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Roy Schwartz,1 Ran Ben Cnaan,1 Ophir Schein,2 Michael Giladi,3 Michal Raz,4 Igal Leibovitch11Oculoplastic and Orbital Institute, Department of Ophthalmology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Department of Plastic Surgery, Assaf Harofeh Medical Center, Tzrifin, Israel; 3Infectious Disease Unit, 4Pathology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelAbstract: A 44-year-old woman, who had undergone gold-weight implantation due to facial palsy and lagophthalmos, arrived at the ophthalmology ward with eyelid swelling and erythema, which rapidly deteriorated under intravenous antibiotics to a necrotic process involving the periocular tissues, the eye, and the anterior orbit. Despite prompt removal of the gold weight, the patient's ocular and systemic condition continued to deteriorate, necessitating evisceration and debridement of necrotic tissue. Cultures showed growth of Staphylococcus epidermidis, Staphylococcus capitis, Candida glabrata, and Candida albicans, and histopathology demonstrated an acute nonspecific necrotizing panophthalmitis. Later on, the patient was admitted to a plastic surgery ward with recurrent severe burns of her thigh, which were highly suggestive of being self-induced, raising the possibility of self-induced damage.Keywords: evisceration, factitious disorder, lagophthalmos

Background: Clinically significant drug-drug interactions can be defined as events in which the pharmacodynamics or pharmacokinetic characteristics of a drug are modified by coadministration of a second drug to the patient’s medication protocol, which can often lead to in an increase of serious adverse reactions. The probability of interactions increases with higher number of drugs administered. Objective: The objective of this prospective study was to determine the prevalence of potential psychotropic drug-drug interactions among hospitalized patients at Psychiatry hospital in Sulaimani city, and to identify the clinical consequence of such combinations. Method: The current study was involved recruiting the data regarding prescribed psychotropic drugs of 60 newly hospitalized psychiatric patients. Data collection on each individual patient was performed on the specific patient dossier of to report any potential psychotropic drug-drug interactions utilizing Medscape drug interaction checker for identification of the different types of drug-drug interactions. Result: The prevalence of potential drug-drug interaction at Psychiatry Unit in Sulaimani city in 60 patients was 98%, of which 16.6% were major drug-drug interactions. The most frequently prescribed medications were antidepressant drugs, most of patients received more than four drugs. Conclusion: From the current study one can conclude that there was a high prevalence of potential drug-drug interactions among psychiatric patients, which was more frequent in patients taking more than one psychotropic medication.

Abstract Background and Aims Sleep is a complex physiological process during which the body and mind enter a period of rest. For a healthy lifestyle, different cohort groups can be affected in different ways. One such cohort is healthcare workers (HCWs)—an unexplored group in Afghanistan. Therefore, the present study examined the association between a range of sociodemographic factors including having night shift work and sleep quality among Afghan HCWs. Methods A cross‐sectional survey was administered in January 2023 among HCWs (N = 342) in the Herat province of Afghanistan. The survey examined sleep quality and its association with a range of sociodemographic factors among HCWs. Logistic regression models were used to examine the association of sleep quality with sociodemographic characteristics among HCWs. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality among HCWs. Results A total of 342 HCWs participated in the present study with an age range of 18 to 60 years. The mean age of the participants was 28.90 years (SD ± 8.10). Just over half of the participants were male (50.3%). Of the 342 participants, 58.5% reported poor sleep quality. Being married status, having higher number of children, not being a doctor, having low economic status, working night shifts, and having a traumatic event occur during past month were among the main variables associated with sleep quality among Afghan HCWs. Multiple regression analysis indicated that having high income [negatively] (AOR = 4.132, p = 0.002), working night shifts [positively] (AOR = 0.288, p

In this study, we report the effect of Zr4+ doping on the optical energy gap and microwave dielectric properties of rutile TiO2. Rietveld analysis explicitly confirmed that Zr4+ occupies the octahedral site, forming a single-phase tetragonal structure below the solubility limit (x < 0.10). Notably, at x = 0.025, a significant enhancement in Q × fo was observed. This enhancement was attributed to the reduction in dielectric loss, associated with a decrease in oxygen vacancies and a lower concentration of Ti3+ paramagnetic centers. This conclusion was supported by Raman and electron paramagnetic resonance spectroscopy, respectively. The origin of high τf in rutile Ti1−xZrxO2 is explained on the basis of the octahedral distortion/tetragonality ratio, covalency, and bond strength.

Background: Anxiety is a common psychological disorder in school-aged children and adolescents. The present study aimed to assess the prevalence of anxiety symptoms and sleep disturbances and their relationship with academic achievement among female students in Herat, Afghanistan. Methods: A cross-sectional survey of 737 female students (mean age 11.8 years old) was conducted across 10 randomly selected schools in Herat, Afghanistan, covering Grades 1 to 6. Students were randomly chosen within these schools. The Depression Anxiety Stress Scale for Youth (DASS-Y) and Pittsburgh Sleep Quality Index (PSQI) assessed anxiety and sleep disturbance, while academic achievement ratings were provided by schoolteachers. Results: Using the DASS-Y and the PSQI, 65.5% reported anxiety symptoms and 46.4% reported sleep disturbance. Low academic achievement correlated significantly with anxiety (r = 0.228) and sleep issues (r = 0.161). Multiple logistic regression analysis identified predictors for anxiety and sleep disturbance. Predictors for anxiety included being aged 13–16 years, having lower class grade, being of low economic status, and having unemployed parents. Predictors for sleep disturbance included being aged 13–16 years, having lower class grade, having an uneducated father, being of low economic status, and having unemployed parents. Conclusion: There is a high prevalence of anxiety symptoms and sleep disturbances among female school students in Herat, Afghanistan. Significant correlations exist between students' academic achievement, anxiety, and sleep disturbances. Addressing anxiety and sleep disturbances among Afghan female school students could be facilitated by revising current government policies concerning students' health. Educational campaigns focused on sleep hygiene and anxiety management for both students and their parents may also prove beneficial.

Introduction: The traditional educational system has concentrated on cognition acquisition and skills essential for physician practice. However, medical educationists are focusing more on good professional doctors now, having a cognitive foundation to work alongside their social roles as a physician-to-be. Aims and Objectives: To assess medical professionalism amongst postgraduate trainees at Bolan Medical Complex Hospital, Quetta. Place and Duration of study: Bolan Medical Complex Hospital, Quetta during February 2024. Material and Methods: A cross-sectional study was conducted to determine professionalism utilizing a pre-validated questionnaire termed Professionalism Assessment Tool (PAT) from 47 Postgraduates (PGs) of the Neurosurgery, General Medicine, and Psychiatry departments. Data was entered and analyzed using SPSS version 29 was used to calculate frequencies and percentages. The chi-square test was utilized to evaluate the association between professional years and items. A p-value of ? 0.05 is considered significant. Results: All 18 PGs from the psychiatry department, 23/36 (64%) from General Medicine, and all 6 from Neurosurgery filled out the questionnaire. 55.3%(n=25/47) were above 25 years of age, The majority were males (n=31, 66%) and 34% females, 36% (n=17/47) PGs were from 1st year of training. Item no 1 and 5 of Domain I and Domain 3 present the highest percentage score (52.4%) respectively. Highly statistically significant results (p-

Abstract Background Mutations in genes involved in DNA damage repair (DDR), a hallmark of cancer, are associated with increased cancer cell sensitivity to certain therapies. This study sought to evaluate the association of DDR pathogenic variants with treatment efficacy in patients with advanced non‐small cell lung cancer (NSCLC). Methods A retrospective cohort of consecutive patients with advanced NSCLC attending a tertiary medical center who underwent next‐generation sequencing in 01/2015‐8/2020 were clustered according to DDR gene status and compared for overall response rate (ORR), progression‐free survival (PFS) (patients receiving systemic therapy), local PFS (patients receiving definitive radiotherapy), and overall survival (OS) using log‐rank and Cox regression analyses. Results Of 225 patients with a clear tumor status, 42 had a pathogenic/likely pathogenic DDR variant (pDDR), and 183 had no DDR variant (wtDDR). Overall survival was similar in the two groups (24.2 vs. 23.1 months, p = 0.63). The pDDR group had a higher median local PFS after radiotherapy (median 45 months vs. 9.9 months, respectively; p = 0.044), a higher ORR (88.9% vs. 36.2%, p = 0.04), and a longer median PFS (not reached vs. 6.0 months, p = 0.01) in patients treated with immune checkpoint blockade. There was no difference in ORR, median PFS, and median OS in patients treated with platinum‐based chemotherapy. Conclusion Our retrospective data suggest that in patients with stage 4 NSCLC, pathogenic variants in DDR pathway genes may be associated with higher efficacy of radiotherapy and immune checkpoint inhibitors (ICIs). This should be further explored prospectively.

Climate change is predicted to have detrimental impacts on sessile invertebrates, including sponges. Mesophotic ecosystems have been suggested to play a major role as refugia for coral reef sponge species, however knowledge regarding the ability of mesophotic sponges to cope with thermal stress is scarce. In this study we compared the response of the sponge Diacarnus erythraeanus, a widespread Red Sea sponge, from the shallow and mesophotic reef, to moderate and acute temperature elevation (2°C and 6°C, respectively) for short and long term periods (two and 35 days, respectively) by measuring physiological parameters (respiration, oxygen removal, pumping rates, and photosynthetic efficiency), and the microbiome composition change. The results indicated that mesophotic and shallow populations of D. erythraeanus are highly tolerant to both moderate and acute heat stress, demonstrating a high survival rate (100%) across the experimental treatments, with no visible signs of bleaching or necrosis. Exposure to heat stress resulted in significant alterations in the physiological parameters of sponges, including higher respiration rate and lower photosynthetic efficiency. These alterations were accompanied by correspondingly significant microbial adjustments, thus emphasizing the essential role of the microbiome in the host’s ability to persist when facing essential environmental stress. Moreover, while shallow and mesophotic sponges showed similar physiological tolerance to heat stress, their microbial response differed: while the microbiome diversity of the mesophotic sponges remained stable throughout the experiment, the shallow one significantly changed. This result suggests that their underlying coping mechanisms might differ between mesophotic and shallow populations. Since the associated-microbiome is largely regulated by the sponge-host genetics, difference in microbial adjustments to stress between populations, could indicate genetic variability between hosts. Therefore, while the results of this study support the hypothesis that mesophotic coral reefs could serve as thermal refugia for some sponge species, it raises the question regarding the validity of MCEs as a refuge for shallow populations. Finally, it emphasizes the crucial need to elucidate the underlying mechanisms governing the sponge-microbiome interactions, specifically in the context of the anticipated climate change scenarios.

IntroductionBivalve molluscs are among the most prominent coastal benthic-suspension-feeders and their farming is the largest and fastest-growing sector of aquaculture. More than a century of intensive laboratory studies (but surprisingly few in-situ studies) has yielded the consensus view that bivalves mainly capture particles >4µm. Nonetheless, bivalves thrive throughout the world’s oceans that are mostly oligotrophic, characterized by low food concentration and dominated by minute autotrophic picoplankton (10 µm.DiscussionThese results suggest that the same basic anatomical tool kit, variably modulated according to taxa, habitat, or life history traits, enables the remarkable evolutionary and ecological success of bivalves in trophically-diverse habitats.

Background: Recent data suggest that human epidermal growth factor receptor 2 (HER2)-low breast cancer may represent a distinct entity. We aimed to compare disease characteristics and outcomes between HER2-low and HER2-0 in estrogen receptor (ER) positive, early-stage breast cancer. Methods: A single center retrospective study comprising all women with ER positive, HER2 negative early breast cancer, for whom an Oncotype DX test was performed between 2005 and 2012. Women were grouped to HER2-low (immunohistochemistry +1 or +2 and in situ hybridization not amplified) or HER2-0. Clinico-pathological features and Oncotype recurrence score (RS) were collected. Data on overall-survival (OS), disease-free survival (DFS) and distant disease-free survival (DDFS) were evaluated according to HER2 expression status. Results: 608 women were included, of which 304 women had HER2-0 and 304 had HER2-low disease. Lobular subtype was significantly more common in HER-0 compared to HER2-low disease (17% vs. 8%, p = 0.005). The prevalence of other clinic-pathological characteristics and long-term prognosis were comparable between both groups. For women with high genomic risk (RS > 25), HER2-low expression was associated with significantly favorable OS (HR = 0.31, 95% CI 0.11–0.78, p = 0.01), DFS (HR = 0.40, 95% CI 0.20–0.82, p = 0.01) and DDFS (HR = 0.26, 95% CI 0.11–0.63, P = 0.002) compared to women with HER2-0. For women with low genomic risk (RS ≤ 25), long-term prognosis was unrelated to HER2 expression. Conclusion: The prognostic impact of HER2-low expression in early-stage luminal disease varies across the genomic risk, with significant favorable outcomes of HER2-low expression compared to HER2-0 in women with high genomic risk.

The optical temperature sensor utilizing the fluorescence intensity ratio (FIR) has garnered significant attention in the past few years due to its rapid response, robust anti-interference capability, remote control feature, and other advantages. In this study, the high-temperature solid-phase approach was used to fabricate a variety of double perovskite-structured La2MgSnO6: Bi3+, Sm3+ (LMS: Bi3+, Sm3+) phosphors. The Rietveld refinement data of XRD and the Gaussian fitting of the emission peak of LMS: 0.02Bi3+ phosphor indicated Bi3+ occupies three lattice sites. The calculation and analysis of average lifetime and energy transfer efficiency substantiated the presence of energy transfer from Bi3+ to Sm3+, with a transfer efficiency of up to 59.07%. The emission intensity of LMS: 0.02Bi3+, 0.05Sm3+ at 403 K maintains 50.2% at the condition of room temperature. The FIR fitting and calculation demonstrated that LMS: 0.02Bi3+, 0.05Sm3+ phosphor possessed good optical temperature sensitivity, with a maximum absolute sensitivity Sa-max of 0.0055 K−1 and a maximum relative sensitivity Sr-max of 0.88% K−1, demonstrating its valuable potential applications for optical temperature sensors.

Background: Locoregional therapy (LRT) in de novo metastatic disease is controversial with inconsistent results from randomized control trials (RCTs). Methods: RCTs comparing LRT and systemic therapy to standard therapy alone in de novo metastatic breast cancer were identified. Hazard ratios (HRs) and their associated 95% confidence intervals (CIs) were computed and pooled in a meta-analysis using generic inverse variance. Overall survival (OS) and time to locoregional progression data were extracted for the intention to treat (ITT) population. Data on OS for pre-specified subgroups defined by tumor subtype and by site of metastases were also extracted. Results: Analyses included 4 trials comprising 970 patients. LRT included standard surgery to the primary breast tumor in all studies, and adjuvant radiation per standard of care was required in 3 studies. Compared to standard treatment, LRT was not associated with improved OS in the ITT population (HR 0.97, 95% CI 0.72–1.29, p = 0.81). However, LRT was associated with improved time to locoregional progression (HR 0.36, 95% CI 0.14–0.95, p = 0.04). LRT was not associated with improved OS in any tumor subtypes, including hormone receptor positive (HR 0.96, 95% CI 0.65–1.43), triple negative (HR 1.4, 95% CI 0.50–3.91) and human epidermal growth factor receptor 2 positive disease (HR 0.93, 95% CI 0.68–1.28). Additionally, LRT did not improve OS in bone only disease (HR 0.97, 95% CI 0.58–1.62) and in visceral disease (HR = 1.02, 95% CI 0.77–1.35). Our critical appraisal has identified some methodological problems in the design and conduct of the studies included that could affect the meta-analysis result. Conclusions: LRT in de novo metastatic breast cancer is not associated with improved OS. Results are consistent among different breast cancer subgroups. However, this conclusion should be interpreted with caution in view of the limitations identified in meta-analysis.

Abstract Background Menstrual and parity history might impact the risk for breast cancer. Data on the impact of these factors on other tumor characteristics are limited. Methods A single center retrospective cohort study comprising all women with estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative, early breast cancer whose tumors were sent to OncotypeDX analysis. The prespecified subgroups were investigated: age of menarche ( 55 years). Differences in tumor characteristics were evaluated using T-test or Mann Whitney for continuous variables or Fisher’s exact test for categorical variables. Outcomes were assessed by Kaplan–Meier survival analysis, with the log-rank test. Results A total of 620 women were included. After median follow-up of 10.4 years, early menopause was associated with significantly worse disease-free survival (HR = 2.26, p = 0.004) and overall-survival (HR = 2.60, p = 0.004), and multiparity was associated with significant worse disease-free survival (HR = 2.16, p = 0.026). These differences remain significant in multivariate analyses. Post-menopausal women were more likely to have stronger ER intensity (p = 0.002) but progesterone receptor (PR) positivity was less frequent (p = 0.009(. Early age of menarche was associated with PR positivity (p = 0.039). No other associations were found between the evaluated subgroups and tumor characteristics. Conclusions The impact of endogenous estrogen exposure had little effect on breast cancer characteristics of early stage, luminal disease. Early menopause and multiparity were associated with worse outcome.

In this study, the Tobit Model as a statistical regression model was used to study factors affecting blood pressure (BP) in patients with renal failure. The data have been collected from (300) patients in Shar Hospital in Sulaimani city. Those records contain BP rates per person in patients with renal failure as a response variable (Y) which is measured in units of millimeters of mercury (mmHg), and explanatory variables (Age [year], blood urea measured in milligram per deciliter [mg/dl], body mass index [BMI] expressed in units of kg/m2 [kilogram meter square], and Waist circumference measured by the Centimeter [cm]). The two levels of BP; high and low were taken from the patients. The mean arterial pressure (MAP) was used to find the average of both levels (high and low BP). The average BP rate of those patients equal to or >93.33 mmHg only remained in the dataset. The 93.33 mmHg is a normal range of MAP equal to 12/8 mmHg normal range of BP. The others have been censored as zero value, i.e., left censored. Furthermore, the same data were truncated from below. Then, in the truncated samples, only those cases under risk of BP (greater than or equal to BP 93.33mmHg) are recorded. The others were omitted from the dataset. Then, the Tobit Model applied on censored and truncated data using a statistical program (R program) version 3.6.1. The data censored and truncated from the left side at a point equal to zero. The result shows that factors age and blood urea have significant effects on BP, while BMI and Waist circumference factors have not to affect the dependent variable(y). Furthermore, a multiple regression model was found through ordinary least Square (OLS) analysis from the same data using the Stratigraphy program version 11. The result of (OLS) shows that multiple regression analysis is not a suitable model when we have censored and truncated data, whereas the Tobit model is a proficient technique to indicate the relationship between an explanatory variable, and truncated, or censored dependent variable.

Sponges play a key role in the transfer of energy and nutrients into many benthic ecosystems, and the volume of water they process is an important regulator of these fluxes. Theoretical scaling relationships between sponge volume, osculum cross-sectional area, and pumping rates were recently proposed and confirmed for small sponge specimens in the lab. To examine how these relationships apply to field populations we measured, in situ, the pumping rate (PR) of 20 species representative of different morphologies and host types (high- and low-microbial-abundance, HMA and LMA) from temperate and tropical regions. The total oscula area (∑OSA) increased allometrically with sponge volume (V) exhibiting similar exponents (∑OSA=aVb, b ranging 0.6–0.7) for all species, except for tropical HMAs (b = 0.99). Osculum flow rate (OFR) also increased allometrically with OSA and oscula of the same size pumped at the same rate irrespective of sponge volume. As a result, and in contrast to former reports, the PR of most of the sponges increased allometrically (PR=a∑OSAb) with scaling exponent b≈0.75, whereas PR of tropical HMAs increased isometrically. Osculum jet speed declined with the increase in the OSA for most species. The number of oscula and their OSA were the best predictors of the PR in sponges, explaining 75–94% of the in situ variation in PR throughout the natural range of sponge size. The pumping rate of a sponge population can be estimated by measuring the osculum density and cross-sectional area distribution once the relationships between the OSA and OFR are established for each species.

(1-x)K0.4Na0.6NbO3–xBiFeO3 lead-free piezoelectric ceramics were successfully prepared in a single perovskite phase using the conventional solid-state synthesis. Relative permittivity (εr) as a function of temperature indicated that small additions of BiFeO3 not only broadened and lowered the cubic to tetragonal phase transition (TC) but also shifted the tetragonal to orthorhombic phase transition (TO–T) toward room temperature (RT). Ceramics with x = 1 mol.% showed optimum properties with small and large signal piezoelectric coefficient, d33 = 182 pC/N and d∗33 = 250 pm/V, respectively, electromechanical coupling coefficient, kp = 50%, and TC = 355°C. kp varied by ∼5% from RT to 90°C, while d∗33 showed a variation of ∼15% from RT to 75°C, indicating that piezoelectric properties were stable with temperature in the orthorhombic phase field. However, above the onset of TO–T, the properties monotonically degraded in the tetragonal phase field as TC was approached.

0.5BaTiO3–(0.5 − x)BiMg1/2Ti1/2O3–xNaNbO3 (x = 0.10–0.30) ceramics were processed via a conventional solid state sintering route. X-ray diffraction analysis and Raman spectroscopy showed the formation of a cubic perovskite structure. Microstructural analysis of the samples revealed densely packed grains. The addition of NaNbO3 resulted in the enhancement in dielectric properties as a function of temperature. Relative permittivity decreased from 850 to 564 (at room temperature) with an increase in x; however, the stability in dielectric properties was improved with an increase in NaNbO3 concentration. At x = 0.25, relative permittivity (εr) was ~630 ± 15% in a temperature range of −70–220 °C with low dielectric loss (tan δ) < 0.025 (−57 to 350 °C) and high recoverable energy density ~0.55 J/cm3 which meet the criterion for X9R MLCC applications.

Background and aim Deficiency of vitamin D is known as a health problem all over the world and a recognized clinical complication of beta thalassemia patients. Vitamin D acts as a hormone at the nuclear receptor rendering it a beneficial medication for a number of diseases. It is believed that vitamin D is important in the modulation of the inflammation system by regulating the formation of inflammatory cytokines and immune cells. This study aimed to investigate the effect of vitamin D supplementation on the red cell indices and cytokines levels in patients with beta thalassemia major, in an open label randomized clinical trial. Patients and Methods: this study performed an open-label randomized clinical trial in patients with beta thalassemia major. Forty-six patients completed the eight weeks clinical trial and were allocated to administer oral vitamin D3 supplement of 100,000 IU every two weeks as an add-on treatment. During the study, hematological indices, serum iron, ferritin, vitamin D, calcium and inflammatory markers (interleukin-6, interleukin-2 and interleukin-10) were evaluated before (at baseline) and after vitamin D supplementation for 8 weeks. Results: Vitamin D3 supplements significantly decreases interleukin-6 levels and elevates the serum levels of anti-inflammatory cytokines IL-2 and IL-10, it also significantly reduced serum ferritin level, but it did not alter the hematological indices. Conclusion: Our results suggest that administration of vitamin D has a potential anti-inflammatory role in beta thalassemia patients and reduces serum ferritin levels, which may reduce the burdens of iron overload in thalassemia patients.

Background: FEV(1) is used for the classification of disease severity and is a good predictor of COPD mortality. However, it is a poor predictor of clinical symptoms, exercise tolerance, and response to bronchodilators in COPD. Progressive reduction in inspiratory capacity (IC) during exercise reflects dynamic hyperinflation and is a good predictor of decreased exercise ability as well as increased exertional dyspnea. In animal models of COPD, N-acetylcysteine (NAC), an antioxidant/mucous modifier, has been shown to modify small airways, which mainly causes lung hyperinflation.Objective: Our goal was to examine the effect of 1,200 mg/d of NAC on lung hyperinflation at rest and after exercise in patients with moderate-to-severe COPD.Methods: This was a randomized, double-blind, cross-over study that included 24 eligible patients > 40 years of age with a diagnosis of COPD, a FEV(1) < 70% of predicted, FEV(1)/FVC ratio < 0.70, and a functional residual capacity > 120% of predicted normal. Patients were randomized to placebo treatment or NAC treatment twice daily for 6 weeks. This was followed by a 2-week washout period, and then patients were crossed over to alternate therapy for an additional 6 weeks. Evaluation was performed after each 6 weeks of each treatment.Results: IC and FVC were higher especially after exercise after NAC treatment compared with placebo treatment. In addition, the relationship of residual volume to total lung capacity was reduced in a similar pattern. Furthermore, endurance time was longer after NAC treatment compared with placebo treatment.Conclusions: NAC treatment of patients with stable, moderate-to-severe COPD has a beneficial effect on physical performance, probably due to a reduction in air trapping.Trial Registration: Clinicaltrials.gov Identifier: NCT00476736. [ABSTRACT FROM AUTHOR]