A Case Report of Mediastinal Teratoma in a Pediatric Patient With Nephrotic Syndrome: Paraneoplastic Syndrome or Incidental Finding?

A 12-year-old female presented with weight gain, edema, and shortness of breath. Laboratory and urine studies confirmed nephrotic syndrome and presence of a mediastinal mass, identified as a mature teratoma after resection. Nephrotic syndrome persisted despite resection and renal biopsy confirmed minimal change disease, which ultimately responded to steroid treatment. She had two relapses of nephrotic syndrome after vaccination administration, both of which occurred within eight months of tumor resection and were responsive to steroids. Autoimmune and infectious workup for other causes of nephrotic syndrome was negative. This is the first reported case of nephrotic syndrome associated with mediastinal teratoma.

Characteristics of Renal Intravascular Large B-cell Lymphoma.

Introduction: Renal intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive B-cell lymphoma with neoplastic cells occupying the vascular lumina with only 53 patients reported to date. Here, we present the largest case series to characterize this rare disease. Methods: We performed a multi-institutional, retrospective review of kidney biopsies and autopsies with a diagnosis of kidney IVLBCL and report our findings. Results: We identified 20 patients with an average age of 65.7 ± 7.8 years (55% males) with IVLBCL on kidney biopsy. The most common clinical presentation was fever and anemia. Acute kidney injury (AKI) was noted in 70% to 90%, proteinuria in 70% to 84.1%, hematuria in 45%, and nephrotic-range proteinuria in 10% to 26.1% of cases. The median (interquartile range) of serum creatinine was 1.75 (1.14, 3.3) mg/dl. Neoplastic lymphoid cells were present in glomeruli, peritubular capillaries, and arteries or veins. Of the patients, 44.3% showed extrarenal infiltration into bone marrow, liver, spleen, central vervous system, lung and skin. Neoplastic cells express CD20, CD79a, PAX-5, and MUM1+, and were CD10-negative. Available follow-up data showed a median survival of 21 months after diagnosis. Extrarenal involvement is a significant and independent predictor of mortality with a hazard ratio of 4.975 (95% confidence interval:1.38, 17.88) after controlling for age and gender. Serum creatinine, age, sex, and infiltration of intrarenal arteries or veins did not affect survival. Conclusion: Kidney IVLBCL is a rare disease that is unexpectedly diagnosed by kidney biopsy, presenting with fever, anemia, mild AKI, and proteinuria. Median survival is 21 months and extrarenal involvement is associated with worse outcome.

Growth performance and carcass traits of two commercial broiler strains fed diet supplemented with essential oils.

The current study aimed to evaluate the efficacy of using essential oils (EOs) on growth, carcass, and meat quality traits of two commercial broiler strains raised to 35 days of age. A total of 384 chicks were obtained upon hatching from a local hatchery (192 Indian River and 192 Hubbard). Birds were allocated randomly according to their strain into three groups: control, EOs, and EOs grower. Body weight was recorded at the beginning of the trial and then at the end of each phase diet as well as for the feed intake. Sixteen birds from the combination of each strain-essential oil were chosen randomly to evaluate carcass characteristics at the end. Hubbard consumed more feed during the grower stage (p = 0.02) and overall (p = 0.002) compared to Indian River. Carcass cuts percentages were affected by strain (p < 0.01). Shear force was lower for the Hubbard (p = 0.002). Essential oils showed a significant effect on cooking loss (p = 0.03). A significant strain by essential oil interactions was obtained for cooking loss, shear force, and meat redness (color coordinate ∗a) Cooking loss was greater for the Indian river with the EOs grower treatment. Briefly, growth and carcass traits were affected by strain. The inclusion of EOs had slightly improved meat quality traits.

Fattening performance, nutrient digestibility, and carcass traits of two fat-tailed sheep breeds.

Fat-tailed sheep breeds are the most widespread types of sheep in the Middle East. They are hardy and have acceptable growth and carcass traits. The purpose of this study is to compare the fattening performance, nutrient digestibility, and carcass characteristics of two fat-tailed sheep breeds, Awassi and Najdi. Thirty single-born Awassi and Najdi male lambs (15 lambs per breed) were examined for fattening and carcass characteristics. The study lasted 70 days (10 days adaptation period and 60 days for collecting the data). Feed consumption was monitored daily, and the body weight of lambs was recorded upon arrival to the trial area and biweekly afterward. Lambs were slaughtered at the end of the study to assess carcass and meat quality characteristics. Nitrogen intake and retained nitrogen were higher (P < 0.05) for Najdi lambs. The digestibility of nutrients was comparable between the two genetic groups. Initial body weight, final body weight, average daily gain, and dry matter intake were not affected (P > 0.05) by the lamb's breed. Furthermore, the feed-to-gain ratio, hot and cold carcass weights, and dressing percentage were not affected by breed type (P > 0.05). Breed type has no influence on the shoulder, loin, and rack percentages of the lamb. Moreover, meat quality traits were not affected by the lamb's breed (P > 0.05). In the dissected leg cut, no differences in the leg component were found among the two breed types (P > 0.05). Results of this study reveal that nitrogen intake and retained nitrogen were higher for Najdi lambs, but this was not reflected in fattening performance and carcass traits.

A typology of Jordanian consumers after Covid-19: The rational, the suspicious, and the cautious consumer.

This study presents a detailed typology of Jordanian consumers that identifies the effects of Covid-19 on their personal, social, and purchase and consumption patterns following the pandemic. Based on a qualitative approach using a sample of Jordanian consumers (N = 71), this study identifies three main types of consumers: the rational, suspicious, and cautious. All were distinguished by cognitive, emotional, and behavioral differences: the rational consumers viewed the pandemic as a natural occurrence, were willing to vaccinate, and took the opportunity to improve their lives and consumption behavior; the suspicious consumers viewed the pandemic as a man-made virus and refused to rationalize their behaviors and follow the social-distancing rules or vaccinate; and the cautious consumers were generally somewhere in between, and while they improved some aspects of their consumption, social, and personal lives, other aspects either remained the same or worsened. The findings have implications for managers and governmental bodies.

Obesity Measures as Predictors of Type 2 Diabetes and Cardiovascular Diseases among the Jordanian Population: A Cross-Sectional Study.

Obesity is strongly associated with cardiovascular diseases (CVD) and type 2 diabetes (T2D). This study aimed to use obesity measures, body mass index (BMI) and waist circumference (WC) to predict the CVD and T2D risk and to determine the best predictor of these diseases among Jordanian adults. A cross-sectional study was conducted at the governmental and military hospitals across Jordan. The study participants were healthy or previously diagnosed with CVD or T2D. The continuous variables were compared using ANOVA, and the categorical variables were compared using the X2 test. The multivariate logistic regression was used to predict CVD and T2D risk through their association with BMI and WC. The final sample consisted of 6000 Jordanian adults with a mean age of 41.5 ± 14.7 years, 73.6% females. The BMI (OR = 1.7, CI: 1.30-2.30, p < 0.001) was associated with a higher risk of T2D compared to WC (OR = 1.3, CI: 1.04-1.52, p = 0.016). However, our results showed that BMI was not associated with CVD risk, while the WC was significantly and positively associated with CVD risk (OR = 1.9, CI: 1.47-2.47, p < 0.001). In conclusion, an elevated BMI predicts a higher risk of T2D, while WC is more efficient in predicting CVD risk. Our results can be used to construct a population-specific intervention to reduce the risk of CVD and T2D among adults in Jordan and other countries with similar backgrounds.

VA-Wide, Multicenter Verification Study of the Cepheid Xpert SARS-CoV-2 Assay.

Early in the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic, there was a progressive increase in diagnostic demands that developed within a relatively short period of time. On February 4, 2020, the Secretary of Health and Human Services issued the Emergency Use Authorization for in vitro diagnostics assays for the Severe Acute Respiratory Syndrome Coronavirus 2 virus. Subsequently, multiple assays were approved under the Emergency Use Authorization, including the Cepheid Xpert SARS-CoV-2 assay. Presented here is a description of the nationally coordinated verification study of the Cepheid assay that was performed within the Veteran's Affairs Health System. This coordinated study helped to expedite the verification process for a majority of the Veteran's Affairs system labs, preserved precious system resources, and highlighted the power of a national medical system in response to an emergency.

Nutritional Status of Pre-school Children and Determinant Factors of Autism: A Case-Control Study.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder triggered by several factors, including those of genetic and environmental nature. ASD can alter communication, behavior, and children's nutritional status, placing them at high risk for nutritional imbalances. Therefore, this study aims to assess preschool autistic children's nutritional status as compared to that of Typically Developing (TD) children of the same age. The study also revealed some of the ASD risk factors among the Jordanian population. It included 52 ASD and 51 TD children (3-6 years), and considered sociodemographic, obstetric, and nutritional factors of the two groups, stratified by gender. Nutritional status was evaluated through a comprehensive questionnaire, 3-day food record, and anthropometric and biochemical measurements. Differences between groups were identified using the chi-square and independent-sample t-test. The logistic regression model was used after the adjustment of confounders to detect an autistic child's determinants. The study showed little difference between ASD and TD children with respect to nutrients' intake inadequacy and biochemical-nutritional deficiencies, but did reveal gender-based differences. Autistic girls were at higher risk of inadequate carbohydrate intake, while autistic boys were at higher risk of inadequate vitamin E, vitamin K, and fluoride compared to TD children. More autistic children had been treated in neonatal care units after birth than had TD children. The regression analysis revealed that lower maternal education level (OR, 12.25; 95% CI, 1.18-126.91), vaginal delivery (OR, 0.273; 95% CI, 0.105-0.712), family history of autism (OR, 0.189; 95% CI, 0.059-0.612), and taking dietary supplements during pregnancy (OR, 4.665; 95% CI, 1.158-18.79) were all determinants of ASD in children. In conclusion, maternal nutrition, postnatal conditions, and nutritional status might be contributors to ASD in children. Pre-school children are at high risk for developing nutritional deficiencies. It is therefore important to maintain optimal nutritional status in pregnant patients, and in children after delivery and during early childhood. Future studies that investigate the role of nutrient deficiencies and nutritional interventions in ASD are necessary. Also required are studies that focus on gender differences in the prevalence of ASD, types and severity of symptoms, and ASD nutrition-related problems.

Is DAIR Still an Effective Way to Eradicate Acute Prosthetic Joint Infections? Our Experience in the Jordanian Royal Medical Services.

BACKGROUND: Prosthetic joint infections is estimated to occur in 1-2% of primary total joint arthroplasty. Debridement, antibiotics, irrigation and retention of prosthesis (DAIR) is the traditional treatment for acute prosthetic joint infections. OBJECTIVE: To determine risk factors of treatment failure in subjects managed with debridement, antibiotics, irrigation and retention of prosthesis for acute prosthetic joint infections. METHODS: Our prospective, double blind and randomized investigation included 70 subjects, of both sexes, aged 63-72 years, who were managed with debridement, antibiotics, irrigation and retention of prosthesis for total hip or total knee arthroplasty acute prosthetic joint infections at Prince Hashim military hospital and Queen Alia military hospital, Jordan, during the period October 2017-October 2020. The observation period was 3 years. Therapy success was defined as absence of infection following 3 years, retention of the prosthesis and no further antibiotics therapy. Prosthetic joint infection was defined based on one or more of: a) growth of the same microorganism in minimum 2 cultures; b) one positive culture and a purulent synovial fluid upon debridement; c) negative culture and minimum 2 of purulent synovial fluid upon debridement. A successful outcome was defined as no clinical and laboratory evidence of infection (serum C-reactive protein less than 10 mg/L) at 3 years. Subjects with chronic, suppressive antibiotics or with prosthesis removal were considered therapy failure. Parameters statistically and remarkably discrepant between success and failure groups were investigated with logistic regression. P less than 0.05 were considered statistically significant. RESULTS: Amount of 46 subjects (65.7%) had no infection during the period of observation. Factors correlated with therapy failure were: history of Rheumatoid Arthritis, delayed infection (more than 1.5 years following arthroplasty), ESR at presentation of more than 50 mm/h and infection induced by coagulase-negative Staphylococcus. Symptoms duration of less than 5 days was associated with a better outcome. The use of Gentamicin sponges was statistically remarkably more in the success group and the use of beads was more in the failure group in the univariate but not in the logistic regression. Less surgical interventions were needed in the group managed with sponges than in the group managed with beads. Prosthetic joint infection induced by coagulase-negative Staphylococcus was associated with a less success rate and streptococcal infections were associated with an increased success rate. CONCLUSION: Rheumatoid arthritis, duration of symptoms of more than 5 days, ESR of more than 50 mm/h, delayed infection (more than 1.5 years following the index arthroplasty) and coagulase-negative Staphylococcus infections reduce the rate of a successful debridement, antibiotics, irrigation and retention of prosthesis therapy.

Zebra-like bodies in COVID-19: is phospholipidosis evidence of hydroxychloroquine induced acute kidney injury?

COVID-19 (from SARS-CoV-2) is the cause of an ongoing pandemic, with an increasing number of cases and significant mortality worldwide. Clinical trials and extensive studies are being conducted on a large scale for a better understanding of the pathophysiology of this disease and its effect on different organs. Several experimental treatment protocols have been introduced, in which hydroxychloroquine (HCQ) was one of the first drugs used. While patients can develop many side effects of HCQ, studies have documented a rare association of long-term HCQ treatment with zebra-like bodies in the ultrastructural examination of kidney biopsies, a finding typically seen in Fabry's disease, as well as in association with chronic HCQ use, among other drugs. We present a similar finding in the postmortem examination of a male in his early seventies with COVID-19 infection, who received five days of HCQ treatment before stopping the medication due to cardiac and renal toxicity.

Successful treatment with bortezomib-containing regimen of primary plasma cell leukemia: a case report.

Plasma cell leukemia represents the most aggressive form of plasma cell dyscrasia. We report a 67-year old male with no previous medical illnesses presented with anemic symptoms. Blood film revealed 35% circulating plasma cells, bone marrow biopsy showed plasma cells constituting 85%. Diagnosis of primary plasma cell leukemia was completed. Induction chemotherapy with bortezomib, doxorubicin, and dexamethasone was started. After the first cycle, plasma cells in peripheral blood disappeared. The patient had complete remission at evaluation after the third cycle. Re-evaluation after the sixth cycle showed that he maintained remission. As he was non-transplant eligible, he was we kept on maintenance bortezomib. Twenty-four months after the diagnosis, the patient remains in remission.

Fibroblast Growth Factor Receptor (FGFR) Inhibitors in Urothelial Cancer.

Dysregulated fibroblast growth factor receptor (FGFR) signaling is associated with several cancers, including urothelial carcinoma. Preclinical studies with FGFR inhibitors have shown significant antitumor activity, which has led to clinical evaluation of multiple FGFR inhibitors. Recently, erdafitinib was approved by the U.S. Food and Drug Administration for advanced urothelial carcinoma with FGFR gene alterations as the first molecularly targeted therapy. Additional ongoing clinical trials with other types of FGFR inhibitors have shown encouraging results. This review summarizes the oncogenic signaling of FGFR alterations, completed and ongoing clinical trials of FGFR inhibitors, and resistance patterns. IMPLICATIONS FOR PRACTICE: Dysregulated fibroblast growth factor receptor (FGFR) signaling is associated with several cancers, including urothelial carcinoma. Preclinical studies with FGFR inhibitors have shown significant antitumor activity, which has led to clinical evaluation of multiple FGFR inhibitors. Most recently, erdafitinib was approved by the U.S. Food and Drug Administration for advanced urothelial carcinoma with FGFR gene alterations as the first molecularly targeted therapy. Additional ongoing clinical trials with other types of FGFR inhibitors have shown encouraging results. This review summarizes the oncogenic signaling of FGFR alterations, completed and ongoing clinical trials of FGFR inhibitors, and resistance patterns.

Thrombotic Microangiopathy Following Arabian Saw-Scaled Viper (Echis coloratus) Bite: Case Report.

BACKGROUND Consumption coagulopathy post envenomation is one the most common complications after a snakebite. It occurs secondary to activation of a coagulation cascade by snake venom and could be followed by a syndrome consistent with thrombotic microangiopathy. The efficacy of plasma exchange for the treatment of thrombotic microangiopathy post envenomation is a matter of debate. CASE REPORT We reported the case of a 50-year-old male who had Arabian saw-scaled viper envenomation. He developed venom induced coagulopathy that improved within 24 hours of antivenom therapy. He subsequently developed micro-angiopathic hemolytic anemia, thrombocytopenia, and renal failure that was consistent with thrombotic microangiopathy. The patient was treated by plasma exchange and hemodialysis. He made a full recovery and was discharged after 4 weeks. CONCLUSIONS This case report supports plasmapheresis as an option for management of a patient who develops thrombotic microangiopathy secondary to snake bite, especially those who do not improve with antivenom and supportive therapy.

Fattening performance and carcass traits of Baladi and Shami-Baladi kids.

BACKGROUND AND AIM: Goat is considered very important ruminant animals that are raised in Jordan; however, the production of the local breeds is low to moderate, and thus, some genetic improvement programs could have a positive effect on the performance of the local breeds. The objective of this study was to investigate the effect of crossing Baladi (BB) goat with Shami. MATERIALS AND METHODS: A total of 30 newly weaned goat kids (15 BB and 15Shami-Baladi [SB] kids) were evaluated for growth performance and carcass traits. The trial lasted for 77 days (7 days for adaptation and 70 days for data collection). Feed intake was measured on a daily basis; body weight of kids was measured at the beginning of the study and biweekly thereafter. At the end of the trial, kids were slaughtered to examine carcass traits. RESULTS: Dry matter intake, initial weight, final weight, and average daily gain (ADG) were not affected by kid's breed type. In addition, breed type of kids showed no significant effect on feed efficiency (feed:gain). Hot and cold carcass weight and dressing percentage were also not affected by kid's breed type. Kid breed type had no significant effect on shoulder, rack, and legs percentages. However, SB kids had a higher loin cut percentage compared to BB kids. In addition, Musculus longissimus depth was higher for SB kids. CONCLUSION: Results of this study indicate that crossing SB goat breeds did not have a significant effect on either growth performance or carcass traits. Further studies using reciprocal cross may reveal different results.

Early Childhood Scoliosis Management by Vertical Expandable Prosthetic Titanium Rib (VEPTR): Experience of Royal Medical Services (RMS).

INTRODUCTION: Scoliosis could develop at the childhood age and progress beyond skeletal maturity. An early spinal fusion arrests growth of the spine and thorax, risking the development of secondary thoracic insufficiency syndrome. Vertical expandable prosthetic titanium rib (VEPTR) is a fusionless technique aiming to correct the deformity with preservation of growth potential. AIM: To show our experience and results regarding the use of VEPTR in children with scoliosis in regard to coronal profiles(length and deformity angle), spinal growth, and the complications we faced during the follow-up of two years after the index procedure. METHODS: A retrospective analysis of prospectively collected data of a case series. Forty child with scoliosis of different etiologies. Their primary diagnoses were neuromuscular scoliosis in 13, Juvenile idiopathic scoliosis in12, Congenital Scoliosis in 8, syndromatic patients 5 and 2 with Arthrogryposis. All 40 patients received percutaneous rib-to-pelvis or rib to vertebra or rib to rib VEPTR implantation between January 2016 and January 2018. None of them needed blood transfusion. They underwent 56 primary implantation, 16(40%) bilateral system and 24(60%) unilateral followed by lengthening procedure in a period of 4-6 months. The patients were assessed based on mechanical measures, that is, the radiographic improvement of their scoliosis, spinal height, and sagittal and coronal correction, which are measured and compared preoperatively, immediately postoperatively and at two years follow up, complication encountered during this period are also counted. RESULTS: The average initial correction in Cobb angle immediately after the index surgery was 14.4° (5°-26°) and the average final correction of Cobb which is measured after the last expansion procedure (Cobb angle of the major curve measured after last expansion minus initial preoperative Cobb angle of the major curve) was 7.3° (12%). The average of preoperative coronal T1-S1 length was 25.6 cm with an average initial correction achieved immediately after implantation of VEPTR of2.8 cm (1.2-5.1cm) which is 10.9%, and the average coronal length gain at 2 years follow up was 5.7 cm (3.7-9.8cm) that is 22.2%. Complication occurred in 18 of our patients (45%). CONCLUSION: Early results of VEPTR for childhood scoliosis are encouraging. Follow-up till skeletal maturity will best determine future indications.

Cortical Bone Trajectory Screws for Fixation Across the Cervicothoracic Junction: Surgical Technique and Outcomes.

STUDY DESIGN: Clinical case series describing a novel surgical technique. OBJECTIVE: Stabilization across the cervicothoracic junction (CTJ) poses technical difficulties which make this procedure challenging. The transition from cervical lordosis to thoracic kyphosis and the orientation of the lateral masses of the cervical spine compared with the pedicles of the thoracic spine create the need to accommodate for 2 planes of alignment when placing instrumentation. A novel surgical technique for instrumentation across the cervicothoracic junction is described. METHODS: The use of cortical bone trajectory (CBT) technique for pedicle fixation in the upper thoracic spine is described in combination with cervical lateral mass or pedicle screws. The application in our first 12 patients for stabilization across the CTJ is described. Two case presentations illustrate the technique. RESULTS: All the patients had rod screw constructs without the need to skip levels, there was no requirement for transverse connectors and only 1 plane of contouring was required. CONCLUSIONS: The use of CBT technique has not been described for the upper thoracic spine. This technique avoids many technical problems associated with posterior instrumentation of the CTJ. The facility of their use in this application arises from the similar coronal plane entry points as the cervical lateral mass screws compared with the more lateral starting point of traditional thoracic pedicle screws. The technique has clinical equipoise to traditional thoracic pedicle screw insertion but with the benefits of an easier ability to perform the instrumentation and saving levels of fusion.

The Potential Use of Layer Litter in Awassi Lamb Diet: Its Effects on Carcass Characteristics and Meat Quality.

Carcass parameters and meat quality in lambs that consumed diets having layer hen litter (LL) were evaluated in a complete randomized study. Forty-two lambs were allocated equally (14 lambs/treatment diet) into one of three iso-nitrogenous diets for 75 days. To partially replace soybean meal and barley, LL was given at 0 (LL0), 150 (LL150), or 300 g/kg (LL300) of dietary dry matter (DM). At the termination of the trial, the characteristics of carcasses (hot and cold carcass weight, dressing percentage, and carcass cuts) and meat quality (Musculus longissimus linear dimensions, ultimate pH, cooking loss, water holding capacity (WHC), shear force (SF), color coordinates) were measured after slaughtering all lambs. Longissimus muscle weight was greatest (p < 0.05) for the LL150. For the dissected loin, intermuscular fat content was lowest for the LL0 diet. However, subcutaneous fat content was lower (p < 0.05) in the LL300 diet than LL0 and LL150 diets. Rib fat depth and Musculus longissimus area were greater (p < 0.05) for LL150 than L0. No differences were found in meat pH or color parameters among treatments but WHC and SF were lower in L0 lambs than in lambs fed LL containing diets. Cooking loss was greater for the LL300 diet than the LL0 diet. In summary, quality of meat and carcasses data indicate the possibility of inclusion of LL up to 300 g/kg DM to growing Awassi lambs.

Growth Performance and Meat Characteristics of the First Awassi-Rambouillet Callipyge Backcross.

The Awassi breed is desirable due to its resilient traits, but shows poor lean meat content on the carcass; the callipyge mutation may enhance growth and meat characteristics. The first backcross of callipyge Awassi-Rambouillet (CRAW) lambs was generated by mating Awassi ewes with heterozygous F1 (50 % Awassi and 50 % Rambouillet) rams for the callipyge mutation. A fattening trial with carriers of CLPG (CRAW), non-carriers (RAW), and Awassi (AW) ram lambs was conducted for 94 days and growth and meat characteristic parameters were recorded. Final body weight, average daily gain (ADG), feed conversion ratio, and dry matter intake, but not initial body weight, were greater in CRAW and RAW lambs as compared to AW lambs; hot and cold carcass, dressing percentage, and shoulder, rack, and loin weights were greater in CRAW vs. AW but not RAW lambs. Leg cuts were heavier in CRAW vs. both RAW and AW lambs; intermuscular and subcutaneous fat percentages were greater in CRAW as compared to AW but not RAW lambs. Non-carcass components showed kidney fat, kidney, liver and testes weights higher in CRAW lambs as compared to AW lambs, but these parameters were similar to those of RAW lambs. There were no differences in fat tail weight. Further, CRAW lambs had higher shear force and water holding capacity than RAW and AW lambs, while cooking loss was the lowest in CRAW lambs. In conclusion, the callipyge mutation with 25% Rambouillet genes can provide efficient improvements in growth and meat characteristics, with the exception of tenderness in Awassi sheep.