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We measured missing mass spectrum of the ^{12}C(γ,p) reaction for the first time in coincidence with potential decay products from η^{'} bound nuclei. We tagged an (η+p) pair associated with the η^{'}NâηN process in a nucleus. After applying kinematical selections to reduce backgrounds, no signal events were observed in the bound-state region. An upper limit of the signal cross section in the opening angle cosθ_{lab}^{ηp}<-0.9 was obtained to be 2.2 nb/sr at the 90% confidence level. It is compared with theoretical cross sections, whose normalization ambiguity is suppressed by measuring a quasifree η^{'} production rate. Our results indicate a small branching fraction of the η^{'}NâηN process and/or a shallow η^{'}-nucleus potential.
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The objective of the present study was to ascertain masticatory efficiency by evaluating electromyographic activity in the masseter and temporalis muscles in subjects with sleep bruxism of varying severity, as determined by BiteStrip. Thirty-four subjects with sleep bruxism were divided into two groups: a mild sleep bruxism group with a mean (± standard deviation) age of 31.3 ± 6.2 years (n = 15) and a severe sleep bruxism group with a mean age of 29.8 ± 7.1 years (n = 19). Full-night polysomnography (PSG) was performed in eligible subjects. The linear envelope integral was used to determine masticatory efficiency on the basis of the electromyographic signal of the masseter and temporalis muscles during habitual and non-habitual chewing. There was significantly higher (p .05) electromyographic activity in the severe bruxism group than in the mild bruxism group during both peanut chewing in the right (p = .03) and left (p = .03) temporalis muscles and raisin chewing in the right (p = .01) and left (p = .05) temporalis muscles. Furthermore, Parafilm M chewing showed similar results in the right (p = .008) and left (p = .02) temporalis muscles. These results suggested that subjects with severe sleep bruxism had lower masticatory efficiency.
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Mastigação , Bruxismo do Sono , Adulto , Eletromiografia , Humanos , Músculo Masseter , Músculo Temporal , Adulto JovemRESUMO
Differential cross sections and photon-beam asymmetries for the γ[over â]pâπ^{-}Δ^{++}(1232) reaction have been measured for 0.7
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The Ï-Λ(1520) interference effect in the γpâK^{+}K^{-}p reaction has been measured for the first time in the energy range from 1.673 to 2.173 GeV. The relative phases between Ï and Λ(1520) production amplitudes were obtained in the kinematic region where the two resonances overlap. The measurement results support strong constructive interference when K^{+}K^{-} pairs are observed at forward angles but destructive interference for proton emission at forward angles. Furthermore, the observed interference effect does not account for the sqrt[s]=2.1 GeV bump structure in forward differential cross sections for Ï photoproduction. This fact suggests possible exotic structures such as a hidden-strangeness pentaquark state, a new Pomeron exchange, or rescattering processes via other hyperon states.
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BACKGROUND: Defaecatory function is often poor after anterior resection. Denervation of the neorectum following high ligation of the inferior mesenteric artery (IMA) is a possible cause of impaired defaecatory function. The purpose of this randomized clinical trial was to clarify whether the level of ligation of the IMA in patients with rectal cancer affects defaecatory function. METHODS: Between 2008 and 2011, patients who underwent anterior resection for rectal cancer were randomized to receive either high or low ligation of the IMA. The primary endpoint was to demonstrate the superiority of low ligation in terms of defaecatory function. RESULTS: One hundred patients were enrolled in the study; 51 were randomized to high ligation of the IMA and 49 to low ligation. There were no differences between the groups in terms of clinical data, except tumour stage, which was more advanced in the high-ligation group (P = 0·046). Nor were there any differences in defaecatory function, self-assessment of defaecation, Faecal Incontinence Quality of Life scale or continence score between groups at 3 months and 1 year. The number of harvested lymph nodes was similar. The rate of symptomatic anastomotic leakage was 16 per cent in the high-ligation group and 10 per cent in the low-ligation group (P = 0·415). CONCLUSION: The level of ligation of the IMA in patients with rectal cancer did not affect defaecatory function or the incidence of postoperative complications. REGISTRATION NUMBER: NCT00701012 (http://www.clinicaltrials.gov).
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Defecação/fisiologia , Artéria Mesentérica Inferior/cirurgia , Neoplasias Retais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Ligadura/métodos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Neoplasias Retais/patologia , Neoplasias Retais/fisiopatologiaRESUMO
The exclusive reaction γpâK(+)π(-)Σ(+) was measured for the first time using linearly polarized photons at beam energies from 1.85 to 2.96 GeV. Angular distributions in the rest frame of the K(+)π(-) system were fitted to extract spin-density matrix elements of the K(*0) decay. The measured parity spin asymmetry shows that natural-parity exchange is dominant in this reaction. This result clearly indicates the need for t-channel exchange of the κ(800) scalar meson.
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Laparoscopia/métodos , Reto/cirurgia , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/instrumentação , Cirurgia Endoscópica Transanal/métodos , Humanos , Laparoscopia/instrumentação , Posicionamento do Paciente , Instrumentos Cirúrgicos , Grampeamento Cirúrgico/métodos , Cirurgia Endoscópica Transanal/instrumentaçãoRESUMO
BACKGROUND: CHOP-21 has remained the standard chemotherapy for aggressive non-Hodgkin's lymphoma (NHL), and dose intensification is a potential strategy for improving therapeutic results. We conducted a phase III trial to determine whether dose-dense strategy involving interval shortening of CHOP (CHOP-14) is superior to CHOP-21. PATIENTS AND METHODS: A total of 323 previously untreated patients (aged 15-69 years) with stages II-IV aggressive NHL were randomized. The primary end point was progression-free survival (PFS). RESULTS: Treatment compliance was comparable in both study arms. At 7-year follow-up, no substantial differences were observed in PFS and overall survival (OS) between CHOP-21 (n = 161) and CHOP-14 (n = 162) arms. Median PFS was 2.8 and 2.6 years with CHOP-21 and CHOP-14, respectively (one-sided log-rank P = 0.79). Eight-year OS and PFS rates were 56% and 42% [95% confidence interval (CI) 47% to 64% and 34% to 49%], respectively, with CHOP-21 and 55% and 38% (95% CI 47% to 63% and 31% to 46%), respectively, with CHOP-14. Subgroup analyses showed no remarkable differences in PFS or OS for patients stratified as per the International Prognostic Index or by age. CONCLUSION: Dose-intensification strategy involving interval shortening of CHOP did not prolong PFS in advanced, aggressive NHL.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma não Hodgkin/tratamento farmacológico , Adolescente , Adulto , Idoso , Anticorpos Monoclonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Ciclofosfamida/uso terapêutico , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Doxorrubicina/uso terapêutico , Feminino , Humanos , Japão , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Vincristina/administração & dosagem , Vincristina/efeitos adversos , Vincristina/uso terapêuticoRESUMO
Differential cross sections and photon-beam asymmetries for the gamma(p)-->K{+}Lambda(1520) reaction have been measured with linearly polarized photon beams at energies from the threshold to 2.4 GeV at 0.6
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We report on the frozen-spin polarized hydrogen-deuteride (HD) targets for photoproduction experiments at SPring-8/LEPS. Pure HD gas with a small amount of ortho-H2 (â¼0.1%) and a very small amount of para-D2 (â¼0.001%) was liquefied and solidified by liquid helium. The temperature of the produced solid HD was reduced to about 30 mK with a dilution refrigerator. A magnetic field (17 T) was applied to the HD to grow the polarization with the static method. After the aging of the HD at low temperatures in the presence of a high-magnetic field strength for three months, the polarization froze. Almost all ortho-H2 molecules were converted to para-H2 molecules. Most remaining para-D2 molecules were converted to ortho-D2 molecules. The para-H2 and ortho-D2 molecules exhibited weak spin interactions with the HD. If the concentrations of the ortho-H2 and para-D2 were reduced appropriately at the beginning of the aging process, the aging time can be shortened. We have developed a new nuclear magnetic resonance (NMR) system to measure the relaxation times (T1) of the 1H and 2H nuclei with two frequency sweeps at the respective frequencies of 726 MHz and 111 MHz and succeeded in the monitoring of the polarization build-up at decreasing temperatures from 600 mK to 30 mK at 17 T. Automatic NMR measurements with the frequency sweeps enabled us to omit the use of a manual tuning circuit and to remove magnetic field sweeps with eddy current heat. This technique enables us to optimize the concentration of the ortho-H2 and to efficiently polarize the HD target within a shortened aging time.
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The first demonstration of cytokine expression in T-cell lymphoma by immunohistochemical methods is reported. Lymph node biopsy specimens were obtained from 18 patients with peripheral T-cell lymphoma. Interleukin 4 (IL-4) and gamma-interferon were each detected in 7 lymph nodes. Lymph node specimens diagnosed as angioimmunoblastic T-cell lymphoma and angiocentric lymphoma having distinctive histopathological features expressed IL-4 more frequently than other T-cell lymphomas, and all 7 patients expressing IL-4 had hypergammaglobulinemia. Lymph nodes with gamma-interferon expression showed an increase in histiocytes and/or epithelioid cells. Thus, IL-4 may play an important role in the development of hypergammaglobulinemia as well as in the growth and histopathogenesis of T-cell lymphoma, and gamma-interferon may be responsible for the development of Lennert's lesion.
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Interferon gama/análise , Interleucina-4/análise , Linfonodos/patologia , Linfoma de Células T/patologia , Anticorpos , Anticorpos Monoclonais , Antígenos CD/análise , Antígenos de Diferenciação de Linfócitos T/análise , Antígenos CD4/análise , Antígenos CD8 , Citocinas/análise , Feminino , Humanos , Imuno-Histoquímica , Interferon gama/genética , Interleucina-4/genética , Linfonodos/imunologia , Linfoma de Células T/imunologia , Masculino , RNA Mensageiro/análise , RNA Mensageiro/genéticaRESUMO
Objetivo. El objetivo de este estudio fue evaluar la adaptación marginal de coronas de disilicato de litio obtenidas mediante técnicas de escaneo (CAD/CAM), antes y des- pués de la cristalización, a través de análisis in vitro con microscopía confocal (MC). Métodos. Fueron confeccionadas 16 réplicas en poliuretano a partir de la pieza 1.4, de modelo typodont, tallada para corona total. Las réplicas fueron divididas en dos gru- pos, de acuerdo a la técnica de escaneo: Técnica Indirecta (Grupo IND, n=08), donde modelos de yeso fueron escaneados con escáner de laboratorio (inEos X5, Sirona Den- tal Systems) y Técnica Directa (Grupo DIR, n=08), donde modelos typodont fueron escaneados con escáner intraoral (CEREC BlueCam, Sirona Dental Systems). A seguir, se fresaron (inLab MC XL, Sirona Dental Systems) coronas en disilicato de litio (IPS e.max CAD, Ivoclar Vivadent) y se adaptaron a las réplicas. Se evaluó la adaptación marginal con análisis de MC en dos momentos, antes y después de la cristalización del disilicato de litio. Los datos fueron analizados con la prueba de Mann-Whitney, t de Student y Wilcoxon (α= 0,05). Resultados. Hubo una diferencia estadísticamente significativa en la adaptación marginal horizontal entre los grupos IND y DIR después de la cristalización (p=0,05). En el grupo IND, la comparación de la adaptación mar- ginal vertical antes y después de la cristalización mostró una diferencia estadísticamente significativa (p=0,038). Conclusiones. Las coronas de disilicato de litio obtenidas me- diante escaneo directo (CAD/CAM) presentaron menor desajuste marginal vertical. La etapa de cristalización afectó la adaptación marginal de las coronas.
Objective. This study aimed to evaluate lithium disilicate marginal adaption on crowns by scanning techniques (CAD/CAM), before and after crystallization, through confocal microscopy (CM) in vitro analysis. Methods. Sixteen polyurethane replicas were per- formed from tooth 1.4, of a typodont model, prepared for a full crown. The replicas were divided into two groups, according to the scanning technique: Indirect Technique (Group IND, n=08), where dental stone models were scanned with a laboratory scanner (inEos X5, Sirona Dental Systems) and Direct Technique (Group DIR, n=08), where typodont models were scanned with an intraoral scanner (CEREC BlueCam, Sirona Dental Systems). Then, the lithium disilicate crowns (IPS e.max CAD, Ivoclar Vivadent) were milled (inLab MC XL, Sirona Dental Systems) and adapted to the replicas. Margin- al adaptation was evaluated with CM analysis before and after lithium disilicate crystalli- zation. Data were analyzed with the Mann-Whitney, t test, and Wilconxon test (α=0.05). Results. There was a statistically significant difference in horizontal marginal adaptation between IND and DIR groups after crystallization (p=0.05). In IND group, the compar- ison of vertical marginal adaptation before and after crystallization showed a statistically significant difference (p=0.038). Conclusions. Lithium disilicate crowns obtained by direct scanning technique (CAD/CAD) showed less vertical marginal maladjustment. The crystallization stage affected the crown's marginal adaptation.
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A novel full-length human cDNA homologous to Glia Maturation Factor-beta (GMF-beta) gene was isolated. Sequence analysis of the entire cDNA revealed an open reading frame of 426 nucleotides with a deduced protein sequence of 142 amino acid residues. The deduced amino acid sequences of its putative product is highly homologous to human GMF-beta (82% identity) and named for GMF-gamma. Northern blot analysis indicated that a message of 0.9 kb long, but not 4.1 kb of GMF-beta, is predominantly expressed in human lung, heart, and placenta.
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DNA Complementar/isolamento & purificação , Proteínas do Tecido Nervoso/genética , Homologia de Sequência de Aminoácidos , Sequência de Aminoácidos , Sequência de Bases , Northern Blotting , Encéfalo , Clonagem Molecular , Feto , Fator de Maturação da Glia , Humanos , Dados de Sequência Molecular , Proteínas do Tecido Nervoso/isolamento & purificação , Especificidade de Órgãos/genéticaRESUMO
Noninfectious pulmonary dysfunction (NIPD) is a common and often fatal complication associated with allogeneic hematopoietic stem cell transplantation (HSCT). An insertion/deletion polymorphism in the angiotensin-converting enzyme (ACE) gene has been extensively studied in relation to cardiovascular and renal disease, and lung fibrosis. In pulmonary fibrosis, D-allele frequency is significantly higher than in the control population. We hypothesized that a similar mechanism exists between post-HSCT NIPD and pulmonary fibrosis in the absence of HSCT. We retrospectively analyzed the incidence of NIPD and the ACE genotype polymorphism in 118 Japanese patients who underwent HSCT from HLA-identical sibling donors. NIPD occurred in 17 cases. Deletion/deletion genotype carriers were more common in the NIPD group than in the other 101 patients (41.2 vs 11.9%; hazard ratio, 5.19; 95% confidence interval, 1.67-16.21). There were no significant relationships between the clinical characteristics of patients and the development of NIPD. These findings suggest that the ACE genotype is associated with the development of NIPD following HSCT. This study is the first to report the relationship between genetic background and NIPD.
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Alelos , Predisposição Genética para Doença , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Pneumopatias/etiologia , Pulmão/patologia , Peptidil Dipeptidase A/genética , Transplante Homólogo/métodos , Adolescente , Adulto , Feminino , Fibrose/patologia , Frequência do Gene , Genótipo , Antígenos HLA/genética , Heterozigoto , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Modelos de Riscos ProporcionaisRESUMO
The purging efficacy of positive selection of autologous CD34+ PBSC with a clinical scale method of magnetic-activated cell sorting system (CliniMACS) was investigated in 48 patients with non-Hodgkin's lymphoma (NHL). The median purity and recovery rate of the CD34+ cells post-selection were 93.3% (range 32.6-99.3) and 72.2% (range 20.5-309.8), respectively. The real-time PCR method to detect the patient-specific monoclonal immunoglobulin heavy chain gene rearrangement (minimal residual tumor; MRT) and CD19 and CD20 positivities were used for the detection of contaminating NHL cells before and after CD34+ selection. After selection, the median (range) depletion rate of MRT was 2.53 (1.52-4.78) log, and that of CD19+ cell and CD20+ cell was 2.46 (0.74-3.64) log and 2.32 (0.40-4.01) log, respectively. In 41 patients, high-dose chemotherapy was performed, followed by the transplantation of the isolated CD34+ cells. Rapid neutrophil recovery as well as platelet recovery was seen with a median time to reach 0.5 x 10(9)/l neutrophils of 10 days (range 8-13) and 20 x 10(9)/l platelets of 14 days (range 10-34), respectively. The present study demonstrated that CliniMACS is a highly effective positive selection method and a high purging efficacy could be obtained without compromising the hematopoietic reconstitution capacity of the graft in NHL patients undergoing high-dose chemotherapy.
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Antígenos CD34 , Sobrevivência de Enxerto , Separação Imunomagnética , Linfoma não Hodgkin/terapia , Células Neoplásicas Circulantes/patologia , Transplante de Células-Tronco de Sangue Periférico/métodos , Adulto , Antineoplásicos/uso terapêutico , Células Clonais , Feminino , Rearranjo Gênico , Humanos , Cadeias Pesadas de Imunoglobulinas/genética , Imunofenotipagem , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Transplante AutólogoRESUMO
This report describes a case of congenital dermatofibrosarcoma protuberans (DFSP) with fibrosarcomatous (FS) and myxoid areas. Immunohistochemical results showed that tumour cells in ordinary DFSP areas were diffusely positive for CD34, whereas in the FS and myxoid areas, few tumour cells were positive for this antigen. Ki-67 positive tumour cell numbers were greater in the FS (11.8%) and myxoid areas (19.8%) relative to ordinary DFSP areas (2.2%). Reverse transcription polymerase chain reaction and sequence analysis showed the presence of an identical COL1A1-PDGFB fusion transcript in ordinary DFSP (plaque-like area), FS, and myxoid areas of DFSP. These results indicate that the three components of DFSP have a common histogenesis. This study documents the first application of gene analysis involving the myxoid area of DFSP.
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Dermatofibrossarcoma/congênito , Mixoma/congênito , Neoplasias Cutâneas/congênito , Adulto , Dermatofibrossarcoma/genética , Dermatofibrossarcoma/patologia , Fibrossarcoma/congênito , Fibrossarcoma/genética , Fibrossarcoma/patologia , Humanos , Cariotipagem , Masculino , Mixoma/genética , Mixoma/patologia , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologiaRESUMO
To detect and monitor tumor cells in the bone marrow (BM) or peripheral blood (PB) of patients with B cell lymphoma, we used the PCR-mediated RNase protection assay to identify the complementarity determining regions (CDR)-III gene rearrangement. This method required neither determination of nucleotide sequences nor construction of tumor-specific oligonucleotide probes or primers. The sensitivity of this assay using B cell lines as well as clinical samples revealed one tumor cell in a background of 10(4)-10(5) normal cells. Using this assay we examined 31 patients with B cell lymphoma in whom an IgH rearrangement of initial tumor tissues was confirmed by Southern blot analysis. Twenty of 31 (65%) patients were able to be analyzed using this assay. Tumor cells in the BM and PB evident on routine morphological examination or surface marker analysis were confirmed by this assay in all the evaluable samples. Moreover, we detected tumor cells in the BM or PB of five patients in whom no tumor cells were identified by conventional methods. The PCR-mediated RNase protection assay is useful to detect minimal residual disease (MRD) in B cell lymphoma because it is highly sensitive, rapid and simple.
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Linfoma de Células B/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sequência de Bases , Feminino , Rearranjo Gênico , Humanos , Região Variável de Imunoglobulina/genética , Linfoma de Células B/genética , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Neoplasia Residual , Reação em Cadeia da Polimerase/métodos , Valor Preditivo dos Testes , Ribonucleases , Sensibilidade e EspecificidadeRESUMO
We performed X-linked restriction fragment length polymorphism (RFLP)-methylation analysis to study the clonality of hematopoiesis in five patients with myelodysplastic syndromes (MDS), who had responded to chemotherapy. Two patients had MDS in blast crisis, two had refractory anemia with an excess of blasts in transformation (RAEB-T), and one had acute myelogenous leukemia with trilineage myelodysplasia (AML-TMDS). Following the administration of low-dose cytarabine therapy or of conventional intensive chemotherapy, we observed a reversion to polyclonal hematopoiesis in three patients who achieved a complete remission (CR). Polyclonal hematopoiesis persisted in one patient in CR, and monoclonal hematopoiesis persisted in another patient of minor response. These results indicate that polyclonal hematopoiesis can be restored in some MDS patients who achieved CR. We are encouraged, therefore, to administer intensive consolidation chemotherapy to prolong the duration of remission.
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Hematopoese , Síndromes Mielodisplásicas/fisiopatologia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Medula Óssea/patologia , Medula Óssea/fisiopatologia , Citarabina/administração & dosagem , Citarabina/análogos & derivados , Citarabina/uso terapêutico , Feminino , Humanos , Metotrexato/administração & dosagem , Metilação , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/patologia , Polimorfismo de Fragmento de Restrição , Indução de RemissãoRESUMO
Sequential molecular and cellular changes during remission induction were investigated in a case of acute promyelocytic leukemia (APL) treated with all-trans-retinoic acid (ATRA). By means of clonality analysis, the assessment of the retinoic acid receptor alpha gene alterations, as well as conventional cytologic studies, it was demonstrated that remission induction of APL by ATRA proceeds in two steps: first, the differentiation of the leukemic clone to mature granulocytes and its subsequent extinction; second, proliferation/differentiation of the residual normal clones to restore polyclonal hematopoiesis.
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Hematopoese/efeitos dos fármacos , Leucemia Promielocítica Aguda/tratamento farmacológico , Tretinoína/uso terapêutico , Adulto , Medula Óssea/patologia , Proteínas de Transporte/genética , Células Clonais , Feminino , Rearranjo Gênico , Humanos , Leucemia Promielocítica Aguda/genética , Leucemia Promielocítica Aguda/patologia , Polimorfismo de Fragmento de Restrição , Receptores do Ácido Retinoico , Indução de RemissãoRESUMO
The in vitro colony-forming capacities of marrow CD34-positive (CD34+) cells from 25 patients with myelodysplastic syndromes (MDS) were studied. In all patients this purified cell population showed erythroid (burst-forming unit erythroid; BFU-E) or non-erythroid colony growth, both of which were more restricted than non-purified mononuclear cell population under stimulation with erythropoietin (EPO) or granulocyte/macrophage colony-stimulating factor (GM-CSF) alone. MDS patients examined were put into two groups; refractory anemia (RA) or RA with ringed sideroblasts (RA/RARS) and RA with excess of blasts (RAEB) or RAEB in transformation (RAEB/RAEB-t). The CD34+ cells of both RA/RARS and RAEB/RAEB-t exhibited a similarity to the cells of normal individuals in their responsiveness to the addition of interleukin 6 (IL-6), IL-3 or stem cell factor (SCF). SCF caused powerful but highly variable responses in both erythroid and nonerythroid colony formation as compared with IL-6 or IL-3. We demonstrated that MDS marrow hematopoietic progenitor cells reactive to GM-CSF or EPO were additionally stimulated with early-acting hematopoietic growth factors including IL-6, IL-3 and SCF in a fashion similar to those of normal individuals.