Therefore, the objective of this study was to characterize S. aureus strains isolated

from women with lactational mastitis and to compare them with the strains responsible for bovine mastitis and noninfectious strains. All the strains were genotyped by both pulsed field gel electrophoresis and multilocus sequence typing and submitted to a characterization scheme that included diverse GS-9973 in vitro assays related to pathogenic potential and antibiotic resistance. Apart from siderophore production, no significant association was observed between the strains from bovine and human mastitis. Statistical differences between human- and bovine-mastitis-associated strains were detected for some traits and virulence determinants, such as the presence of prophages and cna and hlb genes, which were more frequently found within the bovine group. On the contrary, resistance to penicillin was significantly higher among strains isolated from human lactational mastitis, probably related to the common presence of the blaZ gene. A high genetic diversity was found among the strains involved in mastitis in breastfeeding women.”
“Femtosecond pulse laser ablation of aluminum under different ambient air pressures between 1 atm and 4 x 10(-4) Pa is investigated Selleck FK228 using a femtosecond time-resolved shadowgraphic method.

It is observed that as the ambient air pressure decreases, the contact front becomes more and more distinct for a certain pressure range, demonstrating that the confinement effect of the ambient air to

AC220 the ablated target material can play a critically important role in the laser ablation process. It is also found that the concentric and semicircular stripe pattern, which results from the diffraction of the probe beam by the expanding plume of a specific material state and is typically observed in the shadowgraphs for 1-2 ns delay time, gradually blurs and disappears while the ambient air pressure decreases from 1 atm to 7000 Pa. If a prepulse or a relatively large pulse pedestal exists before the main pulse, however, the stripe pattern can still be observed even though the ambient air pressure is 5 x 10(-4) Pa. It is thus inferred that what contributes to the formation of the unique stripe pattern is a mixture of the ejected target material and ionized background gas induced by the femtosecond laser ablation. (C) 2011 American Institute of Physics. [doi:10.1063/1.3554442]“
“Purpose: To evaluate the prevalence of postoperative magnetic resonance (MR) imaging findings in asymptomatic and symptomatic patients after resection of Morton neuroma.

Materials and Methods: This study was approved by the institutional review board. Informed consent was obtained from each participant.

Both groups were interviewed (by telephone) to complete a set of instruments (called the Profile of Chronic Pain: Extended Assessment battery) measuring pain

attitudes and coping methods.

ResultsLogistic regression analysis revealed that continued employment status was inversely related to pain severity and was positively related to higher education and being Hispanic. After controlling for severity and demographic factors, belief in a medical cure and catastrophizing tendencies were significant inverse predictors, and task persistence was a positive predictor of continued Omipalisib employment.

ConclusionsResults revealed both demographic and attitudinal predictors of continued employment and highlight the value of harnessing insights from the psychology of work engagement to better understand the processes underlying pain presenteeism. Interventions designed to keep persons with pain in the active work force should build upon and extend the present findings.”
“Background: Owing to the spectrum of symptoms, URMC-099 side effects,

and concerns in clinically advanced prostate cancer (PC), effective symptom assessment is imperative. In line with recent regulatory guidance on the development of patient-reported outcomes, we undertook a multistep/multistudy approach to develop and test a new symptom index (NCCN FACT-Prostate Symptom Index-17 that can be used to examine the effectiveness of noncurative treatments in advanced PC.

Methods: This included significant

input from two waves of expert medical providers (n = 66 and 11, respectively) and two waves of patient engagement and testing (n = 50 and 24, respectively). The resulting 17-item symptom index for advanced PC was then divided into sets or categories based on whether the symptoms are predominantly disease or treatment related.

Results: Preliminary reliability estimates suggest good internal consistency (alpha = 0.86) and relationships Caspase inhibitor with expected outside validity criteria are moderate to strong.

Conclusions: This new tool may help clinicians and researchers quickly target and measure important symptoms and concerns in advanced PC, leading to increased knowledge of treatment effectiveness of noncurative therapies and improvements in the quality of patient care. Copyright (C) 2010 John Wiley & Sons, Ltd.”
“Raman shifts are investigated on silicon and germanium substrates under the uniaxial tensile strain on various substrate orientations. The strain splits the triply degenerate optical (LO, TO) phonons at the zone center (k approximate to 0). The redshifts of Si Raman peaks induced by the tensile strain on all substrate orientations are observed. With the specific polarization of the incident light, however, the unusual blueshifts of Ge Raman peaks induced by the tensile strain are observed on (110) and (111) Ge substrates.

disease states.

Results: Of 119 respondents, 100 (84%) and 96 (81%) provided a complete set of responses for WTP and TTO questions, respectively. The median WTP and discounted (at 3% per year) TTO values to avoid SC79 cell line each health state were as follows: local reaction, $30, 0.12 days; systemic reaction, $50, 0.22 days; impetigo, $75, 1.25 days; strep throat, $75, 2.5 days; septic arthritis, $1,000, 6.6 days; and toxic

shock syndrome, $3,000, 31.0 days. The median WTP/QALY was significantly higher for vaccine adverse events (similar to$60,000/QALY) compared to disease states ($18,000 to $36,000/QALY).

Conclusions: Parents strongly prefer to prevent GAS disease in children compared to vaccine adverse events. However, implied WTP/QALY ratios were higher for the prevention of vaccine adverse events. Regret for errors of commission vs. omission may differ and should be considered by vaccine policymakers.”
“To develop more efficient quantitative analysis of ethylcarbamate in fermented food, the major disturbance was identified as diethyl succinate on GC-MS through matching

with mass fragmentation pattern on mass library and comparison of retention time. And the clean-up method was developed based on the difference of partition coefficient between ethyl carbamate and diethyl succinate. Finally, a washing step was added with 1% dichloromethane in n-hexane Bioactive Compound Library concentration on diatomaceous earth cartridge, and successfully applied to remove diethyl succinate from the matrix. The developed method showed acceptable recovery rate (69.5-88.4%) and limit of quantitation (1.0-1.2 ng/mL) on several fermented foods.”
“A new selleck recombinant K39 immunochromatographic test (ICT) was compared with the immunofluorescent antibody assay (IFA) for the rapid serological diagnosis of visceral leishmaniasis (VL) in Apulia, Southern Italy. A total of 264 individuals were tested, including 19 patients with VL (three of which were HIV positive), 67 individuals with suspected VL, 40 healthy controls and 138 patients with other diseases. The ICT was positive in all 19 patients with VL and negative

in sera from the remaining individuals. Both the sensitivity and specificity of ICT was 100%. The ICT also worked well in HIV-Leishmania co-infected patients. Antibodies to Leishmania detected by the IFA and ICT remained at detectable levels for up to 12-24 months, A positive reaction by the ICT was detectable at a serum dilution of up to 1:20,480, indicating that a strong immunoresponse is mounted against the recombinant K39 antigen, In conclusion, the ICT is highly sensitive, specific, rapid, noninvasive and cost effective ((sic)8.43 for ICT and (sic)12 for IFA) in the diagnosis of VL in areas of low VL endemicity.”
“In this article, biodegradable poly(butylene succinate-co-butylene terephthalate) (PBST) copolyesters with high molecular weights were synthesized by direct esterification and polycondensation route. The reaction conditions and catalytic systems were investigated in detail.

The mononuclear cells were extracted from tissues and flow cytometry (FCM) was utilized to sort out dNK cells. The phenotypes of dNK cells (CD56(bright)CD16(-)CD3(-) vs CD56(dim)CD16(+)CD3(-))

were detected by FCM. After being co-cultured with Phorbol 12-myristate 13-acetate, ionomycin and monensin, the expression level of interferon (IFN)- in the dNK cells was detected by FCM.

ResultsThe phenotypes of dNK cells from the two groups were dominated by the CD56(bright)CD16(-)CD3(-) subset, see more with no significant statistical difference (P<0.05). The expression level of IFN- in the dNK cells from women with HDCP was on a lower trend than those from women with normal pregnancy, having significant statistical difference (P=0.000<0.05).

ConclusionsOur results indicated that although the phenotype of dNK cells from women with HDCP is of no difference, their functions are abnormal. Impaired cell function leads to a lower expression level of IFN- and this may account for one of the pathogeneses of HDCP.”
“The purpose of this study was to evaluate arterial blood gases

in dogs that were given hydromorphone or extended release liposome-encapsulated hydromorphone (LEH). Dogs were randomly administered LEH, n = 6, (2.0 mg kg(-1)), hydromorphone, n = 6, (0.2 mg kg(-1)) or a placebo of blank liposomes, n = 3, subcutaneously on separate occasions. Arterial blood Dinaciclib samples were drawn at serial time points over a 6-h time period for blood gas analysis. There was no change from baseline values in P(a)CO(2),

P(a)O(2), (HCO(3)-) pH, and SBEc in the dogs that received the placebo. Administration of hydromorphone resulted in significant increases in P(a)CO(2) (maximum (mean + SD] 44.4 + 1.1 mm of Hg) and significant decreases in P(a)O(2) (minimum (mean + SD) 82.4 + 4.7 mm of Hg) and selleckchem pH (minimum (mean + SD) 7.31 + 0.01) compared with baseline. Administration of LEH resulted in significant increases in P(a)CO(2) (maximum (mean + SD) 44.6 + 0.9 mm of Hg) and significant decreases in P(a)O(2) (minimum (mean + SD) 84.8 + 2.6 mm of Hg) and pH (minimum (mean + SD) 7.34 + 0.02) compared with baseline. There was no significant difference between these two groups at any time point. The changes observed in P(a)CO(2), P(a)O(2), and pH, however, were within clinically acceptable limits for healthy dogs. LEH was determined to cause moderate changes in arterial blood gas values similar to those caused by hydromorphone. Published by Elsevier Ltd.”
“AimThe prognosis for severe fetal growth restriction (FGR) with severe oligohydramnios before 26 weeks’ gestation (WG) is currently poor; furthermore, its management is controversial. We report the innovative new management of FGR, such as therapeutic amnioinfusion and tocolysis.

In vaginal surgery, PRF may act as a graft material with better healing and better functional outcome.

We performed a prospective observational study on ten consecutive women requiring surgery for prolapse recurrence (stage II or higher). These

women had high risks for recurrence, erosion with graft materials, and intraoperative and postoperative complications with traditional pelvic reconstructive surgical procedures. ICS score and P-QoL Questionnaire results were assessed preoperatively and postoperatively. Surgery consisted of anterior, selleck posterior, or apical repair plus PRF. Follow-up was performed at 1, 6, 12, 18, and 24 months.

Anatomically, the success rate was 80%. Prolapse symptoms improved by 100%. Sexual activity increased by 20% without dyspareunia. The surgical time was satisfactory (mean, 38.5 min). There were no intraoperative or postoperative complications.

The use of PRF for site-specific prolapse repair is associated with a good functional outcome because of the healing and mechanical properties of PRF.”
“In the last few years, chikungunya has become a major problem in Southeast Asia, with large numbers of cases being reported in Singapore, Malaysia, and Thailand. Much of the current epidemic of chikungunya in Southeast Asia is being driven by the emergence of a strain of chikungunya virus that originated in Africa and spread to islands in the

Indian Ocean, as well as to India and Sri Lanka, and then onwards to Southeast Asia. There is currently no specific treatment for chikungunya and no vaccine is available for this disease. This review Staurosporine supplier seeks to provide a short update on the reemergence of chikungunya in Southeast Asia and the prospects for control of this disease. (C) 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.”
“Objectives. The purpose of this paper is to report a case of osteomyelitis following a bilateral sagittal split osteotomy in a patient who underwent

2-jaw surgery. A review of the management of osteomyelitis is included, with a discussion of implications for the reconstruction of the mandible after see more treatment for osteomyelitis.

Study design. A case of a rapidly progressing osteomyelitis is presented with a detailed review of the management of osteomyelitis, using this case to illustrate key points of management.

Results. In a very short period of time the patient lost a significant portion of the left side of her mandible. The actual management that she underwent, as well as some of the controversies that are present with the treatment of osteomyelitis, is discussed.

Conclusion. Although osteomyelitis of the mandible usually is seen after odontogenic infections and trauma, it can occur in patients undergoing elective osteotomies. When recognized, it should be aggressively treated.

Since aphrodisiacs may also have dopaminergic activity, and there can be a reciprocal relationship between dopaminergic and serotonergic functions in the

central nervous system, the aim here was to study the effect of the ethanolic extract of the aerial parts of R. peregrina on monoamine-mediated behaviour. The RP (100 and 200mg kg(-1) intraperitoneally) Galardin chemical structure significantly inhibited haloperidol (1 mgkg(-1) i.p.) induced catalepsy in mice (p<0.01, dopamine-mediated response) lithium sulphate induced head twitches in rats (serotonin-mediated response) and was without effect on clonidine-induced hypothermia in rats (noradrenaline-mediated response). The study concludes that R. peregrina improves the dopaminergic function, diminishes the serotonin-mediated function and is devoid of any effect on the noradrenergic function. The study suggests

that we should carry out further experiments to investigate the psychopharmacological profile of R. peregrina.”
“Objective: Matrix-associated autologous chondrocyte implantation has been used to treat cartilage defects. We developed a biphasic cylindrical osteochondral composite construct for such use, and conducted this study to determine its feasibility for treating osteochondral lesions in human knees.

Method: Ten patients with symptomatic osteochondral lesions at femoral condyles were treated by replacing pathological tissue with the construct of DL-poly-lactide-co-glycolide, whose lower body was Cilengitide order impregnated with D-tricalcium phosphate and served as osseous phase. The construct had a chamber to load double-minced autologous cartilage, serving as

source of chondrocytes. Osteochondral lesion was drill-fashioned a pit of identical dimension as the construct. Chondrocyte-laden construct was press-fit to fill the pit. Postoperative outcome was evaluated using Knee Injury and Osteoarthritis Outcome Score (KOOS) scale up to 24 months. Magnetic resonance image was taken, and sample tissue was collected with second-look LY294002 arthroscopic needle biopsy at 12 months. Outcome parameters were primarily safety of surgery, and secondarily postoperative change in KOOS and regeneration of hyaline cartilage and cancellous bone.

Results: No patient experienced serious adverse events. Postoperative mean KOOS in “”symptoms”" subscale had not changed significantly from pre-operation until 24 months; whereas those in the other four subscales were significantly higher than pre-operation at 12 and 24 months. Second-look arthroscopy showed completely filled grafted sites, with regenerate cartilaginous surfaces flushed with surrounding native joint surface. Microscopically, regenerated cartilage appeared hyaline.

Conclusion: This novel construct for chondrocyte implantation is safe for surgical application in knee. It repairs osteochondral lesions of femoral condyles by successful regeneration of hyaline cartilage.

The aim of this study was to analyze the benefits and complications of cRSII in a large cohort.

Methods www.selleckchem.com/products/pexidartinib-plx3397.html Retrospective cohort analysis

of all patients undergoing cRSII according to a standardized institutional protocol between 2007 and 2011 in a tertiary pediatric hospital. By means of an electronic patient data management system, vital sign data were reviewed for cardiorespiratory parameters, intubation conditions, general adverse respiratory events, and general anesthesia parameters.

Results A total of 1001 patients with cRSII were analyzed. Moderate hypoxemia (SpO(2) 80-89%) during cRSII occurred in 0.5% (n=5) and severe hypoxemia (SpO(2) <80%) in 0.3% of patients (n=3). None of these patients developed bradycardia or hypotension.

Overall, one single gastric regurgitation was observed (0.1%), but no pulmonary aspiration could be detected. Intubation was documented as difficult’ in two patients with expected (0.2%) and in three patients with unexpected difficult intubation (0.3%). The further course of anesthesia as well as respiratory conditions after see more extubation did not reveal evidence of silent aspiration’ during cRSII.

Conclusion Controlled RSII with gentle facemask ventilation prior to intubation supports stable cardiorespiratory conditions for securing the airway in children with an expected or suspected full stomach. Pulmonary aspiration does not seem to be significantly increased.”
“Aim of the study: To assess the impact of international consensus conference guidelines on the attitude of Swiss specialists Smoothened Agonist purchase when facing the decision to treat chronic hepatitis C patients.

Methods: Questionnaires focusing on the personal situation and treatment decisions were mailed to 165 patients who were newly diagnosed with hepatitis C virus (HCV) infection and enrolled into the Swiss Hepatitis C Cohort

Study during the years 2002-2004.

Results: Survey respondents (n = 86, 52.1%) were comparable to non-respondents with respect to severity of liver disease, history of substance abuse and psychiatric co-morbidities. Seventy percent of survey respondents reported having been offered antiviral treatment. Patients deferred from treatment had less advanced liver fibrosis, were more frequently infected with HCV genotypes I or 4 and presented more often with a history of depression. There were no differences regarding age, socio-economic background, alcohol abuse, intravenous drug abuse or methadone treatment when compared with patients to whom treatment was proposed. Ninety percent of eligible patients agreed to undergo treatment. Overall, 54.6% of respondents and 78.3% of those considered eligible had actually received antiviral therapy by 2007. Ninety-five percent of patients reported high satisfaction with their own hepatitis C management.

In all animals, 75% of the total glucose production was from gluconeogenesis and glycogen synthesis was only detected in some animals. Gluconeogenic pathway was an active contributor to hepatic glucose production and the treatment with oral delivered insulin nanoparticles did not alter this contribution, suggesting that under this treatment, protocol hepatic glucose metabolism is not the most relevant target of insulin action but instead a more generalised effect in peripheral tissues.”
“Objective. Mitotic centromereeassociated kinesin (MCAK) is a microtubule depolymerase indispensable for microtubule binding during

spindle formation. The purpose of this study was to investigate the association GSK1904529A molecular weight of MCAK expression with squamous cell carcinoma of the oral tongue (SCCOT).

Study www.selleckchem.com/products/dinaciclib-sch727965.html Design. Immunohistochemistry was used in 47 cases of SCCOT. Determination of proliferation and migratory capabilities was performed with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and Transwell chamber assay, respectively, on cells from the human tongue squamous cell

carcinoma cell line Tca8113 that were transfected with MCAK small interfering RNA (siRNA).

Results. MCAK expression level in oral tongue cancer tissue is significantly higher (P < .01) than that of corresponding normal tissue. In addition, high expression of MCAK is significantly associated with Selleck MK-0518 lymph node metastasis (P < .05) and tumor staging (P < .01). Moreover, gene silencing of MCAK suppresses proliferation and migration of Tca8113 cells (P < .05; P < .01).

Conclusions. The expression of MCAK may be associated with the progression of SCCOT.”
“A collision tumor in the central nervous system (CNS) is a rare entity. We report a case of a collision tumor with primary CNS lymphoma and astrocytoma in an otherwise healthy young male and the diagnostic challenge associated with it. The tumor showed 2 histologic patterns. The predominant component consisted of anaplastic

astrocytoma with gemistocytic appearance, and the lymphoma cells were kappa restricted B cells with variable cell sizes and some plasmacytoid differentiation. In situ hybridization demonstrated that the lymphoma cells were Epstein-Barr virus (EBV) positive. The patient was neurologically asymptomatic for 2 and half years following surgery, chemotherapy, and radiation.”
“Maxillofacial fractures in Japanese children were retrospectively analyzed. The subjects were 287 patients aged 15 years and younger seeking treatment for maxillofacial fractures in the Department of Oral and Maxillofacial Surgery, Nara Medical University. The patients were 186 males and 101 females. Injuries most frequently occurred as a result of traffic accidents in 125 patients, 92 of which were bicycle-related accidents. Injuries by falling from one level to another were found in 49, primarily in younger children.

Cellular and media alkaline phosphate activity increased similar to the bone allograft. In this study, we came up with a new method to produce the hydroxyapatite. It is a convenient method that can be held in room temperature and low pressure. Also, the product can be manufactured in large quantity. It can be

also transformed into scaffold structure, which will perform a stronger configuration. The manufacturing method will help the bony defect patients and make future medical products.”
“Methods. aEuro integral Offspring from undernourished mother rats with birth weight <–2 SD (IUGR group) and from standard-nourished rats with birth weight between mean +/-+/- 1SD normal birth weight (NBW group) were examined. Levels of fasting glucose, serum insulin, and insulin-like growth factor-1 (IGF-1) were analyzed. Entire pancreas or islet-like cell clusters (ICCs) were collected to evaluate relative beta beta-cell mass and determine the genetic and protein profiles Selleckchem Quisinostat of pancreatic and duodenal homeobox 1 (Pdx1), Cacna1c and Cacna1d using real-time PCR, immunohistochemical staining, and western blotting at day (d) of birth and at d21 of age.

Results. aEuro integral Fasting serum insulin and IGF-1 concentrations were significantly lower in the IUGR group than

in the NBW group at d0 and d21. The levels of Pdx1 and insulin see more mRNAs in IUGR pancreas were also decreased. At birth, the ratios of beta beta-cell mass to body weight were not significantly different between the two groups. However, by d21 the relative beta beta-cell mass in IUGR had not grown to compensate for the increase in body weight, as compared to the NBW group (p < 0.05). The Cacna1c and Cacna1d proteins were significantly

higher in the NBW group than that in the IUGR group at birth, but there were no statistical differences at d21.

Conclusion. aEuro integral Decreased Pdx1 levels and IGF-1 concentration restrain beta beta-cell mass and insulin expression in rat offspring from undernourished mothers. However, Cacna1c and Cacna1d expression were able to reach normal levels as the IUGR rats were aged, indicating that these factors were not responsible for the IUGR rat phenotype of insulin resistance and beta beta-cell dysfunction in later life.”
“Hypothesis: CRT0066101 datasheet Impairments of the medial olivocochlear system (MOCS) increase the risk of environmentally induced auditory neuropathy spectrum disorder (ANSD).

Background: ANSD is a problem in the neural transmission of auditory information that accounts for 10% to 15% of the cases of pediatric hearing loss. The underlying mechanisms of the disorder remain poorly understood, but noise exposure is an important risk factor. The goal of this study was to identify environmental conditions and genetic predispositions that lead to ANSD. Our approach was based on the assumption that noise induces ANSD by impeding the functional maturation of the brain’s sound coding pathways.

By opening the era of an aerobic, oxygen-containing biosphere, they are the true pacemakers of geological and biological evolution. Cyanobacteria

must have been among the first organisms to elaborate mechanisms for the detoxification of partially reduced oxygen species including (hydrogen) peroxide. Since there is still an suprising lack of knowledge on the type, role, and mechanism(s) of peroxide-degrading enzymes in these bacteria, all 44 fully or partially sequenced genomes for haem and non-haem catalases and peroxidases have been critically analysed based on well known structure-function relationships of the corresponding oxidoreductases. It is demonstrated that H(2)O(2)-dismutating enzymes are mainly represented by bifunctional (haem) catalase-peroxidases and AL3818 (binuclear) manganese catalases, with the latter being almost exclusively found in diazotrophic species. Several strains even lack a gene that encodes an enzyme with catalase activity. Two groups of peroxidases are found. Genes encoding putative (primordial) haem peroxidases (with homology to corresponding mammalian enzymes) and vanadium-containing iodoperoxidases are found only in a few species, whereas genes encoding peroxiredoxins (1-Cys, 2-Cys, type II, and Q-type) are ubiquitous in cyanobacteria. In addition, similar to 70% contain NADPH-dependent glutathione peroxidase-like proteins. The occurrence

and phylogeny of these enzymes is discussed, as well as

the present knowledge of their physiological role(s).”
“Study Design. The report https://www.selleckchem.com/products/fosbretabulin-disodium-combretastatin-a-4-phosphate-disodium-ca4p-disodium.html of a rare case of lead poisoning by an intradiscal firearm bullet is presented.

Objective. To describe and discuss the clinical and radiologic features (by computed tomography and magnetic resonance imaging) of a gunshot wound in the L2-L3 space which caused lead poisoning 5 years afterwards.

Summary of Background Data. Lead poisoning from firearm bullets is rare, but the possibility should be investigated in the case of bullets lodged in the joints.

Methods. A 30-year-old man presented to the emergency room with an intense lumbar pain complaint, https://www.selleckchem.com/products/H-89-dihydrochloride.html colic, intestinal constipation, insomnia, and progressive headache for 20 days. He had a history of a gunshot wound 5 years previously, and the bullet was left in situ, in the intravertebral disc between L2 and L3, as confirmed by radiographs, computed tomography, and magnetic resonance imaging. The hypothesis of lead poisoning was confirmed by the laboratory results. Chelation treatment with calcium versenate (disodium ethylenediaminetetraacetate, or CaNa (2) EDTA) was indicated. The patient was admitted and treated once again, before surgical removal of the bullet.

Results. After removal of the bullet, the patient had an episode of recurrence, and a new chelation cycle was performed, with complete resolution.

Conclusion. Lead poisoning can result in severe clinical disorders that require rapid treatment.