2), complement 3 (C3), C4, CH50: lower than normal, anticardiolipin (IgG): 89 (up to 15), lupus anticoagulant: positive, antiβ2glycoprotein was negative. The erythrocyte sedimentation rate (ESR) and c- reactive protein (CRP) tests were done and the values were 35 mm/h and 2+respectively. The patient had headache that continued several days after

CS. It was very severe and resistant to routine medications, so magnetic Inhibitors,research,lifescience,medical resonance imaging (MRI) and magnetic resonance venography (MRV) were planned. Imaging Findings White and gray matter, cerebral ventricles and brain stem were normal. Distal segment of right lateral sinus and sigmoid sinus were not appeared in brain MRV (figure 1). Figure 1 Brain MRV: Distal segment Inhibitors,research,lifescience,medical of right lateral sinus and sigmoid sinus are not appearent. Abnormal hypersignal intensity of right lateral sinus/coronal T2 was detected. White and gray matter signal, cerebral

ventricles and brain stem were normal (figure 2). Figure 2 Brain MRI: Abnormal hypersignal intensity of right lateral sinus/coronal T2. The patient was diagnosed as SLE with secondary APS. Because of refractoriness of the headache to routine medications, thrombolytic therapy with 20 mg tissue plasminogen activator (t-PA) on right sigmoid sinus and transverse sinus was performed by an interventional neurologist seven weeks after she was first hospitalized. Inhibitors,research,lifescience,medical After this procedure the patient’s headache improved, and she was discharged from the Hospital in a good condition. She was then prescribed 7.5 mg prednisolone, 400 mg hydroxychloroquine, Inhibitors,research,lifescience,medical 80 mg aspirin, and 5mg warfarin. Anti coagulation therapy with warfarin was prescribed after thrombolytic therapy and has continued ever since. Her international normalized ratio (INR) has been maintained between 2.5-3. She has been visited by a rheumatologist every month, and has not any problem Inhibitors,research,lifescience,medical of the nervous system. Duration of anticoagulation therapy is controversial and in some papers lifelong

anticoagulation therapy is recommended. Discussion Lupus-induced APS is a major risk factor for thrombosis and abortion during Selleck PLX4032 pregnancy. Co -morbid illnesses like pregnancy-induced hypertension (PIH) are also common.5 Venous thrombosis is more common than arterial thrombosis in the APS.6 The most common site of thrombosis is calf veins, but renal and hepatic veins, and retinal and cerebral sinuses may be involved. The most common site of arterial thrombosis is the cerebral vessels, Tolmetin but in coronary, renal and mesenteric arteries have also been noted. Brey et al. evaluated the presence of lupus anticoagulants (LAs) and anticardiolipin in 160 cases and 340 controls. After adjustment for potential confounders, the relative odds of stroke for women with an anticardiolipin of any isotype or a lupus anticoagulants was 1.87 (95% CI: 1.2 to 2.8).7 Cerebral vein thrombosis (CVT) is more common in women than in men (Female to male ratio: 3 to 1.

8 The leaves, roots, bark, and fruits have all been used medicinally to treat a wide range of ailments. These include, but are not limited to, diabetes, diarrhea, hypertension, malaria, pain, and tropical infections. The fruits are also eaten as a food, but primarily only in times of famine. 9 However, Lucas interpreted elements of the following ancient Hawaiian chant (recorded in 1861 about the interactions between the Gods Kamapua’a and Pele) as evidence that Noni fruit was once eaten in times of famine. 10 Kamapua’a chanted as follows: “I have come now from Puna. Liver is a major site of endogenous glucose production

with a minor contribution to kidney, produces PCI32765 glucose by glycogenolysis and gluconeogenesis. Numerous studies have provided prominent indication that Tenofovir mouse hepatic glucose production theaters an authoritative role in the development of fasting hyperglycemia in diabetes. The enzymes that regulates hepatic glucose metabolism are potential targets for controlling endogenous glucose production and thereby blood glucose levels in diabetes. Hence, the present study was premeditated to gauge the regulatory effect of ethanolic extract of Mengkudu fruit (MFE) on blood glucose, glycogen, glycosylated hemoglobin, plasma insulin and C-peptide levels and glucose metabolic rate limiting enzymes such as hexokinase, pyruvate kinase, LDH, glucose-6-phosphatase,

fructose-1, 6-bisphosphatase, glucose-6-phosphate dehydrogenase, isocitrate dehydrogenase, α-ketoglutarate dehydrogenase, succinate dehydrogenase, malate dehydrogenase, glycogen synthase and glycogen phosphorylase in hepatic and renal tissues in STZ induced experimental diabetes in rats. Figure options Download full-size image Download as PowerPoint slide The above images

represent ripened Mengkudu fruit. Fresh fruits of M. citrifolia were Libraries collected from its natural habitat in the Center for Organic Indian Noni, Madurantakam, Tamil Nadu, India and were authenticated viz. ETARC 03/07-2008. The seeds were selectively removed and the edible part was chopped into small pieces, dried Amisulpride at 50–60 °C, and ground into powder. Known amount of dry powder was repeatedly extracted by the process of maceration in an aspirator using 95% ethanol as menstruum. The extract was concentrated under reduced pressure by rotary evaporator to obtain thick syrup mass, and stored at 4 °C. The yield was approximately 20% of fresh fruit. Working concentrations of the extract were made in nonpyrogenic distilled water before use in the experiments. Animal experiments were reviewed and approved by the Institutional Animal Ethics Committee. (Approval no. 01/022/08). Male Wistar albino rats weighing 160–180 g procured from Tamilnadu Veterinary and Animal Sciences University, Chennai, India were used. The rats were acclimatized and maintained over husk bedding in polypropylene cages in the central animal house facility of the institution.

5% afternoon, and 48.6% evening worsening. Melancholic symptom features were associated with DV, regardless of pattern. Using a neuropsychological test battery, the morning pattern of impairment in the melancholies was comprehensive, affecting attention and concentration/working memory, episodic memory, reaction time, and speed of simultaneous match to sample.18 Significantly improved neuropsychological function was seen in the melancholic patients in the evening, in line with diurnal improvement in mood. Some functions remained impaired in the evening compared with controls; others improved. Inhibitors,research,lifescience,medical Another study also found that complex tests of executive function were sensitive measures of DV19 Mood variability

‘ITic concept of mood variability, rather than Inhibitors,research,lifescience,medical any specific pattern of mood change, has arisen from long-term studies.20 Women with premenstrual syndrome had greater mood variability than normal subjects. Patients with borderline personality disorder also revealed a high degree of mood variability, but random in nature from one day to the next.20 ‘This suggests that mechanisms regulating mood stability may differ from those regulating overall mood state. Dynamic patterns of mood variation were revealed using complex time series analyses of self-assessments of Inhibitors,research,lifescience,medical anxiety and depression for each hour awake during a 30-day period.21 Controls

displayed circadian rhythms with underlying chaotic variability, whereas depressed patients no find more longer had circadian rhythms, but. retained chaotic dynamics. Days with no DV or with typical DV (morning low, afternoon/evening high) occurred with similar frequency in both melancholic patients and

controls.22 In other words, circadian mood variations vary substantially inter- Inhibitors,research,lifescience,medical and intraindividually. Interesting are the attributions: melancholic patients experience spontaneous mood variations as uninfluenceable, whereas healthy controls consider them almost exclusively related to their own activities and/or external circumstances.22 DV and chronotype Many of the above findings of worse morning mood suggest, a late chronotype in MDD. Three new Inhibitors,research,lifescience,medical studies have looked at large populations of bipolar patients, and replicably found a predisposition for late chronotypes.23-25 Additionally, individuals aminophylline with higher depression scores are more likely to be late chronotypes.25 One of the characteristics of circadian rhythms is that the lower the strength of synchronizing agents (zeitgebers), the later they drift. Less light, exposure in winter could underline the reported delayed chronotype in winter depression.26 Could the lower lifestyle regularity and activity level indices (as codified in the Social Rhythm Metric) in bipolar disorder patients compared with controls be an indication of such a diminution of zeitgebers?27 In addition, the timing of five, mostly morning, activities was phase-delayed in patients not only compared with control subjects but with themselves when well.

77,78 Suramin, a sulfonated naphthylurea, has multiple antitumor effects (including an ability to block heparanase activity) but causes relatively severe side-effects in humans.79 PI-88 is a yeast-derived phosphosulfomannan that performed well in phase I and II clinical trials, exhibiting efficacy #Y-27632 chemical structure randurls[1|1|,|CHEM1|]# against several cancers.80 In addition to blocking heparanase activity, it also interferes Inhibitors,research,lifescience,medical with growth factor interactions, leading to inhibition

of angiogenesis.81 However, because PI-88 is a complex mixture of oligosaccharides, characterization of its structure-activity relationships has been complicated, thereby necessitating attempts to generate analogs with desirable pharmacokinetic properties.82 A significant progress is represented by the PG500 series, a collection of new HS mimetics based on anomerically pure, fully sulfated, oligosaccharide glycosides modified by the addition of an aglycone at the reducing end Inhibitors,research,lifescience,medical of

the molecule.82 The aglycones are primarily lipophilic groups chosen specifically to improve the biological activities, primarily the efficacy and pharmacokinetic properties. PG500 series compounds are believed to interfere with two important processes in tumor development, namely angiogenesis via inhibition of VEGF, FGF-1, and FGF-2, and metastasis via inhibition of heparanase activity. Inhibitors,research,lifescience,medical Compound PG545 was tested in a HT29 colon xenograft model and found to inhibit markedly tumor development comparable with the standard of care chemotherapeutic agent Inhibitors,research,lifescience,medical 5-fluorouracil (5-FU).

The fact that administration of these agents to tumor-bearing animals led to significant tumor growth inhibition strongly supports further development of these HS mimetics for the treatment of cancer. Heparin is a Inhibitors,research,lifescience,medical potent inhibitor of heparanase, but its use at high doses is impossible due to the potential for anticoagulant activity.83 Interestingly, low-molecular-weight heparin (LMWH), being more bioavailable and less anticoagulant than heparin, appears to prolong survival of patients with cancer. In several randomized controlled trials, four different types of LMWH increased the survival of patients with advanced cancer.84 Indeed, rather than just preventing fatal pulmonary emboli in cancer patients, it seems more likely that LMWH has direct effects on tumor growth and metastasis. This MycoClean Mycoplasma Removal Kit may be due, at least in part, to inhibition of heparanase enzyme activity by LMWH. On the basis of the structure-activity relationship emerging from our heparanase inhibition studies and in view of clinical data on the anticancerous and anti-inflammatory effect of heparin,84 we initiated a systematic study aimed at obtaining heparanase-inhibiting species of heparin devoid of anticoagulant and proangiogenic activities.

With such surrogate markers, clinical trials will be possible to determine efficacy of antidementia treatments in presymptomatic stages. The goal is to delay progressive

memory loss upon dementia onset so that older people can live longer lives with improved functioning and mental capacities. Selected abbreviations and acronyms AD Alzheimer’s disease FDG-PET fluorodeoxyglucose positron emission tomography ∫MRI functional magnetic resonance imaging MCI Inhibitors,research,lifescience,medical mild cognitive impairment PET positron emission tomography SP senile plaque NFT neurofibrillary tangle NP neuritic plaque Notes Supported by the Montgomery Street Foundation, San Francisco, Calif; the Fran and Ray Stark Foundation Fund for Alzheimer’s Disease Research, Los Angeles, Calif; the Department of Energy; NIH grants MH52453, AG10123, AG13308, and the Alzheimer’s Association Inhibitors,research,lifescience,medical grant IIRG94101. The views expressed are those of the authors and do not necessarily represent those of the Department of Veterans Affairs.
The path of a new drug from concept, to medication may be divided into

two phases, namely drug discovery and drug development. Clinical pharmacology, also Inhibitors,research,lifescience,medical known as phase 1 or human pharmacology, constitutes one of the most critical steps in drug development, as it forms the link between drug discovery and preclinical and clinical drug development, and produces the necessary basis for the confirmatory phase 2 and 3 clinical trials of a new CX-5461 supplier chemical entity (NCE) in patients with the target indication. Clinical pharmacology constitutes an exploratory stage of drug development during which essential information Inhibitors,research,lifescience,medical should be provided about the safety, the pharmacokinetics (quantitative description of the disposition of Inhibitors,research,lifescience,medical a drug in the body or a body compartment over time: “what does the body do to the drug?”), and the pharmacodynamics (quantitative description of drug effects, activity, or toxicity: “what does the drug do to the body?”). Clinical pharmacology starts with the first-time-to-man (FTTM) administration of an

NCE and lasts throughout Idoxuridine drug development. Assessment of the short-term safety and tolerability of single and multiple doses of an NCE in healthy volunteers, whatever the route of administration, is the main objective of the FTTM studies. In addition, preliminary pharmacokinetics and pharmacodynamics (ie, surrogate or biornarkers of expected pharmacological activity and/or unwanted side effects) should be secondary objectives of these studies. Study design No specific guidelines exist; only three gold standards apply: the study should be double-blind and placebocontrolled, and safety is paramount. One dose level may be evaluated in small subgroups of 3 to 5 subjects (2 to 3 subgroups per dose level) and the dose must be increased only after careful review of all the data available from the previous dose level.

For weekly vaccination analyses, we defined weeks as starting on Mondays and ending on Sundays (according to the International Organization for Standardization code ISO-8601) and used EpochConverter (www.epochconverter.com) to assign week counts. For weekly analyses, we calculated the number of children and adults vaccinated in each week and

the cumulative total percentage of all patients vaccinated by the end of each week. We investigated seasonal influenza vaccination Selleck CAL101 trends separately for children and adults. The trends were stratified by patient age categories (6 to 23 months; 2 to 4 years; 5 to 8 years, and 9 to 17 years for children and 18 to 49 years and 50 to 64 years for adults), regions, number of outpatient office visits,

and the type of vaccine. We calculated age at time of vaccination for patients who were vaccinated. For patients who were not vaccinated, the median date of vaccination during that season, based on patients who were vaccinated, was used. For the numerator of vaccination events, we plotted weekly vaccination counts and recorded weeks at which half of SB203580 molecular weight all patients were vaccinated. Because the size of the analyzed population was extremely large, the widths of the confidence intervals for the vaccination rate percent estimates by influenza season, class of age, region, and type of vaccine were Modulators always lower than ±1%; therefore any difference greater than 2% is statistically significant. For seasonal analyses, the eligible analysis population ranged between 1144,098 and 1245,487 for children and 3931,622 and 4158,223 for adults. The total number of vaccinated patients ranged from 198,324 to 312,373 for children and 342,315 to 516,650 for adults. During the five influenza seasons, seasonal influenza vaccination rates medroxyprogesterone in commercially insured children 6 months to 17 years of age increased from 16.5% in the 2007–2008 season

to 25.4% in the 2011–2012 season. The frequency of vaccination decreased with advancing age in children, but this trend was reversed in adults. Children 6 to 23 months of age had the highest likelihood of vaccination against influenza (47–55%; Fig. 1A). Adults 50 to 64 years of age were more likely to be vaccinated than those 18 to 49 years of age (15–19% versus 5–9%, respectively; Fig. 1B). In all age groups, the vaccination rates steadily increased from 2007–2008 through 2009–2010 season and then reached a plateau, with a slight decrease in the 2011–2012 influenza season (Fig. 1A and B). With respect to geography, children in the Northeast had the highest vaccination rates (20%–30%), whereas children in the West had the lowest (14–24%; Fig. 2A). Similar regional differences were observed with adult vaccination rates, which ranged from 5% to 18% (Fig. 2B). The regional differences for all ages varied by 6 to 8 percentage points.

The dose and duration of endosulfan exposure were selected based on previous studies in rats.17,22 Sperm Parameter Analysis At the end of the treatment period, the animals were weighed and anesthetized with diethylether. Then, blood samples were collected via cardiac puncture, and their plasmas were separated and used to assay for testosterone and lactate dehydrogenase (LDH). The testes were removed, weighed, rinsed with in ice-cold saline. The relative weight of the

testes was reported as a percentage of Inhibitors,research,lifescience,medical the body weight. A fraction of the testes of each animal was stored at -20°C for malondialdehyde (MDA) determination, while the remaining fraction was used to determine DSP. For determination of DSP, the testes were decapsulated and homogenized for 4 min in 50 mL of phosphate buffer saline (PBS) solution. The number of homogenization resistant sperm nuclei was counted using a hemocytometer. The numbers were then divided by 6.1 (the duration in days of spermatogenic cycle in rats) to determine Inhibitors,research,lifescience,medical DSP.23 To analyze

the sperm motility and viability, the left epididymis was excised and placed in pre-warmed Petri dish. Caudal epididymes was minced in 4 ml of pre-warmed PBS at 37˚C. The Inhibitors,research,lifescience,medical minced tissue was placed in a 37˚C incubator for 5 min and then filtered through Inhibitors,research,lifescience,medical nylon mesh. To evaluate the sperm viability, a drop of the Eosin stain was

added to the sperm suspension on the slide, kept for 5 min at 37˚C, and then observed under microscope. The head of the dead spermatozoa was stained with red color while the live spermatozoa unstained with Eosin stain. Sperm viability was expressed as the live sperm percentage of as the total sperm counted. For the analysis of sperm motility, one drop of sperm suspension was placed on a Inhibitors,research,lifescience,medical warmed microscope slide and a cover slip was placed over the droplet. At least 10 microscopic fields were observed at 400 X magnification under a microscope and the percentage of motile sperm was calculated. The degree of sperm maturation was assessed by Aniline Blue (AB) staining. The protamine-rich nuclei of mature spermatozoa which contain Panobinostat research buy abundant arginine and cysteine and low level of lysine 17-DMAG (Alvespimycin) HCl react negatively with aniline blue stain and remain unstained whereas the histone-rich nuclei of immature spermatozoa with abundant lysine were stained by AB.24 To perform this staining, 5 µl of the sperm collected from the epididymis was smeared onto the glass slide and allowed to dry. The smears were fixed in 3% buffered glutaraldehyde in 0.2 M phosphate buffer (pH 7.2) for 30 min. The slides were then stained with 5% aqueous AB mixed with 4% acetic acid (pH 3.5) for 5 min. On each slide 200 sperms were examined for the proportion of sperm with unstained head.

Statistical analyses were done with the Statistical Package for Social Sciences (SPSS 15.0 for Windows) software. The authors of this manuscript have certified that they comply with the Modulators Principles Selleckchem PFI-2 of Ethical Publishing in the International Journal of Cardiology. A total of 1620 coronary angiograms were assessed, and 167 were excluded because it was not possible to determine coronary dominance due to technical reasons, extensive

atherosclerosis, presence of occluding thrombi with large filling defects distally, or prior CABG. A total of 1453 cases were included in the study cohort, and the patient characteristics are shown in Table 1. The median age in the study population was 70 (IQR: 58–78), and 55% was male. The overall distribution of left, right, and balanced dominance was 9.1%, 81.2%, and 9.7%, respectively. The cause of death was cardiovascular in 53.9% of the included cases. There were significant differences in age and cause of death between the included and excluded cases. The distribution of coronary dominance across the age groups is presented in Table 2. With increasing age

in the tertiles (respectively, ≤63 years, 64–75 years, and ≥76 years), the prevalence of right coronary dominance increased significantly (P=.001). Although the prevalence of both left dominance and codominance was numerically decreasing, only the decrease in codominant systems was statistically significant (P<.01). No heterogeneity was observed regarding the relation between dominance and age in male and female cases; the overall P for trend was, respectively, <.01 and .05. Moreover, no heterogeneity Hydroxychloroquine in vivo was observed regarding the cause of death (P for trend in cardiac, vascular, and noncardiovascular, respectively, .02, .24, and .03). The distribution of coronary dominance across the age groups according to cause of death is presented in Table 3. In this study, we systematically evaluated the Oxalosuccinic acid type of coronary dominance in different age groups using postmortem angiograms in a large cohort of autopsied patients. We found that the overall prevalence of left, right, and balanced dominance in the

study population was 9.1%, 81.2%, and 9.7%, respectively. Second, the prevalence of right dominance increased with increasing age of the patients who were categorized into three age cohorts of less than 64, 64–74, and older than 75 years, respectively. On the other hand, there was a reduction found in the prevalence of left and codominant systems in the same age categories. These trends were consistent across gender and cause of death. Other reports have described the overall prevalence of the anatomical variants as assessed by (postmortem) coronary angiography or computed tomography [2], [3], [5], [6], [7] and [9]. These studies are summarized in Table 4. Generally, the prevalences of the dominance variants are comparable across the different studies. Two studies in which a relatively high prevalence of balanced systems was observed were described by Hutchins et al.

40 Thompson and colleagues41 have also reported an accelerated decrease in gray matter volume in early-onset schizophrenia. Of particular note, in a recent review of the literature, DeLisi et al42 reviewed evidence for progressive changes in both chronic and first-episode patients. They concluded that progressive changes over time in chronic

click here patients are far less than what is observed in first-episode patients, again underscoring the Inhibitors,research,lifescience,medical fact that progressive changes in the early stages of illness may be more dramatic than changes observed later in the course of the illness. Another recent review43 sheds further light on the issue of progressive changes following first episode. Inhibitors,research,lifescience,medical This review found that progressive changes following first episode were more pronounced in the first 20 years and less pronounced after this time period compared with healthy controls. Of further note, the changes observed included gray matter volume reductions in the frontal and temporal lobes,

as well as increased lateral ventricles. In addition, these changes were associated with more progressive changes associated with poor outcome, more negative symptoms, and poor performance on neurocognitive measures. A review by Pantelis and coworkers17 of longitudinal MRI studies of first-episode patients, prodromal patients, and high-risk individuals also suggests an acceleration of gray matter Inhibitors,research,lifescience,medical reduction early in the course of illness. Specifically, there is gray matter reduction in prefrontal regions, which these investigators believe leads to further progressive changes in medial temporal and Inhibitors,research,lifescience,medical orbitofrontal brain regions. These investigators also interpret findings, to date, as

indicative of an early neurodevelopmental insult or lesion that likely “renders the brain vulnerable to later brain maturation processes” and which takes place during adolescence or early adulthood. These interpretations are reminiscent of Mednick and McNeil’s 1968 two-hit theory of schizophrenia,33 and Feinberg’s Inhibitors,research,lifescience,medical 198232 theory that schizophrenia results from abnormal synaptic pruning. The number of first-episode studies is, however, relatively small compared with out the number of chronic studies. Additionally, the selection of patients differs in that some studies include patients that have been ill for several years, and, while they may not be chronic per se, they might be better classified as reflecting “early schizophrenia” rather than as first-episode schizophrenia. Having said this, however, there are a number of highresolution longitudinal studies that have investigated brain abnormalities at first episode of illness. Some, including Gur and coworkers,37 and Kasai and coworkers,39 are noted above. Another study by Lieberman et al44 reported larger lateral ventricles and reduced volume of the hippocampus at baseline, but only increased lateral ventricles at follow-up 1 year later.

4, SD=1.4, n=88) and not ‘feeling good’ (M=1.9, SD=1.3, n=87). There were less problems with ‘waste of time’ (M=0.3, SD=0.7, n=88) and ‘information given’ (M=0.5,

SD=1.1, n=87), where more than 80% of the 3-deazaneplanocin A datasheet patients did not report any problems at all. Patients in the two groups did not differ significantly in their perception of the various aspects of care outcomes (Table 4). Table 4 Results of the POS (sum and item scores) Inhibitors,research,lifescience,medical Discussion This study evaluated if there are differences within the health-related QoL of patients cared for by GPs who participated in a palliative training course offered by GPs (PAMINO) compared to patients of other GPs. In our study sample, patients did not report any differences in their Inhibitors,research,lifescience,medical QoL and care as measured by QLQ-C15-PAL and POS. The study suggests that PAMINO training makes no noticeable difference to the quality of care for patients between comparable groups of GPs. We tried to include as many GPs and patients as possible, but did not reach our targeted sample size. GPs either did not care for enough eligible patients or did not participate due to time constraints. There were enough practices participating

Inhibitors,research,lifescience,medical in the study (n=90), but only half of them included patients. Mostly, there were less eligible patients in the practices than expected: there were not as many cancer patients as we assumed for our sample size calculation. Therefore, this study has the character of a pilot study and conclusions need to be drawn cautiously. Although our study Inhibitors,research,lifescience,medical is underpowered, it nevertheless describes the quality of life in palliative patients cared for by GPs. Patients considered their QoL to Inhibitors,research,lifescience,medical be moderately high. Not surprisingly, QoL was much lower than in the general German population [13], but higher than in comparable palliative care populations [14]. Additionally, GPs in general

delivered high-quality care in the patients’ view. Compared to patients cared for in nursing these homes [11], they reported better care outcomes. The patients of the German POS validation study [8], who were mostly cared for in palliative care units in hospital, also reported worse care outcomes than our study population. As was to be expected, both measures correlated highly showing the high interdependence of care outcomes and health-related quality of life as perceived by patients. Although our study failed to reveal statistical significant differences within the QoL of patients, it does not mean that the initiative had no impact at all. Unlike non-participating doctors, GPs participating in this voluntary training might gain valuable knowledge and skills in caring for palliative patients, which are of increasing importance in the future.