“
“Although cancer in children is rare, it is the second most common cause of childhood mortality in developed countries. It often presents

with nonspecific symptoms similar to those of benign conditions, leading to delays in the diagnosis and initiation of appropriate treatment. Primary care physicians should have a raised index of suspicion and explore the possibility of cancer in children who have worrisome or persisting signs and symptoms. Red flag signs for leukemia or lymphoma include unexplained and protracted pallor, https://www.selleckchem.com/products/NVP-AUY922.html malaise, fever, anorexia, weight loss, lymphadenopathy, hemorrhagic diathesis, and hepatosplenomegaly. New onset or persistent morning headaches associated with vomiting, neurologic symptoms, or back pain should raise concern for tumors of the central nervous system. Palpable masses in the abdomen or soft tissues, and persistent bone pain that awakens the child

are red flags for abdominal, soft tissue, and bone tumors. Leukokoria is a red flag for retinoblastoma. Endocrine symptoms such as growth arrest, diabetes insipidus, and precocious or delayed puberty may be signs of endocranial or germ cell tumors. Paraneoplastic RSL-3 manifestations such as opsoclonus-myoclonus syndrome, rheumatic symptoms, or hypertension are rare and may be related to neuroblastoma, leukemia, or Wilms tumor, respectively. Increased suspicion is also warranted for conditions associated with a higher risk of childhood cancer, including immunodeficiency syndromes and previous malignancies, as well as with certain

genetic conditions and familial cancer syndromes such as Down syndrome, Li-Fraumeni syndrome, hemihypertrophy, neurofibromatosis, and retinoblastoma. (Copyright (C) 2013 American Academy of Family Physicians.)”
“Aquaporin (AQP)-5 has been shown to be expressed MEK162 supplier in the secretory parts of mouse, rat and horse sweat glands. However, the precise localization of AQP-5 in normal and diseased human skin has not been fully determined. The aim of the present study was to further clarify the immunolocalization of AQP-5 in normal human skin and hypohidrotic skin diseases. Normal human scalp skin and biopsies from skin affected by hypohidrotic diseases were analyzed for AQP-5 and/or dermcidin expression by immunohistochemistry, immunofluorescence and/or immunoelectronmicroscopy. AQP-5 was expressed on the apical and basolateral plasma membranes of the clear cells in eccrine sweat coils, but not in ductal components or apocrine glands. Numbers of AQP-5-positive coils in the secretory part of eccrine sweat glands were decreased in Sjogrens syndrome, but not in skin affected by idiopathic segmental anhidrosis or idiopathic pure sudomotor failure.

In the other four patients, complete closure of the RSVA was confirmed by color Doppler echocardiography. No complications were observed during 9-19 months of follow-up. Percutaneous closure of an RSVA is feasible and can be used as an alternative to surgery.”
“The milk-flow, imaging, and histopathological characteristics of the teat in five cows with toxic mastitis were investigated. Teats were grouped into type I (without gross and histopathological abnormality), type II (no abnormal

gross findings, but with histopathological abnormality), and type III (with gross and histopathological abnormality). Normal teats from CX-6258 manufacturer six cows served as controls. Type II and III teats had lower milk-flow, compared with the controls. Ultrasonography revealed no abnormal findings, except for irregular mucosal surface in type II teats and absence of hyperechoic line along the teat canal in type III teats. The theloscopic findings varied from normal to mucosal abnormalities in type II and Ill teats. Histopathology demonstrated epithelial changes, congestion, hemorrhage, edema, cellular infiltration, BTSA1 inhibitor and elastic fiber degradation in type

II and III teats, with the type Ill teats showing severe changes. Toxic mastitis was characterized by impaired milk-flow and various degrees of imaging and histopathological abnormality. (C) 2011 Elsevier Ltd. All rights reserved.”
“Background and aim: The relationship between metabolic syndrome (MS) and blood and plasma viscosity has been scarcely investigated. In the present study we have evaluated the difference in blood and plasma viscosity between

subjects with and without MS, in order to verify whether viscosity measurement can add more information on the overall cardiovascular risk connected with the presence of the MS.

Methods and Results: Two hundred and sixty nine women and 520 men have been enrolled. Blood and plasma viscosity have been measured with a cone-plate viscometer equipped with a cp-40 spindle. MS has been defined according to the third report of the National Cholesterol Education Program, Adult R788 chemical structure Treatment Panel III.

Eighty four women and 154 men fulfilled the criteria for MS. Hematocrit adjusted blood viscosity was higher in subjects with MS compared to those without the syndrome, both in mates (shear rate 225 s(-1): 4.60 +/- 0.38 vs. 4.52 +/- 0.33 cP, p < 0.01) and females (4.57 +/- 0.28 vs. 4.46 +/- 0.31 cP, p < 0.01). Blood viscosity was correlated with all components of MS but glucose, and after adjustment for them the difference between subjects with or without MS was completely abolished. Plasma viscosity was significantly higher only in females with MS.

Conclusions: These data demonstrate that blood viscosity is increased in subjects with MS, but the increase seems to depend on the metabolic alterations of the syndrome. The independent contribution of the rise in blood viscosity to the cardiovascular risk connected with the presence of MS seems therefore negligible.

We distinguish five different manifestation patterns of mosaicism, including the Blaschko lines pattern, patchy pattern without midline separation, checkerboard pattern, phylloid pattern and lateralization pattern. All forms of epigenetic mosaicism, including the various patterns of X-inactivation, appear to be caused by the action of retrotransposons. A new concept is functional autosomal mosaicism transmittable through the action of retrotransposons.”
“In this study,

hydroalcoholic leaf extracts of Couroupita guianensis were examined for antioxidant activity, phytochemical and total phenolic composition, stimulation of human skin fibroblast (HSF) proliferation and UV-absorption. The radical scavenging capacity, reducing power and protection against Adavosertib in vitro joint oxidation of linoleic acid and beta-carotene bleaching oxidation in emulsion were used to evaluate the antioxidant activity. The results of this study strongly indicate in vitro antioxidant activity, which may be due to the presence of a high total phenolic content. In order to identify active principles, the extracts were submitted to fractionation THZ1 price and the compounds isolated were the flavonoids

2′,4′-dihydroxy-6′-methoxy3′,5′-dimethylchalcone (1), 7-hydroxy-5-methoxy-6,8-dimethylflavanone (2) and the phenolic acid 4-hydroxybenzoic acid (3). In addition, a high level of stimulation of HSF proliferation and significant absorption of UV radiation were also observed. The results suggest that the hydroalcoholic leaf extracts of C. guianensis have promising skin care properties.”
“We report a patient with an autologous Navitoclax mouse stem cell transplant and history of residence in a Chagas disease (CD) endemic area who developed Chagas reactivation after induction for transplantation. We recommend that patients at risk for CD be screened before transplantation, and patients found to have chronic infection be monitored for reactivation post transplant.”
“The present review highlights the development of the integument and its adnexa from the primitive metazoans to man. The different stages of development

represent independent, partially convergent evolutions rather than a continuous evolutionary line. The epidermis of the invertebrates ( sponges, cnidaria, worms, echinoderms and arthropods) always consists of one layer of pluripotent cells. The barrier function of the integument at this level is achieved with physico-chemical barriers, toxin production, fortification of the epidermis in the form of a cuticula, a syncytium or a neodermis. The lower vertebrates (cyclostoma, fishes and amphibians) have a stratified epidermis harboring many secretory cells. In terrestrial amphibians the outermost cell layer of the epidermis is cornified, and the secretory cells are relocated in the dermis. Terminal differentiation and cornification of the epidermis in the birds and mammals result in a more uniform shape of the epithelium. Stem cells are now restricted to some basal regions of the epithelium.

These conditions include idiopathic and familial forms of the disease and disease forms associated with connective tissue disease, congenital heart defects involving systemic-to-pulmonary arterial shunts, portal hypertension, and HIV infection.

It has been shown that treatment with specific drugs (e.g. prostanoids, endothelin-receptor antagonists and phosphodiesterase type-5 inhibitors) is effective in these patients and that these drugs can also be administered in various combinations. An evidence-based treatment algorithm has been developed for these patients.

In patients with pulmonary Galardin supplier hypertension due to left heart disease or lung disease, treatment focuses on the underlying condition and there is no convincing evidence that agents approved for pulmonary arterial hypertension are effective. For patients with chronic thromboembolic pulmonary hypertension, the treatment of choice is pulmonary endarterectomy. However, drugs intended specifically Selleck Stattic for the treatment of pulmonary arterial hypertension may be considered in inoperable cases or after suboptimal surgery.”
“Coenzyme Q10 (Q10) loaded solid lipid nanoparticles (SLN) were

prepared by the high speed homogenization method and incorporated into Carbopol 974P hydrogels. Compritol 888 ATO (C888) was employed as the lipid base; Poloxamer 188 (P188) and Tween 80 (Tw80) were used as surfactant and co-surfactant. Optimum particle size with narrow distribution was obtained as 152.2 nm for blank and 142.4 nm for Q10 loaded SLNs. The overall charge of loaded SLNs was -13.7 +/- 1.3 mV. Q10 entrapment efficiency was 89 % and the production yield was 94 A, Transmission electron microscopy analysis provided evidence of colloidal size, spherical shape while differential scanning calorimetry analysis confirmed recrystallization of the lipid after the preparation of SLNs. Trolox equivalent antioxidant capacity (TEAC) analysis has shown that antioxidant potential of Q10 can be protected this website in SLNs. Rheological characteristics

demonstrated that the SLN incorporating gels were shear thinning and the mechanical strength of the gels was suitable for topical application. Diffusion studies from rat abdominal skin revealed that the delivery of Q10 was doubled in SLN incorporating gels, approximately 40 mu g cm(-2), in comparison with gels prepared with only Q10 (not incorporated in SLNs). As a result, it can be stated that Q10-SLN loaded gels can be successful delivery systems for carrying Q10 efficiently into the skin without losing its antioxidant properties.”
“Feeding disorders and the association of neonatal feeding disorders with other outcomes were assessed in a cohort of 84 children with neonatal arterial ischemic stroke at a tertiary children’s hospital. Both chi(2) tests and Fisher’s exact test were used to test associations. Forty-one of 84 children (48.8%) had feeding difficulties. Infarcted vascular territory (unilateral vs bilateral, P=.24) and neonatal seizures (P=.

25 to 0.78 at a high reaction efficiency and characterized with LY2606368 in vitro regard to their molecular structure and aqueous solution viscosity. On the basis of the dry synthesis of CMS, the properties of CMS-bonded shell core sand were investigated, and practical production experiments were carried out. The results show that there was a new sharp peak in the infrared spectrum that represented the carboxymethyl groups and formation of CMS. The viscosity of the CMS aqueous solution increased with increasing DS and amount of CMS. When DS was in the range 0.3-0.5

and the mass fraction was 5-7%, the CMS aqueous solution had a suitable viscosity, which was helpful for the improvement of the properties, such as flowability, permeability, and strength, of the CMS core sand. In addition, a CMS shell core with an appropriate wall thickness (10-20 mm) for the purpose of obtaining both sufficient strength and permeability could be made with the CMS-bonded core sand and a hot-core-box process. The final pouring results prove that high-quality iron castings with smooth inner cavities could be produced with the CMS-bonded shell core and that it (namely the CMS-bonded shell-core) could be used as a replacement for the furan resin-bonded sand core. (C) 2010 Wiley

Periodicals, Inc. J Appl Polym Sci 116: 2893-2900, 2010″
“In addition to its medical impact with respect to loss of control, drug effects, and comorbidity, epilepsy has a marked impact on a child’s life. Population-based studies show that 70-76% of children with epilepsy have some type of disability ASP2215 purchase or handicap affecting their daily life and choices for the future. Comorbidity and, specifically, learning

disability (sometimes referred to as mental retardation) modify the life of a child and the family. To improve these children’s position in society, Doramapimod mw they should have the same opportunities and be allowed to make choices on the basis of their abilities, not their diagnosis of epilepsy. Supporting the development of acceptance, self-reliance, self-respect, and self-empowerment of children with epilepsy is crucial to their achieving a place in the community equal to their abilities. This is a challenging task for their families, relatives, school teachers, employers, and legislators. (C) 2009 Elsevier Inc. All rights reserved.”
“OBJECTIVE: To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.

EVIDENCE: MEDLINE searches were conducted from November 2008 to October 2009 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only.

00 for P-Cx43 and NP-Cx43). It also revealed that, after aconitine treatment, the amount of phosphorylated PKC Apoptosis Compound Library ic50 alpha (P-PKC alpha) decreased significantly. Similar changes were revealed in phosphorylation status occurring in PKC alpha in the cultures under the same treatment conditions. These observations suggest that aconitine not only induces dephosphorylation of Cx43, but also alters expression of P-PKC alpha in cultured cardiomyocytes.”
“Pectic enzyme production was induced in vitro by culturing the pathogen (P flourescens) in minimal salt medium containing citrus pectin as the only carbon source and in vivo by inoculating the pathogen into healthy onion bulbs. The

spent broth and onion rot extract were obtained and enzyme detection was done using viscometric method and

cup plate assay. The crude enzyme was partially purified by precipitating with ammonium sulphate and dialyzed against water at 4 degrees C for 24 h before use. The activity of the purified enzyme was determined based on the macerating ability on Onion and Potato discs and later by estimation of reducing sugars (galacturonic this website acid) level. The type of cleavage reaction of the enzyme was determined using the thiobarbituric acid reaction and the presence of antimicrobial substance in the rot tissue was also investigated. The pathogen produced a hydrolytic polygalacturonase in vitro and in vivo. The purified enzyme showed appreciable activity with all the assay methods used. Activity was highest at pH 5 in the culture filtrate sample and at pH 4 in the rot extract. Maceration was observed in potato and onion discs. The detection of increasing concentration of polyphenols

selleck products in the rot tissue during rot development demonstrated the plant’s response to the pathogen.”
“Background: It is known that daily smoking is associated with the development of alcohol use disorders. However, non-daily smoking is prevalent in young adults and is associated with increased rates of problematic alcohol use in cross-sectional data. It is unknown whether non-daily smoking is predictive of hazardous drinking and alcohol use disorders using longitudinal data. The primary aim of the present investigation was to explore the temporal relationship between non-daily smoking and drinking in young adults, and secondarily, whether college status modified this relationship.

Methods: Using Waves 1 (200172002) and 2 (2004-2005) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we examined the predictive relationship of smoking status at Wave 1 and change in college status between Waves on alcohol drinking, hazardous drinking, and alcohol abuse and dependence disorders at Wave 2. The sample was restricted to individuals aged 18-25 years at Wave 1.

Findings: Daily and non-daily smokers at Wave 1, compared to nonsmokers, were at a greater risk for hazardous drinking and alcohol use disorders at Wave 2, after controlling for Wave 1 drinking.

The dyeability strongly depends on the plasma exposure time, gaseous mixture, and energy input. The permanency of the bond between the dye molecules and drug discovery the plasma film can be characterized as the fastness property of dyed PET. The stability of the plasma coating has been examined with an abrasion and pilling tester. (c) 2008 Wiley

Periodicials, Inc. J Appl Polym Sci 111: 2545-2552, 2009″
“Background: Anterior cruciate ligament (ACL) injury and reconstruction in the skeletally immature patient are becoming more common. The purpose of this study was to develop a reproducible anatomic ACL reconstruction technique, based on intra-articular and extra-articular landmarks, that reliably produces a femoral tunnel of adequate length and diameter while avoiding the distal femoral physis.

Methods: Magnetic resonance images

(MRIs) of one hundred and eighty-eight children (age range, six to seventeen years) were evaluated. Two extra-articular landmarks, the femoral insertion of the popliteus tendon and the lateral femoral epicondyle, and one intra-articular landmark, the central portion of the femoral footprint of the ACL, were identified. Computer software was used to plot these landmarks this website in all three planes and to draw lines representing. two potential femoral tunnels. The first line connected the center of the ACL femoral footprint with the insertion of the popliteus tendon, and the second connected the center of the ACL femoral footprint with the lateral femoral epicondyle. The length of each tunnel, the shortest distance from the center of each tunnel to the distal femoral physis, and the height of the lateral femoral condyle from the physis to the chondral surface and to the base of the cartilage cap were calculated. A three-dimensional MRI reconstruction was used to confirm that placement of a femoral tunnel with use of the chosen landmarks would avoid the distal femoral physis.

Results: Entinostat datasheet The mean distance from the center of the preferred

ACL tunnel, which connected the center of the ACL femoral footprint with the insertion of the popliteus tendon, to the distal femoral physis was 12 mm, independent of sex (p = 0.94) or age, and the shortest distance was 8 mm. The length of this proposed tunnel averaged 30.1 mm in the boys and 27.4 mm in the girls (p < 0.001), and it averaged 25.4 mm at an age of six years and 29.7 mm at an age of seventeen years. The mean distance from the center of the alternative tunnel, which connected the center of the ACL femoral footprint with the lateral epicondyle, to the distal femoral physis was 8.8 mm in the boys and 8.9 mm in the girls (p = 0.55). The mean length of this alternative tunnel was 34.3 mm in the boys and 31.6 mm in the girls (p < 0.001).

Sensitivities of the model estimates to input parameters were tested. The result showed that emission www.selleckchem.com/products/bms-345541.html rates, compartment dimensions, transport velocity and degradation rates of BaP were the most influential parameters for the model output. Monte Carlo simulation was carried out to determine parameter uncertainty, from which the coefficients of variation for the estimated BaP concentrations in air and soil were computed,

which were 0.46 and 1.53, respectively. The model output-concentrations of BaP in multimedia environment can be used in human exposure and risk assessment in the Bohai coastal region. The results also provide significant indicators on the likely dominant fate, influence range of emission and transport processes determining behavior of BaP in the Bohai coastal region, which is instrumental in human exposure and risk assessment in the region. (C) 2013 Elsevier Ltd. All rights reserved.”
“It remains uncertain whether hepatitis B virus (HBV) covalently closed circular DNA (cccDNA) and pregenomic RNA (pgRNA) can be detected in the serum or peripheral blood mononuclear cells (PBMC) of patients with chronic hepatitis

B (CHB) infection. We examined HBV cccDNA and pgRNA in the serum and PBMC, and investigated the effect of lamivudine therapy on the viral loads in the PBMC of CHB patients. Paired serum and PBMC samples from 50 treatment-naive CHB patients [25 hepatitis B e antigen Selleckchem TGF beta inhibitor (HBeAg) positive and 25 HBeAg negative] were quantified for total HBV DNA, cccDNA and pgRNA by real time polymerase chain reaction. HBV cccDNA

and pgRNA were below the lower detection limit in all serum samples, and in 84% of PBMC. HBV DNA (r = 0.889, P < 0.001) and pgRNA (r = 0.696, P < 0.001) in PBMC correlated with the HBV DNA in serum. In the longitudinal study, 30 patients treated with lamivudine therapy for a median duration of 34 weeks (range 12-48 weeks) were examined. The median HBV DNA reduction in PBMC before and after treatment was 1.318 (range -0.471 to 3.846) log units, which was significantly lower than serum HBV DNA reduction [3.371 (range -0.883 to 9.454) log units, P < selleck products 0.05]. HBV cccDNA and pgRNA were undetectable in the serum of CHB patients. HBV viral loads in PBMC correlated with serum HBV DNA. Lamivudine therapy had less effect on the HBV viral loads in PBMC compared with the serum viral loads.”
“We report a detailed description of an innovative route of a melt spinning (MS) technique combined with a subsequent spark plasma sintering process in order to obtain high performance p-type Bi(0.52)Sb(1.48)Te(3) bulk material, which possesses a unique low-dimensional structure. The unique structure consists of an amorphous structure, 5-15 nm fine nanocrystalline regions, and coherent interfaces between the resulting nanocrystalline regions.

To replace the proper amount of postoperative soft tissue deficit in the neck area, we use an oversized ALT flap design. This allows reconstruction of the specific anatomical defects, protection of the important neck structures, and prevention of a sunken appearance. An oversized flap may also provide

additional coverage for fixation hardware to prevent its exposure, especially after radiotherapy. In the event of partial flap loss, some viable parts of the oversized flap may be possible to advance or rotate to replace the nonviable part to avoid a repeated free flap procedure 4-Hydroxytamoxifen research buy or other more complicated reconstructive procedures.”
“A multiple-unit system comprising mucoadhesive bilayer buccal tablets of carvedilol-loaded chitosan microspheres

(CMs) was developed to improve bioavailability and therapeutic efficacy of carvedilol. Drug-loaded CMs were prepared by spray drying, evaluated for powder and particle characteristics, and optimized batch of CMs was Birinapant compressed into bilayer buccal tablets using Carbopol. Tablets were evaluated for physicochemical parameters, in vitro drug release, in vivo pharmacokinetic and pharmacodynamic studies. Optimized formulation, CMT1 (CMT, chitosan microsphere tablet) showed maximum mucoadhesive force (50 +/- 1.84 dyne/cm(2)), exhibited 73.08 +/- 3.05% drug release and demonstrated zero-order kinetics with non-Fickian release mechanism. Pharmacokinetic studies in rabbits showed significantly higher C-max (71.26 +/- 6.45 ng/mL), AUC(0-10) (AUC, area under the curve 390.75 +/- 5.23 ng/mL/h) and AUC(0-infinity) (664.72 ng/mL/h) than carvedilol oral tablet. Pharmacodynamic studies confirmed reduction in mean arterial pressure, see more heart rate, body weight and triglyceride on administration of bilayer buccal tablet compared to oral carvedilol tablet. Multiple-unit system exhibited enhanced bioavailability and sustained release of carvedilol, indicating

its improved therapeutic potential for the treatment of hypertension.”
“In the past few decades, concurrent chemoradiation has conclusively been established as the standard of care in resectable, locally advanced head and neck cancer. Platins until now have been the established radiosensitizer in all concurrent settings, including postoperative high-risk scenarios. However, retrospective and evolving data suggest that they have their limitations in terms of compatibility, toxicity, and intrinsic resistance. There is therefore the need to explore the scope of other agents that may address these issues through a different mode of action, a better toxicity profile, or preferably a combination of both. In recent years, taxanes have emerged as an effective chemotherapeutic agent for head and neck cancer for recurrent or metastatic disease and chemoinduction for downstaging before definitive treatment. In this article, the authors review the potential of taxanes as an alternative to platins in the concurrent setting.

This non-methoxylated derivative of the studied polymer reduced in a reversible way the transepithelial electrical resistance of CaCo-2 monolayers at concentrations not higher than 0.003 % w/v, indicating

that the absence of steric hindrance from methoxyl groups improves the effect of N-trimethylchitosan chloride, but at expense of a narrow range of action and higher cytotoxicity. The results of in vitro permeation studies conducted in bicameral Transwell (R) systems suggested that Oligomycin A price the permeability of capreomycin sulfate is low, although it was not established if the transport is exclusively paracellular or membrane transporters are involved. By using increasing concentrations of the polymer in the range of 0.001 – 0.003% w/v, it was observed a slight increase in RG-7112 mouse the transport of capreomycin. Therefore, it was concluded that further studies should use N-trimethylchitosan chloride with a lower

degree of quaternization or controlled methoxylation, in order to increase the mass to use and obtain a product that is able to remain retained in the intestinal lumen and which in turn interacts with the epithelium.”
“Over the last 4 years, three genetic etiologies of hyper IgE syndromes have been identified: STAT3, DOCK8, and Tyk2. All of these hyper IgE syndromes are characterized by eczema, sinopulmonary infections, and greatly elevated serum IgE. However, each has distinct clinical manifestations. Mutations in STAT3 cause autosomal dominant HIES ( Job’s syndrome), which is unique in its diversity of connective tissue, skeletal, and vascular

abnormalities. DOCK8 deficiency is characterized by severe cutaneous viral infections such as warts, and a predisposition to malignancies at a young age. Only one individual has been identified with a hyper IgE phenotype associated with Tyk2 deficiency, which is characterized by nontuberculous mycobacterial infection. The identification of these genetic etiologies is leading to advances in understanding the pathogenesis of these syndromes with the goal of P005091 inhibitor improving treatment.”
“To describe great-vessel dimensions in patients with D-loop transposition of the great arteries (TGA) who have undergone atrial switch operation (ATSO). Patients who have undergone arterial switch operation for TGA have a high incidence of dilation of the neoaortic root. The incidence and degree of great artery dilation in patients who have undergone ATSO for TGA has not previously been described. A retrospective database review identified patients with TGA and intact ventricular septum who underwent ATSO at < 1 year of age with cardiac magnetic resonance (CMR) within the previous 5 years (n = 39).