Based on PFGE profile analyses, no capsular switch events were de

Based on PFGE profile analyses, no capsular switch events were detected and thus no evidence was found in our study of vaccine escape recombinant isolates as reported by Bruegemann et al. in 2007 [40]. However, Cabozantinib datasheet it should be noted that the failure to detect capsular switch events could be linked to the relatively small sample size of 174 PFGE profiles. In the present

study, besides the pneumococcal prevalence comparisons that allowed detection of the known serotype replacement phenomenon between VT and NVT isolates (Table 2 and Table 3), we actually identified the mechanism of the vaccine’s effect in our setting. We show that within a month, in children aged between 12 and 24 months, a single dose of PCV7 decreases VT colonization as it prevents de novo acquisition, and conversely increases NVT colonization, namely by enhancing NVT unmasking ( Table 4). Our data is in accordance with previous studies, which suggest that conjugate

vaccines reduce VT carriage by preventing de novo acquisition rather than clearance [19], [41], [42] and [43]. Besides this major mechanism of the vaccine’s effect we propose that an additional one is the enhancement of NVT unmasking ( Table 4). Assessment of this last mechanism was only possible due to the study of multiple colonization. As a result of the paucity of multiple carriers, we were unable to conclude about a specific Dipeptidyl peptidase tendency BMS-387032 clinical trial of serotype associations before and after a single vaccine dose. Nevertheless, we found that 13 serotypes (6A, 6B, 7F, 11A, 14, 16F, 17F, 19A, 19F, 23B, 23F, 33F, and 38) and non-typeable isolates were able to co-colonize, associating with other serotypes in the children’s nasopharynx. In the vaccinated group, serotype 6A was the most common serotype observed among multiple carriers. Worthy of note is the fact that in the PCV7 era, the nasopharynx of multiple carriers can constitute

a reservoir for VT isolates. Some VTs (e.g. 6B, 14 and 19F) prevailed as minor serotypes “masked” by the dominant NVT isolates, in opposition to what occurred in the control. Whether or not the preferred co-existence of some serotypes reflects similarity of their chemical structures, similar nutritional requirements and/or bacteriocin compatibility [44] of the particular isolates remains to be determined. In summary, the present study demonstrates that, as early as 1 month after vaccination with a single dose, PCV7 causes serotype replacement of VT by NVT isolates in single and multiple carriers, with the mechanisms of the vaccine’s effect being the prevention of VT de novo acquisition and enhancement of NVT unmasking.

SDS-PAGE analysis showed purity of >95% Its functionality was ve

SDS-PAGE analysis showed purity of >95%. Its functionality was verified by its ability to form the stable C3-convertase [47]. The VCP Selleck NVP-AUY922 specific mAbs were generated by immunizing 5–6 week old BALB/c mice with the rVCP. In brief, mice were immunized with 20 μg of rVCP in Freund’s complete adjuvant, followed by two boosts 15 days post prime at weekly intervals with the same dose, but in Freund’s incomplete adjuvant. Following immunization, spleen was removed and the spleen cells were fused in-house with myeloma cells as per established protocols [48] and [49]. The clones from the fusion were screened by ELISA and subcloned to isolate the individual clones.

Antibody isotyping was performed by an ELISA-based hybridoma isotyping kit (BD Biosciences, San Diego, CA, USA). The IgG mAbs were purified by capryllic acid precipitation method or by Hi-Trap affinity protein G column (GE Healthcare Bio-Sciences, Sweden). Homogeneity of mAbs was assured by SDS-PAGE analysis. VACV pathogenicity studies were performed in rabbits using skin lesion model [36]. In brief, 104 pfu of VACV-WR strain in sterile PBS in a total volume of 100 μl were injected intradermally with or without the mAb on the shaved backs of two New Zealand White Crizotinib in vivo rabbits (age 6–7 months) in duplicate and lesions formed (scabs) were measured after every 24 h using calipers. The mean of four measurements was used for graphical representation

of individual time point per site. To study the role of complement during infection, similar experiments were also performed in two additional rabbits depleted of complement by administering 100 U/kg of cobra venom factor.

All the results were grouped and statistically evaluated by performing Mann–Whitney Rank Sum test (SigmaStat). The experimental protocol was approved by the Institute’s Animal Care and Use Committee. The ELISA plates were coated overnight at 4 °C with rVCP or VCP mutants (CCP 1–3, CCP 2–4, CCP 1–2, CCP 2–3, CCP 3–4; 200 ng/well), blocked by adding 5% milk and incubated with mAbs (1 μg/well) for 1 h at room temperature. Binding was probed by adding 1:2000 diluted anti-mouse HRP conjugate (Biorad, Hercules, Cediranib (AZD2171) CA) and detected with 2,2′-Azino-bis (3-ethylbenzthiazoline) 6-sulfonic acid (ABTS) (Roche, Mannheim, Germany) at 414 nm. Inhibition of factor I cofactor activity of VCP by mAbs was determined as described below. rVCP (0.5 μg) was mixed with 3 μg of mAb and incubated for 15 min at 37 °C. Thereafter, 3 μg of C3b or C4b and 0.1 μg of factor I was added to the reaction mixture and the volume was adjusted to 20 μl using PBS. It was then further incubated at 37 °C for 2 h. The reaction was stopped by adding SDS-PAGE sample buffer containing DTT and C3b/C4b cleavages were analyzed on a 10% SDS-PAGE gel [40]. Inhibition of the classical pathway decay-accelerating activity of VCP by mAbs was determined by utilizing a hemolytic assay [42] and [50].

Second, the high false negative rate (34–40%) (Hill et al 2011) m

Second, the high false negative rate (34–40%) (Hill et al 2011) means that many of the ‘low risk’ group will still be at risk of having a poor outcome. The SBST risk categories should therefore supplement and not replace clinical judgment. Finally, full length questionnaires may still be more useful for selecting and monitoring treatment in the high risk group (Beneciuk et al 2012). Further research could look at including ‘resilience’ factors which may have a unique predictive ability for chronic pain (Sturgeon and Zautra 2010). Prospective validation studies in different cultural and clinical settings will also make the tool more appealing to

physiotherapists. “
“The Ten Test (TT) is a quantitative sensory test requiring no test equipment (Strauch 2003). The subject reports his/her light touch perception of the skin area being tested compared to the reference normal area when the examiner gives Ribociclib molecular weight a simultaneous stimulus by stroking a

normal area and the area under examination. When examining subjects with bilateral hand involvement it has been suggested that a normally innervated facial comparator could be used. The response from the patient rating the sensibility of the test area is recorded as a fraction out of 10 between 1/10 and 10/10 (10 = normal sensory perception). The test may be repeated to Cabozantinib chemical structure produce an average score. Detailed test procedure available at Reliability and validity: Bumetanide The TT has been found to be reliable and repeatable. Inter-observer reliability was excellent (ICC = 0.91) and very strong agreement (D = 1.00, p < 0.003) was found between examiners ( Strauch 1997; Sun 2010). Good to excellent intra-observer reliability (ICC = 0.62 to 0.90, p < 0.05) was found ( Strauch 1997) when equal delivery of the stimulus pressure to the test and normal areas was evaluated. Multiple studies demonstrated the TT may be used for outcome measurement ( Novak 2003, 2005; Humphreys 2007). The TT is recommended for: clinical use in patients age > 5 years ( Sun 2010); different conditions of upper extremities

( Patel 1999; Faught 2002; Novak 2005), and lower extremities ( Humphreys 2007); and pre/post operative sensory evaluation ( Strauch 1997, MacDermid 2004, Novak 2003). This test provides a quantitative score to the ratings obtained while the examiner administers light moving touch stimuli to a test area and simultaneously comparing that to a reference area of ‘normal’ sensation. Advantages: The TT is quick to administer, requires no equipment and can be used where self-report measures are not feasible or possible. It provides a reliable option for clinicians in busy clinical settings, and/or where quantitative sensory testing equipment is unavailable. Limitations: The test requires patient co-operation and the concept of rating sensibility may be cognitively challenging for some patients.

3–10 1 mg and 1 0–3 1 mg in adults and children, respectively) T

3–10.1 mg and 1.0–3.1 mg in adults and children, respectively). This confirms the assumptions made by the EFSA and the WHO that the established thresholds are regularly exceeded, in particular in children—cf. above. In addition, the CHMP based its assessment of chronic aluminium toxicity on pharmacovigilance databases (reports of serious and non-serious adverse events from the register of spontaneous reports or from clinical studies)

from Germany from 1988 to 2008 (7638 reactions were analysed). Due to the low number of potential aluminium-associated side effects reported (except for the known granulomas), the CHMP arrived at the conclusion that there are no safety concerns. To what extent such a database is suitable to detect associations between SCIT and the development of diseases, which could have a latency period, remains to be seen. In their conclusion, the Safety Working Party to the CHMP places the cumulative aluminium AG-014699 cell line dose of 12 mg aluminium absorbed from a 3-year SCIT (0.5 mg per injection, 6-week interval = 4 mg per year × 3 years of therapy) in the context of an adult’s lifelong cumulative dose of 165–505 mg as “safe oral dietary intake (TWI)”. Thus, the contribution of such an SCIT to the lifelong cumulative total dose is calculated as being fewer than

10%. In connection with the estimation on the basis of the side effects database, the CHMP draws the conclusion that there is no risk from aluminium in SCIT [65]. It is general practice BI 2536 ic50 in toxicology to consider maximal values (within a licensed indication) of the substance in question. The final assessment of the CHMP does not seem to be based on a similar rationale and it ignored up-titration period(s)

completely. If 1.14 mg (top aluminium-adjuvant dose) is considered and 6-week intervals, then the human body burden of aluminium totals 27.36 mg (1.14 mg × 8 × 3 years). DNA ligase If the maintenance dose were based on monthly (cf. above) instead of the 6-week intervals, this amounts to 41.04 mg (1.14 mg × 12 × 3 years) and still would not include up-titration. Over the course of their lives, many allergic patients will receive treatments for several allergens—some lifelong (cf. above). The cumulative dose of aluminium from immunotherapy used as basis by the CHMP does not appear to reflect the amount of exposure a patient will receive in practice. In addition to this, it was compared to dietary intake (i.e. the immunotherapy cumulative dose being <10% of this) – a route of administration with a totally different adsorption rate. This is not only misleading but a fundamental mistake. In January 2014 the Paul-Ehrlich-Institut (PEI) published its opinion regarding aluminium in SCIT “Sicherheitsbewertung von Aluminium in Therapieallergenen” [66]. Within this document, the German regulatory authority essentially repeats conclusions drawn from the CHMP in 2010 [65].

Therefore, we have to conclude that more research is needed to ev

Therefore, we have to conclude that more research is needed to evaluate prognostic factors for poor recovery, re-sprains, and residual pain. Possibly, the prognosis could by improved by additional diagnostics, such as magnetic resonance imaging and radiography. A large cohort study may be helpful to identify patients at risk and to evaluate the consequences of these persistent complaints. Footnotes:a Cybex EDI 320, New York, USA. eAddenda: Appendix 1

available at Ethics: The Medical Ethics Committee of the Erasmus Medical Center in Rotterdam Alpelisib purchase (196.926/2000/238) approved this study. All participants gave written informed consent before data collection began. Support: Local fund, Zorgonderzoek Erasmus MC, of the Erasmus Medical University (EMCR-2000). “
“Participation in regular physical activity is recognised as one of the most important health behaviours for reducing the impact of many chronic diseases (Schutzer and Graves 2004). The benefits of physical activity have long been recognised in cardiovascular disease, diabetes, musculoskeletal health, and mental illness (Department of Health 2004a). Physical activity may have a prognostic benefit for people with chronic obstructive pulmonary disease (COPD), having been associated with lower risk of mortality and of hospitalisation for COPD exacerbation (Garcia-Aymerich et al 2006). Physical activity

may seem counterintuitive selleck screening library for people with COPD because of associated exertional dyspnoea.Reduced activity can contribute to a downward disease spiral of worsening breathlessness, muscle however de-conditioning, and disability (Polkey and Moxham 2006). Pulmonary rehabilitation aims to attack this spiral and has proven consistently effective

for improving exercise tolerance and health-related quality of life in people with COPD (Lacasse et al 2006). A course of pulmonary rehabilitation typically comprises twice-weekly supervised sessions of exercise and education over six to eight weeks (BTS 2001). Despite unequivocal short-term effectiveness, the benefits tend to be lost at 12 to 18 months. Maintaining the benefits of pulmonary rehabilitation is recognised as an important component of long-term disease management, yet uncertainty remains as to how this can be achieved. A paucity of compelling evidence exists What is already known on this topic: Pulmonary rehabilitation improves exercise tolerance and quality of life in people with chronic obstructive pulmonary disease. Ongoing adherence to exercise appears important to maintain the benefits of pulmonary rehabilitation, but it is unclear how adherence can be supported. What this study adds: People with chronic obstructive pulmonary disease who have completed a course of pulmonary rehabilitation believe that ongoing structured exercise with professional and peer support would assist them to continue regular exercise. They also believe that their health status could limit their exercise adherence.

Pain and physical function belong to the core set of outcomes for

Pain and physical function belong to the core set of outcomes for phase III trials in osteoarthritis ( Bellamy 1997). Short-term (post-intervention) effects were analysed. Outcome measures were extracted by the principal author (MJJ). Two reviewers (MJJ and AFL) extracted information about the different intervention components. For each study and outcome measure, effect sizes were calculated using the difference in the mean change within the intervention and control group divided by the pooled baseline standard deviation. Positive values indicate that the intervention group improved on average more than the control group. Effect sizes of 0.2 to 0.5 can be interpreted as small,

selleck inhibitor 0.5 to 0.8 as moderate, and greater than 0.8 as large effects. To calculate the standard error of the effect size estimates, the pre-test post-test correlation must be known for the pain and function measurements within each study. Since this information was not available for any of the studies, we assumed a correlation of 0.6. All of the analyses were repeated using

an assumed correlation of 0.4 and 0.8, yielding essentially identical results. A meta-analysis was then conducted to obtain the average effect for the different intervention types and to compare these effects against each other. We anticipated AUY-922 research buy that no trials might be found that directly compare any of the three interventions. Therefore we pre-planned a mixed-effects meta-regression model for this purpose, using restricted DNA ligase maximum likelihood estimation to estimate the amount of (residual) heterogeneity and using appropriate

dummy variables for the different intervention codes. To examine potential effect modification, we repeated this analysis including the type of control group (education/usual care/ultrasound vs none), study quality (EBRO score), treatment delivery mode (individual vs group), duration of treatment period (in weeks), treatment frequency per week, duration of treatment period × frequency, sex (% females), mean age of the sample, measurement instrument (WOMAC pain/function vs other) and type of weight bearing exercise used (non-weight bearing, weight bearing, or both) as covariates in the model. All analyses were carried out in R (version 2.10.1) using the ‘metafor’ package (Viechtbauer 2010). Of the 153 retrieved trials identified by the literature search, 21 were relevant. Twelve of these relevant studies were randomised controlled trials that met the inclusion and exclusion criteria. Figure 1 outlines the flow of studies through the review. Reasons for exclusion of the studies were: no non-exercise control group (Deyle et al 2005, Diracoglu et al 2005, McCarthy et al 2004, Veenhof et al 2006); no or only light strengthening exercises used in the intervention (Bautch et al 1997, Kovar et al 1992), and not possible to classify under one of the three codes.

3) Flotillin-1 and flotillin-2 (also called reggie-2 and reggie-

3). Flotillin-1 and flotillin-2 (also called reggie-2 and reggie-1, respectively) are lipid raft-associated

proteins and are thought to be involved in clathrin- and caveolae-independent endocytosis pathways, which is already stated by several studies [22], [23], [24] and [25]. Another study discussed a contribution of flotillins to maturation processes of late phagosomes SB431542 in vitro in macrophages (J774) [26]. Furthermore, Vercauteren and co-workers reported a flotillin-1-dependent uptake mechanism of polyplexes in retinal pigment epithelium (RPE) cells [27]. These results corroborate the findings demonstrated in the present study, in which flotillin-1/2 were partially detected in LAMP-1-bearing vesicles of H441 and ISO-HAS-1 (see additional Fig. 1), but it did not colocalize

with early endosomal marker proteins such as EEA1 (early antigen 1, data not shown). Since this Ibrutinib phenomenon occurs in a variety of cell types such as macrophages (J774), epithelial cells (H441, HeLa, RPE) or endothelial cells (ISO-HAS-1), it appears to be a general phenomenon. Thus, flotillins may play a general key role in late- or lysosomal degradation or storage processes. Uptake experiments with Sicastar and AmOrSil in H441 which were carried out under coculture conditions also revealed an incorporation in flotillin-1 and -2 labelled vesicles for Sicastar Red but not for AmOrSil (Fig. 6) after an incubation period of 4 h and 20 h further cultivation in fresh serum-containing media. The H441 cells in coculture differed from the monoculture with respect to time-and dose-dependency of the nanoparticle uptake. Quantification isothipendyl experiments clearly showed NPs to a higher

extent in H441 in MC compared to H441 in CC with ISO-HAS-1. Based on fluorescence intensity measurements, the H441 in CC did not take up the NPs (Fig. 5A and B). The polarised, barrier-forming H441 in CC required an increased exposure time (permanent 48 h) and an up to 10x higher dose than MCs to observe a visible uptake of Sicastar Red. The reasons for these observations are currently unclear but might be associated to the more restrictive barrier in the CC or with more matured endocytosis mechanisms. The H441 in CC with ISO-HAS-1 displayed a barrier-forming cell phenotype with a more differentiated and polarised state similar to that observed in the in vivo biological barrier. These cells develop a tight barrier demonstrated by a continuous circumferential ZO-1 (zonula occludens-1) staining [9] and [28]. The H441/ISO-HAS-1 coculture achieve a transepithelial electrical resistance (TER) value that averages 560 ± 6 Ω cm2 [9] and [28].

There is currently no evidence for a direct vaccine impact on the

There is currently no evidence for a direct vaccine impact on the time to clear a pneumococcal colonisation episode, but it should be noted that the amount of data on this subject is very limited. Two studies have reported the vaccine effect on

future duration of colonisation and both found no effect of PCV [20] and [21]. In addition, the impact of PCV on existing colonisation seems limited [1]. An effect of PCV on the density of VT colonisation was shown in the American Indian trial in selleck compound library which those receiving PCV and nevertheless being colonised with the VT strains had lower density of colonisation as compared to those receiving the control vaccine and being colonised with the VT pneumococci [21]. Vaccine efficacy is generally defined as a relative reduction in some measure of risk in the vaccinated group compared to the unvaccinated group [15]. It is thus

expressed as 1-RR, where RR is the risk ratio. With colonisation as the event of interest, risk itself can be quantified concerning any of the endpoints discussed in Section 2. This means that there are several possible vaccine efficacy estimands (parameters) that could be considered even in the same study (Table 1). The two estimands of primary interest are VEacq, efficacy against pneumococcal acquisition, and VET, the combined efficacy against acquisition and duration of colonisation (Fig. 1). These two parameters bear immediate relevance to the direct and indirect buy GDC-0941 protection due to vaccination. The latter is a broader concept, oxyclozanide because it includes the potential vaccine effect on clearance of colonisation. Without assumptions of the vaccine effect on clearance, VET is the parameter that can be estimated in a cross-sectional study (Section 4). VEcol is an umbrella term including both VEacq and VET as well as other possible estimands of interest. Vaccine efficacy against acquisition, VEacq, is defined as the vaccine-induced relative

reduction in the hazard rate of acquisition of a select set of pneumococcal (vaccine) serotypes in the individual. The hazard relates to an individual susceptible to acquire the vaccine strains. Consequently, we define susceptibility as the state of being uncolonised by any of the vaccine types. It is also possible to consider VEacq in all subjects, irrespective of the current state of colonisation [10] and [11]. However, such unconditional VEacq does not take into account potential vaccine-induced within-host changes in the pneumococcal flora. Specifically, those already carrying vaccine serotypes then count as susceptible, and the unconditional vaccine efficacy is therefore smaller than VEacq conditioned on susceptibility.

aureus TMPK compared to other bacterial TMPKs and human TMPK have

aureus TMPK compared to other bacterial TMPKs and human TMPK have been identified. 11, 25 and 26 Also, human TMPK selectively phosphorylates the D enantiomer of dTMP and its analogs 26 ( Fig. 4A and B). This enantioselectivity of nucleoside-activating enzymes most likely have a strong impact on the efficacy mTOR inhibitor and specificity of new antimicrobial agents. Human TK has very close homology with the TK of S. aureus ATCC12600 however, ( Fig. 2A and B) humanTK1 has a unique KEN box in the C terminal region which is the binding site for ubiquitin ligase and thereby degrades HTK via an ubiquitin proteasome pathway, 15 which is distinctly absent in the S. aureus

TK. In the present study TMPK and TK genes of S. aureus ATCC12600 have been cloned, expressed and characterized. The TMPK and TK kinetics clearly indicated that TMPK and TK are highly active enzymes in this pathogen and showed very close structural similarities with human TMPK and TK. However, absence

of KEN sequence in S. aureus TK aids in the proliferation of this bacteria and the distinct differences observed in the substrate enantioselectivity of human TMPK conclude that dTMP analogs having L specificity could be strong antimicrobial agents. These unique differences correlated with variations in functions probably explains the rapid proliferation of S. aureus in its human host and which can be very serious and life threatening with the infections caused by multi drug resistant strains of PF-01367338 concentration S. aureus. All authors have none to declare. “
“Figure options Download full-size image Download as PowerPoint slide Chalcones are well known intermediates for synthesizing various heterocyclic compounds1 like flavones, isoxazoles, pyrazoles, tetrahydro-2-chromens,2 etc. Chalcones either natural or synthetic are known to exhibit various biological activities. Due to the interesting activities of chalcones derivatives as

biological agents, considerable attention has been focused on this class of compounds. Chalcones are known to exhibit antimalarial,3 antibacterial,4 anticancer,5 antileishmanial,6 science antifibrogenic,7 antiinflammatory,8 immunomodulatory,9 cytotoxic and antitrypanosoma cruzi10 activities. Some chalcone derivatives show herbicidal activity11 and substituted chalcones have exhibited fungi static and fungicidal activity. Flavanoids or chromones represent an awfully important group of naturally occurring bioactive compounds. This field of investigation was initiated in 193612 by discovery of citrin, known as ‘Vitamin P’ (P stands for permeability). Flavonoids constitute one of the major classes of naturally occurring and synthetic organic compounds which exhibit significant biological activity.

36 μl while in malaria patients the mean value of

AST 23

36 μl while in malaria patients the mean value of

AST 23.76 μl. The difference between AST value in normal and patients of each of malaria patients was non-significant (P > 0.47 μl). With reference to serum creatinine, the results show that the mean level of creatinine in serum of normal healthy subjects is 0.5033 mg/dl while in malaria patients the mean value of creatinine is 1.20 mg/dl. The difference between creatinine value in normal and patients of each of malaria patients was significant (P > 0.000349). As presented in results the slide positivity rate in present study is 22%. In the light of results of present study it seems that the low slide positivity rate as presented above may have been under estimated. Due to rush of work and sometimes due to lack of adequate facilities in district hospitals and buy Natural Product Library malaria control offices it is find more possible to miss many positive cases. Whereas a reduced slide positivity rate reflects a declining trend. The present study shows that the prominent species infecting the people in our situation is P. vivax (92.8%). This is consistent with the results of other similar studies conducted for different areas of Karachi (Pakistan).

Rafi et al 5 reported that in their studies P. vivax was the predominant species. A similar study was also made in Quetta, Pakistan, by Azeem et al 6 In this study a total of 263018 subjects who were screened, the positive smears were 91679 (34.85%), of which P. falciparum was detected 28166 (30.72%) and P. vivax 61313 (66.87%), which show that malarial infection due to P. vivax is greater in Quetta, which is similar to our results. In our study we take 3500 malarial suspected patients of which 767 were positive slides showing 712 (92.8%) P. vivax and 55 (7.2%) P. falciparum, which is similar to the study. 6 They reported hepatocellular jaundice or the so called, malarial hepatitis with an incidence of approximately 2.6% from North–East India. Harris

et al found that 72% of patients with jaundice have direct bilirubinemia and elevated liver enzymes suggesting through hepatocelluler damage. 2 Ashley et al 7 from Thailand reported an incidence of jaundice in 32% of falciparum malaria although the bilirubin level was predominantly conjugated. Similarly, Harris in South India found that 37% cases of falciparum malaria had hyper bilirubin. 2 Present study also shows that jaundice is more common in falciparum malaria as compared to its presence in vivax malaria. Hazra et al 8 found an association of jaundice in 40% and 9.09% cases with falciparum malaria, and P. vivax respectively, from Calcutta. A similar study of Kochar et al 9 also showed that bilirubin level increases due to malarial infection which causes malarial hepatitis. A study revealed that the plasma concentration of conjugated bilirubin (P < 0.02), that total bilirubin (P < 0.05) and the ratio between the two were all significantly (P < 0.01) higher in the 47 patients studied.