Elaboration of massage technique for semen collection and examination of semen characteristics in chinchilla (Chinchilla lanigera).

The practice of artificial insemination for the long-tailed chinchilla has not been fully elaborated to date, and existing data available regarding their reproduction properties is contradictory. Until now, the collection of semen for chinchillas has been most-commonly obtained using electro-ejaculation methods exclusively. The primary objective of this study was the development of a manual technique for semen collection which meets all animal welfare requirements. An additional aim was to determine the basic spermatological parameters, such as motility, concentration, type and ratio of morphological abnormalities and live/dead cell ratio, under typical northern-hemisphere conditions, in Hungary. Over a 3 month period, a special massage technique was developed for the study, and using this method, the sperm parameters of 46 males were subsequently analyzed weekly for a period of one year. Approximately 66% of chinchillas responded positively to this technique, with the success rate of semen-collection attempts showing no variation between seasons. Average sperm concentration for the whole year was 935.17 million/ml using this method. Total cell motility was the highest in winter (90.3%), and the lowest in spring (84.3%). The proportion of live, intact cells were above 80% on average for the year, while the ratios of live, morphologically abnormal and dead cells were 6% and 14%, respectively. We found that midpiece abnormalities occurred in the highest proportion (0.95%-3.38%), while the head abnormalities showed the lowest ratio (0.01%-0.15%). Standard deviation among the parameters was relatively high, with the spring season proving to be the weakest in terms of sperm quality. This study has demonstrated that, semen can be successfully collected without the use of electro-ejaculation or anesthesia. Furthermore, although spermatological parameters do exhibit some fluctuation for the different times of the year, semen collected is nonetheless suitable for the purpose of artificial insemination of chinchillas at any time.

Rape, sunflower and forest honeys for long-term environmental monitoring: Presence of indicator elements and non-photosynthetic carbon in old Hungarian samples.

In this paper, we present the time-dependent elemental composition and AMS radiocarbon dating results of 36 rape, sunflower and forest honey samples, collected between 1985 and 2018 in geographically close locations. Based on the elemental information, we conclude that bee products regardless the type provide useful environmental information of the previous decades, such as the decreasing trend of airborne Pb emission can be traced. However, radiocarbon results agree less with the atmospheric bomb peak. Random offsets were observed in the specific radiocarbon activity of the honey samples indicating that rape, sunflower and forest honey samples are not as reliable materials for radiocarbon dating as acacia honeys. The radiocarbon results show that the rape, sunflower and forest honey samples can contain non-photosynthetic carbon, presumably derived from the soil. Thus, the complex application of honey samples for environmental reconstruction requires the species-separated investigation of bee products to reveal their adaptability for assessment approaches.

Biochemical Characterisation of Human Transglutaminase 4.

Transglutaminases are protein-modifying enzymes involved in physiological and pathological processes with potent therapeutic possibilities. Human TG4, also called prostate transglutaminase, is involved in the development of autoimmune and tumour diseases. Although rodent TG4 is well characterised, biochemical characteristics of human TG4 that could help th e understanding of its way of action are not published. First, we analysed proteomics databases and found that TG4 protein is present in human tissues beyond the prostate. Then, we studied in vitro the transamidase activity of human TG4 and its regulation using the microtitre plate method. Human TG4 has low transamidase activity which prefers slightly acidic pH and a reducing environment. It is enhanced by submicellar concentrations of SDS suggesting that membrane proximity is an important regulatory event. Human TG4 does not bind GTP as tested by GTP-agarose and BODIPY-FL-GTPγS binding, and its proteolytic activation by dispase or when expressed in AD-293 cells was not observed either. We identified several potential human TG4 glutamine donor substrates in the AD-293 cell extract by biotin-pentylamine incorporation and mass spectrometry. Several of these potential substrates are involved in cell-cell interaction, adhesion and proliferation, suggesting that human TG4 could become an anticancer therapeutic target.

FvmnSOD is involved in oxidative stress defence, mitochondrial stability and apoptosis prevention in Fusarium verticillioides.

Superoxide dismutases are key enzymes in elimination of the superoxide anion radical (O2 •- ) generated intracellularly or by exogenous oxidative stress eliciting agents, like menadione. In this study, we investigated the physiological role of the manganese superoxide dismutase-encoding gene in Fusarium verticillioides via the construction of a gene deletion mutant, ΔFvmnSOD and comparing its phenotype with that of the wild-type parental strain and a ΔFvmnSOD' C strain, complemented with the functional manganese superoxide dismutase gene. Deletion of FvmnSOD had no effect on the relative intracellular superoxide ratio but increased the sensitivity of the fungus to menadione sodium bisulphite on Czapek-Dox stress agar plates. The lack of FvmnSOD caused changes in mitochondrial morphology and physiology: The volumetric ratio of these cell organelles in the second hyphal segment, as well as the total, the KCN-sensitive cytochrome c-dependent and the KCN+SHAM (salicylhidroxamic acid)-resistant residual respiration rates, were higher in the mutant as compared to the wild-type and the complemented strains. Nevertheless, changes in the respiration rates were attributable to the higher volumetric ratio of mitochondria found in the gene deletion mutant. Changes in the mitochondrial functions also brought about higher sensitivity to apoptotic cell death elicited by the Penicillium chrysogenum antifungal protein. The gene deletion mutant developed significantly thinner hyphae in comparison to the wild-type strain. Deletion of FvmnSOD had no effect on fumonisin B1 and B2 production of the fungus grown in Myro medium as a static culture.

FvatfA regulates growth, stress tolerance as well as mycotoxin and pigment productions in Fusarium verticillioides.

FvatfA from the maize pathogen Fusarium verticillioides putatively encodes the Aspergillus nidulans AtfA and Schizasaccharomyces pombe Atf1 orthologous bZIP-type transcription factor, FvAtfA. In this study, a ΔFvatfA deletion mutant was constructed and then genetically complemented with the fully functional FvatfA gene. Comparing phenotypic features of the wild-type parental, the deletion mutant and the restored strains shed light on the versatile regulatory functions played by FvAtfA in (i) the maintenance of vegetative growth on Czapek-Dox and Potato Dextrose agars and invasive growth on unwounded tomato fruits, (ii) the preservation of conidiospore yield and size, (iii) the orchestration of oxidative (H2O2, menadione sodium bisulphite) and cell wall integrity (Congo Red) stress defences and (iv) the regulation of mycotoxin (fumonisins) and pigment (bikaverin, carotenoid) productions. Expression of selected biosynthetic genes both in the fumonisin (fum1, fum8) and the carotenoid (carRA, carB) pathways were down-regulated in the ΔFvatfA strain resulting in defected fumonisin production and considerably decreased carotenoid yields. The expression of bik1, encoding the polyketide synthase needed in bikaverin biosynthesis, was not up-regulated by the deletion of FvatfA meanwhile the ΔFvatfA strain produced approximately ten times more bikaverin than the wild-type or the genetically complemented strains. The abolishment of fumonisin production of the ΔFvatfA strain may lead to the development of new-type, biology-based mycotoxin control strategies. The novel information gained on the regulation of pigment production by this fungus can be interesting for experts working on new, Fusarium-based biomass and pigment production technologies. Key points • FvatfA regulates vegetative and invasive growths of F. verticillioides. • FvatfA also orchestrates oxidative and cell wall integrity stress defenses. • The ΔFvatfA mutant was deficient in fumonisin production. • FvatfA deletion resulted in decreased carotenoid and increased bikaverin yields.

Analysis of fumonisin mycotoxins with capillary electrophoresis - mass spectrometry.

This paper demonstrates the development of an analytical method based on CE coupled to ESI-MS for the identification and quantification of fumonisin mycotoxins. Separation and detection parameters (pH of background electrolyte (BGE), organic modifier content, sheath liquid (SL) composition, MS mode and nebuliser pressure) were optimised. Ammonium formate/ammonia (pH = 9.5) with 10% ACN modifier was found the most suitable BGE. Positive mode MS was used for detection by scanning the m/z range of 400-1200. Separation was highly affected by the nebuliser pressure, a 25% improvement in peak resolution was achieved by applying the optimised parameters. The 'dilute and shoot' approach was applied to overcome disturbing effects caused by the matrix of fungi supernatant samples. The available sample volume affected the reproducibility of the measurements greatly: the scattering of peak intensities were between 4 and 11 RSD% instead of 27-195 RSD% for fumonisin B1 and fumonisin B2 when the available volume was ~200 µL instead of ~20 µL. Quantitative determinations were carried out in Fusarium verticillioides and Fusarium proliferatum culture supernatant (raw) and mycelium (cleaned up) samples. The optimised method enabled the detection of 11 fumonisins in Fusarium proliferatum inoculated rice samples; 2 of them were quantified based on external calibration and 4 other compounds with fumonisin-like formulas were detected.

The Fungal Iron Chelator Desferricoprogen Inhibits Atherosclerotic Plaque Formation.

Hemoglobin, heme and iron are implicated in the progression of atherosclerosis. Therefore, we investigated whether the hydrophobic fungal iron chelator siderophore, desferricoprogen (DFC) inhibits atherosclerosis. DFC reduced atherosclerotic plaque formation in ApoE-/- mice on an atherogenic diet. It lowered the plasma level of oxidized LDL (oxLDL) and inhibited lipid peroxidation in aortic roots. The elevated collagen/elastin content and enhanced expression of adhesion molecule VCAM-1 were decreased. DFC diminished oxidation of Low-density Lipoprotein (LDL) and plaque lipids catalyzed by heme or hemoglobin. Formation of foam cells, uptake of oxLDL by macrophages, upregulation of CD36 and increased expression of TNF-α were reduced by DFC in macrophages. TNF-triggered endothelial cell activation (vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecules (ICAMs), E-selectin) and increased adhesion of monocytes to endothelium were attenuated. The increased endothelial permeability and intracellular gap formation provoked by TNF-α was also prevented by DFC. DFC acted as a cytoprotectant in endothelial cells and macrophages challenged with a lethal dose of oxLDL and lowered the expression of stress-responsive heme oxygenase-1 as sublethal dose was employed. Saturation of desferrisiderophore with iron led to the loss of the beneficial effects. We demonstrated that DFC accumulated within the atheromas of the aorta in ApoE-/- mice. DFC represents a novel therapeutic approach to control the progression of atherosclerosis.

Protein-peptide based assay for the characterization of human blood coagulation factor XIII-A isopeptidase activity.

Blood coagulation factor XIII-A (FXIII-A), a member of the transglutaminase enzyme family, is best known for its fibrin clot stabilizing function during blood coagulation. It possesses amine incorporating and protein crosslinking transamidase activities, but it is also able to cleave the previously formed isopeptide bond by its isopeptidase activity. Our aim was to develop a protein-based assay for better characterization of FXIII-A isopeptidase activity. The first attempt applying the crosslinked D-dimer of fibrin as a substrate was not successful because of poor reproducibility. Then, the principle of an earlier published anisotropy based activity assay was adapted for the measurement of FXIII-A isopeptidase activity. After crosslinking the fluorescently labelled α2-antiplasmin derived peptide and S100A4(GST) lysine donor protein, this protease-resistant γ-glutamyl-ε-lysine isopeptide bond containing protein-peptide product was applied as a substrate for FXIII-A. Using this substrate and detecting decreasing anisotropy, kinetic measurement of FXIII-A isopeptidase activity was achieved at high sensitivity even in a complex biological sample and in the presence of inhibitor.

Effects of selenate and red Se-nanoparticles on the photosynthetic apparatus of Nicotiana tabacum.

Selenium (Se) is a natural trace element, which shifts its action in a relatively narrow concentration range from nutritional role to toxicity. Although it has been well established that in plants chloroplasts are among the primary targets, the mechanism of toxicity on photosynthesis is not well understood. Here, we compared selenate and red-allotrope elemental selenium nanoparticles (red nanoSe) in in vitro tobacco cultures to investigate their effects on the structure and functions of the photosynthetic machinery. Selenate at 10 mg/L concentration retarded plant growth; it also led to a decreased chlorophyll content, accompanied with an increase in the carotenoid-to-chlorophyll ratio. Structural examinations of the photosynthetic machinery, using electron microscopy, small-angle neutron scattering and circular dichroism spectroscopy, revealed significant perturbation in the macro-organization of the pigment-protein complexes and sizeable shrinkage in the repeat distance of granum thylakoid membranes. As shown by chlorophyll a fluorescence transient measurements, these changes in the ultrastructure were associated with a significantly diminished photosystem II activity and a reduced performance of the photosynthetic electron transport, and an enhanced capability of non-photochemical quenching. These changes in the structure and function of the photosynthetic apparatus explain, at least in part, the retarded growth of plantlets in the presence of 10 mg/L selenate. In contrast, red nanoSe, even at 100 mg/L and selenate at 1 mg/L, exerted no negative effect on the growth of plantlets and affected only marginally the thylakoid membrane ultrastructure and the photosynthetic functions.

Transcriptome-Based Modeling Reveals that Oxidative Stress Induces Modulation of the AtfA-Dependent Signaling Networks in Aspergillus nidulans.

To better understand the molecular functions of the master stress-response regulator AtfA in Aspergillus nidulans, transcriptomic analyses of the atfA null mutant and the appropriate control strains exposed to menadione sodium bisulfite- (MSB-), t-butylhydroperoxide- and diamide-induced oxidative stresses were performed. Several elements of oxidative stress response were differentially expressed. Many of them, including the downregulation of the mitotic cell cycle, as the MSB stress-specific upregulation of FeS cluster assembly and the MSB stress-specific downregulation of nitrate reduction, tricarboxylic acid cycle, and ER to Golgi vesicle-mediated transport, showed AtfA dependence. To elucidate the potential global regulatory role of AtfA governing expression of a high number of genes with very versatile biological functions, we devised a model based on the comprehensive transcriptomic data. Our model suggests that an important function of AtfA is to modulate the transduction of stress signals. Although it may regulate directly only a limited number of genes, these include elements of the signaling network, for example, members of the two-component signal transduction systems. AtfA acts in a stress-specific manner, which may increase further the number and diversity of AtfA-dependent genes. Our model sheds light on the versatility of the physiological functions of AtfA and its orthologs in fungi.

Stress tolerances of nullmutants of function-unknown genes encoding menadione stress-responsive proteins in Aspergillus nidulans.

A group of menadione stress-responsive function-unkown genes of Aspergillus nidulans (Locus IDs ANID_03987.1, ANID_06058.1, ANID_10219.1, and ANID_10260.1) was deleted and phenotypically characterized. Importantly, comparative and phylogenetic analyses of the tested A. nidulans genes and their orthologs shed light only on the presence of a TANGO2 domain with NRDE protein motif in the translated ANID_06058.1 gene but did not reveal any recognizable protein-encoding domains in other protein sequences. The gene deletion strains were subjected to oxidative, osmotic, and metal ion stress and, surprisingly, only the ΔANID_10219.1 mutant showed an increased sensitivity to 0.12 mmol l(-1) menadione sodium bisulfite. The gene deletions affected the stress sensitivities (tolerances) irregularly, for example, some strains grew more slowly when exposed to various oxidants and/or osmotic stress generating agents, meanwhile the ΔANID_10260.1 mutant possessed a wild-type tolerance to all stressors tested. Our results are in line with earlier studies demonstrating that the deletions of stress-responsive genes do not confer necessarily any stress-sensitivity phenotypes, which can be attributed to compensatory mechanisms based on other elements of the stress response system with overlapping functions.

Penicillium antifungal protein (PAF) is involved in the apoptotic and autophagic processes of the producer Penicillium chrysogenum.

PAF, which is produced by the filamentous fungus Pencicillium chrysogenum, is a small antifungal protein, triggering ROS-mediated apoptotic cell death in Aspergillus nidulans. In this work, we provide information on the function of PAF in the host P. chrysogenum considering that carbon-starving cultures of the Δpaf mutant strain showed significantly reduced apoptosis rates in comparison to the wild-type (wt) strain. Moreover, the addition of PAF to the Δpaf strain resulted in a twofold increase in the apoptosis rate. PAF was also involved in the regulation of the autophagy machinery of this fungus, since several Saccharomyces cerevisiae autophagy-related ortholog genes, e.g. those of atg7, atg22 and tipA, were repressed in the deletion strain. This phenomenon was accompanied by the absence of autophagosomes in the Δpaf strain, even in old hyphae.

[Psychiatric aspects of infectious diseases -- a literature review]. / A fertozo betegségek pszichiátriai vonatkozásai -- irodalmi áttekintés.

It is essential for the psychiatrist working in the consultation-liaison field or with comorbid patients to be familiar with the psychiatric aspects of central nervous infectious diseases or infectious diseases with psychiatric symptoms. Authors have reviewed the most important psychiatric aspects of common infectious diseases. Essential knowledge for setting up a diagnosis and starting appropriate treatment has been summarized. The most important interactions of infectological and psychiatric treatments have also been discussed.

[Neurocognitive impairments of HIV infected individuals -- preliminary results of a national prevalence study in Hungary]. / HIV-fertozött személyek neurokognitív eltérései -- hazai prevalenciavizsgálat elozetes eredményei.

UNLABELLED: BACKGROUND and PURPOSE: The outcome of HIV infection has dramatically improved due to the widespread use of combined antiretroviral therapy (cART). Opportunistic infections faded and internal and hemato-oncological diseases along with neurological conditions came to the forth. Present study is to evaluate neurocognitive performance of the Hungarian HIV infected individuals, at first in this setting. PATIENTS and METHODS: We performed this cross-sectional pilot study within the frames of a national, single-center; prospective study on group of HIV infected patients, analyzing medical data and neurocognitive performance. Based on international recommendations visual memory, visuomotor coordination, non-verbal learning ability, executive functions and reaction time were tested by six domains of a computerized neuropsychological test battery (Vienna Test System). RESULTS: Data of 59 enrolled HIV individuals were analysed; nine of whom were women (15%), median age 42.6 (IQR: 32.4-48.1) years. In 32.2% (n=19) of patients neurocognitive impairment was detected. Duration of infection and cART treatment time tended to be longer in impaired group (not significant). Lower CD4 cell count at the time of examination (p=0.047), psychiatric diseases other than depression (p=0.005) were found significantly associated with impairment; tertiary education qualification were more common (p=0.033) among non-affected patients. By correlation analysis age, infected time and duration of cART were significantly associated with motor deficit. CONCLUSION: HAND was detected in almost one third part of examined patients, which largely corresponds that in developed countries were observed. Duration of infection and of cART therapy associated motor deficit was found to be the most common impairment. This finding might be interpreted by direct effect of HIV, neurotoxicity of antiretro virals and also by accelerated ageing of this population.

Monitoring of four dipyrone metabolites in communal wastewater by solid phase extraction liquid chromatography electrospray ionization quadrupole time-of-flight mass spectrometry.

Liquid chromatography quadrupole time-of-flight spectrometry (LC-Q-TOF-MS), equipped with electrospray ionization (ESI), was developed for the determination of the main metabolites of dipyrone - 4-aminoantipyrine (4-AA), 4-acetylaminoantipyrine (4-AAA), 4-formylaminoantipyrine (4-FAA) and 4-methylaminoantipyrine (4-MAA) in communal wastewater after reversed-phase solid phase extraction (SPE) in the low to several µg/l concentration range. Samples originated from conventional wastewater treatment plant (WWTP) using activated sewage sludge as well as from a pilot-scale WWTP operating in mixed mode (activated sewage sludge and cascade biofilms reactors with biofilms growing on fix beds and roots of greenhouse plants). Results of the present study confirmed the outcomes of our previous report according to which, 4-FAA was the most persistent metabolite, while 4-AAA and 4-MAA could be determined in the highest and lowest concentration, respectively. Moreover, the study of intraday variation of the concentration of these metabolites revealed that the concentration of 4-AA, 4-AAA and 4-FAA registered a 46%-75% increase in the samples collected at noon compared to those collected at 6 AM. Chlorination did not affect considerably the removal efficiency (about 15%) of these metabolites in samples collected for 3 months consecutively before and after disinfection. Both wastewater treatment techniques efficiently removed 4-AAA (between 80 and 96%). However, in the summer season, the removal efficiency of conventional WWTP using open-air aerated tanks is lower by 30%, (on average) than in the cold season. The concentration of the investigated metabolites showed increased concentrations in the winter season confirming the intake habits of the population from this popular analgesic and antipyretic drug.

In vitro efficacy of 5 antifungal agents against Candida parapsilosis, Candida orthopsilosis, and Candida metapsilosis as determined by time-kill methodology.

Killing activity of amphotericin B, fluconazole, voriconazole, posaconazole, and 5-fluorocytosine was determined against 6 Candida parapsilosis, 3 Candida orthopsilosis, and 4 Candida metapsilosis clinical isolates. After 24 h, 1 of 6 C. parapsilosis, 1 of 3 C. orthopsilosis, and 3 of 4 C. metapsilosis isolates were killed at 1 to 4 microg/mL (1-8x MIC) amphotericin B. The remaining isolates were killed by 2 to 4 microg/mL amphotericin B after 48 h. Fluconazole was fungistatic at > or =1x MIC (0.5-2 microg/mL) against C. parapsilosis and at > or =2x MIC (4-8 microg/mL) against C. orthopsilosis and C. metapsilosis isolates. Voriconazole inhibited C. parapsilosis at > or =1x MIC (0.015-0.12 microg/mL), but the other 2 species were inhibited only at 4 to 8x MIC (0.25-0.5 microg/mL). Against C. orthopsilosis and C. metapsilosis, posaconazole was fungistatic close to the MIC (0.03-0.06 and 0.015-0.03 microg/mL, respectively). Against C. orthopsilosis and C. metapsilosis, fluconazole and voriconazole, but not posaconazole, seem to be less active in vitro than against C. parapsilosis.

Sibutramine-associated psychosis (case report).

INTRODUCTION: There are altogether four reported cases in the literature about psychotic episodes associated with sibutramine, which has been registered as an appetite suppressant for 10 years. OBJECTIVE: Authors review the case of a patient who, after being on sibutramine for three weeks, passed gradually into a psychotic state. CASE SUMMARY: A 39-year-old white woman started to take sibutramine to lose weight at a dosage of 10 mg/day. After taking the pill for two weeks her behavior changed basically, she neglected her tasks and irrealistic thoughts appeared in her mind. Later, she recalled these weeks as if they had been a dream. In two weeks time after spontaneous abrupt of sibutramine intake symptoms disappeared without any treatment. The examination did not reveal organic disturbances or psychiatric illnesses. DISCUSSION: The result of the psychological examination rendered it probable, that the multitude of severe difficulties the patient had experienced in her life before she developed a pathological condition had weakened her psychic defense mechanism, making her vulnerable to the drug's psychosis-inducing properties. The correlation between the symptoms and sibutramine intake according to the Naranjo ADR scale is "probable". CONCLUSION: On the basis of this case, authors suggest that those persons exposed to increased stress or being vulnerable to psychosis in any other way should take sibutramine with extra caution and under close supervision only.

Varying appearance of focal nodular hyperplasia in nuclear medicine imaging.

The focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor, which contains variable quantities of normal hepatic cellular elements: Kupffer cells, hepatocytes, bile ducts, and blood vessels. Two patients with suspicion of FNH were investigated by colloidal, blood pool, and hepatobiliary scintigraphy. Dynamic perfusion examination (with labeled RBCs), planar and SPECT studies were performed in all cases. Diagnosis was confirmed by histologic examination. We suggest the importance of combined imaging because of various appearance of the tumor. In our experience SPECT imaging after a planar study is a useful sequence, especially in small tumors in the exact location of activity.

Claudin expression in Barrett's esophagus and adenocarcinoma.

Claudins (CLDNs) are key molecules in cell adhesion, polarity, and control of paracellular solute transport. Several studies suggested that changes in claudin pattern have a role in cancer development. This study aimed to detect alterations in CLDN 1, 2, 3, 4, and 7 expression patterns in Barrett's esophagus (BE) and adenocarcinoma (ACC) compared with that in foveolar epithelium (FOV), normal squamous epithelium (SQ), and squamous cell carcinoma (SQCC). One hundred twenty five surgically or endoscopically removed, paraffin-embedded cases were studied by immunohistochemistry and analyzed statistically. BE, ACC, and FOV were dissected from 30 paraffin-embedded samples for further mRNA expression analysis. CLDN 7 was the dominating type in all epithelia and carcinomas, but its expression did not differ in normal and altered tissues. CLDN 1 expression was significantly increased in SQCC compared with that in SQ. CLDNs 3 and 4 were significantly elevated both in BE and ACC compared with that in FOV. CLDN 2 expression increased significantly in ACCs compared with that in BE. This is the first report proving similarities and differences regarding claudin expression pattern in BE and ACC compared with that in FOV and SQ. Our data prove a close link in CLDN pattern between BE and ACC, adding further evidence that BE is an alteration preceding esophageal ACC.