Using miR-125b and let-7 as representative miRNAs, Wu et al45 sho

Using miR-125b and let-7 as representative miRNAs, Wu et al45 showed that in mammalian cells the reduction in mRNA abundance is a consequence of accelerated deadenylation, which leads to rapid mRNA decay. Besides regulating translational processes, it has been shown that miRNA can also regulate gene transcription by targeting transcription factors. In this case, levels of transcription factors are downregulated by miRNAs, which in turn cause less expression of mRNA, leading to reduced Inhibitors,research,lifescience,medical protein synthesis.46,47 Recent evidence suggests that miRNA biogenesis can be regulated at the epigenetic level.48 For example, inhibitors of

DNA methylation and histone deacetylases can affect expression of several miRNAs.49 On the other hand, Inhibitors,research,lifescience,medical a subset of miRNAs can control the expression of epigenetic regulators, such as DNA methyltransferases, histone deacetylases, and polycomb group genes, leading to transcriptional activation of numerous protein coding gene sequences, thereby contributing to gene expression. This network of feedback

between miRNAs and epigenetic pathways appears to form an epigenetics-miRNA regulatory circuit, and to organize the whole gene expression profile.50 The expression of miRNAs is tissue-specific51-53 and, in some cases, even cell-type-specific.54-56 In addition, some of the miRNAs are expressed specifically Inhibitors,research,lifescience,medical at the developmental stages.57,58 Approximately 20% to 40% of miRNAs in the brain are developmentally regulated.59,60 For example, miR-124a, which is conserved at the nucleotide level and is important for neuronal differentiation, neurite outgrowth, Inhibitors,research,lifescience,medical and glucocorticoid receptor (GR)—mediated functions, is expressed throughout embryonic and adult brain.61,62 There are studies which suggest that miRNAs, such as miR-124 and miR-128, are primarily expressed in neurons, whereas miR-23, miR-26, and miR-29 are expressed in high amounts in astrocytes.63 A recent study by He et al64 Inhibitors,research,lifescience,medical suggests that

a large number of miRNAs show distinct profiles in glutamatergic and GABAergic selleck chemicals neurons and subtypes Rolziracetam of GABAergic neurons. Even within neurons, it has been demonstrated that some of the pre-miRNAs are highlyexpressed in the dendrites where they can be locally transcribed into mature miRNAs65 and can locally regulate mRNA translation. These include synaptically enriched miRNAs: miR-200c, miR-339, miR-332, miR-318, miR-29a, miR-7, and miR-137.65,66 Several of the miRNAs are also expressed in the exons and presynaptic nerve terminals; some of them (miR-16, miR-221, miR-204, miR-15b) are highly expressed in distal axons compared with cell bodies.67 Moreover, a number of miRNAs encoded by a common pri-miRNA were differentially expressed in the distal axons, suggesting that there is a differential subcellular transport of miRNAs derived from the same coding region of the genome.

Short-term memory is particularly impaired and the significance o

Short-term memory is particularly impaired and the significance of such a change is sometimes not fully appreciated by families and others (including professionals), often being put down to a normal age-related decline. Changes in personality may, retrospectively-, be regarded as one of the earliest signs of dementia and are well documented

in the later stages. Blessed et al1 described eleven types of personality change which are summarized below Consensus criteria for the diagnosis of Alzheimer’s disease have been published and widely validated.2 Symptoms of vascular Inhibitors,research,lifescience,medical dementia Differentiation between AD and vascular dementia can be difficult because the two conditions often coexist. The onset of vascular dementia is usually sudden and can sometimes follow a clearly definable cerebrovascular accident. The course is usually described as a stepwise progression with episodes of confusion with fluctuations in the degree of cognitive Inhibitors,research,lifescience,medical impairment. There is more lability of mood and a greater tendency towards depression and anxiety than is generally seen in AD. Very occasionally, small lacunar infarcts can be associated with gradual mental deterioration

without focal signs. The patchy nature of the psychological deficits in contrast to the global impairment of AD is said to distinguish between the Inhibitors,research,lifescience,medical two types of dementia, with relative preservation of personality and insight in vascular dementia. The key features that distinguish between AD and vascular dementia were described by Ilachinski3 and made up into a checklist from which a score (the Ischemic or Ilachinski score) is derived. The original score was based on features

of vascular dementia in a textbook of Inhibitors,research,lifescience,medical psychiatry Inhibitors,research,lifescience,medical and studies of the cerebral blood flow in patients with dementia. Patients from the initial study group were relatively young and more mildly affected by their selleckchem illness than are patients seen in most old-age psychiatry services. A bimodal distribution of scores was found and suggested that patients with a score below 4 had a dementia of the Alzheimer type and those having a score of 7 or above a vascular dementia. Patients scoring between 4 and 7 were thought to have a mixed picture. The key features of vascular dementia are shown in Table I4-6 More recently, the validity of using PD184352 (CI-1040) the Ilachinski score to differentiate between vascular dementias and other types of dementias has been questioned. The Ilachinski score has been criticized as not being sufficiently sensitive. Moreover, higher scores on the Ilachinski do not mean that a diagnosis of vascular dementia is more likely, and the checklist does not take into account results from neuroradiological examinations. Infarctions are common in older people, including those with AD, and thus a mixed picture is common.

49 Clients

with CG typically experience prolonged, inten

49 Clients

with CG typically experience prolonged, intense painful emotions; rumination, often around themes of self-blame; and maladaptive behaviors, including avoidance of triggers to the extent that functioning is disrupted.50 Although the causes are not yet understood, the mechanism is believed to be incomplete processing of information about the death. Specifically, the mental representation of the attachment figure is disrupted, such that the loss is acknowledged in declarative memory but not in implicit memory. This leads to a lack of acceptance of the finality Inhibitors,research,lifescience,medical of the loss. Moreover, the exploratory system does not re-engage, such that the grieving individual can become distanced from other people Inhibitors,research,lifescience,medical and the world generally. Thus, the basic principle underlying

CGT is that grief is a natural, adaptive process.51 This implies that treatment of CG involves removing the impediments to successful resolution of the grieving process. Through a variety of loss- and restoration-focused techniques, the therapist works to facilitate the progress of grief to help the client come to terms with the death. A number of investigations have provided empirical support for this model of treatment. After initial Inhibitors,research,lifescience,medical pilot studies showed promising results,52,53 CGT was compared with standard IPT in a randomized trial with 83 adult outpatients with complicated grief.45 Participants in both conditions received 16 individual sessions of psychotherapy. Treatment response was defined Inhibitors,research,lifescience,medical as a score of 1 or 2 (“very much improved” or “much improved”) on the interviewer-rated Clinical Global Impression Improvement scale and as time to a 20-point or better decrease in scores on the self-reported Inventory of Complicated Grief. Response rates were higher (51 % vs 28%) and time to response faster in the CGT group than in the IPT group. A secondary analysis Inhibitors,research,lifescience,medical examining the impact of naturalistic pharmacotherapy on participants in this trial found that

response rates in the CGT group were higher among those taking antidepressant medications, and that this effect was mediated by reduced attrition among those taking medications.54 Among patients receiving CGT, 42% of those not taking antidepressants, vs only 9% of those taking such medication, terminated the trial prematurely. By contrast, in the IPT condition, only Sodium butyrate 30% of those taking medications and 23% of those not taking medications dropped out. These data Sunitinib suggest that CGT may be a challenging treatment, particularly for individuals who are not also taking medication. Investigators have subsequently tested CGT with Japanese women bereaved by violent death55 and in substance abusers56; results suggest that the benefits of treatment are not restricted to Western cultures or individuals without comorbid drug or alcohol abuse. Description of the treatment As noted above, the theory includes elements drawn from both IPT and CBT.

Given the scope and magnitude of the impact of losing a loved one

Given the scope and magnitude of the impact of losing a loved one, it is notable that relatively few negative long-term consequences usually occur. Most people meet the coping demands, with the help of supportive companions, and find a pathway that leads to restoration of a potentially satisfying and meaningful life.2 However, an important minority, currently estimated at about 7% of bereaved people,3 does not cope effectively with bereavement. Instead, they become Inhibitors,research,lifescience,medical entangled in grief, caught up in a futile struggle of silent

protest, trying to avoid reminders, and being carried helplessly on endless waves of acutely painful emotion. These people are suffering from complicated grief (CG), a syndrome in which healing is impeded and acute grief is intense Inhibitors,research,lifescience,medical and prolonged. Clinicians need to recognize symptoms of CG and differentiate this condition from usual acute grief, as well as depression and anxiety disorders. It is useful to have a framework for conceptualizing CG in order to better accomplish the differential diagnosis and to recognize risk factors and understand principles used to treat CG. Keeping terminology straight Using the terms Inhibitors,research,lifescience,medical bereavement, grief, and mourning interchangeably is a problem. To do so is not wrong, but it is more useful to allow the terms to denote specific components of the

experience of loss. Therefore, in this paper, the term bereavement refers to the experience of Inhibitors,research,lifescience,medical having lost someone close. Grief is the psychobiological response to bereavement whose hallmark is a blend of yearning and sadness, along with thoughts, memories, and images of the deceased person. Insofar as we never stop feeling sad that loved ones are gone, or stop missing them, grief is permanent. However, the acute, all-consuming intensity usually moderates over Inhibitors,research,lifescience,medical time, as grief becomes deeper, less intrusive, and integrated into our lives. Mourning is the array of psychological processes that are set

in motion by bereavement in order to moderate and integrate grief by coming to terms with the loss and reorienting to a world without our loved one in it. Different kinds of bereavement Adenosine When we look, we can discern a general framework for grief, but its day-to-day manifestations are variable and wide-ranging, influenced by many factors. Important and among them is the relationship to the bereaved person and specific circumstances of the death. Several studies Doxorubicin suggest that grief is most intense and difficult for people bereaved of a child or a life partner, and these are the people most likely to experience CG. In general, death of a child is the most difficult kind of loss, and bereaved family members are at elevated risk for depression and anxiety for close to a decade after the loss.4,5 In addition these parents are at risk for a range of physical illnesses.

4,6 Complaints arising from the skeletal system were the main rea

4,6 Complaints arising from the www.selleckchem.com/products/pd-1-pd-l1-inhibitor-2.html skeletal system were the main reason for seeking medical attention in children.8 In the Gür5 study on distinct groups of adults and children, the skeletal complications of brucellosis were more frequent in the children than in the adults (table 1). Table 1 Frequency of the skeletal

involvement of brucellosis in children Inhibitors,research,lifescience,medical and adults (in percentages Location and Character of Skeletal Involvement It seems that the most prevalent location of the skeletal involvement of brucellosis in adults is the sacroiliac joint.6,11 However, some researchers believe that in brucellosis, peripheral joint involvement is more common than is sacroiliitis.9,12,13 There was no agreement between four studies that exclusively appraised the skeletal Inhibitors,research,lifescience,medical involvement of brucellosis in children with respect to the most frequent site of the involvement of the disease (tables 2 and ​and3).3). According to the studies of Gür5 and Geyik6 in children,

sacroiliac and peripheral joints were equally affected in brucellosis, whereas Al-Eissa4 and Gómez12 Inhibitors,research,lifescience,medical reported that the involvement of peripheral joints was more common than that of the sacroiliac joint in children. Table 2 Frequency of the skeletal involvement of brucellosis in children according to different studies (reported in percentages Table 3 Comparison of the sites of the skeletal involvement of brucellosis between children and adults Involvement of Peripheral Joints Both types of direct joint involvement (septic arthritis) and reactive arthritis may occur in brucellosis. Peripheral joint involvement, Inhibitors,research,lifescience,medical including knee, hip, ankle, shoulder, wrist, and elbow as well as even sternoclavicular joints, has been reported in brucellosis. Involvement of the small joints of hands and feet is rare. However, Shen20 reported the involvement of the proximal interphalangeal joints. Overall, probably the

most common form of the skeletal involvement of brucellosis in children Inhibitors,research,lifescience,medical is peripheral arthritis. Arthritis can be acute (3 months), sub-acute (3 to 12 months), or chronic (more than 12 months). As is shown in table 4, and according to various studies, peripheral joint involvement in children with brucellosis ranges from 13.6% to 50%. Table 4 Frequency of peripheral arthritis in children suffering Carnitine dehydrogenase from brucellosis According to the Al-Eissa’s4 study on 40 children suffering from Brucella arthritis, pain, soft tissue swelling on the joint, limitation of motion, and warmth were almost always present and, occasionally, some degrees of erythema or joint effusion were observed. This fact was confirmed in other studies carried out on children.8,12,20,5 Interestingly, 36 out of the 40 studied children with Brucella arthritis had arthralgias in joints without arthritis. In a study on children by Gómez,12 50% of the patients with Brucella arthritis had arthralgias in joints without arthritis.

Results Demographic and clinicopathologic characteristics of the

Results Demographic and clinicopathologic characteristics of the IBET151 patient population Table 1 shows the patient distribution; their demographic, clinicopathological and molecular characteristics; and their correlation with survival. For both treatment groups, there were similar distributions of patient age, gender, ethnicity, tumor stage, tumor location, tumor size, and tumor grade, in terms of deaths due to CRC. The median follow-up period of the complete study population of 112 patients was 9.31 years (range <1 – >20 years). Survival analysis based on treatment Univariate Kaplan-Meier survival analysis demonstrated no significant differences in overall

Inhibitors,research,lifescience,medical survival rates between the surgery-alone and the 5-FU-treated patient groups (log rank, P=0.71) Inhibitors,research,lifescience,medical (data not shown). Bax (G) 8 mutation frequency and its relation to clinicopathologic features We analyzed for the presence of mutations in the (G) 8 tract of the Bax gene in

a human CRC cell line (LoVo) and in 83 CRCs. The LoVo cells displayed a bi-allelic Bax (G) 8 frame-shift mutation; this status was used as a reference in CRCs for Bax mutations (Fig 1). In our analysis, 23 of 83 (28%) CRCs demonstrated biallelic Bax (G) 8 frame-shift mutations. The majority of CRCs with mutations at the G (8) tract also had Inhibitors,research,lifescience,medical low Bax expressing (20 of 23, 87%). CRCs that displayed these mutations were significantly higher for male patients (17 of 23, 74%) and distal tumors (18 of 23, 79%). However, there was Inhibitors,research,lifescience,medical no association between the presence of Bax (G) 8 mutations with age, race/ethnicity, depth

of wall infiltration, tumor grade, tumor stage, lymph node invasion, or presence of distant metastasis (data not shown). Since the number Inhibitors,research,lifescience,medical of CRCs with Bax mutations is small, we have not further analyzed the mutational data to assess correlation between Bax mutations and patient survival in the surgery alone and surgery and 5-FU therapy patient groups separately. Figure 1 Mutational analysis at 94-base-pair region encompassing the (G) 8 tract in the Bax coding sequence in colorectal adenocarcinoma, adjacent benign epithelium and in LoVo cell line. Olopatadine The CRC and corresponding normal tissue demonstrated lack of Bax (G) 8 frame-shift … Bax immunophenotypic expression analysis Immunoreactivity for Bax was observed in the cytoplasm. In most CRCs, the Bax staining pattern was homogenous, ranging from low to high levels. In 11% of CRCs (12 cases), however, there was intratumoral heterogeneity. A low level of Bax expression was observed consistently in benign colonic epithelium, lymphocytes, and endothelial cells (Fig 2A-C). The presence of staining in intra-tumoral lymphocytes was used as an internal positive control. Of the CRCs, 54% (60 of 112) had high levels of Bax expression (22 of the 5-FU treated group and 38 of the surgery-alone group).

Amyloidosis is a disease condition in which the extracellular dep

Amyloidosis is a disease condition in which the extracellular deposition of pathological

insoluble fibrillar proteins occurs in various organs that can impair tissue structure and function.1) Amyloidosis may be systemic or localized and is currently classified according to the type of precursor protein.2) The three most frequent types of systemic Inhibitors,research,lifescience,medical amyloidosis are acquired monoclonal immunoglobulin light-chain amyloidosis, familial transthyretin amyloidosis (ATTR), which can be caused by mutations of transthyretin (TTR), and systemic senile amyloidosis related to wild-type TTR.3) TTR is one of over 20 known proteins that are capable of forming amyloid Protein Tyrosine Kinase inhibitor fibrils in vivo. Although both wild-type and mutated TTR can form amyloid, alterations in the primary structure of the TTR protein due to TTR mutations can result in greatly accelerated amyloid formation and these mutation are the origin of Inhibitors,research,lifescience,medical all symptomatic cases of ATTR.3),4) More than

100 amyloidogenic TTR mutations have been reported in association with markedly variable clinical features, disease penetrances, Inhibitors,research,lifescience,medical and prognoses.5-7) Cardiac involvement in amyloidosis is a manifestation of one of several systemic diseases known as amyloidoses.1),8) Regardless of the underlying pathogenesis, cardiac amyloidosis is characterized by extracellular amyloid infiltration throughout the heart. This infiltrative process results in biventricular wall thickening with non-dilated ventricles and may Inhibitors,research,lifescience,medical also involve the conduction system.9) However, cardiac involvement may be the predominant feature or be found during investigation in a patient presenting with another major organ involvement.10) Furthermore, the initial suspicion of cardiac amyloidosis

is often triggered by the recognition that the heart disease is part of a multiorgan disorder.10) Here, we report a case of cardiac amyloidosis, suspected based upon two-dimensional echocardiographic findings, which presented with autonomic dysfunction, chronic gastrointestinal symptoms, and uncertain cardiac symptoms. Case In July 2010, a 53-year-old man was admitted to Inhibitors,research,lifescience,medical our neurology clinic for the evaluation of dizziness and headache of three years duration. He had not been diagnosed with hypertension, diabetes, or pulmonary disease. The patient presented with chronic diarrhea and a residual urine sensation of several years duration, and reported PDK4 taking an alpha-blocker to treat the latter. In addition, he complained of non-rotating dizziness aggravated by abrupt standing for 1 years. However, despite of the cessation of alpha-blocker treatment, which could have been responsible for the orthostatic hypotension, the non-rotating dizziness did not improve. On physical examination, blood pressure was 108/65 mmHg and his pulse rate was regular at 60 beats/min in the supine position. However, when the patient changed posture from supine to standing, his blood pressure fell below 80/45 mmHg.

The call workers systematically asked ambulance callers for infor

The call workers systematically asked ambulance callers for information: age and sex of the patient(s), and the chief complaint of the patient, and GDC-0199 purchase whether they could observe if the caller was not a patient himself/herself. Call workers also interviewed callers to obtain information that was used to assess the patient’s life threat Inhibitors,research,lifescience,medical risk such as consciousness level, breathing status, walking ability, position (lying down or not), and complexion (face colour and sweating). Age was stratified into six groups. Consciousness level was graded to clear, not clear, unconscious, or unconfirmed.

Breathing status was graded to normal, abnormal/dypnea, apnea, or unconfirmed. Walking ability was graded to as usual, walk with support, unable Inhibitors,research,lifescience,medical to walk, or unconfirmed. This information was entered into a computer-based triage form during the phone call. The triage form categorized patients into A (there is a probability that the patient faced an imminent risk of dying), B (there is a possibility that the patient faced a risk of dying), or C (the probability that the patient faced a risk of dying

was very low) [13], based on previous data [14]. Inhibitors,research,lifescience,medical The triage form also quantitatively estimated the patient’s life threat risk. Inhibitors,research,lifescience,medical If the estimated life threat risk was higher than 10%, the triage form categorized patients into A+ (the probability that the patient faced a risk of dying was very high), and an ambulance, a fast response car, and a fire engine were dispatched. At least one emergency life-saving technician was present in the ambulance and fast response car. If patients are categorized in groups A or B, an ambulance and a fast response car are dispatched. If patients are categorized into C, an Inhibitors,research,lifescience,medical ambulance is dispatched [14]. Cases where patients were transported from hospital to hospital were excluded from the call triage target. Cases where the caller did

not observe the patient, i.e., they were mere messengers, were judged as inappropriate to be triaged. Classifying severity Ambulance crews judge obvious death as having occurred if bodies show livor mortis, cadaveric stiffing, or putrefaction, and therefore do not transport them. If Linifanib (ABT-869) an obvious sign of death is not identified, advanced life support is provided to every patient cardiac and/or pulmonary arrest (CPA) has occurred. Information for patients identified with CPA at the scene was entered into the record system by ambulance crews. The condition of patients when they arrive at an emergency department (ED) by ambulance is routinely logged into the city’s computer-based ambulance transport record system.

Authors’ contributions MP, RS and AP designed the study; SP, DG,

Authors’ contributions MP, RS and AP designed the study; SP, DG, MM, RS, MP and AP reviewed the literature; SP; DG and MM collected data; SP and DG performed analysis; SP, DG, MP, GZ and AP wrote draft. All Authors revised and approved the manuscript. Pre-publication history The pre-publication

history for this paper Inhibitors,research,lifescience,medical can be accessed here: http://www.biomedcentral.com/1471-227X/13/3/prepub Acknowledgement The authors gratefully acknowledge all the police forces that have provided the data and the Fondazione Prato Ricerche which provided part of the instrumentation necessary to the study.
Emergency Departments (ED) not only provide care to patients with critical and life threatening emergencies, but also look after Inhibitors,research,lifescience,medical round the clock to those who have acute yet stable medical illnesses [1-3]. The resultant ED overcrowding which was first Inhibitors,research,lifescience,medical described twenty years ago, has now become a well-established barrier in access to health care [4-6]. The problem is exacerbated in low income countries by utilization of ED as a primary access point to the healthcare especially on weekends and after hours for less urgent conditions [1]. However, the balance

is now tilting towards high acuity patients, ED boarding of admitted patients, and hospital occupancy as a cause of ED overcrowding

rather than influx of non-urgent patients [4,5,7]. ED overcrowding not only reduces patient satisfaction Inhibitors,research,lifescience,medical but it also increases the check details number of patients that leave without being seen by a physician (LWBS) [3,7]. Large number of these patients may not find appropriate care elsewhere and therefore a critical treatment Inhibitors,research,lifescience,medical opportunity is missed by the health system. The percentage of LWBS patients has been recognized as a proxy indicator of ED performance and overcrowding [8,9]. A number of studies from high income countries with well-established primary health care system have reported a variable number of LWBS which ranges between <1% to 20% of all ED visits [10-14]. It has been suggested that patients however who LWBS are at an increased risk of morbidity and mortality; however, a more recent administrative follow-up demonstrated these patients are at a lower risk of hospitalization and death than triage-matched controls [15-19]. Several factors have been found as being associated with LWBS, such as low acuity illness, young age, and male sex and prolonged waiting time [20-24].

Follow-up information was collected until the first of the ensuin

Follow-up information was collected until the first of the ensuing events occurred: death of the patient, loss to follow-up, transplantation or hepatectomy. Primary and secondary issues The occurrence of cytolysis following chemoembolization was our main variable of interest. We used the definition by Paye et al. for cytolysis that is an elevation

of AST above 100 UI/L with at least a doubling of the baseline value for AST (12) occurring within the first 5 days following treatment. Our primary issue was to evaluate if cytolysis was associated with a favourable radiological response Inhibitors,research,lifescience,medical two months after treatment. Our secondary issues were to investigate if cytolysis was associated with the development of hepatobiliary complications and overall survival. Liver failure was defined as the development of hepatic encephalopathy, doubling of baseline bilirubin, 25% increase in INR or appearance of ascites during the hospitalisation post TACE. Statistical analysis The statistical analysis was twofold: Inhibitors,research,lifescience,medical first, we considered the treatment outcomes using the treatment

as the unit of interest, as patients could undergo several sequential treatments. Second, we analysed the survival-related outcomes, this time using the patient as the unit of interest. When the unit of analysis was the treatment, generalized estimating equations (GEE) with an exchangeable correlation Inhibitors,research,lifescience,medical structure were used to account for the correlation between Inhibitors,research,lifescience,medical multiple treatments from the same patients. Continuous variables expressed as mean (standard deviation, sd) were compared with the Student t test when the unit of analysis was the patient. Similarly, categorical variables were compared using GEE at the treatment level and with the chi-square test at the patient level. We constructed Kaplan-Meier curves for the time to death according to the presence or absence of cytolysis at the time of the first treatment. Cases were censored in case of transplantation or loss to follow-up. Administrative censoring was set at 18 months after the Inhibitors,research,lifescience,medical first treatment. Association among demographic, biochemical and

prognostic Etomidate score variables was estimated using multivariable Cox’s proportional hazards regression model. Variables selected were those that are known to be associated with survival from liver cancer and liver disease and included the alphafetoprotein (AFP) levels (16,17), Okuda score (18,19) or CLIP score (18,20,21), MELD score and patient’s age. The Doxorubicin order natural logarithm of the AFP was used for the analysis to improve the fit of the regression model. To account for the impact of tumour differentiation on the response to chemotherapy, radiological response was adjusted according to the log of the alphafetoprotein levels as high AFP levels are associated with poorer tumour differentiation (22). Analyses were performed using R version 2.13.1 (The R Foundation for Statistical Computing, Vienna, Austria) statistical software and Stata v. 11.