(C) 2009

Elsevier Ltd All rights reserved “
“Object

(C) 2009

Elsevier Ltd. All rights reserved.”
“Objectives: We investigated a new technique for identifying the lung intersegmental line using infrared thoracoscopy with intravenous injection of indocyanine green.

Methods: This was an experimental animal study, and target segments were established preoperatively. Six adult beagle dogs underwent thoracotomy. After the corresponding pulmonary artery of the target segment had been ligated, indocyanine green was administered intravenously during infrared thoracoscopy. The lung was separated into 2 areas, white and blue, according to the blood flow on the monitor. We marked the visceral pleura with

electrocautery along the transition zone showing a change in color from blue to white. The Mdm2 inhibitor experimental lung was removed and subjected to pathologic and radiologic analysis.

Results: After injection of indocyanine green, infrared thoracoscopy showed that the area of normal perfusion changed to blue, whereas the area at which perfusion was absent remained white. The transition zone between colors was distinct, and the blue stain remained visible during the marking procedure. Three-dimensional computed tomographic analysis indicated that the marking separated the target segmental bronchus from the adjacent one. Detailed macroscopic and microscopic study confirmed that the marking corresponded selleck Calpain to the intersegmental line.

Conclusion: By using infrared thoracoscopy with indocyanine green, it is possible to detect the intersegmental line without inflating

the lung.”
“Previous studies have shown that in comparison with the sighted, blind individuals display superior non-visual perceptual abilities and differ in brain organisation. In this study, we investigated the performance of blind and sighted participants on a vibrotactile discrimination task. Thirty-three blind participants were classified into one of three groups (congenital, early, late), depending on the age at which they became blind. Consistent with previous neuroimaging data, individuals blinded after late childhood (14 years) showed no advantage over sighted participants. Both the congenitally- and early-blind participants were better than the sighted. The congenitally blind participants were even more accurate than the early-blind participants; a distinction that has not been drawn previously. Duration of blindness did not predict task performance and the effect of onset age persisted after duration of daily Braille reading was accounted for. We conclude that complete visual deprivation early in life leads to heightened tactile acuity. (C) 2009 Elsevier Ltd. All rights reserved.


“The authors review

research on judgments of rando


“The authors review

research on judgments of random and nonrandom sequences involving binary events with a focus on studies documenting gambler’s fallacy and hot hand beliefs. The domains of judgment include random devices, births, lotteries, sports performances, stock prices, and others. After discussing existing theories of sequence judgments, the authors conclude that in many everyday settings people have naive Selleck Givinostat complex models of the mechanisms they believe generate observed events, and they rely on these models for explanations, predictions, and other inferences about event sequences. The authors next introduce an explanation-based, mental models framework for describing people’s beliefs about binary sequences, based on 4 perceived characteristics of the sequence generator: randomness, intentionality, control, and goal complexity. Furthermore, they propose a Markov process framework as a useful theoretical notation for the description of mental models and for the analysis of actual event sequences.”
“Highly active antiretroviral therapy (HAART) suppresses HIV-1 replication, transforming the outlook for infected patients. However, reservoirs of replication-competent forms of the virus persist during HAART, and when treatment is stopped, high rates of HIV-1 replication return. Recent insights into HIV-1 latency, as well as a report that

HIV-1 infection was eradicated in one individual, have renewed interest in finding a cure for HIV-1 infection. Strategies for HIV-1 eradication include gene therapy and TEW-7197 ic50 hematopoietic stem cell transplantation, stimulating host immunity to control HIV-1 replication, and targeting XL184 mouse latent HIV-1 in resting memory CD4(+) T cells. Future efforts should aim to provide better understanding of how to reconstitute the CD4(+) T cell compartment with genetically engineered cells, exert immune

control over HIV-1 replication, and identify and eliminate all viral reservoirs.”
“The APOBEC3 family comprises seven cytidine deaminases (APOBEC3A [A3A] to A3H), which are expressed to various degrees in HIV-1 susceptible cells. The HIV-1 Vif protein counteracts APOBEC3 restriction by mediating its degradation by the proteasome. We hypothesized that Vif proteins from various HIV-1 subtypes differ in their abilities to counteract different APOBEC3 proteins. Seventeen Vif alleles from seven HIV-1 subtypes were tested for their abilities to degrade and counteract A3G, A3F, and A3H haplotype II (hapII). We show that most Vif alleles neutralize A3G and A3F efficiently but display differences with respect to the inhibition of A3H hapII. The majority of non-subtype B Vif alleles tested presented some activity against A3H hapII, with two subtype F Vif variants being highly effective in counteracting A3H hapII.

The goal of this prospective study was to assess the safety, dura

The goal of this prospective study was to assess the safety, durability, and effect on recanalization rates of the Cerecyte (Micrus Corp., Sunnyvale, CA) bioactive coil.

METHODS: Two hundred twelve ruptured and unruptured aneurysms

in 176 patients were prospectively enrolled in a database registry during a 12-month period. Adverse clinical outcomes directly attributed to the use of the Cerecyte coil were documented. Angiographic outcomes were determined immediately after coil embolization and during follow-up studies. All patients who received stent assistance or a non-Cerecyte coil were excluded. Two independent endovascular surgeons reviewed follow-up films. Any discrepancy was deemed a recurrence.

RESULTS: After exclusion criteria, 81 patients with 89 aneurysms were available for a minimum of 6 months of follow-up. Of those 89 aneurysms, 65% were ruptured aneurysms and were treated in the acute

setting. The mean size NF-��B inhibitor of the aneurysm was 7 mm. The mean angiographic follow-up period was 11.2 months. Recurrences requiring retreatment as a result of dome filling were identified in six aneurysms (6.7%). Four aneurysms (4%) developed compaction of more than 20%, which was defined click here as interstitial filling of the fundus. There was one thromboembolic event leading to permanent neurological deficit. No cases of chemical meningitis or delayed hydrocephalus occurred.

CONCLUSION: The Cerecyte bioactive coil seems to be safe and effective for use in both ruptured and unruptured aneurysms. The bioactive polymer within the coils allows similar handling characteristics of a bare platinum coil. Studies to assess long-outcomes with direct comparison to platinum coils and alternative bioactive coils are warranted.”
“Sequences of the coat protein amino acids of definitive and tentative species of carlaviruses deposited in GenBank were aligned and a region of seven amino acids (GLGVPTE) was found to be conserved. The corresponding nucleotides were CH5424802 solubility dmso aligned, allowing the design of a degenerate primer that together with an oligo dT anti-sense primer, was effective for the detection of three distinct

carlavirus species, two transmitted by aphids and one by whitefly. These primers have the advantage that about 940 nt from the 3′-terminus, comprising part of the CP gene (about 60%), the 11 K gene, and the terminal untranslated region can be amplified for sequencing. The fact that this amino acid sequence is conserved in almost all of the sequenced carlaviruses, allows the prediction that this primer pair will be useful as a diagnostic tool for carlavirus species. (C) 2007 Elsevier B.V. All rights reserved.”
“OBJECTIVE: Blood blister-like aneurysms are small hemispherical bulges from the dorsomedial wall of the internal carotid artery that resemble berry aneurysms but differ in their clinical and surgical features.

Multiple receptor subtypes (Y1R, Y2R, and Y5R) have been suggeste

Multiple receptor subtypes (Y1R, Y2R, and Y5R) have been suggested to contribute to NPY’s effects on rodent anxiety and depression-related behaviors.

Objectives To further elucidate the role of Y1R in (1) NPY’s anxiolytic-like effects and (2) fluoxetine’s antidepressant-like and neurogenesis-inducing effects.

Methods Mice lacking Y1R were assessed for spontaneous anxiety-like behavior

find more (open field, elevated plus-maze, and light/dark exploration test) and Pavlovian fear conditioning, and for the anxiolytic-like effects of intracerebroventricularly (icv)-administrated NPY (elevated plus-maze). Next, Y1R -/- were assessed for the antidepressant-like effects of acute fluoxetine in the forced swim test and chronic fluoxetine in the novelty-induced hypophagia test, as well as for chronic fluoxetine-induced hippocampal neurogenesis.

Results Y1R -/- exhibited largely normal baseline behavior as compared to +/+ littermate controls. Intraventricular administration of NPY in Y1R -/- mice failed to produce the normal anxiolytic-like effect in the elevated plus-maze test seen in selleck compound +/+ mice. Y1R mutant mice showed higher immobility in the forced swim test and longer latencies in the novelty-induced hypophagia test. In addition, Y1R -/- mice responded normally to the acute and chronic effects of fluoxetine treatment in the forced swim test and the novelty-induced hypophagia test, respectively,

as well as increased neuronal precursor cell proliferation in the hippocampus.

Conclusions These data demonstrate that Y1R is necessary for the anxiolytic-like effects of icv NPY, but not for the antidepressant-like or neurogenesis-inducing effects of fluoxetine. The present study supports targeting Y1R as a novel therapeutic target for anxiety

disorders.”
“Iron and palladium binding an exopolysaccharide (EPS) were obtained and purified from cultures of bacterial cells of Klebsiella oxytoca BAS-10. The strain BAS-10 was able to grow under anaerobic conditions with Fe(III)-citrate as energy and carbon source, producing Fe(III)-EPS that was extracted and used as catalyst in the oxidation reaction of phenol with H2O2. The same bacterial strain was cultivated anaerobically with Na-citrate and Pd-2(NO)(3) was added during the exponential growth to afford buy SRT1720 a Pd-EPS, named Bio-Pd (A), that, after isolation and purification, was used as catalyst in the reductive dehalogenation of chlorobenzene as model reaction. For comparison other two palladium binding polysaccharides were prepared: (a) a second type Pd-EPS, named Bio-Pd (B), was obtained by an exchange reaction with Pd acetate starting from an iron-free EPS produced by strain BAS-10 growing on Na-citrate medium; (b) a third type of palladium, named Bio-Pd (C), bound to a different polysaccharide, was recovered after the same exchange reaction applied on glycolipid emulsan obtained from an aerobic culture of Acinetobacter venetianus RAG 1.

Abuse was associated with heightened IL-6 and TNF-alpha levels; f

Abuse was associated with heightened IL-6 and TNF-alpha levels; for TNF-alpha, this relationship was magnified in caregivers compared with controls. Moreover, abuse and caregiving status were associated significantly and independently with higher

levels of depressive symptoms. Conclusions: Adverse childhood events are related to continued vulnerability among older adults, enhancing the impact of chronic stressors. Childhood A-1210477 chemical structure adversities cast a very long shadow.”
“Stroke, of which about 87% is ischemic stroke, constitutes one of the main causes of morbidity, disability, and mortality worldwide. Ischemic brain injury has complex pathological mechanisms. Considerable evidence has been collected over the last few years suggesting that oxidative stress associated with excessive production of reactive oxygen species is a fundamental mechanism of brain damage in stroke and reperfusion after stroke. Oxidative stress is an important trigger of neuronal apoptosis in ischemic stroke. In this current study, it was found that cocaine-regulated and amphetamine-regulated transcript 55-102 (CART(55-102)) inhibited oxygen-induced and glucose

deprivation (OGD)-induced neurotoxicity in a dose-dependent manner. The peak dose of CART(55-102) was 0.4 nmol/l. In addition, the level of intracellular this website reactive oxygen species was decreased in OGD-treated neurons in the presence of 0.4 nmol/l CART(55-102). Mitochondrial membrane potential (m) and mtDNA mRNA expressions were increased in OGD-treated neurons in the presence of 0.4 nmol/l CART(55-102). The current study suggests that

CART(55-102), by inhibiting oxidative stress, may be developed into therapeutic agents for ischemic Veliparib price stroke.”
“Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient’s age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.

Consistent with this, the mutations also reduced viral RNA produc

Consistent with this, the mutations also reduced viral RNA production in a cell-free replication system. In vivo, viruses containing residue 5 mutants produce viable virus, and an aromatic phenylalanine was maintained with only a slightly decreased virus growth rate. However, nonaromatic amino acids resulted in slow-growing viruses that reverted to wild type. The structural basis for this polymerase phenotype is yet to be determined, and we speculate that amino acid residue 5 interacts directly with template Mocetinostat supplier RNA or is involved

in a protein structural interaction that stabilizes the elongation complex.”
“Resveratrol, a polyphenol derived e.g. from red grapes, has been shown to mediate several positive biological actions such as protection of cells against oxidative stress. It can also influence cell signaling, but the mechanisms behind Belnacasan concentration its antioxidant properties are largely unknown. Here we show that RSV reduces oxidative stress and enhances cell survival in PC6.3 cells depending

on the concentration. In these cells, RSV increased the levels of antioxidants, SOD2 and TRX2, and of X chromosome-linked inhibitor of apoptosis protein. RSV also activated NF kappa B signaling as shown using luciferase reporter constructs. These findings show that RSV regulates oxidative stress and mitochondrial antioxidants in neuronal cells. This may contribute to MTMR9 cell protection in various brain disorders. (C) 2010 Elsevier Ireland Ltd. All rights reserved.”
“Norovirus GII/4 is a leading cause of acute viral gastroenteritis in humans. We examined here how the GII/4 virus evolves to generate and sustain new epidemics in humans, using 199 near-full-length

GII/4 genome sequences and 11 genome segment clones from human stool specimens collected at 19 sites in Japan between May 2006 and February 2009. Phylogenetic studies demonstrated outbreaks of 7 monophyletic GII/4 subtypes, among which a single subtype, termed 2006b, had continually predominated. Phylogenetic-tree, bootscanning-plot, and informative-site analyses revealed that 4 of the 7 GII/4 subtypes were mosaics of recently prevalent GII/4 subtypes and 1 was made up of the GII/4 and GII/12 genotypes. Notably, single putative recombination breakpoints with the highest statistical significance were constantly located around the border of open reading frame 1 (ORF1) and ORF2 (P <= 0.000001), suggesting outgrowth of specific recombinant viruses in the outbreaks. The GII/4 subtypes had many unique amino acids at the time of their outbreaks, especially in the N-term, 3A-like, and capsid proteins. Unique amino acids in the capsids were preferentially positioned on the outer surface loops of the protruding P2 domain and more abundant in the dominant subtypes.

Recanalization was found in one patient at 12 months and in two p

Recanalization was found in one patient at 12 months and in two patients at 24 months. Seven limbs had reflux in previously treated areas, treated segments, and segments in continuity with them. Three underwent an intervention to correct symptomatic reflux. The other four had no symptoms. After 1 year, eight limbs developed reflux in new locations and four underwent treatment. Symptoms resolved in most patients soon after the operation. The mean follow-up was 16 months (range, 2-39 months). After selleck screening library 8 to 12 months postprocedurally, the laser-treated veins were fibrotic and almost indistinguishable on DU imaging from the surrounding tissues. In five patients (2.25%) postoperative

paresthesia occurred > 2 to 3 days postoperatively and persisted in the follow-up. No paresthesia occurred in our last series whenever a larger amount of tumescent cold saline was infused around the vein.

Conclusion: Endovenous laser ablation of the SSV has excellent early and midterm results. The prevalence of thrombosis and paresthesia is very low. Symptom relief is very good. (J Vasc Surg 2009;49:973-9.)”
“Objectives:

Owing to its structural and anatomic characteristics, imaging of the lymphatic system has been difficult. The conventional diagnostic method of radionuclide-based imaging has the disadvantage of poor resolution. Recent work has shown that magnetic resonance imaging (MRI) can depict lymphatic buy LY3039478 channels in patients LY2874455 with lymphedema. This study evaluated the anatomic and functional images of contrast MR lymphangiography in the diagnosis of limb lymphatic circulation disorders.

Methods: The study enrolled 27 patients with primary lymphedema. Four patients had bilateral disease, and 23 had unilateral disease. Contrast-enhanced lymphangiography was performed with a 3.0-T MR unit after the intracutaneous injection of gadobenate dimeglumine into the interdigital webs of the dorsal foot. The kinetics of enhanced lymph flow within the lymphatic system were calculated

using the formula [speed in cm = total length of visualized lymph vessel in cm/inspection time in minutes] and by comparing dynamic nodal enhancement and time-signal intensity curves between edematous and contralateral limbs. Morphologic abnormalities of the lymphatic system were also evaluated.

Results: Examination of the MRIs after injection of the contrast agent showed enhanced lymphatic channels consistently visualized in all clinical lymphedematous limbs and in five contralateral limbs of unilateral lymphedema patients. The speed of flow within the lymphatics of lymphedematous limbs was 0.3 to 1.48 cm/min. Contrast enhancement in inguinal nodes of edematous limbs was significantly less than that of contralateral limbs (P < .01). Dynamic measurement of contrast enhancement showed a remarkable lowering of peak time (P < .01) and peak enhancement (P < .01), and a delay in outflow in inguinal nodes of affected limbs compared with that of control limbs.

Our data support the hypothesis of functional differentiation in

Our data support the hypothesis of functional differentiation in general and the specific role of the anterior PF299804 supplier hippocampus in episodic memory in particular. Diffusivity measurements might be highly sensitive to functionally relevant degenerative alterations of the hippocampus. (C) 2010 Elsevier Ltd. All rights reserved.”
“Aims: The management of asymptomatic severe mitral regurgitation remains controversial. The aim of the study was to assess the long-term survival, incidence of cardiac complications, factors that predict outcome, and effect of mitral surgery on the long-termprognosis of patients with asymptomatic severe mitral regurgitation amenable

to valve repair.

Methods: One hundred ninety-two asymptomatic patients (mean age, 63 +/- 13 years) with severe degenerative mitral regurgitation diagnosed by 2-dimensional echocardiography between 1990 and 2001 were prospectively followed for a median of 8.5 years.

Results: Overall, cardiovascular, and event-free survival was evaluated in 2 groups of patients: a “”conservative approach” group (n = 67) and an “”early surgery” group (n = 125). Outcomes were also analyzed among patients with atrial fibrillation, pulmonary hypertension, or both, as well as in patients free of any mitral regurgitation complications. In the whole population, 10-year overall survival was significantly lower with the conservative approach than early surgery

(50% +/- 7% vs 86% +/- 4%, log-rank < 0.0001). Similar results were obtained in the subgroups with atrial fibrillation and/or pulmonary hypertension. The 10-year propensity-matched score-adjusted hazards ratio for overall mortality, MK-0518 in vitro cardiac mortality, and cardiovascular events for the conservative treatment were 5.21, 4.83, and 4.40, respectively.

Conclusion: Our results show that the outcome of asymptomatic patients with severe degenerative mitral regurgitation is better with an early surgical approach rather than a more conservative treatment

strategy. (J Thorac Cardiovasc Surg 2009;138:1339-48)”
“In the current research we used a neurolinguistic paradigm (N400), in which brain activation to semantically congruent and incongruent actions (with respect to the AG-014699 research buy context) was compared in men and women. Twenty-three right-handed students viewed 260 pictures portraying people engaged in simple actions. Perception of plausible and understandable actions (e.g., smiling couple clinking glasses of champagne) was contrasted with that of implausible and unintelligible actions (e.g., businesswoman balancing on one foot in desert). ERP data showed early processing of the action’s purpose in the female brain, with a larger parietal N200 to understandable behavior. Source reconstruction (swLORETA) located the neural generators of this effect in the inferior/parietal, left inferior/frontal, left and right premotor areas, right cingulate cortex, right superior/temporal and extra-striate cortex belonging to the so-called “”human mirror-neuron system (MNS)”".

The 2 pigs did not show any vital sign changes, and, 2 weeks post

The 2 pigs did not show any vital sign changes, and, 2 weeks post procedure, they had no findings of osteomyelitis.

CONCLUSION: Based on our studies, the manubrium of the sternum appears to be an ideal location for the placement of the distal end of a CSF diversionary shunt when other anatomic receptacles are not an option. In vivo human studies are now required to verify our findings.”
“In vitro infection of cells with the betaherpesvirus

human cytomegalovirus (HCMV) stimulates an innate immune response characterized by phosphorylation of the transcription factor interferon regulatory factor 3 (IRF3) and subsequent expression of IRF3-dependent genes. While previous work suggests that HCMV envelope glycoprotein B is responsible for initiating this reaction, the signaling pathways stimulated by virus infection Pictilisib solubility dmso that lead to IRF3 phosphorylation have largely been uncharacterized.

Recently, we selleck inhibitor identified Z DNA binding protein 1 (ZBP1), a sensor of cytoplasmic DNA, as an essential protein for this response. We now describe a human fibroblast cell line exhibiting a recessive defect that results in the absence of activation of IRF3 following treatment with HCMV but not Sendai virus or double-stranded RNA. In addition, we show that while exposure of these cells to soluble HCMV glycoprotein B is capable of triggering IRF3-dependent gene transcription, transfection of the cells with double-stranded DNA is not. PF-6463922 nmr Furthermore, we show that overexpression of ZBP1 in these cells

reestablishes their ability to secrete interferon in response to HCMV and that multiple ZBP1 transcriptional variants exist in both wild-type and mutant cells. These results have two major implications for the understanding of innate immune stimulation by HCMV. First, they demonstrate that HCMV glycoprotein B is not the essential molecular pattern that induces an IRF3-dependent innate immune response. Second, IRF3-terminal signaling triggered by HCMV particles closely resembles that which is activated by cytoplasmic double-stranded DNA.”
“BACKGROUND: Diffusion tensor imaging (DTI) infers the trajectory and location of large white matter tracts by measuring the anisotropic diffusion of water. DTI data may then be analyzed and presented as tractography for visualization of the tracts in 3 dimensions. Despite the important information contained in tractography images, usefulness for neurosurgical planning has been limited by the inability to define which are critical structures within the mass of demonstrated fibers and to clarify their relationship to the tumor.

OBJECTIVE: To develop a method to allow the interactive querying of tractography data sets for surgical planning and to provide a working software package for the research community.

METHODS: The tool was implemented within an open source software project.

)”
“Human noroviruses (family Caliciviridae)

are the

)”
“Human noroviruses (family Caliciviridae)

are the leading cause of nonbacterial gastroenteritis worldwide. Although Human noroviruses are significant enteric pathogens, there exists no reliable vaccine or therapy to treat infected individuals. To date, attempts to cultivate Human noroviruses within the laboratory have met with little success; however, the related murine norovirus mouse norovirus 1 (MNV-1) has provided an ideal model system to study norovirus replication due to the ease with buy Staurosporine which the virus is cultivated and the ability to infect a small animal model with this virus. Previously we have identified the association between MNV-1 and components of the host secretory pathway and proposed a role for the viral open reading frame 1 proteins in the replication cycle. Here we describe for the first time a role for cytoskeletal components in early MNV-1 replication events. We show that the MNV-1 utilizes microtubules to position the replication complex adjacent to the microtubule organizing center. Chemical disruption of the microtubule network Selleck Givinostat disperses the sites of MNV-1 replication throughout the cell and impairs production of viral protein and infectious virus. Furthermore, we demonstrate the ability of MNV-1 to redistribute acetylated tubulin to the replication complex and that this association is potentially mediated via the MNV-1 major structural protein,

VP1. Transient expression of MNV-1 VP1 exhibited extensive colocalization with both alpha-tubulin and acetylated tubulin and was observed to alter the check details distribution of acetylated tubulin in transfected cells. This study highlights the role of the cytoskeleton in early virus replication events and demonstrates the importance of this interaction in establishing the intracellular location of MNV-1 replication complexes.”
“BACKGROUND

The course of autosomal dominant polycystic kidney disease (ADPKD) is often associated with pain, hypertension,

and kidney failure. Preclinical studies indicated that vasopressin V-2-receptor antagonists inhibit cyst growth and slow the decline of kidney function.

METHODS

In this phase 3, multicenter, double-blind, placebo-controlled, 3-year trial, we randomly assigned 1445 patients, 18 to 50 years of age, who had ADPKD with a total kidney volume of 750 ml or more and an estimated creatinine clearance of 60 ml per minute or more, in a 2: 1 ratio to receive tolvaptan, a V-2-receptor antagonist, at the highest of three twice-daily dose regimens that the patient found tolerable, or placebo. The primary outcome was the annual rate of change in the total kidney volume. Sequential secondary end points included a composite of time to clinical progression (defined as worsening kidney function, kidney pain, hypertension, and albuminuria) and rate of kidney-function decline.

RESULTS

Over a 3-year period, the increase in total kidney volume in the tolvaptan group was 2.8% per year (95% confidence interval [CI], 2.5 to 3.1), versus 5.