27 and 28 Michellamines A and B have been isolated from this plan

27 and 28 Michellamines A and B have been isolated from this plant source. Lomatium suksdorfii belonging to the family Apiaceae has shown to suppress HIV-1 viral replication in H9 lymphocyte cells. 29Polyalthia suberosa has yielded Lanostane-type triterpene, subserosal which has again shown to suppress anti-HIV replication activity in H9 lymphocytes in vitro. The plant Rhus succedanea L. (Family Anacardiaceae) has its active constituent as biflavonoids, robustaflavone and hinokiflavone which have shown strong inhibition of the polymerase of HIV-1 reverse transcriptase. 30Galanthus nivalis L. has yielded the plant lectin G. nivalis buy HKI-272 agglutinin (GNA) which

is a potent inhibitor that stops the spread of HIV among lymphocytes by targeting gp 120 envelope glycoprotein. 31Acer okamotoanum belonging to the family Aceraceae has given a flavonoid gallate ester having inhibition against HIV-1 integrase enzyme. Aqueous extract of the leaves of Andrographis paniculata (Acanthaceae) has exhibited inhibition against the protease and reverse transcriptase enzymes. 32Tripterygium hypoglaucum, Celastrus

hindsii and Tripterygium wilfordii all belonging to the family Celastraceae have led to the find more isolation of Triptonine A and Triptonine B, Celasdin B and Diterpene lactones respectively. 33, 34 and 35 These bioactive compounds have shown potent in vitro anti-HIV

activity. The plant Humulus lupulus (Cannabaceae) has led to the discovery of a Xanthohumol which has shown HIV-1 inhibitory Terminal deoxynucleotidyl transferase activity as well as HIV-1 induced cytopathic effects and led to the production of viral p24 antigen and reverse transcriptase in C8166 lymphocytes. 36 Inhibitory activity against HIV replication in acutely infected H9 cells has been established by the use of monosodium and monopotassium salts of isomeric caffeic acid tetramer from the plant Arnebia euchroma. Two dicaffeoylquinic acids, namely, 3,5-dicaffeoylquinic acid, and 1-methoxyoxalyl-3,5-dicaffeoylquinic acid have been isolated from Achyrocline satureioides (Lam.) which have shown potent and irreversible inhibition against HIV-1 integrase. 37 and 38 The aqueous and ethanol extract of Bulbine alooides (Asphodelaceae) have shown to inhibit HIV-1 protease. 39 The sulfonated polysaccharides from Agardhiella tenera has shown to inhibit the cytopathic effect of HIV-1 and HIV-2 in MT-4 cells. 40 Two bioactive compounds from Garcinia speciosa viz Protostanes and Garcisaterpenes A and C have inhibitory effect against HIV-1 reverse transcriptase. 41 Water soluble lignins which inhibit HIV-1 protease have been isolated from Inonotus obliquus from the family Hymenochaetaceae. 42Calophyllum teysmannii has given (−)-calonolide B which is having lesser activity than A form.

Dr A N Bulut is employed by the Şap institute, which manufacture

Dr A.N. Bulut is employed by the Şap institute, which manufactures the vaccines under evaluation. The authors are grateful to various members of the Turkish state veterinary services for their assistance during the execution of these field studies. Particular thanks go to Musa Alkan and Oktay Tezal of the Şap institute. Prof Paul Fine (London School of Hygiene MLN0128 mouse & Tropical Medicine) helped initiate this project. We acknowledge the work of the Dr Yanmin Li and colleagues at The Pirbright Institute (WRLFMD) who performed

vaccine matching and potency studies mentioned in this paper. This work was funded by the European Commission for the Control of FMD, the Biotechnology and Biological Science Microbiology inhibitor Research Council and the Şap institute, Ankara, Turkey. D.J. Paton is a Jenner Investigator. “
“In 1989, the World Health Organization and the journal Vaccine convened an expert advisory conference in Oxford (UK) entitled “Vaccines for

Sexually Transmitted Diseases” [1] to explore the possibilities for vaccination to reduce the major negative impact of sexually transmitted infections (STIs) on global health. The proceedings of this conference described a fledgling recombinant hepatitis B vaccine that had been only minimally implemented, and predicted that development of a protective vaccine against human papillomavirus (HPV) was unlikely and perhaps should not be pursued [1]. Less than 25 years later, safe and effective vaccines against both infections are major public health success stories. Hepatitis B vaccination has now been incorporated into the national infant immunization programs of 181 countries, and 79% of newborns worldwide have received 3 doses of the vaccine [2]. Millions of hepatitis B virus infections, and resulting deaths from chronic liver disease and cancer, have already been prevented. HPV vaccines, first introduced in 2006, are highly efficacious in preventing HPV types causing 70% of cervical cancers, a disease affecting more than half a million women a year globally. Already showing an impact on HPV prevalence and genital

warts in several countries, HPV vaccines are poised to be rolled out on a much larger scale and are expected to avert millions of cervical cancer deaths. Recent global efforts to improve only sexual and reproductive health and reduce vaccine-preventable diseases provide a unique opportunity to build on these successes and work toward new STI vaccines, to complement important existing STI prevention efforts such as sexual health education and condom promotion. Following the 1994 International Conference on Population and Development, which first formally recognized the rights of individuals to both sexual and reproductive health, there have been increasing calls for action to achieve a broad global vision of sexual and reproductive health, including prevention and control of STIs.

The ‘universal’ nature of the vaccine (protects against homologou

The ‘universal’ nature of the vaccine (protects against homologous and non-homologous virus), the absence of robust natural immunity to an antigen critical for pathogenesis such as site II on the F protein, the genetic stability of the palivizumab binding site [42] as compared to other sites such as antigenic site Ø [43], and the safety and the apparent potency of the vaccine, reinforce the premise that efficacy testing of the vaccine is warranted. The clinical development of an RSV vaccine may be divided amongst three populations: infants, infants/preschool children Anti-diabetic Compound Library and the elderly. Maternal immunization, the

active immunization of pregnant women to provide trans-placental transferred antibody for passive protection of the infant, is a priority strategy for PD0325901 molecular weight protection of young infants

against RSV and has been successfully employed for tetanus, pertussis and influenza vaccines [44]. Older infants and toddlers may also benefit from active immunization and many strategies including live viral vaccines and purified subunit vaccines have been employed in early clinical testing [45]. An RSV purified F protein showed clinical promise in children and CF patients, but proved difficult to manufacture and stabilize [22] and [46]. The clinical evaluation of a novel vaccine must also take into account the history of the formalin inactivated RSV vaccine (Pfizer Lot 100 vaccine) that unexpectedly caused severe exacerbation of pulmonary disease in children who subsequently acquired RSV infections [33] and [47]. Although the precise mechanisms underlying these findings remain open to debate [48], the phenomenon of vaccine-enhanced RSV disease was limited to RSV-naïve infants immunized with FI-RSV and has not been observed either with passive antibody prophylaxis (monoclonal or polyclonal) in clinical trials using purified F protein vaccines in adults or older RSV-seropositive Cediranib (AZD2171) children [22], [46] and [49].

Thus, the path forward for development of a vaccine in older infants and children will need to be carefully considered. However, a vaccine that induces high affinity antibodies that exhibit neutralization or fusion inhibition in vitro, largely absent in FI-RSV vaccinated infants [50], and is associated with protection without disease exacerbation in vivo in relevant animal models and finally shows efficacy in another setting such as maternal immunization may be considered in the absence of a licensed vaccine for this population. Finally, the RSV disease burden in elderly and high risk adults and the data indicating an F subunit vaccine is safe along with the absence of historical safety concerns due to enhanced disease in this population suggests further testing of the safety and efficacy as a seasonal respiratory vaccine is warranted. The induction of PCA by the RSV F nanoparticle vaccine provides an important rationale for further clinical evaluation in the relevant susceptible populations. We thank Kwan Ngai for technical support.

CR formulations provide certain advantages when compared to their

CR formulations provide certain advantages when compared to their IR counterparts. CR formulations can reduce peak to trough fluctuations in the plasma concentration–time profile (compared to multiple-dose administration of an IR product), hence reducing fluctuation-related side effects and/or sub-therapeutic concentrations. CR formulations can increase the exposure over time of drugs with a short elimination half-life, and can be used to target delivery into distal regions

STI571 cost of the intestine (e.g. colon), or where there is a need for targeted delivery for the treatment of a specific disease, such has Crohn’s disease (Langer, 1990, Rubinstein, 2005 and Thombre, 2005). This can lead to an increased patient compliance. Furthermore, CR formulations can be of use in drug PLX3397 concentration development when the standard IR formulation is not an alternative due to unfavourable pharmacokinetic properties of the drug candidate (Langer, 1990, Rubinstein, 2005 and Thombre, 2005). One of the main goals when developing a CR formulation of a marketed drug is

to achieve, at least, the same exposure as the equivalent dose of their IR counterpart. In general however the relative bioavailability of a CR formulation compared to its IR counterpart is expected to be less than 100% (European Medicines Agency, 2013). Several physiological factors can influence the observed Tolmetin differences in systemic exposure between IR and CR. A CR formulation is intended to release its drug content within 12–24 h, in contrast the small intestinal transit time is around 2–5 h (Davis et al., 1986, Fallingborg et al., 1989 and Yu et al., 1996). Therefore a majority of the dose should be released into distal regions of the small intestine and the colon, where the residence time in the colon is about 12–24 h (Coupe et al., 1992, Davis et al., 1986 and Fallingborg et al., 1989). The extended release may limit the absorption potential for a drug formulated as CR as, in

general, the distal regions of the intestine provide a less favourable environment for drug absorption. For instance, the reduced surface area available for absorption in the distal region of the GI tract may limit the absorption for poorly permeable compounds (Tannergren et al., 2009 and Watts and Lllum, 1997), the intestinal pH increases towards the distal portion of the intestine consequently limiting the aqueous solubility of basic compounds (Fallingborg et al., 1989). Finally, the lack of bile salts, less fluid volume in the colon, differences in the regional permeability and possible degradation by colonic microflora can also have a negative impact on the drug absorption of CR formulations (Lennernas, 2014a, Schiller et al., 2005, Sutton, 2009 and Tannergren et al., 2009).

The main correlates of protection

from clinical disease a

The main correlates of protection

from clinical disease and weight loss in mice inoculated with active DI virus + A/WSN compared with control receiving inactivated DI virus + A/WSN are (a) reduction in the amount of infectious virus in the lungs of mice on day 2 (83-fold), day 4 (27-fold) and day 6 (10-fold), (b) reduction in genomic RNAs 1 and 7 in the lung on day 4, (c) larger amounts of 244 DI RNA in the lung on days 2 and 4, and (d) absence of lung consolidation. It appears therefore see more that the key events necessary to maintain animal wellbeing occur early in infection, with the main protective action of DI virus taking place at 2 and 4 days after infection or earlier. Protection correlated with high amounts of lung DI RNA and low amounts of lung infectivity. Despite the relatively high virus load in the lungs of protected mice, they appeared to be clinically normal at this time, gaining weight, and exhibiting no lung consolidation. A summary of BIBW2992 price the main features of the delayed onset disease in SCID mice given the lower dose (1.2 μg) of active 244 DI virus + A/WSN and the acute disease in SCID mice given the same amount of inactivated 244 DI virus + A/WSN is shown in Table 1. In the acute disease, significant weight loss and clinical signs coincided with or occurred 1 day later than infectivity reaching

approximately 106 ffu in the lung, with consolidation commencing 1–2 days later. In contrast,

mice treated with DI virus attained similar levels of infectivity and significant consolidation on day 8, but significant weight loss and clinical Sitaxentan signs were not apparent for another 3 days. However, once initiated the course of disease in the acute and late onset disease groups was indistinguishable. We have not seen any relapse in many hundreds of wild-type mice, with no known immune defect, protected with 244 DI virus from various influenza A viruses, and this includes observing most mice for 7 weeks and some for 6 months after infection (authors’ unpublished data). Lung consolidation in SCID mice infected with an influenza A virus is described as plum coloured areas on the lung surface (as we found), which microscopically presents as a proliferative pneumonia, comprising a massive multifocal to coalescing proliferative bronchitis, bronchiolitis, and alveolitis, marked proliferation of type II pneumocytes, and hyperplastic and hypertrophic columnar epithelium lining the airways [26]. A substantial migration of natural killer cells into the lungs of influenza virus-infected SCID mice has also been reported, although they played no role in disease progression [27]. In mice given a 10-fold higher DI dose, disease was delayed by a further 7 days showing that the delay was DI virus dose-dependent (Fig. 1d and f).

En France, parmi les 315 femmes enceintes ou en post-partum du re

En France, parmi les 315 femmes enceintes ou en post-partum du registre établi lors de la pandémie de 2009, les césariennes et les accouchements prématurés étaient plus fréquents parmi les learn more cas les plus graves, tout comme les nouveau-nés avec un plus faible poids de naissance [16]. Pour autant, il n’a pas été noté un excès de décès chez les nouveau-nés selon que les patientes étaient hospitalisées ou non [16]. Lors de cette

même pandémie de 2009, un nouveau-né né par césarienne d’une mère infectée, a développé une toux sèche. Une PCR pratiquée quatre heures après sa naissance était positive pour le virus A (H1N1) pdm09, confirmant une probable transmission prénatale du virus grippal [26]. Dans l’étude de cohorte prospective française il n’a pas été observé d’impact de l’infection grippale H1N1 sur l’issue de grossesse mais le nombre de cas de grippe était très faible [17]. En dehors d’un contexte pandémique, il n’existe actuellement pas de recommandation spécifique concernant la prise en charge d’une grippe en cours de grossesse. Devant un syndrome grippal avec une bonne tolérance clinique, en

l’absence de signe de gravité et de comorbidité, le diagnostic virologique n’est pas recommandé de façon systématique en contexte épidémique saisonnier. Une évaluation du bien-être fœtal par un enregistrement cardiotocographique et une échographie pourra être proposé à partir de 25 semaines d’aménorrhée (SA). L’examen obstétrical doit permettre de s’assurer de l’absence de menace d’accouchement buy CT99021 prématuré associée et écarter les diagnostics différentiels devant toute fièvre en cours de grossesse : une infection à Listeria en raison de sa gravité et une pyélonéphrite en raison de sa Adenosine fréquence. En pratique, un bilan comprenant une numération sanguine, un dosage de la C-reactive protein, au minimum une série d’hémocultures sur milieu aérobie et anaérobie et un ECBU sera réalisé comme

devant toute fièvre en cours de grossesse. Un traitement antibiotique probabiliste dirigé contre la Listeria (amoxicilline ou érythromycine en cas d’allergie à la pénicilline) doit être institué dans l’attente de la négativité des examens bactériologiques. Un traitement symptomatique antipyrétique sera adjoint avec une surveillance à domicile de la bonne évolution clinique. En cas de signes respiratoires sévères ou de comorbidité, un prélèvement nasopharyngé sera réalisé pour rechercher le virus de la grippe et instituer, le cas échéant, un traitement spécifique par oseltamivir (Tamiflu® 75 mg × 2 par jour per os pendant cinq jours) (avis du Haut conseil de la santé publique du 9 novembre 2012, http://www.hcsp.fr/docspdf/avisrapports/hcspa20121109_antivirauxextrahospgrippe.pdf). Les données disponibles sont en faveur d’une bonne tolérance de l’oseltamivir en cours de grossesse [27].

The quality criteria for health checks developed in this project<

The quality criteria for health checks developed in this project

go beyond these general aims; they aim to promote autonomous informed decisions by clients and require description of the condition and the target population, and clear information about the harms and costs. The workshop agreement is a consensus document by a diverse group of stakeholders across EU member states, composed through several rounds of internal and external consultations. The agreement has no legal status; providers of health checks are not obliged to adhere to these criteria. Rather, together with reviews that have demonstrated the lack of scientific evidence for health checks (Krogsboll et al., 2012), the workshop agreement can be a starting point for further Venetoclax mw discussion on the desirability and feasibility of regulation and monitoring INCB018424 in vivo of the quality of health checks that are not yet regulated.

Efficient and effective regulation and monitoring of the quality of health checks will undoubtedly be a challenge. The offer of health checks is broad and diverse, coming from both health care organizations as well as the commercial industry. Yet, providers of health checks and follow-up examinations (health care organizations and industry), users (consumers and consumer organizations) and payers (health insurance companies and governments) all have good reasons to demand quality others and quality standards. Together with regulatory agencies, such as the European Medicines Agency (EMEA) and the US Food and Drug Administration (FDA), they could work toward feasible solutions for the regulation of this upcoming market. In light of the cross-border offer of many health checks, discussion and collaboration on an international level is advised. Given the concerns about the quality and limited

impact of health checks, it is in the interest of protecting individuals and of keeping the health care system accessible and affordable that further steps are taken to ensure the quality of health checks. The proposed criteria can be a starting point for further discussion. The authors declare there is no conflict of interest. The authors acknowledge all participants that contributed to the development of the workshop agreement. The CEN Workshop Agreement (CWA 16642) includes the list of participants. The Ministry of Health, Welfare and Sport in the Netherlands initiated the project and financed NEN to facilitate the process. The European Partnership for Action Against Cancer (EPAAC) (Consortium Grant 631-024/12/023), a project co-funded by the Health program of the European Union, provided funding for travel and subsistence cost for participants to attend the meetings.

Setting: Nine outpatient rehabilitation centres in the Netherland

Setting: Nine outpatient rehabilitation centres in the Netherlands. Participants: Patients with a stroke who had been discharged home and who could walk 10 m without assistance were included. Cognitive deficits and inability to communicate were key exclusion criteria. Randomisation of 250 participants 3-MA order allocated 126 to task oriented circuit training and 124 to individualised physiotherapy. Interventions: The task oriented circuit training group trained for 90 min twice-weekly for 12 weeks supervised by physiotherapists and sports trainers as they completed 8 mobility-related stations in groups of 2 to 8 participants.

Individualised outpatient physiotherapy was designed to improve balance, physical conditioning, and walking. Outcome measures: The primary outcome was the mobility domain of the stroke impact scale measured at 12 weeks and 24 weeks. The domain includes 9 questions about a patient’s perceived mobility competence and is scored from 0 to 100 with higher scores indicating better mobility. Secondary outcome measures included selleck compound other domains of the stroke impact scale, the Nottingham extended ADL scale, the falls efficacy scale, the hospital anxiety and depression scale, comfortable walking speed, 6-minute walk distance, and a stairs test. Results: 242 participants completed the study. There were no differences in the mobility domain of the stroke impact scale between the groups at 12 weeks (mean difference (MD)

–0.05 units, 95% CI –1.4 to 1.3 units) or 24 weeks (MD –0.6, 95% CI –1.8 to 0.5). Comfortable walking speed (MD 0.09 m/s, 95% CI 0.04 to 0.13), 6-minute walk distance (MD 20 m, 95% CI 35.3 to 34.7), and stairs test (MD –1.6 s, 95% CI –2.9 to –0.3) improved a little more in the circuit training group than the control group at 12 weeks. The memory and thinking domain of the stroke impact scale (MD –1.6 units, 95% CI –3.0

to –0.2), and the leisure domain of the Nottingham extended ADL scale (MD –0.74, 95% CI –1.47 to –0.01) improved a little more in the control group than the circuit training group at 12 weeks. The groups did not differ significantly on the remaining secondary outcomes at 12 weeks or 24 weeks. Carnitine palmitoyltransferase II Conclusion: In patients with mild to moderate stroke who have been discharged home, task oriented circuit training completed in small groups was as effective as individual physiotherapy in improving mobility and may be a more efficient way of delivering therapy. [95% CIs calculated by the CAP Co-ordinator] Evidence that task-specific circuit training may improve walking after stroke has been growing since the first pilot study published in 2000 (Dean et al 2000). From research into motor learning and several meta-analyses of rehabilitation we know that increasing the amount of practice will improve outcome. However repeated behavioural observation studies have shown low levels of physical activity during rehabilitation after stroke.

09 M Tris borate, 2 mM EDTA, pH 7 8) at 90 mV for 60 min cDNA wa

09 M Tris borate, 2 mM EDTA, pH 7.8) at 90 mV for 60 min. cDNA was prepared from 2 μg of total RNA using the Superscript™ First-Strand Synthesis System (Invitrogen, Paisley, UK) with random hexamer primers according to the manufacturer’s protocol. Samples were incubated at 65 °C for 5 min then held

on ice for 1 min before the addition of Superscript III reverse transcriptase. Samples were then incubated at 25 °C for 10 min followed by reverse transcription at 50 °C for 50 min. The reaction was terminated by heating to 85 °C for 5 min to inactivate the enzyme. Quantitative PCR was carried out on a 7500 Real Time PCR Sequence Detection System (Applied Biosystems, Foster City, CA). TaqMan analysis was performed in a 25 μl reaction mixture containing 30 ng CB-839 datasheet cDNA, TaqMan Universal PCR Master Mix (comprising AmpliTaq Gold DNA polymerase, dNTPs with dUTP, passive reference and optimised selleck products buffer) and Assay-on-demand™ gene expression assay mixes containing specific primers and probes (all from Applied Biosystems). The PCR conditions comprised a 2 min incubation at 50 °C followed by a 10 min polymerase activation at 95 °C. This was followed by 40 cycles alternating between 95 °C for 15 sections and 60 °C for 1 min each.

Amplification curves were analysed using the SDS version 3.2 software (Applied Biosystems, Foster City, CA). The baseline and threshold values were set and the Ct values extracted for each gene of interest. Relative quantification was calculated using the geometric mean of two selected house-keeping genes, gapdh and mvp. Relative gene expression

levels were calculated using the equation 2−ΔCt. An arbitrary classification system was applied to the data quantifying relative expression levels secondly as ‘high’ >0.5, ‘moderate’ between 0.02 and 0.5, ‘low’ between 0.001–0.02 and ‘negligible’ <0.001. All transport experiments were conducted in standard buffer solution (SBS) comprising Hank’s Balanced Salt Solution (HBSS) supplemented with 20 mM 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid (HEPES). Cell layers were allowed to equilibrate in SBS for 60 min at 37 °C before TEER measurements were taken. Each condition was carried out in quadruplicate and only layers with a resistance >250 Ω cm2 were accepted for experimentation. For transport studies with radiolabelled markers, donor compartments were filled with 0.51 ml (apical to basolateral (AB) transport) or 1.51 ml (basolateral to apical (BA) transport) of SBS containing 25 nM 3H-digoxin and/or 6.55 μM 14C-mannitol. Receiver compartments were filled with 1.5 ml (AB transport) or 0.5 ml (BA transport) of SBS. At the start and end of the experiment, 10 μl samples were taken from the donor compartments for determination of the initial and final concentration. Every 30 min over a 2 h period, 300 μl samples (AB transport) and 100 μl samples (BA transport) were taken from the respective receiver chambers and replaced with the same volume of SBS.

Although 13 risk factors were identified, none was confirmed as s

Although 13 risk factors were identified, none was confirmed as significant http://www.selleckchem.com/products/azd5363.html in an independent study. Four

failed to be validated as predictive in a subsequent study, which amplifies the need for validation studies. The remaining nine that await validation are spinal symmetry, lumbar spine extension endurance, the ratio of lumbar flexion mobility to extension endurance, the ratio of lumbar extension mobility to extension endurance, the ratio of lumbar flexion and extension mobility to extension endurance, high levels of physical activity, parttime work, abdominal pain, and psychosocial difficulties. Future research should use a standard definition of low back pain, use short recall periods, and report raw data to enable results to be meaningfully pooled across studies. Given the constraints of predictive studies and the many covariates, measurement of predictors Selleck Gefitinib may be futile and a focus on intervention studies may yield greater benefit. eAddenda: Appendix 1 available at www.JoP.physiotherapy.asn.au. “
“Postoperative pulmonary complications are a major cause of morbidity after thoracotomy, resulting in patient discomfort, prolonged length of hospital stay, and increased healthcare costs (Stephan et al 2000, Zehr et al 1998). Thoracotomy can also lead to long-term restriction of shoulder function and range of motion, reduced muscle strength, chronic pain, and reduced health-related quality of life (Gerner 2008,

Kutlu et al 2001, Li et al 2003, Schulte et al 2009). In Australia and New Zealand, physiotherapy is routinely provided after thoracotomy with the aim of preventing and treating both

pulmonary and musculoskeletal complications (Reeve et al 2007). Reeve and colleagues (2010) recently reported the primary outcome associated with the current study. A respiratory physiotherapy intervention provided 3-mercaptopyruvate sulfurtransferase after pulmonary resection via open thoracotomy did not decrease the incidence of postoperative pulmonary complications or length of stay, compared to that achieved by a control group who were managed by medical and nursing staff using a standardised clinical pathway. This clinical pathway included early and frequent position changes in bed, sitting out of bed from the first postoperative day, early ambulation, and frequent pain assessment. The ability of a postoperative physiotherapy shoulder exercise program to prevent or minimise shoulder dysfunction after thoracotomy has not been investigated. Therefore, the research questions associated with the secondary outcomes of this study were: 1. In patients undergoing elective pulmonary resection via open thoracotomy, does a postoperative physiotherapy exercise program that includes progressive shoulder exercises improve pain, range of motion, muscle strength and shoulder function? A randomised trial with intention-to-treat analysis, assessor blinding, and concealed allocation was undertaken as described fully by Reeve and colleagues (2008).