001) were noted in the pneumonia group. No significant differences were noted between the groups regarding labour induction (23.8% vs. 27.9%, p = 0.240), non-progressive labour second stage (2.5% vs. 1.6%, p – 0.387) and post-partum haemorrhage (1.3% vs. 0.5%, p – 0.224). Furthermore, patients with

pneumonia were significantly associated with preterm delivery (PTD, 537 weeks) (35.6% vs. 7.7%, p50.001) and perinatal mortality (7.5% vs. 1.3%, p50.001). Pneumonia was found as an independent risk factor for PTD (OR = 5.4, 95% CI 3.8-7.7, p < 0.001), in a multivariable model controlling for IUGR, placental abruption and preeclampsia Controlling for possible confounding variables such as IUGR, gestational Selleckchem BI-D1870 age at delivery, placental abruption and maternal age, using another multivariable model with perinatal mortality as the outcome variable, pneumonia was not identified as an independent risk factor for perinatal mortality (weighted OR = 0.9; 95% CI 0.4-1.9; p = 0.718). Conclusion. Maternal pneumonia is associated with adverse perinatal outcomes

and specifically it is an independent risk factor for PTD. Keywords: Pregnancy, pneumonia, outcomes.”
“Intraoral vertical ramus osteotomy (IVRO) is widely used as a surgical corrective method to treat patients with skeletal class III malocclusion with mandibular setback. However, the conventional surgical method applied for mandibular advancement has induced such complications as condylar luxation caused by the SNX-5422 instability of the placement of the proximal Fosbretabulin order segment. To avoid this complication, it has been necessary to use the fixation of the proximal and distal segments with

an L-shaped compact lock plate via an extraoral approach. This has made surgeons hesitate to propose this osteotomy for patients with skeletal class II malocclusions. We herein report a new surgical approach for the IVRO for mandibular corrective advancement with endoscopically assisted fixation of an L-shaped compact lock plate and good positioning of the condyle via an intraoral approach.

The osteotomized mandibular segments were fixed with an L-shaped compact lock plate using right-angled burs and right-angled screwdrivers. Seven patients were included in this study. The average degree of mandibular advancement was 6.1 mm (range, 3.5-9 mm). Our results suggest that mandibular advancement by IVRO with endoscopically assisted intraoral fixation of an L-shaped compact lock plate in patients with skeletal class II malocclusion might be useful to improve the occlusion and facial aesthetics by maintaining good positioning of the condyle.”
“Background: Gastroesophageal reflux disease (GERD) is said to be the causative factor in up to 41 percent of adults with chronic cough. Treatment for GERD includes conservative measures (diet manipulation), pharmaceutical therapy (e.g., motility or prokinetic agents, histamine H-2 antagonists, proton pump inhibitors [PPIs]), and fundoplication.

New products have been marketed and many changes in prescribing habits have occurred since then, and the effect on AEs reporting is unclear. It was hypothesized that changing practices for i. v. iron products has

caused changes in the rates of serious AEs and large differences exist between Eur and NA. Rates of AEs for three I. v. iron preparations (iron sucrose (IS], ferric gluconate [FG] and high and low MW iron dextran [HMWID, LMWID]) were compared by product and continent from January 1, 2003 to June 30, 2009 for selected countries in Eur and NA, using the Uppsala Monitoring Center’s database. Rates of total, anaphylaxis and other serious allergic AEs were calculated as number of AEs divided by i. v. iron sales standardized to 100 mg dose equivalents (DEq) of iron. Quarterly sales (millions learn more of 100 mg DEq of iron) increased A-1210477 order from the first quarter 2003 to the end of the second quarter of 2009 by 1 % for FG, 16% for IS and 2% for ID. Total AEs for NA plus Eur were similar for FG and IS, but total AEs were 6- to 7-fold higher for ID. Rates of anaphylaxis were 6- to 11-fold higher in Eur plus NA combined for ID than for IS or FG. In NA, there were substantially higher reports for total, anaphylaxis and other serious allergic AEs with FG compared to IS, whereas the reverse was the case in

Eur. Odds ratios (OR) showed higher risks of anaphylaxis with FG in NA vs. Eur (OR = 4.40, P < 0.0001) and lower risks with IS (OR = 0.24, P < 0.0001). Odds of anaphylaxis with LMWID in Eur vs. FG and IS were 42.08 and 16.92 (both P < 0.0001), respectively. In NA, odds of anaphylaxis with ID vs. FG and IS were 2.36 and 17.73 (both P < 0.0001), respectively.

Differences between NA and Eur may be related to varied treatment practices. ID had the highest rates of all types of AEs, and IS and FG had a continued trend for lowest rates of AEs.”
“A sensitive and selective reverse-phase liquid chromatography electrospray ionization mass spectrometry (LC-ESI-MS) Trichostatin A solubility dmso method was developed and validated to quantify pseudoephedrine (CAS 90-82-4) in human plasma. Phenacetin was used

as the internal standard (I.S.). Sample preparation was performed with a deproteinization step using acetonitrile. Pseudoephedrine and I.S. were successfully separated using gradient elution with 0.5% trifluoroacetic acid (TFA) in water and 0.5% TFA in methanol at a flow-rate of 0.2 mL/min. Detection was performed on a single quadrupole mass spectrometer by a selected ion monitoring (SIM) mode via electrospray ionization (ESI) source. The ESI source was set at positive ionization mode. The ion signals of m/z 166.3 and 180.2 were measured for the protonated molecular ions of pseudoephedrine and I.S., respectively. The lower limit of quantification (LLOQ) of pseudoephedrine in human plasma was 10 ng/mL and good linearity was observed in the range of concentrations 10-500 ng/mL (R(2) = 1). The intra-day accuracy of the drug containing plasma samples was more than 97.

CASE: We present the case of a patient with nonalcoholic steatohepatitis or nonalcoholic fatty liver disease and resultant portal hypertension who developed an unusual porto-systemic shunt, which at first was thought to represent a highly vascular gynecologic mass. The splanchnic blood was shunted through a recanalized vein interconnecting the splenic vein with

the parametrial venous plexus.

CONCLUSION: Unrecognized portal hypertension and resultant porto-systemic shunts may mask themselves as vascular masses and result in catastrophic surgical outcomes if not fully characterized preoperatively. (Obstet Gynecol 2012;119:455-9) DOI: 10.1097/AOG.0b013e3182331611″
“Patients on peritoneal dialysis (PD) are at high cardiovascular (C-V) risk, and www.selleckchem.com/products/tpx-0005.html dyslipidemia, one of the major traditional C-V risk factors, is a common complication in chronic kidney disease. PD treatment may worsen lipid profile, because it confers a more atherogenic state than hemodialysis. There is evidence that in the general population, lipid-lowering therapy reduces C-V mortality, both in terms of primary and secondary prevention. The association between dyslipidemia and C-V mortality in dialysis

patients is not well defined, and hypocholesterolemia, selleck kinase inhibitor related to malnutrition/inflammation, is a confounding factor. However, despite the unfavorable lipid profile in PD patients and their high C-V mortality rate, until now we have had no conclusive data that the treatment of dyslipidemia in PD patients might contribute to reducing C-V mortality. selleck kinase 抑制剂 At the moment, following the ATPIII and K-DOQI recommendations in considering dialysis patients as high

C-V risk patients seems a reasonable approach, awaiting new large trials in PD patients. The present therapeutic tools to treat dyslipidemia in PD patients, such as diet, fibrates, omega-3, statins, carnitine, phosphate binders and use of glucose-free dialysis bags, are considered, with attention to high-risk diabetic patients, with the possible use of intraperitoneal insulin. The data indicate a correctable nihilism in treating dyslipidemia in the general population, probably even exacerbated in PD patients. However, it will only be with the correction of all of the C-V risk factors, traditional and uremia-related ones, that in future we shall hope to observe the reduction of C-V death in PD patients.”
“Aim: The ultrastructural changes in the intestine were studied during experimental acute edematous and necrotizing porcine pancreatitis. The immunohistochemical expression of E-cadherin and beta-catenin in the jejunum and colon was assessed to characterize changes in the adherens junctions.

Methods: Twenty-four pigs were randomized to controls (n = 8) or to develop mild edematous (n = 8, saline infusion to pancreatic duct) or severe necrotizing pancreatitis (n = 8, taurocholic acid infusion).

Levels of lipid peroxidation (LPO), reduced glutathione (GSH), as well as hydrogen peroxide (H(2)O(2)) were also measured in homogenates of the liver and kidney of the treated animals to determine oxidative stress induced by trichloroethylene (TCE), ethyl alcohol, and heavy metal mixture (H. M. M) individually and in different combinations. An increase up to the extent of 382% in malonaldehyde, a marker of LPO, was recorded in almost all the treatment groups in both the tissues. Similarly,

a rise of 218% in GST activity was also recorded in kidney of TCE-treated animals. Although H. M. M ingestion resulted in significant change of 125% in SOD activity of hepatic tissue, the level of GR was increased by 93% in the renal tissue of the exposed rats. Solitary dose of alcohol in general did not show a significant change. Moreover, the changes in the levels of antioxidants were much more prominent when these toxicants were given in https://www.selleckchem.com/products/MLN8237.html combination rather than alone. Overall, these results demonstrate the changes www.selleckchem.com/products/blasticidin-s-hcl.html in the levels of antioxidant enzymes and GSH system, as well as alterations in the LPO and H(2)O(2) levels as a result of test toxicants. (c) 2009 Wiley Periodicals, Inc. Environ Toxicol 26: 207-216, 2011.”
“Febrile ulceronecrotic Mucha-Habermann

disease is a rare fulminant variant of pityriasis lichenoides et varioliformis acuta, characterized by a rapidly progressive course with predominant ulceronecrotic lesions associated with fever and systemic manifestations. It carries a great morbidity and is potentially fatal. The exact pathogenesis is not clear, and it has been proposed to be the result of hypersensitivity reaction to an infection. We report a patient with febrile ulceronecrotic Mucha-Habermann disease

in a 12-year-old boy in whom the condition was most likely precipitated by parvovirus infection, and he showed a favorable response to a combination of prednisolone with narrow band ultraviolet B (NB-UVB) phototherapy.”
“Immune and inflammatory response activation is a common feature of connective tissue diseases and systemic vasculitis. The aim of our study was to evaluate the possible involvement of TNF alpha c.-308A > Emricasan G, IL-10 c.-1082A > G, uteroglobin c. 38A > G, TGF beta 1 c. 869C > T and NF kappa B2 c.-1837T > C gene polymorphisms in susceptibility to connective tissue diseases. Our study cohort included 68 unrelated patients affected by rheumatoid arthritis (RA) (37 patients) and ANCA-positive [micropolyangiitis (mPA) 17 patients] or ANCA-negative systemic vasculitis [including 8 patients with Henoch-Schonlein purpura (HSP) and 6 patients with mixed cryoglobulinaemia (MC)] as well as 98 control subjects. Allele frequency analysis of uteroglobin c. 38G > A polymorphism showed a significant increase in the c. 38A allele in patients (p = 0.002).

Patients with endovascular repair of rAAA

between April 2004 and May 2010 were included. Intra-abdominal pressure (IAP) was measured in the bladder every 4 h. IAH and ACS were defined according to the World Society of the Abdominal Compartment selleck chemical Syndrome consensus document. Early conservative treatments (diuretics, colloids and neuromuscular blockade) were given to patients with IAP > 12 mmHg.

Results: Twenty-nine patients, who underwent endovascular repair of a rAAA, had their IAP monitored. Twenty-five percent of them were in shock at arrival. Postoperatively, 10/29 (34%) patients had an IAP > 15 mmHg and six (21%) had an IAP > 20 mmHg. Three (3/29, 10%) patients developed ACS that necessitated abdominal decompression in two. Five out of six patients with IAP > 20 mmHg presented with preoperative shock. All patients except one with preoperative shock developed some degree of IAH.

Conclusion: IAH and ACS are common and potential serious complications after EVAR for GSK2118436 nmr rAAA. Successful outcome depends on early recognition, early conservative treatment to reduce IAH and decompression

laparotomy if ACS develops. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.”
“Purpose of review

The term ‘dual diagnosis’ most commonly refers to the combination of severe mental illness and substance-use disorder (SUD). It is estimated that 7-10 million people in the USA alone have at a minimum one psychiatric disorder in addition to a SUD. As many of the psychiatric illnesses implicated have their origins in childhood, the pediatric population is not immune to this ‘dual diagnosis’, particularly with the increasing availability of PF-03084014 street drugs

and increasing accessibility to prescription drugs. The purpose of this review is to identify the magnitude of the problem and strengthen awareness among pediatric healthcare professionals who may provide prevention and/or early intervention.

Recent findings

Causes for the dual diagnosis are unknown, but there are four hypotheses: common factors (risk factors common to both disorders), secondary mental disorder (substance use precipitates mental disorder), secondary substance use (‘self-medication hypothesis’) and bidirectional (presence of either mental illness or SUD can contribute to the development of the other).

Summary

Those with the presence of this dual diagnosis are more likely to be nonadherent to treatment and may well have poorer outcomes. Integrated care for the maladies rather than split or isolated care is recommended. Psychosocial therapy holds promise for treating patients with dual diagnosis.”
“Neurovascular dysfunction is an integral part of Alzheimer disease (AD).

The Ala307Thr and Ser680Asn polymorphisms selleck products of FSHR were analyzed by polymerase

chain reaction-restriction fragment length polymorphism (PCR-RFLP) and direct DNA sequencing.

The distributions of genotype and allele of Ala307Thr and Ser680Asn polymorphisms of FSHR were not statistically different between the PCOS patients and the controls. Analysis of the frequency of FSHR polymorphisms showed no statistical difference among the PCOS patients with different obesity standards. Although there were no statistical differences in the most of the endocrine parameters including LH, LH/FSH, E2, P and T as well as the clinical pregnancy rate, there were significant differences in the levels of FSH and PRL among PCOS patients carrying different genotypes of Ala307Thr and Ser680Asn polymorphisms.

The P5091 nmr Ala307Thr and Ser680Asn polymorphisms of FSHR are not associated with

PCOS in Han ethnic Chinese women in north China. The FSHR polymorphisms was related to the levels of FSH and PRL but not other PCOS-associated endocrine hormones as well as clinical pregnancy rate in PCOS patients of Han Chinese ethnical population.”
“To validate the Canine Brief Pain Inventory (CBPI), which is based on the human Brief Pain Inventory (BPI), in a canine model of spontaneous bone cancer.

One hundred owners of dogs with bone cancer self-administered the CBPI on three occasions to test the reliability, validity, and responsiveness of the measure.

Factor analysis, internal consistency, convergent validity, and an extreme group validation assessment were completed using the responses from the first administration

of the CBPI. Test-retest reliability was evaluated using two administrations of the instrument, 1 week apart. Responsiveness was tested by comparing responses 3 weeks apart.

The “”severity”" and “”interference”" factors hypothesized based on the BPI were demonstrated in the CBPI in dogs with bone cancer. Internal consistency was high (Cronbach’s alpha, 0.95 and 0.93), as was test-retest reliability (kappa, 0.73 and 0.65). Convergent validity was demonstrated with respect to quality of life (r = 0.49 and 0.63). Extreme group validation against normal dogs showed significantly higher factor scores (P < 0.001 for both).

The CBPI reliably measures the same pain constructs in the companion canine model check details of spontaneous bone cancer as the BPI does in people with bone cancer. This innovative approach to preclinical outcomes development, validating a preclinical outcome measure that directly corresponds to an outcome measure routinely used in clinical research, applied to a readily available animal model of spontaneous disease could transform the predictive ability of preclinical pain studies.”
“Aims Fecal incontinence (FI) is embarrassing, resulting in poor quality of life. Rectal sensation may be more important than sphincter strength to relieve symptoms.

Perioperative and long-term outcomes were compiled.

There Semaxanib research buy were 255 curative gastric resections during 12 years. An R0 resection was performed in 96 % with a perioperative mortality rate of 1.6 %. A D2 dissection was performed in 85 % of cases in the past 6 years, with no increase in perioperative morbidity or mortality detected. The 5-year overall survival was 53 %.

Our results demonstrate that both short- and long-term outcomes of surgical resection in gastric cancer patients, comparable to international high-volume centers, can be achieved in an Australian upper GI unit. A D2 lymph node dissection can be performed safely without any increase

in perioperative risk in a specialist unit that has the necessary training but also the perioperative support structures to manage these complex patients.”
“The prevalence

of obesity is 33 % and is expected to reach 50 % based on current US trends. Bariatric surgery is effective in producing long-term weight loss, yet it requires adherence to the recommended diet and physical activity. This study assessed whether the short-form International Physical Activity Questionnaire (IPAQ-SF) data at 1 year postbariatric surgery would correlate with success (defined as more than 50 % excess weight loss (EWL)) after surgery.

The IPAQ-SF questionnaire provided assessment of OTX015 research buy subjects’ activity level over the last 7 days, in four separate activity domains: vigorous, moderate, walking, and sitting.

Questionnaires were completed and collected at the 1-year postbariatric surgery group visit. Then, 118 subjects who completed the IPAQ-SF were subdivided based HSP990 on loss of greater than or less than 50 % of their excess weight, which in turn was based on ideal body weight. In subjects with a parts per thousand

yen50% EWL (n = 49), we noted 67.1 +/- 8.8 % EWL versus 33.2 +/- 9.4 % in those with < 50 % EWL (n = 69) (p < 0.001). The a parts per thousand yen50 % EWL group performed 420 (216-960) min of total activity per week versus 300 (172-718) min for the < 50 % group. The a parts per thousand yen50 % EWL group engaged in 120 (8-180) min of vigorous activity, 150 (28-330) min of moderate activity, and 233 (109-512) min of walking versus 40 (0-255), 68 (0-204), and 188 (83-341) min, respectively, for the < 50 % EWL group.

Physical activity does correlate with success after bariatric surgery, as measured by excess weight loss (a parts per thousand yen50 % EWL).”
“Background: Patients undergoing chronic hemodialysis (HD) have an impaired immune response with a dysregulated Th1/Th2 cytokine network and altered the levels of thyroid hormone (TH) in euthyroid sick syndrome.

In this context, the objective of this review is to present the main advances in the development of analytical methods for determination of tropical disease BMN 673 drugs using electroanalytical, spectrophotometric and liquid chromatographic

techniques.”
“Two new daphnane diterpenoids, trigoxyphins J and K (1 and 2), and one new friedelane triterpene derivative, 3-O-benzoylpluricostatic acid (3), together with thirteen known terpenoids (4-16) were isolated from Trigonostemon xyphophylloides (Croiz.) L.K. Dai and T.L. Wu. Their structures were identified on the basis of physicochemical properties and spectroscopic data. All compounds were evaluated for their cytotoxicity against K562, SGC-7901, and BEL-7402 tumor cell lines, respectively. (C) 2013 Published by Elsevier B.V. on behalf of Phytochemical Society of Europe.”
“Family planning is one of the principle tools

of human development. Ensuring that all babies are wanted and planned reduces health care and social costs. Human numbers will increase to 11 Lonafarnib Metabolism inhibitor billion by the end of this century, and human activities are the leading cause of environmental change that threaten our health and happiness. Therefore, the provision of highly effective contraceptive methods represents an important priority of primary medical care. Since women and men with complicated medical problems remain interested in sex, medical and surgical specialists need to understand click here how contraception and pregnancy will interact with the underlying condition. This paper discusses the interaction between population growth and the environment, and reviews modern methods of contraception.”
“Hypertrophic

scars and keloids result from an abnormal fibrous wound healing process in which tissue repair and regeneration-regulating mechanism control is lost. These abnormal fibrous growths present a major therapeutic dilemma and challenge to the plastic surgeon because they are disfiguring and frequently recur.

To provide updated clinical and experimental information on hypertrophic scars and keloids so that physicians can better understand and properly treat such lesions.

A Medline literature search was performed for relevant publications and for diverse strategies for management of hypertrophic scars and keloids.

The growing understanding of the molecular processes of normal and abnormal wound healing is promising for discovery of novel approaches for the management of hypertrophic scars and keloids. Although optimal treatment of these lesions remains undefined, successful healing can be achieved only with combined multidisciplinary therapeutic regimens.

The authors have indicated no significant interest with commercial supporters.

We treated it with a total excision with wide margins and neck dissection. There was no recurrence during the follow-up period of 5 years up until now. We present a case of an unusually huge CEPA in the oral cavity.”
“Background and Purpose: Because of the limited working space available during retroperitoneal laparoscopic LDN-193189 radical

nephrectomy (LRN), the body habitus of the patient is likely to affect the risk of operative difficulties. This study sought to determine whether anthropometric measurements based on CT and abdominal radiography could be used to predict operative difficulties during retroperitoneal LRN.

Patients and Methods: Between August 2004 and January 2012, 96 consecutive patients with preoperative GSK690693 CT and abdominal radiography examinations underwent retroperitoneal LRN for a T-1 or T-2 stage renal tumor at our institution. The association between anthropometric measurements and demographics of patients and operative duration, estimated blood loss (EBL), and perioperative complications were retrospectively analyzed. Multivariate analysis was performed, and P < 0.05 was considered significant.

Results: Anterior perirenal fat distance (P = 0.016) and distance from the 12th rib to the iliac crest (P = 0.038) were independently associated with operative duration.

Only anterior perirenal fat distance (P = 0.001) was independently associated with EBL. No intraoperative complications and reoperations occurred. The occurrence or severity of postoperative complications was not significantly associated with anthropometric measurements. Body mass index >= 25.0 kg/m(2) was not significantly associated with operative difficulties.

Conclusion: The anterior perirenal fat distance and the distance from the 12th rib to the iliac crest can be used to predict operative difficulties during retroperitoneal LRN.”
“Coffee is the beverage consumed during pregnancy that is most commonly HDAC 抑制剂 associated with adversely affecting the developing fetoplacental unit. Since placental 11 beta-hydroxysteroid dehydrogenase type 2 (11 beta-HSD-2) is an important

determinant for maintenance of fetal glucocorticoid levels during pregnancy, we investigated the effect of coffee on 11 beta-HSD-2 expression in the human placental choriocarcinoma cell line, JEG-3. Addition of coffee to the culture medium of JEG-3 cells increased 11 beta-HSD-2 gene expression after 24 hr in a dose-dependent manner. Cellular 11 beta-HSD-2 activity, which was calculated by the amount of cortisol that was converted to cortisone in the culture medium, also increased in the coffee-treated JEG-3 cells. None of the major constituents of coffee, such as caffeine, caffeic acid or chlorogenic acid, showed any ability to induce 11 beta-HSD-2 gene expression. The 11 beta-HSD-2-inducing activity in coffee was extractable with ethyl acetate.

The absence of significant interactions between country of interview and the common correlates of substance use disorders indicated that

the influence of these factors was similar in the USA and Australia. In conclusion, the current investigation revealed striking differences in the rates of conditional drug dependence between Australia and the USA. The cross-national generalizability of the relationships between the common correlates and prevalence of substance use and dependence indicates that a similar process of vulnerability to dependence may be operating in the USA and Australia. In the future, these cross-national differences could be used to help better understand the factors that influence drug use and the development of dependence. (C) 2008 Elsevier Ireland Ltd. learn more All rights reserved.”
“Objective: The aim of this study was to describe the most frequently found bacterial microorganisms in bloodstream isolates taken from patients in intensive care units in Colombia and their resistance profiles.

Methods: This was a multicentre descriptive observational study that was carried out between January 2001 and June 2008 with laboratory data from 33 participating hospitals in a surveillance network.

Results: The most frequently found microorganisms were coagulase-negative Staphylococci 39.6%, Staphylococcus

Protease Inhibitor Library order aureus 12.3%, Klebsiella pneumoniae 8.2%, Escherichia coli 5.7%, Acinetobacter baumannii, 4.0% and Pseudomonas aeruginosa 3.8%. Coagulase-negative see more Staphylococci registered greater than 70% oxacillin resistance rate. S. aureus presented a change in its multiresistance profile during the years of follow-up. There was a trend towards a lower resistance rate among E. coli and K. pneumoniae isolates during the study period while A. baumannii carbapenem resistance rate exceeded 50%.

Discussion: There has been a change in the frequency of species

being isolated with a higher frequency of enterobacteriaceae compared to Gram-positive microorganisms, in general with a high resistance rate. (c) 2013 Elsevier Editora Ltda. All rights reserved.”
“Background: Massive endoprostheses provide orthopaedic oncologists with many reconstructive options after tumor resection, although failure rates are high. Because the number of these procedures is limited, failure of these devices has not been studied or classified adequately. This investigation is a multicenter review of the use of segmental endoprostheses with a focus on the modes, frequency, and timing of failure.

Methods: Retrospective reviews of the operative databases of five institutions identified 2174 skeletally mature patients who received a large endoprosthesis for tumor resection. Patients who had failure of the endoprosthesis were identified, and the etiology and timing of failure were noted.