Biochemical Resolution Research Articles

Serum Triglyceride Concentrations in Miniature Schnauzers with and without a History of Probable Pancreatitis

The association between hypertriglyceridemia and pancreatitis remains obscure in dogs. A possible role of hypertriglyceridemia as a cause of pancreatitis in Miniature Schnauzers has been suspected. To compare serum triglyceride concentrations between Miniature Schnauzers with and without a recent history of pancreatitis. Seventeen Miniature Schnauzers with a history of pancreatitis (group 1) and 34 age-matched Miniature Schnauzers without a history of pancreatitis (group 2) were prospectively enrolled. Prospective case-control study. Two samples were collected from each of the 17 Miniature Schnauzers with pancreatitis: 1 during pancreatitis and 1 after clinical and biochemical resolution of pancreatitis. Serum triglyceride and cholesterol concentrations were compared between group 1 (after resolution of pancreatitis) and group 2. Miniature Schnauzers in group 1 were significantly more likely to have hypertriglyceridemia (>108 mg/dL) (71%) after resolution of pancreatitis than Miniature Schnauzers in group 2 (33%; odds ratio = 5.02; 95% confidence interval = 1.4-17.8; P = .0163). Serum triglyceride concentrations were significantly higher in dogs of group 1 (median: 605.0 mg/dL) after resolution of pancreatitis than in dogs of group 2 (median: 73.5 mg/dL; P = .002). Miniature Schnauzers with a history of pancreatitis were 5 times more likely to have hypertriglyceridemia than controls. Hypertriglyceridemia might be associated with the development of pancreatitis in some dogs of this breed. Additional studies are needed to further clarify the role of hypertriglyceridemia in the development of pancreatitis in Miniature Schnauzers as well as other dog breeds.

Bariatric surgery vs. advanced practice medical management in the treatment of type 2 diabetes mellitus: rationale and design of the Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently trial (STAMPEDE)

Obesity and Type 2 diabetes mellitus (T2DM) are closely interrelated, and are two of the most common chronic, debilitating diseases worldwide. Surgical approaches to weight loss (bariatric surgery) result in marked improvement of T2DM, however randomized trials directly comparing the efficacy of surgical and medical approaches are lacking. The Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial was designed to evaluate the efficacy of two bariatric surgery procedures involving gastric restriction only (laparascopic sleeve gastrectomy) and gastric bypass (Roux-en-Y) to advanced medical therapy in patients with T2DM with modest obesity with BMI of 27-42 kg/m2. This single site, prospective, randomized controlled trial will enroll 150 subjects who will be followed. The primary end point will be the rate of biochemical resolution of T2DM at 1 year as measured by HbA1c < 6%. The safety and adverse event rates will also be compared between the three arms of the study.

Toxic Hepatitis Induced by Show-Wu-Pian, a Chinese Herbal Preparation

Herbal preparations are widely available and often regarded by the public as harmless remedies for a variety of medical ailments. However, some of these products or their metabolites can cause adverse effects such as liver damage. In this case report a 53-year-old female taking shou-wu-pian for 8 months presented with acute hepatitis. Histopathological assessment of liver tissue obtained by biopsy was consistent with a toxic reaction. Clinical and biochemical resolution was brought about following cessation of the drug. It is important for clinicians to consider Chinese herbal preparations as a potential cause of abnormal liver function test results.

Early Adolescent Nutritional Rickets

To evaluate early adolescents with nutritional rickets and their responses to treatment. 203 adolescents (aged 10 to 13 years) presenting with clinical features of lower-limb deformity, carpopedal spasm, joint swelling, a significant limp, or non-traumatic joint pain were screened for nutritional rickets. Multi-specialty examinations were performed. Family size, number of earning members, number and gender of children, preference for vegetarian food, composition of the meals, and the amount of milk consumed in a day were recorded. Radiographs of wrists, knees, ankles, and pelvis, as well as serum calcium, phosphate, and alkaline phosphatase levels were evaluated. The diagnosis of nutritional rickets was made based on a combination of clinical, radiological, and biochemical criteria, and confirmed by the responses to treatment. Children with nutritional rickets were treated by a single large intramuscular dose of vitamin D (600,000 IU) along with oral calcium and supplementary vitamin D as well as advice on diet and sunlight exposure. 40 females and 11 males were diagnosed as having nutritional rickets. 65% presented with bilateral knee pain with aggravation at night, 37% presented with lower-limb deformity, 24% had joint swelling especially at the wrist and ankle, 6% had a significant limp and walked with an antalgic gait secondary to pathological fractures. No patient reported carpopedal spasm. All patients had rachitic changes on radiographs in some but not all bones (100% in the ulna, 45% in the radius, 37% in the upper tibia, 37% in the lower fibula and 22% in the lower tibia). Three patients had pathological fractures. 55% had hypocalcaemia, 41% had hypophosphataemia and 100% had raised serum alkaline phosphatase levels. The mean time for biochemical resolution was 12 (range, 3-24) weeks. For radiological resolution it was 5 (range, 2-6) months, with the lower end of ulna being last to resolve. Radiographs of the lower end of ulna and serum alkaline phosphatase levels can be used as a screening and monitoring tool for nutritional rickets in early adolescents. There may be a high prevalence of subclinical vitamin-D deficiency in our adolescent population.

Hypoglycemia and Clinical Outcomes in Patients With Diabetes Hospitalized in the General Ward

We read with interest the article by Turchin et al. (1) on clinical outcomes in patients with diabetes. The investigators show that hypoglycemia while in the hospital leads to an increase in length of stay and higher mortality. In parallel to this, we would also highlight the importance of staffing levels and the time to biochemical resolution of hypoglycemia. Previous studies have shown that low levels of hospital nursing staff lead to an increased incidence of pneumonia, bed sores, andtk;2 overall poorer outcomes (2). We studied the rates of hypoglycemia and the effect of nurse staffing on its resolution on a medical ward …

Differential Recognition and Hydrolysis of Host Carbohydrate Antigens by Streptococcus pneumoniae Family 98 Glycoside Hydrolases

The presence of a fucose utilization operon in the Streptococcus pneumoniae genome and its established importance in virulence indicates a reliance of this bacterium on the harvesting of host fucose-containing glycans. The identities of these glycans, however, and how they are harvested is presently unknown. The biochemical and high resolution x-ray crystallographic analysis of two family 98 glycoside hydrolases (GH98s) from distinctive forms of the fucose utilization operon that originate from different S. pneumoniae strains reveal that one enzyme, the predominant type among pneumococcal isolates, has a unique endo-beta-galactosidase activity on the LewisY antigen. Altered active site topography in the other species of GH98 enzyme tune its endo-beta-galactosidase activity to the blood group A and B antigens. Despite their different specificities, these enzymes, and by extension all family 98 glycoside hydrolases, use an inverting catalytic mechanism. Many bacterial and viral pathogens exploit host carbohydrate antigens for adherence as a precursor to colonization or infection. However, this is the first evidence of bacterial endoglycosidase enzymes that are known to play a role in virulence and are specific for distinct host carbohydrate antigens. The strain-specific distribution of two distinct types of GH98 enzymes further suggests that S. pneumoniae strains may specialize to exploit host-specific antigens that vary from host to host, a factor that may feature in whether a strain is capable of colonizing a host or establishing an invasive infection.

Clinical Improvement After Duodenojejunal Bypass for Nonobese Type 2 Diabetes Despite Minimal Improvement in Glycemic Homeostasis

Glycemic control of type 2 diabetes mellitus (T2DM) remains a dilemma to physicians. Although gastric bypass surgery undertaken for morbid obesity has been shown to resolve this disease well, data on the effectiveness of duodenojejunal bypass in improving or resolving T2DM and the metabolic syndrome (MS), especially in nonobese patients are scarce. This study was intended to evaluate the clinical effects of laparoscopic duodenojejunal bypass (LDJB) in patients with T2DM and a body mass index of <35 kg/m(2). We conducted a 12-month prospective study on the changes in glucose homeostasis and the MS in seven T2DM subjects undergoing LDJB with similar DM duration, type of DM treatment, and glycemic control. Laboratory values including glycosylated hemoglobin A (HbA1c), fasting blood glucose, cholesterol, triglyceride, and C-peptide were followed throughout the 12 months. Serum levels of gastric inhibitory peptide and ghrelin were followed for 1 month. Serum levels of gastrin and glucagon-like peptide were followed for 3 months. At 12 months after surgery, all subjects consistently felt relief from fatigue, pain and/or numbness in the extremities, polyuria, and polydypsia. Clinical resolution was obtained for one patient, and the preoperative diabetic medication requirements decreased for most of the other patients. The subjects demonstrated an overall improved HbA1c (from 9.4% to 8.5%) and fasting blood glucose level (from 209 to 154 mg/dl). Although the change in fasting blood glucose approached statistical significance, these measures of glucose homeostasis did not achieve significance. Cholesterol and triglycerides increased slightly, and C-peptide decreased slightly over 1 year. These changes were not statistically significant. Although this is a small series, our data show that at 12 months after surgery, clinical improvement was obvious in all of our seven patients, but LDJB may not be effective at inducing remission of T2DM and the MS in certain patients undergoing this operation. This suggests that larger patient studies should be conducted, before concluding that surgery may offer clinical and biochemical resolution to a disease once treated only medically. Longer follow-up is required for better evaluation.

Rickets: A cause of delayed walking in toddlers

Children with complaints of not able to walk were investigated for rickets by appropriate history, clinical examination, serum biochemistry and radiology. Children more than 1 yr were included. Each child was evaluated keeping in mind the possible causes of delayed walking. Also each child was thoroughly examined and diagnosed by combination of clinical, radiological, biochemical findings and response to treatment. Out of forty-two non-walkers during the study period, 25 patients turned out to be affected by nutritional rickets (60%). On follow-up at 3 weeks of treatment, all 25 patients (100%) showed radiological and biochemical response. Five patients were lost to follow-up after 3 weeks of treatment. Seventeen patients started walking within 3 months of treatment. Two patients did not start walking even after complete biochemical and radiological resolution. Radiological resolution, with limiting factor being the healing of lower end of ulna, averaged 5 months. The study reveals that majority of ricketic non-walkers start walking within 2 to 5 months of appropriate treatment.

The effect of the copper(II) salt anion in the Chiral Ligand-Exchange Chromatography of amino acids

Due to the strong involvement in numerous biochemical processes, the separation and resolution of amino acids is a continuously challenging task. Among the experimental parameters affecting the performances in a Chiral Ligand-Exchange Chromatography (CLEC) environment, the effect of the copper(II) salt counter-ion has received very limited attention. Aimed at evaluating the Cu(II) counter-ion effect upon the overall chromatographic performances when the S-trityl-( R)-cysteine is adopted as the chiral selector for the coated stationary phase, a number of both organic (acetate, formate, trifluoromethane-sulfonate) and inorganic (bromide, chloride, nitrate, perchlorate, sulfate) salts has been engaged for the enantiomer separation of a selected set of aliphatic (Allo-Ile, Ile, Leu, Nor-Leu, Nor-Val, Val) and aromatic (AIDA, ATIDA, His, Phe, Phg, Tyr) amino acids. By varying the physico-chemical nature of the Cu(II) anion, a pronounced impact upon the resolution factor ( R S ) has been observed. Even if to a lesser extent, the enantioseparation factor values ( α) underwent variation, as well. A molecular modelling investigation has also been carried out as a rationalization attempt of the observed chromatographic outcomes.

Síndrome constitucional asociado a hepatotoxicidad por metformina

Metformin is an oral antidiabetic agent frequently used to manage type II diabetes. This drug produces nonspecific gastrointestinal symptoms in 5-20% of patients and, more rarely, has also been associated with severe adverse effects such as lactic acidosis. Only a few isolated cases of hepatotoxicity due to this drug have been documented. We report the case of an 83-year-old man with constitutional syndrome and hepatic biochemical alterations, which were attributed to metformin after ruling out an oncologic etiology and observing complete clinical and biochemical resolution after withdrawal of the drug.

Letters to the Editor

19 August 2007 Dear Editor, A CASE OF SANDIFER'S SYNDROME: SIGNIFICANCE IN THE DIFFERENTIAL DIAGNOSIS OF GROWTH RETARDATION Sandifer's syndrome presents classically with gastroesophageal reflux and dystonic movements, often associated with hiatus hernia. Here we describe an unusual case of a Sandifer's syndrome in a 8-year-old boy who presented growth retardation as an initial manifestation and developed abnormal neck movement with an interval of 3 years. The patient was referred to our hospital with paleness and a 3-year history of growth failure, his height and weight being just above −3 SD and −1.5 SD, respectively (Fig. 1). His growth was within the normal range; however, it became markedly retarded after age 5 (Fig. 1). The milestones of mental development were normal. The patient had no complaint of abdominal pain, diarrhoea, nausea or vomiting. There was no history of mucus or blood in the stools; however, intermittently, stool samples contained occult blood. On physical examination, the patient's skin and conjunctivae were very pale. Routine investigations revealed anaemia with 5.4 g/dL haemoglobin and hypoproteinemia (4.8 g/dL) with 3.2 g/dL albumin. Inflammatory markers were negative. Growth hormone under basal conditions and after stimulation tests was within the normal range. Abdominal ultrasound scan and colonoscopy showed negative findings; thus, the patient underwent an upper endoscopy to detect the bleeding source. At endoscopy, multiple ulcers and erosions were seen in the distal oesophagus (Fig. 2). The stomach and the duodenum appeared normal. Histopathologic examination of the biopsy specimens showed no significant eosinophilic infiltration in the oesophageal and gastric mucosa. To examine gastroesophageal reflux, he underwent 24-h pH monitoring. The 24-h study confirmed severe gastroesophageal reflux, with a reflux index (percentage of time the pH was less than 4 in the lower esophagus) of 60% (normal < 4%). Interestingly, within 6 months after the referral to our hospital, the patient developed tilting of the head towards the right shoulder. Other than tilting of the head, no other abnormalities were found on neurological examination. Based on gastroesophageal reflux with abnormal movement, we diagnosed the patient as having Sandifer's syndrome. The patient was treated with prokinetic agent and lansoprazole (1.5 mg/kg/day). Three months after starting the treatment, a repeat upper endoscopy showed an improvement of oesophageal lesions. His haemoglobin and total protein levels returned almost to normal, although his growth had remained poor (height −3.08 SD, weight −1.52 SD) and the tilting of the head remained no improvement. Nissen fundoplication was, therefore, carried out at the age of 10 years. Three months after operation, abnormal posturing, anaemia and hypoproteinemia had resolved with the improvement of poor eating behaviour. During the 32-month follow-up after the operation to date, growth retardation had remarkably improved (Fig. 1). The clinical and biochemical resolution after surgical treatment let us confirm that growth retardation was originated from gastroesophageal reflux with esophagitis. In the patients with gastroesophageal reflux, poor weight gain is sometimes found; however, short stature is rarely ever associated.1 On the other hand, growth retardation with short stature is a frequent extraintestinal manifestation of inflammatory bowel disease in children and adolescent.2 Reduced calorie intake, steroid use and a direct effect of inflammation have been proposed as potential aetiological factors. In our case, growth hormone test was normal thus reduced calorie intake, and an oesophageal inflammation may cause growth retardation. The present report suggests that erosive oesophagitis with gastroesophageal reflux can cause short stature. In Sandifer's syndrome, dystonic movement appears in the early phase and is important as a differential diagnosis of movement disorders in neurological field.3-5 As far as the literature survey shows, there is no report that dystonic movement appears with a long internal. In the case of having vomiting, abdominal pain with abnormal posturing, it is not difficult to suspect Sandifer's syndrome. However, if the patient does not have any typical symptoms, differential diagnosis is complicated. Our case suggests that abnormal movements may arise with intervals after the onset of oesophagitis and that Sandifer's syndrome should be taken into consideration as a cause of growth retardation. Comparison of patient's growth curve with growth curve of normal Japanese boys. PPI, Proton Pump Inhibitor. Endoscopic appearance. Multiple ulcers and erosions in the distal oesophagus.

Bilateral laparoscopic adrenalectomy for corticotrophin–dependent Cushing's syndrome: a review of the Mayo Clinic experience

There has been a rapid shift from open to laparoscopic approaches in adrenal surgery, but the safety and efficacy of bilateral laparoscopic adrenalectomy (BLA) in patients with corticotrophin (ACTH)-dependent Cushing's syndrome continues to be defined. Review outcomes in the largest series of patients reported to date undergoing BLA for ACTH-dependent Cushing's syndrome. Retrospective review study. Between January of 1995 and October of 2006, BLA was attempted in 68 patients with ACTH-dependent Cushing's syndrome (26 ectopic ACTH syndrome; 42 persistent pituitary-dependent Cushing's syndrome following pituitary surgery). Review of peri-operative morbidity and mortality, biochemical parameters and patient-reported symptom response from chart review and mailed questionnaire. BLA was successfully completed in 59 of 68 patients (87%); nine (13%) required conversion to open adrenalectomy (OA). Intra-operative complications occurred in three patients (4.4%) (two BLA, one OA), and non-operative complications occurred in 11 (16%) patients (eight BLA, three OA). There were no peri-operative deaths. Median hospitalization was 5.5 days (range, 3-28) and 11.9 days (range, 4-29) for the BLA and OA groups, respectively. In patients with follow-up data available, all achieved biochemical resolution and at least partial clinical resolution of signs and symptoms associated with hypercortisolism. Resolution of hypertension, diabetes and obesity was achieved in 64%, 29% and 35% of patients carrying those diagnoses prior to surgery, respectively. This study further supports the role of BLA as an effective treatment option for patients with ACTH-dependent Cushing's syndrome.

Allogeneic bone marrow transplantation in a 7-year-old girl with congenital erythropoietic porphyria: a treatment dilemma

Congenital erythropoietic porphyria (CEP, Günther's disease) has a very variable phenotype. In the more severely affected, bone marrow transplantation (BMT) is potentially curative, but is not without risks. We describe a 7-year-old girl with CEP characterized by severe photosensitivity but only mild anaemia, in whom the difficult decision to proceed with allogeneic BMT was made after discussion in a multidisciplinary team. She has shown successful engraftment, accompanied by biochemical and clinical resolution of her metabolic disease. She remains well 3 years later, the oldest patient with CEP receiving BMT to survive beyond 12 months. However, she has experienced significant morbidity including florid cutaneous graft-versus-host disease with postinflammatory hypopigmentation. Her case is important in highlighting the delay in diagnosis not uncommon in this condition and the complex decision-making process involved in proceeding with BMT.

Long-term disease free survival in a patient with metastatic adreno-cortical carcinoma after complete pathological response to chemotherapy plus mitotane

Adreno-cortical carcinoma (ACC) is a rare cancer with poor prognosis. Complete surgical resection of the primary tumor and, when feasible, of the local and distant metastases offers the best prospects for long-term survival; conversely, the role of systemic therapy in patients developing unresectable metastatic disease is unclear. We describe the case of a young female patient (36 yr) who presented with an androgen-releasing metastatic ACC. Treatment consisted of five courses of chemotherapy with etoposide, doxorubicin and cisplatin (EDP scheme) plus oral mitotane, which caused the complete disappearance of distant metastases and reduction of the primary tumor, as documented by serial computed tomography (CT) scans of the chest and the abdomen. Moreover, during treatment, clinical and biochemical resolution of the hypersecretory status occurred. The left adrenal gland was then removed and histopathological examination showed extensive tumor necrosis and the absence of viable cancer cells. The patient is currently alive without evidence of recurrence 3 yr after surgery. This report shows that chemotherapy plus mitotane could result in complete pathological remission, which may be a surrogate for long-term progression- free survival in metastatic ACC patients.

Intra‐operative parathyroid hormone monitoring in secondary hyperparathyroidism: is it useful?

To assess the use of intra-operative parathyroid hormone (PTH) level monitoring as a predictor of persistent hypoparathyroidism after total parathyroidectomy in renal hyperparathyroidism. University Teaching Hospital Otorhinolaryngology and Head and Neck Surgery Unit. All patients with renal hyperparathyroidism undergoing parathyroidectomy between January 2004 and July 2005. Twenty-nine patients were identified. Comparison is made between pre- and intra-operative PTH levels (ioPTH) in patients who at 3 months postoperatively maintained hypoparathyroidism and patients who did not. Results were analysed to see whether ioPTH predicts maintenance of the hypoparathyroid state. The mean preoperative PTH level was 932 pg/L (range: 58-1808). The mean postoperative PTH level was 147 pg/L (range: 16-498). The mean 3-month PTH level was 47 pg/L (range: <1-515). The mean postoperative PTH level for patients with a persistently high PTH level at 3 months was 286 pg/L (range: 272-299), compared with 63 pg/mL (16-160) in patients remaining normparathyroid, and 159 pg/L (range: 39-498) for patients with persistent hypoparathyroidism. If the normoparathyroid state is strictly considered to be failure following total parathyroidectomy, ioPTH is not predictive of hypoparathyroidism. However, ioPTH is indicative of biochemical resolution of the hyperparathyroid state (normo- or hypoparathyroidism). We conclude that the use of ioPTH monitoring in the surgical management of secondary hyperparathyroidism fails to predict persistent hypoparathyroidism following total parathyroidectomy, but does predict biochemical resolution of hyperparathyroidism.

An extended model for biochemical kinetic resolution of enantiomers

An extended model, which relates the parameters of the conversion ratio of the substrate ( c), the optical purity expressed as enantiomeric excess (ee), the enantiomeric ratio ( E) and the equilibrium constant ( K) in biochemical kinetic resolution of enantiomers, has been developed. The model predications have been verified experimentally via the enantioselective hydrolysis of ketoprofen methyl ester and the enantioselective esterification of ketoprofen in organic solvent.

Successful conservative management of idiopathic fibrosing pancreatitis in children

Idiopathic fibrosing pancreatitis, a rare cause of obstructive jaundice and abdominal pain in children, which has certain features in common with the emerging entity of autoimmune pancreatitis as described in adults, has frequently been managed surgically. We present our experience of successful conservative management of this condition in children. Three children (6-12 years; two girls, one boy) presented with a short history of abdominal pain followed by obstructive jaundice. Abdominal ultrasonographic examination in each case showed dilated intrahepatic and common bile ducts with a bulky pancreas, predominantly the head. These findings were confirmed by magnetic resonance imaging. In two cases, the diagnosis of fibrosing pancreatitis was made by exclusion after extensive investigation. The third case had a percutaneous ultrasound-guided pancreatic needle biopsy. Two patients were managed by supportive medical therapy alone, whilst the third, with symptomatic obstructive jaundice, underwent temporary endoscopic stenting of the common bile duct. Cases have been followed-up for 12-49 months. There was complete clinical and biochemical resolution of obstructive jaundice in all three cases. Plasma bilirubin concentrations decreased to normal within 3-8 weeks. Serial abdominal imaging showed a gradual resolution of biliary dilatation and abnormal pancreatic morphology with subsequent pancreatic atrophy. Two children developed steatorrhoea that responded to pancreatic enzyme supplements, and one patient developed diabetes mellitus. None of the cases needed invasive surgery for diagnosis or management. With careful radiological and biochemical assessment and monitoring, invasive surgery can be avoided in the management of fibrosing pancreatitis. The eventual outcome is no different from reported surgically treated cases.

A steroid cell tumor outside the ovary is a rare cause of virilization

To report the case of a female who presented in childhood with symptoms and signs of hyperandrogenism secondary to an extraovarian steroid cell tumor. Case report. Endocrine investigation unit of a university teaching hospital. An 11-year-old female presented with symptoms and signs of hyperandrogenism. Ultrasonography, MRI imaging, bilateral adrenal and ovarian venous sampling, laparoscopy, and laparotomy. Ultrasonography, laboratory tests. Hyperandrogenism was due to an extraovarian steroid cell tumor located in the broad ligament. The tumor was successfully removed at laparotomy with biochemical and clinical resolution of the hyperandrogenism. Extraovarian steroid cell tumor is a rare cause of hyperandrogenism.

Membrane protein structure quality in molecular dynamics simulation

Our goal was to assess the relationship between membrane protein quality, output from protein quality checkers and output from molecular dynamics (MD) simulations. Membrane transport proteins are essential for a wide range of cellular processes. Structural features of integral membrane proteins are still under-explored due to experimental limitations in structure determination. Computational techniques can be used to exploit biochemical and medium resolution structural data, as well as sequence homology to known structures, and enable us to explore the structure–function relationships in several transmembrane proteins. The quality of the models produced is vitally important to obtain reliable predictions. An examination of the relationship between model stability in molecular dynamics (MD) simulations derived from RMSD (root mean squared deviation) and structure quality assessment from various protein quality checkers was undertaken. The results were compared to membrane protein structures, solved at various resolution, by either X-ray or electron diffraction techniques. The checking programs could predict the potential success of MD in making functional conclusions. MD stability was shown to be a good indicator for the quality of structures. The quality was also shown to be dependent on the resolution at which the structures were determined.

Delayed treatment of acute hepatitis HCV? Yes, but when, who, and how?

Delayed treatment of acute hepatitis HCV? Yes, but when, who, and how?