Furthermore, this review gives an in-depth overview of the differ

Furthermore, this review gives an in-depth overview of the different techniques and vehicles for intracellular mRNA delivery exploited by us and other groups, comprising electroporation, gene gun injection, lipo- and polyplexes. Finally, it covers recent literature describing specific applications for mRNA based gene delivery, showing that until now most attention has been paid to vaccination

strategies. JQEZ5 clinical trial This review offers a comprehensive overview of current knowledge of the major theoretical as well as practical aspects of mRNA-mediated transfection, showing both its possibilities and its pitfalls and should therefore be useful for a diverse scientific audience. (C) 2010 Elsevier B.V. All rights reserved.”
“Recently, microsatellite polymorphisms have been reported to S3I-201 solubility dmso be associated with four genes, GABRB3, MAOB, PAH, and SLC6A4, and their relationships have been tested to five symptom factors: hallucinations, delusions, negative symptoms, mania, and depression.

These factors were frequently present in schizophrenia spectrum disorders in the Irish Study of High Density Schizophrenia Families (ISHDSF) with a proband with the diagnosis of schizophrenia (Bergen et al., 2009). Of these, GABRB3 and PAH were reported to be significantly associated with hallucinations and delusions in a 90-family subset of the ISHDSF, respectively. In this study, we tested the association of genetic markers from these four gene regions with the approximate five clinical symptoms, based upon 256 schizophrenia patients, with genotypic data obtained by higher resolution single nucleotide polymorphism (SNP) Selleck VS-6063 genotyping. We found one GABRB3 SNP (rs1426891, 70.8 kb downstream of this gene) and haplotype constructed by three SNPs (rs1426891, rs2912602, and rs2912600) were significantly associated with hallucinations in Caucasians after Bonferroni correction

for multiple testing (Bonferroni corrected P.. 0.032 and 0.016, respectively). Additionally, we found one haplotype constructed by two SNPs, rs5905587-rs37615860, in MAOB/NDP gene region was significantly associated with delusions in all samples tested (Bonferroni corrected P: 0.048). These results provide additional evidence that GABRB3 and MAOB/NDP gene regions might constitute risk factors for hallucinations and delusions in schizophrenia. (C) 2012 Elsevier Ireland Ltd. All rights reserved.”
“Hydrazoic acid (HN3)-potentially explosive, highly toxic, and very hygroscopic-is the simplest covalent azide and contains 97.7 wt % nitrogen. Although its molecular structure was established decades ago, its crystal structure has now been solved by X-ray diffraction for the first time. Molecules of HN3 are connected to each other by hydrogen bonds in nearly planar layers parallel to (001) with stacking sequence A, B, … The layer distance, at 2.

Asymmetric phase-transfer catalysis was unable to provide the (S)

Asymmetric phase-transfer catalysis was unable to provide the (S)-alpha-Me-o-cyanophenylalanine precursor for (S)-alpha-MeAba in acceptable enantiomeric purity. However, by using a Schollkopf chiral auxiliary, this intermediate was obtained in 88% ee. [(S)-Aba 3-Gly 4] dermorphin retained mu-opioid affinity but displayed an increased delta-affinity. The corresponding R epimer was considerably less potent. In contrast, the [(R)-alpha-MeAba3-Gly4] dermorphin isomer was more potent than its S epimer. Tar-MD simulations of both non-methylated [Aba 3-Gly 4] dermorphin analogues showed a degree of folding at the C-terminal residues toward the N

terminus of the peptide, without SNS-032 purchase however, adopting a stabilized beta-turn conformation. The alpha-methylated analogues, on the other hand, exhibited a type I/I’ beta-turn BI-2536 conformation over the alpha-MeAba3 and Gly4 residues, which was stabilized by a hydrogen bond involving Tyr5-H(N) and D-Ala 2-CO.”
“Achieving effective controllable

delivery of therapeutic biomacromolecules for long action without new molecular entities generation or carriers employed offers a promising alternative and significant clinical benefit. We show here that recombinant human interferon-alpha (rhIFN) can form a three dimensional ordered structure that is featured by spherical semi-crystalline through molecular self-assembly directed by a polycationic short peptide. The phase diagrams for self-assembly were constructed to identify the optimal regions for nucleation and ordered growth, and which were followed by the physico-chemical characterization of the ordered self-assemblies, including morphology, particle size, X-ray diffraction, circular dichroism and biological potency evaluations. With varied molar ratio of the two composed selleckchem biomacromolecules,

the dissolution behaviors of the self-assemblies could be manipulated in vitro and in vivo. The plasma pharmacokinetics suggested that s.c. administration of self-assemblies at the specified relative proportion of rhIFN to polycationic peptide offered a significant prolonged duration time of rhIFN blood levels up to seven days. Moreover, molecular simulation was performed to better understand their binding site and mode. The work described here demonstrates the possibility of spherical ordered self-assembly of biomacromolecules for controllable delivery application of therapeutic proteins. (C) 2012 Elsevier Ltd. All rights reserved.”
“Histone deacetylases (HDACs) counterbalance acetylation of lysine residues, a protein modification involved in numerous biological processes. Here, Hdac1 and Hdac2 conditional knock-out alleles were used to study the function of class I Hdac1 and Hdac2 in cell cycle progression and haematopoietic differentiation.

ResultsThe VE1 antibody showed a sensitivity of 85% and a specifi

ResultsThe VE1 antibody showed a sensitivity of 85% and a specificity of 100% as compared to DNA pyrosequencing results. There was 100% concordance between VE1 immunostaining of primary and metastatic melanomas from the same patient. V600K, V600Q, and V600RBRAF melanomas did not positively stain with VE1. ConclusionsThis hospital-based study finds high sensitivity and specificity

for the BRAF VE1 immunostain in comparison to pyrosequencing in detection of BRAFV600E in melanomas.”
“Replication of damaged DNA (translesion synthesis, TLS) is realized by specialized DNA polymerases. Additional protein factors such as replication AZD7762 manufacturer protein A (RPA) play important roles in this process. However, details of the interaction are unknown. Here we analyzed the influence of the hRPA and its mutant hABCD lacking domains responsible for protein-protein interactions on ability of DNA polymerase lambda to catalyze TLS. The primer-template structures containing varying parts of extended strand (16 and 37 nt) were used as model systems imitating DNA intermediate of first stage of TLS. The 8-oxoguanine disposed in

+1 position of the template strand in relation to 3′-end of primer was exploited as damage. It was shown that RPA stimulated TLS DNA synthesis catalyzed by DNA polymerase lambda in its globular but not in extended conformation. Moreover, this effect is dependent on the presence of p70N and p32C domains in RPA molecule.”
“Context: Animal studies suggest that hypophosphatemic rickets (HPR) is associated see more with muscle function deficits, but it is unknown whether humans with HPR have a muscle disorder.\n\nObjective: Our objective was to assess calf muscle size and density (an indicator of muscle quality) and lower extremity muscle function selleck kinase inhibitor in patients with HPR.\n\nSetting: The study was carried out in the outpatient department of a pediatric orthopedic

hospital.\n\nPatients and Other Participants: Participants included 34 individuals with HPR (6-60 yr; nine males) and 34 age-and gender-matched controls.\n\nMain Outcome Measures: Calf muscle parameters (muscle cross-sectional area and density) were measured by peripheral quantitative computed tomography. Lower extremity muscle function (peak force per body weight and peak power per body mass) was measured by jumping mechanography through five tests with different levels of difficulty: multiple two-legged hopping, multiple one-legged hopping, single two-legged jump, chair-rise test, and heel-rise test.\n\nResults: Compared with age-and gender-matched controls, patients with HPR had normal muscle size (P = 0.58) but lower muscle density (P = 0.008) and lower peak muscle force and power (P < 0.001 in each test).

3%), followed by A (61, 25 7%) and C (14, 5 9%) The

dist

3%), followed by A (61, 25.7%) and C (14, 5.9%). The

distribution of HBV genotypes between patients with acute hepatitis and CHB (carriers + CHB + LC + HCC), or between carriers and disease states (CHB + LC + HCC), or between mild chronic infection (carriers + CHB) and complications of chronic HBV infection (LC + HCC) was similar. Eighty-seven patients had liver biopsy; the median histological activity index (HAI) and fibrosis stage at baseline were similar between genotype groups (four [1-9] genotype A [n = 28]), three (2-4) genotype C (n = 4) and four (1-10) genotype D (n = 55); P = 0.33 for HAI score; (0.5 [0-6] genotype A, 0.5 [0-4] genotype C and 1 [0-6] genotype D; P = 0.92 for fibrosis stage). The response to therapy was similar between the genotypes.\n\nClinical, histological severity and therapeutic responses GS 1101 are similar among patients with HBV genotypes A and D.”
“Many plants accumulate substantial starch reserves in their leaves during the day and remobilize Selleckchem Ruboxistaurin them at night to provide carbon and energy for maintenance and growth. In this paper, we explore the role of a sugar-signaling metabolite, trehalose-6-phosphate (Tre6P), in regulating the accumulation and turnover of transitory starch in Arabidopsis (Arabidopsis thaliana) leaves. Ethanol-induced overexpression of trehalose-phosphate synthase during the

day increased Tre6P levels up to 11-fold. There was a transient increase in the rate of starch accumulation in the middle of the day, but this was not linked to reductive activation of ADP-glucose pyrophosphorylase. A 2- to 3-fold increase in Tre6P during the night led to significant inhibition of starch degradation. Maltose and maltotriose did not accumulate, suggesting that Tre6P affects an early step in the pathway

of starch degradation in the chloroplasts. Starch granules isolated from induced plants had a higher orthophosphate content than granules from noninduced control plants, consistent either with disruption of the phosphorylation-dephosphorylation cycle that is essential for efficient starch breakdown or with inhibition of starch hydrolysis by beta-amylase. Nonaqueous fractionation of leaves showed that Tre6P is predominantly BAY 63-2521 concentration located in the cytosol, with estimated in vivo Tre6P concentrations of 4 to 7 mu M in the cytosol, 0.2 to 0.5 mu M in the chloroplasts, and 0.05 mu M in the vacuole. It is proposed that Tre6P is a component in a signaling pathway that mediates the feedback regulation of starch breakdown by sucrose, potentially linking starch turnover to demand for sucrose by growing sink organs at night.”
“BACKGROUND: Polyunsaturated fatty acids lower serum triglycerides by a mechanism that may involve the inhibition of stearoyl-CoA desaturase (SCD).\n\nOBJECTIVE: We sought to evaluate the effects of serum fatty acids on 1) the SCD index in a controlled clinical setting, and 2) SCD regulation in Hep G2 cells.

48 samples of saliva were collected from 16 healthy subjects over

48 samples of saliva were collected from 16 healthy subjects over 3 days. Each sample was split in two and the first half treated with an oral rinse, while the second was left untreated

as a control sample. Nepicastat clinical trial The 96 H-1 NMR metabolomic profiles obtained in the dataset are affected by three factors, namely 16 subjects, 3 sampling days and 2 treatments. These three factors contribute to the total variation in the dataset. When analysing datasets from saliva using traditional methods such as PCA (principal component analysis), the overall variance is dominated by subjects’ contributions, and we cannot see trends that would highlight the effect of specific factors such as oral rinse. In order to identify these trends, we used methods such as MSCA ( multilevel simultaneous

component analysis) and ASCA (ANOVA simultaneous component analysis), that provide variance splits according to the experimental factors, so that we could look at the particular effect of treatment on saliva. The analysis of the treatment effect was enhanced, as it was isolated from the overall variance and assessed without confounding factors.”
“The purpose of this study was to perform a systematic review of the existing literature on the incidence of hypertrophic scarring and the psychosocial impact of burn scars. In a comprehensive literature review, the authors identified see more 48 articles published since 1965 and written in English which

reported the incidence and risk factors for hypertrophic scarring or assessed outcomes related to scarring. Most studies had important methodological limitations limiting the generalizability of the findings. In particular, the absence of standardized valid measures of scarring and other outcome variables was a major barrier to drawing strong conclusions. Among studies on hypertrophic scarring, the prevalence rate varied between 32 and 72%. Identified risk factors included dark skin, female gender, young age, burn site on neck and upper limb, multiple surgical procedures, meshed skin BMS 345541 graph, time to healing, and burn severity. With regard to psychosocial outcomes, two studies compared pediatric burn survivors with a nonburn comparison group on a body image measure; neither study found differences between groups. Across studies, burn severity and location had a modest relationship with psychosocial outcome variables. Psychosocial variables such as social comfort and perceived stigmatization were more highly associated with body image than burn characteristics. To advance our knowledge of the epidemiology of scars and the burden of scars, future studies need to implement more rigorous methodologies. In particular, standardized valid measures of scarring and other outcomes should be developed. This process could be facilitated by an international collaboration among burn centers.

Therefore, we call upon scientists, governments, and internationa

Therefore, we call upon scientists, governments, and international governmental and non-governmental organizations to harmonize current approaches in marine mapping and to develop a framework that is applicable throughout the Mediterranean region. Such coordination between stakeholders is urgently needed before more countries undertake further extensive habitat mapping, so that future conservation planning can use integrated spatial datasets.”
“Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and long-term use of ICSs

have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular selleck chemicals importance in elderly patients due to the presence of comorbidities and age-related behavioral, C59 supplier cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide

practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent selleckchem exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design

of specifically tailored clinical studies in the elderly.”
“Primary intraosseous arteriovenous malformations (AVMs) are rare and have only been occasionally reported. We herein report a histologically proven case of primary intraosseous AVM in the tibia, which mimicked a fibrous tumour on radiography. This presentation carries a risk of triggering acute large haemorrhage through unnecessary biopsy. In intraosseous AVM, the magnetic resonance (MR) imaging features typical of a soft tissue AVM are absent, making diagnosis difficult. In this report, peculiar MR features in the presence of a connecting vessel between the normal deep venous system of the lower extremity and the tumour provide a clue for the early diagnosis of primary intraosseous AVM.

Changes to drug education and prevention programs may be needed t

Changes to drug education and prevention programs may be needed to enhance understanding of drug properties and actions. (C) 2013 Elsevier Ireland Ltd. All rights reserved.”
“Vast amounts of effort have been devoted to investigate patterns of genetic diversity

and structuring in plants and animals, but similar information is scarce for organisms of other kingdoms. The study of the genetic structure of natural populations of wild yeasts can provide insights into the ecological and genetic correlates of clonality, Etomoxir inhibitor and into the generality of recent hypotheses postulating that microbial populations lack the potential for genetic divergence and allopatric speciation. Ninety-one isolates of the flower-living yeast Metschnikowia gruessii from southeastern Spain were DNA fingerprinted using amplified fragment length polymorphism (AFLP) markers. Genetic diversity and structuring was investigated with band-based methods and model-and nonmodel-based clustering. Linkage disequilibrium tests were used to assess reproduction mode.

Microsite-dependent, diversifying selection was tested by comparing genetic characteristics of isolates from bumble bee vectors and different floral microsites. AFLP polymorphism (91%) and genotypic diversity were very high. Genetic diversity was spatially structured, as shown by AMOVA (Phi(st) = 0.155) and clustering. The null hypothesis of random mating was rejected, clonality seeming the prevailing reproductive mode in the populations studied. Genetic diversity of isolates

declined from bumble bee mouthparts to floral microsites, and frequency of five Selleck Vadimezan AFLP markers varied significantly across floral microsites, thus supporting the hypothesis of diversifying selection on clonal lineages. Wild populations of clonal fungal microbes can exhibit levels of genetic diversity and spatial structuring that are not selleck inhibitor singularly different from those shown by sexually reproducing plants or animals. Microsite-dependent, divergent selection can maintain high local and regional genetic diversity in microbial populations despite extensive clonality.”
“Chronic oesophagitis dissecans is a rare disorder with unknown pathogenesis. We report the case of a 42 year old woman who presented with chronic dysphagia. Endoscopic examination enabled a diagnosis of dissecans oesophagitis to be made. The purpose of this work is to review the clinical, endoscopic and therapeutic aspects of this rare and often unrecognized disorder.”
“HPV-vaccinated women develop CIN III very rarely. We have identified a study group of 38 such patients and showed that a specific HPV genotype prevalence in those cases equals the prevalence of HPV genotypes in CIN III present in the general Czech population. In all cases, CIN III was diagnosed within 3 years after having completed the HPV vaccination.

Our results provide a general understanding about how sea ice in

Our results provide a general understanding about how sea ice in Arctic affects regional and global methane balance.

(C) 2012 Elsevier Ltd. All rights reserved.”
“The arbuscular-mycorrhizal-fungal (AMF) communities from the El Palmar National Park of Entre Rios Province, Argentina, were investigated and characterized. The species of AMF present in five distinct vegetation types-gallery forest, grassland, marsh, palm forest, and scrubland-were isolated, identified and quantified over 2 y. Forty-six AMF morphotaxa were found. The composition find more of the AMF communities differed between the seasons, soil and vegetation types. Seasonal variations were observed in members of the Acaulosporaceae, Archaeosporaceae, Claroideoglomeraceae, Gigasporaceae and Pacisporaceae. Depending on soil type, the AMF-spore communities were dominated by members of one of the two main orders of the Glomeromycota. AMF communities from grassland and palm forest, which occur on sandy soils, comprised primarily members of the Diversisporales, with a high percentage of species of Acaulospora and of Gigasporaceae. Communities from the gallery forest, marsh and scrubland,

PARP inhibitor which occur on loam-clay soils, were composed of members of the Glomerales, with a high percentage of spores from species of Glomus. Thus, both AMF and plant communities would appear to be strongly and similarly influenced by edaphic conditions.”
“An analysis of signal reconstruction possibility using a small set of MK-2206 mouse samples corrupted by noise is considered. False detection and/or misdetection of sparse signal components may occur as a twofold influence of noise: one is a consequence of missing samples, while the other appears from an external source. This analysis allows us to determine a minimal number of available samples required for a non-iterative reconstruction. Namely, using a predefined probability of error, it

is possible to define a general threshold that separates signal components from spectral noise. In the cases when some components are masked by noise, this threshold can be iteratively updated. It will render that all components are detected, providing an iterative version of blind and simple compressive sensing reconstruction algorithm. (C) 2014 Elsevier B.V. All rights reserved.”
“We tested the hypothesis that clevidipine, a rapidly acting dihydropyridine calcium channel blocker, is not inferior to nitroglycerin (NTG) in controlling blood pressure before cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG). In this double-blind study from October 4, 2003 to April 26, 2004, 100 patients undergoing CABG with CPB were randomized at four centres to receive intravenous infusions of clevidipine (0.2-8 mu g center dot kg(-1)center dot min(-1)) or NTG (0.

We studied the outcome of patients treated with letrozole as PET

We studied the outcome of patients treated with letrozole as PET.\n\nMETHODS: Patients with early oestrogen

receptor (ER)/progesterone receptor (PR)-positive breast cancer treated with letrozole from February 2001 to September 2009 were reviewed. Inoperable and locally advanced tumours were excluded. Reasons for offering PET, response, survival, cause of death, time to initial and best response, fracture incidence, and late failure rates were studied.\n\nRESULTS: In click here all, 104 patients received PET due to frailty (n = 48), comorbidity (n = 30), old age (n = 9), and patient preference (n = 17). Median follow-up was 56 months (4-106). Eighty-five cancers responded to letrozole (stable disease (SD, n = 19), reduction in size (PR, n = 42),

and complete response ((CR), n = 24)). Median survival was 51 months (4-103), time to initial response (PR/CR) 4.5 months (2-24), and time to best response 8.5 months (3-50). Letrozole was stopped in 25 patients due to progressive disease (n = 19), side effects (n = 5), and patient choice (n = 1). Only 12 of 49 deaths were from breast cancer.\n\nCONCLUSION: Letrozole is a reasonable alternative in elderly women with early ER/PR-positive invasive breast cancer who are unfit or unwilling to undergo standard therapy. British Journal of Cancer (2011) 105, 1825-1829. doi: 10.1038/bjc.2011.470 www.bjcancer.com Published online 8 November 2011 (C) 2011 Cancer Research UK”
“Lipases comprise a group of hydrolytic enzymes which catalyze reversibly the hydrolysis and synthesis of triacylglycerides MK-0518 mouse in the selleck compound oil water interface. In this study, a response surface approach was used to study the production of extracellular lipase from Ganoderma lucidum which has diverse applications in various fields. Interactions were studied for five different variables (moisture, canola oil cake, olive oil, pH and time of incubation) which were found influential for lipase production. Using the statistical approach (response surface methodology), the maximum yield of lipase (4838 U/gds) by G. lucidum was observed

under optimum conditions. The optimum values of these parameters were as follows: canola oil cake (12.50 g), moisture level (60%), pH (4.5), olive oil as inducer (2.0%) and incubation period (96 h) at 30 degrees C. Exploration of fungal diversity for improved production of lipases using statistical models makes it a high-profile area for novel discovery with enormous potential of massive returns.”
“Background: Adenosine deaminase (ADA) is useful in the diagnosis of tuberculous pleural effusion (TPE). This study aims to determine the factors affecting pleural fluid ADA levels and to establish the optimal ADA levels for diagnosis of TPE for different age groups.\n\nMethods: This was a retrospective study from January 2007 to October 2011.

There were several significant findings : 1) related subsidence [

There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05).\n\nConclusion : Cage subsidence and osteophyte formation were find more radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.”
“Objective: The aim of the present study was to determine age at menopause and the prevalence of menopausal symptoms among women in a community in Babol,

Iran, and then identify the factors associated with these symptoms and age.\n\nMethods: A retrospective, descriptive, epidemiological study was conducted on the characteristics of perimenopausal and postmenopausal women. A total of 1,397 individuals aged 45 to 63 years were selected using a standard cluster sampling technique. The questionnaire used included menopausal symptoms, menopause status, causes of menopause, use of hormones, reproductive history, and sociodemographic factors. A standard questionnaire

named Symptom ScoreCard was used to assess the frequency and severity of menopausal symptoms. The data were analyzed by chi(2) analysis, t test, analysis of variance, and adjusted odds Blasticidin S purchase ratios with their 95% CIs.\n\nResults: Recalled mean +/- SD age at natural menopause was 47.7 +/- 4.9 years. No significant difference by age at menopause was observed in sociodemographic data, smoking status, reproductive history, and oral contraceptive use. The most prevalent symptoms were irritability (72.1%), joint pain

(70.6%), and depression (59.7%) during the previous 2 weeks. An increase in the percentage of occurrence and severity of some symptoms with transition to menopause was observed. The total score for menopausal symptoms was 13.0 +/- 7.7. High economic situation (odds ratio, 1.89; 95% CI, 1.37-2.58) was a factor significantly associated with a total menopausal score of higher than 15.\n\nConclusions: This study shows Selleck DMXAA a high prevalence of menopausal symptoms and an earlier mean age at menopause (47.7 y) for women in a community in Babol, Iran. It would be beneficial to establish a menopausal clinic in primary healthcare centers for the clinical staff to monitor postmenopausal women.”
“Hypertension is a common chronic medical condition affecting over 65 million Americans. Uncontrolled hypertension can progress to a hypertensive crisis defined as a systolic blood pressure >180 mm Hg or a diastolic blood pressure >120 mm Hg. Hypertensive crisis can be further classified as a hypertensive urgency or hypertensive emergency depending on end-organ involvement including cardiac, renal, and neurologic injury. The prompt recognition of a hypertensive emergency with the appropriate diagnostic tests and triage will lead to the adequate reduction of blood pressure, ameliorating the incidence of fatal outcomes.