Our hypothesis is that a natural

Our hypothesis is that a natural AZD6244 purchase proteolytic fragment of spp24 is identical to an osteogenic protein previously described independently by two investigators. To test this hypothesis, spp24 and a truncated form of spp24 were separately implanted with recombinant human BMP-2 (rhBMP-2) in a rodent model of spine fusion.

Methods: Two isoforms of spp24 were constructed with use of DNA recombinant technology. Spp24 with or without rhBMP-2 were added to collagen sponges and implanted bilaterally between L4 and L5 transverse processes. Radiographs were made biweekly, and spines were explanted after eight weeks. Gross evaluation, microquantitative computed tomography study, and histological

analysis were performed to evaluate bone growth.

Results: Animals that received full-length spp24 and rhBMP-2 exhibited a complete obliteration of bone growth, while animals with the truncated form in combination with rhBMP-2 exhibited a mild inhibition to bone growth, with bone area measured from radiographs. Manual assessment and gross

evaluation of all spines confirmed the results obtained from the bone-area measurements. Microquantitative computed tomography provided three-dimensional visual images of representative specimens, while histological staining of spine tissue displayed cellular evidence of bone formation.

Conclusions: Results from this investigation confirm that the various isoforms of spp24 affect the bone-healing activity of rhBMP-2 in CB-839 concentration the rat spine fusion model. Thus, proteolytic modification of this protein is a likely mechanism for the regulation of BMP availability in the physiological environment. Future studies will define the roles of these proteins in controlling the activity of BMPs and other members of the transforming growth factor-beta family of cytokines. This information will increase the understanding of normal bone-healing, allowing for the engineering of more effective orthopaedic treatment.”
“The stability of spin-spiral structures in an Fe monolayer on a W(110) substrate is investigated by means of the

first-principles film full-potential linearized augmented plane-wave method, and the role of spin-orbit Nirogacestat ic50 coupling (SOC) on the spin-spiral structures is determined. Our calculations demonstrate that without SOC, the spin-spiral structures are energetically favored over the ferromagnetic (FM) state, but that when the strong SOC at the Fe/W(110) interface is introduced, the formation of the spin-spiral structures is suppressed. Thus, the ground state of the system appears to be the FM state-as observed in experiments. (C) 2009 American Institute of Physics. [DOI: 10.1063/1.3070635]“
“The anti-tumor effects and molecular mechanism of deguelin on the human lung cancer A549 cells xenografts in nude mice was investigated. In lung cancer xenograft mice, the effect of deguelin (2, 4, and 6 mg/kg b.w.

Although clinical staging systems have improved significantly and

Although clinical staging systems have improved significantly and now comprise tumor characteristics, liver function and patient performance status, the integration of molecular data into these algorithms is still hypothetical.

Molecular profiling of HCC has led to a better understanding of the physiopathology of this neoplasm and has allowed developing novel therapeutic approaches (e.g. molecular targeted therapies) for a tumor previously considered as therapy-refractory.


analysis of different reported genomic datasets has revealed common subclasses between different studies, highlighting their biological relevance in HCC. Gene signatures derived from tumors see more and from the adjacent tissue have been able to differentiate subclasses with different outcomes and have been proposed as potential predictive markers

in the clinical setting. Genomic characterization of surrounding non-tumor tissue might be of particular interest to identify patients at high risk of developing HCC and Selleck Elacridar therefore to select those patients that would benefit of potential chemopreventive strategies.

Epigenetic analyses (methylation and miRNA profiling) are adding up to the knowlegde derived from gene expression data and should not be forgotten in the molecular diagnosis of HCC.

Integrative analyses of genetic and epigenetic information of the tumor and the surrounding tissue should be used to identify novel biomarkers and therapeutic targets in HCC, to improve existing treatment algorithms and to eventually design a more personalized medicine in this devastating disease.”
“Objective This is the fourth edition of diagnostic and treatment guidelines for complex regional pain

syndrome find more (CRPS; aka reflex sympathetic dystrophy). Methods Expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included. The literature review was supplemented with knowledge gained from extensive empirical clinical experience, particularly in areas where high-quality evidence to guide therapy is lacking. Results The research quality, clinical relevance, and state of the art of diagnostic criteria or treatment modalities are discussed, sometimes in considerable detail with an eye to the expert practitioner in each therapeutic area. Levels of evidence are mentioned when available, so that the practitioner can better assess and analyze the modality under discussion, and if desired, to personally consider the citations. Tables provide details on characteristics of studies in different subject domains described in the literature.

The optimal magnetic properties of B(r)=5 9 kG, (i)H(c)=8 2 kOe,

The optimal magnetic properties of B(r)=5.9 kG, (i)H(c)=8.2 kOe, and (BH)(max)=7.2 MGOe could be attained in Nd(9.5)Fe(71.5)Ti(2.5)Zr(0.5)Cr(1)B(14.5)C(0.5) magnet. (C) 2010 American Institute of Physics. GSK461364 clinical trial [doi: 10.1063/1.3348679]“
“The condition, currently known as spinal muscular atrophy with respiratory distress type 1, is an unusual variant of spinal muscular atrophy type 1 that is characterized by early respiratory failure due to diaphragmatic paralysis. The defective gene, the immunoglobulin mu-binding protein 2 (IGHMBP2 gene), of this autosomal recessive disorder is located on chromosome 11 q 13 and

encodes immunoglobulin mu-binding protein 2. The natural history and phenotypic spectrum of the disease are still not clear. The authors present the first genetically proven case of spinal muscular atrophy with respiratory distress type 1 to be reported from Saudi Arabia. The parents are first cousins and the causative gene sequencing revealed mutation in exon 7 reported for the first time in a homozygous form. The clinical scenario of the case is discussed. The findings in the muscle magnetic resonance imaging (MRI) are presented.”
“BackgroundConsensus concerning nomenclature

and classification of acne scars is lacking. Classification based solely on clinical examination represents see more an unmet need that could be improved with the use of objective, reproducible assessments.

ObjectiveTo assess clinical and ultrasound morphologic features in 41 patients with scars resulting from moderate to severe acne and to determine whether correlation exists.

Materials and MethodsEighty-one lesions clinically identified as boxcar, ice pick, rolling, hypertrophic, or keloidal were evaluated using high-frequency ultrasound (22MHz).

ResultsUltrasound results generally correlated with clinical

appearance. Eight scars clinically classified as ice pick showed a typical boxcar morphology upon ultrasound examination. Ultrasound showed that ice pick and boxcar scars were the deepest, with 95.8% between 0.2 and 0.5mm.

ConclusionsHigh-frequency ultrasound is a noninvasive technique that is useful in the Tubastatin A supplier evaluation and correct classification of acne scars. It represents an important adjunct to clinical examination, because it provides reliable objective and reproducible information useful to the selection of the best treatment option specifically customized to each individual patient’s needs.”
“Unilateral laterothoracic exanthem is a self-limited disease that occurs most commonly in children. It is characterized by unilateral exanthem, often in axillary region. The etiology is unknown, bill a viral agent is suspected. We report a 1-year-old white girl with unilateral laterothoracic exanthem associated with Epstein Barr virus infection, suggesting this virus has a possible etiologic role.

Final follow-up was performed at a mean of 147 months Outcome me

Final follow-up was performed at a mean of 147 months. Outcome measures included the Constant score and the Subjective Shoulder Value (SSV). Osteoarthritis,

the acromiohumeral distance, and the so-called A769662 critical shoulder angle were assessed on standardized radiographs.

Results: Forty-six shoulders in forty-four patients were available at the time of final follow-up. The mean SSV increased from 29% preoperatively to 70% at the time of final follow-up, the relative Constant score improved from 56% to 80%, and the pain score improved from 7 to 13 points (p < 0.0001 for all). Mean flexion increased from 118 degrees to 132 degrees, abduction increased from 112 degrees to 123 degrees, and external rotation increased from 18 to 33. Mean abduction strength increased from 1.2 to 2.0 kg (p = 0.001). There was a slight but significant increase in osteoarthritic changes. JPH203 supplier Inferior results occurred, in shoulders with insufficiency of the subscapularis muscle and fatty infiltration of the teres minor muscle. Superior functional results were observed in shoulders with a small postoperative

critical shoulder angle.

Conclusions: Latissimus dorsi tendon transfer offered an effective treatment for irreparable posterosuperior rotator cuff tears, with substantial and durable improvements in shoulder function and pain relief. Shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results, as did those with a large critical shoulder angle.”
“Abdominal pain is common and frequently Selleckchem LY2157299 debilitating in patients with chronic pancreatitis. Medical therapy includes abstinence

from tobacco and alcohol and the use of analgesics and adjunctive agents. In many patients, a trial of non-enteric-coated pancreatic enzymes and/or antioxidants may be tried. Endoscopic or surgical therapy requires careful patient selection based on a detailed analysis of pancreatic ductal anatomy. Those with a non-dilated main pancreatic duct have limited endoscopic and surgical alternatives. The presence of a dilated main pancreatic duct makes endoscopic or surgical therapy possible, which may include ductal decompression or pancreatic resection, or both. Randomised trials suggest surgical therapy is more durable and effective than endoscopic therapy. Less commonly employed options include EUS-guided coeliac plexus block, thoracoscopic splanchnicectomy, or total pancreatectomy with auto islet cell transplantation. These are used rarely when all other options have failed and only in very carefully selected patients. (C) 2010 Elsevier Ltd. All rights reserved.”
“Lipid oxidation is one of the major chemical reactions occurring during food processing or storage and may have a strong impact on the final quality of foods.


We enrolled 30 consecutive TR patients (27 women


We enrolled 30 consecutive TR patients (27 women, aged 57.8 +/- 9.6 years) who had undergone prior left-sided valve surgery. A computer-assisted analysis was performed for objective calculation of QRS duration before and after surgery.

Results: At a median CMR follow-up of 27.5 months postsurgery, QRS duration was cut by 14.6%, from 110.4 +/- 14.6 msec to 96.9 +/- 11.9 msec (P < 0.001), while CMR showed a decrease in RV end-diastolic volume index (RV-EDVI) from 179.5 +/- 59.7 to 119.1 +/- 30.4 mL/m(2) (P < 0.001). QRS duration correlated significantly with RV-EDVI and RV end-systolic volume index (r = 0.65, P < 0.001 and r = 0.53, P < 0.001, respectively), and a percent change in QRS duration was significantly correlated with a percent change in

RV-EDVI (r = 0.40, P = 0.03). When significant RV reverse PD173074 molecular weight remodeling was defined as a reduction in RV-EDVI =20% following TR surgery, the sensitivity and specificity for significant RV reverse remodeling were 75% and 78%, respectively, with a 9% reduction in QRS duration (P = 0.01, area underneath the receiver operator curve [AUC] = 0.81).

Conclusions: The extent of changes in postoperative QRS duration can be used as a useful, inexpensive, and simple index reflecting the occurrence of significant RV reverse remodeling in patients undergoing corrective TR surgery.”
“Steric strains arising between the substituent PS-095760 atoms at nitrogen (S, SO, or SO2) and the methyl group located in positions 3 or 5 of the quinoid ring of 3,5-dimethyl-substituted quinone monoimines lead to the increased angle C=N-S. As a result in these quinone monoimines the reactions of 1,2-addition become thermodynamically possible since the formation of quinolide structures with the sp(3)-hybridized VX-661 nmr carbon atom removes the steric strain.”
“Uterine leiomyomas are common tumors in women of reproductive age and are frequently detected during pregnancy. The major complications during pregnancy include abortion,

preterm delivery, abruptio placentae, intrauterine growth retardation, dystocia, and postpartum hemorrhage. Little attention is given to uterine leiomyomas postpartum compared to leiomyomas prior to childbirth. In the present case, a 27-year-old woman, gravida 1 para 1, presented with massive vaginal bleeding, urinary retention and lower abdominal pain on postpartum day 41. She was diagnosed with uterine inversion due to leiomyoma. After a vaginal myomectomy, the uterus was re-placed with a combined vaginal and abdominal approach. Because of timely medical intervention, the patient managed to overcome the crisis and her reproductive organs were successfully preserved.”
“The physiological and global transcriptomic response of the metal-resistant bacterium Cupriavidus metallidurans CH34 to stable non-radioactive strontium (Sr) was investigated. C.

While individual agents may be insufficient for tolerance inducti

While individual agents may be insufficient for tolerance induction, they provide possibilities for reduction of steroid or calcineurin inhibitor use, alternatives to rejection episodes refractory to

conventional therapies, and specialized immunosuppression for highly sensitized patients.”
“Serum alanine aminotransferase (ALT) concentration is the most commonly used marker for hepatocellular injury. We investigated the suitable cutoff value of serum ALT for the diagnosis or prediction of fatty liver. In 1578 Japanese adults (1208 men, 370 women; 35-69 years of age) who visited our center both in 2000 and between April 2007 and March 2008 (2007-2008), serum ALT concentration was an independent predictor of fatty liver in men in 2000 and in both sexes in 2007-2008. A significant check details increase in the frequency of fatty liver was detected in participants with elevated serum ALT concentrations, and serum levels of ALT in 2000 were associated with fatty liver in 2007-2008 when the cutoff value was set at 30 IU/L in men and 19 IU/L in women. The frequency of fatty liver in 2007-2008 www.selleckchem.com/products/pf-06463922.html was significantly lower in participants without fatty liver in 2000 whose serum

ALT decreased between 2000 and 2007-2008. Our results suggest that serum ALT might be not only an indicator of fatty liver but also a predictor of the regression of fatty liver, and cutoff values of serum ALT of 30 IU/L in men and 19 IU/L in women are suitable for the screening selleck screening library of fatty liver.”
“Patients affected by migraine without aura very often consult different specialists who, misunderstanding the correct diagnosis, submit them to different instrumental examinations. The objective of the study was to assess if each instrumental examination was really useful for a faster migraine definition, or on the contrary, it increased the time delay for a correct diagnosis. We enrolled 300 consecutive patients referring to our Headache Center with a first

diagnosis of migraine without aura and submitted them to a face-to-face interview about time from disease’s onset to a correct diagnosis. In each patient, the first instrumental examination performed to specifically investigate migraine-related symptoms was defined. Brain MRI, brain CT, sinus CT, sinus X-rays, cervical spine X-rays and EEG were the most often performed examinations. All the exams, with the exception of brain CT, determined a significant increase of time delay in migraine diagnosis (p < 0.05). Brain CT was significantly associated with a higher probability to obtain a correct diagnosis in less than 1 year. Migraine without aura patients are usually addressed to perform radiological and other instrumental examinations.

Recent results of amyloid immunotherapy raised the question wheth

Recent results of amyloid immunotherapy raised the question whether beta-amyloid is sufficient target for AD therapy. Neurofibrillary tangles (NFTs), which contain hyperphosphorylated tau, are another pathological hallmark of AD. NFTs are observed in entorhinal cortex, limbic, and neocortex over the course of clinical progression. NFTs are associated with synapse and neuron loss, suggesting that the process of NFT formation is involved in brain dysfunction. During NFT formation, tau forms a variety of different aggregation species, including tau oligomers, granules, and fibrils. Analysis of different human tau-expressing mouse lines reveals

that soluble hyperphosphorylated tau, which includes tau oligomer, is involved in synapse loss, whereas granular tau formation is involved in neuronal loss. Therefore, inhibition of tau aggregation and tau phosphorylation is expected to prevent synapse loss and neuron loss, and may slow or halt Small molecule library cell line the progressive dementia in AD.”
“PURPOSE: To determine whether institution of a structured YM155 mw surgical curriculum for ophthalmology residents decreased the rate of sentinel surgical complications.

SETTING: Veterans Affairs Medical Center, Des Moines, Iowa, USA.

METHODS: A retrospective review was performed of third-year ophthalmic

resident quality-assurance surgical outcomes data at a single residency-training site from 1998 to 2008. The primary outcome measure was IAP inhibitor defined as a sentinel event; that is, a posterior capsule tear (with or without vitreous loss) or vitreous loss (from any cause) occurring during a resident-performed case. The study population was divided into 2 groups. Group 1 comprised surgical cases of residents trained before the surgical curriculum change (academic years 1998 to 2003) and Group 2, surgical cases

of residents trained with the enhanced curriculum (academic years 2004 to 2008). Data from 1 year (academic year 2003 to 2004) were excluded because the transition to the enhanced curriculum occurred during that period. The data were analyzed and adjusted for surgical experience.

RESULTS: In Group 1 (before institution of surgical curriculum), there were 823 cases with 59 sentinel complications. In Group 2 (after institution of surgical curriculum), there were 1009 cases with 38 sentinel complications. There was a statistically significant reduction in the sentinel complication rate, from 7.17% before the curriculum changes to 3.77% with the enhanced curriculum (P = .001, unpaired 2-tailed t test).

CONCLUSION: Implementation of a structured surgical curriculum resulted in a statistically significant reduction in sentinel event complications, even after adjusting for surgical experience. J Cataract Refract Surg 2009, 35:1956-1960 (C) 2009 ASCRS and ESCRS”
“Tau is a sticky protein mainly expressed by neurons, which may be found in different subcellular fractions or outside the cell.

Arterial blood gas drawn prior to initiation of TH was utilized t

Arterial blood gas drawn prior to initiation of TH was utilized to measure pH in all patients. Shockable and non-shockable CA patients were divided into two sub-groups based on pH (pH < 7.2 and pH >= 7.2). The primary end-point was measured using the Pittsburgh Cerebral Performance Category (CPC) scale prior to discharge from the hospital: good (CPC 1 and 2) and poor (CPC 3 to 5) neurologic outcome.

Results: Sixty-two percent of shockable

click here CA patients with pH >= 7.20 had good neurological outcome as compared to 34% patients with pH < 7.20. Shockable CA patients with pH >= 7.20 were 3.3 times more likely to have better neurological outcome when compared to those with pH < 7.20 [p = 0.013, OR 3.3, 95% CI (1.28-8.45)]. In comparison, non-shockable CA patients with p = 7.20 did not have a significantly different neurological outcome as compared to those with Histone Demethylase inhibitor pH < 7.20 [p = 0.97, OR 1.02, 95% CI (0.31-3.3)].

Conclusion: Presence of severe acidemia at initiation of TH in shockable CA survivors is significantly associated with poor neurological outcomes. This effect was not observed in the non-shockable CA survivors. (C) 2013 Elsevier

Ireland Ltd. All rights reserved.”
“It has been almost 30 years since Doll and Peto suggested that most of the differences in cancer rates could be attributed to the environment and behavioral factors including diet. Since then epidemiological studies have reported that individuals consuming large amounts of fruits and vegetables have a reduced risk of cancer. From this evidence, large

randomized trials of long duration were designed to test the hypothesis that some micronutrients contained in plant foods decrease cancer risk. Despite the promising experimental and epidemiological data, most randomized controlled trials failed to confirm a protective role for single or combined elements in cancer prevention. The results from randomized trials of micronutrients for cancer prevention have been mixed. Some trials did not demonstrate chemopreventive efficacy for their primary endpoints but showed statistically significant reductions in secondary outcomes, whereas Ferroptosis activation others showed unexpected harmful effects. On the basis of these findings and reflections of what went wrong it is important to find alternative approaches to move forwards in cancer prevention. Clearly, the evidence is not encouraging for further preventive trials on cancer in healthy populations. However, if we identify high-risk individuals using models that include genetic polymorphisms, or in the future, MicroRNA profiles, prevention trials could be designed to target only these groups. European Journal of Cancer Prevention 20:518-525 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

“BACKGROUND: Vietnam has an emerging human immunodeficienc

“BACKGROUND: Vietnam has an emerging human immunodeficiency virus (HIV) epidemic (estimated population

https://www.selleckchem.com/products/apo866-fk866.html prevalence 0.5%), but valid data on HIV prevalence among tuberculosis (TB) patients are limited. Recent increases in TB notification rates among young adults may be related to HIV.

OBJECTIVES: To assess the prevalence of HIV infection among smear-positive TB patients in six provinces with relatively high HIV population prevalence in Vietnam.

METHODS: All patients who registered for treatment of smear-positive TB during the fourth quarter of 2005 were offered HIV testing.

RESULTS: Of the 1217 TB patients included in the study, 100 (8.2%) tested HIV-positive. HIV prevalence varied between 2% and 17% in the provinces, and was strongly associated with age < 35 years, injecting drug use, commercial sex work and a history of sexually transmitted disease. Among men aged 15-34 years, the rate of notification of new smear-positive TB that was attributable to HIV infection varied from 3-4 per 100 000 population in mainly rural provinces to 20-42/100 000

in provinces with rapid industrial and commercial development.

CONCLUSION: Among TB patients in Vietnam, HIV infection is concentrated in drug users, as well as in specific geographic areas where it has considerable impact on TB notification rates among men aged 15-34 this website years.”
“Aim: The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio is well known to be related to metabolic syndrome (MS) and its components in adults of different races. There is low prevalence of MS but high occurrence of various metabolic disorders in Chinese adolescent women with polycystic ovary syndrome (PCOS). We sought to assess if the ApoB/ApoA1 ratio can be used as a predictive marker of MS and pre-MS in Chinese adolescent women with PCOS. Material and Methods: This cross-sectional selleck study included 160 Chinese adolescent women. Based on International Diabetes Federation criteria for

MS, patients who had no less than two components of MS but did not meet the criteria for the diagnosis of MS were considered as having pre-MS. Results: The ApoB/ApoA1 ratio was higher in obese subjects with high free androgen index (FAI). The ApoB/ApoA1 ratio increased significantly as the number of MS components increased and provided 87.5% of sensitivity and 78.9% of specificity with a threshold value of 0.63 for MS, 86.2% of sensitivity and 79.4% of specificity with a threshold value of 0.58 for pre-MS in Chinese adolescent women with PCOS. Conclusion: The ApoB/ApoA1 ratio was a good predictive marker of MS and pre-MS in Chinese adolescent women with PCOS. FAI could be involved in obesity-related metabolic abnormalities.”
“SETTINGS: National Tuberculosis Reference Laboratory, Central Public Health Laboratory, Ministry of Health, Oman.

The effects of VHF mixing on plasma characteristics, especially i

The effects of VHF mixing on plasma characteristics, especially its spatial profile, are investigated using both computational

modeling and Quisinostat diagnostic experiments. The two-dimensional plasma model includes the full set of Maxwell equations in their potential formulation. The plasma simulation results show that electron density peaks at the center of the chamber at 180 MHz due to the standing electromagnetic wave. Electrostatic effects at the electrode edges tend to get stronger at lower VHFs such as 60 MHz. When the two rf sources are used simultaneously and power at 60 MHz is gradually increased, the ion flux becomes uniform and then transitions to peak at electrode edge. These results are corroborated by Langmuir probe measurements of ion saturation current. VHF mixing is therefore an effective method for dynamically controlling plasma uniformity. The plasma is stronger and more confined when the 60 MHz source is connected to the smaller bottom electrode compared to the top electrode.”
“Background: Legg-Calve-Perthes disease consists of idiopathic osteonecrosis. of the femoral head, causing proximal femoral growth deformity. Recent advances in surgical technique have permitted safe surgical dislocation of the hip, allowing selleck kinase inhibitor for correction of femoracetabular impingement. The purpose of this study was to characterize the location and number of lateral epiphyseal arteries supplying the femoral

head in children with healed Legg-Calve-Perthes disease.

Methods: This retrospective study included nineteen children (twenty-two hips) with a diagnosis of Legg-Calve-Perthes disease (the LCPD group) and a matched control group of seventeen children (twenty hips) with developmental hip dysplasia. All patients underwent high-resolution contrast-enhanced magnetic resonance imaging (MRI) to visualize

the path of the medial femoral circumflex artery and the lateral epiphyseal artery branches supplying the femoral head.

Results: All patients Go 6983 ic84 in the LCPD group were classified as having Waldenstrom grade-4 disease. Their average age at the time of MRI was fifteen years (range, eleven to eighteen years). The lateral epiphyseal arteries reliably inserted on the posterior-superior aspect of the femoral neck from a superior-anterior to a superior-posterior position in both groups. An average of 2.63 (standard deviation [SD], 1.47) retinacular vessels were visualized in the LCPD group, compared with 5.20 (SD, 1.06) retinacular vessels in the dysplasia group (p < 0.0001).

Conclusions: The lateral epiphyseal arteries of the femoral head reliably insert in a narrow anatomic window on the femoral neck. Reperfusion of the medial femoral circumflex artery does occur in patients with Legg-Calve-Perthes disease; however, the overall number of vessels is decreased as compared with that in patients with developmental hip dysplasia.