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1.
Oncol Rep ; 51(6)2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38695244

RESUMO

Following the publication of the above article, a concerned reader drew to the Editor's attention that certain of the Transwell cell migration and invasion assay data featured in Figs. 5C and 6C were strikingly similar to data appearing in different form in other articles written by different authors at different research institutes that had already been published elsewhere prior to the submission of this paper to Oncology Reports, or were submitted for consideration for publication at around the same time. In view of the fact that certain of these data had already apparently been published prior to the submission of this article for publication, the Editor of Oncology Reports has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [Oncology Reports 37: 2743­2750, 2017; DOI: 10.3892/or.2017.5555].

2.
Food Chem ; 450: 139460, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38703671

RESUMO

To identify interesting relationships between anthocyanin degradation and color variation during food processing, black carrot slice (BCS) was dried by air-impingement jet drying (AIJD) and hot air drying (HAD). AIJD was a better technology for drying BCS than HAD. Results of colorimeter determination showed that the color of BCS was significantly changed during AIJD at 50, 60 and 70 °C. UHPLC-QqQ-MS/MS analysis found that AIJD-induced degradations of main BCS anthocyanins, cyanidin-3-xylosyl(feruloylglucosyl)galactoside and cyanidin-3-xylosyl(sinapoylglucosyl)galactoside, belonged to non-spontaneous endothermic reactions, which followed the 0.5- and 1-order kinetic equations, respectively. Anthocyanin content and colors obtained from colorimeter presented strong positive correlation, particularly the a* and chroma values. We further developed a Python script based on image recognition technology to visualize the correlation matrixes between the anthocyanin contents and colors of BSC images. The plots revealed that strong positive correlations between anthocyanins and colors primarily concentrated in the sample's periphery following a concentric pattern.

3.
Food Chem ; 451: 139464, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38704990

RESUMO

Silver-metal organic framework (Ag@MOF) has exhibited outstanding antimicrobial activity in antimicrobial applications, and reducing the biotoxicity associated with silver has become a research priority. In this study, Ag@MOF was initially modified with sodium alginate (SA) to form SA-Ag@MOF. The results showed that SA could control the release of Ag+, reducing the release by about 8% at 24 h, and the biotoxicity was significantly reduced. Finally, SA-Ag@MOF was applied as an antimicrobial agent in citric acid-modified PVA film to develop a novel composite antimicrobial film. When added at 2 MIC, the CA3-M2 film can effectively inhibit the growth of E. coli and S. aureus, and the inhibition rate has reached 98%. For white radish packaging applications, CA3-M2 film inhibited the growth of surface microorganisms, while ensuring moisture and tissue hardness to extend shelf-life up to 7 days. Overall, the strategy conceived here can be a theoretical basis for novel antimicrobial packaging.

4.
Molecules ; 29(9)2024 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-38731534

RESUMO

Two unreported heteropolysaccharides, denoted as YCJP-1 and YCJP-2, were isolated from the herbs of Chloranthus japonicus. YCJP-1 was a heteropolysaccharide composed of glucose, galactose, arabinose, mannose, rhamnose, and a minor proportion of uronic acids, with the molecular weight mainly distributed in the 74,475-228,443 Da range. YCJP-2 was mainly composed of glucose, mannose, and galactose, with the molecular weights ranging from 848 to 5810 Da. To further evaluate the anti-gastric cancer effects of C. japonicus, the inhibitory effects of the crude polysaccharide (YCJP) and the purified polysaccharides (YCJP-1 and YCJP-2) were determined using a CCK-8 assay and colon-forming assay on MGC-803 and AGS gastric cancer cell lines. Our results showed that YCJP, YCJP-1, and YCJP-2 possess prominent inhibitory effects on the proliferation of MGC-803 and AGS cells, and the AGS cell was more sensitive to YCJP, YCJP-1, and YCJP-2. Moreover, YCJP-2 demonstrated superior anti-gastric cancer effects compared to YCJP-1. This could potentially be attributed to YCJP-2's higher glucose content and narrower molecular weight distribution.


Assuntos
Proliferação de Células , Polissacarídeos , Neoplasias Gástricas , Humanos , Polissacarídeos/farmacologia , Polissacarídeos/química , Polissacarídeos/isolamento & purificação , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Extratos Vegetais/farmacologia , Extratos Vegetais/química , Antineoplásicos Fitogênicos/farmacologia , Antineoplásicos Fitogênicos/química , Antineoplásicos Fitogênicos/isolamento & purificação , Peso Molecular , Caryophyllaceae/química
5.
Food Chem X ; 22: 101425, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38736979

RESUMO

This study was designed to reveal the relationship among browning, polyphenol degradation, Maillard reaction (MR) and flavor variation in jujube fruit (JF) during air-impingement jet drying (AIJD). Five kinds of JFs were dried by AIJD at 60 °C and vacuum freeze drying. Colorimeter and chemometric analysis found that AIJD induced color changes of JF pulp and peel. AIJD also reduced the total polyphenols content and total flavonoids levels in JF. The Fe3+ reducing capacity and 2,2'-Azinobis-(3-ethylbenzothiazoline-6-sulphonate) cationic radical scavenging capacity of JF were reduced by 31.6% and 8.2%, respectively. Seven polyphenols were identified in JF, and epicatechin was found related to change of JF pulp color by sparse partial least square (sPLS). sPLS revealed that 3-deoxy glucosone, N-ε-carboxymethyl-l-lysine and 5-hydroxymethylfurfural associated with JF color. sPLS found that MR generated 3-methyl-butanoic acid and cyclobutanone during AIJD of JF. Chemometrics is an effective tool to disclose mechanism of color changes in food.

6.
J Cell Mol Med ; 28(8): e18275, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38568058

RESUMO

Breast cancer (BC) remains a significant health concern worldwide, with metastasis being a primary contributor to patient mortality. While advances in understanding the disease's progression continue, the underlying mechanisms, particularly the roles of long non-coding RNAs (lncRNAs), are not fully deciphered. In this study, we examined the influence of the lncRNA LINC00524 on BC invasion and metastasis. Through meticulous analyses of TCGA and GEO data sets, we observed a conspicuous elevation of LINC00524 expression in BC tissues. This increased expression correlated strongly with a poorer prognosis for BC patients. A detailed Gene Ontology analysis suggested that LINC00524 likely exerts its effects through RNA-binding proteins (RBPs) mechanisms. Experimentally, LINC00524 was demonstrated to amplify BC cell migration, invasion and proliferation in vitro. Additionally, in vivo tests showed its potent role in promoting BC cell growth and metastasis. A pivotal discovery was LINC00524's interaction with TDP43, which leads to the stabilization of TDP43 protein expression, an element associated with unfavourable BC outcomes. In essence, our comprehensive study illuminates how LINC00524 accelerates BC invasion and metastasis by binding to TDP43, presenting potential avenues for therapeutic interventions.


Assuntos
Neoplasias da Mama , RNA Longo não Codificante , Feminino , Humanos , Bioensaio , Neoplasias da Mama/genética , Transformação Celular Neoplásica , Ontologia Genética , RNA Longo não Codificante/genética
7.
BMC Psychiatry ; 24(1): 262, 2024 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-38594695

RESUMO

BACKGROUND: Schizophrenia (SCZ) is a profound mental disorder with a multifactorial etiology, including genetics, environmental factors, and demographic influences such as ethnicity and geography. Among these, the studies of SCZ also shows racial and regional differences. METHODS: We first established a database of biological samples for SCZ in China's ethnic minorities, followed by a serum metabolomic analysis of SCZ patients from various ethnic groups within the same region using the LC-HRMS platform. RESULTS: Analysis identified 47 metabolites associated with SCZ, with 46 showing significant differences between Miao and Han SCZ patients. These metabolites, primarily fatty acids, amino acids, benzene, and derivatives, are involved in fatty acid metabolism pathways. Notably, L-Carnitine, L-Cystine, Aspartylphenylalanine, and Methionine sulfoxide demonstrated greater diagnostic efficacy in Miao SCZ patients compared to Han SCZ patients. CONCLUSION: Preliminary findings suggest that there are differences in metabolic levels among SCZ patients of different ethnicities in the same region, offering insights for developing objective diagnostic or therapeutic monitoring strategies that incorporate ethnic considerations of SCZ.


Assuntos
Esquizofrenia , Humanos , Esquizofrenia/diagnóstico , Minorias Étnicas e Raciais , Povo Asiático , Etnicidade , China , Predisposição Genética para Doença
8.
J Clin Oncol ; : JCO2302380, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38657188
9.
Heliyon ; 10(7): e28970, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38596112

RESUMO

Determining suitable irrigation technology is of paramount for promoting water-saving agriculture, particularly for winter wheat-summer maize rotation system in well-irrigated regions. To optimize and assess the efficacy of various irrigation technologies (specifically, semi-fixed sprinkler irrigation, walking sprinkler, semi-automatic buried telescopic sprinkler irrigation, thin-soft spray tape irrigation, drip irrigation, self-driven winch sprinkler and manually moving spray gun irrigation, marked as A, B, C, D, E, F and G) applied in south central North China Plain, we first conducted an economic analysis for the winter wheat-summer maize rotation. Subsequently, employing a comprehensive set of 20 indicators spanning economic, societal, technological, ecological, and resource aspects, we employed a TOPSIS model with integrative weighting approach using "AHP + Entropy". We also employed principal component analysis and the Sankey diagram method to explore characteristics of different irrigation techniques and indexes. Irrigation mode E, conserving energy by 63.19% compared to mode B and offering labor savings five times greater than the mode D. The highest economic benefit for the rotation system was observed with the mode C, resulting in a 25.26% increase compared to the mode G. The top three irrigation modes based on scores were D, G, and E, with scores of 0.532, 0.490, and 0.474, respectively. The Sankey diagram revealed distinct preferences among different agricultural entities for specific irrigation modes. For specific stakeholders, we recommend irrigation modes D, G, F, and B for small farmers, large and specialized family businesses, family farms, and farmer cooperatives, respectively. In conclusion, our findings provide valuable scientific support and recommendations for the practical application of irrigation technology in agricultural production.

10.
Pharm. pract. (Granada, Internet) ; 22(1): 1-10, Ene-Mar, 2024. graf, tab
Artigo em Inglês | IBECS | ID: ibc-231374

RESUMO

Objective: Systemic studies on anti-PD-1 therapy in patients with metastatic colorectal cancer (mCRC) with microsatellite instability or mismatch repair defects are lacking. We aimed to summarize the evidence regarding the efficacy and safety of pembrolizumab, nivolumab, ipilimumab, and tislelizumab in mCRC. Methods: Network meta-analyses (NMAs) can provide comparative efficacy and safety data for clinical decision-making. In this NMA, eligible publications from PubMed, EMBASE, Web of Science, and Cochrane Library from 2016 to April 2023 were identified through a systematic literature review. Literature screening and data extraction were performed according to established criteria. The quality of the literature was evaluated using the Cochrane risk of bias tool, and statistical analysis was performed using Revman5.4 and R language. The main outcome indicators, DCR, ORR, PFS, and OS, were used to evaluate the effectiveness of the drugs, and the main outcome indicators AE and SAE were used to evaluate the safety of each program. Results: Fifteen studies with a sample size of 798 patients were included. In terms of effectiveness, the disease control rate DCR of PD-1 inhibitors was 0.727[95% CI:0.654-0.794]; objective response rate ORR was 0.448[95% CI:0.382-0.514]; and the 1-year progression-free survival rate was 0.551[95% CI:0.458-0.642]. The 1-year overall survival rate was 0.790[95% CI:0.705-0.865]. The adverse events associated with anti-PD-1 were 0.567[95% CI:0.344-0.778] in terms of safety. The total incidence of grade 3 or higher adverse events was 0.241[95% CI:0.174-0.313]. In the subgroup analysis results, the incidence of DCR in the nivolumab + ipilimumab group was 0.826[95% CI:0.780-0.869], the ORR was 0.512[95% CI:0.377-0.647], and the PFS was 0.668[95% CI:0.516-0.804]. The incidence of AE was 0.319 [95% CI:0.039-0.700] and SAE was 0.294 [95% CI:0.171-0.433]... (AU)


Assuntos
Humanos , Neoplasias Colorretais , Metástase Neoplásica , Nivolumabe , Ipilimumab , Preparações Farmacêuticas
11.
Aging (Albany NY) ; 16(5): 4138-4148, 2024 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-38462692

RESUMO

Hypertension is one of the most important risk factors for chronic kidney diseases, leading to hypertensive nephrosclerosis, including excessive albuminuria. Azilsartan, an angiotensin II type 1 receptor blocker, has been widely used for the treatment of hypertension. However, the effects of Azilsartan on urinary albumin excretion in hypertension haven't been reported before. In this study, we investigated whether Azilsartan possesses a beneficial property against albuminuria in mice treated with angiotensin II and a high-salt diet (ANG/HS). Compared to the control group, the ANG/HS group had higher blood pressure, oxidative stress, and inflammatory response, all of which were rescued by Azilsartan dose-dependently. Importantly, the ANG/HS-induced increase in urinary albumin excretion and decrease in the expression of occludin were reversed by Azilsartan. Additionally, it was shown that increased fluorescence intensity of FITC-dextran, declined trans-endothelial electrical resistance (TEER) values, and reduction of occludin and krüppel-like factor 2 (KLF2) were observed in ANG/HS-treated human renal glomerular endothelial cells (HrGECs), then prevented by Azilsartan. Moreover, the regulatory effect of Azilsartan on endothelial monolayer permeability in ANG/HS-treated HrGECs was abolished by the knockdown of KLF2, indicating KLF2 is required for the effect of Azilsartan. We concluded that Azilsartan alleviated diabetic nephropathy-induced increase in Uterine artery embolization (UAE) mediated by the KLF2/occludin axis.


Assuntos
Albuminúria , Benzimidazóis , Hipertensão , Oxidiazóis , Camundongos , Humanos , Animais , Albuminúria/tratamento farmacológico , Células Endoteliais , Ocludina
12.
CNS Neurosci Ther ; 30(3): e14652, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38433011

RESUMO

AIM: This study aims to elucidate the cellular dynamics and pathophysiology of white matter hemorrhage (WMH) in intracerebral hemorrhage (ICH). METHODS: Using varying doses of collagenase IV, a consistent rat ICH model characterized by pronounced WMH was established. Verification was achieved through behavioral assays, hematoma volume, and histological evaluations. Single-cell suspensions from the hemorrhaged region of the ipsilateral striatum on day three post-ICH were profiled using single-cell RNA sequencing (scRNA-seq). Gene Ontology (GO) and gene set variation analysis (GSVA) further interpreted the differentially expressed genes (DEGs). RESULTS: Following WMH induction, there was a notable increase in the percentage of myeloid cells and oligodendrocyte precursor cells (OPCs), alongside a reduction in the percentage of neurons, microglia, and oligodendrocytes (OLGs). Post-ICH WMH showed homeostatic microglia transitioning into pro-, anti-inflammatory, and proliferative states, influencing lipid metabolic pathways. Myeloid cells amplified chemokine expression, linked with ferroptosis pathways. Macrophages exhibited M1 and M2 phenotypes, and post-WMH, macrophages displayed a predominance of M2 phenotypes, characterized by their anti-inflammatory properties. A surge in OPC proliferation aligned with enhanced ribosomal signaling, suggesting potential reparative responses post-WMH. CONCLUSION: The study offers valuable insights into WMH's complex pathophysiology following ICH, highlighting the significance and utility of scRNA-seq in understanding the cellular dynamics and contributing to future cerebrovascular research.


Assuntos
Acidente Vascular Cerebral , Substância Branca , Animais , Ratos , Acidente Vascular Cerebral/complicações , Hemorragia Cerebral/genética , Anti-Inflamatórios , Análise de Sequência de RNA
13.
Trends Plant Sci ; 2024 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-38553259

RESUMO

IRON MAN (IMA) peptides have a critical role in iron uptake and homeostasis, but whether and how they associate with plant immunity signaling remain unclear. Recently, Cao et al. provided intriguing insights into the underlying plant mechanisms that restrict root iron acquisition on perception of microorganism-associated molecular patterns (MAMPs) by spatial IMA-1 turnover.

14.
J Leukoc Biol ; 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38447557

RESUMO

Immune functional decline and remodeling accompany aging and frailty. It is still largely unknown how changes in the immune cellular composition differentiate healthy individuals from those become frail at a relatively early age. Our aim in this exploratory study was to investigate immunological changes from newborn to frailty, and the association between health statute and various immune cell subtypes. The participants analyzed in this study covered human cord blood cells and peripheral blood cells collected from young adults, healthy and frail old individuals. A total of 30 immune cell subsets was performed by flow cytometry based on the surface markers of immune cells. Furthermore, frailty was investigated for its relations with various leukocyte subpopulations. Frail individuals exhibited a higher CD4/CD8 ratio, a higher proportion of CD4+ central memory T (TCM) cells, CD8+ effector memory T cells, CD27- switched memory B (CD27-BSM) cells, CD27+ switched memory B cells, age-associated B cells (ABCs) and CD38-CD24- B cells, and a lower proportion of naïve CD8 + T cells and progenitor B cells. The Frailty index score was found to be associated with naïve T cells, CD4/CD8 ratio, ABCs, CD27-BSM cells, and CD4+ TCM cells. Our findings conducted a relatively comprehensive and extensive atlas of age- and frailty-related changes in peripheral leukocyte subpopulations from newborn to frailty. The immune phenotypes identified in this study can contribute to a deeper understanding of immunosenescence in frailty and may provide a rationale for future interventions and diagnosis.

15.
Sci Rep ; 14(1): 5106, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429392

RESUMO

Taking the return-airway 4204 with roof cutting in Longquan Coal Mine as the engineering background, roof structure, key parameters, and deviatoric stress evolution were studied. Conclusion: The Key Stratum within a 4-8 times mining height is considered as Near Key Stratum. Cutting the roof makes it possible to form a cantilever structure of the Key Stratum on the solid coal side, which is more conducive to the stability of gob-side roadway. During cutting angle of 90-55°, the deviatoric stress increases linearly, and the increase rate is coal pillar > solid coal > roof > floor. While cutting length from 0 to 35 m, the deviatoric stress decreases linearly, and the decreasing range: coal pillar > solid coal > roof > floor. When coal pillar width is from 30 to 4 m, the deviatoric stress of left side and floor presents a "single peak" distribution. The deviatoric stress of coal pillar changes from an asymmetric "double peak" to a bell-shaped distribution, and the deviatoric stress of roof changes from a "single peak" to an asymmetric "double peak" distribution. Under same coal pillar width, the deviatoric stress of left, coal pillar and roof after roof cutting decreases most obviously, followed by the floor. Finally, the coal pillar width is 8 m, the cutting angle is 75°, the cutting length is 20 m, and the hole spacing is 1.0 m. The support scheme is bolt + metal mesh + steel belt + anchor cable combined support. The stable period of roadway is about 10 days.

16.
J Phys Chem Lett ; 15(9): 2453-2461, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38407025

RESUMO

The organic-inorganic halide perovskite has become one of the most promising candidates for next-generation memory devices, i.e. memristors, with excellent performance and solution-processable preparation. Yet, the mechanism of resistive switching in perovskite-based memristors remains ambiguous due to a lack of in situ visualized characterization methods. Here, we directly observe the switching process of perovskite memristors with in situ photoluminescence (PL) imaging microscopy under an external electric field. Furthermore, the corresponding element composition of conductive filaments (CFs) is studied, indicating that the metallic CFs with respect to the activity of the top electrode are essential for device performance. Finally, electrochemical impedance spectroscopy (EIS) is conducted to reveal that the transition of ion states is associated with the formation of metallic CFs. This study provides in-depth insights into the switching mechanism of perovskite memristors, paving a pathway to develop and optimize high-performance perovskite memristors for large-scale applications.

17.
Opt Lett ; 49(3): 594-597, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38300067

RESUMO

High-purity structural colors with low fabrication cost are in demand for their commercial applications. Here, we demonstrate an all-dielectric Fabry-Pérot cavity structure consisting of four-layer lossy and lossless dielectric films alternately stacked for producing high-purity and angle-invariant reflective colors. Multiple cavity resonances function together to significantly suppress the undesired reflection with the enhanced optical absorption, leading to a distinct and saturated color with a high efficiency of ∼70%. Besides, due to the high refractive indices of constituent materials, the color appearance of the designed structure can be maintained well at ±50° incident angle for two polarization states. The excellent color performance of the proposed device together with cost-effective manufacturing convenience opens up new avenues for their large-area applications in various areas.

18.
Life (Basel) ; 14(2)2024 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-38398731

RESUMO

The growth and development of honeybees are influenced by many factors, one of which is the cell size of the brood comb. Larger worker bees can be obtained by being raised in bigger cells. However, whether cell size has the same effect on drone development is still unknown. Here, using 3D-printed foundations, we observed the development of drones kept in comb cells of different sizes from the late larval stage through eclosion. The results showed that drones in larger cell-size combs had heavier body weights, longer body lengths, and larger head widths, thorax widths, and abdomen widths compared to those in smaller cell-size combs. Furthermore, regardless of developmental stages, the drones' body weights increased linearly with the comb's cell size. However, the other morphological changes of drones in different developmental stages were out of proportion to the cell-size changes, resulting in smaller cells with a higher fill factor (thorax width/cell width). Our findings confirm that comb cell size affects the development of honeybees; drones become bigger when raised in large cells.

19.
J Org Chem ; 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38323758

RESUMO

Herein, we report a single-step, multicomponent approach to versatile γ-lactams through dual photoredox/nickel-catalyzed dicarbofunctionalization of α,ß-unsaturated γ-butyrolactam. This reaction utilized alkyl trimethylgermanium as a radical precursor and acyl chloride as the electrophile, demonstrating remarkable functional group compatibility.

20.
J Multidiscip Healthc ; 17: 609-617, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38348208

RESUMO

Purpose: This study aimed to establish a stereoscopic neural learning network through deep learning and construct an artificial intelligence (AI) diagnosis system for the prediction of benign and malignant thyroid diseases, as well as repeatedly verified the diagnosis system and adjusted the data, in order to develop a type of AI-assisted thyroid diagnosis software with a low false negative rate and high sensitivity for clinical practice. Patients and Methods: From July 2020 to April 2023, A total of 36 patients with thyroid nodules in our hospital were selected for diagnosis of thyroid nodules based on the Expert Consensus on Thyroid Ultrasound; samples were taken by aspiration biopsy or surgically and sent for pathological diagnosis. The ultrasonic diagnosis results were compared with the pathological results, a database was established based on the ultrasonic diagnostic characteristics and was entered in the AI-assisted diagnosis software for judgment of benign and malignant conditions. The data in the software were corrected based on the conformity rate and the reasons for misjudgment, and the corrected software was used to evaluate the benign and malignant conditions of the 36 patients, until the conformity rate exceeded 90%. Results: The initial conformity rate of the AI software for identifying benign and malignant conditions was 88%, while that of the software utilizing the database was 94%. Conclusion: We established a stereoscopic neural learning network and construct an AI diagnosis system for the prediction of benign and malignant thyroid diseases, with a low false negative rate and high sensitivity for clinical practice.

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