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[(somewhat)-354.3(compared)-345.5(with)-350.5(the)-345.2(age-matched)-348.9(controls.)-352.3(In)]TJ
0 -1.2203 TD
[(general,)-229.2(it)-225.3(would)-227.3(appear)-230(from)-229.1(this)-223.7(study)-231.9(that)-225.1(at)-227.6(the)-225.1(onset)]TJ
T*
[(of)-344.7(strenuous)-347.7(exercise,)-344.7(patients)-345.1(with)-344.1(T1DM)-344.1(have)-345(a)-340.9(slug-)]TJ
0 -1.2266 TD
[(gish)-354.1(breakdown)-348.5(of)-351(stored)-355.9(liver)-349.8(and)-347.3(muscle)-357(glycogen,)-347.5(a)]TJ
0 -1.2203 TD
[(reduced)-222.1(energy)-221.4(ux)-221.5(through)-218.8(the)-218.7(TCA)-219.5(cycle,)-218(and)-220.9(reduced)]TJ
T*
[(rates)-216.9(of)-218.2(adipose)-213.7(mobilization.)-217.1(It)-217.6(may)-210.2(be)-219.3(that)-212.5(the)-218.7(failure)-217.7(to)]TJ
T*
[(lower)-406.9(circulating)-404.7(insulin)-405.7(levels)-407.3(at)-404.6(the)-402.1(onset)-406.2(of)-407.9(exercise)]TJ
0 -1.2266 TD
[(promotes)-285.1(these)-289.5(disturbances)-283.8(in)-285.1(fuel)-283.5(mobilization.)-286.7(None-)]TJ
0 -1.2203 TD
[(theless,)-284.6(the)-282(job)-284(still)-277.9(can)-280.4(get)-283(done!)]TJ
ET
62.022 644.258 239.131 .45349 re
f
62.022 457.115 239.131 .45352 re
f
62.022 457.115 .51025 187.597 re
f
300.642 457.115 .51022 187.597 re
f
BT
/F4 1 Tf
8.9663 0 0 8.9663 62.022 434.3243 Tm
[(Short-term)-274.5(exercise)-271(training)-271.5(improves)-269.3(insulin)-272.2(sensitivity)]TJ
T*
[(but)-335.9(does)-336.3(not)-329.6(inhibit)-339.5(inammatory)-334.1(pathway)-333.2(in)-338(immune)]TJ
0 -1.2266 TD
[(cells)-336.5(from)-331.1(insulin-resistant)-337.8(subjects)]TJ
/F8 1 Tf
0 -1.8336 TD
[(Reyna)-558.2(SM)]TJ
6.7246 0 0 5.9768 103.4645 399.9684 Tm
(13)Tj
8.9663 0 0 8.9663 113.5559 395.9432 Tm
[(,)-331.7(Tantiwong)-558.9(P)]TJ
6.7246 0 0 5.9768 169.3984 399.9684 Tm
(2,3)Tj
8.9663 0 0 8.9663 177.7889 395.9432 Tm
[(,)-331.7(Cersosimo)-565.3(E)]TJ
6.7246 0 0 5.9768 231.1936 399.9684 Tm
(2,3)Tj
8.9663 0 0 8.9663 239.6409 395.9432 Tm
(,)Tj
-19.8097 -1.2203 TD
[(DeFronzo)-559.6(RA)]TJ
6.7246 0 0 5.9768 115.7102 388.97 Tm
(2,3)Tj
8.9663 0 0 8.9663 124.1574 385.0015 Tm
[(,)-331.7(Sriwijitkamol)-560.9(A)]TJ
6.7246 0 0 5.9768 190.148 388.97 Tm
(2)Tj
8.9663 0 0 8.9663 193.4928 385.0015 Tm
[(,)-338(Musi)-555.9(N)]TJ
6.7246 0 0 5.9768 230.6834 388.97 Tm
(24)Tj
-25.1823 -2.6654 TD
(1)Tj
8.9663 0 0 8.9663 64.8567 369.0708 Tm
.0201 Tc
[(Medical)-297.9(R)-3.1(esearch)-295.6(D)-.3(iv)-4.7(ision,)-299(Regional)-304.3(Acad)-4.7(emic)-294.7(Health)-301.9(Center,)]TJ
-.3161 -1.2203 TD
.0206 Tc
[(Edinburg,)-368(T)5(X;)]TJ
6.7246 0 0 5.9768 120.1889 362.0976 Tm
0 Tc
(2)Tj
8.9663 0 0 8.9663 123.7039 358.129 Tm
.0202 Tc
[(Diabet)-5.6(es)-366.2(Division,)-368.4(U)-.2(niver)-5.8(s).5(ity)-365(o)2(f)-367.4(T)-1.8(exas)-366.2(Healt)-5.6(h)]TJ
-6.8793 -1.2266 TD
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[(S)-4.3(c)1.5(ien)-4.3(c)1.5(e)-354.6(C)2.2(e)-6.9(n)2(ter)-354.7(a)-5.5(t)-354.4(S)2(a)-5.5(n)-352(Anto)-5.5(nio,)-356.9(Sa)-5.5(n)-352(A)-2.7(nt)-6.7(onio)-5.5(,)-350.5(T)-2.9(X;)]TJ
6.7246 0 0 5.9768 256.0818 351.1558 Tm
0 Tc
(3)Tj
8.9663 0 0 8.9663 259.6534 347.1306 Tm
.0207 Tc
[(Texas)-353.1(D).3(ia-)]TJ
-22.0417 -1.2203 TD
.0201 Tc
[(betes)-575(I).7(nst)-5.7(i)-.8(tut)-5.7(e).4(,)-570.8(S)3(a)-4.5(n)-572.3(Antonio,)-570.8(TX;)-570.8(a)1.8(nd)]TJ
6.7246 0 0 5.9768 220.7621 340.1574 Tm
0 Tc
(4)Tj
8.9663 0 0 8.9663 224.3338 336.1889 Tm
.0198 Tc
[(Geriatr)-6.2(i)-1.1(c,)-571.1(Research,)]TJ
-18.1025 -1.2203 TD
.02 Tc
[(Education,)-254.8(and)-257.7(C)3.1(linical)-253.8(Cente)-6(r).3(,)-254.8(A)-1.8(udie)-258.9(L.)-261.1(Mur)-6(phy)-257.7(VA)-254.7(Hospital,)]TJ
0 -1.2266 TD
.0231 Tc
[(Sa)4.8(n)-329.1(A)1.3(n)6(t)-2.7(o)4.8(n)6(io,)-327.6(T)1.1(X)]TJ
8.4682 0 0 8.4682 62.022 298.7149 Tm
0 Tc
[(J)-334.1(Diabetes)-337.1(Res)-338.1(2013;)]TJ
/F9 1 Tf
8.7635 0 TD
(2013)Tj
/F8 1 Tf
2.0017 0 TD
[(:)-332.4(107805)]TJ
/F10 1 Tf
8.9663 0 0 8.9663 62.022 276.4913 Tm
(Aim)Tj
/F7 1 Tf
1.1128 -1.8336 TD
[(To)-284(determine)-292.9(if)-288.5(exercise)-284.9(improves)-292.4(insulin)-291.9(sensitivity)-288.2(in)-285.1(in-)]TJ
-1.1128 -1.2203 TD
[(sulin-resistant)-353(subjects)-348.1(by)-343.9(downregulating)-354.5(proinammatory)]TJ
T*
[(signaling)-286.3(in)-278.8(immune)-281.5(cells.)]TJ
/F10 1 Tf
0 -2.447 TD
(Methods)Tj
/F7 1 Tf
1.1128 -1.8336 TD
.022 Tc
[(Th)6(e)-287.7(s)1.7(tud)6.4(y)-285.9(includ)6.4(ed)-284.5(17)-287.3(lean,)-284.4(8)-287.3(obese)-287.7(n)-.4(o)6.6(n)-.4(di)5.8(ab)4.9(eti)5.8(c)-2.6(,)-284.4(a)3.5(nd)-284.5(11)]TJ
-1.1128 -1.2203 TD
.0199 Tc
[(obese)-315.1(subject)-5.9(s)-316.5(w)5.6(ith)-318.6(T)-2.1(2DM.)-318.1(Five)-315.1(T2DM)-320.3(subjects)-316.5(w)-.7(er)-6.1(e)-315.1(d)4.3(iet)-5.9(-)]TJ
T*
.0203 Tc
[(tre)-4.9(a)1.8(ted,)-374.6(thre)-4.9(e)-371.6(T)-1.7(2DM)-376.8(subject)-5.5(s)-373(w)-.3(ere)-377.9(n)-2.1(ewly)-369.8(diagnosed,)-374.6(and)]TJ
0 -1.2266 TD
.021 Tc
[(one)-295(T)-1(2DM)-300.3(p).7(articipant)-295.6(was)-302.8(d)5.4(iagn)5(osed)-291.8(2)-301(m)4.5(onths)-296.5(b)-2.4(efore)-295(t)-4.8(h)5(e)]TJ
0 -1.2203 TD
[(study.)-285.4(Three)-288.7(m)4.5(onths)-283.8(b)-2.4(efore)-288.7(t)1.6(he)-288.7(study,)-285.4(the)-288.7(subject)-4.8(s)-283.8(d)-1(id)-285.5(not)]TJ
T*
.0205 Tc
[(exe)-4.7(r).8(cise)-478.9(or)-473.4(only)-477.1(exerc)-4.1(i)4.3(se)-4.7(d)-475.7(o)-1.2(nce)-478.9(d)-1.5(uring)-483.4(t)1.1(he)-478.9(week,)-475.6(h)-1.9(ad)-482(a)]TJ
0 -1.2266 TD
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[(stab)5(le)-186.5(b)5(o).4(d)6.5(y)-184.6(wei)5.9(g)-1.3(ht)-180.7(vary)5(ing)-184.7(o)6.7(nly)-184.6(b)5(y)-184.6(1)-186.1(kg)-184.6(for)-180.9(3)-186.1(m)5.6(o).4(nths)-187.9(b)5(e)3.2(fo)6.7(re)]TJ
0 -1.2203 TD
.0199 Tc
[(the)-568(s)-.4(tudy,)-571(a)1.4(nd)-564.8(underwent)-568.6(a)1.4(n)-565.2(i)-2.6(nsulin)-571.5(clamp)-569.5(p)-.4(roce)-5.3(dure)]TJ
T*
[(within)-344(12)-346.4(weeks)-341.9(a)1.3(fte)-5.4(r)-341.3(m)3.3(ea)-5(surin)]TJ
15.0991 0 TD
.0204 Tc
[(g)-344.4(subject)-5.4(s)-341.9(baseline)-339.9(VO2-)]TJ
-15.0991 -1.2203 TD
.0202 Tc
[(peak.)-482.2(T)-1.8(he)-485.5(subjects)-486.9(p)-.1(art)-5.6(i)4(cipa)]TJ
13.2971 0 TD
.0203 Tc
[(ted)-482.2(i)-2.2(n)-482.6(a)-485(super)-5.7(v).6(ised)-482.2(exercise)]TJ
-13.2971 -1.2266 TD
.0194 Tc
[(program)-288(w)-1.2(ithin)-293.8(1)-289.9(week)-294.8(of)-290.9(t)-6.4(h)3.4(e)-290.3(i)-3.1(nsulin)-293.8(clamp.)-293.3(The)-290.3(p)-7.2(rogram)]TJ
0 -1.2203 TD
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[(consisted)-444.5(o)-1.6(f)-441.9(a)-441(40-minut)-5.7(e)-441.4(cycle)-441.4(e)1.2(rgomete)-5.1(r)-442.2(exercise)-441.4(f)-5.7(o)4.7(r)-442.2(1)-4.7(5)]TJ
T*
[(consecutive)-447.7(d)-1.9(ays.)-450.7(The)-447.7(s)-6.5(ubjects)-449.7(blood)-450.8(samples)-449.1(w)-.5(er)-5.9(e)-447.7(c)1.9(ol-)]TJ
0 -1.2266 TD
.0198 Tc
[(lect)-6(ed)-406.8(bef)-6(o)4.4(r)-6.2(e)-403.7(and)-406.8(a)1.3(fte)-5.4(r)-404.5(t).4(he)-403.7(pre)-5.4(-)-404.3(and)-406.8(p)-.5(ost-e)-5.4(xe)-5.4(rcise)-403.7(i)-2.7(nsulin)]TJ
27.9978 74.5534 TD
.0206 Tc
[(clamps)-809(to)-810.5(isolate)-807.6(t)1.2(he)-807.6(peripheral)-804.9(blood)-804.4(mononuclear)]TJ
0 -1.2203 TD
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[(cell)5.5(s)-276.8(\()-4.1(PMNC\).)-272.1(Toll)5.5(-lik)4.6(e)-275.4(r)-4.3(ecepto)6.3(rs)-276.8(4)-275(a)3.2(nd)-278.5(2)-275(\()2.3(TL)6.1(R4)-275(and)-278.5(T)6.1(LR2\))]TJ
0 -1.2266 TD
.0202 Tc
[(a)-4.6(c)2(tivity)-407.8(we)-5(re)-409.7(detec)-4.4(t).8(ed)-412.8(with)-413.1(primary)-414.2(a)1.7(nd)-406.4(se)-5(condar)-5.8(y)-407.9(a)1.7(nti-)]TJ
0 -1.2203 TD
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[(bod)6.1(i)-.8(es)-232.5(usi)5.5(n)-.7(g)-229.3(e)-3.5(nh)5.7(anced)-234.2(c)3.5(hem)5.2(ilum)5.2(i)-.8(nescen)5.7(ce)-231.1(reag)4.6(ents.)-234.1(U)1.3(sing)]TJ
T*
.0195 Tc
[(W)-4.8(e).6(ste)-5.7(r)-.2(n)-945(b)-3.9(lotting,)-950.8(r)-.2(esear)-6.5(c)1.3(hers)-949.2(me)-5.7(asured)-950.9(extrac)-5.1(ellular)]TJ
0 -1.2266 TD
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[(si)5.9(gn)6.1(al)5.9(-reg)5(ulated)-783.9(ki)5.9(nase)-793.5(\(E)]TJ
12.8861 0 TD
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[(R)4.2(K)-.7(\))-788.7(p).8(hospho)5.7(r)1.4(ylatio)5.7(n;)-791.1(C-Jun)]TJ
-12.8861 -1.2203 TD
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[(a)-5(m)3.3(ino-)-6(terminal)-451.6(kinase)-454.3(\()-126.1(J).4(NK\))-448.6(w)-.8(as)-449.4(meas)-6.8(ured)-451.1(as)-449.4(well.)-444.7(An)]TJ
T*
.0173 Tc
[(e)-7.9(n)-5.1(zym)-5.6(e)-1.6(-l)-5.2(in)-5.1(k)-6.1(e)-1.6(d)-618(i)-5.2(mm)-5.6(un)-5.1(os)-9.3(or)]TJ
12.6585 0 TD
.0199 Tc
[(bent)-619.2(assay)-616.8(\().5(ELISA\))-619.2(k)-3.5(it)-619.2(mea-)]TJ
-12.6585 -1.2266 TD
.0241 Tc
[(su)3.8(r)4.4(e)5.2(d)-573.3(n)1.7(u)3.8(c)5.9(le)5.2(ar)-571(fa)5.6(c)5.9(t)4.7(or)4.4(-k)7(a)5.6(p)3.8(p)3.8(a)-.7(-)4.7(l)7.9(igh)8.1(t)4.7(-c)5.8(ha)5.6(in)8.1(-e)5.2(nh)8.1(an)8.1(ce)5.2(r)-577.3(o)2.4(f)-577(a)5.6(c)5.8(t)4.7(i-)]TJ
0 -1.2203 TD
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[(va)6.1(t)5.2(e)5.7(d)-244(B)-237.6(ce)5.7(ll)8.4(s)-242.3(\()5.2(NF)]TJ
/F14 1 Tf
7.6634 0 TD
0 Tc
(j)Tj
/F7 1 Tf
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.0218 Tc
[(B)-240.4(p)1.5(65\))-244.2(b)4.7(in)5.8(ding)4.7(,)-246.7(w)7.5(hich)-247.1(pl)5.6(ay)4.7(s)-245.1(a)-243.3(key)-241.8(r)2.1(ole)-243.6(i)5.6(n)]TJ
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[(r)-5.8(e)1.3(gulating)-281.4(the)-276.9(i)-2.3(mmune)-276.9(r).5(esponse)-283.2(t).8(o)-279.7(i)-2.3(nf)-5.6(ect)-5.6(i)4(on.)]TJ
/F10 1 Tf
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(Results)Tj
/F7 1 Tf
1.1128 -1.8336 TD
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[(Sub)3.9(j)-2.9(ects)-555.7(wi)4.8(th)-551.4(T)5.3(2)-3.8(DM)-546.9(had)-557.4(t)1.6(h)5(e)-554.3(hi)4.8(ghest)-554.9(f)1.6(asting)-552.5(g)3.9(l)-1.5(ucose)]TJ
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[(level)4.8(s).7(,)-329.7(i)4.8(nam)4.5(matory,)-323.4(a)2.5(nd)-323.4(endothel)4.8(ial)-324(m)-1.9(arkers.)-323.4(O)-1(b)3.9(e)-4.2(se)-320.3(an)5(d)]TJ
T*
.0182 Tc
[(s)-8.4(u)-2.1(bje)-7(c)0(ts)-533.2(wit)-7.6(h)-529(T2)-6.6(DM)-524.4(h)-4.2(a)-.3(d)-534.9(a)-525.1(h)-4.2(i)-4.3(gh)-4.2(er)-532.6(fasti)-4.3(n)-4.2(g)-530(i)2(n)-4.2(sul)-4.3(in)-535.3(lev)-7.8(e)-.7(l,)]TJ
0 -1.2266 TD
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[(H)-5.6(b)2.6(A1)-5.1(c,)-242.5(and)-242.5(n)-2.7(on-e)-5.5(steried)-242.5(fat)-6.1(t).3(y)-244(a)1.2(cid)-242.5(\().3(NEFA\))-246.3(c)1.5(oncentr)-6.3(a)1.2(tion)]TJ
0 -1.2203 TD
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[(t)-5.4(h)4.4(an)-324.4(the)-327.3(c)-4.2(ontrol)-330.9(lean)-324.4(group.)-324(Based)-324(o)-1.3(n)-324.4(t)-5.4(he)-327.3(lower)-328.1(t)1(otal)-330.9(glu-)]TJ
T*
.0206 Tc
[(cose)-365(disposal)-368.6(using)-363.2(the)-365(i)-1.9(nsul)]TJ
13.3856 0 TD
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[(in)-361.1(cl)5.5(am)5.2(p,)-366.9(d)6.1(i)-.8(abetic)-363.3(and)-360.7(o)0(bese)]TJ
-13.3856 -1.2266 TD
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[(p)-6.2(o)5.1(pulat)-5.3(ions)-594.1(had)-589.5(m)-2.4(ore)-592.7(i)-2(nsulin)]TJ
15.0612 0 TD
.0199 Tc
[(resist)-5.9(ance)-593.3(than)-596.8(the)-593.3(l)-2.6(ean)]TJ
-15.0612 -1.2203 TD
.0201 Tc
[(p)-6.6(o)4.7(pulat)-5.7(ion.)-292.6(The)-295.9(d)-1.9(iabet)-5.7(i)3.9(c)-301.6(a)1.6(nd)-292.7(obese)-295.9(g)-3.3(roups)-297.4(did)-299(n)-2.3(ot)-302.8(signi-)]TJ
T*
.0199 Tc
[(c)-4.7(a)1.4(ntly)-218.5(decre)-5.3(a)1.4(se)-220.3(BM)-4.2(I)-216.2(o)-1.8(r)-221.1(w)-.7(eight)-220.8(w)-.7(ith)-217.4(t).5(he)-220.3(increa)-4.9(se)-220.3(in)-223.8(exerc)-4.7(i)3.7(se.)]TJ
T*
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[(A)375.2(l)385.7(s)381.6(o)380.2(,n)379.5(oc)383.7(h)379.5(a)383.4(n)379.5(g)384.8(eo)380.2(c)383.7(c)377.3(u)381.6(r)382.2(r)382.2(e)383(di)379.4(nH)382.9(b)378.5(A)381.5(1)383.4(c)383.7(,N)376.6(E)386.3(F)378.5(A)381.5(,).6(g)384.8(l)379.4(u)381.6(c)383.6(o)380.2(s)381.6(e)383(,).6(a)377.1(n)385.9(d)]TJ
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14.3657 0 TD
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[(rcise,)-297.9(in)5.2(sulin)-292(sensi)5(t)1.8(ivity)-299.4(i)5(n-)]TJ
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[(c)-5.5(r)-.6(ease)-6.1(d)-375.9(b)2(y)-383.7(11%)-374.5(in)-376.3(lea)-5.7(n)3.1(,)-382.2(15%)-380.9(in)-376.3(obese,)-382.2(and)-375.9(32%)-380.9(in)-382.6(T2)-5.7(DM)]TJ
T*
.021 Tc
[(groups)-543(\()]TJ
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4.2553 0 TD
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(p)Tj
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(<)Tj
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[(immune)-231.9(system\))-232.5(l)-1.6(evels)-233.3(i)4.7(n)-235.4(t)1.5(he)]TJ
13.3856 0 TD
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[(PMNC)-233.1(subjects)-234.2(w)-.6(it)-5.8(h)-230(d)-2(iabetes)]TJ
-13.3856 -1.2203 TD
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[(we)-5.8(re)-631.8(4)-5.4(.)3.8(2-)-6.4(fold)-634.9(higher)-638.9(compa)-5.4(r)-.3(ed)-634.9(wit)-6.4(h)-635.2(the)-631.8(l)-3.1(ean)-635.2(subje)-5.8(cts)]TJ
T*
0 Tc
(\()Tj
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(p)Tj
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(<)Tj
/F7 1 Tf
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[(0)-4.9(.)4.3(0)-4.9(5)1.4(\).)-330.8(TLR4)-327.4(was)-335.5(2)1.4(.7)-4.9(-fold)-324.5(\()]TJ
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(p)Tj
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(=)Tj
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8.9663 0 0 8.9663 131.1874 445.8329 Tm
[(,)-338(West)-557.1(DS)]TJ
6.7246 0 0 5.9768 172.2897 449.8015 Tm
(42)Tj
8.9663 0 0 8.9663 179.0362 445.8329 Tm
[(,)-331.7(Williamson)-561.5(DF)]TJ
6.7246 0 0 5.9768 243.1558 449.8015 Tm
(43)Tj
8.9663 0 0 8.9663 249.9023 445.8329 Tm
(,)Tj
-21.207 -1.2266 TD
[(Yanovski)-558.7(SZ)]TJ
6.7246 0 0 5.9768 109.5307 438.8597 Tm
(44)Tj
-7.5033 -2.6749 TD
(1)Tj
8.9663 0 0 8.9663 62.4189 418.9038 Tm
[(Weight)-475.1(Control)-478.2(and)-477.4(Diabetes)-476.6(Research)-472.4(Center,)-475.7(Warren)-472.5(Alpert)]TJ
-.2972 -1.2203 TD
[(Medical)-399.1(School)-395.1(of)-393.2(Brown)-395.9(University)-396.9(and)-395.2(Miriam)-396(Hospital,)-399.4(Pro-)]TJ
T*
[(vidence,)-514.1(RI;)]TJ
6.7246 0 0 5.9768 108.0567 400.9889 Tm
(2)Tj
8.9663 0 0 8.9663 111.4015 397.0204 Tm
[(National)-520.1(Institute)-513.5(of)-513.3(Diabetes)-520.9(and)-515.4(Digestive)-512.6(and)]TJ
-5.7602 -1.2266 TD
[(Kidney)-497.1(Diseases,)-495.8(National)-494.8(Institutes)-495.2(of)-494.4(Health,)-493(Bethesda,)-493.7(MD;)]TJ
6.7246 0 0 5.9768 58.5637 379.0487 Tm
(3)Tj
8.9663 0 0 8.9663 61.9653 375.0802 Tm
[(Johns)-364.8(Hopkins)-360.6(School)-369.8(of)-361.6(Medicine,)-363.6(Baltimore,)-371.9(MD;)]TJ
6.7246 0 0 5.9768 253.1338 379.0487 Tm
(4)Tj
8.9663 0 0 8.9663 256.4787 375.0802 Tm
(Pennington)Tj
-21.9405 -1.2203 TD
[(Biomedical)-488(Research)-478.7(Center,)-482(Baton)-480.7(Rouge,)-485.3(LA;)]TJ
6.7246 0 0 5.9768 241.455 368.107 Tm
(5)Tj
8.9663 0 0 8.9663 244.7999 364.1385 Tm
[(Johns)-484.9(Hopkins)]TJ
-20.638 -1.2266 TD
[(School)-464.6(of)-462.7(Medicine,)-464.7(Baltimore,)-466.8(MD)]TJ
/F7 1 Tf
14.96 0 TD
(;)Tj
/F8 1 Tf
6.7246 0 0 5.9768 199.1055 357.1653 Tm
(6)Tj
8.9663 0 0 8.9663 202.4503 353.1401 Tm
[(Department)-464.3(of)-462.7(Preventive)]TJ
-15.9148 -1.2203 TD
[(Medicine,)-780.9(University)-782.6(of)-778.9(Tennessee)-774.8(Health)-781(Sciences)-781.6(Center,)]TJ
T*
[(Memphis,)-277.3(TN;)]TJ
6.7246 0 0 5.9768 113.896 335.2251 Tm
(7)Tj
8.9663 0 0 8.9663 117.2976 331.2566 Tm
[(Division)-276.5(of)-273.1(Epidemiology)-279.3(and)-275.1(Community)-276.3(Health,)]TJ
-6.4178 -1.2266 TD
[(University)-839.5(of)-842.1(Minnesota,)-834.9(Minneapolis,)-844(MN;)]TJ
6.7246 0 0 5.9768 246.5574 324.2834 Tm
(8)Tj
8.9663 0 0 8.9663 249.959 320.2582 Tm
(NIH/NIDDK)Tj
-21.2134 -1.2203 TD
[(Southwest)-272(American)-262.8(Indian)-269.2(Center;)]TJ
6.7246 0 0 5.9768 190.7149 313.2849 Tm
(9)Tj
8.9663 0 0 8.9663 194.1165 309.3164 Tm
[(Weight)-266.4(Control)-263.2(and)-268.8(Diabetes)]TJ
-14.9853 -1.2203 TD
[(Research)-756.9(Center,)-760.2(Warren)-757(Alpert)-758.5(Medical)-759.5(School)-755.5(of)-753.6(Brown)]TJ
T*
[(University)-321(and)-319.4(Miriam)-313.8(Hospital,)-323.5(Providence,)-314.8(RI;)]TJ
6.7246 0 0 5.9768 239.6409 291.4015 Tm
(10)Tj
8.9663 0 0 8.9663 246.3873 287.433 Tm
[(Department)-318.9(of)]TJ
-20.815 -1.2266 TD
[(Biostatistical)-243.8(Sciences,)-240.7(Wake)-238.3(Forest)-233.9(University)-245.1(School)-237(of)-235.1(Medicine,)]TJ
0 -1.2203 TD
[(Winston-Salem,)-545.9(NC;)]TJ
6.7246 0 0 5.9768 141.6189 269.4614 Tm
-.07 Tc
(11)Tj
8.9663 0 0 8.9663 147.8551 265.4929 Tm
0 Tc
[(NIH/NIDDK,)-546.1(Bethesda,)-537.9(MD;)]TJ
6.7246 0 0 5.9768 264.1322 269.4614 Tm
(12)Tj
8.9663 0 0 8.9663 270.8787 265.4929 Tm
(Depart-)Tj
-23.5465 -1.2203 TD
[(ment)-563.4(of)-557.6(Medicine,)-565.9(Baylor)-560.1(College)-564.6(of)-557.6(Medicine,)-559.6(Houston,)-563(TX;)]TJ
6.7246 0 0 5.9768 59.074 247.5779 Tm
(13)Tj
8.9663 0 0 8.9663 65.8204 243.5527 Tm
[(Roybal)-342.9(Comprehensive)-348.4(Health)-351(Center,)-342.9(Los)-345.8(Angeles,)-348.8(CA;)]TJ
6.7246 0 0 5.9768 274.8472 247.5779 Tm
(14)Tj
8.9663 0 0 8.9663 281.5936 243.5527 Tm
(Cen-)Tj
-24.7416 -1.2203 TD
[(ters)-540(for)-533(Disease)-536.5(Control)-535.1(and)-534.3(Prevention,)-530.2(Atlanta,)-536.3(GA;)]TJ
6.7246 0 0 5.9768 272.8062 236.5795 Tm
(15)Tj
8.9663 0 0 8.9663 279.5527 232.611 Tm
(NIH/)Tj
-24.5139 -1.2203 TD
[(NIDDK,)-429.1(Bethesda,)-430.4(MD;)]TJ
6.7246 0 0 5.9768 151.7102 225.6377 Tm
(16)Tj
8.9663 0 0 8.9663 158.4566 221.6693 Tm
[(Department)-432.7(of)-424.8(Clinical)-431.5(Epidemiology,)]TJ
-11.0082 -1.2266 TD
[(University)-403.2(of)-399.5(Texas)-401.5(Health)-395.3(Science)-401.5(Center)-396.9(at)-404.4(San)-393.8(Antonio,)-401.2(San)]TJ
0 -1.2203 TD
[(Antonio,)-426.5(TX;)]TJ
6.7246 0 0 5.9768 110.4378 203.6976 Tm
(17)Tj
8.9663 0 0 8.9663 117.1842 199.729 Tm
[(Center)-415.9(for)-425.5(Human)-415.6(Nutrition,)-422.5(University)-422.2(of)-418.5(Col-)]TJ
-6.4051 -1.2203 TD
[(orado)-649.3(Health)-654.5(Sciences)-648.8(Center,)-646.4(Aurora,)-648.7(CO;)]TJ
6.7246 0 0 5.9768 235.6157 192.7559 Tm
(18)Tj
8.9663 0 0 8.9663 242.3621 188.7874 Tm
[(Joslin)-653.6(Diabetes)]TJ
-20.3661 -1.2266 TD
[(Center,)-501(Boston,)-496.9(MA;)]TJ
6.7246 0 0 5.9768 142.696 181.8141 Tm
(19)Tj
8.9663 0 0 8.9663 149.4425 177.7889 Tm
[(NIH/NIDDK,)-501.8(Bethesda,)-500(MD;)]TJ
6.7246 0 0 5.9768 264.1322 181.8141 Tm
(20)Tj
8.9663 0 0 8.9663 270.8787 177.7889 Tm
(Depart-)Tj
-23.5465 -1.2203 TD
[(ment)-405.3(of)-405.8(Health)-401.6(and)-401.6(Physical)-402.8(Activity,)-406.5(University)-409.5(of)-399.5(Pittsburgh,)]TJ
T*
[(Pittsburgh,)-681.1(PA;)]TJ
6.7246 0 0 5.9768 125.5748 159.874 Tm
-.0785 Tc
(21)Tj
8.9663 0 0 8.9663 131.811 155.9055 Tm
0 Tc
[(Division)-674.9(of)-671.4(Epidemiology)-677.6(and)-673.4(Community)]TJ
-8.0364 -1.2203 TD
[(Health,)-252.8(University)-251.5(of)-254.1(Minnesota,)-246.8(Minneapolis,)-256(MN;)]TJ
6.7246 0 0 5.9768 248.8251 148.9323 Tm
(22)Tj
8.9663 0 0 8.9663 255.5716 144.9638 Tm
(Department)Tj
-21.8393 -1.2266 TD
[(of)-374.2(Preventive)-378.3(Medicine,)-376.2(University)-377.9(of)-374.2(Tennessee)-370.1(Health)-376.3(Sciences)]TJ
0 -1.2203 TD
[(Center,)-425.1(Memphis,)-416.4(TN;)]TJ
6.7246 0 0 5.9768 146.6645 126.9921 Tm
(23)Tj
8.9663 0 0 8.9663 153.411 123.0236 Tm
[(Department)-426.4(of)-418.5(Medicine,)-420.5(University)-422.2(of)]TJ
-10.4454 -1.2203 TD
[(Washington,)-384.3(Seattle,)-383.9(WA;)]TJ
6.7246 0 0 5.9768 158.2866 116.0504 Tm
(24)Tj
8.9663 0 0 8.9663 165.033 112.0819 Tm
[(Department)-382.1(of)-380.5(Preventive)-384.7(Medicine,)]TJ
-11.7416 -1.2266 TD
[(University)-434.8(of)-431.1(Tennessee)-427(Health)-433.2(Sciences)-427.5(Center,)-431.4(Memphis,)-429.1(TN;)]TJ
6.7246 0 0 5.9768 58.5637 94.1102 Tm
(25)Tj
8.9663 0 0 8.9663 65.3102 90.1417 Tm
[(NIH/NIDDK)-302.9(Southwest)-297.3(American)-300.7(Indian)-294.5(Center,)-298.7(Phoenix,)-295.8(AZ;)]TJ
6.7246 0 0 5.9768 58.5637 83.1685 Tm
(26)Tj
8.9663 0 0 8.9663 65.3102 79.2 Tm
[(Division)-845.6(of)-842.1(Preventive)-846.2(Medicine,)-844.1(University)-845.8(of)-848.4(Alabama)]TJ
-.6196 -1.2266 TD
[(at)-619.4(Birmingham,)-616.6(Birmingham,)-616.6(AL;)]TJ
6.7246 0 0 5.9768 196.3275 72.2267 Tm
(27)Tj
8.9663 0 0 8.9663 203.0739 68.2015 Tm
[(Weight)-614.2(and)-616.5(Eating)-615.6(Dis-)]TJ
-15.9843 -1.2203 TD
[(order)-551(Program,)-550.6(University)-548.6(of)-551.3(Pennsylvania,)-553.1(Philadelphia,)-548.2(PA;)]TJ
6.7246 0 0 5.9768 309.6566 730.1478 Tm
(28)Tj
8.9663 0 0 8.9663 316.403 726.1227 Tm
[(Department)-717.2(of)-722(Clinical)-716(Epidemiology,)-724.8(University)-719.4(of)-722(Texas)]TJ
-.6196 -1.2203 TD
[(Health)-414.2(Science)-420.5(Center)-415.9(at)-417.1(San)-412.8(Antonio,)-413.8(San)-419.1(Antonio,)-413.8(TX;)]TJ
6.7246 0 0 5.9768 529.9652 719.1494 Tm
(29)Tj
8.9663 0 0 8.9663 536.655 715.1809 Tm
(De-)Tj
-25.1842 -1.2203 TD
[(partment)-474.9(of)-469.1(Medicine,)-477.4(University)-472.8(of)-469.1(Washington,)-479.1(Seattle,)-472.4(WA;)]TJ
6.7246 0 0 5.9768 309.6566 697.2659 Tm
(30)Tj
8.9663 0 0 8.9663 316.403 693.2407 Tm
[(Diabetes)-495.6(Unit,)-491.6(Massachusetts)-497.6(General)-491(Hospital,)-494.2(Boston,)-496.9(MA;)]TJ
6.7246 0 0 5.9768 309.6566 686.2676 Tm
-.0785 Tc
(31)Tj
8.9663 0 0 8.9663 315.8928 682.2991 Tm
0 Tc
[(Department)-514.9(of)-519.6(Medicine,)-515.3(St.)-513.6(LukesRoosevelt)-523.5(Hospital,)-519.5(New)]TJ
-.5627 -1.2203 TD
[(York,)-404.8(NY;)]TJ
6.7246 0 0 5.9768 351.5527 675.3258 Tm
(32)Tj
8.9663 0 0 8.9663 358.2991 671.3573 Tm
[(Roybal)-406.1(Comprehensive)-405.3(Health)-407.9(Center,)-412.5(Los)-402.7(Angeles,)]TJ
-5.2923 -1.2266 TD
(CA;)Tj
6.7246 0 0 5.9768 329.2157 664.384 Tm
(33)Tj
8.9663 0 0 8.9663 335.9054 660.3589 Tm
[(Department)-552.8(of)-544.9(Medicine,)-546.9(St.)-545.3(LukesRoosevelt)-555.1(Hospital,)]TJ
-2.7947 -1.2203 TD
[(New)-567.6(York,)-575.5(NY;)]TJ
6.7246 0 0 5.9768 376.3841 653.3857 Tm
(34)Tj
8.9663 0 0 8.9663 383.1306 649.4172 Tm
[(Department)-571.8(of)-570.2(Medicine,)-572.2(Baylor)-572.7(College)-570.9(of)]TJ
-8.0617 -1.2203 TD
[(Medicine,)-420.5(Houston,)-430.2(TX;)]TJ
6.7246 0 0 5.9768 403.8235 642.4439 Tm
(35)Tj
8.9663 0 0 8.9663 410.5699 638.4754 Tm
[(Department)-426.4(of)-424.8(Biostatistical)-427.2(Sciences,)]TJ
-11.122 -1.2203 TD
[(Wake)-320.5(Forest)-328.7(University)-321(School)-325.5(of)-323.6(Medicine,)-325.6(Winston-Salem,)-324.5(NC;)]TJ
6.7246 0 0 5.9768 309.6566 620.5038 Tm
(36)Tj
8.9663 0 0 8.9663 316.403 616.5353 Tm
[(Center)-485.4(for)-488.7(Womens)-487.7(Health)-490.1(Research,)-487.9(University)-491.7(of)-488(Colorado)]TJ
-.6196 -1.2203 TD
[(Health)-313.1(Sciences)-313.7(Center,)-317.6(Aurora,)-313.6(CO;)]TJ
6.7246 0 0 5.9768 447.6471 609.562 Tm
(37)Tj
8.9663 0 0 8.9663 454.3936 605.5935 Tm
[(Department)-318.9(of)-311(Health)-319.4(and)]TJ
-16.0096 -1.2203 TD
[(Physical)-668.4(Activity,)-672(University)-668.8(of)-671.4(Pittsburgh,)-668.4(Pittsburgh,)-674.8(PA;)]TJ
6.7246 0 0 5.9768 309.6566 587.6786 Tm
(38)Tj
8.9663 0 0 8.9663 316.403 583.6534 Tm
[(Pennington)-635.8(Biomedical)-633.5(Research)-636.8(Center,)-640.1(Baton)-632.4(Rouge,)-637(LA;)]TJ
6.7246 0 0 5.9768 309.6566 576.6802 Tm
(39)Tj
8.9663 0 0 8.9663 316.403 572.7117 Tm
[(Division)-339.8(of)-342.6(Preventive)-340.4(Medicine,)-338.3(University)-346.3(of)-336.3(Alabama)-342.6(at)-341.2(Bir-)]TJ
-.6196 -1.2203 TD
[(mingham,)-383.4(Birmingham,)-389(AL;)]TJ
6.7246 0 0 5.9768 418.5637 565.7384 Tm
(40)Tj
8.9663 0 0 8.9663 425.3101 561.7699 Tm
[(Weight)-386.6(and)-382.6(Eating)-388(Disorder)-390.6(Pro-)]TJ
-12.766 -1.2266 TD
[(gram,)-332.6(Uni)11.3(ve)12.4(rsit)15.2(y)-328.3(o)0(f)-323.6(Penn)19.1(sylv)17.4(ani)13.4(a,)-324.7(Phi)14.6(la)11.5(delp)17.4(hia)12(,)-325.4(PA;)]TJ
6.7246 0 0 5.9768 503.8298 554.7967 Tm
-.0785 Tc
(41)Tj
8.9663 0 0 8.9663 510.0093 550.7715 Tm
0 Tc
[(Div)16.2(isi)14.5(on)-326.2(of)]TJ
-22.2124 -1.2203 TD
[(Pub)14.3(lic)-407.1(Hea)17.6(lth)-406.5(Sci)14(enc)15.2(es,)-402.7(Wake)-402.7(For)14.6(est)-406.5(Uni)11.3(ve)12.4(rsi)15.7(ty)-411(Sch)16.4(ool)-411.4(of)-405.8(Med)13.6(i-)]TJ
T*
[(ci)12.1(ne,)-425.3(Win)13.9(sto)12.2(n-S)16(alem)15.7(,)-432.9(NC;)]TJ
6.7246 0 0 5.9768 410.1164 532.8566 Tm
(42)Tj
8.9663 0 0 8.9663 416.7495 528.8881 Tm
[(Depa)18.1(rt)11.5(men)12.5(t)-436.8(o)0(f)-431.1(Hea)17.6(lth)-425.5(Beha)16.5(vio)12(r)-430.7(and)]TJ
-11.8112 -1.2266 TD
[(Hea)17.6(lth)-242.1(Edu)18.4(cati)12.3(on)15.3(,)-249.5(Col)13.6(lege)-236.7(of)-241.4(Pub)14.3(lic)-236.4(Hea)11.3(lth,)-232.4(Uni)11.3(ve)12.4(rsit)15.2(y)-246.1(o)0(f)-247.8(Ark)16.2(ans)14.6(as)]TJ
0 -1.2203 TD
[(fo)11.5(r)-348.5(Med)13.6(ic)12.1(al)-342.6(Sci)14(enc)15.2(es,)-339.4(Lit)12.2(tle)-338.2(Roc)16.8(k,)-343.6(AR;)]TJ
6.7246 0 0 5.9768 452.466 510.9164 Tm
(43)Tj
8.9663 0 0 8.9663 459.0991 506.9479 Tm
[(Cen)15.9(ters)-337.7(fo)11.5(r)-348.5(Dis)15(eas)12(e)-348.5(Con)17.4(-)]TJ
-16.5344 -1.2203 TD
[(tr)11.5(ol)-323.6(and)-319.4(Pre)14.6(ven)14.3(tio)11(n,)-323.5(Atl)13.8(ant)14.8(a,)-324.7(GA;)]TJ
6.7246 0 0 5.9768 437.7826 499.9747 Tm
(44)Tj
8.9663 0 0 8.9663 444.4724 496.0062 Tm
[(NIH)15.7(/N)11.4(IDDK)11.5(,)-325.4(Bet)14.8(hesd)18.6(a,)-324.7(MD)]TJ
8.4682 0 0 8.4682 310.8472 480.4156 Tm
[(N)-334.6(Engl)-330.2(J)-334.1(Med)-340.4(2013;)]TJ
/F9 1 Tf
8.7568 0 TD
(369)Tj
/F8 1 Tf
1.5063 0 TD
[(:)-332.4(14554)]TJ
/F10 1 Tf
8.9663 0 0 8.9663 310.8472 453.1463 Tm
[(Background)-335.4(and)-329.4(Rationale)]TJ
/F7 1 Tf
1.1128 -1.8336 TD
[(To)-423.1(determine)-432(whether)-433(a)-429.5(long-term)-430.5(intensive)-433.5(lifestyle)-434.4(in-)]TJ
-1.1128 -1.2203 TD
[(tervention)-211.3(for)-212.6(weight)-209.3(loss)-204.9(decreases)-213.5(cardiovascular)-210.8(morbidity)]TJ
T*
[(and)-277.8(mortality)-284.9(for)-282.1(overweight)-283(or)-281.7(obese)-280.2(patients)-288.2(with)-280.9(T2DM.)]TJ
/F10 1 Tf
0 -2.447 TD
(Methods)Tj
/F7 1 Tf
1.1128 -1.8336 TD
[(The)-335.1(study)-339.4(followed)-346.4(5,145)-336.1(overweight)-339.9(or)-338.6(obese)-343.4(T2DM)-337.8(pa-)]TJ
-1.1128 -1.2203 TD
[(tients)-420.1(for)-421.3(up)-420(to)-420.6(13.5)-412.4(years.)-419.7(Each)-422.5(patient)-419.6(was)-419.8(randomly)-419.6(as-)]TJ
0 -1.2266 TD
[(signed)-224.2(to)-230.9(an)-224.2(intervention)-230.8(\(targeting)-232.3(a)-227.1(7)0(%)-222.4(loss)-230.2(in)-221.9(body)-229.6(weight\))]TJ
0 -1.2203 TD
[(or)-250.1(control)-259.5(group.)-253.8(The)-252.9(intervention)-256.1(group)-257.2(emphasized)-255.6(weight)]TJ
T*
[(loss)-299.8(through)-307.3(decreased)-303.7(caloric)-305.8(intake)-302.1(and)-303.1(increased)-301.4(physical)]TJ
T*
[(activity,)-179.3(while)-182.7(the)-187.1(control)-183.6(group)-181.3(emphasized)-186(diabetes)-182.8(support)]TJ
0 -1.2266 TD
[(and)-277.8(education.)]TJ
/F10 1 Tf
0 -2.4406 TD
(Results)Tj
/F7 1 Tf
1.1128 -1.8336 TD
[(The)-385.7(intervention)-395.2(group)-396.3(had)-385.3(greater)-391.3(weight)-392.7(loss)-394.6(than)-386.1(the)]TJ
-1.1128 -1.2266 TD
[(control)-253.2(group)-250.9(\(8.6%)-257(vs.)-251.6(0.7%)-250.2(at)-252.9(1)-252.4(year,)-247.7(6.0%)-256.5(vs.)-251.6(3.5%)-250.2(at)-252.9(study)]TJ
0 -1.2203 TD
[(end\).)-325.8(Additionally,)-325.9(the)-326.2(intervention)-332(group)-326.7(reduced)-323.3(glycated)]TJ
T*
[(hemoglobin)-284.9(and)-290.4(initially)-284.7(improved)-287.8(tness)-287.6(and)-284.1(all)-284.8(cardiovas-)]TJ
0 -1.2266 TD
[(cular)-269.9(risk)-269.2(factors,)-273(besides)-272.6(low-density-lipoprotein)-282.2(cholesterol)]TJ
0 -1.2203 TD
[(levels,)-264.8(more)-266.5(so)-263.3(than)-272.3(the)-263(control)-272.2(group.)-266.4(The)-265.5(primary)-260.7(outcome)]TJ
T*
[(\(composite)-553.2(of)-547(death)-550(from)-551.6(cardiovascular)-552.2(causes,)-549.4(nonfatal)]TJ
T*
[(myocardial)-336.3(infarction,)-336.1(nonfatal)-341.8(stroke,)-335(or)-332.3(hospitalization)-344.7(for)]TJ
0 -1.2266 TD
[(angina\))-539(occurred)-538.1(in)-538(403)-536(intervention)-547(patients)-541.1(and)-537(in)-538(418)]TJ
0 -1.2203 TD
[(control)-202.6(patients.)-208.9(The)-208.6(trial)-203.8(was)-204.8(stopped)-206.2(early)-204.1(\(after)-203.9(a)-201.8(follow-up)]TJ
T*
(of)Tj
/F12 1 Tf
1.1508 0 TD
(*)Tj
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