Clinical severity on admission was significantly different between the 2 groups. Three of 5 patients with percutaneous transluminal angioplasty achieved recanalization. Two of 3 cases with recanalization resulted in poor outcomes. Conclusions: Clinical severity on admission was the determinant factor of functional prognosis in patients with basilar artery occlusion.”
“Stromal cell-derived factor-1 (SDF-1/CXCL12) induces intracellular signaling pathways crucial for mobilization, migration, proliferation

Sapitinib price and survival of many cell types via CXCR4, a chemokine CXC-motif receptor, member of the G protein-coupled receptor family. Despite playing a key role in such major processes as embryogenesis, cell differentiation and organ regeneration, molecular mechanisms underlying CXCR4 signaling remain elusive, even more so, as CXCR4 seems to activate both G-protein-dependent and G-protein-independent pathways. CXCR4 is expressed on multiple cell types including lymphocytes, hematopoietic stem cells, endothelial and epithelial

cells, and cancer cells. In fact, overexpression of this receptor has been detected in many different types of cancer. The SDF-1/CXCR4 axis is also involved in tumor progression, angiogenesis, metastasis, and survival. This pathway is therefore a target for therapeutics that can block the SDF-1/CXCR4 interaction or inhibit downstream intracellular signaling. Clinical mobilization of hematopoietic stem cells (HSC), learn more a nowadays popular method of collecting material for hematopoietic progenitor stem cell transplantation, is also dependent on the

SDF-1/CXCR4 axis. Granulocyte colony-stimulating factor (G-CSF), administered to a transplant donor during clinical treatment, violates interactions between CXCR4 and its ligand, which results in degradation of HSC anchorage in bone marrow and the release of these cells into peripheral blood.

In this paper we describe https://www.selleckchem.com/HDAC.html the clinical significance of CXCR4 and its ligand, as well as the role of CXCR4 and its gene polymorphisms in disease susceptibility.”
“Chemical-vapor generation (CVG) is widely used as a sample-introduction technique for atomic spectrometry, with the advantages of efficient matrix separation, high analyte-transport efficiency, and high selectivity and sensitivity. Recently, photoinduced CVG (photo-CVG) was demonstrated to be a powerful alternative to conventional CVG. In photo-CVG, volatile species (including hydrides, elemental, carbonylated and alkylated analytes) are generated from non-volatile precursors by ultraviolet irradiation in the presence of low-molecular-weight organic compounds. Photo-CVG is simple, fast and environmentally friendly with little interference from transition metals. Its analytical applications have been demonstrated in analysis of Hg, conventional hydride-forming elements (As, Bi, Sb, Se, Te), transition metals (Ni, Co, Fe) and non-metals (I).

The lesions were treated percutaneously using 34 vascular plugs and 19 coils.

Conclusions. Vascular fistulas can be occluded percutaneously with good results. Small fistulas can be closed using coils, while vascular plugs are preferable for large lesions. Both devices are highly effective as occluders

and no particular difficulty or significant complication was observed.”
“Subclinical rejection (SCR) is quite common early following renal transplantation and decreases progressively with time. The immunological profile of the recipient, the immunosuppressive regimen used, and the occurrence of prior episodes of clinical acute rejection (AR) are Staurosporine cell line all risk factors for SCR. SCR, in turn, is a risk factor for chronic interstitial

and tubular fibrosis and has been associated with worse glomerular filtration rate (GFR) and graft survival. Early SCR should be initially treated with pulse steroids. SCR is a form of biopsy-proven AR and, particularly if treated, must be fairly reported and displayed as a solid endpoint in clinical studies.”
“Introduction and objectives. Postoperative atria] fibrillation is a common complication of carrying out cardiac surgery with extracorporeal circulation VX-809 clinical trial (ECC). The aim of this study was to determine whether preoperative left atrial contractile dysfunction, as assessed by tissue Doppler echocardiography, is associated with the development of postoperative new-onset atrial fibrillation (PAF).

Methods. Transthoracic Doppler echocardiography was performed preoperatively in patients undergoing elective cardiac surgery. Left atrial contractile function was evaluated by tissue Doppler imaging (TDI) of the mitral annulus.

Results. The

study included 92 selleck patients in sinus rhythm preoperatively who underwent elective cardiac surgery with ECC: 73 (79%) were male and 19 (21%) were female, and their mean age was 67 +/- 10 years. Of these, 19 (20.6%) developed PAF 34 +/- 12 h postoperatively. Bivariate analysis showed that PAF was associated with older age (71 +/- 7 years vs. 66 +/- 10 years; P=.034), a large left atrial diameter (LAD), and a low peak atrial systolic mitral annular velocity (A velocity) and a high mitral E/A ratio on TD1. Logistic regression analysis showed that PAF was independently associated with a large LAD (odds ratio [OR]=2.23; 95% confidence interval [Cl], 1.05-4.76; P=.033) and a low A velocity (OR=0.70; 95%Cl, 0.55-0.99; P=.034).

Conclusions. Preoperative left atrial dysfunction, as assessed by TDI, was associated with an increased risk of PAF.”
“Donor advocacy is a critical feature of live donor transplantation.

In all, 37 (2.2%) of the 1,641 encounters for oral/facial problems were considered severe, 266 (16.2%) moderately severe, and 1,338 (81.5%) were for pain/loss of function.

Conclusions: Although the majority of military personnel with oral/facial problems

experience mild to moderate pain or loss of dental function, approximately 20% are of sufficient severity to cause the warfighter to experience a limitation of their operational capability.”
“Neuroinflammatory responses are involved in Alzheimer’s disease (AD) pathogenesis. In the present study, the protective effects of resveratrol, a polyphenolic compound, on cognitive deficits induced by lipopolysaccharide (LPS) were examined in rats, and the possible mechanisms were explored. The data showed that resveratrol administration by intraperitoneal injection (i.p.) may inhibit cognitive deficits induced by bilateral intracerebroventricular injection of 5 mu g of LPS in rats. Subsequently, resveratrol afforded LY3023414 molecular weight beneficial actions on the inhibition of tumor necrosis factor (TNF)-alpha, cyclooxygenase (COX)-2, and amyloid-beta protein precursor (APP) generation, as well as the inhibition of phospho-transcription factors of nuclear factor kappa B p65 (p-NF-kappa B p65) activation followed by the presence of LPS in rat hippocampus. The results of the present study indicate that resveratrol may attenuate LPS-induced direct neuroinflammation in rats,

and its mechanisms are, at least partly, due to inhibition of the generation of TNF-alpha, COX-2, and APP, and the related phosphorylation of NF-kappa B. These Selleck P005091 findings suggest that resveratrol might be a potential agent for treatment of neuroinflammation-related diseases, such as AD.”
“OBJECTIVES: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic

Birinapant factors of mortality and walking ability after discharge.

METHODS: This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >= 70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 +/- 6.4 years. RESULTS: On admission to the unit, the average Barthel score of these patients was 77.2 +/- 27.8 points, and the average Charlson index score was 2.14 +/- 2.05. The mean length of stay was 8.9 +/- 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death.

Design: Two generations in the 1958 British birth cohort were studied, including cohort members (parents’ generation) with BMI at 7, 11, 16, 23, and 33 y (n = 16,794) and a one-third sample of their offspring selected in 1991 aged 4-18 y (n = 2908). We applied multilevel models to allow for within-family correlations.

Results: Childhood BMI increased on average by 0.25-1.10 between the 2 generations, depending on sex and age group, and overweight/obesity increased from 10% to 16%. Parents’ BMI in childhood and adulthood independently influenced offspring BMI, but no significant difference in the strength of influence

was observed. For example, Adriamycin supplier adjusted increase in BMI for offspring aged 4-8 y was equivalent to 0.37 and 0.23 for a 1-SD increase in maternal BMI at 7 and 33 y, respectively. Similar patterns were observed for risk of overweight/obesity AZD1208 price and for paternal BMI at most ages.

Conclusions: Excessive BMI gains of parents during childhood and adulthood were associated

with a higher BMI and risk of obesity in the offspring. Reductions in the incidence of child obesity in the current population may reduce obesity in future generations. Am J Clin Nutr 2009; 89: 551-7.”
“Although malaria in pregnancy can cause very significant neonatal morbidity, congenital malaria is a very rare condition in both endemic and non-endemic areas. A case of congenital malaria by Plasmodium vivax, initially mistaken for neonatal sepsis, is described. The correct diagnosis was accidentally done, as congenital malaria had been missed in the initial differential diagnosis.

Vivax malaria is the leading species in congenital infections in Europe. This condition should be included in the differential diagnosis of neonatal sepsis even if the mother has no proven malarial episodes during the gestational period.”
“Internationally, surgical training is facing the challenge of balancing research and clinical experience in the context of reduced working hours. This study aimed to investigate trainees and trainers’ views on surgeons participating

in full-time research during surgical training.

An anonymous voluntary survey was conducted of surgical Fludarabine supplier trainers and trainees in two training systems. To examine surgeons’ views across two different training schemes, surgeons were surveyed in Ireland (Royal College of Surgeons in Ireland) and in a Canadian centre (University of Toronto) between January 2009 and September 2010 (n = 397 respondents).

The majority of respondents felt that time spent in research by trainees was important for surgery as a specialty, while 65 % felt that research was important for surgical trainees (trainers 79 %, trainees 60 %, p = 0.001). A higher proportion of Canadian surgeons reported that they enjoyed their time spent in research, compared to Irish surgeons (84 vs. 66 %, p = 0.05).

In this study, we evaluated the Aabs profile (anti-Ro/SS-A 52 kDa, anti-Ro/SS-A 60 kDa, anti-La/SS-B, anti-Sm and ANAs) as well as their titer or reactivity, in a

local cohort of 169 patients with SAPs. We related those Aabs profiles and titers with the presence or absence of CP, and we found that there was no significant association between the presence of anti-Ro/SS-A Aabs and the occurrence of CP. On the other hand, a statistically significant positive association was found between CP and high reactivity anti-Sm Aabs, though this fact could be biased by the incidence of both events in SLE patients. To sum up, in the particular population studied, there is no direct relationship between anti-Ro/SS-A Aabs and CP, which Selleck AG-881 is in agreement with some authors and in disagreement with many others, contributing to the endless discussion of this issue.”
“We report the temperature dependence of the surface phonon polariton click here (SPhP) spectra of alpha-SiO2 (quartz), propagated to the far-field by a grating, in the temperature range between 300 K and 800 K. Room temperature data for a 670 nm deep grating are compared to a simulated spectrum using a finite-difference frequency-domain approach. The inputs to the simulation are the dielectric

functions measured by infrared ellipsometry and modeled as a set of damped oscillators. The simulated spectra are in good agreement with experiment. The width of the SPhP reflectivity dip depends on the depth of the grating. For a grating depth of 280 nm, the width of the reflectivity dip in the temperature range 300 < T < 800 K is comparable to what is expected for the SPhP excitations of a flat surface. For a grating depth of 670 nm, the width of the reflectivity dip increases significantly due to coupling to far-field radiation. (C) 2011 American Institute of Physics. [doi:10.1063/1.3624603]“
“A total of 600 crossbred pigs, whereof

56 were randomly selected for more in-depth studies of carcass and pork quality, were employed to test different tuna oil feeding regimens. The focus was put on the efficiency to enrich lean and adipose tissue with n- 3 fatty acids and the expression SU5402 molecular weight of adverse side-effects on performance, carcass, and pork quality. The 4 treatments were 0% tuna oil in diet (T0; control), 1% of unrefined tuna oil in diet fed from 35 to 90 kg of BW (T1), and 3% of unrefined tuna oil in diet offered during the early (35 to 60 kg of BW; T3-E) or late stage of fattening (75 to 90 kg of BW; T3-L). With this arrangement, pigs consumed equal lifetime amounts of tuna oil (approximately 1.6 kg per pig). None of the tuna oil treatments had significant effects on performance. There were no differences in carcass quality among tuna oil groups except for group T3-E where carcasses and loin chops were fatter than those of the other groups.

Results: 525 EVAR and 1176 OR for asymptomatic AAA were identified. LOS was shorter after EVAR than OR (4 vs. 7 days, p < .001). During primary hospitalization procedure-related complications (12% vs. 6%) and general complications (21% vs. 8%) were more common after OR than EVAR (p < 0.001). The 30-day reintervention rate was higher for OR than EVAR (18% vs. 6%, p < 0.001), but there was no difference in readmissions within 30 days. During follow-up (mean 29 15 months) aneurysm-related complications after EVAR were outweighed by procedure-related complications after OR.

Conclusion: Elective Nutlin-3 order AAA repair in Denmark is overall comparable with international results

and both perioperative and late outcomes after EVAR of elective AAA are better than the results after OR. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.”
“The International Headache Society (IHS) defines GM6001 ophthalmoplegic migraine (OM) as recurrent attacks of headache with migrainous characteristics, associated with paresis of one or more ocular

cranial nerves (commonly the third cranial nerve), and in the absence of any demonstrable intracranial lesion other than MRI changes within the affected nerve. According to the IHS criteria, it is diagnosed when at least two attacks with migraine-like headaches are accompanied with, or followed within 4 days of onset by, paresis of one or more of the third, fourth

or sixth cranial nerves. Parasellar, orbital fissure and posterior fossa lesions should be ruled out by appropriate investigations. It is unlikely that OM is a variant of migraine, since the headache often lasts for a week or more and there is a latent period of up to 4 days from the onset of headache to the onset of ophthalmoplegia. Furthermore, in some cases MRI shows gadolinium uptake in the cisternal part of the affected cranial nerve and this suggests that the condition may be a recurrent demyelinating neuropathy. In general, patients demonstrated a: (1) prolonged time for symptom resolution to occur (median time 3 weeks); (2) tendency for recurrent episodes to have more severe and persistent find more nerve involvement; (3) evidence of permanent neurological sequelae with recurrent episodes (30% of patients); (4) rapid improvement and shortened duration with corticosteroid therapy and; (5) transient, reversible MRI contrast enhancement of the affected cranial nerve (86% of patients). Different pathogenetic mechanisms, which include compressive, ischemic and inflammatory, have been suggested for OM. Here, a 15-year-old Ethiopian with recurrent attacks of headache and third nerve palsy is presented. The subsequent discussion focuses on current evidences with regard to the clinical characteristics, possible pathogenetic mechanisms and treatment. Finally, a brief discussion of the situation in Africa will be presented.

Although evaluation is often aimed at distinguishing benign from malignant masses, FRAX597 price the majority of adnexal masses are benign. About 90% of adnexal masses can be adequately characterized with US alone. In this article, the important US features that should allow one to make a reasonably confident diagnosis in most cases will be discussed. The role of follow-up US and alternative imaging modalities, along with the importance of careful reporting of adnexal masses, will also be

reviewed.”
“Leaf senescence induced by 2,4-dichlorophenoxyacetic acid (2,4-D) and senescence inhibition caused by supplementation with silver (Ag+) ions in the form of silver nitrate (AgNO3) or silver nanoparticles (AgNPs) were investigated in 8-day-old mung bean (Vigna radiata L. Wilczek) seedlings. Inhibition of root and shoot elongation were observed in mung bean seedlings treated with 500 mu M 2,4-D. Concomitantly, Bucladesine clinical trial the activity of 1-aminocyclopropane-1-carboxylic acid synthase was significantly induced in leaf tissue. Leaf senescence induced by 2,4-D was closely associated with lipid peroxidation as well as increased levels of cytotoxic hydrogen peroxide (H2O2) and superoxide radicals (O-2(center dot-)). Despite

decreased catalase activity, the activities of peroxidase, superoxide dismutase, monodehydroascorbate reductase, dehydroascorbate reductase, and glutathione reductase were increased during 2,4-D-induced leaf senescence. Further, the levels of reduced selleck inhibitor ascorbate, oxidized ascorbate, and reduced glutathione were markedly decreased, whereas the level of oxidized glutathione increased. 2,4-D-induced leaf senescence in mung bean was accompanied by an increase in positive terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling, nuclear DNA fragmentation, and the activity of a 15-kDa Ca2+-dependent DNase. Supplementation with 100 mu M AgNO3 or AgNPs inhibited 2,4-D-induced leaf senescence. The present results suggest that increased oxidative stress (O-2(center dot-) and H2O2)

led to senescence in mung bean leaves. Furthermore, significantly induced antioxidative enzymes are not sufficient to protect mung bean cells from 2,4-D-induced harmful ROS. (C) 2010 Elsevier Masson SAS. All rights reserved.”
“Objective: This study compared the acute phase (12-week) efficacy of fluoxetine versus placebo for the treatment of the depressive symptoms and the cannabis use of adolescents and young adults with comorbid major depression (MDD) and a cannabis use disorder (CUD) (cannabis dependence or cannabis abuse). We hypothesized that fluoxetine would demonstrate efficacy versus placebo for the treatment of the depressive symptoms and the cannabis use of adolescents and young adults with comorbid MDD/CUD.

Methods: We conducted the first double-blind placebo-controlled study of fluoxetine in adolescents and young adults with comorbid MDD/CUD.

Food tolerance and satisfaction were also lower after R-LSG. Engagement in regular physical activity increased from 0 to 16.7 % in the R-LSG group and from 8 to 33 % in the P-LSG group. After R-LSG, 58 % reported eating at scheduled times, compared with 85 % after P-LSG. Levels of healthy food selection, food tolerance, normative eating patterns, and physical activity were lower in the R-LSG group than in the P-LSG group. This study highlights the need to develop pre- and post-surgery treatment that would promote better behavioral outcomes in

the growing number of individuals undergoing repeat bariatric surgery.”
“Background-

Substantial evidence-practice gaps exist in the management of acute coronary syndromes (ACS) in China. Clinical pathways are tools for improving ACS quality of care but Gamma-secretase inhibitor have not been Selleckchem Fer-1 rigorously evaluated.

Methods and Results-

Between October 2007 and August 2010, a quality improvement program was

conducted in 75 hospitals throughout China with mixed methods evaluation in a cluster randomized, controlled trial. Eligible hospitals were level 2 or level 3 centers routinely admitting > 100 patients with ACS per year. Hospitals were assigned immediate implementation of the American Heart Association/American College of Cardiology guideline based clinical pathways or commencement of the intervention 12 months later. Outcomes were several key performance indicators reflecting the management of ACS. The key performance indicators were measured 12 months after commencement in intervention hospitals and compared with baseline data in control hospitals, using data collected from 50 consecutive patients in each hospital. Pathway implementation was associated with an increased proportion of patients discharged on appropriate medical therapy,

with nonsignificant improvements or absence of effects on other key performance indicators.

Conclusions-

Among hospitals in China, the use of a clinical pathway for the treatment of ACS compared with usual care improved secondary prevention treatments, but effectiveness was otherwise limited. An accompanying process evaluation identified several health system barriers to more successful implementation.

Clinical Trial Registration-

URL: http://www.anzctr.org.au/default.aspx. selleck compound Unique identifier: ACTRN12609000491268.”
“Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder found in 3% to 8% of children and adolescents. An important part of ADHD management is psychopharmacology, which includes stimulants, norepinephrine reuptake inhibitors, alpha-2 agonists, and antidepressants. Medications with the best evidence-based support for ADHD management are the stimulants methylphenidate and amphetamine. A number of newer, long-acting stimulants are now available and a number of new medications are considered that are under current research.

One tonometric catheter was placed inside the sigmoid colon (intraluminal) and another extraluminally in close contact with the serosa of the sigmoid colon

(extraluminal). Intra- and extraluminal partial pressure of carbon dioxide (pCO(2)) were measured every 10 min during 48 h postoperatively, 1536 simultaneous measurements. Intraluminal pH (pHi) and extraluminal pH (pHe) were calculated, and intra-abdominal pressure (IAP) was measured, every 4 h. Colonic ischaemia was defined as pHi <= 7.1.

Results: Mean pHi was 7.18 +/- 0.11 and mean pHe was 7.28 +/- 0.09. With a pHe cut-off value of <= 7.2, the sensitivity and specificity to detect colonic ischaemia were 95% and 95%, respectively. Accuracy was 95% and the positive and negative predictive values 0.80 and 0.99, respectively. The positive likelihood ratio was 19 and the negative likelihood ratio 0.05.

Conclusion: Extraluminal tonometry may serve Selonsertib purchase as a screening test: A pHe-value <7.2 indicates suspected colonic ischaemia, meriting further investigation. It was not able to evaluate the severity of ischaemia. GSK3235025 mouse (C) 2011 European

Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.”
“Objective: Risk factors related to the outcome of childhood asthma are not yet well established. We aimed to investigate the long-term outcome for children with asthma to determine the risk factors in predicting persistence of disease. Methods: Sixty-two children with asthma were evaluated retrospectively at the end of a 10-year follow-up. Patients were asked to complete a questionnaire requesting clinical information, and underwent physical examination, skin prick testing, a pulmonary function test and bronchial provocation testing. Immunologic parameters evaluated were allergen-specific IgE and IgG4 levels, and allergen-induced generation of CD4(+)CD25(+) cells. Results: Mean age at final assessment was 15.9 +/- 3.6 years, and duration of follow-up was 10.30 +/- 1.27 years. Fifty percent of patients outgrew their asthma during the 10-year follow-up period. All

the non-atopic patients outgrew their disease during the study period, whereas 67% of atopic patients did not. We identified two risk factors independently related to the persistence AC220 order of symptoms: presence of bronchial hyper-responsiveness and presence of rhinitis. Atopic children who were in remission demonstrated significantly higher allergen-induced CD4(+)CD25(+) T cells compared to healthy controls. Conclusions: Atopy, presence of rhinitis, positive and presence of bronchial hyper-reactivity are important risk factors for the persistence of asthma in children. Allergen-induced CD4(+)CD25(+) T cells were higher in the atopic children who outgrew their disease, implicating an immunological mechanism of asthma remission in children.

(C) 2011 American Institute of Physics. [doi:10.1063/1.3653285]“
“A new Staphylococcus xylosus strain was isolated. The extracellular lipase of S. xylosus DNA Synthesis inhibitor (wt-SXL2) was purified to homogeneity from the culture medium. The specific activity of the purified enzyme, measured at pH 8.5 and 55 degrees C using tributyrin or olive oil emulsion, reached, respectively, 6300 U/mg or 2850 U/mg. The sequenced 18 N-terminal amino acid showed a high degree

of identity with known staphylococcal lipase sequences.

The gene encoding the mature lipase was cloned and sequenced. The deduced amino acid sequence showed a significant similarity with various staphylococcal lipases. The highest overall identity (98.74%) was found with S. xylosus lipase (SXL1). The mature part of the lipase was expressed in Escherichia coli. The LB-100 datasheet recombinant lipase was purified by affinity chromatography. The specific activity of the recombinant

lipase was 4100 or 1500 U/mg using tributyrin or olive oil emulsion as substrate, respectively, at pH 8.5 and 55 degrees C.

The wild type and recombinant lipases presented a quite interesting thermal stability, after an incubation of 60 min at 55 degrees C and they are found to be highly stable at a pH ranging from 4 to 11. Due to its stability at high temperature and in organic solvent, the wt-SXL2 was used as biocatalyst to synthesise a high added value molecules. (C) 2011 Elsevier B.V. All rights reserved.”
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Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to cam CME credit. This activity has been planned and implemented

in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education Tozasertib in vivo for physicians Medscape, LLC designates this educational activity for a maximum of 0.75 A AM PRA Category 1 Credits (TM), Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures (2) study the education content (3) take the post-test and/or complete the evaluation at http://www.medscape.com/cme/eid; (4) view/print certificate.