BackgroundStandardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD.MethodsA total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units.ResultsThere was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: −0.24, 95% CI −0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks.ConclusionsThe standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation.Trial registration numberISRCTN81189044.

The first U.S. prospective long-term survivorship data with the STAR™ Ankle prosthesis found it to be an excellent long-term option for the treatment of ankle arthritis.

To summarize luteal function during pregnancy briefly, there are physiological processes initiated by the embryo and/or conceptus in early pregnancy that serve to prolong the life-span of the corpus luteum. Some of these processes are well defined, but others remain more obscure. The corpus luteum is maintained in a functional state throughout pregnancy (at least in those species described in this review), even though in several species progesterone production by the corpus luteum is not required after the first third of the gestational period. The cessation of secretory function by the corpus luteum of pregnancy at the end of gestation is apparently actively induced. There is evidence in some species (especially the goat) that this is due to PGF2alpha released from the uterus or placenta. It is concluded that the occurrence of luteal regression in several species of mammal can be attributed to the physiological release of PGF2alpha from both the pregnant and nonpregnant uterus.

Prostaglandin, a smooth muscle-stimulating depressor acidic lipid discovered int he human seminal plasma in 1935, is now used as a generic term for a family of closely related derivatives of prostanoic acid which are widely distributed in animal tissues. Prostaglandins are biosynthesized from arachidonic acid and dihomo-gamma-linolenic acid, both of which are derived from dietary linoleic acid. This finding provided a link to the observation that linoleic acid is an essential constituent of the diet. It is possible that prostaglandin compounds play a biochemical role fundamental to many, or all, animal cells. They have been implicated in sperm transport, menstruation, parturition, and control of placental blood flow. They may also play a role in the central nervous system, although this role may well be other than that of synaptic transmitter. Release of prostaglandin from various tissues is brought about by nerve stimulation. In adipose tissues, the amounts released may be sufficient to inhibit formation of cyclic AMP by the released noradrenaline, thus providing a local negative feedback mechanism. Prostaglandins also possibly play a role in muscular contractility, essential fatty acid deficiency, inhibition of lipid mobilization, atherosclerosis, and thrombosis.

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