Tumor-feeding artery diameter reduction is associated with improved short-term effect of hepatic arterial infusion chemotherapy plus lenvatinib treatment

BACKGROUND Recently,hepatic arterial infusion chemotherapy(HAIC)plus lenvatinib has been frequently used to treat unresectable hepatocellular carcinoma(uHCC)in China.In the clinic,the hepatic arteries of some patients shrink significantly during this treatment,leading to improved short-term efficacy.AIM To investigate the relationship between the shrinkage of hepatic arteries and the short-term effect of HAIC plus lenvatinib treatment.METHODS Sixty-seven participants with uHCC were enrolled in this retrospective study.The patients received HAIC every 3 wk,followed by oral lenvatinib after the first HAIC course.Hepatic artery diameters were measured on CT before treatment and after 1 and 2 mo of treatment.Meanwhile,the changes in tumor capillaries were also examined on pathological specimens before and after 1 mo of treatment.The antitumor response after 1,3,and 6 mo of treatment was assessed using the modified Response Evaluation Criteria in Solid Tumors(mRECIST).The relationship between the changes in vessel diameters and the short-term effect of the combination treatment was evaluated by receiver-operating characteristic and logistic regression analyses.RESULTS The hepatic artery diameters were all significantly decreased after 1 and 2 mo of treatment(P<0.001),but there was no difference in the vessel diameters between 1 and 2 mo(P>0.05).The microvessel density in the tumor lesions decreased significantly after 1 mo of combination treatment(P<0.001).According to mRECIST,46,41,and 24 patients had complete or partial responses after 1,3,and 6 mo of treatment,respectively,whereas 21,21,and 32 patients had a stable or progressive disease at these times,respectively.Shrinkage of the tumor-feeding artery was significantly associated with the tumor response after 1,3,and 6 mo of treatment(P<0.001,P=0.004,and P=0.023,respectively);however,changes in other hepatic arteries were not significantly associated with the tumor response.Furthermore,shrinkage of the tumor-feeding artery was an independent factor for treatment efficacy(P=0.001,P=0.001,and P=0.002 and 1,3,and 6 mo,respectively).CONCLUSION The hepatic arteries shrank rapidly after treatment with HAIC plus lenvatinib,and shrinkage of the tumor-feeding artery diameter was closely related to improved short-term efficacy.

Short-term Effects of Air Pollution on Mortality in a Heavily Polluted Chinese City

Since the London fog in 1952, numerous epidemioLogical studies have revealed that both short-term and long-term exposure to air pollutants is associated with the development of diseases[1]. Up to date, the assessment of air quality on health and air quality standard establishment in developing countries were mainly relied on extrapolation based on the results from long-term cohort studies conducted in Europe and North America.

Clinical Observation on the Improved Short-Term Effects of Anti-Tumor Purified Chinese Medicine Injection Ai-Jing for 138 Cases with Malignant Tumors

The subjects of this study were to observe the improved short-term effects of anti-tumor purified Chinese medicine injection Ai-Jing for 138 cases with malignant tumors. This was a multi-center clinical study, and a total of 138 patients included 96 males and 42 females, with the age from 60 to 76 years. Ai-Jing has obtained the Chinese invention patent since 2008 (ZL991-03528.3). A novel technique acupoint injection method was adopted. Except for lung cancer, patients with other malignant tumors were injected once every other day, 2 ml each time. A course of treatment needs 6 Ai-Jing injections, lung cancer patients need 10 - 20 Ai-Jing injections. At the same time, patients were treated with traditional medicine decoction. Due to the limited number of cases, cure rate, recovery rate and remission rate were calculated as a whole, respectively 18.12%, 44.20% and 32.15%. All the invalid patients were lung cancer, accounting for 16.67% of the patients treated with lung cancer, and the total treatment inefficiency was 6.52%. Conclusion: Chinese Medicine Injection Ai-Jing extracts the effective components of anti-cancer and tumorigenesis, and has the effects of anti-cancer and tumorigenesis, anti-inflam-matory and analgesic, and repairing body damage, with small toxic and side effects and low cost.

A comparison of the short-term effects of fixed platform versus rotating high-fiexion prosthesis for the patients with osteoarthrities of knee

Objective To compare the preliminary clinical outcome between fixed platform and rotating high-flexion prosthesis following total knee replacement(TKR).Methods Form January 2007 to December 2009,68 patients with osteoarthritis of

Short-term effect of rehabilitation training on children with neuropathic acontractile sphincter incontinence

Objective To evaluate the short-term effect of pelvic floor muscle rehabilitation training under the guidance of doctors on children with neuropathic acontractile sphincter incontinence ( NASI) . Methods Sixty-eighty children ( aged 4 - 12 mean,7) years with NASI

Predictive value of serum levels of transforming growth factor beta 1 for the short-term effects of radiotherapy and chemotherapy in patients with esophageal cancer

Objective To investigate variation in levels of transforming growth factor beta 1(TGF-β1)before and after radiotherapy in patients with esophageal cancer in order to evaluate the predictive value of TGF-β1 for the effects of radiotherapy Methods A total of 140 patients with esophageal squamous carcinoma undergoing radical radiation therapy in the Department of Oncology from March 2015 to December 2017 were enrolled.The patients were divided into the effective(115 cases)and ineffective(25 cases)groups according to World Health Organization(WHO)criteria for the evaluation of solid tumors(2009 RECIST standard).TGF-β1 levels were measured in all patients by using enzyme-linked immunosorbent assay(ELISA).Multiple-factor analysis of the predictive value of the treatment efficacy was performed by Cox regression analysis.Results After radiotherapy,36,79,and 25 cases experienced complete response(CR),partial response(PR),and no response(NR),respectively,with a total effective rate of 82.14%.The TGF-β1 level was significantly lower in the effective group than that in the ineffective group(P<0.05)and covariance analysis revealed significantly reduced TGF-β1 level in esophageal cancer patients following radiotherapy.The multi-factor Cox regression model revealed that the predictive value of TGF-β1 for the effect of radiotherapy was largest,with a hazard ratio[HR]of 1.955(P=0.002),followed by exposure dose,with(HR=1.367;P=0.035).Conclusion Serum TGF-β1 level can serve as a predictor for the short-term effects of radiotherapy in patients with esophageal cancer.

Evaluation of short-term effects of drug-loaded microspheres and traditional transcatheter arterial chemoembolization in the treatment of advanced liver cancer

BACKGROUND Liver cancer is a malignant tumor with high morbidity and mortality.Transcatheter arterial chemoembolization(TACE)is the main method for surgically unresectable liver cancer.In recent years,drug-loaded microspheres have been gradually applied in TACE technology.There are some controversies about the therapeutic effects of drug-loaded microspheres TACE(D-TACE)and traditional TACE.AIM To explore the short-term efficacy of D-TACE and traditional TACE in the treatment of advanced liver cancer.METHODS The clinical data of 73 patients with advanced liver cancer admitted to the First and Sixth Medical Centers of Chinese PLA General Hospital from January 2017 to October 2019 were retrospectively analyzed.Among them,15 patients were treated with D-TACE,and 58 patients were treated with traditional TACE.Clinical baseline characteristics,perioperative laboratory indices,postoperative adverse reactions and postoperative complications were compared between the two groups.RESULTS There was no statistical difference between the two groups for the postoperative response:The highest postoperative body temperature of the drug-loaded microsphere group was 38.0±0.9℃and the postoperative highest body temperature of the traditional TACE group was 38.3±0.7℃(t=-1.414,P=0.162).For the 24 h postoperative nausea and vomiting after surgery in terms of scoring and postoperative pain scores,the traditional TACE group was higher than the drugloaded microsphere group(χ2=14.33,P=0.014;χ2=32.967,P=0.000)and the two groups had significant statistical differences.The disease control rate at 3 mo after treatment in the drugloaded microsphere group was 60%and the disease control rate at 3 mo after treatment in the traditional TACE group was 75.9%(χ2=4.091,P=0.252).There was no statistical difference between the two groups of data.During the follow-up period,the number of interventional treatments received was once in the drug-loaded microsphere group and the traditional TACE group received an average of 1.48 treatments(χ2=10.444 P=0.005).There was a statistical difference between the two groups.CONCLUSION Compared with traditional TACE,D-TACE may have some advantages in the treatment of advanced hepatocellular carcinoma with a large tumor load in the short term,but the long-term clinical efficacy needs additional follow-up studies.In addition,compared with the traditional group,the patients in the drug-loaded microsphere group had better subjective tolerance and could reduce the number of interventional treatments.Therefore,D-TACE is worthy of clinical promotion.

Short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function

BACKGROUND Hepatectomy is the first choice for treating liver cancer.However,inflammatory factors,released in response to pain stimulation,may suppress perioperative immune function and affect the prognosis of patients undergoing hepatectomies.AIM To determine the short-term efficacy of microwave ablation in the treatment of liver cancer and its effect on immune function.METHODS Clinical data from patients with liver cancer admitted to Suzhou Ninth People’s Hospital from January 2020 to December 2023 were retrospectively analyzed.Thirty-five patients underwent laparoscopic hepatectomy for liver cancer(liver cancer resection group)and 35 patients underwent medical image-guided microwave ablation(liver cancer ablation group).The short-term efficacy,complications,liver function,and immune function indices before and after treatment were compared between the two groups.RESULTS One month after treatment,19 patients experienced complete remission(CR),8 patients experienced partial remission(PR),6 patients experienced stable disease(SD),and 2 patients experienced disease progression(PD)in the liver cancer resection group.In the liver cancer ablation group,21 patients experienced CR,9 patients experienced PR,3 patients experienced SD,and 2 patients experienced PD.No significant differences in efficacy and complications were detected between the liver cancer ablation and liver cancer resection groups(P>0.05).After treatment,total bilirubin(41.24±7.35 vs 49.18±8.64μmol/L,P<0.001),alanine aminotransferase(30.85±6.23 vs 42.32±7.56 U/L,P<0.001),CD4+(43.95±5.72 vs 35.27±5.56,P<0.001),CD8+(20.38±3.91 vs 22.75±4.62,P<0.001),and CD4+/CD8+(2.16±0.39 vs 1.55±0.32,P<0.001)were significantly different between the liver cancer ablation and liver cancer resection groups.CONCLUSION The short-term efficacy and safety of microwave ablation and laparoscopic surgery for the treatment of liver cancer are similar,but liver function recovers quickly after microwave ablation,and microwave ablation may enhance immune function.

Locally Enhanced Flow and Electric Fields Through a Tip Effect for Efficient Flow‑Electrode Capacitive Deionization

Low-electrode capacitive deionization(FCDI)is an emerging desalination technology with great potential for removal and/or recycling ions from a range of waters.However,it still suffers from inefficient charge transfer and ion transport kinetics due to weak turbulence and low electric intensity in flow electrodes,both restricted by the current collectors.Herein,a new tip-array current collector(designated as T-CC)was developed to replace the conventional planar current collectors,which intensifies both the charge transfer and ion transport significantly.The effects of tip arrays on flow and electric fields were studied by both computational simulations and electrochemical impedance spectroscopy,which revealed the reduction of ion transport barrier,charge transport barrier and internal resistance.With the voltage increased from 1.0 to 1.5 and 2.0 V,the T-CC-based FCDI system(T-FCDI)exhibited average salt removal rates(ASRR)of 0.18,0.50,and 0.89μmol cm^(-2) min^(-1),respectively,which are 1.82,2.65,and 2.48 folds higher than that of the conventional serpentine current collectors,and 1.48,1.67,and 1.49 folds higher than that of the planar current collectors.Meanwhile,with the solid content in flow electrodes increased from 1 to 5 wt%,the ASRR for T-FCDI increased from 0.29 to 0.50μmol cm^(-2) min^(-1),which are 1.70 and 1.67 folds higher than that of the planar current collectors.Additionally,a salt removal efficiency of 99.89%was achieved with T-FCDI and the charge efficiency remained above 95%after 24 h of operation,thus showing its superior long-term stability.

Late effects of the treatment of childhood cancer

Excellent progress has been made in the last few decades in the cure rates of pediatric malignancies,with more than 80%of children with cancer who have access to contemporary treatment being cured.However,the therapies responsible for this survival can also produce adverse physical and psychological long-term outcomes,referred to as late effects,which appear months to years after the completion of cancer treatment.Research has shown that 60%to 90%of childhood cancer survivors(CCSs)develop one or more chronic health conditions,and 20%to 80%of survivors experience severe or life-threatening complications during adulthood.Therefore,understanding the late side effects of such treatments is important to improve the health and quality of life of the growing population of CCSs.

Novel Methodologies for Preventing Crack Propagation in Steel Gas Pipelines Considering the Temperature Effect

Using the software ANSYS-19.2/Explicit Dynamics,this study performedfinite-element modeling of the large-diameter steel pipeline cross-section for the Beineu-Bozoy-Shymkent gas pipeline with a non-through straight crack,strengthened by steel wire wrapping.The effects of the thread tensile force of the steel winding in the form of single rings at the crack edges and the wires with different winding diameters and pitches were also studied.The results showed that the strengthening was preferably executed at a minimum value of the thread tensile force,which was 6.4%more effective than that at its maximum value.The analysis of the influence of the winding dia-meters showed that the equivalent stresses increased by 32%from the beginning of the crack growth until the wire broke.The increment in winding diameter decelerated the disclosure of the edge crack and reduced its length by 8.2%.The analysis of the influence of the winding pitch showed that decreasing the distance between the winding turns also led to a 33.6%reduction in the length of the straight crack and a 7.9%reduction in the maximum stres-ses on the strengthened pipeline cross-section.The analysis of the temperature effect on the pipeline material,within a range from-40℃ to+50℃,resulted in a crack length change of up to 5.8%.As the temperature dropped,the crack length decreased.Within such a temperature range,the maximum stresses were observed along the cen-tral area of the crack,which were equal to 413 MPa at+50℃ and 440 MPa at-40℃.The results also showed that the presence of the steel winding in the pipeline significantly reduced the length of crack propagation up to 8.4 times,depending on the temperature effect and design parameters of prestressing.This work integrated the existing methods for crack localization along steel gas pipelines.

Relationship between parenting stress and behavioral and emotional problems in preschool children: A mediation effect analysis

BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current status of family rearing,parental stress,and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emo-tional problems.METHODS We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023.The children and their parents were evaluated using a questionnaire survey.Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing,and the structural equation model was constructed to test the mediating effect.RESULTS The score for behavioral/emotional problems of 258 preschool children was(27.54±3.63),the score for parental stress was(87.64±11.34),and the score for parental family rearing was(31.54±5.24).There was a positive correlation between the behavioral and emotional problems of the children and the“hostile/mandatory”parenting style;meanwhile,showed a negative correlation with the“support/participation”parenting style(all P<0.05).The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%.CONCLUSION Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children.Despite paying attention to the behavioral and emotional problems of preschool-age children,clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.

Variations in quantifying patient reported outcome measures to estimate treatment effect

In the practice of healthcare,patient-reported outcomes(PROs)and PRO measures(PROMs)are used as an attempt to observe the changes in complex clinical situations.They guide us in making decisions based on the evidence regarding patient care by recording the change in outcomes for a particular treatment to a given condition and finally to understand whether a patient will benefit from a particular treatment and to quantify the treatment effect.For any PROM to be usable in health care,we need it to be reliable,encapsulating the points of interest with the potential to detect any real change.Using structured outcome measures routinely in clinical practice helps the physician to understand the functional limitation of a patient that would otherwise not be clear in an office interview,and this allows the physician and patient to have a meaningful conver-sation as well as a customized plan for each patient.Having mentioned the rationale and the benefits of PROMs,understanding the quantification process is crucial before embarking on management decisions.A better interpretation of change needs to identify the treatment effect based on clinical relevance for a given condition.There are a multiple set of measurement indices to serve this effect and most of them are used interchangeably without clear demarcation on their differences.This article details the various quantification metrics used to evaluate the treatment effect using PROMs,their limitations and the scope of usage and implementation in clinical practice.

Effects of Short-term Freezing on Endodormancy Release in Nectarine Bud

[Objective] This study aimed to investigate the endodormancy release in nectarine bud treated by short-term freezing. [Method] Through short-term freezing at seven different temperatures for three different periods on bud, the livability, burst, ratio of free water to bound water and membrane permeability of ＇Shuguang＇ nec- tarine bud were studied. [Result] On November 10, compared with non-freezing treatment （CK）, the bud burst, ratio of free water to bound water and membrane permeability treated by freezing at -5 and -8 ℃ were almost the same as CK. But the rest freezing treatments advanced the date of endodormancy release, while the bud burst, ratio of free water to bound water and membrane permeability were high- er than CK. on November 20 and 30, the effects of the freezing treatment on en- dodormancy release were the same when the treatment on November 10, and the effect was better as the treatment was later. [Conclusion] The correlation of the rate of bud burst, ratio of free water to bound water, and membrane permeability of the different freezing treatments indicated that the change from bound water to free wa- ter and the increase of membrane permeability were probably the signal of endodor- mancy release.

The Impact of Meteorological Factors on the Short-term Cumulative Effect of Air Particulate in Tianjin

In order to reveal the rapid increase mechanism of particulate concentration in short time,a notion of short-term cumulative effect of air particulate is defined as the significant increase of pollutant concentration in a short time under the condition of breeze,stable weather and constant emission caused by human being's activities. Subsequently,an index of short-term cumulative effect is established with air diffusive equation,and then the macro-scale meteorological situation and micro-scale factors of forming the short-term cumulative effect are discussed with the observation data. The macro-scale meteorological variables contain upper-level weather situations and surface weather situations. The micro-scale factors mainly include the boundary-layer height and boundary-layer stability. The analyses show that boundary-layer factors and weather variables have a significant influence on the short-term cumulative effect. The notion of short-term cumulative effect will play an important role in interpreting the severe pollution weather.

The effect of fire disturbance on short-term soil respiration in typical forest of Greater Xing'an Range, China

We investigated the effect of fire disturbance on short-term soil respiration in birch （Betula platyphylla Suk.） and larch （Larix gmelinii Rupr.） forests in Greater Xing’an range, northeastern China for further understanding of its effect on the carbon cycle in ecosystems. Our study show that post-fire soil respiration rates in B. platyphylla and L. gmelinii forests were reduced by 14%and 10%, respectively. In contrast, the soil heterotrophic respiration rates in the two types of forest were similar in post-fire and control plots. After fire, the contribution of root respiration to total soil respiration was dramatically reduced. Variation in soil respiration rates was explained by soil moisture （W） and soil tem-perature （T） at a depth of 5 cm. Exponential regression fitted T and W models explained Rs rates in B. platyphylla control and post-fire plots （83.1% and 86.2%） and L. gmelinii control and post-fire plots （83.7%and 88.7%）. In addition, the short-term temperature coefficients in B.

Effect of Short-Term Exposure to Mercuric Chloride on the Air-Breathing Catfish,Heteropneustes fossilis──Ⅱ.Scanning Electron Microscopic Study of the Gill

Alterations in the respiratory epithelium of gills of a catfish, Heteropneustes fossilis by the sublethal and lethal concentrations of HgCl2 have been observcd using scanning electron microscope. Fish exposed to 0.1 ppm shows a thin coat ot mucus, but the continuous layer of mucus is not retained in 0.3 ppm after 24 h of exposure. Epithelial cells of the gill filament are hyperplastic. Other changcs in the respiratory epithelium are contraction of epithelium, formation of interlamellar bridge and diminishing number of microridges. Massive destruction of the respiratory epithelium by deep lesions and sloughing of epithelial layer in 0.5 and 1.0 ppm solutions after 6-12 h of exposure apparently causes death to the fish. SEM observations are well in conformity with the findings made at light microscopic level

Effects of short-term heat stress on PSII and subsequent recovery for senescent leaves of Vitis vinifera L. cv. Red Globe

Heat stress occurs frequently in energy-saving sunlight greenhouses(ESSG) at the late growth stage. Three-year delayed cultivation(DC) of the Red Globe cultivar of Vitis vinifera L. was used to clarify the physiological mechanisms of short-term heat stress on PSII and subsequent recovery from heat stress. By November, the photosynthetic function had declined and the fall in transpiration rate(E) with heating time increased the possibility of heat damage. In July, the most obvious increase was in the relative variable fluorescence at J point at 40°C, and in November it changed to K point. The 5 min of heat treatment resulted in a significant increase of the relative variable fluorescence at 0.3 ms(W), and after 10 min of heat treatment, the number of reactive centres per excited cross section(RC/CS), probability that a trapped exciton moves an electron into the electron transport chain beyond Q–(at t=0)(Ψ) and quantum yield of electron transport at t=0(φ) decreased significantly(P<0.05), suggesting that the reaction centre, donor and acceptor side of photosystem II(PSII) were all significantly inhibited(P<0.05) and that the thermal stability of the photosynthetic mechanism was reduced. The inhibition of energy fluxes for senescent leaves in November was earlier and more pronounced than that for healthy leaves, which did not recover from heat stress of more than 15 min after 2 h recovery at room temperature.

Effects of short-term osmotic stress on leaf hydraulic conductivity and ZmPIPs mRNA accumulation in maize seedlings

Plants maintain water balance by varying hydraulic properties, and plasma membrane intrinsic proteins（PIPs） may be involved in this process. Leaf xylem and root hydraulic conductivity and the m RNA contents of four highly expressed Zm PIP genes（Zm PIP1;1, Zm PIP1;2, Zm PIP2;2, and Zm PIP2;5） in maize（Zea mays） seedlings were investigated. Under well-watered conditions, leaf hydraulic conductivity（K_（leaf）） varied diurnally and was correlated with whole-plant hydraulic conductivity. Similar diurnal rhythms of leaf transpiration rate（E）, K_（leaf） and root hydraulic conductivity（K_（root）） in well-watered plants are important for maintaining whole-plant water balance. After 2 h of osmotic stress treatment induced by 10% polyethylene glycol 6000, the K_（root） of stressed plants decreased but K_（leaf） increased, compared with well-watered plants. The m RNA contents of four Zm PIPs were significantly up-regulated in the leaves of stressed plants, especially for Zm PIP1;2. Meanwhile, Zm PIP2;5 was significantly down-regulated in the roots of stressed plants. After 4 h of osmotic stress treatment, the E and leaf xylem water potentials of stressed plants unexpectedly increased. The increase in K_（leaf） and a partial recovery of K_（root） may have contributed to this process. The m RNA content of Zm PIP1;2 but not of the other three genes was up-regulated in roots at this time. In summary, the m RNA contents of these four Zm PIPs associated with K_（leaf） and K_（root） change in maize seedlings during short-term osmotic stress, especially for Zm PIP1;2 and Zm PIP2;5, which may help to further reveal the hydraulic resistance adjustment role of Zm PIPs.

Effect of proximal femoral osteoporosis on cementless hip arthroplasty: A short-term clinical analysis

Objective： The aim of this retrospective investigation was to explore the influence of femoral osteoporosis on short-term curative effects ofcementless hip arthroplasty and to evaluate the femoral metaphyseal bone mineral density （BMD） for femoral osteoporosis in order to guide prosthesis choice and rehabilitation. Methods： We performed 127 total arthroplasty operations between June 1999 to February 2003 and investigated 49 cementless hip replacements with the Metalcancellous cementless Lubeck Ⅱ system being used in all hips. There were twenty men and twenty-nine women whose mean age at the time of the operation was 60 years （range, 52-81 years）. The patients were divided into osteoporosis or normal groups according to the femoral metaphyseal BMD measured preoperatively. The average duration of follow-up was 30 months （range, 8-52 months）. We evaluated all of the patients from a clinical standpoint with use of a standard-terminology questionnaire with respect to the short-term curative effects and patients＇ satisfaction. Hip pain status and functional ability were important indicators of treatment efficacy. Results： Harris hip score and patients＇ satisfaction in femoral osteoporosis patients who underwent noncemented hip arthroplasty were lower （P=0.004, P=0.03） while the incidence of thigh pain was higher （P=0.03） than the patients with non-osteoporosis. Conclusion： The higher incidence of pain, as well as the decrease in function experienced by the patients in osteoporosis group, supports the case that cementless arthroplasty is not a better choice for those patients and that we had better select prosthesis based on the femoral metaphyseal BMD.