To assess the impact that routine postoperative


To assess the impact that routine postoperative

radiographs have in clinical outcome and clinical decision-making.

Summary of Background Data. No standard exists that outlines how often and when radiographs should be taken after lumbar fusion. Routine postoperative radiographs can be a source of inconvenience and cost to patients, radiation exposure, and possibly, confounding information.

Methods. The patients who underwent a single or multilevel lumbar instrumented fusion were investigated. At each time-point after surgery, it was noted if they demonstrated this website new symptoms or clinical deterioration. The Fisher exact test was used to analyze the categorical data.

Results. Sixty-three patients (25 males and 38 females) LEE011 in vitro were identified with a mean age of 52 years (range, 20-87). Plain radiographs were taken at 269 visits including all time-points. In 17 (6.3%) visits, abnormal findings were found in 13 patients, including suspected pseudoarthrosis on radiographs (n = 10) and adjacent segment disease on radiographs (n = 3). They were found during 11 of 50 visits

(22%) in the patients with new symptoms or clinical deterioration and during 6 of 219 visits (2.7%) in the asymptomatic patients. The probability of an abnormal finding was significantly lower in the asymptomatic patients (P < 0.001). Before the 6-month follow-up, abnormal findings were found in 1 of 111 visits (0.9%) and in 16 of 158 visits (10%) at the 6-month follow-up or later. The probability of an abnormal finding was significantly lower before the 6-month follow-up (P < 0.001). In six of the seven symptomatic patients (86%) with suspected pseudoarthrosis on radiographs, pseudoarthrosis was initially suspected between 6 and 12 months after surgery.


This study suggests that plain radiographs should be performed as indicated clinically rather than routinely after instrumented lumbar fusion. The vast majority of asymptomatic patients do not require routine postoperative radiographs.”
“Purpose: To compare the diagnostic accuracy of fluorine 18 fluorodeoxyglucose Selleck PLX 4720 (FDG) positron emission tomography (PET) in the detection of colon lesions with that of delayed PET/computed tomography (CT) performed after the administration of a laxative-augmented contrast medium.

Materials and Methods: All patients gave written informed consent according to the guidelines issued by the institutional review board. In a prospective study performed from November 2005 to December 2006, images obtained in 847 patients were reviewed by two physicians in consensus. Colorectal FDG uptake on initial PET images that exceeded background FDG accumulation was graded as minimal, equivocal, or positive. When the initial PET scan revealed a colorectal region of increased uptake, either oral or anal laxative-augmented contrast medium was administered on the basis of the site of colorectal FDG focus and delayed PET/CT was performed.

Abstracts without treatment recommendations were excluded Relati

Abstracts without treatment recommendations were excluded. Relationships between level of evidence, fracture location, and treatment recommendation were statistically evaluated with use of Spearman correlations and logistic regression analysis.

Results: Overall, a higher

proportion of studies gave less aggressive (47%, ninety of 190) or neutral (27%, fifty-one of 190) recommendations than more aggressive treatment recommendations (26%, forty-nine of 190). Only 24% of operative studies and 11% of nonoperative studies recommended more aggressive treatment (p = 0.001). Case series were more learn more likely to recommend more aggressive treatments than comparative studies (30% versus 17%, p = 0.025). Also, studies with a smaller sample size were more likely to recommend more aggressive treatments (p = 0.006). The great majority of Level-I and Level-II (91%, ten of eleven), Level-III (81%, thirty-nine of forty-eight), and Level-IV (70%, ninety-two of 131) studies, however, provided either neutral or less-aggressive treatment recommendations.

Conclusions: The majority of research

presented at POSNA and AAOS meetings over the past two decades fails to support the trend toward increasingly PLX4032 aggressive treatment of pediatric upper extremity fractures. This dichotomy between clinical research and the direction of clinical treatment must be explored in our efforts to provide evidence-based care of pediatric upper extremity fractures.”
“A superconducting ring could be used to simulate the supercurrent conduction, and its interaction with magnetic vortices in a superconducting solenoid, allowing one to investigate the nature of the vortex structure and its pinning in the presence of the persistent supercurrent. The dissipation of the persistent supercurrent has been studied in a ring-shaped high

purity single crystal of Bi2Sr2CaCu2Ox in order to obtain the information about the exponent mu, a parameter in the scaling relation between the effective energy barrier against vortex motion U-eff and the persistent current density J. The measurements of the persistent supercurrent decay show a transition from a strongly nonlogarithmic to a logarithmic decay find more regime with an increasing temperature. In response to a small increase in the concentration of oxygen vacancies mu decreases in the logarithmic decay regime but remains almost constant in the nonlogarithmic one. (C) 2010 American Institute of Physics. [doi:10.1063/1.3374661]“
“Aims: We report our initial 3-year experience of chemoradiotherapy for cervical cancer with computed tomography-based image-guided high dose rate (HDR) brachytherapy using the tandem-ring applicator.

Materials and methods: Twenty-eight patients were treated between February 2005 and December 2007. All patients received initial external beam radiotherapy (EBRT) followed by HDR brachytherapy (planned dose 21 Gy to point A in three fractions over 8 days).

5-8 mg/kg) produced marked, significant and dose related inhibiti

5-8 mg/kg) produced marked, significant and dose related inhibition of PGE(2) synthesis (COX-2) ex vivo.

The data demonstrate that in the dog robenacoxib is a highly selective inhibitor of the COX-2 isoform of COX, and significantly inhibits COX-2 and spares COX-1 in vivo when administered orally over the dosage range 0.5-4.0 mg/kg. (C) 2009 Elsevier Ltd. selleck compound All rights reserved.”

Smear-negative tuberculosis (TB) is difficult to diagnose and has been associated with poor treatment outcomes and excessive mortality, particularly in high human immunodeficiency virus (HIV) prevalent settings. However, few studies have used mycobacterial culture to rigorously confirm all smear-negative TB cases in a population-based cohort.

DESIGN: We included all culture-confirmed, pulmonary TB cases reported to the US National TB Surveillance System CHIR-99021 cost from 1993 to 2008. We analyzed smear-negative TB risk factors and survival, as compared to smear-positive TB. We calculated prevalence ratios (PRs) and adjusted for confounders (aPR).

RESULTS: From 1993 to 2008, 159 121 cases of culture-confirmed pulmonary TB were reported in the United States, of which 58 786 (37%) were sputum smear-negative. Smear-negative TB cases were more likely to be foreign-born

(aPR 1.10, 95%CI 1.08-1.12), incarcerated (aPR 1.52, 95%CI 1.48-1.56) or HIV-infected (aPR 1.27, 95%CI 1.24-1.30). Hispanics and non-Hispanic Blacks were less likely to have smear-negative TB (respectively aPR 0.87, 95%CI 0.85-0.89 and aPR 0.90,

95%CI 0.89-0.92). Smear-negative TB cases had lower mortality (aRR 0.78, 95%CI 0.74-0.81), independent PHA-739358 of HIV status.

CONCLUSION: Smear-negative TB represents a large proportion of TB cases in the United States, and occurs more often among persons in groups more likely to undergo TB screening. The lower mortality may indicate earlier TB detection, and underscores the need for continued vigilance in screening of high-risk persons.”
“In this study the disposition kinetics and plasma availability of moxifloxacin in Muscovy ducks after single intravenous (iv.), intramuscular (i.m.) and oral (p.o.) administrations of 5 mg kg(-1) b.wt. were investigated. The concentrations of moxifloxacin in the plasma were measured using high-performance liquid chromatography (HPLC) with fluorescence detection on samples collected at frequent intervals after drug administration. Following intravenous injection, the decline in plasma drug concentration was bi-exponential with half-lives of (t(1/2 alpha)) 0.22 +/- 0.10 h and (t(1/2 beta)) 2.49 +/- 0.26 h for distribution and elimination phases, respectively. The volume of distribution at steady-state (V(dss)) was 1.02 +/- 0.14 1 kg(-1) and the total body clearance (Cl(tot)) was 0.32 +/- 0.11 1 kg h(-1), respectively. After intramuscular and oral administration of moxifloxacin at the same dose the peak plasma concentrations (C(max)) were 2.38 +/- 0.43 and 2.11 +/- 0.36 mu g ml(-1) and were obtained at 1.47 +/- 0.26 and 1.

001) affected by site, with site averages ranging from 1 01 to 2

001) affected by site, with site averages ranging from 1.01 to 2.36 mu L g(-1) fresh weight. In 2009 and 2010, oil concentration was significantly (P < 0.05) negatively correlated with site temperature over the ABT-263 supplier growing season. Studies of shoot growth showed that the rate of leaf emergence was significantly (P < 0.001) correlated with both soil and air temperatures and the relationships suggested base temperatures of 5.2 degrees C and 6.9 degrees C for air and soil, respectively. (c) 2013 Elsevier B.V. All rights reserved.”
“Background: Route environments can positively influence people’s active commuting and thereby contribute

to public health. The Active Commuting Route Environment Scale (ACRES) was developed to study active commuters’ perceptions Nirogacestat nmr of their route environments. However, bicycle commuters represent a small portion of the population in many cities and thus are difficult

to study using population-based material. Therefore, the aim of this study is to expand the state of knowledge concerning the criterion-related validity of the ACRES and the representativity using an advertisement-recruited sample. Furthermore, by comparing commuting route environment profiles of inner urban and suburban areas, we provide a novel basis for understanding the relationship between environment and bikeability.

Methods: Bicycle commuters from Greater Stockholm, Sweden, advertisement- (n = 1379) and street-recruited (n = 93), responded to the ACRES. Traffic planning and environmental experts from the Municipality of Stockholm (n = 24) responded to a modified version of the ACRES. The criterion-related validity assessments were based on whether or not differences between the Selleck SB202190 inner urban and the suburban route environments, as indicated by the experts and by

four existing objective measurements, were reflected by differences in perceptions of these environments. Comparisons of ratings between advertisement-and street-recruited participants were used for the assessments of representativity. Finally, ratings of inner urban and suburban route environments were used to evaluate commuting route environment profiles.

Results: Differences in ratings of the inner urban and suburban route environments by the advertisement-recruited participants were in accord with the existing objective measurements and corresponded reasonably well with those of the experts. Overall, there was a reasonably good correspondence between the advertisement-and street-recruited participants’ ratings. Distinct differences in commuting route environment profiles were noted between the inner urban and suburban areas. Suburban route environments were rated as safer and more stimulating for bicycle-commuting than the inner urban ones. In general, the findings applied to both men and women.

C-peptide significantly correlated with WC, leptin,

C-peptide significantly correlated with WC, leptin, UA, and HDL-C and was predicted by three biomarkers; UA, WC and HDL-C. Whereas, insulin significantly correlated with only two biomarkers including leptin and DBP and was predicted by UA and DBP. Conclusions. The present study highlighted the association between MetS and CVD in young Arab

females and the possible role of C-peptide in the prediction of CVD.”
“Peritoneal dialysis (PD) is associated with functional and structural changes of the peritoneal membrane. In this review we describe factors contributing to peritoneal tissue remodeling, including uremia, peritonitis, volume loading, the presence of a catheter, and the PD fluid itself. These factors initiate recruitment and activation of peritoneal cells such as macrophages and mast

cells, as well as activation of peritoneal cells, including mesothelial cells, fibroblasts, and endothelial cells. We provide an overview of cytokines, growth factors, and other mediators involved in PD-associated changes. Activation of downstream pathways of cellular modulators can induce peritoneal tissue remodeling, leading to ultrafiltration loss. Identification of molecular pathways, cells, and cytokines involved in the development of angiogenesis, fibrosis, and membrane failure may lead to innovative therapeutic strategies that can protect the peritoneal membrane from the consequences of long-term PD.”
“AimTo examine the relationship between preterm birth and socioeconomic factors, past history, cervical length, cervical Selleckchem PR-171 interleukin-8, bacterial vaginosis, underlying diseases, use of medication, employment status,

sex of the fetus and multiple pregnancy.

MethodsIn a multicenter, prospective, observational study, 1810 Japanese women registering their future delivery were enrolled at 8(+0) to 12(+6) weeks of gestation. Data on cervical length and delivery were obtained from 1365 pregnant women. Multivariate logistic regression analysis was performed.

ResultsShort cervical length, steroid use, multiple pregnancy and male fetus were risk factors for preterm birth before 34 weeks of gestation. Multiple pregnancy, low educational level, short cervical length and part-timer were risk factors for preterm birth before 37 weeks of gestation.

ConclusionMultiple pregnancy and cervical shortening at 20-24 weeks of gestation was a stronger risk factor for preterm birth. Any pregnant woman being part-time employee or low educational level, having a male fetus and requiring steroid treatment should be watched for the development of preterm birth.”
“Levels of cortisol, a hormone produced by the adrenal gland, follow a daily, 24-hour rhythm with concentrations reaching a minimum in the evening and a peak near rising time. In addition, cortisol levels exhibit a sharp peak in concentration within the first hour after waking; this is known as the cortisol awakening response (CAR).

The objective of this study was to determine the bacterial coloni

The objective of this study was to determine the bacterial colonization of jawbone and identify

the bacterial phylotypes associated with BRONJ. Materials and methods: Culture-independent 16S rRNA gene-based molecular techniques were used to determine and compare the total bacterial diversity in bone samples collected from 12 patients with cancer (six, BRONJ with history of BP; six, controls without BRONJ, no history of BP but have infection). Results: Denaturing gradient gel electrophoresis profile and Dice coefficient displayed S3I-201 price a statistically significant clustering of profiles, indicating different bacterial population in BRONJ subjects and control. The top three genera ranked among the BRONJ group were Streptococcus (29%), Eubacterium (9%), and Pseudoramibacter (8%), while in the control group were Parvimonas (17%), Streptococcus (15%), and Fusobacterium (15%). learn more H&E sections of BRONJ bone revealed layers of bacteria along the surfaces and often are packed into the scalloped edges of the bone. Conclusion: This study using limited sample size indicated that the jawbone associated with

BRONJ was heavily colonized by specific oral bacteria and there were apparent differences between the microbiota of BRONJ and controls.”

Congenital heart defects are the most common fetal structural anomalies of which a significant number remain unrecognized during postnatal life. Fetal electrocardiography (FECG) is an ideal clinical tool to complement ultrasonography for the screening and management of these cases where early and accurate diagnoses would allow definite rather than palliative treatment. The objective of this report was to correlate the particular FECG results found with the different types of congenital heart defects involved and to further demonstrate the usefulness of FECG in clinical settings.

Material & Methods:

This is a report of four cases of prenatally diagnosed congenital heart defects seen at a university hospital in Sendai, check details Japan. Their

complete and thorough evaluation included, among other tests, abdominal FECG analysis.


The presence of premature ventricular contractions, a prolonged pre-ejection period (PEP > 75 msec), and prolonged QTc intervals (QTc > 440 msec) served as markers of hemodynamic alteration but were unlikely determinants of disease severity precluding further investigation.


In practice, similar findings found on FECG should raise the index of suspicion for the presence of congenital heart disease and prompt a targeted ultrasound scan.”
“Because of an apparent sexual ambiguity (enlarged clitoris), a 1-year-old mongrel dog was presented to the clinic. A positive result on a GnRH stimulation test revealed the existence of functional testicular tissue.

Further tests found out dislipidemia, hyperhomocysteinemia, impai

Further tests found out dislipidemia, hyperhomocysteinemia, impaired glucose tolerance. Transcranial Doppler showed right to left shunting. We also prescribed

the screening tests for vasculitis (normal). In our opinion this case highlights the relevance of vascular risk factors in MA complications also in male subjects.”
“The higher risk for amyotrophic lateral sclerosis (ALS) among professional soccer players, recently reported in Italy, has stimulated investigations in the search for environmental factors that may be at the origin of the increased susceptibility to the disease. Here we studied if high concentrations of branched-chain amino acids (BCAAs), widely used among athletes as dietary integrators to improve physical performance, may be related to an excitotoxic neuronal cell damage. Our results show that (i) high concentrations of BCAAs are neurotoxic and increase selleck chemical excitotoxicity in

cortical neurons; (ii) Sapitinib neurotoxicity is brain area specific, being detected in cortical, but not in hippocampal neurons; (iii) it is related to NMDA receptor overstimulation, since it is abolished in the presence of MK-801, a specific NMDA channel blocker; (iv) it depends on the presence of astrocytes. We describe here a possible biological link between an environmental factor (high dietary intake of BCAAs) and the increased risk of ALS among soccer players.”
“Vaccinia virus (VACV) is the etiological agent of bovine vaccinia (BY), an important zoonosis that affects dairy cattle. There

are many aspects of the disease that remain unknown, and aiming to answer some of these questions, the clinical, hematological, and biochemical parameters of VACV experimentally infected cows were evaluated. In the first GS-7977 mouse part of the study, lactating cows were infected with VACV-GP2 strain. In the second part, animals previously infected with VACV-GP2 were divided into two treatment groups: Group 1, immunosuppressed cows; and Group 2, re-infected cows. In this study, BV could be experimentally reproduced, with similar lesions as observed in natural infections. Moreover, a short incubation period and local lymphadenopathy were also observed. VACV could be detected by PCR and isolated from scabs taken from teat lesions of all inoculated and re-inoculated animals. Lymphocytosis and neutrophilia were observed in all animals from the first part of the experiment, and lymphopenia and relative neutrophilia were observed in the immunosuppressed animals. Detection of viral DNA in oral mucosa lesions suggests that viral reactivation might occur in immunosuppressed animals. Moreover, clinical disease with teat lesions may occur in previously VACV-infected cows under the experimental conditions of the present study. (C) 2013 Elsevier Ltd. All rights reserved.”
“This paper studies the domain configurations in platelets with perpendicular uniaxial anisotropy.

Materials and Methods: After institutional review board approval,

Materials and Methods: After institutional review board approval, written informed consent was waived. The study was HIPAA compliant. Thirty-six calcium oxalate stones were scanned in an anthropomorphic phantom. For the fixed threshold method, stones were segmented with 0.6-mm-thick sections by using attenuation thresholds of

130 and 575 HU (equal to half of mean attenuation of all stones). For the variable threshold method, stones were segmented at an attenuation threshold equal to half of the attenuation of each stone and at variable section thicknesses (0.6, 1, and 3 mm), tube currents (150, 100, and 50 mAs [reference]), and tube voltages (100 and 80 kVp). Normalized Bland-Altman analysis was used to assess the bias and precision of the two CT methods compared see more this website with that of the fluid displacement method (reference standard). Two independent readers retrospectively measured stone volumes in 17 patients (male-to-female ratio, 1.4; mean age, 55 years), and interobserver agreement was assessed by using Bland-Altman limits of agreement.

Results: The variable threshold method was more accurate and precise than the fixed threshold method with an attenuation threshold of 130 HU (P < .0001). Thinner sections (0.6 and 1 mm) resulted in more accurate (P < .05) and precise (P < .0001) stone volume

measurements than 3-mm-thick sections. With the variable threshold

method, no significant difference was seen in the accuracy and precision of stone volume measurements at various tube currents and tube potentials. Interobserver agreement was high with the fixed and variable threshold 4-Hydroxytamoxifen in vitro methods (r > 0.97).

Conclusion: An attenuation threshold-based CT method can be used to quantify urinary stone volume even at low radiation doses. The most accurate and precise method utilizes variable attenuation derived from the attenuation of each stone and thin sections.”

Finding fruiting bodies and hyphae of Aspergillus species in a routine cervicovaginal Pap smear is a rare occurrence. When encountered, it is important to distinguish between a true infection and contamination. The fruiting body also plays a very important role in distinguishing the various Aspergillus species.


A 52-year-old woman underwent routine gynecologic anti Pap smear examination. Her per-vaginal and per-speculum examinations were unremarkable. Pap smear showed atrophic changes with few acute inflammatory cells. However, a large number of hyphae and marry fruiting bodies of Aspergillus species were observed in the smears. Close examination of the smear and clinical investigation indicated that the presence of Aspergillus species was due to contamination. Clinical follow-up with repeat Pap smear after 1 month was unremarkable.

Am J Clin Nutr 2009;90:1440-5 “
“Objective: To evaluate the

Am J Clin Nutr 2009;90:1440-5.”
“Objective: To evaluate the urodynamic parameters, development of bladder function and complications of clean intermittent self-catheterization (CIC) in Chinese schoolchildren with neurogenic underactive bladder. Methods: Ninety-three children with neurogenic underactive ROCK inhibitor bladder were successfully treated with CIC or combined with

oxybutynin for two years follow-up. According to bladder compliance before CIC, they were subdivided into a normal bladder compliance (NBC) group and a low bladder compliance (LBC) group. Urodynamic parameters and complications were recorded. Results: At follow-up, the incidence of neurogenic detrusor overactivity was found to have significantly decreased in both groups. Moreover, maximum selleckchem cystometric capacity (CC) and relatively safe CC in the NBC group was significantly higher than those before CIC. However, relatively safe CC was significantly lower than that before CIC, and detrusor leakage point

pressure was significantly higher than that before CIC in the LBC group. The incidences of bacteriuria, vesicureteral reflux (VUR), febrile urinary tract infections (UTI) and macroscopic hematuria were, respectively, 62, 13, 25 and 15%, and those of VUR and febrile UTI in the LBC group were significantly higher than those in the NBC group. Conclusion: For these cases, the complications of CIC are rare, and bladder compliance seems to be correlated with the development of bladder function and complications during CIC. Copyright (C) 2011 S. Karger

AG, Basel”
“We present a model of data retention for phase change memory devices in which the active medium is a thin layer of chalcogenide glass. Data retention capability is compromised when a crystalline path is spontaneously formed in the glassy host, essentially shunting the device. We determine the probability and statistics of device failure for systems in which the crystalline volume fraction is below the critical volume fraction of percolation theory. In that regime, we show that rectilinear crystalline path formation is favored see more and we determine the criteria for when such paths dominate over the typical percolation cluster scenario. Our analytical approach, based on modeling the formation of such paths in terms of a half-space random walk, leads to closed form expressions that relate data retention characteristics to device parameters. The model is used to examine the effects of device geometry, temperature, and external fields. The temporal statistics of device reliability are also considered for several failure mechanisms. A computer simulation is employed that supports our derived relationships between failure probability and device parameters. (C) 2010 American Institute of Physics. [doi:10.1063/1.3478713]“
“Background/Aims: A correlation has been observed between DNA ploidy and other prognostic parameters such as tumor stage and grade.


were evaluated with the Interstitial Cystitis Sy


were evaluated with the Interstitial Cystitis Symptom Index/Problem Index (ICSI-PI) and scaled global response assessments (GRA) for the first 24 months post IPG placement. Data were analyzed using Pearson’s Chi-square, Fisher’s Exact, or Wilcoxon rank test. Results: Of 141 subjects (82% female), 86 (61%) had sensory testing and 55 (39%) did not. Sensory and no sensory testing groups were not significantly different on demographics, urologic diagnosis, IPG implant rates (76/84; 90% and 48/55; 87% respectively) or mean operative time (37.9 +/- 13.9 minutes vs. 35.5 +/- 11.6). Within 4 years, 19/141 (13.5%) were revised and/or explanted. For explant alone, 11/86 (13%) in the sensory and only 3/55 (5.5%) in the no sensory group (P selleck kinase inhibitor = 0.16) were explanted. Overall, ICSI-PI scores improved over time (P < 0.0001) and most reported improvement on the GRA at each time point, but Selleckchem Citarinostat no differences were seen between groups. Conclusions: Intraoperative sensory testing during sacral lead placement does not necessarily improve IPG implantation rates or clinical outcomes of neuromodulation. Neurourol. Urodynam. 30:1489-1492, 2011. (C) 2011 Wiley Periodicals, Inc.”
“Bariatric surgery for morbid obesity has been established as an effective treatment method and has been shown to be associated with resolution of co-morbidities. Despite its success, some patients may

require revision because of weight regain or mechanical complications. From September 2005 to December 2009, 42 patients underwent revisional Roux-en-Y gastric bypass (RYGB). All procedures were performed by one surgeon. Demographics, indications for revision, complications, and weight loss were reviewed. Thirty-seven patients A-1155463 price were treated with laparoscopic (n = 36) or open (n = 1) RYGB after failed laparoscopic adjustable gastric banding. Four patient were treated with laparoscopic (n = 3) or open (n-1) RYGB after failed vertical banded gastroplasty, and one patient underwent open redo RYGB due to large gastric pouch. Conversion rate from laparoscopy to open surgery was 2.5% (one patient).

Mean operative time was 145.83 +/- 35.19 min, and hospital stay was 3.36 +/- 1.20 days. There was no mortality. Early and late complications occurred in six patients (14.2%). The mean follow-up was 15.83 +/- 13.43 months. Mean preoperative body mass index was 45.15 +/- 7.95 that decreased to 35.23 +/- 6.7, and mean percentage excess weight loss was 41.19 +/- 20.22 after RYGB within our follow-up period. RYGB as a revisional bariatric procedure is effective to treat complications of restrictive procedures and to further reduce weight in morbidly obese patients.”
“BACKGROUND: Type A or B Niemann-Pick disease (NPD) is characterized by the accumulation of sphingomyelin in the lysosomes and cell membranes.