Medical Specialties Commons^™

Nrg Oncology/Rtog 0921: A Phase 2 Study Of Postoperative Intensity-Modulated Radiotherapy With Concurrent Cisplatin And Bevacizumab Followed By Carboplatin And Paclitaxel For Patients With Endometrial Cancer., Akila N. Viswanathan, Jennifer Moughan, Brigitte E. Miller, Ying Xiao, Anuja Jhingran, Lorraine Portelance, Walter R. Bosch, Ursula A. Matulonis, Neil S. Horowitz, Robert S S. Mannel, Luis Souhami, Beth A. Erickson, Kathryn A. Winter, William Small, David K. Gaffney

Department of Radiation Oncology Faculty Papers

BACKGROUND: The current study was conducted to assess acute and late adverse events (AEs), overall survival (OS), pelvic failure, regional failure, distant failure, and disease-free survival in a prospective phase 2 clinical trial of bevacizumab and pelvic intensity-modulated radiotherapy (IMRT) with chemotherapy in patients with high-risk endometrial cancer.

METHODS: Patients underwent a hysterectomy and lymph node removal, and had ≥1 of the following high-risk factors: grade 3 carcinoma with >50% myometrial invasion, grade 2 or 3 disease with any cervical stromal invasion, or known extrauterine extension confined to the pelvis. Treatment included pelvic IMRT and concurrent cisplatin on days 1 …

Current Management Of Heart Failure: When To Refer To Heart Failure Specialist And When Hospice Is The Best Option., Behnam Bozorgnia, Paul J. Mather

Division of Cardiology Faculty Papers

Heart failure is a common syndrome caused by different abnormalities of the cardiovascular system that result in impairment of the ventricles in filling or ejecting blood. It is one of the most common causes of hospitalization in the United States, with a very high cost to the health care system. This article focuses on the causes of left ventricle dysfunction and the presentation and management of heart failure, both acute and chronic.

Role Of Shared Care In The Relationship Between Depressive Symptoms And Self-Care In Patients With Heart Failure, Susan Cole

Dissertations (1934 -)

Heart failure (HF) is a chronic condition affecting over 5 million Americans. Heart failure accounts for over 32 billion dollars in total cost each year, and is the most common cause of hospitalization for persons 65 years of age or older. Patients with HF experience poor self-care, are at risk for depressive symptoms, and have high rates of 30-day hospital readmissions. Social support influences depressive symptoms, self-care, and hospital readmissions. Shared care was used to operationalize social support. Shared care is a system of three relationship processes communication, decision making, and reciprocity, used to exchange social support. The purpose of …

The Utilization Of The Anatomage Virtual Dissection Table In The Education Of Imaging Science Students, Tanya M. Custer, Kim Michael

Posters and Presentations: Medical Imaging & Therapeutic Sciences

Objectives: The purpose of this research was to investigate the use of the Anatomage Virtual Dissection Table in the education of imaging science students and to assess the beliefs and perceptions of the students in regard to using the Table for teaching imaging-based anatomy & pathology.

Subjects & Methods: Study participants included 17 medical imaging students to include 9 Diagnostic Medical Sonography students, 2 Magnetic Resonance Imaging students, 2 Nuclear Medicine Technology students, 2 Radiation Therapy students and 2 Cardiovascular Interventional Technology students. Data was collected through focus groups and course/instructor evaluations. The researchers followed Creswell’s procedure for data analysis …

Aspergillus Fumigatus Spinal Abscess In An Immunocompetent Child, Mohammad Faizan Zahid, Joveria Farooqi

Department of Pathology and Laboratory Medicine

No abstract provided.

Epilepsy In Pakistan: National Guidelines For Clinicians, Fowzia Siddiqui, Tipu Sultan, Shahid Mustafa, Sarwar Jamil Siddiqui, Shaukat Ali, Abdul Malik, Zafar Sajjad, Saleem Barech, Rashid Jooma

Section of Neurology

Introduction: Epilepsy is one of the most common chronic neurological disorders requiring prolonged treatments and drugs. According to The World Health Organization (WHO), epilepsy is one of those serious brain disorders that affect not only the individual but has a deep impact on the family and society in general. Approximately 50 million people are affected with epilepsy around the world36, though proper epidemiological studies do not exist for Pakistan it is estimated that the prevalence of epilepsy is 9.99/1000. Highest prevalence is seen in people younger than 30 years of age, i.e. about 2 million people and 1/10th of the …

Landscape Analysis Of Multi-Sectoral Initiatives For Under-Nutrition In Pakistan, Zulfiqar Ahmed Bhutta, Albertha Nyaku, Jane Keylock, Shehla Zaidi, Jai Das

Community Health Sciences

Mapping of Multi-Sectoral Initiatives for Nutrition in Pakistan, Challenges faced, Opportunities, and potential for Cross- Sectoral Synergies.

Depresi Di Bidang Penyakit Dalam:Tantangan Pengembangan Dalam Pendidikan, Pelayanan, Dan Penelitian Di Indonesia, E. Mudjaddid

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Perbandingan Kadar Soluble Platelet-Selectin Pada Berbagai Stadium Karsinoma Nasofaring Dan Korelasinya Dengan Hitung Trombosit, Adi Surya Komala, Asrul Harsal, Andhika Rachman, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Karsinoma nasofaring (KNF) merupakan jenis keganasan yang unik dengan distribusi geografis dan etnis tertentu. Daerah Cina Selatan dan Asia Tenggara memiliki insidens kejadian yang tinggi. Indonesia memiliki insidens 5,66 kasus per 100.000 penduduk per tahun. Salah satu penyebab kematian pada pasien dengan keganasan adalah trombosis. Kadar soluble Platelet-selectin (sP-selectin) yang tinggi dalam plasma, hasil dari aktivasi sel-sel endotel dan trombosit, adalah salah satu prediktor kejadian trombosis. Penelitian ini bertujuan untuk mengetahui kadar sP-selectin pada berbagai stadium karsinoma nasofaring dan korelasinya dengan hitung trombosit.

Metode. Dilakukan studi potong lintang pada 60 kasus karsinoma nasofaring yang baru terdiagnosis di …

Korelasi Trigliserida Pascaprandial Dengan Penanda Biologis Aktivasi Endotel Pada Artritis Reumatoid, Amanda Pitarini Utari, Harry Isbagio, Budiman Darmowidjojo, Shuffrie Effendi

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Terdapat peningkatan mortalitas akibat penyakit kardiovaskular (PKV) sebesar 50% pada pasien artritis reumatoid (AR). Trigliserida pascaprandial (TGPP) saat ini dikaitkan dengan risiko penyakit jantung iskemik, infark miokard, stroke iskemik, kematian, serta peningkatan kadar molekul adhesi. Kadar molekul adhesi yang meningkat merupakan tanda terjadinya aktivasi endotel, proses awal pada terbentuknya lesi aterosklerosis. Belum ada penelitian tentang peran TGPP dalam risiko kardiovaskular pada pasien AR. Penelitian ini ingin mengetahui hubungan antara TGPP dengan penanda biologis aktivasi endotel.

Metode. Penelitian ini adalah studi potong lintang, yang menggunakan analisis korelasi dengan analisis multivariat. Sampel diambil dengan metode consecutive sampling. Pada subjek penelitian dilakukan …

Korelasi Antara Kadar Matriks Metalloproteinase 9, Laju Endap Darah, Faktor Reumatoid, Dan Lama Sakit Dengan Gambaran Radiologis Pada Pasien Artritis Reumatoid, Giri Aji, Sumariyono Sumariyono, Kahar Kusumawidjaja, Murdani Abdullah

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Artritis Reumatoid (AR) merupakan penyakit autoimun dengan etiologi yang belum jelas, gejala utama dari AR adalah keradangan pada sendi yang ditandai dengan sinovitis simetris dan erosi tulang, walaupun perjalanan penyakit AR sulit diduga dengan sifat kronik-remisi-eksaserbasi namun secara umum hasil akhir dari AR adalah deformitas sendi. Penelitian terakhir pada AR menunjukkan adanya overekspresi dari sejumlah enzim matrix metallopeoteinases (MMPs) yang mempunyai kemampuan degradasi komponen kolagen dam matriks ekstraseluler tulang rawan Beberapa penelitian menemukan keterlibatan MMP-2, MMP-9, MMP-1 ,MMP-8 dan MMP-3 pada penyakit AR. Penelitian di Taiwan oleh Chang Yh menunjukkan peningkatan kadar aktivitas MMP-9 pada pasien AR di …

Gambaran Endoskopi Saluran Cerna Bagian Atas Pada Pasien Dispepsia Usia Lanjut Di Rumah Sakit Cipto Mangunkusumo, Hendra Agustian, Dadang Makmun, Czeresna H. Soejono

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Salah satu masalah kesehatan yang sering terjadi pada pasien usia lanjut adalah gangguan saluran cerna bagian atas. Pada pasien usia lanjut dapat terjadi perubahan di lambung akibat proses penuaan antara lain perubahan integritas mukosa (berkurangnya kadar prostaglandin mukosa, integritas vaskuler menurun, dan penurunan aktivitas anti radikal bebas). Tindakan endoskopi merupakan tindakan yang relatif aman pada usia lanjut untuk menegakkan diagnosis saluran cerna bagian atas. Pemeriksaan endoskopi lebih awal sangat penting dilakukan untuk dapat mencegah penyulit yang mungkin terjadi akibat penyakit pada saluran cerna. Penelitian ini bertujuan untuk mengetahui karakteristik pasien dispepsia usia lanjut yang telah dilakukan pemeriksaan endoskopi saluran …

Probabilitas Temuan Kanker Kolorektal Pada Pasien Simtomatik Berdasarkan Unsur-Unsur Asia Pacific Colorectal Screening (Apcs), Muhammad Yamin Lubis, Murdani Abdullah, Irsan Hasan, Suhendro Suwarto

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Kanker Kolorektal (KKR) masih menjadi masalah besar di dunia pada umumnya dan di Indonesia pada khususnya. Kolonoskopi dapat melihat lesi di kolon tetapi biayanya mahal bila dilakukan pada semua pasien asimtomatik. Memakai komponen unsur-unsur Asia Pacific Colorectal Screening (APCS) dapat memprediksi KKR pada pasien simtomatik sehingga kolonoskopi hanya merupakan modalitas untuk menstratifikasi KKR. Penelitian ini bertujuan untuk mengetahui probabilitas kanker kolorektal menggunakan unsur-unsur APCS pada penderita simtomatik.

Metode. Penelitian kasus-kontrol retrospektif dilakukan di RS Cipto Mangunkusumo Jakarta, sejak bulan Februari 2014 hingga Mei 2014. Data dikumpulkan dari catatan rekam medis pasien di RSCM. Kelompok kasus adalah subjek …

Diagnosis Dan Tata Laksana Paroksismal Nokturnal Hemoglobinuria, Laurentius A. Pramono, Birry Karim, Marha Iskandar, Asnawi Yanto

Jurnal Penyakit Dalam Indonesia

Paroksismal nokturnal hemoglobinuria (PNH) merupakan kelainan darah yang sangat jarang. Penegakan diagnosis PNH cukup panjang, mulai darianamnesis, pemeriksaan fisik, serta pemeriksaan laboratorium (darah dan urin) dimulai dari yang sederhana sampai lanjutan. Penyelidikan ini tidak saja memerlukan perencanaan klinis yang matang, melainkan juga waktu dan tenaga yang banyak, serta biaya yang mahal. Selain itu, sampai saat ini, pilihan pengobatan untuk PNH masih sangat terbatas, dengan keberhasilan yang belum memuaskan sepenuhnya. Berikut kami laporkan sebuah kasus PNH pada seorang perempuan 18 tahun.

Peran Procalcitonin Sebagai Penanda Inflamasi Sistemik Pada Sepsis, Dana Dharaniyadewi, Khie Chen Lie, Suhendro Suwarto

Jurnal Penyakit Dalam Indonesia

Terapi antibiotika awal dan tepat merupakan faktor yang penting untuk kesintasan pasien sehingga diperlukan pemeriksaan yang cepat dan akurat untuk deteksi adanya bakteri di sirkulasi. PCT merupakan biomarker yang paling sering dipelajari dan rutin digunakan dalam praktik klinik dan rekomendasi saat ini di beberapa negara. Kadar PCT serum meningkat pada sepsis. Kadar PCT normal di bawah 0,5 ng/mL dan kadar PCT > 2 ng/mL memiliki risiko tinggi untuk sepsis. PCT lebih unggul daripada CRP untuk diagnosis dan prognosis sepsis pada pasien kritis tetapi penggunaannya harus tetap diiringi dengan penilaian secara klinis. Hal ini terutama penting pada awal infeksi atau pasien dengan …

Faktor-Faktor Yang Mempengaruhi Keberhasilan Terapi Antibiotik Empirik Pada Pasien Sepsis Berat Dan Syok Sepsis Di Bangsal Rawat Inap Penyakit Dalam Rumah Sakit Cipto Mangunkusumo, Sudirman Katu, Suhendro Suwarto, Herdiman T. Pohan, Murdani Abdullah

Jurnal Penyakit Dalam Indonesia

Pendahuluan. Salah satu faktor utama yang berperan pada keberhasilan terapi pada pasien sepsis berat dan syok sepsis adalah penggunaan antibiotika empirik yang adekuat. Penelitian ini ditujukan untuk mengetahui faktor utama apa yang paling berpengaruh terhadap keberhasilan pengobatan antibiotika empirik pada pasien sepsis berat dan syok sepsis.

Metode. Studi kohort retrospektif dengan subjek dari data rekam medik (RM) pasien yang telah di rawat inap di ruang ICU dan perawatan Penyakit dalam RSCM Jakarta antara bulan Januari 2011 - Juni 2012. Kriteria inklusi adalah semua data RM pasien dewasa dengan sepsis, sepsis berat dan syok sepsis yang di rawat di …

Novel Cross Talk Between Igf-Ir And Ddr1 Regulates Igf-Ir Trafficking, Signaling And Biological Responses., Roberta Malaguarnera, Maria Luisa Nicolosi, Antonella Sacco, Alaide Morcavallo, Veronica Vella, Concetta Voci, Michela Spatuzza, Shi-Qiong Xu, Renato V Iozzo, Riccardo Vigneri, Andrea Morrione, Antonino Belfiore

Kimmel Cancer Center Faculty Papers

The insulin-like growth factor-I receptor (IGF-IR), plays a key role in regulating mammalian development and growth, and is frequently deregulated in cancer contributing to tumor initiation and progression. Discoidin domain receptor 1 (DDR1), a collagen receptor tyrosine-kinase, is as well frequently overexpressed in cancer and implicated in cancer progression. Thus, we investigated whether a functional cross-talk between the IGF-IR and DDR1 exists and plays any role in cancer progression.Using human breast cancer cells we found that DDR1 constitutively associated with the IGF-IR. However, this interaction was enhanced by IGF-I stimulation, which promoted rapid DDR1 tyrosine-phosphorylation and co-internalization with the IGF-IR. …

Treatment For Inclusion Body Myositis, Michael R. Rose, Katherine Jones, Kevin Leong, Maggie C. Walter, James Miller, Marinos Dalakas, Ruth Brassington, Robert Griggs

Department of Neurology Faculty Papers

Background Inclusion body myositis (IBM) is a late-onset inflammatory muscle disease (myopathy) associated with progressive proximal and distal limb muscle atrophy and weakness. Treatment options have attempted to target inflammatory and atrophic features of this condition (for example with immunosuppressive and immunomodulating drugs, anabolic steroids, and antioxidant treatments), although as yet there is no known effective treatment for reversing or minimising the progression of inclusion body myositis. In this review we have considered the benefits, adverse effects, and costs of treatment in targeting cardinal effects of the condition, namely muscle atrophy, weakness, and functional impairment. Objectives To assess the effects …

Selective Impact Of Cdk4/6 Suppression On Patient-Derived Models Of Pancreatic Cancer., Agnieszka K Witkiewicz, Nicholas A Borja, Jorge Franco, Jonathan Brody, Md, Charles Yeo, John Mansour, Michael A Choti, Peter Mccue, Erik S Knudsen

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Pancreatic ductal adenocarcinoma (PDA) harbors an exceedingly poor prognosis, and is generally considered a therapy-recalcitrant disease due to poor response to conventional chemotherapy coupled with non-actionable genetic drivers (e.g. KRAS mutations). However, PDA frequently loses p16ink4a, thereby leading to deregulation of CDK4/6. Surprisingly, in established cell models and xenografts, CDK4/6 inhibition has a modest effect on proliferation and resistance develops rapidly. To determine if such weak response was an intrinsic feature of PDA, we developed primary tumor explants that maintain the tumor environment and recapitulate feuture of primary PDA. The CDK4/6 inhibitor PD-0332991 was highly efficient at suppressing proliferation in …

Obstetrician-Gynecologists’ Knowledge Of Health Disparities And Barriers Among American Indian/Alaska Native Women In Washington State, Katherine M. Jones, Greta B. Raglan, Sophia M. Lannon, Jay Schulkin

Journal of Health Disparities Research and Practice

Background: Health disparities between American Indian/Alaska Native (AI/AN) women and other races/ethnicities have long been noted. Obstetricians-Gynecologists (Ob-Gyn) play a significant role in well-woman care and are often the first and most frequent point of medical contact for women, particularly among minority and low-income women.

Objective: This study aimed to assess Ob-Gyns’ knowledge, beliefs, and practices related to health disparities among AI/AN women.

Method: A self-administered questionnaire, consisting of questions about knowledge, beliefs, and practices of health disparities among AI/AN women, was mailed to 722 members of The American College of Obstetricians and Gynecologists (ACOG) practicing in the state of …

Inotropes Are Linked To Increased Mortality In Heart Failure, M. Chadi Alraies, Bill Tran, Sirtaz Adatya

The VAD Journal

No abstract provided.

Taranis Functions With Cyclin A And Cdk1 In A Novel Arousal Center To Control Sleep In Drosophila., Dinis J.S. Afonso, Die Liu, Daniel R. Machado, Huihui Pan, James E.C. Jepson, Dragana Rogulja, Kyunghee Koh

Department of Neuroscience Faculty Papers

Sleep is an essential and conserved behavior whose regulation at the molecular and anatomical level remains to be elucidated. Here, we identify TARANIS (TARA), a Drosophila homolog of the Trip-Br (SERTAD) family of transcriptional coregulators, as a molecule that is required for normal sleep patterns. Through a forward-genetic screen, we isolated tara as a novel sleep gene associated with a marked reduction in sleep amount. Targeted knockdown of tara suggests that it functions in cholinergic neurons to promote sleep. tara encodes a conserved cell-cycle protein that contains a Cyclin A (CycA)-binding homology domain. TARA regulates CycA protein levels and genetically …

Participation In Clinical Research: A Thorough Explanation In Their Own Language Helps Family Medicine Patients Decide., Anita Kurt Phd, Rn, Charity Curtis Mph, Melanie B. Johnson Mpa, Henry Liu Md, Beth Careyva Md, Jerry Chang Bs, Alex Winter Bs, Claudia P. Santiago Ba, Wendy H. York Bs, Ma, Kathleen Staubinger Rn, Bsn, Brian Stello Md

Department of Family Medicine

No abstract provided.

Exogenous 17-Β Estradiol Administration Blunts Progression Of Established Angiotensin Ii-Induced Abdominal Aortic Aneurysms In Female Ovariectomized Mice, Sean E. Thatcher, Xuan Zhang, Shannon Woody, Yu Wang, Yasir Alsiraj, Richard Charnigo, Alan Daugherty, Lisa A. Cassis

Saha Cardiovascular Research Center Faculty Publications

BACKGROUND: Abdominal aortic aneurysms (AAAs) occur predominately in males. However, AAAs in females have rapid growth rates and rupture at smaller sizes. Mechanisms contributing to AAA progression in females are undefined. We defined effects of ovariectomy, with and without 17-β estradiol (E2), on progression of established angiotensin II (AngII)-induced AAAs in female mice.

METHODS: We used neonatal testosterone exposures at 1 day of age to promote susceptibility to AngII-induced AAAs in adult female Ldlr^-/- mice. Females were infused with AngII for 28 days to induce AAAs, and then stratified into groups that were sham, ovariectomized (Ovx, vehicle), or Ovx …

Pleiotropic Effects Of Bitter Taste Receptors On [Ca2+]I Mobilization, Hyperpolarization, And Relaxation Of Human Airway Smooth Muscle Cells., Blanca Camoretti-Mercado, Susan H Pauer, Hwan Mee Yong, Dan'elle C Smith, Deepak A. Deshpande, Phd, Steven S An, Stephen B Liggett

Center for Translational Medicine Faculty Papers

Asthma is characterized by airway inflammation and airflow obstruction from human airway smooth muscle (HASM) constriction due to increased local bronchoconstrictive substances. We have recently found bitter taste receptors (TAS2Rs) on HASM, which increase [Ca2+]i and relax the muscle. We report here that some, but not all, TAS2R agonists decrease [Ca2+]i and relax HASM contracted by G-protein coupled receptors (GPCRs) that stimulate [Ca2+]i. This suggests both a second pathway by which TAS2Rs relax, and, a heterogeneity of the response phenotype. We utilized eight TAS2R agonists and five procontractile GPCR agonists in cultured HASM cells. We find that heterogeneity in the …

Inotropes Are Not Linked To Increased Mortality In Heart Failure, Maya Guglin

The VAD Journal

How to use inotropes is one of the most controversial topics in the management of heart failure. While most clinicians use these drugs, and recognize the state of inotrope dependency, current guidelines recommend them onlu as a bridge or palliation. Thus, inotropes are considered either neutral or detrimental in terms of outcomes. Meanwhile, properly designed randomized clinical trials testing the outcomes on inotropes, have never been performed and it is unlikely that they will ever be attempted. These trials would require randomizing patients with advanced heart failure, low output syndrome, and impaired end-organ perfusion into groups that received or not …

An Assessment Of Current Palliative Care Beliefs And Knowledge: The Primary Palliative Care Providers' Perspective, Yvonne Patten, Maria M. Ojeda, Carolyn Lindgren

All Publications

No abstract provided.

Rater Perceptions Of Bias Using The Multiple Mini-Interview Format: A Qualitative Study, Anthony A. Donato, Richard L. Alweis, Caroline Fitzpatrick

Reading Hospital Internal Medicine Residency

The Multiple Mini-Interview (MMI) format appears to mitigate individual rater biases. However, the format itself may introduce structural systematic bias, favoring extroverted personality types. This study aimed to gain a better understanding of these biases from the perspective of the interviewer

Exercise Improves Host Response To Influenza Viral Infection In Obese And Non-Obese Mice Through Different Mechanisms., Kristi J. Warren, Molly M. Olson, Nicholas J. Thompson, Mackenzie L. Cahill, Todd A. Wyatt, Kyoungjin J. Yoon, Christina M. Loiacono, Marian L. Kohut

Journal Articles: Pulmonary & Critical Care Med

Obesity has been associated with greater severity of influenza virus infection and impaired host defense. Exercise may confer health benefits even when weight loss is not achieved, but it has not been determined if regular exercise improves immune defense against influenza A virus (IAV) in the obese condition. In this study, diet-induced obese mice and lean control mice exercised for eight weeks followed by influenza viral infection. Exercise reduced disease severity in both obese and non-obese mice, but the mechanisms differed. Exercise reversed the obesity-associated delay in bronchoalveolar-lavage (BAL) cell infiltration, restored BAL cytokine and chemokine production, and increased ciliary …

Deregulation Of Mir-34b/Sox2 Predicts Prostate Cancer Progression., Irene Forno, Stefano Ferrero, Maria Veronica Russo, Giacomo Gazzano, Sara Giangiobbe, Emanuele Montanari, Alberto Del Nero, Bernardo Rocco, Giancarlo Albo, Lucia R Languino, Dario C Altieri, Valentina Vaira, Silvano Bosari

Department of Cancer Biology Faculty Papers

Most men diagnosed with prostate cancer will have an indolent and curable disease, whereas approximately 15% of these patients will rapidly progress to a castrate-resistant and metastatic stage with high morbidity and mortality. Therefore, the identification of molecular signature(s) that detect men at risk of progressing disease remains a pressing and still unmet need for these patients. Here, we used an integrated discovery platform combining prostate cancer cell lines, a Transgenic Adenocarcinoma of the Mouse Prostate (TRAMP) model and clinically-annotated human tissue samples to identify loss of expression of microRNA-34b as consistently associated with prostate cancer relapse. Mechanistically, this was …