The aim of this ABT199 work was to present a reliable UPLC–MS/MS method for the simultaneous determination of AT and EZ in human plasma with a low limit of quantification (0.1 ng mL−1) to facilitate the pharmacokinetic and bioavailability studies of this combination in humans. The developed method was used to investigate the pharmacokinetic and bioequivalence

study of commercially available combination product B versus the reference standard branded combination product A. The choice of this method, despite of its high cost, was due to its superior sensitivity, specificity and efficiency. The fast injection cycles, low injection volumes and negligible carryover together contributed to the speed

and sensitivity of the UPLC analysis, 13 a quality that was highly appreciated in analysis of AT and EZ mixture in plasma. Standards of atorvastatin and ezetimibe were supplied and certified by ADWIA, Egypt (purity 99% and 99.5% respectively). The internal standard etilefrine was supplied and certified by DELTA Pharma, Egypt (purity 98.6%). Acetonitrile, formic acid, tert-butyl methyl ether and methanol, KH2PO4, Na2HPO4 were Merck products (Germany). Deionized bi-distilled water (Milli-Q® system, USA) was used. All other chemicals and solvents were of the highest www.selleckchem.com/products/gsk2656157.html analytical grade available. The human plasma used in the validation procedure was over obtained from the holding company for biological products and vaccines (VACSERA, Egypt). Analytical separations were performed with an ACQUITY™ UPLC system equipped with a micro-vacuum degasser, binary gradient pumps, thermostatted autosampler, thermostatted column compartment, and an ACQUITY™ UPLC BEH C18 column (50 mm × 2.1 mm, 1.7 μm), all obtained from Waters Corp. (USA). The column temperature was maintained at 40 °C. The mobile phase was 0.1% formic acid in water and acetonitrile mixture. The mobile phase was used in a gradient mode according to the profile shown in Table 1. The flow rate was adjusted to 0.7 mL min−1.

The mobile phase was filtered through a 0.22-μm membrane filter (Millipore, USA) before use. The autosampler temperature was kept at 10 °C and the samples were injected onto the column with an injection volume of 10 μL. The data acquisition run time was kept at 1.2 min for the mass spectrometer (MS). All data were collected and processed using Empower™ 2 Software (Waters Corp). Mass spectra were acquired on a Quattro Premier XE™ Micromass® triple quadrupole mass spectrometer (Waters Corp.) with an electrospray ionization interface operated in positive and negative ion mode at source temperature 150 °C and desolvation temperature 480 °C. The operating conditions were optimized by flow injection of a mixture of all analytes as follows: nitrogen carrier gas flow 900 L h−1, argon collision gas flow 0.

The clinical trial was carried out in four Community Health Centers (Centres de Santé Communautaires, CSCOMs), two in the Daoudabougou Quartier (ASACODA and ADASCO) and two in the Niamakoro Quartier (ASACONIA and ANIASCO), located in Commune VI of Bamako, Mali, between April 2007 and March 2009. The protocol and informed consent form were approved by the Ethics Committee of the Faculté de Medécine, de Pharmacie et d’Odonto-Stomatologie (FMPOS) of the University of Bamako, the Institutional Review Board (IRB) of the University of Maryland, Baltimore and the Western IRB (Olympia, WA, DNA Damage inhibitor USA). A formal authorization was obtained from the Ministry of Health

(MoH) of Mali before approaching the communities, where sensitization was achieved through sequential community meetings

before the first participants were enrolled into the study. At each CSCOM, a community meeting this website was carried out with the CSCOM Executive Committee, local religious, socio-cultural and administrative leaders, traditional healers, modern doctors, school teachers, and local community members. The consent form, translated into Bambara (the most commonly spoken language in Bamako), was available both as a written consent form and on audiotape (for illiterate parents). The investigators explained the study objectives, individual and community benefits and individual risks associated with participating in the study. Participants at these meetings were encouraged to ask questions on any aspect

of the study and answers were provided by the study investigators. Literate parents who decided to enroll their infants into the study did so after reading the Bambara or French version of the consent form and signing the French version. Illiterate parents who agreed for their infants to be enrolled inscribed a witnessed mark on the French written consent form after listening to the audio tape of the consent in Bambara and after having their questions about the study answered. A respected literate community member designated by the community leader and known to the parents served as the impartial literate witness Terminal deoxynucleotidyl transferase for illiterate parents who inscribed the consent form. Data regarding the symptoms of the acute gastroenteritis episodes were collected by study personnel using a questionnaire when an infant with ≥3 looser-than-normal stools in a 24 h period and/or forceful vomiting was brought by the parent/guardian to the CSCOM. An independent un-blinded Data Safety Monitoring Board that included a Malian expert in pediatrics and clinical trials was established to monitor all adverse events during the trial. Following administration of each dose of vaccine or placebo, every infant was followed prospectively for 2 weeks with household visits on day 7 and on day 14 to detect adverse events.

17 As per a latest research SB203580 nmr article, considering the therapeutic limitations of existing drugs and the threat of emerging resistance, the need for new antibiotics remains high.18 In this scenario, antibiotic combination therapy in the treatment of MRSA and hGISA infection may be a very popular

approach. The rationale behind combining the two drugs is that, they simultaneously target D-Ala-D-Ala-containing peptidoglycan precursors and the active site of penicillin-binding proteins. It has been hypothesized that simultaneous and/or sequential binding of the vancomycin component to the nascent peptidoglycan substrate presents a high effective concentration of the ceftriaxone component at the active site of both PBP2 and PBP2a, thereby conferring high potency to this combination product, including multi-resistant MRSA and hGISA strains (study under communication). The checkerboard microtiter GDC0449 plate assay is used to test the activities of drugs in combination against all the tested strains by determining the FIC index. Using this method current study has established that the combination of vancomycin with l-arginine and ceftriaxone

achieve a desirable synergistic effect without degradation of either component which is protected by presence of non antibiotic adjuvant. It has been observed that vancomycin resistant isolate became extremely sensitive to β-lactam antibiotics when used in combination.18 Earlier it was demonstrated that vancomycin monotherapy is ineffective in the treatment of hGISA infections when given alone, however, when vancomycin was given in combination with β-lactams (in separate infusion lines to avoid precipitation of drugs), demonstrated synergistic activity against a variety of staphylococcal isolates.18 and 19 In the present study FIC index of

≤0.5, TKC, broth dilution, agar diffusion studies carried out against all clinical isolates and indicated synergy between the vancomycin with l-arginine and ceftriaxone in a ratio of 1:1. Earlier, the synergistic activity of vancomycin and oxacillin was studied and found that vancomycin and oxacillin were synergistic against many clinical isolates Adenosine of MRSA.20 The synergistic activity of these antibiotics was achieved with sub-MIC combinations of one-fourth to one-half of the MICs of vancomycin and oxacillin. Similarly, synergism of vancomycin with other drugs, β-lactam antibiotics has been reported.21 The finding of this study suggest the introduction of combined therapy of CVA1020 (vancomycin with l-arginine and ceftriaxone) for the treatment of MRSA and hGISA is a suitable alternative to curb growing gram positive resistance where acquisition and spread of MRSA and hGISA among S. aureus constitute a major threat in the modern medicine. All authors have none to declare.

Before each measurement, 950 μl Hepes buffer was added to 50 μl of the lipoplexes or polyplexes. Toxicity of the lipoplexes and polyplexes was evaluated using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT; Sigma) assay after transfecting the different complexes in the BGM cell line, which are kidney epithelial cells from the African Green Monkey (ATCC: CCL-26). Briefly, BGM cells were seeded in 96-well plates (100 μl/well; 3 × 105 cells/ml) and transfected 24 h later by pipetting the complexes into the culture medium (MEM supplemented

with 10% FCS, 1% vitamins, 1% l-glutamin, 1% streptomycin and 2% vancomycin, all products from Invitrogen). Cytotoxicity of all lipoplexes and polyplexes was tested in duplicate after 24 and 48 h of incubation with the complexes by adding

buy Birinapant MTT (10 μl, 0.5 mg/ml) to the cells. The MTT assay was performed as described before [18] and the percentage cell survival was calculated as follows: [OD585–OD620 (transfected cells)]/[OD585–OD620 (non-transfected cells)] × 100%. Complexes inducing less than 40% cell death were selected to perform quantification of ompA expression. To determine transfection efficiencies, lipoplexes and polyplexes were transfected in duplicate in BGM cells, seeded in 24-well plates (500 μl/well; 3 × 105 cells/ml) and cultured in an atmosphere of 37 °C and 5% CO2. After 24 h, the culture medium was removed, cells were rinsed with PBS and MEM, without serum and antibiotics, was added. An appropriate amount of all different lipoplexes and polyplexes was added to the cells. After incubating 3 h at 37 °C and 5% CO2, complexes were removed, cells were rinsed again A-1210477 mouse with PBS and complete culture medium was added. Naked pDNA and complexes with PolyFect® transfection

reagent (Qiagen) were used as negative and positive controls, respectively. At 24 and 48 h following transfection, cells were trypsinized and Megestrol Acetate resuspended in 300 μl PBS. To quantify ompA expression, the percentage of transfected cells was determined by measuring EGFP fluorescence (488 nm) using a FACSCanto flow cytometer (BD Biosciences, Erembodegem, Belgium). Polyplexes and naked pDNA were aerosolised by using a Cirrus™ Nebulizer (Intersurgical Ltd., Berkshire, UK). This nebulizer, designed to provide particles up to 5 μm (mass median diameter of 3.5 μm), was connected to a pump that generated a pressure of 180 kPa and an air flow rate of 8 l/min. Aerosols were collected on a microscopic glass slide allowing the aerosol droplets to condense onto the slide. The condensation fluid was collected in a sterile tube. Afterwards, pDNA concentration, particle size and zeta potential of the nebulised polyplexes were examined. Subsequently, the transfection capability of the nebulised complexes was checked by flow cytometrical analysis of transfected BGM cells as described in Section 2.4. Plasmid DNA integrity was determined using gel electrophoresis.

Parasite suspension (1 × 106 tachyzoites/ml) was treated with 1% formaldehyde for 30 min at room temperature. After washing twice in PBS, parasites were dry-fixed in microscopic slides and stored at −20 °C. ArtinM and Jacalin from A. integrifolia were prepared in one of our laboratories (MCRB). The total ZVADFMK extract preparation of seeds from A. integrifolia, as well as their purification to generate

d-mannose (ArtinM)- and d-galactose (Jacalin)-binding lectins, were performed as previously described [11] and [13]. The homogeneity and purity degree of the lectins were evaluated by electrophoresis in polyacrylamide gel in the presence of sodium dodecyl sulfate (SDS-PAGE at 15%) under non-reducing conditions. All experiments were carried out with 8–12-week-old female C57BL/6 mice maintained under standard

conditions in the Bioterism Center and Animal Experimentation, Federal University of Uberlândia, MG, Brazil. All procedures were conducted according to guidelines for animal ethics and the study received approval of the Ethics Committee for Animal Experimentation of the institution. Six groups of 13 mice were immunized subcutaneously (200 μl/animal) three times selleck at two-week intervals, as follows: 25 μg NLA mixed with 1 μg ArtinM in sterile PBS (NLA + ArtinM group); 25 μg NLA mixed with 100 μg Jacalin in sterile PBS (NLA + JAC group); 25 μg NLA alone (NLA group);

1 μg ArtinM alone (ArtinM group); 100 μg Jacalin alone (JAC group); and diluent only (PBS group). The adopted doses of antigen and lectins were based on previous studies [14], [15] and [29]. Blood samples were collected at 0, 15, 30, 45 and 60 days after immunization (d.a.i.), and the sera stored at −20 °C until to be analyzed for the presence of specific antibodies. Levels of N. caninum-specific total IgG, IgG1 and IgG2a antibodies were measured by ELISA as described elsewhere [29], with modifications. High-affinity microtiter plates were coated with NLA (10 μg/ml), washed with PBS plus 0.05% Tween 20 (PBS-T) and blocked with 5% skim milk in PBS-T for 1 h at room temperature. Serum samples were diluted 1:25 in 1% skim milk-PBS-T and incubated for 1 h (for MycoClean Mycoplasma Removal Kit IgG detection) or 2 h (for IgG1 and IgG2a detection) at 37 °C. After washing, peroxidase-labeled goat anti-mouse IgG (1:1000; Sigma Chemical Co., St Louis, MO) or biotin-labeled goat anti-mouse IgG1 (1:4000) or anti-mouse IgG2a (1:2000) antibodies (Caltag Lab. Inc., South San Francisco, CA) were added and incubated for 1 h at 37 °C. Next, streptavidin-peroxidase (1:1000; Sigma) was added for IgG1 and IgG2a detection assays. The assays were developed with 0.01 M 2,2-azino-bis-3-ethyl-benzthiazoline sulfonic acid (ABTS; Sigma) and 0.03% H2O2. Optical density (OD) values were determined in a plate reader at 405 nm.

2), indicating the formation of silver nanoparticles with the reduction of silver ions. Silver nanoparticle synthesized, initially observed by color change from pale white to brown was further conformed by UV–visible spectroscopy. The color change occurs due to the excitation of surface plasmon resonance in the silver metal nanoparticle. Silver nanoparticles from endophytic fungi, Pencillium sp showed maximum absorbance this website at 425 nm after 24 h of incubation

( Fig. 3), implying that the bioreduction of AgNO3 has taken place following incubation of the cell free culture filtrate along with AgNO3. Surface plasmon peaks were also located at 410 nm as reported by Shivaraj et al 15 using Dorsomorphin mouse Aspergillus flavus. Whereas, Afreen et al 16 reported peak at 422 nm with Rhizopus stolonifer. Maliszewska et al 17 reported the absorption spectrum of spherical silver nanoparticles produced by Pencillium sp presents a maximum peak between 420 nm and 450 nm. TEM measurements were carried out to determine the morphology and size details of the synthesized silver nanoparticles. Size and shape of the nanoparticles were recorded from drop coated films of silver nanoparticles synthesized extracellularly by endophytic fungi, Pencillium sp. ( Fig. 4). TEM micrographs revealed nanosized and well dispersed silver nanoparticles formed predominantly spherical in shape with the size of 25 nm. FTIR spectroscopic

analysis is carried out to determine the possible interaction between silver and bioactive molecules which are responsible for the synthesis and stabilization of silver nanoparticles.

FTIR spectrum revealed that the silver nanoparticles synthesized from endophytic fungi, Pencillium sp. revealed two bands at 1644 and 1538 cm−1 that corresponds to the binding vibrations of amide I and amide II bands of proteins respectively 18( Fig. 5). While their corresponding stretching vibration were seen at 2923 and 3290 cm−1 and much it is also known that protein nanoparticles interactions can occur either through free amino groups or cysteine residues in protein and via electrostatic attraction of negatively charged carboxylate groups in enzymes. 19 The three bands observed at 1393, 1233, and 1074 cm−1 can be assigned to C–N stretching vibrations of aromatic and aliphatic amines respectively. 18 These observations indicate the presence and binding of proteins with silver nanoparticles which plays an important role in stabilization and also as reducing agents by which well dispersed nanoparticles can be obtained. Antimicrobial activity of biosynthesized silver nanoparticles were studied against pathogenic bacteria (clinical isolates) using agar well diffusion assay method and zone of inhibition were depicted in Fig. 6 and Table 1. Wells were loaded with different concentrations-20 μl, 40 μl, 60 μl and 80 μl of silver nanoparticles respectively.

Their http://www.selleckchem.com/products/at13387.html baseline characteristics are presented in Table 1. Ten (53%) participants undertook the control intervention (exercise using either a treadmill or cycle ergometer as prescribed by the treating physiotherapist) first. The two exercise

interventions were conducted for all participants within a 48 hour period, within 72 hours of discharge. Both exercise modes were delivered by the same physiotherapist in the Physiotherapy Gym of the Adult Cystic Fibrosis Unit at The Prince Charles Hospital in Brisbane, Australia. Exercise heart rate and oxygen saturation data during rest and each exercise intervention are presented in Table 2. During the 15-minute exercise, there was no significant difference in the average heart rate between the gaming console exercise of 144 beats/min (SD 13) and control exercise of 141 beats/min (SD 15), mean difference 3 beats/min (95% CI −3 to 9). However, gaming console exercise induced a significantly higher maximum heart rate, by 9 beats/min (95% CI 3 to 15) and a significantly higher minimum heart rate, by 13 beats/min (95% CI 2 to 24). Average, maximum and minimum oxygen saturation during exercise did not differ significantly

between the groups, with between-group differences of only 1–2% (absolute). Participants thought both exercise modes provided a ‘hard’ workout, rating each on average a score of about 15 on the RPE www.selleckchem.com/products/SNS-032.html scale (Table 3). Energy expenditure at rest and during the 15 minutes of exercise is presented in Table 2. No data were recorded for two participants, one each in both exercise interventions. There were no significant differences between the two exercise modes during the 15 minutes of exercise (1.0 MET, 95% CI −0.3 to 0.5). However, there was a significant difference between the two exercise interventions for the total energy expended in the whole exercise session not (26 kcal, 95% CI 17 to 35), as presented in Table 3. The participants’

perception of the exercise is presented in Table 3. Participants rated the gaming console exercise as significantly more enjoyable on the 10-cm visual analogue scale, mean difference 2.6 cm (95% CI 1.6 to 3.6). Participants did not perceive significantly different fatigue or workload between the two types of exercise. Participants thought both exercise modes were an effective form of exercise, rating each on average a score of about 8 on the visual analogue scale. Similarly, participants thought both exercise modes would be feasible to include as part of their regular exercise regimen, rating each on average a score of about 8 on the visual analogue scale. The amount of dyspnoea also did not differ between the two types of exercise. Exercise involving a gaming console appears to be a feasible mode of aerobic exercise for adults with cystic fibrosis.

We consecutively recruited 63 patients: 53 with wet AMD and 10 with ERM or MH. Of the wet AMD patients, 23 were excluded because of either higher omega-3 content in their diets, other anti-VEGF treatments, or new submacular hemorrhage. Of the 30 patients recruited with wet AMD, 8 were excluded from statistical analysis (1 from group 1, 4 from group 2, and 3 from group 3) because they either had retinal angiomatous proliferation or a large fibrotic component (more than 50%) of the choroidal neovascularization. Two of 10 patients with ERM PERK inhibitor or MH from group 4 also were excluded

because they were found to have diabetes and mild nonproliferative diabetic retinopathy. A total of 22 patients with wet AMD (9 in group 1, 6 in group 2, and 7 in group 3) and 8 control patients were included for VEGF-A analysis (Figure 1). The primary outcome was vitreous VEGF-A levels, and secondary outcomes were plasma VEGF-A levels and central foveal thickness (CFT) measures. Vitreous and plasma VEGF-A levels were collected at the time of anti-VEGF treatment. At enrollment, we collected data on age, gender, number of previous anti-VEGF injections, time

from last anti-VEGF injection, and Snellen visual acuity (converted to logMAR for statistical analysis; Table). The anti-VEGF treatment regimen consisted of 3 loading doses followed by pro re nata injections based on disease activity measured monthly by spectral-domain optical coherence tomography (Cirrus, Carl Zeiss Meditec, Toronto, Canada). Fluorescein angiography also was performed on all patients with wet AMD on the day click here of the anti-VEGF injection (when vitreous biopsy and blood samples were collected). After the surgical field was sterilized and using 5% povidone–iodine, patients were draped in a standard manner with placement of a lid speculum. A 27-gauge self-retaining infusion line (Insight Instruments, Stuart, Florida, USA) of balanced salt solution was placed first, followed by the placement

of a 29-gauge trocar with a chandelier light connected to a mercury vapor light source (Synergetics, O’Fallon, Missouri, USA). The surgical view during the procedure was provided through a surgical operative microscope and a Volk contact lens (Volk direct image ×1.5 magnifying disposable vitrectomy lens; Volk Optical, Mentor, Ohio, USA). The vitreous biopsy was performed using a 23-gauge sutureless Retrector system (Insight Instruments) in all patients. The model used in the study is a portable, battery-powered system with a maximum cut rate of 600 cpm (cuts per minute) and features a retractable sheathed guillotine 25-gauge cutter with an in-built needle (23 gauge). The needle was introduced bevel down through displaced conjunctiva in an oblique 1-plane tunnel into the vitreous cavity 3 to 4 mm from the limbus. At least 0.

Further studies are needed to substantiate the NPs charge effects on permeation of nanoencapsulated molecules across deeper skin layers. PLGA NPs with similar properties (50:50 PLGA composition, 57.0 mV zeta potential,

10% w/w dye loading) and close particle size (117.4 versus 122.0 nm for Rh B and FITC NPs, respectively, Table 1) were used as nanocarrier for Rh B and FITC to assess the contribution of encapsulated dye-related variables to skin permeation across MN-treated skin. The two dyes have different molecular characteristics in terms of chemical structure (a hydrophobic reactive S C N substituent in FITC structure, Fig. 1), MW (479.02 versus 389.38 Da for Rh B and FITC, respectively), and saturated solubility at physiological pH (0.99 versus 0.09 g/L for Rh B and FITC, respectively) [25]. Despite the similarity of the nanocarrier properties and a smaller MW (389.38 Da), significantly SB203580 lower Q48 (97.0%) and flux (97.2%) Alisertib values were obtained for FITC compared to the more soluble and

larger MW Rh B ( Fig. 8 and Table 2). This provided evidence for significant implication of the physicochemical properties of encapsulated molecules, particularly solubility, in the MN-mediated flux. Dye solubility would affect the release and molecular diffusion steps of the hypothesized mechanism. Higher solubility was reported to increase drug flux across MN-treated skin since the dermis Metalloexopeptidase does not represent a distinct barrier to hydrophilic drugs once the SC is bypassed [45]. For instance, Stahl et al. [46] demonstrated enhanced MN-driven permeation of the more hydrophilic

permeants paracetamol and diclofenac compared to the lipophilic drugs ibuprofen and ketoprofen, irrespective of molecular weights. Further, enhanced transdermal flux was demonstrated for the water soluble hydrochloride form of naltrexone compared to the base [47] and the more soluble naltrexone glycolate compared to the hydrochloride salt [48]. The significantly lower flux of FITC can be ascribed to poor solubility due to the hydrophobic isothiocyanate substituent. This probably resulted in slower release from NPs and saturation of the microenvironment, resulting in reduced concentration gradient and molecular diffusion. In addition, the N C S group was reported to enhance reactivity of FITC toward nucleophiles such as amine and sulfhydryl groups on proteins with the formation of covalent dye-protein conjugates in vitro [49] and interaction with biomacromolecules in the human skin [50]. Difference in skin permeation of Rh B and FITC was confirmed by confocal microscopic images obtained at 48 h post-skin treatment (Fig. 9a–d). These showed deposition of fluorescent Rh B and FITC NPs on the skin surface and probably superficial layers of SC in addition to infiltration of NPs inside MN-created channels ( Fig. 9a and b, respectively), as reported previously [22].

The overall

improvement in left ventricular ejection fraction AZD2014 molecular weight was comparable to that obtained with aerobic training only (WMD –0.5%, 95% CI –4.3 to 3.3) ( Figure 2, see also Figure 3 on the eAddenda for detailed forest plot). Exercise capacity: The effect of resistance training alone on peak oxygen consumption was calculated using the pooled post-intervention data of four studies with 96 participants. Resistance training alone showed a favourable trend only on peak oxygen consumption (WMD 1.4 ml/kg/min, 95% CI –0.3 to 3.1) ( Figure 4a, see also Figure 5a on the eAddenda for detailed forest plot). The effect of resistance training as an adjunct to aerobic training was derived from three studies with 115 participants. The addition of resistance training to aerobic training did not significantly affect peak oxygen consumption (WMD –0.7 ml/kg/min, 95% CI –2.3 to 1.0) ( Figure 4b, see also Figure 5b on the eAddenda for detailed forest plot). Two studies with 40 participants examined the effect of resistance training alone on the 6-minute walk test. The post-intervention data were pooled using a fixed effect model. Resistance training increased the 6-minute walk distance significantly, by 52 m (95% CI 19 to 85) more than non-training (Figure

6, see also SNS-032 Figure 7 on the eAddenda for detailed forest plot). No studies of resistance training as an adjunct to aerobic exercise measured the 6-minute walk distance. Quality of life: Two studies examining the effect of resistance training alone measured quality of life. Cider and colleagues (1997) used the Quality of Life Questionnaire – Heart Failure, which measures somatic and emotional aspects, old life satisfaction, and physical limitations. They reported unchanged quality of life in the training group. Tyni-Lenné and colleagues (2001) used the Minnesota Living with Heart Failure Questionnaire as the measurement tool, on which

lower scores indicate better quality of life. They reported a beneficial effect of resistance training on quality of life after 8 weeks, with median scores of 19 (range 0 to 61) in the resistance training group and 44 (range 3 to 103) in the control group (p < 0.001). Two studies with 57 participants examined the effect of resistance exercise as an adjunct to aerobic training. Both used the Minnesota Living with Heart Failure Questionnaire. Their data were pooled using a fixed effect model. Adding resistance training to aerobic training programs did not significantly change Minnesota Living with Heart Failure Questionnaire scores compared to those obtained with aerobic exercise alone, WMD 0.9 (95% CI –5.4 to 3.7) (Figure 8, see also Figure 9 on the eAddenda for detailed forest plot). A third study (Beckers et al 2008) used the Health Complaints Scale, which primarily measures somatic symptoms.