correlated with the level of the androgen receptor(AR)in The Cancer Genome Atlas dataset and Western blot analysis of cell lines.Conclusions:Our study suggested that YAP1 expression is heterogeneous in PCa tissue samples;therefore,YAP1 might play different roles in different aspects of PCa progression.This might involve AR–YAP1 interplay in PCa.
文摘This study is to assess the potential factors that could affect the serum prostate-specific antigen （PSA） level in healthy younger men. We evaluated the associations of age, body mass index （BMI） and serum lipid profile with serum PSA level in 6774 Chinese men （aged 20-49 years） who received a routine health examination. Eligible men were classified into 10-year age groups, BMI was categorized as underweight （〈18.5）, normal （18.5-22.9）, overweight （23.0-24.9）, obese （25.0-29,9） and very obese （〉30） according to the redefined World Health Organization （WHO） criteria for the Asia-Pacific region. PSA levels were compared among groups as well, In multiple linear regression analysis, PSA was positively correlated with age （P〈0.0001）. Negative correlations existed between PSA and BMI （P〈0.0001） and triglyceride level （P=0.01）. No relationship could be found between PSA and serum cholesterol （P=0.711） or high-density lipoprotein （HDL; P =0.665）. In addition, we found that serum PSA levels increased with age and decreased with BMI. Our study demonstrates that age, BMI and triglyceride levels influence the PSA level in men 〈50 years of age.
文摘BACKGROUND Acute liver failure(ALF)can be a primary presentation of Wilson disease(WD).Mortality rates are high in WD with ALF(WDALF).Predictions of mortality in WDALF vary by model and are sometimes contradictory,perhaps because few patients are studied or WD diagnoses are questionable.AIM To determine the outcomes among well-documented WDALF patients and assess mortality model performance in this cohort.METHODS We reviewed the medical records of our pediatric WDALF patients(n=41 over 6-years-old,single-center retrospective study)and compared seven prognostic models(King’s College Hospital Criteria,model for end-stage liver disease/pediatric end-stage liver disease scoring systems,Liver Injury Unit[LIU]using prothrombin time[PT]or international normalized ratio[INR],admission LIU using PT or INR,and Devarbhavi model)with one another.RESULTS Among the 41 Han Chinese patients with ALF,WD was established by demonstrating ATP7B variants in 36.In 5 others,Kayser-Fleischer rings and Coombs-negative hemolytic anemia permitted diagnosis.Three died during hospitalization and three underwent liver transplantation(LT)within 1 mo of presentation and survived(7.3%each);35(85.4%)survived without LT when given enteral D-penicillamine and zinc-salt therapy with or without urgent plasmapheresis.Parameters significantly correlated with mortality included encephalopathy,coagulopathy,and gamma-glutamyl transpeptidase activity,bilirubin,ammonia,and serum sodium levels.Area under the receiver operating curves varied among seven prognostic models from 0.981 to 0.748 with positive predictive values from 0.214 to 0.429.CONCLUSION WDALF children can survive and recover without LT when given D-penicillamine and Zn with or without plasmapheresis,even after enlisting for LT.
基金supported by grants from the Beijing Municipal Science and Technology Project of Traditional Chinese Medicine(JJ2014-25)the Capital Funds for Health Improvement and Research(CFH-2018-2-2173 and CFH-2020-1-2171)。
文摘Background:Fuzheng Huayu tablet is a traditional Chinese medicine(TCM)used for the treatment of liver fibrosis and cirrhosis.However,whether the combination with Fuzheng Huayu tablet could affect the antiviral efflcacy of nucleos(t)ide remains a concern.The objective of this trial was to explore the impact of Fuzheng Huayu tablet on antiviral effect of entecavir in patients with hepatitis B cirrhosis.Methods:A prospective,randomized control trial was conducted.Patients with compensated hepatitis B cirrhosis were randomly divided into the treatment group(entecavir capsule plus Fuzheng Huayu tablet)and the control group(entecavir capsule plus simulant of Fuzheng Huayu),and followed up for 48 weeks.The dynamic changes of HBV DNA load,the rate of serological conversion of HBeAg,liver function,renal function and liver stiffness measurement(LSM)were monitored.The general clinical data and adverse events were also recorded.Results:There was no significant difference in the rate of virological response and cumulative virological response between the treatment group and the control group(P>0.05).After 48 weeks of treatment,the HBeAg seroconversion rate,biochemical response rate and LSM value were 21.05%and 4.76%(P=0.164),86.96%and 65.96%(P=0.017),9.5 kpa and 10.6 kpa(P=0.827)in the treatment group and the control group,respectively.No serious adverse events related to the study therapy occurred during the trial.Conclusions:The antiviral entecavir combined with Fuzheng Huayu tablet did not affect the antiviral efflcacy of entecavir,but could improve the rate of biochemical response,and had a tendency to improve the rate of serological conversion of HBeAg and liver fibrosis in patients with hepatitis B cirrhosis.Fuzheng Huayu tablet is clinically safe for patients with hepatitis B cirrhosis.
文摘Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1<sup>+</sup> or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.
基金Federal Agency for Support and Evaluation of Graduate Education (CAPES – Brazil, Grant ID 19/2016)Fondation for Research Support of Minas Gerais (FAPEMIG – Brazil)University of New South Wales (UNSW – Australia)
文摘Rock slope hazard assessment is an important part of risk analysis for open pit mines.The main parameters that can lead to rock slope failures are the parameters traditionally used in geomechanical classifications,the slope geometrical parameters and external factors like rainfall and blasting.This paper presents a methodology for a hazard assessment system for open pit mine slopes based on 88 cases collated around the world using principal components analysis,discriminant analysis and confidence ellipses.The historical cases used in this study included copper,gold,iron,diamond,lead and zinc,platinum and claystone mines.The variables used in the assessment methodology are uniaxial compressive strength of intact rock;spacing,persistence,opening,roughness,infilling and orientation of the main discontinuity set;weathering of the rock mass;groundwater;blasting method;and height and inclination of the pit.While principal component analysis was used to quantify the data,the discriminant analysis was used to establish a rule to classify new slopes about its stability condition.To provide a practical hazard assessment system,confidence ellipses were used to propose a hazard graph and generate the HAS-Q.The discriminant rule developed in this research has a high discrimination capacity with an error rate of 11.36%.
文摘Peristaltic motion induced by a surface acoustic wave of a viscous, compressible and electrically conducting Maxwell fluid in a confined parallel-plane microchannel through a porous medium is investigated in the presence of a constant magnetic field. The slip velocity is considered and the problem is discussed only for the free pumping case. A perturbation technique is employed to analyze the problem in terms of a small amplitude ratio. The phenomenon of a “backward flow” is found to exist in the center and at the boundaries of the channel. In the second order approximation, the net axial velocity is calculated for various values of the fluid parameters. Finally, the effects of the parameters of interest on the mean axial velocity, the reversal flow, and the perturbation function are discussed and shown graphically. We find that in the non-Newtonian regime, there is a possibility of a fluid flow in the direction opposite to the propagation of the traveling wave. This work is the most general model of peristalsis created to date with wide-ranging applications in biological, geophysical and industrial fluid dynamics.
文摘This study focuses on the transitions in flow states around two-, three-and four-inline square cylinders under the effect of Reynolds numbers at two different gap spacing values using the lattice Boltzmann method. For this purpose, Reynolds number is varied in the range 1–130 while two different values of spacing taken into account are gap spacing =2 and 5. Before going to actual problem, the code is tested for flow around a single square cylinder by comparing the results with experimental and numerical results of other researchers, and good agreement is found.The current numerical computations yield that for both spacing values and all combinations of cylinders there exist three different sates of flow depending on Reynolds numbers: steady state, transitional state and unsteady state. It is found that the range of Reynolds numbers for these flow states is different for both spacing values. At gap spacing =2 the range of Reynolds numbers for each flow state decreases by increasing the number of cylinders while at gap spacing =5 opposite trend is observed. The results also show that at gap spacing =2 the reduction in drag force is greater than the corresponding reduction at gap spacing =5. The maximum reduction in drag force is observed at Reynolds numbers =1 at both spacing values. Similarly, at both spacing values and all Reynolds numbers, the maximum reduction in drag force is observed for the case of four-inline square cylinders.
文摘BACKGROUND There is scarce data on the long-term mortality and associated prognostic factors in patients with dilated car-diomyopathy(DCM).The study aimed to investigate the all-cause mortality up to 15 years(mean 7.9±5.7 years)in such patients,and the independent prognostic factors influencing their long-term mortality.METHODS One hundred and sixty-six consecutive patients with DCM were prospectively enrolled from 2002 to 2003.The mean age of patients was 59.5±10.4 years,and approximately 57%were male.They were followed up by telephone or outpa-tient visit at least every three months until 2019 or all-cause death occurred.Predictors of mortality were identified using mul-tivariate logistic regression analysis.RESULTS During the 15 years of follow-up,five patients were lost to follow-up,and the complete data records of 161 patients were included in the analysis.Patients were treated with angiotensin-converting-enzyme inhibitors(ACEI)or angiotensin-recept-or blocker(ARB),β-blockers,mineralocorticoid receptor antagonist(MRA),diuretics and digitalis from 2002 to 2004,and main-tained at the maximum tolerated doses between 2004 and 2019.Our safety targets to maintain heart rate and blood pressure at 60-80 beats/min and 90-120/60-80 mmHg,respectively.All-cause mortality in the first five years was 55.9%.The independent risk factors for the 5-year mortality were age≥70 years old(OR=5.45,P=0.006),systolic blood pressure(SBP)>120 mmHg(OR=3.63,P=0.004),6-minute walk distance(6MWD)<450 m(OR=3.84,P=0.001).15-year all-cause mortality was 65.8%.The inde-pendent risk factors for 15-year mortality were age≥70 years old(OR=16.07,P=0.009),LVEF≤35%(OR=5.69,P=0.003),and SBP>120 mmHg(OR=9.56,P<0.001).CONCLUSIONS This study was the first to demonstrate the 15-year survival rate of 34%in DCM patients.The DCM patients’first five-year all-cause mortality decreased significantly after continuous standardized treatment and intensive management.The mortality then plateaued in the following 10 years.Age≥70 years,LVEF≤35%,and SBP>120 mmHg were independent predict-ors of 15-year all-cause mortality.
文摘Angiosarcoma is a rare primary malignant neoplasm of the liver with a poor prognosis. Here, we report a case of a patient with a ruptured hepatic angiosarcoma which was treated by emergency catheter-directed embolization, followed by leflc-sided hemihepatectomy.
基金Supported by the projects from the State Administration of Traditional Chinese Medicine (200907001)National Science Foundation of China (No. 30825047 and 90709007)
文摘OBJECTIVE:H1N1 was a new and potentially serious infectious disease,in human,the severity of influenza can vary from mild to severe,thus to find an effective and safety way to control the influenza pandemic is of crucial importance.This retrospective study describes the duration of viral shedding in H1N1 patients that were hospitalized and treated in China.METHODS:Clinical data were collected from May to July,2009 in China for 963 patients with influenza A(H1N1) virus infection.Patients were treated based on the guidelines issued by the Chinese Ministry of Health.The primary outcome was duration of viral shedding and statistical comparisons were performed.RESULTS:In the patients with body temperature greater than 38.0℃,there were no differences in virus shedding duration among the patients taking oseltamivir within two days,patients undergoing Traditional Chinese Medicine(TCM) therapy or those receiving no drug therapy.In patients with body temperature 338.1℃,TCM therapy reduced the viral shedding duration(P<0.05,vs.oseltamivir therapy).Furthermore,taking oseltamivir two days after onset of symptoms might prolong the virus shedding duration(P<0.05,vs.taking oseltamivir less than 2 days of onset).CONCLUSION:TCM therapy is effective for reducing the length of virus shedding in patients with body temperature 338.0℃.Oseltamivir used for reducing virus shedding duration should be taken within two days of onset.
基金Supported by National Key Technology R&D Programs in the 11th Five-Year Plan of China:Study on Comprehensive Evaluation Method of Integral Effect of Traditional Chinese Medicine Treatment for Heart Failure(No.2006BAI08B02-01)Ministry of Education of People's Republic of China"Program for Innovative Research Team in University"–Research on TCM for the Prevention and Treatment of Cardiovascular Diseases(No.IRT_16R54)Tianjin Science and Technology Program:Tianjin TCM Clinical Medicine Research Center(No.15ZXLCSY00020)
文摘OBJECTIVE: To assess the efficacy and safety in patients with chronic heart failure(CHF) of Western medication plus Traditional Chinese Medicine(TCM) preparations.METHODS: This prospective, single-blind, randomized, controlled, and multicenter clinical trial began on September 17, 2008, and was completed on June 25, 2011. A total of 340 inpatients, aged 40-79 years, with exacerbating CHF from 10 hospitals were enrolled and randomly allocated within 24 h of admission. The trial included three intervention periods. During hospitalization, the control group received western medication for CHF and the treatment group received Danhong injection with Shenfu injection or Shenmai injection. After discharge,all patients were treated with Qiliqiangxin capsules and Buyiqiangxin tablets or a placebo for 6 months. After the 6-month intervention, both groups received only continuous western medication. The primary endpoint was all-cause mortality.The efficacy assessments were as follows: B-type natriuretic peptide(BNP), Lee's HF score, the 6-minute walking test(6 MWT), left ventricular ejection fraction(LVEF), and the Minnesota Living with Heart Failure Questionnaire(MLHFQ). The safety assessments were as follows: blood and urine routine examination, hepatic and renal function, electrolytes in blood and adverse events.RESULTS: Compared with the control group, the treatment group showed a 30.99% reduction in all-cause mortality and an improved survival rate.The treatment group showed greater improvement in 6 MWT(P = 0.02) than the control group on discharge, after 12-month follow-up, there was a time-group interaction for MLHFQ(P = 0.03). Incidence rate of adverse events and other relevant safety indexes were not statistically significant between the two groups.CONCLUSION: Western medication plus TCM treatment can increase 6-minute walking distance(improve exercise tolerance) and quality of life with heart failure patients.
