The Athens Insomnia Scale (AIS), Sheehan Disability Scale (SDS), and Clinical Global Impression scale (CGI) were completed

at baseline, after each month of treatment and after the first week of run-out phase. Additional assessment tools comprised sleep diaries, the Leeds Sleep Evaluation Questionnaire (LSEQ) and actigraphic recordings.

Results: Subjective sleep time increased by 61.5 +/- 72.3 min in the group with low BDI and 60.0 +/- 59.4 min in the group with increased BDI at the end of the treatment phase. The significant improvements were also observed in the AIS, CGI, LSEQ and SDS. During the run-out phase the improvement was sustained in patients with PF-04929113 in vitro low BDI, while AIS scores, sleep latency and total sleep time deteriorated in patients with increased BDI.

Conclusions: Patients with subthreshold GSK3326595 cell line depression, even if the depressive symptoms do not fulfill the time criteria for depressive episode, show marked worsening of insomnia after discontinuation of sleep promoting medication. (C) 2011 Elsevier Inc. All rights reserved.”
“New treatments for adults with acute lymphoblastic T-cell leukemia (T-ALL) are urgently

needed, as the current rate of overall remission in these patients is only about 40 percent. We recently showed the potential therapeutic benefit of the pegylated-human-arginase I (peg-Arg I) in T-ALL However, the mechanisms by which peg-Arg I induces an anti-T-ALL effect remained unknown. Our results show the induction of T-ALL cell apoptosis by peg-Arg I, which associated with a global arrest in protein synthesis and with the phosphorylation of the eukaryotic-translation-initiation factor 2 alpha (eIF2 alpha). Inhibition of eIF2 alpha phosphorylation in T-ALL cells prevented the apoptosis induced by peg-Arg I, whereas the expression of a phosphominnetic SDHB eIF2 alpha

form increased the sensibility of T-ALL cells to peg-Arg I. Phosphorylation of eIF2 alpha by peg-Arg I was mediated through kinases PERK and GCN2 and down-regulation of phosphatase GADD34. GCN2 and decreased GADD34 promoted T-ALL cell apoptosis after treatment with peg-Arg I, whereas PERK had an unexpected anti-apoptotic role. Additional results showed that phospho-eIF2 alpha signaling further increased the anti-leukemic effects induced by peg-Arg I in T-ALL-bearing mice. These results suggest the central role of phospho-eIF2 alpha in the anti-T-ALL effects induced by peg-Arg I and support its study as a therapeutic target. Leukemia (2013) 27, 569-577; doi:10.1038/leu.2012.247″
“Background: Cross-sectional studies have associated poor insight in patients with obsessive-compulsive disorder (OCD) with increased OCD symptom severity, earlier age of onset, comorbid depression, and treatment response. The goal of this current study was to examine the relationship between dimensions of OCD symptomatology and insight in a large clinical cohort of Brazilian patients with OCD.

Experimentally, we tested the validity of this approach. In chloralose-urethane anesthetized rats, the left cervical vagus

(LCV) was placed on TE which could function as such or selleck inhibitor as bipolar electrodes (BE) by the use of a selector switch. The spread of current to the adjacent tissues (rectus capitis muscle underlying the LCV, and the right cervical vagus (RCV) incised and translocated beside the target, LCV) was compared between TE and BE. When the stimulus intensity was increased, contraction occurred in the capitis muscle with BE, but not TE. Compound spike potentials of A fiber origin were evoked in the non-target RCV on high-intensity stimulation with BE, but not TE. Constant voltage stimulation of the LCV with TE produced bradycardia of the same magnitude as that with BE. In conclusion, constant voltage stimulation using TE can minimize current

spread without changing the stimulus’s effects. (C) 2009 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.”
“Purpose: Mocetinostat cost We compared clinicopathological characteristics and outcomes in patients with bladder cancer who were exposed to graded arsenic levels in drinking water.

Materials and Methods: From 1993 through 2006, 977 patients with bladder cancer in Taiwan were studied retrospectively. Patients were from 3 areas, including the core zone (arsenic related blackfoot disease endemic area with a well water arsenic level of 350 to 1,100 ng/ml), zone 1 (a well water arsenic level of 350 ng/ml or greater but not a blackfoot disease endemic area) and zone 2 (a well water arsenic level of less than 350 ng/ml). Clinicopathological characteristics and survival outcome were compared among the groups.

Results: Of these patients 81 (8.3%), 246 (25.2%) and 650 (66.5%) G protein-coupled receptor kinase lived in the core zone, and zones 1 and 2, respectively. More high grade and high stage tumors were observed in core zone patients than in those in zones I and 2, including high grade in 48.7% vs 41.4% and 39.2% of patients,

advanced disease in 39.5% vs 31.0% and 18.5% and nodal metastasis in 8.6% vs 3.3% and 3.4%, respectively. Median overall and cancer specific survival in core zone patients was significantly shorter than in patients in zones 1 and 2, including 69 vs 119 and 113-month overall survival and for the 75th percentile of cancer specific survival 34.5 vs 119 and 113 months, respectively. On multivariate analysis with adjustment for tumor grade and stage the zonal difference was not a significant factor for overall or cancer specific survival.

Conclusions: Patients with arsenic related bladder cancer may have decreased overall and cancer specific survival because they have more unfavorable tumor phenotypes than patients in other areas in Taiwan.”
“Previous studies in children with diabetes found that hyperglycemia induces memory dysfunction.

Besides CaMKII activity was otherwise reduced by 7-chlorokynurenate.”
“The contributions of hippocampal long-term depression (LTD) to explicit Bucladesine learning and memory are poorly understood. Electrophysiological and behavioral studies examined the effects of modulating NMDA receptor-dependent LTD on spatial learning in the Morris water maze (MWM). The NMDA receptor co-agonist D-serine substantially enhanced NR2B-dependent LTD, but not long-term potentiation (LTP) or depotentiation, in hippocampal slices from adult wild type mice. Exogenous D-serine did not alter

MWM acquisition, but substantially enhanced subsequent reversal learning of a novel target location and performance in a delayed-matching-to-place task. Caspase Inhibitor VI concentration Conversely, an NR2B antagonist disrupted reversal learning and promoted perseveration. Endogenous

synaptic D-serine likely saturates during LTP induction because exogenous D-serine rescued deficient LTP and MWM acquisition in GrinI(D481N) mutant mice having a lower D-serine affinity. Thus, D-serine may enhance a form of hippocampal NR2B-dependent LTD that contributes to spatial reversal learning. By enhancing this form of synaptic plasticity, D-serine could improve cognitive flexibility in psychiatric disorders characterized by perseveration of aberrant ideation or behaviors.”
“Objective: Previous reports indicate that the prevalence and severity of carotid stenoses is greater in peripheral artery disease (PAD) than in coronary artery disease (CAD). To date, no study has compared these two populations with respect to plaque echogenicity, which is an independent risk factor for cerebrovascular events.

Methods: In 43 PAD patients without CAD and in 43 CAD patients without PAD, carotid plaques were studied with high-resolution B-mode ultrasound and by computerized SPTBN5 measurement of the gray-scale median.

Results: At visual analysis, the prevalence of hypoechoic plaques

was 39.5% in PAD and 18.6% in CAD (P = .033). The corresponding values for gray-scale median analysis were 34.9% and 14.0% (P = .024). At multivariate analysis, PAD patients showed a greater risk of having hypoechoic plaques than CAD patients at visual (odds ratio [OR], 4.39, 95% confidence interval [CI] 1.21-15.92, P = .025) and gray-scale median analysis (OF, 5.13; 95% CI, 1.27-20.67; P = .021). This association was no longer significant when neutrophil number was included among the covariates. In this model, only an increased neutrophil count was associated with hypoechoic plaques (P <.01 for both visual and gray-scale median analysis). Indeed, neutrophil count was greater in PAD than in CAD (4.4 +/- 1.0 vs 3.9 +/- 1.2 10(9)/L, P = .030). The concordance between visual typing of carotid plaques and gray-scale median measurement was good (p = 0.714, P < .01).

We used cross-sectional data from The Netherlands Study of Depression and Anxiety (NESDA). Our study sample consisted of 2353 participants (age 18-65) of whom 1701 had a

current anxiety and/or depressive diagnosis and 652 were healthy controls. Anxiety and depression diagnoses were conducted using the DSM-IV based Composite International Diagnostic Interview. Controlling for sociodemographics and physical activity level we found that persons with a major depressive disorder I-BET-762 solubility dmso (MDD) spend significantly more leisure time using the computer. We found that persons with dysthymia, panic disorder and agoraphobia spend significantly more daily hours watching television compared to controls. This study illustrates that sedentary behaviors occur more frequently among persons with a mental disorder, independent of general physical activity level. (C) 2010 Elsevier Ireland Ltd. All rights reserved.”
“Background/Aims: Neointimal thickening results from inflammation in association with vascular smooth muscle cell (VSMC) proliferation. We studied the role of perivascular adipose tissue (PVAT) on VSMC proliferation and intima-media thickening (IMT) in a rodent model of chronic inflammation. Methods: The abdominal aorta and surrounding PVAT of tumour necrosis factor (TNF)-alpha-injected mice were examined 28 days after administration. Plasma and PVAT cytokines were

measured with Milliplex (TM) assays. Inflammatory cells were examined with immunofluorescence. Expression of transforming growth factor (TGF)-beta 1, matrix metalloproteinase (MMP)-2, MMP-9 and MMP-12 was PU-H71 clinical trial examined with immunohistochemistry, immunoblotting

and zymography. IMT was determined. Cell proliferation and TGF-beta 1 mRNA levels were examined after treating VSMC with PVAT homogenates +/- MMP-2 inhibitors (batimastat, selleck products ARP 100 or TIMP-2) and SB-431542, a selective inhibitor of the TGF-beta-type 1 receptor. Results: Significant increases in CD3, CD68, neutrophils, vascular cell adhesion molecule-1 and MMP-2 in PVAT, and TGF-beta 1 and IMT of the aorta of TNF-alpha-injected mice were observed. PVAT of TNF-alpha-injected mice significantly up-regulated TGF-beta 1 and increased cell proliferation in a dose-dependent manner and was attenuated by SB-431542, batimastat, ARP 100 and TIMP-2. Conclusions: Our study shows that chronic PVAT inflammation leads to MMP-mediated increase in TGF-beta 1 and hence VSMC proliferation. Copyright (C) 2013 S. Karger AG, Basel”
“A 57-year-old woman was admitted to the hospital because of a 19-month history of recurrent painful bullous and erosive skin lesions. Multiple skin-biopsy specimens had yielded diverse diagnoses. A diagnostic procedure was performed. Presentation of CaseDr. Amir Aboutalebi (Dermatology): A 57-year-old woman was admitted to this hospital because of recurrent painful bullous and erosive skin lesions.

54, p<0.001) and smoking (OR 0.63, p<0.001) on elevated CRP levels Tozasertib datasheet in women compared with men.

Conclusions. CRP levels were raised in those with MI and co-morbid MI and depression; the positive association with depression was explained by confounding factors. We found new evidence that might help understand gender-specific

patterns. Future studies should explore the neurobiological mechanisms underpinning these interrelations and their relevance for treatment of these conditions.”
“The human brain can dynamically adapt to the changing surroundings. To explore this issue, we adopted graph theoretical tools to examine changes in electroencephalography (EEG) functional networks while listening to music. Three different excerpts of Chinese Guqin music were played to 16 non-musician subjects. For the

main frequency intervals, synchronizations between all pair-wise combinations of EEG electrodes were evaluated with phase lag index (PLI). Then, weighted connectivity networks were created and their organizations were characterized in terms of an average clustering coefficient and characteristic path length. We found an enhanced synchronization level in the alpha2 band during music listening. Music perception showed a decrease of both normalized clustering coefficient and path length in the alpha2 band. Moreover, differences in network measures were not observed between musical excerpts. These experimental results demonstrate an increase of functional Epigenetics inhibitor connectivity as well as a more random network structure in the alpha2

band during music perception. The present study offers support for the effects of music on human brain functional networks with a trend toward a more efficient but less economical architecture. (c) 2013 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Purpose: We evaluated the long-term safety and efficacy medroxyprogesterone of an adjustable continence device (ACT (R) or ProACT (TM)) in male and female patients with neurogenic stress urinary incontinence.

Materials and Methods: Data on patients consecutively treated with implantation of an adjustable continence device due to neurogenic stress urinary incontinence were reviewed from the start of our experience to the current 4-year followup.

Results: We reviewed data on 13 male and 24 female patients with neurogenic stress urinary incontinence due to different forms of pelvic nerve or spinal cord lesions. Mean +/- SD age at implantation was 46.2 +/- 17.4 years. Of the patients 92% performed clean intermittent self-catheterization. The device was implanted bilaterally using general and local anesthesia in 16.2% and 83.8% of cases, respectively. From before implantation to 48-month followup the mean number of urinary incontinence episodes decreased from 6.1 +/- 2.4 to 2.8 +/- 3.1 and the mean number of pads used per 24 hours decreased from 4.2 +/- 2.7 to 2.2 +/- 2.2. Of the patients 54.

Incidence and mortality varied substantially from year to year in any one setting.

Interpretation Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on health services worldwide. Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not available.”
“Comparative proteomics was applied to three vegetative organs

of Brassica napus, the leaf, stem, and root using 2-DE. Among the >1600 analyzed spots, 43% were found to be common to all three organs, suggesting the existence of a “”basal”" or ubiquitous proteome composed of housekeeping proteins. The green organs, leaf, and stem, were closely related (similar to 80% common spots) while the root displayed more organ-specific polypeptides (similar to 10%). Reference maps were established using IWR-1 MS, allowing the identification Milciclib in vitro of 93, 385, and 266 proteins in leaf, stem, and root proteomes, respectively. Bioinformatic analyses were also performed; in silico functional categorization and cellular localization allow obtaining a precise picture of the cell molecular network within vegetative organs. These proteome maps can be explored using the PROTICdb software at the following address: http://bioinformatique.moulon.inra.fr/proticdb/web_view/.”
“Minocycline

has been reported to reduce infarct size after focal cerebral ischemia, due to an attenuation of microglia activation and prevention of secondary damage from stroke-induced neuroinflammation. We here investigated the effects of minocycline on endogenous neural stem Liothyronine Sodium cells (NSCs) in vitro and in a rat stroke model. Primary cultures of fetal rat NSCs were exposed to minocycline to characterize its effects on cell survival and proliferation. To assess these effects in vivo, permanent cerebral ischemia was induced in adult rats, treated systemically with minocycline or placebo. Imaging 7 days after ischemia comprised (i) Magnetic Resonance Imaging (MRI),

assessing the extent of infarcts, (ii) Positron Emission Tomography (PET) with [C-11]PK11195, characterizing neuroinflammation, and (iii) PET with 3′-deoxy-3′[F-18]fluoro-L-thymidine ([F-18]FLT), detecting proliferating endogenous NSCs. Immunohistochemistry was used to verify ischemic damage and characterize cellular inflammatory and repair processes in more detail. In vitro, specific concentrations of minocycline significantly increased NSC numbers without increasing their proliferation, indicating a positive effect of minocycline on NSC survival. In vivo, endogenous NSC activation in the subventricular zone (SVZ) measured by [F-18]FLT PET correlated well with infarct volumes. Similar to in vitro findings, minocycline led to a specific increase in endogenous NSC activity in both the SVZ as well as the hippocampus. [C-11]PK11195 PET detected neuroinflammation in the infarct core as well as in pert-infarct regions, with both its extent and location independent of the infarct size.

“
“We investigated the correlation between age and the fractional anisotropy (FA) values of peripheral nerves in healthy adults and compared the age-corrected FA values of peripheral nerves in healthy subjects and patients with polyneuropathy.

The institutional review board approved this study and informed consent was obtained from all participants before entry into the study. We optimized diffusion tensor imaging using a

3-T magnetic resonance scanner and an extremity coil for scanning tibial nerves. The effect of age and sex on the FA values of tibial nerves in healthy volunteers was investigated and the age-corrected FA Selleck SU5402 values of tibial nerves in healthy volunteers and patients with polyneuropathy were compared.

The maximum FA values of the tibial nerves remained constant until age 45 (approximately 0.516); they subsequently decreased by 0.004/year in healthy volunteers. After removing the effect of age with an age-adjusted

equation, the median maximum FA values in the volunteers and patients were 0.518 (range, 0.406-0.616) and 0.442 (range, 0.376-0.530), respectively. The age-corrected FA values were significantly lower in the patients than the healthy volunteers (p < 0.001). There was no significant gender-related difference in the maximum FA values of the tibial nerves Selleckchem Quisinostat (p = 0.416).

The age-corrected FA value of the peripheral nerves helps to differentiate between age-related peripheral nerve degeneration and polyneuropathies.”
“Warning signals can shorten reaction time (RT) via either a top-down mechanism, temporal attention,

or a bottom-up one, phasic arousal. The goal of this review article is to identify Farnesyltransferase the locus at which these processes influence RT. Electrophysiological and behavioral evidence indicate that the chronometric locus for both modulatory effects lies mainly within a narrow window at the center of the stimulus-response interval. This interval presumably encompasses late perceptual, response selection, and early motor processes. Phasic arousal is theorized to reduce the threshold for response selection within a circuit involving the supramarginal gyrus. A blind-sight study indicates that conscious, cortical level processing is necessary for temporal attention, at least when the warning signal is visual.”
“It is widely believed that calorie restriction (CR) can extend the lifespan of model organisms and protect against aging-related diseases. A potential CR mimetic is resveratrol, which may have beneficial effects against numerous diseases such as type 2 diabetes, cardiovascular diseases, and cancer in tissue culture and animal models. However, resveratrol in its current form is not ideal as therapy, because even at very high doses it has modest efficacy and many downstream effects.

The purpose of this study is to compare the incidence of microemboli in two distinct time periods when procedural modifications were implemented into a CAS program.

Methods. Following a retrospective quality review of our CAS cohort (n = 27) from November 2004 through April 2006 (period 1),

we enrolled patients (n = 20) from May 2006 through February 2008 (period 2) undergoing CAS into a prospective cohort that included obtaining pre- and postprocedure DW-MRI exams. Procedural modifications during period 2 included the preferential use of closed-cell systems (60% 7-Cl-O-Nec1 chemical structure vs 0% in period 1), early heparinization at the initiation of arterial access, and elimination of an arch angiogram. The hospital records of these 47 patients

were reviewed; symptoms, comorbidities, lesion characteristics, periprocedural information, and postoperative outcomes were collected. The incidence and location of acute, postprocedural microemboli were determined using DW-MRIs.

Results. Twenty (74%) CAS patients from period I and seven (35%) patients from period 2 demonstrated acute microemboli on postprocedural DW-MRI (P = .02). The mean number of microemboli in period I was 4.1 +/- 5.3 vs 1.5 +/- 2.7 during period 2 (P = .04). Two of the 27 patients (7.4%) during period 1 experienced temporary neurologic changes that resolved within 36 hours. None of the patients during Depsipeptide molecular weight period 2 exhibited any neurologic changes. Patient demographics, comorbidities, and presenting symptoms were similar between the two groups except for smoking prevalence, female presence, and obesity (BMI > 30). Period 2 patients when compared with period 1 had more technically challenging anatomy with more calcified lesions (68% vs 27%), longer lesions (15.9 mm vs 8.2 mm), and higher incidence of ulceration (55% vs 27%) (all P < .04).

Conclusion: Despite successful performance of 47 consecutive CAS procedures without permanent neurologic sequelae, significant reductions in periprocedural embolic events as identified via DW-MRI lesions Quinapyramine may be achieved through implementation of quality

improvement measures identified through continuous outcome analysis. The long-term neurologic benefits associated with reduced subclinical neurologic events remains to be determined. (J Vasc Surg 2009; 49:607-13.)”
“Stent-assisted coiling (SAC) is an alternative to surgical clipping for the treatment of wide-necked intracranial aneurysms (IA). However, little information is available concerning the long-term results of this treatment. The aim of this study was to report the long-term clinical and anatomical findings in 32 patients with 34 wide-necked IA treated by SAC.

A retrospective review of our prospectively maintained database identified all patients followed up for wide-necked IA treated by SAC. The clinical charts, procedural data, and angiographic results were reviewed.

Although definitive studies examining the usefulness of nerve blocks are lacking, reports suggest that this selleck inhibitor area deserves further attention in the hope of acquiring evidence of effectiveness.”
“Background: Inadequate iliac artery diameter, calcification, and tortuosity are associated with increased incidence of iliac injury during abdominal (EVAR) and thoracic endovascular aneurysm repair (TEVAR). Despite careful preoperative

assessment and use of iliac conduits, inadvertent iliac rupture is a source of morbidity and mortality. This report details our single-center, 10-year experience with intraoperative iliac artery rupture and describes a successful endovascular salvage technique.

Methods: PFT�� chemical structure All patients undergoing EVAR and TEVAR between August 1997

and June 2008 were reviewed. Computed tomography (CT) measurements of access vessels were obtained for all patients. The smallest diameter of the external or common iliac artery was used to determine suitability for access based on the instructions for use for each device. Patients who underwent repair of a procedure-related iliac artery rupture were identified. Outcomes among patients who did not have an access vessel rupture (nonruptured group) and those who did (ruptured group) were compared. Patency of the endovascular iliac repair is reported.

Results: During the study period, 369 EVARs and 67 TEVARs were performed. Eleven iliac DOK2 conduits were used, all during TEVAR (16%). There were

18 ruptured iliac arteries in 17 patients; 11 EVAR patients (2.98%) sustained iliac rupture vs six TEVAR patients (8.9%). One EVAR patient was converted to open repair. Seventeen ruptures in 16 patients were successfully treated with endovascular stent graft placement. Iliac rupture was more likely to occur during TEVAR (8.9%) than EVAR (2.98%; P = .0239, Fisher exact test). Significantly more women were in the ruptured group (76% vs 19%; P < .0001, Fisher exact test). Patients in the ruptured group had longer lengths of stay (7.6 vs 5.1 days; P = .0895, t test), no 30-day mortality, but a procedure-related mortality of 11.8%. In the nonrupture group, 30-day mortality was 6.6% (4 of 61) and 2.8% (10 of 358) for TEVAR and EVAR, respectively, and procedure-related mortality was 9.8% (6 of 61) and 3.1% (11 of 358). For endovascular repair of iliac rupture, primary and primary-assisted patency was 88.2% and 94.1%, respectively, with median follow-tip of 40 months (range 10-115 months).

Conclusion: Iliac rupture during EVAR or TEVAR can be successfully managed with endovascular stent grafting. Higher mortality and length of stay associated with iliac artery rupture confirm that there is no substitute for prevention. Access vessels of all patients undergoing EVAR Should be examined closely for suitability.

“
“The purpose of this study was to examine

whether mechanisms, involved during PF-6463922 cell line the maintenance of familiar movement information in memory, were influenced by the degree of familiarity of the display in which the movements were embedded. Twelve gymnasts who possessed high visual and motor familiarity with the movements employed in this study, were recruited. They were invited to retain for a short period of time familiar movements viewed previously and presented under different displays with the aim of recognizing them at a later stage. The first display was a realistic, familiar display which presented videos of movements. The second display was an unfamiliar impoverished display never experienced in every day life which Wortmannin solubility dmso showed point-light

movements. Activity during the maintenance period was considered in five frequency bands (4-8Hz, 8-10 Hz, 10-13 Hz, 13-20Hz, 20-30Hz) using a non-linear measure of functional connectivity. The results in the 13-20 Hz frequency band showed that functional connectivity was greater within the frontal and right temporal areas during the unfamiliar display (i.e., point-light maintenance condition) compared to the familiar display (i.e., video maintenance condition). Differences in functional connectivity between the two maintenance conditions in the beta frequency band are mainly discussed in the light of the process of anticipation. Subjects’ perception of the expected difficulty of the upcoming recognition task is discussed. (c) 2012 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Atherosclerosis is an inflammatory disease of the arteries, else which results in major morbidity and mortality. Immune cells initiate and sustain local inflammation. Here, we focus on how dendritic cell (DC)-mediated processes might

be relevant to atherosclerosis. Although only small numbers of DCs are detected in healthy arteries, these numbers dramatically increase during atherosclerosis development. In the earliest fatty streaks, DCs are found next to the vascular endothelium. During plaque growth, new DCs are actively recruited, and their egress from the vessel wall is dampened. In the adventitia next to mature atherosclerotic lesions, tertiary lymphoid organs develop, which also contain DCs. Thus, DCs probably participate in all stages of atherosclerosis from fatty streaks to mature lesions.”
“Background First dose oral co-trimoxazole and referral are recommended for WHO-defined severe pneumonia. Difficulties with referral compliance are reported in many low-resource settings, resulting in low access to appropriate treatment. The objective in this study was to assess whether community case management by lady health workers (LHWs) with oral amoxicillin in children with severe pneumonia was equivalent to current standard of care.