Next, we examined the relationship between VMP1-dependent autopha

Next, we examined the relationship between VMP1-dependent autophagy and apoptosis and found that VMP1 down-regulation sensitizes

cells to apoptosis and that agents that induce apoptosis down-regulate VMP1. In conclusion, similar to its reported role in other cell types, VMP1 is an important regulator of autophagy in colorectal cell lines. However, in contrast to its role in pancreatic cell lines, in colorectal cancer cells, VMP1-dependent autophagy appears to be pro-survival rather than pro-cell death. (C) 2013 Elsevier Inc. All rights reserved.”
“The smaller than 1 Hz EEG slow oscillation (SO) is a hallmark of slow-wave sleep (SWS) and is critically involved in sleep-associated memory formation. Previous studies showed that SOs and associated memory function click here can be effectively enhanced by closed-loop auditory stimulation, when

clicks are presented in synchrony with upcoming SO up states. However, increasing SOs and synchronized excitability also bear the risk of emerging seizure activity, suggesting the presence of mechanisms in the healthy brain that counter developing hypersynchronicity during SOs. Here, we aimed to test the limits of driving SOs through closed-loop auditory stimulation in healthy humans. https://www.selleckchem.com/products/PD-173074.html Study I tested a “Driving stimulation” protocol (vs “Sham”) in which trains of clicks were presented in synchrony with SO up states basically as long as an ongoing SO train was identified on-line. Study II compared Driving stimulation with a “2-Click” protocol where the maximum of stimuli delivered in a train was limited to two clicks. Stimulation Z-DEVD-FMK inhibitor was applied during SWS in the first 210 min of nocturnal sleep. Before and after sleep declarative word-pair memories were tested. Compared with the Sham control, Driving stimulation prolonged SO trains and enhanced SO amplitudes, phase-locked spindle activity, and overnight retention of word pairs

(all ps smaller than 0.05). Importantly, effects of Driving stimulation did not exceed those of 2-Click stimulation (p bigger than 0.180), indicating the presence of a mechanism preventing the development of hypersynchronicity during SO activity. Assessment of temporal dynamics revealed a rapidly fading phase-locked spindle activity during repetitive click stimulation, suggesting that spindle refractoriness contributes to this protective mechanism.”
“Granzyme A (GrA) is a serine protease produced in cytotoxic lymphocytes, lung epithelial cells (alveolar type-II cells), and alveolar macrophages. In the present study, recombinant rat GrA (rGrA) was found to cause rounding and detachment of an alveolar type-II epithelial cell line, A549. Also, rGrA stimulated release of a neutrophil chemoattractant, interleukin-8, from the cells, via a mechanism involving microtubule disruption, probably resulting from reduction of cell adhesion to culture dishes.

Plasma from an apparently 27-year-old healthy male, blood type A+

Plasma from an apparently 27-year-old healthy male, blood type A+, was used in the study. A concentration of 100 mg.dL(-1) apolipoprotein

L1 (APOL1) was detected in the plasma. Forty mice were divided into four groups with 10 animals each. Group A comprised uninfected animals. Mice from groups B, C and D were inoculated with a T evansi isolate. Group B was used as a positive control. At three days post-infection (DPI), the mice were administered intraperitoneally with human plasma. A single dose of 0.2 mL plasma was given to those in group C. The mice from group D were administered five doses of 0.2 mL plasma with a 24 hours interval between the doses. Group B showed high increasing parasitemia Selleck PARP inhibitor that led to their death within 5 DPI. Both treatments eliminated parasites from the blood and increased the longevity of animals. An efficacy of 50 (group C) and 80% (group D) of human plasma trypanocidal activity was found using PCR. This therapeutic success was likely achieved in AC220 order the group D due to their higher levels of APOL1 compared with group C.”
“Protein-peptide interactions have recently been found to play an essential role in constructing intracellular signaling networks. Understanding the molecular mechanism of such interactions and identification of the interacting partners would be of great value for

developing peptide therapeutics against many severe diseases such as cancer. In this study, we describe a

structure-based, general-purpose strategy for fast and reliably predicting protein-peptide binding affinities. This strategy combines unsupervised knowledge-based statistical potential derived from 505 interfacially diverse, non-redundant protein-peptide complex structures and supervised quantitative structureactivity relationship (QSAR) modeling trained by 250 protein al-peptide interactions with known structure and affinity data. The built partial least squares (PLS) model is confirmed to have high stability and predictive power by using internal 5-fold cross-validation Flavopiridol and rigorous Monte Carlo cross-validation (MCCV). The model is further employed to analyze two large groups of HLA-and SH3-binding pep-tides based upon computationally modeled structures. Satisfactorily, although the PLS model is originally trained with dissociation constants (Kd) of protein-peptide binding, it shows a good correlation with other two affinity qualities, i.e. SPOT signal intensities (BLU) and half maximal competitive concentrations (IC50). Furthermore, we perform systematic comparisons of our method with several widely used, representative affinity predictors, including molecular mechanics- based MM-PB/SA, knowledge-based DFIRE and docking score HADDOCK, on a small panel of elaborately selected protein-peptide systems.

34) High ankle joint ‘apparent efficiency’ suggests that recoili

34). High ankle joint ‘apparent efficiency’ suggests that recoiling Achilles’ tendon contributes a significant amount of ankle joint positive power during the push-off phase of walking in humans.”
“Sindbis Virus (SV), the prototype alphavirus in the family togaviridae, infects both mammalian and insect cells. Roscovitine order The ability of SV to infect cells possessing significantly different biochemical environments suggests that there may be a common mode of

entry into each cell type. Previous studies show that up to 4 h post infection cells are permeable to small ions and alpha sarcin suggesting that the plasma membrane is compromised as infection takes place. Thin-section electron microscopy has also shown SV to bind to the plasma membrane and lose its electron dense core through a pore like structure developed upon interaction of the virus with the cell surface. Using freeze-fracture replicas, thin-sections and antibody labeling the data presented herein show virus associated with

intramembrane particles on mosquito cells. These data suggest that the intramembrane particles associated with SV may be part of the pore structure consisting of virus proteins and cell receptor. (C) 2011 Elsevier Inc. All rights reserved.”
“Background; Recent Recent technological advances in miniaturisation have allowed for a confocal scanning microscope selleck chemicals llc robe integrated into trans-endoscopic probes enabling endoscopists to collect in vivo virtual biopsies of the gastrointestinal mucosa during endoscopy.\n\nAims: The aim of the present study was to assess prospectively the clinical applicability and predictive power of a probe-based confocal laser endomicroscopy for the in vivo diagnosis of colorectal neoplasia.\n\nMethods: Patients with evidence of colorectal superficial neoplasia at routine endoscopy, were included prospectively in this study. Lesions were identified using white-light endoscopy followed by Selleckchem BEZ235 pCLE imaging recorded by a Coloflex UHD-type probe. The images were interpreted as either neoplastic

or not according to vascular and cellular changes. pCLE readings were then compared with histopathological results from endoscopically resected lesions and/or targeted biopsy specimens.\n\nResults: A total of 32 lesions were identified in 20 consecutive patients. Histopathology diagnosis was of adenomas in 19 cases, hyperplastic polyps in 11 cases and adenocarcinoma in 2 cases. For the detection of neoplastic tissue pCLE had a sensitivity of 100%, a specificity of 84.6%, an accuracy of 92.3, a PPV of 90.5% and a NPV of 100%.\n\nConclusions: pCLE permits high-quality imaging, enabling prediction of intraepithelial neoplasia with a high level of accuracy. (C) 2010 Editrice Gastroenterologica ltaliana S.r.l. Published by Elsevier Ltd. All rights reserved.”
“Objectives: To assess non-invasively and in real time the three-dimensional organization of cells within porous matrices by combining Fourier Domain Optical Coherence Tomography (FDOCT) and Impedance Spectroscopy (IS).

While the majority of patients with strabismus are treated with s

While the majority of patients with strabismus are treated with surgery there are a number of cases where surgery is not possible and good long-term ocular alignment can be maintained with repeated injections of botulinum toxin.\n\nMethods 65 patients who had undergone over 25 injections of botulinum toxin A for long-term control of their deviation were identified

and asked to fill in and return the Adult Strabismus questionnaire (AS-20) to assess their QoL.\n\nResults 46 questionnaires were available for analysis. The mean AS-20 score in our patients compared favourably with Selleckchem Mocetinostat that reported for normal controls and was much higher than that reported for patients with strabismus.\n\nConclusion Long-term MEK inhibitor injections with botulinum toxin A is a good treatment for maintaining ocular alignment if squint surgery is not indicated and those patients receiving treatment score near the level of normal controls in QoL terms.”
“Mint protein family, as adaptor molecules, contains three members, Mint1, Mint2 and Mint3. Although Mint3

is ubiquitously expressed, Mint1 and Mint2 have been reported to express specifically in neuron. Here we demonstrated Mint1 and Mint2 expression pattern in rat spinal cord. The protein level of Mint2 was found to be higher than that of Mint1 in rat spinal by western blot. In an attempt to know Mint2 distribution in the spinal cord of rat, in situ hybridization was carried out, Mint2 mRNA was showed to be ubiquitously distributed in cervical, thoracic and lumbar sections of rat spinal cord, and high intensive signal was detected in motor neurons. These were further confirmed by fluorescent immunohistochemistry, Mint2 was also found to exist throughout gray matter especially motor neurons where Mint2 was mainly located in perikaryon, however, Mint1 was showed to be relatively lower. By electron microscope, Mint2 was found to be mainly located in vesicles in perikaryon in motor neuron of lumbar section, and at the same time Mint2 was located in axons in myelin and presynaptic find protocol terminals. These data suggest that Mint2 may play more

important role in spinal cord than the other two family members.”
“Adaptive adjustments of strategies help optimize behavior in a dynamic and uncertain world. Previous studies in the countermanding (or stop-signal) paradigm have detailed how reaction times (RTs) change with trial sequence, demonstrating adaptive control of movement generation. Comparatively little is known about the adaptive control of movement cancellation in the countermanding task, mainly because movement cancellation implies the absence of an outcome and estimates of movement cancellation require hundreds of trials. Here, we exploit a within-trial proxy of movement cancellation based on recordings of neck muscle activity while human subjects attempted to cancel large eye-head gaze shifts.

To investigate its role in proton translocation, we characterized

To investigate its role in proton translocation, we characterized the electron transfer and proton translocation activity of complex I variants lacking either NuoL or parts of the C-terminal domain. Our data suggest that the H(+)/2e(-) stoichiometry of the Delta NuoL variant is 2, indicating a different stoichiometry for proton translocation as proposed from structural data. In addition, the same H(+)/e(-) stoichiometry is obtained with the variant lacking the C-terminal transmembraneous KU-57788 solubility dmso helix of NuoL, indicating its role in energy transmission.”
“Today, the reconstruction

of the organismal evolutionary tree is basedmainly on molecular sequence data. However, sequence data are sometimes insufficient to reliably resolve in particular deep branches. Thus, it is highly desirable to find novel, more reliable types of phylogenetic markers that can be derived from the wealth of genomic data. Here, we consider the gain of introns close to older preexisting ones. Because correct splicing is impeded by very small exons, nearby pairs of introns very rarely coexist, that is, the gain of the new intron

is nearly always associated with the loss of the old intron. Both events may even be directly connected as in cases of intron migration. Therefore, it should be possible to identify one of the introns as ancient ( plesiomorphic) and the other as novel ( derived or apomorphic). To test the suitability of such near intron pairs ( NIPs) as a marker class for phylogenetic MEK inhibitor drugs analysis, we undertook an analysis of the evolutionary positions of bees and wasps ( Hymenoptera) and beetles

( Coleoptera) in relation to moths ( Lepidoptera) and dipterans ( Diptera) using recently completed genome project data. By scanning 758 putatively orthologous gene structures of Apis mellifera ( Hymenoptera) and Tribolium castaneum ( Coleoptera), we identified 189 pairs of introns, one from each species, which are located less than 50 nt from each other. A comparison with genes from 5 other holometabolan and 9 metazoan outgroup genomes resulted in 22 shared derived OICR-9429 mouse intron positions found in beetle as well as in butterflies and/ or dipterans. This strongly supports a basal position of hymenopterans in the holometabolous insect tree. In addition, we found 31 and 12 intron positions apomorphic for A. mellifera and T. castaneum, respectively, which seem to represent changes inside these branches. Another 12 intron pairs indicate parallel intron gains or extraordinarily small exons. In conclusion, we show here that the analysis of phylogenetically nested, nearby intron pairs is suitable to identify evolutionarily younger intron positions and to determine their relative age, which should be of equal importance for the understanding of intron evolution and the reconstruction of the eukaryotic tree.

Here, we report that Itch interacts with and targets pluripotency

Here, we report that Itch interacts with and targets pluripotency-associated AMN-107 ic50 transcription factor Oct4 for ubiquitination.

Moreover, Itch enhances Oct4 transcriptional activities and controls Oct4 protein stability dependent on its catalytic activity. Importantly, silencing Itch expression compromises ESC self-renewal capacity and somatic cell reprogramming efficiency. Taken together, our study identifies Itch as a regulator of Oct4 stability and transcriptional activity, establishing a functional link between an E3 ligase and the regulation of pluripotency. J. Cell. Physiol. 228: 14431451, 2013. (c) 2012 Wiley Periodicals, Inc.”
“Plasma from a small subset of subjects chronically infected with HIV-1 shows remarkable magnitude and breadth of neutralizing activity. From one of these

individuals CBL0137 solubility dmso (CH0219), we isolated two broadly neutralizing antibodies (bnAbs), CH01 and VRC-CH31, from two clonal lineages of memory B cells with distinct specificities (variable loop 1 and 2 [V1V2] conformational specificity and CD4-binding site specificity, respectively) that recapitulate 95% of CH0219 serum neutralization breadth. These data provide proof of concept for an HIV-1 vaccine that aims to elicit bnAbs of multiple specificities.”
“Background: Thermal ablation procedures, including radiofrequency ablation (RFA) or laser-induced interstitial thermotherapy (LITT), are now well established in the treatment of malignant unresectable hepatic tumors. But the impact of partial ablation (PA) on long-term survival following computed tomography (CT)-guided radiofrequency ablation GS-7977 mw and laser- induced interstitial thermotherapy of unresectable malignant liver lesions and the associated

risk factors of PA remain partially unknown.\n\nMaterials/Methods: This study included 254 liver tumors in 91 consecutive patients (66 men and 25 women; age 60.9 +/- 10.4 years; mean tumor size 25 14 mm [range 5-70 min]) who underwent thermal ablation (RFA or LITT) between January 2000 and December 2007. Mean follow-up period was 21.1 month (range 1-69 months). Survival rate and local progression-free survival (PFS) were calculated for patients with complete ablation (CA) vs. patients with partial ablation (PA) to assess the impact on long-term survival.\n\nResults: Median survival after CA was 47 months compared to 25 months after PA (P=0.04). The corresponding 5-year survival rates were 44% vs. 20%. Median PFS for CA was 11 months compared to 7 months for PA (P=0.118). The sole statistically significant risk factor for PA was tumor size (>30 mm; P=0.0003). Sustained complete ablation was achieved in 71% of lesions <30 mm vs. 47% of lesions >30 mm.\n\nConclusions: We conclude that achievement of complete ablation is a highly important predictor of long-term survival and that tumor size is by far the most important predictor of the likelihood of achieving complete ablation.


“Background The aetiology of childhood brain tumours (CBT


“Background. The aetiology of childhood brain tumours (CBT) is largely unknown. Damage to germ cells after parental exposure to airborne carcinogens, such as volatile organic compounds and polycyclic aromatic hydrocarbons is one plausible pathway. This analysis aimed to investigate whether parental refuelling of vehicles or the use of domestic wood heaters LXH254 mouse in key time periods relating to the child’s birth was associated with an increased risk of CBT. Procedure. Cases smaller than 15 years of age were recruited through 10 paediatric

oncology centres around Australia; controls were recruited through nationwide random-digit dialling, frequency matched to cases on age, sex and State of residence. Exposure to refuelling and wood heaters was ascertained through questionnaires from both parents. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression, adjusting for relevant covariates. Results. Data were available for 306 case and 950 control families. Paternal refuelling

bigger than = 4 times/month was associated with an increased risk of CBT (OR 1.59, 95% CI: 1.11, 2.29), and a dose-dependent trend was observed (P = 0.004). No association was seen for maternal refuelling. Omipalisib Use of closed, but not open, wood heaters before (OR 1.51, 95% CI: 1.05, 2.15) and after (OR 1.44, 95% CI: 1.03, 2.01) the child’s birth was associated with increased risk of CBT, but dose-response relationships were weak or absent. Conclusions. Paternal refuelling of vehicles bigger than = 4 times/month and the use of closed

wood heaters before the child’s birth may increase the risk of CBT. Replication in larger studies is needed. (C) 2014 Wiley Periodicals, Inc.”
“The University of Florida and Shands Hospital recently launched a genomic medicine program focused on the clinical implementation of pharmacogenetics called the Personalized Medicine Program. We focus on a pre-emptive, chip-based genotyping approach that is cost effective, while providing experience that will be useful as genomic medicine moves towards genome sequence data for patients becoming available. The Personalized Medicine Program includes PLX3397 Protein Tyrosine Kinase inhibitor a regulatory body that is responsible for ensuring that evidence-based examples are moved to clinical implementation, and relies on clinical decision support tools to provide healthcare providers with guidance on use of the genetic information. The pilot implementation was with CYP2C19-clopidogrel and future plans include expansion to additional pharmacogenetic examples, along with aiding in implementation in other health systems across Florida.”
“The aim of the current study was to use whole brain voxel-based morphometry (VBM) to assess the gray matter (GM) changes in unmedicated patients with obsessive-compulsive disorder (OCD) compared with normal controls. We compared the GM volumes in 28 patients with 22 matched healthy controls using a 1.

Quantitative real time PCR (qPCR) and immunohistochemistry were u

Quantitative real time PCR (qPCR) and immunohistochemistry were used to examine the bacterin uptake into skin and gill tissue. Side effects were assessed by behavioural examination, histology and blood serum analysis. The sonication intensity of 171 mW/cm(2) Raf tumor was enough for increasing skin permeability, but caused heavy erratic swimming and gill haemorrhages. Sonication intensities as low as 105 mW/cm2 did not modify skin permeability and enhanced the bacterin uptake into the gill tissue by factor 15 compared to conventional immersion. Following sonication,

the gill permeability for the bacterin decreased after 20 min and 120 min by factor 3 and 2, respectively. However, during sonication, erratic swimming of the fish raised some concerns. Further reduction of the sonication intensity to 57 mW/cm2 did not induce erratic swimming, and the bacterin uptake into the gill tissue was still increased by factor 3. In addition, a decreasing albumin globulin ratio in the

serum of the rainbow trout within 40 min revealed that LFS leads to an inflammatory response. Consequently, based on both increased bacterin uptake and the inflammatory Nocodazole response, low intensity LFS has the potential to enhance vaccine immunity without significant side effects. (C) 2014 Elsevier Ltd. All rights reserved.”
“In order to survive a temperature downshift, bacteria have to sense the changing environment and adjust their metabolism and structure. Two-component signal transduction systems (TCSs) play a central role in sensing and responding to many different environmental stimuli. Although the nonproteolytic (group II) Clostridium botulinum represents a major hazard in chilled foods, the cold adaption mechanisms of group II C. botulinum organisms are not known. Here, we show that the CLO3403/CLO3404 TCS of C. botulinum E1 Beluga is involved

in the cold shock response and growth at 12 degrees C. Cold shock induced the expression of the genes encoding the histidine kinase (clo3403) and the response regulator (clo3404) by more than 100-fold after 5 h relative to their expression in a nonshocked culture at the corresponding time point. The involvement of CLO3403/CLO3404 in growth at low temperature Nutlin-3 concentration was demonstrated by impaired growth of the insertional clo3403 and clo3404 knockout mutants at 12 degrees C compared to the growth of the wild-type culture. Additionally, the inactivation of clo3403 had a negative effect on motility. The growth efficiency at 12 degrees C of the TCS mutants and the motility of the kinase mutants were restored by introducing a plasmid harboring the operon of the CLO3403/CLO3404 TCS. The results suggest that the CLO3403/CLO3404 TCS is important for the cold tolerance of C. botulinum E1 Beluga.”
“Background: Major depressive disorder (MDD) is projected to rank second on a list of 15 major diseases in terms of burden in 2030.

To access the health facilities 71 8% (545/759) of patients exper

To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long

distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the BIX 01294 nmr last year. Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare.”
“Morphine is one of the most commonly prescribed medications for the treatment of chronic pain after a spinal cord injury (SCI). Despite widespread use, however, little is known about the secondary consequences of morphine use after SCI. Unfortunately, our previous studies show that administration of a single dose of morphine, in the acute phase of a moderate spinal contusion injury, significantly attenuates locomotor function, reduces weight gain, and produces symptoms of paradoxical pain (Hook et al., 2009). The current study focused on the cellular mechanisms that mediate these effects. Based

on data from other models, we hypothesized that pro-inflammatory cytokines might play a SBE-β-CD nmr role in the morphine-induced attenuation of function. Experiment 1 confirmed that systemic morphine (20 mg/kg) administered one day after a contusion injury significantly increased expression levels of spinal IL-1 beta

24 h later. Experiment 2 extended these findings, demonstrating that a single dose of morphine (90 mu g, it.) applied directly onto the spinal cord increased expression levels of spinal IL-1 beta at both 30 min and 24 h after administration. Experiment 3 showed that administration of an interleukin-1 receptor antagonist (IL-1ra, it.) prior to intrathecal morphine (90 mu g), blocked the adverse effects of morphine on locomotor recovery. Further, Proteasome inhibition assay pre-treatment with 3 mu g IL-1ra prevented the increased expression of at-level neuropathic pain symptoms that was observed 28 days later in the group treated with morphine-alone. However, the IL-1ra also had adverse effects that were independent of morphine. Treatment with the IL-1ra alone undermined recovery of locomotor function, potentiated weight loss and significantly increased tissue loss at the injury site. Overall, these data suggest that morphine disrupts a critical balance in concentrations of pro-inflammatory cytokines in the spinal cord, and this undermines recovery of function. (C) 2010 Elsevier Inc. All rights reserved.

This review

aims at describing major findings and future

This review

aims at describing major findings and future prospects in the field, especially after the VS-4718 nmr use of antibiotics as growth promoters was totally banned in Europe, with special emphasis on the application of genomic technologies to improve quality and safety of fermented foods.”
“The guidelines of the German Neurological Society dealing with therapy and treatment of Parkinson syndromes have been more and more accepted as a diagnostic and therapeutic standard by German neurologists. While attending the 12th Parkinson expert meeting in Frankfurt in November 2011 a group of 6 neurologists working either in a hospital setting or in private practice took on the task to check the feasibility of the guidelines for diagnosis of Parkinson syndromes within the everyday neurological context. The group concluded that the guidelines in general are helpful for the installation of a diagnostic setting for Parkinson syndromes although the use of some tools like the levodopa test as well as SPECT or PET examinations remain controversial. These diagnostic tools will often not be used in clinical practice in the sense of the guidelines, this can lead to either legal issues or conflicts with the patients

as they also have full access to check details the guidelines of the neurological society. A shortened

version of the guidelines including a graded diagnostic scheme as well as a weighted assessment BYL719 cost of the diagnostic tools regarding their usefulness for the diagnosis of Parkinson syndromes would be helpful in the opinion of the expert group.”
“Objective\n\nTo quantify the variation in emergency department (ED) wait times by patient race/ethnicity and payment source, and to divide the overall association into between- and within-hospital components.\n\nData Source\n\n2005 and 2006 National Hospital Ambulatory Medical Care Surveys.\n\nStudy Design\n\nLinear regression was used to analyze the independent associations between race/ethnicity, payment source, and ED wait times in a pooled cross-sectional design. A hybrid fixed effects specification was used to measure the between- and within-hospital components.\n\nData Extraction Methods\n\nData were limited to children under 16 years presenting at EDs.\n\nPrincipal Results\n\nUnadjusted and adjusted ED wait times were significantly longer for non-Hispanic black and Hispanic children than for non-Hispanic white children. Children in EDs with higher shares of non-Hispanic black and Hispanic children waited longer. Moreover, Hispanic children waited 10.4 percent longer than non-Hispanic white children when treated at the same hospital.