The extent of changes in genes related to several possible mode(s

The extent of changes in genes related to several possible mode(s) of action highlights the changes in cellular functions and signaling pathways that play major roles. In addition to understanding the pathways related to mode of action for chemicals, these data could lead to the identification of genomic signatures that could be used for screening of chemicals for their potential to cause disease and click here developmental disorders. (C) 2011 Elsevier Ltd. All rights reserved.”
“Evaluation of: Ghosh D, Li Z, Tan XF, Lim TK, Mao Y, Lin Q. RAQ based quantitative proteomics approach validated the role of calcyclin binding protein

(CacyBP) in promoting colorectal cancer metastasis. Mol. Cell Proteomics 12(7), 1865-1880 (2013). The use of iTRAQ-based relative quantification is demonstrated by Ghosh et al. to analyze the downstream effectors of a calcyclin-binding protein, AZD8186 which is proposed to promote colorectal cancer progression. These findings are reviewed and discussed in relation to the need to establish robust in vitro model cell lines for identification of cancer-specific pathways and to confirm the leads generated by proteomic analysis.”
“Vanishing bone lesions have been previously described in patients with eosinophilic granuloma.

We present the magnetic resonance imaging, computed tomography, scintigraphic

and histological findings in a 26-year-old woman presenting with a painful scapular mass that subsequently completely resolved, compatible with the diagnosis

of eosinophilic granuloma.

Clinicians should be aware of the multimodality appearances and natural history of resolving eosinophilic granuloma.”
“Background: Phthalate VX-680 and phenol exposure is prevalent among the general population and of potential concern for pregnant women and children because of their suspected susceptibility to endocrine effects.

Objectives: To evaluate the extent of exposure to several phthalates and phenols in a sample of Spanish pregnant women – according to their individual characteristics (age, social class, education, and body mass index) – and children who participated in the INMA – Infancia y Medio Ambiente (Environment and Childhood) project.

Methods: One spot urine sample was taken during the third trimester of pregnancy from 120 pregnant women and from 30 4-year old children belonging to 5 Spanish birth cohorts, and analyzed for 11 phthalate metabolites and 9 phenols.

Results: Three metabolites of di(2-ethylhexyl) phthalate, mono-2-ethyl-5-carboxypentyl phthalate, mono-2-ethyl-5-hydroxyhexyl phthalate, and mono-2-ethyl-5-oxohexyl phthalate; two metabolites of dibutyl phthalates, mono-isobutyl phthalate and mono-n-butyl phthalate; monoethyl phthalate (MEP), the main metabolite of diethyl phthalate; and two phenols, methyl paraben (M-PB) and 2,5-dichlorophenol were detected in the urine samples of all women. The highest urinary concentrations were for MEP and M-PB.

0012) In MRSA infections, the untreated eyes contained 4 91 log

0012). In MRSA infections, the untreated eyes contained 4.91 log CFU/mL, which was similar to besifloxacin-treated eyes with either treatment (P >=.5830). Eyes treated with moxifloxacin or moxifloxacin alternative formulation contained significantly fewer CFUs than untreated controls or besifloxacin-treated

eyes at both prophylactic time points (P <=.0008).

CONCLUSIONS: Moxifloxacin had greater in vivo effectiveness against MSSA and MRSA than besifloxacin. The aqueous antibiotic concentrations suggest limited penetration by besifloxacin, accounting for its lack of effectiveness.”
“Background: Respondent-driven sampling (RDS) is a form of chain-referral sampling that is increasingly being used for HIV behavioural surveillance. When used for surveillance purposes, a sampling method should be relatively inexpensive and simple to operate. This study examined GSK2126458 in vitro whether an RDS survey of people who GW786034 purchase inject drugs (PWID) in Sydney, Australia, could be successfully conducted through the use of minimal and existing resources.

Method: The RDS survey was conducted on the premises of a local needle and syringe program (NSP) with some adjustments to take into account the constraints of existing resources. The impact of the survey on clients and on staff was examined by summarizing NSF service data and by conducting post-survey discussions with NSP staff.

Results:

From November 2009 till March 2010, 261 participants were recruited in 16 waves. A significant increase was found in the number of services provided by the NSP during and after data collection. Generally, staff felt that the survey had a positive impact by exposing a broader group of people to the NSF. However, conducting the survey may

have led to privacy issues for NSF clients due to an increased number of people gathering around the NSP.

Conclusions: This study shows that RDS can be conducted with the use of minimal and existing resources under certain conditions selleck chemicals llc (e.g., use of a self-administered questionnaire and no biological samples taken). A more detailed cost-utility analysis is needed to determine whether RDS’ advantages outweigh potential challenges when compared to simpler and less costly convenience methods. (C) 2011 Elsevier Ireland Ltd. All rights reserved.”
“The genus Mesosetum is a primarily South American genus with 42 species. Mesosetum chaseae, regionally known as ‘grama-do-cerrado’, is abundant in the Pantanal Matogrossense (Brazil); it is a valuable resource for livestock and for environmental conservation. We collected specimens from the Nhecolandia sub-region of the Brazilian Pantanal, located in Corumba, Mato Grosso do Sul, Brazil. We examined chromosome number, ploidy level, meiotic behavior, microgametogenesis, and pollen viability of 10 accessions. All the accessions were diploid, derived from x = 8, presenting 2n = 2x = 16 chromosomes.

The only advantage of injecting anesthetic into trigger points ma

The only advantage of injecting anesthetic into trigger points may be to reduce the pain of the needling process, which may not be an insignificant benefit.”
“Breast cancer is the most common non skin cancer and the second leading cause of cancer death in North American women. Mammography is the only screening test shown to reduce breast cancer related mortality. There is general agreement that screening should be offered at least biennially to women 50 to 74 years of age. For women 40 to 49 years of age, the risks and benefits of screening should be discussed, and the decision to perform screening should take into consideration the individual patient

risk, AZD8186 values, and comfort level of the patient and physician. Information is lacking about the effectiveness of screening in women 75 years and older. The decision to screen women

in this age group should be individualized, keeping the patient’s life expectancy, functional status, and goals of care in mind. For women with an estimated lifetime breast cancer risk of more than 20 percent or who have a BRCA mutation, screening should begin at 25 years of age or at the age that is five to 10 years younger than the earliest age that breast cancer was diagnosed in the family. Screening with magnetic resonance imaging may be considered in high-risk women, but its impact on breast cancer mortality is uncertain. Clinical breast examination plus mammography seems to CRT0066101 concentration be no more effective than mammography alone at reducing breast cancer mortality. Teaching breast self-examination does not improve mortality and is not recommended; however, women should be aware of any changes in their breasts and report buy Sapitinib them promptly. (Am Fam Physician. 2013;87(4):274-278.

Copyright (C) 2013 American Academy of Family Physicians.)”
“Aims To evaluate the effect of Tolterodine on urethral and bladder afferent nerves in women with detrusor overactivity (DO) in comparison to placebo, by studying the changes in the current perception threshold (CPT). Methods: Women with overactive bladder symptoms and idiopathic DO were recruited and randomized in a double-blind manner between placebo and tolterodine extended release. All women underwent CPT testing of the bladder and urethra using a Neurometer constant current stimulator. CPT values were determined at three frequencies, including 2,000 Hz (corresponding to Ab-fibers), 250 Hz (corresponding to Ad-fibers), and 5 Hz (corresponding to C fibers) before and 7 days on treatment. CPT values before and on treatment were compared using a Wilcoxon Signed Rank test. Results: Twenty women (mean age 46 years) were studied. There was no statistical difference between the two groups in terms of age, ethnicity, severity of symptoms and pre-treatment CPT values. Only in the tolterodine group there was a significantly increased CPT value at 5 and 250 Hz upon both urethral and bladder stimulation after 1 week of treatment.

However, radioresistance occurs in nearly 30% of patients treated

However, radioresistance occurs in nearly 30% of patients treated with potentially curative doses. Therapeutic synergy between radiotherapy and androgen ablation treatment provides a promising strategy for improving the clinical outcome.

Accordingly, the androgen deprivation-induced signaling pathway may also mediate radiosensitivity in PCa cells. The C4-2 cell line was derived from the androgen-sensitive LNCaP parent line under androgen-depleted condition and had acquired androgen-refractory characteristics. In our study, the response to radiation was evaluated in both LNCaP and C4-2. Results showed that C4-2 cells were more likely to survive from irradiation and appeared more aggressive in their resistance to radiation treatment compared with LNCaP, as measured by clonogenic assays Luminespib inhibitor and cell viability and cell cycle analyses. Gene expression analyses revealed that a set of genes involved in cell cycle arrest and DNA repair were differentially regulated in LNCaP and C4-2 in response to radiation, which was also consistent with the radiation-resistant property observed in C4-2 cells. These results strongly suggested that the radiation-resistant property may develop with progression of PCa to androgen-independent status. Not only can

the LNCaP and C4-2 PCa progression model be applied for investigating androgen-refractory progression, but it can also be used to explore the development of radiation resistance in PCa.”
“Off-axis electron holography has been used to map the electrostatic potential JIB-04 cell line distribution of threading screw dislocations in differently n-doped 4H-SiC epitaxial layers. Observed phase contrast indicated the presence of a negatively charged dislocation core. Comparison between experimental and simulated potential MEK162 cell line profiles indicated that the density of trapped charges increased for a higher doped epilayer. Assuming a single level of the trap at the core, the ionization energy of the trap was calculated to be 0.89 +/- 0.22 eV. (C) 2011 American Institute of Physics. [doi:10.1063/1.3544066]“
“Multiwalled carbon

nanotube (MWCNT)filled polycarbonate (PC)/styrene-acrylonitrile (SAN) blends with a wide range of blend compositions were prepared by melt mixing in a rotational rheometer, and the effect of SAN on the electrical properties of the PC/MWCNT composites was studied. The structure/electrical property relationship was investigated and explained by a combination of MWCNT localization and blend morphology. Transmission electron micrographs showed selective localization of MWCNTs in the PC phase, regardless of the blend morphology. When the SAN concentration was 10-40 wt%, which corresponded to sea-island (10-30 wt%) and cocontinuous (40 wt%)blend morphologies (PC was continuous in both structures), the electrical resistivity decreased with increases in the SAN content.

The allograft functioned well immediately after surgery, and we d

The allograft functioned well immediately after surgery, and we did not observe histological findings of rejection and https://www.selleckchem.com/products/acy-738.html recurrent FSGS in protocol biopsies at two months and one yr after transplantation. Four years after transplantation, the urine protein excretion reached 11 g/d, and the serum creatinine increased over 2.5 mg/dL. We diagnosed nephrotic syndrome due to recurrent FSGS with graft dysfunction and confirmed FSGS lesions with severe endothelial injury with an allograft biopsy, associated with calcineurin inhibitor (CNI) nephrotoxicity. Thereafter, we performed plasmapheresis and steroid therapy with subsequent low-density

lipoprotein adsorption, combined with the reduction of tacrolimus. The nephrotic syndrome improved dramatically with the multiple therapeutic approaches. Primary FSGS recurs frequently in patients immediately after kidney transplantation. Post-transplant FSGS has various causes, such as recurrent primary disease, obesity, hyperfiltration, donor-related nephrosclerosis, and CNI-induced arteriolopathy. In the case of nephrotic syndrome after kidney transplantation, we should consider not only recurrent FSGS, but also CNI-induced nephrotoxicity

to determine the optimal treatment.”
“ObjectiveThis study aimed to determine the effects of cognitive emotion regulation strategies on depressive symptoms in GDC973 women with breast cancer.

MethodsFive hundred and nine women with breast cancer completed a demographic survey, the Chinese version of Cognitive Emotion Regulation Questionnaire (CERQ-C), and the Center for Epidemiological Studies Depression Scale (CES-D) at the initial assessment (T1). One month later (T2), 504 patients completed the CES-D. Patients were assigned selleck screening library to four groups: H-H (CES-D scores 16 at both timepoints), H-L (CES-D score 16 at T1, <16 at T2), L-H (CES-D score <16 at T1, 16 at

T2) and L-L (CES-D scores <16 at both timepoints).

ResultsOver 80% patients had mild or no depressive symptoms at both timepoints. There were significant group differences in cognitive emotion regulation strategies. CERQ-C subscale scores for adaptive strategies were higher, and scores for maladaptive strategies were lower among patients in L-L and H-L groups than among those in H-H group. Hierarchical regression analyses showed that cognitive emotion regulation strategies at T1 differentiated depressive symptoms at T2, accounting for 56.5% of variance after controlling for sociodemographic and biological variables and baseline levels of depression. Greater acceptance, positive refocusing, and positive reappraisal at T1 were associated with fewer depressive symptoms at T2.

ConclusionsCognitive emotion regulation strategies accounted for considerable variance in depressive symptom scores 1month later.

Methods: Between June 1, 2003, and June 30, 2007, clinical and pr

Methods: Between June 1, 2003, and June 30, 2007, clinical and procedural data of all STEMI patients who were referred to the catheterization this website laboratory were prospectively collected. Patients who sustained prolonged cardiac arrest were excluded.

Results:

A total of 1154 patients from regional hospitals and 325 patients initially presenting to the PCI centre were referred for acute intervention. There was no significant in-hospital mortality difference between the 2 groups (3.7% vs 4.0%, respectively; P = 0.87). Multiple logistic regression analysis showed that advanced age, female gender, multivessel coronary disease, history of hypertension, low ejection fraction, increased left ventricular end-diastolic pressure, and thrombolytic pretreatment, but not transfer status, were independent predictors for mortality. Among the 1154 transfer patients, 937 patients (81.2%) returned immediately post procedure and had a lower mortality rate than the remaining 217 patients (18.2%) who required admission to the PCI centre following cardiac catheterization (1.9% vs 11.5%, P < 0.001).

Conclusion: A regional system of STEMI care based on rapid patient transfer to a PCI centre

and repatriation was feasible and safe.”
“To determine the effectiveness of conservation efforts, scientists and land managers must evaluate the ability of conservation areas to protect biological diversity. The historic town of Concord, Massachusetts, home of the philosopher and naturalist Henry David Thoreau, provides a unique opportunity to examine how well conservation areas TGF-beta inhibitor preserve biodiversity in a suburban landscape. About 35% of total land area in the town has been protected, and botanists, including Thoreau, have surveyed plants in Concord five times over the last 170 years. We spent 5 years (2003-2007) re-surveying a subset of Concord’s flora for species presence and abundance. Of the species

seen by Thoreau in the mid-19th century in Concord, we could not locate 27%, and an additional 36% persist in one or two populations where they are vulnerable to local extinction. Most species losses appear to have occurred in the past three to four decades. Certain groups, such Blebbistatin price as orchids, have shown particularly severe losses. More native species are declining in abundance than are increasing. Non-native species represent an increasing percentage of the flora, with many increasing in abundance. The flora has experienced a net loss of species over the past four decades, with 82 species gained and 236 species missing. Because many species are rare on a local scale, persisting as one or two small populations, local extinctions will likely continue in coming decades. Habitat management, primarily to prevent tree establishment, appears to have allowed many rare species of open habitats to persist and recover.

Conclusion: OTC aspirin is safe and effective Safety concerns sh

Conclusion: OTC aspirin is safe and effective. Safety concerns should not limit brief use to relieve acute pain, cold or fever. (C) 2012 Published by Elsevier Ltd.”
“Interstitial pneumonia develops in association with inhaled particles. In-air microparticle induced X-ray emission (in-air micro) analysis was previously employed to assess the spatial distribution and content of particles in surgical lung biopsy specimens. The aim of this study was to assess the efficacy of in-air microanalysis for transbronchial lung biopsy Nepicastat solubility dmso specimens in patients with or without occupational exposure. The elements composing

lung particles and their locations could be identified by in-air microanalysis. Silicon was the major component of particles. Quantitative analysis revealed that the elements composing lung particles

varied between patients. In a patient with suspected nickel exposure, aluminium, vanadium, and calcium were detected, but was not detected. In a patient without a work history (housewife), various elements were detected. In-air micro-analysis was useful for assessing the spatial distribution and content of particles in specimens from patients. Occupational exposure was not necessarily associated with deposition of particles in the lungs. Therefore, in the diagnosis of, elemental analysis of specimens by in-air micro-analysis PU-H71 could be useful for assessing

exposure to particles objectively.”
“The basal nucleus of the amygdala (BA) is involved in the formation of context-dependent conditioned fear and extinction memories. To understand the underlying neural mechanisms we developed a large-scale neuron network model of the BA, composed of excitatory and inhibitory leaky-integrate-and-fire neurons. Excitatory BA neurons received conditioned stimulus (CS)-related input from the adjacent lateral nucleus (LA) and contextual input from the hippocampus or medial prefrontal cortex (mPFC). We implemented a plasticity mechanism according to which CS and contextual synapses were potentiated RSL3 Metabolism inhibitor if CS and contextual inputs temporally coincided on the afferents of the excitatory neurons. Our simulations revealed a differential recruitment of two distinct subpopulations of BA neurons during conditioning and extinction, mimicking the activation of experimentally observed cell populations. We propose that these two subgroups encode contextual specificity of fear and extinction memories, respectively. Mutual competition between them, mediated by feedback inhibition and driven by contextual inputs, regulates the activity in the central amygdala (CEA) thereby controlling amygdala output and fear behavior. The model makes multiple testable predictions that may advance our understanding of fear and extinction memories.

By taking the first derivative of the potential, we were able to

By taking the first derivative of the potential, we were able to calculate the electric

field inside the device. The maximum of the electric field, which locates the p-n junction, occurred at the interface between CdTe and CdS. However, the electric field at this location had a strong peak, in agreement with the existence of the interdiffusion layer, with higher doping, at the junction. The presence of this layer was confirmed by transmission electron microscopy. We also investigated the distribution of the potential and electrical field inside a CdTe/SnO(2) device, without the CdS layer, and showed that the interdiffusion does not happen in this case. Finally, we used Poisson’s equation to estimate the doping inside the CdTe film in both devices. DMXAA (C) 2010 American Institute of Physics. [doi:10.1063/1.3463386]“
“Submerged conidia and blastospores of the entomopathogenic fungus Isaria fumosorosea FDA-approved Drug Library nmr are produced in several liquid culture media. However, yields and the ecological fitness of these propagules vary according to culture media composition. In most culture media, hyphae, blastospores and submerged conidia are white but we found that in some media they develop a brown pigmentation. A dark pigment was extracted from brown-pigmented propagules and analyzed by IR spectroscopy.

Adsorption bands coincided to those characteristics of melanins.

Hadamard’s matrices were employed in order to increase submerged conidia yields and brown pigmentation of fungal propagules. Media containing 20-30 mg/l of FeSO(4)center dot 7H(2)O and 6-12 mg/l Of CuSO(4)center dot 5H(2)O allowed reaching the highest pigmentation (9 in a hedonic scale). A maximal concentration Of Submerged conidia of 1.0 (+/- 1.2) x 10(12) cell/l VX-689 clinical trial was achieved after 120 h of liquid culture in a improved culture medium. containing 25 ml/l of Polyethylene glycol (MW 200), substance which enhanced submerged conidia production. reducing free mycelia or mycelial pellets formation. In the improved

medium, it was estimated that more than 60% of produced biomass corresponded to submerged conidia and blastospores, while ill other media, mycelia were the main product (80-97%). (C) 2009 Elsevier B.V. All rights reserved.”
“Two analyses, cubic and piecewise random regression, were conducted to model growth of crossbred cattle from birth to about two years of age, investigating the ability of a piecewise procedure to fit growth traits without the complications of the cubic model. During a four-year period (1994-1997) of the Australian “”Southern Crossbreeding Project”", mature Hereford cows (N = 581) were mated to 97 sires of Angus, Belgian Blue, Hereford, Jersey, Limousin, South Devon, and Wagyu breeds, resulting in 1141 steers and heifers born over four years.


“Introduction Subcutaneous or submucosal infiltration of


“Introduction. Subcutaneous or submucosal infiltration of cosmetic materials is a very common practice, because of the ease with which such materials can be deposited, and their presumed innocuousness. However, in recent years there have been reports of foreign body granulomatous reactions occurring many years after infiltration.

Method. Data were

collected on the clinical manifestations, histopathological findings, treatment, and course of the lesions of 15 patients.

Results. One male and 14 females presented orofacial swelling an average of 7 years after MDV3100 mw the infiltration of silicone (n = 9), hyaluronic acid (n = 2), collagen (n = 2), methacrylate (n = 1), and polyalkylimide (n = 1). The patients were treated mainly with systemic corticosteroids, and were followed for an average of 17 months.

Conclusions. Systemic corticosteroids are able to control granulomatous reactions, which manifest in the form of outbreaks and tend to undergo spontaneous remission over the years. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 237-241)”
“The SnTe, Sn(1-x)Eu(x)Te selleck chemicals llc and Sn(1-x)Sr(x)Te (x < 0.06) films were prepared by hot wall epitaxy. The ternary alloy films prepared in cation rich condition had hole concentration around 1 x 10(19) cm(-3) with high mobility exceeding 2000 cm(2)/V s at room temperature. Optical transmission spectra were also measured in the

temperature range from 100 to 400 K and compared with theoretical calculations. Optical transmission spectra of the SnTe were simulated successfully assuming bumped band edge structures. A band inversion model was proposed for the Sn(1-x)Eu(x)Te and Sn(1-x)Sr(x)Te systems, and the optical transmission spectra were also simulated successfully assuming the band Dinaciclib inversion model. (C) 2010 American Institute of Physics. [doi:10.1063/1.3446819]“
“A micro-tensile testing machine placed

in the chamber of a scanning electron microscope is used to perform in situ fatigue tests on a 43 phr carbon black-filled cis-1,4-polyisoprene rubber; the crack tip is observed in real-time during crack propagation. These observations lead to a detailed description of the crack tip morphology; the crack front is a regular pattern of diamond-shaped zones delimited by extended straight ligaments. Fatigue crack growth is driven by the ligaments breakage, which occurs in all the zones of the crack front surface continuously in time but at different velocities. This phenomenon of nonlocalized damage explains initiation and limited propagation of branches which deviate from the main crack. All those mechanisms are sources of energy dissipation which explains the great fatigue properties of NR. Finally, from similar experiments conducted on styrene butadiene rubber, it is established that the peculiar morphology of the crack tip and mechanism of crack propagation in NR are due to strain-induced crystallization.

Moreover, we compare these parameters with those obtained by gas

Moreover, we compare these parameters with those obtained by gas chromatography. (C) 2011 Elsevier Ltd. All rights reserved.”
“OBJECTIVE: To estimate the prevalence of major and minor depression, panic disorder, and suicidal ideation during pregnancy

while also Autophagy activity inhibition identifying factors independently associated with antenatal depressive disorders.

METHODS: In this prospective study, participants were 1,888 women receiving ongoing prenatal care at a university obstetric clinic from January 2004 through January 2009. Prevalence of psychiatric disorders was measured using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria based on the Patient Health Questionnaire. Multiple logistic regression identified factors associated with probable major depressive disorder and any depressive disorder.

RESULTS: Antenatal depressive disorders were present in 9.9% with 5.1% (97) meeting criteria for probable major depression and 4.8% (90) meeting criteria for probable minor depression. Panic disorder was present in 3.2% (61), and current suicidal ideation was reported by 2.6% (49). Among patients with probable major depression, 29.5% (28) reported current suicidal ideation. Psychosocial stress (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.21-1.36), domestic violence (OR 3.45; 95% CI 1.46-8.12),

chronic medical conditions (OR 3.05; 95% CI 1.63-5.69), and race (Asian: OR 5.81; 95% CI 2.55-13.23; or African American: OR 2.98; 95% CI 1.24-7.18)each significantly increased selleckchem the odds of probable antepartum major depressive disorder, whereas older age (OR 0.92; 95% CI 0.88-0.97) decreased the odds. Factors associated with odds of any depression were similar overall except that Hispanic ethnicity (OR 2.50; 95% CI 1.09-5.72) also independently increased the odds of any depression.

CONCLUSION: Antenatal major and minor depressive disorders are common and significantly associated with clinically relevant

and identifiable risk factors. By understanding the high point prevalence and associated factors, clinicians can potentially improve the diagnosis and treatment rates of HDAC inhibitor serious depressive disorders in pregnant women.”
“Maxillectomies often result in anatomical defects that need to be reconstructed. In partial maxillectomies, the most significant defect is the formation of an oronasal or oral-antral fistula. This creates discomfort and needs to be addressed secondarily with local or regional flaps. Here, we describe a technique adopted in 8 patients in which limited maxillectomies are carried out in a way that preserves the nasal and sinus mucosa, preventing the formation of fistulas and allowing the use of flaps that would normally carry a high risk of fistula formation. Contemporary bone reconstruction with grafts was used in 2 patients.