Study protocol to investigate the effects of testosterone therapy as an adjunct to exercise rehabilitation in hypogonadal males with chronic heart failure

BACKGROUND: Testosterone deficiency is a common occurrence in men with chronic heart failure (CHF) and may underpin features of advanced disease, including reduced skeletal muscle mass and fatigue. It is positively correlated with cardiac output and exercise capacity in patients with CHF, whereas a significant improvement in both these parameters has been observed following testosterone replacement therapy. Testosterone therapy has also been shown to reduce circulating levels of inflammatory markers, (TNF-α, sICAM-1 and sVCAM-1) in patients with established coronary artery disease and testosterone deficiency. This pilot study will assess the feasibility of a combined exercise rehabilitation and adjunctive testosterone therapy intervention for evoking improvements in exercise capacity, circulating inflammatory markers, cardiac and skeletal muscle function, indices of psychological health status and quality of life in hypogonadal males with chronic heart failure. METHODS/DESIGN: Following ethical approval, 36 patients will be randomly allocated to one of two groups: testosterone or placebo therapy during exercise rehabilitation. A combined programme of moderate intensity aerobic exercise and resistance (strength) training will be used. The primary outcome measure is exercise capacity, assessed using an incremental shuttle walk test. Secondary outcome measures include measures of peak oxygen uptake, cardiac function, lower-limb skeletal muscle contractile function and oxygenation during exercise, circulating inflammatory markers, psychological health status and quality of life. DISCUSSION: Exercise rehabilitation can safely increase exercise capacity in stable CHF patients but there is a need for studies which are aimed at evaluating the long-term effects of physical training on functional status, morbidity and mortality. This pilot study will provide valuable preliminary data on the efficacy of testosterone therapy as an adjunct to exercise rehabilitation on a range of functional, physiological and health-related outcomes in this patient population. Preliminary data will be used in the design of a large-scale randomised controlled trial, aimed at informing clinical practice with respect to optimisation of exercise rehabilitation in this patient group

Comments on D-brane Interactions in PP-wave Backgrounds

We calculate the interaction potential between widely separated D-branes in PP-wave backgrounds in string theory as well as in low-energy supergravity. Timelike and spacelike orientations are qualitatively different but in both cases the effective brane tensions and RR charges take the same values as in Minkowski space in accordance with the expectations from the sigma model perturbation theory.Comment: Latex, 22 pages. Typos corrected and a reference added, final versio

Spinning Strings as Small Black Rings

Certain supersymmetric elementary string states with spin can be viewed as small black rings whose horizon has the topology of S^1 \times S^{d-3} in a d-dimensional string theory. By analyzing the singular black ring solution in the supergravity approximation, and using various symmetries of the \alpha' corrected effective action we argue that the Bekenstein-Hawking-Wald entropy of the black string solution in the full string theory agrees with the statistical entropy of the same system up to an overall normalization constant. While the normalization constant cannot be determined by the symmetry principles alone, it can be related to a similar normalization constant that appears in the expression for small black holes without angular momentum in one less dimension. Thus agreement between statistical and macroscopic entropy of (d-1)-dimensional non-rotating elementary string states would imply a similar agreement for a d-dimensional elementary string state with spin. Our analysis also determines the structure of the near horizon geometry and provides us with a geometric derivation of the Regge bound. These studies give further evidence that a ring-like horizon is formed when large angular momentum is added to a small black hole.Comment: LaTeX file, 31 pages; v2: references to earlier work adde