The effective cation exchange capacity was calculated as a molar

The effective cation exchange capacity was calculated as a molar ratio of exchangeable Al (Ex-Al3+) to the sum of exchangeable Ca (Ex-Ca2+), exchangeable Mg2+, exchangeable sodium (Ex-Na+),

Ex-K+, and Ex-Al3+[15]. The Al saturation was calculated as Al/effective cation exchange capacity. The soils were also extracted using 0.1M Na-pyrophosphate (pH 10.0; soil ratio: extractant 1:100, with shaking for 16 h) for organic Al (Alp) [16]. The Al in the extract solution was measured in duplicates using an atomic absorption spectrometry equipped with graphite furnace selleck products atomizer (PerkinElmer Analyst 700; PerkinElmer Inc., Norwalk, CT, USA). The data were statistically evaluated using the Data click here Processing System 11.0 edition for Windows [17] (Zhejiang University, Hangzhou, China). Data are presented as the mean ± standard deviation. Analysis of correlation was performed with three replicates. Some studies have indicated that unbalanced cations and nutrition disorders have contributed to a decline in ginseng

garden soil conditions [1] and [18]. A measurement of the major cations was carried out seasonally. Both concentrations of Ex-Na+ and Ex-K+ stayed relatively constant without obvious spatial variation during 2009; however, they sharply increased in the 0–5 cm depth in the spring of 2010 (Fig. 1A–J). The exception was the decrease in both the Ex-Na+ and Ex-K+ in transplanted 1-yr-old ginseng soils in the spring, which might be driven by individual factors. The Ex-Ca2+ concentration showed a decrease within a 1-yr cycle of investigation (Fig. 1K–O). For transplanted 1-yr-old ginseng soils particularly, the Ex-Ca2+ concentration sharply decreased Astemizole in the three depths after the spring of 2009 (Fig. 1N). Although the Ex-Ca2+ concentrations in

the transplanted 2-yr-old ginseng soil were constant, a value of approximately 0.4 was the lowest of the detected Ex-Ca2+ concentration data (Fig. 1O). The exchangeable Mg2+ concentrations were kept relatively constant at the three soil depths for the different aged ginsengs within a 1-yr cycle (Fig. 1P–T). The NH4+ concentrations showed sharp decreases at all three depths from the spring of 2009 (Fig. 2A–E). The decrease was more remarkable in the summer and autumn. There were two obvious exceptions: the increase of NH4+ in the 0–5 cm layer for the 1- and 3-yr-old ginseng soils during the next spring (Fig. 2A,C), which might have been driven by individual factors. The surface (0–5 cm) NO3− concentration exhibited a remarkable increase in the summer and autumn, and then sharply decreased to the original level by the next spring (Fig. 2F–L). The NO3− concentrations in the 0–5-cm layer peaked in the autumn and were over 10-fold greater than those in the spring (Fig. 2F–L).

, 2007) With regard to the effort to apply RNAi to pest manageme

, 2007). With regard to the effort to apply RNAi to pest management, the focus has been on non-cell autonomous RNAi. Two types of dsRNA uptake mechanisms have

been identified. In Caenorhabditis elegans Maupas, the best characterized animal for RNAi, two transmembrane proteins involved in the dsRNA uptake in non-cell autonomous RNAi were identified. SID-1 (Systemic RNAi Defective) is essential and sufficient to mediate systemic spreading of RNAi signal while SID-2 is gut-specific and mainly facilitates environmental RNAi in cooperation with SID-1 ( Feinberg and Hunter, 2003; McEwan et al., 2012; Winston et al., 2002, 2007). The second dsRNA uptake mechanism involves a receptor-mediated endocytosis pathway specific for environmental RNAi. It was first discovered selleck screening library in Drosophila S2 cells and later shown to also play a Small Molecule Compound Library role in worms indicating its evolutionary conservation ( Jose and Hunter, 2007; Saleh et al., 2006; Ulvila et al., 2006). While C. elegans demonstrated a very strong RNAi response, among the thirty or so insect species in which the RNAi phenomenon has been investigated thus far, sensitivity to systemic RNAi has been found to vary considerably, with successful

suppression of gene expression presumed to depend on intrinsic properties of species, as well as the genes and tissues being targeted (reviewed in Bellés (2010)). In several less derived insect species, systemic RNAi responses are quite robust, even persisting into subsequent generations via germ line transmission ( Bucher et al., 2002; Liu and Kaufman, 2004a, b; Lynch and Desplan, 2006; Mito et al., 2008; Ronco et al., 2008). In contrast, some of the more derived dipteran and lepidopteran species that have been examined appear to be refractory to systemic RNAi. Responses to injected dsRNA in the Lepidoptera have been found to be particularly variable (reviewed in Terenius et al. (2011)). Among several proposed contributing factors in the susceptibility of insect species to RNAi, the stability of dsRNA after entering into the insect has been highlighted by a few recent studies. DNA/RNAse non-specific activity distinct

from that of dicer has been reported in several lepidopteran species (Allen and Dapagliflozin Walker, 2012; Arimatsu et al., 2007; Garbutt et al., 2012; Liu et al., 2012). These extracellular enzymes are secreted into various tissues and digest dsRNA. This at least partially explains the observation that in Drosophila melanogaster Meigan and lepidopterans, hemocytes are in general much easier to target for RNAi than other tissues, since dsRNAs are usually directly injected into hemolymph. More intriguingly, one study showed that for an RNAi-insensitive insect, Manduca sexta Linnaeus, exogenous dsRNA was subject to rapid degradation in hemolymph whilst for Blattella germanica Linnaeus, a phylogenetically more basal species known to be highly susceptible to RNAi, dsRNA persisted much longer ( Garbutt et al.

In past years, the occurrence of vanillin as an intermediate in t

In past years, the occurrence of vanillin as an intermediate in the microbial degradation of FA has been reported by many research groups [28], [45], [54] and [66]. Natural vanillin has a high demand in the flavor market as it is used as a flavoring agent in foods, beverages, pharmaceuticals and other industries [20]. Industries such as chocolate and ice cream together capture about 75% of the total market of vanillin, while the small amount is used in baking.

Vanillin is also used in the fragrance industry for the making of good quality of perfumes, in cleaning products, in livestock fodder and pharmaceuticals to cover the unpleasant odors or tastes of medicines. Biosynthesis of vanillin from FA (Fig. 4) is achieved by the conversion of FA into feruloyl SCoA (reduced feruloyl coenzyme A) using ATP (adenosine triphosphate) and CoASH (reduced coenzyme A). Removal of water and CH3COSCoA BMS-754807 mouse (reduced acetyl coenzyme Atezolizumab datasheet A) molecule converts feruloyl SCoA finally into vanillin. In addition of above functions, vanillin can also be used in visualization of components in thin layer chromatography staining plates. These stains give a range of colors for the different components. Pseudomonas putida is found to convert the FA to into vanillic acid very efficiently.

ROS (reactive oxygen species) formation is the main cause of UV-induced skin damage. During the exposure to radiation, a photon interact with trans-urocanic acid in skin and generate Rho singlet oxygen that can activate the entire oxygen free radical cascade with oxidation of proteins, nucleic acid and lipids, resulting in the photoaging changes and skin cancer [6] and [7]. FA is a strong UV absorber [17], and skin absorbs it at the same rate at acidic and neutral pH [68]. FA structure is similar to tyrosine, and it is believed that FA inhibits the melanin formation through competitive inhibition with tyrosine. It gives a considerable protection to the skin against UVB-induced erythema in a time dependent manner [68]. FA alone or in alliance with vitamin E

and vitamin C provides about 4–8 fold protection against solar-simulated radiation damage on most likely interacting pro-oxidative intermediates. Successful photoprotection with solar-simulated ultraviolet induced photodamage was recorded on a pig (in vivo experiments) by using a mixture of FA (0.5%), vitamin E (1%) and, vitamin C (15%) [38]. In the etiology of cancer, free radical plays a major role; therefore antioxidants present in diet have fastidious consideration as potential inhibitors of abandoned cell growth. FA’s anti-carcinogenic activity is related to its capability of scavenging ROS and stimulation of cytoprotective enzymes [6]. By doing this, FA diminished lipid peroxidation, DNA single-strand rupture, inactivation of certain proteins, and disruption of biological membranes [26].

However, IL-1β is not consistently

elevated in the synovi

However, IL-1β is not consistently

elevated in the synovial fluid of OA patients [53] and [92] and the endogenous IL-1 receptor antagonist, which blocks IL-1 activity, is produced by synoviocytes at higher levels in OA than PLX-4720 solubility dmso in RA [33]. Attempts to block IL-1 activity therapeutically in patients have been associated with only minimal symptom-reducing efficacy at best [18] and [20]. However, it is possible that IL-1 activity is important in specific clinical settings in OA. Production of active IL-1 requires activation of the NALP3 inflammasome; activation of the inflammasome by uric acid crystals has been implicated in flares of gouty arthritis [69]. Other crystals, including basic calcium phosphate [76] and hydroxyapatite [48] have recently been shown to activate inflammasome-mediated IL-1 production. Both hydroxyapatite and basic calcium phosphate crystal deposition occurs in patients with OA. Therefore, it is possible that IL-1 is important in patients with OA and evidence of crystalline deposition. TNF-α is readily detectable in SF in patients

with OA [92]. Like Liver X Receptor agonist IL-1, TNF can activate chondrocyte-mediated catabolic protease production [51]. The well-established clinical efficacy of TNF inhibition in the setting of RA, and the availability of blocking agents, led to trials of a TNF-inhibitor in an open-label pilot study to treat pain and inflammation in twelve patients with erosive hand OA [67]. Like the IL-1 trials, this trial did not demonstrate significant efficacy, but improvement in pain and physical function scores was reported for some individuals. It remains to be seen whether different patient subsets will respond to targeted therapies

blocking the actions of TNF. The perivascular inflammatory cell infiltrates observed in the OA synovium are largely composed of lymphocyte populations [7]. Based on this observation, our group investigated the expression and activity of cytokines involved in lymphocyte biology in OA synovium. We focused our efforts on the common-γ chain family of cytokines (including IL-2, IL-15, and IL-21) which are involved in recruitment, survival and activity of lymphocytes [89]. IL-15 was consistently Chloroambucil detectable and elevated in patients with early stage OA, compared with end-stage OA patients undergoing total knee arthroplasty. In rheumatoid synovial fibroblasts, TLR-2 and -4 stimulation were shown to induce IL-15 production in vitro [49]. Both synoviocytes [89] and chondrocytes (Scanzello, unpublished results) from OA patients express the specific IL-15 receptor, suggesting there may be multiple cellular targets of IL-15. Serum IL-15 detected using a proteomic approach was associated with the presence and progression of radiographic OA [62]. Studies by Long et al. showed that IL-7, another common-γ chain cytokine which activates lymphocytes, is produced by chondrocytes [66].

Later studies showed that these three SNPs were associated with H

Later studies showed that these three SNPs were associated with HbF levels in sickle cell disease (SCD) patients from other populations: African American and Brazilian [6], African British [7] and [11], and Tanzanian [7]. HMIP-2 is characterized by eleven PCI-32765 mouse SNPs, all of which have shown a strong association with HbF levels in Europe, but only some of them have shown a significant association in SCD African ancestry patients [9] and [11]. The MAF of rs9399137 (C), considered the most significantly associated with HbF expression, is less common in African populations, with frequencies of 1–2% in African descendant SCA patients without European

admixture [7] and [11]. Similarly, a 3-bp (TAC) deletion, which is in complete LD with the minor allele of rs9399137 and considered as the functional motif for this QTL, is also more common in non-African populations [12]. However, the minor allele of rs9399137 (C) was

found with significantly higher frequencies in African American SCA patients with HbF unusually CDK and cancer higher than among patients with low HbF (18% versus 3%; P = 0.02) [8]. The authors suggested that some patients with markedly elevated HbF might have inherited the minor allele of rs9399137 due to European genetic admixture. In summary, the HBS1L-MYB intergenic polymorphism is also associated with HbF among SCA patients of African ancestry, although much less significantly so when compared with European and Chinese patients because of their much lower MAF (review

in [4]). Positive association between the MAF of rs7482144 (A), in the Gγ-globin (HBG2) gene promoter, and HbF levels, has been well documented in Tanzanian patients selected from the Muhimbili Sickle Cell Collaborative Program [6], in Dar-es-Salaam [7], and in African American SCD patients selected from the Cooperative Study of Sickle Cell Disease (CSSCD) [13]. However, no significant effects of rs7482144 on HbF levels were found in African British patients very of African-Caribbean (Jamaican, Trinidanian) or West African (Nigerian, Ghanaian, Sierra Leonean) descent, selected from King’s College Hospital, in London, nor in African Brazilian patients from the State of Pernambuco, Brazil — northeastern region [6]. Further evidence of the influence of rs7482144 on HbF levels has been obtained in African–American patients also selected from the CSSCD when patients with high levels of HbF who showed the minor allele (A) presented a frequency significantly higher than that found among those with low levels of HbF (30% versus 10%, P = 0.002). However, the frequencies of the A allele of rs7482144 were not different between high and low HbF groups in another sample of African–American SCA patients selected from the Reference Laboratory Diagnosis of hemoglobin in the Boston Medical Center (10% versus 8%, respectively, P = 1.0) [8].

The highest decolorization value was obtained in case of methyl o

The highest decolorization value was obtained in case of methyl orange and trypan blue, almost no decolorization Nutlin-3 mouse was detected in case of ramazol yellow. Formation of GNPs was confirmed by the formation of violet color after 90 min at room temperature that gave a significant peak at 550 nm. Size distribution of the formed GNPs using DLS and TEM imaging of GNPs showed highly mono dispersed GNPs with size range of 22–39 nm. The FTIR spectrum of laccase before and after formation of GNPs (Fig.

9 and Fig. 10), showed the change in the corresponding peaks of functional groups before and after formation of GNPs, expressing change in intensity of the major peak at 3016 cm−1 that corresponds to OH and/or NH functional groups and the peak of 1631 cm−1 corresponds to carbonyl group, both could be ascribed to secondary amide structure. Incubation of laccase enzyme in the presence of HAuCl4 at different temperatures showed that as temperature increased, absorbance increased which indicated higher concentration of formed GNPs. Testing the effect of gamma radiation on the production of GNPs showed that increasing the dose of radiation increased the production of GNPs; maximum GNPs production was noticed at 5 kGy. No color was detected in blank sample (radiation before mixing with HAuCl4). In case of effect of different concentrations

of HAuCl4 on GNPs synthesis, the best volume of HAuCl4 was 0.3 ml as it gave Resminostat the highest concentration of GNPs; further increase in gold volumes caused decrease BLZ945 ic50 in GNPs concentration The most efficient lignolytic fungi are the basidiomycetes. They could be either white or brown-rot fungi, both of which are taxonomically so close to each other that they sometimes appear in the same genus. Almost all species of white-rot fungi were reported to produce laccase to varying degree [21]. After screening seven fungal strains, Pleurotus ostreatus (a well-known white-rot fungus) was chosen due to its relatively high laccase activity compared

to other laccase producing fungi. Pleurotus ostreatus is a common edible mushroom also known as Oyster mushroom. It was first cultivated in Germany as a subsistence measure during the World War I [22]. It is now grown commercially around the world for food. Increasing the production of lignolytic enzymes may be achieved by modifying the source of carbon and nitrogen in the medium. Since the high cost of the enzyme is a major limitation in using laccase in an industrial scale; using agricultural wastes not only decreases the cost but also solves an environmental problem [23]. Wheat bran is an abundant byproduct formed during wheat flour preparation; it has been selected to perform the present study for its high yield of laccase.

036) between the 2 techniques 16 Further

036) between the 2 techniques. 16 Further Epigenetics Compound Library larger trials are needed to confirm the potential of this red flag technique and to compare its yield with that of CE-guided biopsies. Patients with long-standing extensive colitis are at increased risk for developing neoplasia and the literature suggests that surveillance endoscopy reduces mortality from CRC in these patients. CE with indigo carmine or methylene blue has replaced random biopsies as a standard for surveillance in these patients; this is supported by several clinical trials and incorporated

in recent guidelines. Future studies on digitally enhanced imaging, such as NBI, will continue to be of interest, but one has to be cautious that current data do not show their superiority compared with CE. Future unmet needs in colitis surveillance include proper training and implementation for all endoscopists. Although the evidence is abundant and supports the use of CE, it is far from being widely implemented outside of tertiary referral centers. The minimal criteria need to be standardized to determine properly trained endoscopists. An endoscopist

may need to start with CE coupled with 4-quadrant biopsies and then cautiously proceed with CE-guided biopsies once competence metrics are met. The implementation of these techniques needs to be monitored in prospective quality registries BIBW2992 order to ensure patient safety and the performance by secondary care gastroenterologists. “
“Most nonpolypoid colorectal neoplasms (NP-CRNs) are visible, and their detection can be learn more facilitated by the use of chromoendoscopy. Patients with inflammatory bowel disease (IBD) have a high risk of colitis-associated dysplasia and cancer.1 and 2 These types of dysplasia and cancer, as compared with sporadic adenoma/carcinoma, seem to

have a distinct growth pattern, which can be flat, multifocal, or anaplastic.3, 4, 5, 6 and 7 Therefore, it is important that careful surveillance with colonoscopy is performed for all patients with IBD and, more frequently, for those considered to be at high risk.8, 9, 10, 11 and 12 Traditionally, flat dysplasia in ulcerative colitis (UC) has been considered to be detectable only by using random biopsy specimens of mucosa that appeared unremarkable during endoscopy.13, 14 and 15 However, recent studies have shown that most of them are visible; thus, their detection as nonpolypoid colorectal neoplasms (NP-CRNs) is an integral component in the prevention of colitic cancer.9, 16, 17 and 18 Unlike dysplasia-associated lesions or masses, which are readily visible using conventional endoscopy,19 the detection of NP-CRN can be more difficult. NP-CRN in colitic IBD (cIBD) is often present simply as redness or a granular patch of mucosa that may not be readily distinguishable from the surrounding inflamed mucosa.

Two periods can be distinguished: one was from 1900 to 1950, when

Two periods can be distinguished: one was from 1900 to 1950, when the annual rate of increase in total zinc in the sediments was 2.5 μg g−1 y−1, and the other from 1950 to 1990, when the annual rate of increase of zinc in the sediments fell to 1.5 μg g−1 y−1. Several authors

relate the elevated zinc concentration in sediments to anthropogenic discharges to the aquatic environment ( Zhu et al. 2001, Taylor & Kesterton 2002, Bi 2003, Dassenakis et al. 2003, Wu et al. 2004, Dong et al. 2004, Yuan et al. 2004, Abd El-Azim & El-Moselhy 2005, Saad & Ahdy 2006, Huang et al. 2007, Luo et al. 2008). As long as Nozha Hydrodrome received untreated sewage from the surrounding urban areas, the rise in zinc concentrations in the sediments reflected the progressive expansion in Selleckchem GW3965 urbanization with time during the period from 1900 to 1990. In 1990, the municipality of Alexandria city completed the construction

of the Nozha district sewer system and the new East Wastewater Treatment Plant (EWTP) that serves the southern and western districts of the city. After the implementation of the sewer system and sewage treatment plant, much of the discharge of untreated domestic effluents GSK1210151A datasheet to Nozha Hydrodrome stopped (WWCG 1992). Since then, and despite the ongoing urbanization around the Hydrodrome, the zinc concentration in the sediments has been decreasing at a rate of 1.5 μg g−1 y−1. The point of determining the concentrations

of zinc and cadmium in the mobile and residual phases was to assess the stability of the studied metals in the solid phase. The similar vertical distribution patterns (temporal behaviour) for the concentrations of the metals in the different phases indicate that there is a slow or probably no mobilization with time and that the metals tend to be trapped in the Branched chain aminotransferase solid phase. By contrast, an insignificant relationship indicates mobilization of the metal from the solid to the dissolved phase. To test the potential mobilization from sediment to water the average cosine θ coefficients (Rphases) for zinc and cadmium were calculated. This measure represents the relationship between the mobile phases and the residual phase of a metal with time. The average Rphases for zinc concentrations in sediment is 0.9 (Figure 2). This highly significant relationship, together with the environmental conditions prevailing in Nozha Hydrodrome – pH=8.9 (Youssef & Masoud 2004) and DO=6.02 mg l−1 (Saad & Safty 2004) – suggests that zinc tends to be trapped in the sedimentary compartment. This interpretation could also be inferred from the similarity of the patterns of the vertical distribution curves for zinc in the different phases (Figure 2). Moreover, the average concentration of dissolved zinc in Nozha Hydrodrome water is 8.1 μg 1−1 ( Saad 1987).

, 2011) Given the paucity of studies on plant–plant interactions

, 2011). Given the paucity of studies on plant–plant interactions in TAE, a research priority is to apply the methodologies that have developed by plant community ecologists in other alpine ecosystems and, more generally, in other stressful

ecosystems (see Callaway, 2007, Brooker et al., 2008 and Lortie, 2010 for reviews). This would allow ranking the Lumacaftor many potential factors specific to TAE that may change the outcome of plant–plant interactions (see, e.g. Baumeister and Callaway, 2006). Key approaches include (1) studying interactions at community level (Cavieres and Badano, 2009 and Maestre et al., 2009), (2) using the most appropriate interaction indices (Armas Kinase Inhibitor Library price et al., 2004 and Seifan et al., 2010), and (3) considering intraspecific variability in nurses in the outcome of interactions (Albert et al.,

2011 and Violle et al., 2012), especially by measuring plant functional traits (e.g. at leaf level: SLA, LDMC) to quantify more thoroughly the specific effect of TAE on plants (Violle et al., 2007 and Gross et al., 2009). We present in more details two key methodological approaches, which may evidence specific outcome of plant–plant interactions in TAE: studies along gradients and in situ manipulative experiments. (1) Studies along gradients. One particularly relevant method to examine the effects of environmental the variables on the outcome of plant–plant interactions at a local level is to examine plant performance along altitudinal gradients ( Körner, 2007 and Lortie, 2010). This would be relevant for example when considering the variable “annual rainfall amount” which is expected to increase with altitude at high latitude, but has a reverse pattern at low latitudes.

In parallel, variation in slope aspect through north-south comparisons close to the tropics or with East–West comparisons close to the Equator may provide interesting local comparisons by generating abrupt shifts in water stress with potential effects on the outcome of plant–plant interactions ( Badano et al., 2005, Cavieres et al., 2006, Farji-Brener et al., 2009 and Soliveres et al., 2010). From a macro-ecological perspective, analyses or meta-analyses of the outcome of plant–plant interactions along large-scale latitudinal gradients (see Holzapfel et al., 2006, Cavieres and Badano, 2009 and Kikvidze et al., 2011), are required to yield a global view of TAE’s specific effects on plant–plant interactions.

Cytokines facilitate pain via a pathway that leads to release of

Cytokines facilitate pain via a pathway that leads to release of neurotransmitters or neuromodulators that activate spinal cord glia and enhance pain (Watkins and Maier, 2005). Although the TNF-α inhibitors infliximab (Karppinen et al., 2003) and etanercept (Genevay et al., 2004) had each shown encouraging

results in open-label studies involving disk-related sciatica prior to inception of the OSTEOPATHIC Trial, few patients in our study involving nonspecific chronic LBP were likely to be using such agents. Thus, it is possible that OMT may have reduced serum TNF-α concentration, thereby enhancing the analgesic GSI-IX in vitro effects of prescription and non-prescription medications that were mediated via different mechanisms. It also has been

shown that healthy cigarette smokers have higher serum TNF-α concentrations than comparable non-smokers (Petrescu et al., 2010). Consequently, it is reasonable to speculate that any TNF-α reducing effects of OMT may inhibit pathways that maintain or enhance pain in cigarette smokers. Psoas syndrome is a muscular Adriamycin mouse imbalance that may be frequently missed in patients with LBP (Tufo et al., 2012). Muscle functional magnetic resonance imaging has demonstrated greater transverse relaxation time asymmetry of the psoas muscle in patients with LBP vs. controls, and OMT significantly reduced this asymmetry while also providing LBP improvement (Clark et al., 2009). Because psoas syndrome is often found in patients with longstanding and disabling LBP (Greenman, 1996), remission of psoas syndrome is a feasible mechanism of action underlying clinical

response to OMT in subgroups of patients with LBP duration greater than one year, greater deficits in back-specific functioning, and poorer general health. Indeed, we found psoas syndrome to be present at baseline in 117 (51%) of the 230 patients allocated to receive OMT in the OSTEOPATHIC Trial, and remission of psoas syndrome at the final scheduled Tryptophan synthase treatment session at week 8 was strongly predictive of a clinical response at the week 12 exit visit (Licciardone et al., 2014). There are several limitations of the present study. The assessment of clinical response to OMT was performed only at six study visits and there were no data on possible response at other intervening time points. The inclusion of only those patients with high baseline pain severity wherein OMT was most efficacious limited the sample size and statistical power of the subgroup analyses and their generalizability. These subgroup analyses were not originally planned and the absence of blocked randomization within any subgroup raises the possibility that unknown confounders may have biased the subgroup results. No attempt was made to identify such potential confounders, nor to use multivariate techniques to control for available covariates because of the relatively small sample size.