The association of several risk factors (such as advanced maternal

age, pre-existing chronic hypertension, pre-existing nephropathy, obesity, suboptimal glycaemic control) increases the risk of preeclampsia. In that case, the classic follow-up (blood pressure measurement, proteinuria) should Go 6983 supplier be more frequent than monthly (professional consensus). The risk of Caesarean section is increased by macrosomia, whether suspected prenatally or not, but this increased risk remains whatever the birth weight (EL3). Diagnosis and treatment of GDM do not reduce the risk of severe perineal lesions, operative vaginal delivery and postpartum haemorrhage (EL2). Some psychological symptoms, such as anxiety and alteration of self-perception, can

occur upon diagnosis of GDM (EL3). The treatment of GDM appears to reduce the risk of postpartum depression symptoms (EL2).\n\nConclusion: Most of the information published on GDM covers the risks of preeclampsia and Caesarean section; intensive care of GDM reduces these risks. Pregnancy care should be adjusted to the risk factors. (C) 2010 Elsevier Masson SAS. All rights reserved.”
“The cyclic (c) AMP responsive element binding protein (CREB) plays a key role in many cellular processes, including differentiation, proliferation, and signal transduction. Furthermore, CREB overexpression was found in tumors of distinct origin and evidence suggests an association with tumorigenicity. To establish a mechanistic selleckchem link between HER-2/neu-mediated transformation and CREB protein expression and function, in vitro models of HER-2/neu-overexpressing and HER-2/neu-negative/silenced selleck chemicals counterparts as well as human mammary carcinoma lesions with defined HER-2/neu status were used. HER-2/neu overexpression resulted in the induction and activation of CREB protein in vitro and in vivo, whereas short hairpin RNA (shRNA)-mediated inhibition of HER-2/neu correlated with downregulated CREB activity. CREB activation in HER-2/neu-transformed cells enhanced

distinct signal transduction pathways, whereas their inhibition negatively interfered with CREB expression and/or activation. CREB downregulation in HER-2/neu-transformed cells by shRNA and by the inhibitors KG-501 and lapatinib caused morphologic changes, reduced cell proliferation with G(0)-G(1) cell-cycle arrest, which was rescued by CREB expression. This was accompanied by reduced cell migration, wound healing, an increased fibronectin adherence, invasion, and matrixmetallo proteinase expression. In vivo shCREB-HER-2/neu(+) cells, but not control cells, exerted a significantly decreased tumorgenicity that was associated with decreased proliferative capacity, enhanced apoptosis, and increased frequency of Tlymphocytes in peripheral blood mononuclear cells. Thus, CREB plays an important role in the HER-2/neu-mediated transformation by altering in vitro and in vivo growth characteristics.”
“Background.

\n\nMaterials and Methods Pregnancies at risk for fetal Hb Bart’s disease scheduled for cordocentesis at 18 to 22 weeks were recruited into the study. Maternal serum-free beta-hCG, PAPP-A, and AFP concentrations were measured before cordocentesis, and the final fetal diagnosis

of Hb Bart disease was based on fetal Hb typing using high-performance liquid chromatography.\n\nResults Of 57 recruited pregnancies, 11 had fetal Hb Bart’s disease and 46 were unaffected. Maternal serum alpha-fetoprotein (MSAFP) concentrations were significantly higher in women with fetal Hb Bart’s disease than those with unaffected fetuses (median 99.53 vs 50.83, P < 0.001), whereas the concentrations of free beta-hCG and PAPP-A were not significantly different between the two groups (P = 0.543 and 0.777, respectively).\n\nConclusion Ralimetinib clinical trial Second-trimester MSAFP may be clinically a useful screening test for fetal Hb Bart’s disease among BMS-777607 solubility dmso pregnancies at risk. Copyright (C) 2011 John Wiley & Sons, Ltd.”
“BACKGROUND. Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are common abnormalities in elderly men. It is considered that epithelial stem cells are involved

in the etiology and development of both diseases. To distinguish aberrant from normal cells, the knowledge about primary epithelial stem/progenitor cells (ES/P) is essential. The aim of this study was to examine the role of surface markers to distinguish between different subsets of prostate basal epithelium.\n\nMETHODS. The expression pattern of prostate tissue single cell suspensions was analyzed by flow cytometry using different markers. Sorted cell populations were examined for their clonogenic capacity and the resulted colonies were analyzed with flow cytometry, Western blot, and qPCR for stem cell, basal, and luminal epithelium markers. Additionally, the histological localization of the examined markers was determined using immunofluorescence.\n\nRESULTS.

Using the combination of CD49f, Trop-2, and surface CD24, basal cell subsets with distinct differentiation capacities were dissected (CD49f(+)Trop-2(+)CD24(-) Selleckchem MK-8931 and CD49f(+)Trop-2(+)CD24(+)). Although cells from the two subsets gave rise to similar basal colonies, qPCR of primary tissue revealed that higher levels of basal marker expression were detected in the CD49f(+)Trop-2(+)CD24(-) subset. Immunofluorescence analysis showed a prominent expression of CD24 by luminal and basal cells.\n\nCONCLUSIONS. Subsets with distinct differentiation capacities within the basal epithelium (CD49f(+)Trop-2(+)CD24(-) and CD49f(+)Trop-2(+)CD24(+)) can be distinguished in human prostate.

“
“Background. Childhood adversity has been associated with onset of psychosis in adulthood but these studies have used only general definitions of this environmental risk indicator. Therefore, we sought to explore the prevalence of more specific adverse childhood experiences amongst those with and without psychotic disorders using detailed assessments in a large epidemiological case-control sample Cell Cycle inhibitor (AESOP).\n\nMethod. Data were collected on 182 first-presentation psychosis cases and 246 geographically matched controls in two UK centres. Information relating to the timing and frequency of exposure to different

types of childhood adversity (neglect, antipathy, physical and sexual abuse, local authority care, disrupted living arrangements and lack of supportive figure) was obtained using the Childhood

Experience of Care and Abuse Questionnaire.\n\nResults. Psychosis cases were three times more likely to report severe physical abuse from the mother that commenced prior to 12 years of age, even after adjustment for other significant forms of adversity and demographic confounders. A non-significant trend was also evident for greater prevalence of reported severe maternal antipathy amongst those with psychosis. Associations with maternal neglect and childhood sexual abuse disappeared after adjusting for maternal physical abuse and antipathy. Paternal maltreatment and other forms of adversity were not associated with psychosis nor was there evidence of a dose-response effect.\n\nConclusions. Pinometostat price These findings suggest that only specific adverse childhood experiences are associated with psychotic disorders and only in a minority of cases. If replicated, this greater precision will ensure that research into the mechanisms underlying the pathway from childhood adversity to psychosis is more fruitful.”
“In this training study, we aimed to selectively train participants’ filtering mechanisms to enhance visual working memory (WM) efficiency. The highly restricted nature of visual WM capacity renders efficient filtering mechanisms crucial for its successful functioning. Filtering Blebbistatin clinical trial efficiency in visual WM can be measured

via the lateralized change detection task with distractors. From an array of items, only a subsample must be memorized (targets), whereas distractors must be filtered out. From the EEG recorded while items are maintained in memory, slow potentials over posterior recording sides can be extracted. In addition, the contralateral delay activity (CDA) can be calculated as the difference wave between contralateral and ipsilateral slow potentials. As the amplitudes of contralateral slow potentials and CDA reflect the number of remembered items, one can infer if distractors were filtered out. Efficient filtering mechanisms are also highly important in multiple object tracking (MOT). We trained participants’ filtering ability with the aid of this latter task.

“
“The present study aimed to obtain data on the occurrence of Giardia duodenalis in calves in four major cattle rearing countries in Europe (Germany, UK, France and Italy), along with genotyping data and risk factors associated with these infections. A total of 2072 calves were sampled on 207 farms. The majority of the animals were Holstein dairy or mixed Holstein calves (n = 1565 or 75.5%), and were female (n = 1640 or 79.1%). The average age was 7.8 weeks PARP inhibitor (SD = 4.1; median = 7; range = 2-16 weeks). All fecal samples were tested using a commercially available monoclonal antibody-based ELISA. The overall apparent prevalence

of G. duodenalis for the four countries was 45.4% (n = 942/2072) and the overall farm prevalence was 89.9% (186/207), with differences in both animal and farm prevalence between the four countries. The prevalence was significantly higher in animals up to 8 weeks (OR=1.88; P<0.001) compared to older calves, SBI-0206965 and several management factors including contact with the Dam, Frequency of cleaning of the Maternity Pens, and Disinfection of the Calf Housing were found to be associated with infection. Positive samples were withheld for genotyping using the beta-giardin and triose phosphate isomerase gene: G. duodenalis assemblage E was most prevalent,

although 43% of the isolates were typed as assemblage A, with differences in between countries. Furthermore, 32% of the examined samples was found to be a mixed assemblage A and E infection, which is consistent with previous reports. The results of the present study confirm previous findings in other European countries that G. duodenalis infections are common in calves.

The infection especially occurs in animals younger than 2 months, and the proportion of positive animals gradually decreased with increasing age. (C) 2012 Elsevier B.V. All rights reserved.”
“Aims: The prediction of individuals’ use of medical services and associated costs is crucial for medical systems. We modeled a risk assessment equation that included patient sociodemographic characteristics and health risk behaviors (obesity, smoking, and alcohol abuse) to strengthen the power of self-reported health status to predict healthcare resource use. We also sought to uncover gender-specific differences selleck inhibitor in the predictive value of the models.\n\nMethods: Before their first primary care visit, 509 new patients were interviewed. Data collected included sociodemographics, self-reported health status Medical Outcomes Study Short-Form (MOS SF-36), body mass index (BMI), and screening for alcoholism and smoking. Subsequent use of healthcare services for 1 year was determined by reviewing medical and billing records.\n\nResults: Generalized linear models and two-part regressions were estimated relating the five types of charges (plus total charges) to self-reported physical health status, controlling for gender, age, education, income, obesity, smoking, alcohol abuse, and mental health status.

Ectodermal and mesenchymal sources of BMP4 control the expression of BMP/TGF beta antagonist Nog, whereas mesenchymal sources of Nog define the neurogenic borders of the olfactory pit. Fgf8 hypomorph mouse models, Fgf8(neo/neo) and Fgf8(neo/null), displayed severe craniofacial defects together with overlapping defects in the olfactory pit including (1) lack of neuronal formation ventrally, where GnRH neurons normally form, and (2) altered expression of Bmp4 and Nog, with Nog ectopically expressed in the nasal mesenchyme and no longer defining the GnRH and vomeronasal neurogenic border. Together our data show that (1) FGF8 is not sufficient to induce ectodermal

progenitors of the olfactory pit to acquire neural fate and (2) altered neurogenesis and lack of GnRH neuron specification after chronically reduced Fgf8 expression reflected Selleckchem GSK-3 inhibitor dysgenesis of the nasal region and loss of a specific neurogenic permissive milieu that was defined by mesenchymal signals.”
“Reconfiguration Raf inhibitor review of surgical services in the Mid-West in 2009 resulted in a large increase in numbers of patients undergoing emergency surgery for appendicitis in University Hospital Limerick (UHL). The aim of this study was to assess the impact of reconfiguration on the management of appendicitis in this area. Data on all patients who underwent appendicectomy between January and June

2007 were compared with the corresponding data from January to June 2011. The numbers of operations, types of operations, lengths of stay (LOS), operation start times, rates of negative histology specimens and readmissions within 30 days were compared. One hundred and twenty-five appendicectomies [48 laparoscopic (38.4 %)] were performed in the 2007 group of which 32 specimens (25.6 %) were histologically negative. Three hundred and nineteen appendicectomies [238

laparoscopic (74.6 %)] were performed in the 2011 group of which 62 specimens (19.4 %) were histologically negative. The increase in numbers of laparoscopic procedures was significant (p smaller than 0.001). The reduction in the negative appendicectomy rate was not statistically significant (p = 0.16). There were 10 conversions (20.8 %) to open surgery in the 2007 period and 12 (5 %) in the 2011 period (p = 0.001). Mean LOS for the 2007 Nepicastat inhibitor and 2011 groups was 4.45 and 3.16 days (p smaller than 0.001). Six (4.8 %) readmissions within 30 days occurred in the 2007 group with 20 (6.3 %) in the 2011 group (p = 0.66). Though reconfiguration of surgical services has resulted in a significant increase in workload, LOS has decreased significantly while maintaining acceptably low negative appendicectomy, conversion and readmission rates.”
“BACKGROUND Obesity has been linked to the development of hypertension, but whether total adiposity or site-specific fat accumulation underpins this relationship is unclear.

For greater SB-715992 concentration accuracy when smear quality is poor, Plasmodium AutoCount, can be used in conjunction with Counting Aid.”
“Calcium-dependent protein kinases (CDPKs) play a vital regulatory role in abiotic stress responses in plants. We isolated the ZmCK1 gene encoding a CDPK from maize seedlings. The predicted ZmCK1 protein contains a typical Ser/Thr protein kinase domain and four EF-hand calcium-binding motifs in its N-terminal and C-terminal halves, respectively. The catalytic and regulatory domains were linked by a well-conserved junction domain. A ZmCK1::hGFP fusion protein was found to localize into the cytoplasma and nucleus upon introduction into Arabidopsis mesophyll protoplasts. ZmCK1 transcription was

highly activated by salt and cold, and moderately by drought and exogenous ABA in maize seedling. Isolation of the ZmCK1 promoter revealed some cis-acting elements responding to stresses. Overexpression of ZmCK1 improved drought, salt, and cold stress tolerance in transgenic Arabidopsis plants. Our results suggested that ZmCK1 produces a functional kinase that may play a regulatory role in abiotic stress response.”
“We characterize a mechanism of injury, injury pattern, and treatment algorithm for adductor pollicis myotendinous injuries in 2 professional baseball players.

Etomoxir order Similar to myotendinous eccentric injuries in other anatomical areas, the adductor pollicis sustains a sudden forceful eccentric load during a jammed swing, resulting in intramuscular strain or tendon rupture. Based on the reported injury mechanism, and magnetic resonance imaging features of these myotendinous injuries, the thumb of the top hand during a jammed ML323 supplier swing was suddenly and forcefully eccentrically abducted from a contracted and adducted position, resulting in injury patterns. (Copyright (C) 2013 by the American Society for Surgery of the Hand. All rights reserved.)”
“While transcatheter closure of mitral and aortic paravalvular leaks has been well-described,

there are no prior reports of such procedures for prosthetic tricuspid valves. We describe our experience with percutaneous closure of a tricuspid paravalvular leak in a 34-year-old patient with a history of tricuspid atresia. He had previously undergone repair with placement of a right atrium-to-right ventricle conduit and most recently, placement of a bio-prosthetic tricuspid valve. He subsequently developed significant tricuspid paravalvular leak with symptoms of severe right heart failure. His clinical status was improved following successful transcatheter closure of the defect. (c) 2013 Wiley Periodicals, Inc.”
“A rare amyloid precursor protein gene variant, A673T (rs63750847) was recently reported to protect against Alzheimer’s disease and age-related cognitive decline among Icelanders and the same rare variant was observed also in Finnish, Norwegian, and Swedish populations.

ObjectiveTo assess whether molecular allergy diagnostics for grass pollen allergens could help with predicting

provocation test outcomes and serve as a basis for future component-resolved specific immunotherapy. MethodsSera of 101 adults with grass pollen allergy was analysed for IgE against timothy grass pollen (Phleum pratense), rPhl p 1, rPhl p 2, nPhl p 4, rPhl p 5b, rPhl p 6, rPhl p 7, rPhl p 11 and rPhl p12 and correlated with the individuals’ outcome in Selleckchem C59 the nasal and conjunctival provocation tests and investigated in regard to a potential component-resolved specific immunotherapy. ResultsAn increasing number of sensitizations to timothy grass allergens was correlated to a positive reaction LY294002 molecular weight in the conjunctival (4.9 vs. 3.6, P=0.003) and nasal provocation

tests (4.5 vs. 2.2, P=0.0175). In molecular sensitization profiles, a substantial heterogeneity was detected, with none of the patients exactly matching the allergen composition of a previously published component-resolved specific immunotherapy containing Phl p 1, Phl p 2, Phl p 5a/b and Phl p 6. The results indicate that in 95% of the patients, a proportion of 50% of timothy-IgE would be targeted with such a specific immunotherapy, while in 50% and 10% of patients, 80% and 90% of timothy-IgE would be targeted, respectively. Conclusion and Clinical RelevanceMolecular allergy diagnostics is a prerequisite for future component-resolved specific immunotherapy due to the high heterogeneity of sensitization profiles. However, of current clinical relevance is the observed correlation between the number of sensitizations DMH1 TGF-beta/Smad inhibitor and provocation test outcome.”
“At present, only eight cases

of tracheal adenoid cystic carcinomas (ACCs) mimicking thyroid tumors have been reported. Since there are no guidelines available regarding their diagnosis and treatment, they present a significant clinical challenge. In the present study, patient treatment was analyzed to deliver the first concise summary of treatment options in patients with ACC mimicking a thyroid tumor. In addition, all available data regarding molecular abnormalities of this disease have been discussed. The current study presents a case of a 17-year-old patient with a tracheal ACC mimicking a thyroid tumor. The patient was diagnosed in 2007 with a pathological mass between the left lobe of the thyroid and the trachea, and underwent surgery and radiotherapy. In 2010, multiple lesions in the lungs were diagnosed and pulmonary metastasectomy was performed. Following surgery, the patient has been disease-free for almost 30 months. Thyroid tumor biopsy may reveal ACCs. This pathological report requires further investigation of the head and neck in order to confirm if the disease is of tracheal origin.

\n\nConclusions and implications: rac-BHFF derivatives may serve as valuable pharmacological tools to elucidate the pathophysiological roles played by GABAB receptors in the central and peripheral nervous systems.”
“Protein kinase C (PKC) isozymes are key signal transducers involved in normal physiology and disease and have been widely implicated in cancer progression. Despite our extensive knowledge of the signaling pathways regulated by PKC isozymes and their effectors, there is essentially no information on how individual members of the PKC family regulate gene transcription. Here, we report Wnt beta-catenin pathway the first PKC isozyme-specific analysis of global gene expression by microarray using RNAi depletion

of diacylglycerol/phorbol ester-regulated PKCs. A thorough analysis of this microarray data revealed unique patterns of gene expression controlled by PKC alpha, PKC delta, and PKC epsilon,

which are remarkably different in cells growing in serum or in response to phorbol ester stimulation. PKC delta is the most relevant isoform in controlling the induction of genes by phorbol ester stimulation, whereas PKC epsilon predominantly regulates gene expression in serum. We also established selleck chemicals that two PKC delta-regulated genes, FOSL1 and BCL2A1, mediate the apoptotic effect of phorbol esters or the chemotherapeutic agent etoposide in prostate cancer cells. Our studies offer a unique opportunity for establishing novel transcriptional effectors for PKC isozymes and may have significant functional and therapeutic implications.”
“Background. Despite the increasing use of extended lung donors, the shortage of lung donors remains. Usage of non-heart-beating (NHB) lung donors contributes to fight this shortage. We describe our experience in 21 consecutive adult lung transplantations using nonheparinized category III NHB donors and standard flush preservation.\n\nMethods. From January 2005 to December 2008, we collected donor and recipient GSK2879552 order data of all NHB category III lung transplantations performed in Our center. For comparison, we also collected the data of all heart-beating (HB) lung transplantations

in the same period. We focused on data describing the donor, the donor procedure, the recipient’s primary graft dysfunction, survival, rejection episodes, and the lung graft function.\n\nResults. Twenty-one NHB and 77 HB lung transplantations were performed. Circulation arrest occurred after 14 (4-62) min and warm ischemia time was 30 (19-44) min. Occurrence of primary graft dysfunction, acute rejection episodes, development of bronchiolitis obliterans syndrome was equal to the HB cohort as was the 2 years survival of 95% in the NHB group compared with 86% in the H B group. Lung graft function during the first 2 years tended to be better preserved in the NHB group.\n\nConclusion. Category III NHB lung donation is a good alternative in addition to H B lung donation.

Genotypes 3 and 4 have been identified in parallel in pigs, wild boars and other animal species and their zoonotic potential has been confirmed. Until 2010,

these genotypes along with avian HEV strains infecting chicken were the only known representatives of the family Hepeviridae. Thereafter, additional HEV-related viruses have been detected in wild boars, distinct HEV-like viruses were identified in rats, rabbit, ferret, mink, fox, bats and moose, and a distantly related agent was described from closely related salmonid fish. This review summarizes the characteristics see more of the so far known HEV-like viruses, their phylogenetic relationship, host association and proposed involvement in diseases. Based on the reviewed knowledge, a suggestion for a new taxonomic grouping scheme of the viruses within the family Hepeviridae is presented. (c) 2014 Elsevier B.V. All rights reserved.”
“Epstein-Barr virus (EBV)-associated gastric carcinoma accounts for nearly 10% of all gastric carcinomas and has distinct demographic, clinical and pathological features compared with EBV-negative gastric carcinoma. We herein report the case of a patient with EBV-associated gastric carcinoma followed up for 12 years during the natural course of the disease. The appearance of the tumor on gastroscopy and computed tomography gradually changed,

and the size of the lesion increased very slowly during the 12 years, without metastasis. The present case indicates that some find more EBV-associated gastric carcinomas progress very slowly.”
“Murine light chain 3 (LC3) exists as two isoforms, LC3 alpha and beta: LC3 beta is an RNA-binding Linsitinib protein that enhances fibronectin (FN) mRNA translation, and is also a marker of autophagy. We report embryonic expression patterns for LC3 alpha and LC3 beta, with some overlap but notable differences in the brain, and in tissues of non-neuronal origin. LC3 beta knockout (-/-) mice develop normally without a compensatory increase in LC3 alpha LC3 beta-/- embryonic fibroblasts (MEFs) exhibit reduced FN synthesis but maintain wild type (WT) levels of FN protein. No significant changes in proteins associated with

FN turnover, i.e., caveolin-1, LRP-1, or matrix metalloproteinases were identified. Autophagosomes form in amino acid-starved LC3 beta-/-MEFs, and Caesarean-delivered pups survive as long as WT pups without an increase in LC3-related proteins linked to autophagy. These results suggest novel compensatory mechanisms for loss of LC3 beta, ensuring proper FN accumulation and autophagy during fetal and neonatal life.”
“Manipulation of product heterogeneity was attempted by using yeast extract as nitrogen source in Alternaria alternata S-f6 transformation process of 4′-demethylepipodophyllotoxin. When the nitrogen source of NaNO(3) was replaced by yeast extract, the heterogeneity of biotransformation products was significantly varied from a single product (i.e.

By tuning the area fraction of the small disks, relaxation process for the small disks shows concave-to-convex crossover and logarithmic Tariquidar purchase decay behavior, as found in other binary mixtures with large size disparity. Moreover, diffusion of both species is suppressed by adding small disks. Long-time diffusion for the small disks shows power-law-like behavior at sufficiently high area fractions of the small disks, which implies precursors

of a glass transition for the large disks and a localization transition for the small disks. Therefore, our results demonstrate the generic dynamic features in highly size-asymmetric binary mixtures. (C) 2012 American Institute of Physics. [http://dx.doi.org/10.1063/1.4751546]“
“Inappropriate antibiotic use contributes to the emergence and spread of drug resistant infections. Though injection drug users are at increased risk for drug resistant infections, few studies have examined antibiotic use in this population.\n\nTo selleck understand patterns and determinants of antibiotic use among injection drug users.\n\nFive focus groups were conducted with 28 current injection drug

users recruited from a syringe exchange program in Philadelphia and analyzed using the constant comparative method to identify emergent themes. Twenty-six participants also completed a written survey instrument.\n\nInjection drug users reported frequent antibiotic exposure, with 12 of 26 participants reporting use of antibiotic medications at least once in the previous 30 days. Participants reported several patterns of antibiotic use that were see more potentially harmful, including delays in seeking medical care, failing to fill prescriptions, obtaining antibiotics from non-provider sources, and poor adherence

to prescribed regimens. The major determinants of inappropriate antibiotic use were delayed recognition of severity of illness, reluctance to wait to be seen, previous mistreatment by providers, lack of insurance, prioritizing purchasing drugs of abuse over antibiotics, forgetting to take antibiotics because of distractions that accompany drug use, concerns about interactions between antibiotics and other substances, and an irregular diet. Additionally, injection drug users commonly misunderstood the concept of antibiotic resistance and equated it with tolerance.\n\nInjection drug users reported potentially dangerous antibiotic use behaviors and described determinants of these behaviors. Outreach and educational interventions to improve antibiotic use should target high-risk populations, such as injection drug users, and consider their distinct antibiotic use behaviors and determinants.”
“The sensory innervation of the clavicle remains controversial. The supraclavicular, subclavian, and long thoracic/suprascapular nerves, alone or together, may be responsible for pain transmission after clavicular fracture and surgery.