70 and 71 There are twenty members of MMPs including the collagen

70 and 71 There are twenty members of MMPs including the collagenases

(MMP-1, MMP-8, MMP-13), gelatinases (MMP-9), stromelysins (MMP-3).72, 73 and 74 MMPs are involved in regulating cellular migration, CB-839 ECM protein transformation, ECM degradation and apoptosis in the growth plate.75 and 76 Overexpression of MMPs (e.g. MMP-9 and MMP-13) are considered to be crucial in the development of OA.62 Moreover, Cytokines also stimulate chondrocytes in OA cartilage to secret high levels of matrix metalloproteinase 13 or collagenase-3 (MMP-13), require zinc and calcium for their activity.77 The ROS formed by reduction of oxygen are the radical superoxide (O2.−), hydroxyl radical (OH.), peroxyl (ROO.), alkoxyl click here (RO.) and hydroperoxyl (HO2.), nitric oxide (NO) and nitrogen

dioxide (NO2.) and non radical such as hydrogen peroxide (H2O2), hypochlorous acid (HOCl−), Ozone (O3), singlet oxygen (O2) and peroxynitrite (ONOO−).78 Recent studies showed that chondrocytes produce reactive oxygen species (ROS), including superoxide anions, hydrogen peroxide, hydroxyl radicals, and large amount of nitric oxide in response to interleukin1,79, 80 and 81 ROS are generated by activated macrophages and neutrophils participate in inflammatory responses.78, 82 and 83 ROS are capable of inducing degradation of collagen and aggrecan in chondrocytes.84 and 85 Nitric oxide is a short lived radical synthesized via the oxidation of arginine by a family of nitric oxide synthases (NOS),86 NO’s role in joint diseases was first reviewed by,87, 88 and 89 chondrocyte and macrophyges can produce NO and prostaglandins consecutively in response to cytokines,88, 89 and 90 ROS can reduce synthesis of hyaluronic acid (HA) main component of ECM.91 Lipid Idoxuridine peroxidation refers to oxidation of polyunsaturated fatty acids (PUFA) leading to a variety of hydroperoxide and aldehyde products that are highly reactive with components of the cell and the extracellular matrix and mediate

collagen degradation.45, 92 and 93 Taken together, it is indicated that the distribution of lipids in cartilage changing during aging and OA.94 and 95 Fig. 2 shows the brief schematic diagram of development of OA in joint. Treatment of osteoarthritis (OA) is mainly based on the pathophysiological events that alter the initiation and progression of OA. Understanding the mechanism and Modulation of cytokines and MMPs would be a main target for treatment and prevention of Osteoarthritis. All authors have none to declare. “
“Many plants have nutritive value as well as they are the major source of medicine. The medicinal value of these plants lies in phytochemical constituents that cause definite pharmacological action on the human body.

One study subject responded to more than 90% of the epitopes test

One study subject responded to more than 90% of the epitopes tested; although the most recent viral load MG-132 manufacturer was not available for this particular donor during

the study time period, this type of immune response could also be expected in earlier stages of infection. Due to delays in diagnosis, not all subjects recruited in Mali after their first positive HIV test were identified as HIV infected at an early stage of disease. The one subject who did not respond to any of the 31 epitopes tested in ELISpot assays (data not shown) had a very high viral load (445,000 copies/ml) and low CD4+ T cell count that would be more typical of chronic, untreated infection, a condition that also contributes to lack of response, likely leading to the lack of positive IFNγ responses in ELISpot assays. While 95% of the selected epitopes were positive in at least one subject in either Providence or Mali, no single epitope was immunodominant within cohorts or across cohorts.

This lack of immunodominance illustrates the importance of including a broad array of epitopes for the development of a globally relevant vaccine [78], [79] and [80]. There were only three predicted epitopes that did not elicit a positive response in this set of peptides; two of these epitopes (POL-1007 and POL-1016) have been published by other groups, one as a class II epitope and the other for a different HLA restriction (Table 1), calling into question the buy Ribociclib possibility that either these epitopes were not correctly predicted (by EpiMatrix) or were not properly processed or presented on HLA-A2. POL-1007 did bind with very high affinity to HLA-A2 in vitro, which supports its identification as an HLA-A2 epitope. The third epitope for which no response was detected is a novel epitope identified in our 2009

analysis, VPU-3009. The lack of immune response to this epitope may be a function of its low binding affinity to HLA-A2. Epitope-based vaccines containing epitopes restricted by six “supertype” HLA, such as HLA-A2, are believed to be the best approach to generate broad T-cell responses with the greatest possible coverage of the human population until [47] and [48]. In this paper, we identified 38 potential HLA-A2 epitopes for inclusion in our GAIA or other pan-HLA-reactive HIV-1 vaccines, and of these, 36 are good candidates. In work published previously, our group selected and confirmed epitopes immunogenic for HLA-B7 [32] and HLA-A3 [48], and a prior publication by our group describes the validation of promiscuous “immunogenic consensus sequence” class II epitopes in Providence and Bamako [49]. In addition to their remarkable conservation across years, the utility of the HLA-A2 epitopes described here is also supported by their aggregate conservation of 48% and 45% across countries and clades, respectively (Fig. 2). While it appears that HLA-A2 haplotypes are less equipped to fight HIV due to a low binding affinity for conserved epitopes, Altfeld et al.

Mice (n = 4–8 per group) were prime-boost immunised i n /i m wit

Mice (n = 4–8 per group) were prime-boost immunised i.n./i.m. with 1 × 107 plaque forming units (PFU) rFPV followed by 1 × 107 PFU rVV expressing HIV-1 antigens and IL-13Rα2 or IL-4C118 antagonist as described in Table 1 under mild methoxyfluorane anaesthesia two weeks apart. Similarly groups of

mice were used as unimmunised controls. Immediately prior to delivery the viruses were diluted in phosphate buffered saline (PBS) and sonicated 20–30 s to obtain an homogeneous viral suspension, intranasal rFPV was given in a final volume of 20–25 μl and i.m. rVV were delivered, 50 μl per quadriceps. To evaluate CD8 T cell mediated protective immunity, 6 weeks post booster vaccination, immunised and unimmunised mice were challenged intranasally with 75–100 PFU of influenza virus PR8 expressing the KdGag197–205 epitope of HIV as described previously [23]. Body weight was monitored BI 6727 datasheet for 9–10 days after challenge. The attenuated recombinant influenza virus PR8-KdGag197–205

incorporates the H2-Kd restricted immuno-dominant epitope AMQMLKETI [32] into the influenza virus neuraminidase stalk, constructed as described by Cukalac et al. [39]. Intra-nasal challenge of naïve BALB/c Torin 1 datasheet (H2-Kd) mice with PR8-KdGag197–205 induces significant weight loss, followed by weight gain as the mice recover from a mild flu, over a 10 day period. The cells infected with PR8-KdGag197–205 present the MHC-I restricted HIV-Gag epitope, and in HIV Gag immunised mice CD8+ CTL specific for HIVGag197–205 will kill the infected cells limiting replication and dissemination of the recombinant influenza virus significantly reducing weight loss. The ability to maintain body weight about specifically at peak infection (4–7 days) is considered a measure of CD8+ T cell mediated protective immunity not antibody immunity. To measure systemic and mucosal T cell responses mice were euthanized at different time intervals (2 and 8 weeks) post-boost immunisation, and 10 days post influenza-KdGag197–205 challenge; spleen, genito-rectal nodes (GN) or iliac lymph nodes and Peyer’s patch (PP) were

removed and cell suspensions prepared in complete (5% FBS) RPMI as described previously [20], [40] and [41]. Allophycocyanin-conjugated KdGag197–205 tetramers were synthesised at the Bio-Molecular Resource Facility at The John Curtin School of Medical Research (BRF/JCSMR), ANU. 2–5 × 106 splenocytes or mucosal lymphocytes were stained with anti-CD8-FITCα antibody (Biolegend, USA) and Allophycocyanin-conjugated KdGag197–205 tetramer at room temperature and analysed as described previously [20], [40] and [42]. All the appropriate controls were performed and the background tetramer counts in naïve mice were found to be between 0.05 and 0.5% in spleen, 0.02–0.05% in mucosal tissue and GN. Also following KdGag197–205 tetramer staining the dissociation assays were performed as described before [21] and [43].

02 00 275, version 2 0d)] The essential oil from the seed of H

02.00.275, version 2.0d)]. The essential oil from the seed of H. candolleanum (Wight et Arn) was obtained by

hydro distillation and analyzed by gas chromatography–mass spectrometry (GC–MS). Twenty-one compounds were identified representing approximately 98.1% of the oil ( Table 1). Interestingly, there were significant differences between the main components of the essential oil of H. candolleanum. The major volatile components of seed were methyl cinnamate (22.38%), n-hexyl hexanoate (21.74%) and octyl alcohol (11.78%). The oxygenated monoterpenes predominated with 86.67% followed by monoterpenes (9.79%). The essential oil composition ABT 888 of various members of this genus have been reported, and they contain monoterpene hydrocarbons (e.g. p-cymene; γ-terpene; α- and β-pinene; limonene etc.), oxygenated monoterpenes (e.g. iso-bornyl acetate, linalool, n-octanol, terpinene-1-ol-4 etc.), and sesquiterpene (e.g. caryophyllene oxide) in their volatile fractions. Different octyl esters, especially n-octyl acetate, are reported to be the major constitute Ibrutinib molecular weight in most of the oils investigated. In the present study octyl ester of hexanoic acid (8.87%) was found to be more compared to the

octyl acetate (2.57%) along with octanol (11.78%). Methyl cinnamate was reported for the first time as the major component from the essential oil of H. candolleanum. The results revealed that essential oil obtained from the seed of H. candolleanum contains twenty-one compounds in various concentrations. The major component of seed is methyl cinnamate (22.38%). All authors have none to declare. “
“Drug delivery to the colon is beneficial for the oral delivery of proteins and peptide drugs degraded by digestive enzymes of the stomach and small Parvulin intestine and for the delivery of low molecular weight compounds.1 Delivery of drug substances to the colon may improve systemic bioavailability to a level which is not feasible by un-modified oral

drug delivery. This may improve efficacy of drug treatment or open up the possibility to switch to oral instead of parenteral administration.2 Targeted drug delivery into the colon is highly desirable for local treatment of a variety of bowel diseases such as ulcerative colitis, cirrhosis disease, amebiasis, colonic cancer and local treatment of colonic pathologies and systemic delivery of protein and peptide drugs. This route may also be useful in the treatment of diseases susceptible to diurnal rhythm such as asthma, arthritis, etc.3 There are several approaches, which is utilized in achieving colon targeting include use of pH-sensitive polymer, time-dependent formulation, bacterial degrading coating material, biodegradable polymer matrix and hydrogels and prodrug.4 Microspheres have played a vital role in the development of controlled and or sustained release drug delivery systems.

Permissive parenting was associated with higher levels of physica

Permissive parenting was associated with higher levels of physical activity among 10- to 11-year-old learn more children. Maternal logistic support was associated with girls’ physical activity, while paternal logistic support was associated with boys’ physical activity. To promote physical activity, public health professionals could encourage parents to increase logistic support for their children’s physical activity. We have no conflicts of interest to declare. We would like to thank all of the children, parents, and schools that participated in this

study. This study was funded by a project grant from the British Heart Foundation (ref PG/06/142). This report is also a research arising from a Career Development Fellowship (to Dr. Jago) supported by the National Institute for Health Research. The views expressed in this publication are those of the authors Tofacitinib price and not necessarily

those of the NHS, the National Institute for Health Research, or the Department of Health. “
“Young children are often negative about smoking: they think it is unhealthy and stinks. This attitude explains why only 2% of the Dutch children aged 10–12 years smoke (STIVORO, 2008). Due to factors like smoking behavior of peers and parents, social pressure to smoke, and non-smoking policies (Bidstrup et al., 2009 and Bernat et al., 2008), this aversion to smoking diminishes rather quickly. It results in 23% smokers among 14-year olds and 44% among 18-year olds (STIVORO, 2008). Gervais et al. (2006) suggest that see more a person’s first puff presents the beginning of a rapid process that leads to

symptoms of nicotine dependence and escalating cigarette use. Moreover, adolescents who are stable users of tobacco at the age of 12 show greater weekly cigarette consumption and are more likely to become nicotine-dependent (Riggs et al., 2007). The transition to high school is a period in which students are very vulnerable to factors that lead to smoking (Côté et al., 2004). This emphasizes the importance to prepare 10-to 12-year-old children before they are most apparently facing the temptation to experiment with tobacco. In a review on the efficacy of non-smoking interventions (NHS, 1999), the authors also state that an important addition to present intervention practice would be to start interventions at an earlier age, before attitudes and beliefs about smoking are being formed. Starting an education program in elementary school could therefore be an effective instrument in the prevention of smoking onset in adolescence. Flay (2009) performed a critical review of several reviews on the effects of school programs on prevention of tobacco use. There were some clear directions on what types of programs are most effective.

This may have resulted in accelerated waning of immunity

This may have resulted in accelerated waning of immunity selleckchem in the HRV_2D group, and consequently lack of efficacy over a 2-year period. The immunogenicity of a HRV_2D compared to HRV_3D in settings such as ours, however, needs further validation as our study was not powered to address this. A third further possible reason for decreased efficacy of Rotarix in our setting over 2 consecutive seasons may relate to the possibility of severity of gastroenteritis episodes in which rotavirus is identified during the second year being due to co-infection with other enteric pathogens. In this study,

co-infections were not evaluated. Co-infection with rotavirus and other bacterial and viral enteropathogens has been observed in infants and toddlers in similar settings,

and occurs in about 20% of cases [27] and [28]. As it is not possible to rule out the possibility of co-infection contributing to severe gastroenteritis symptoms rather than rotavirus per se being responsible for the illness severity in our study, this also needs to be evaluated further. The possibility of co-infection contributing to more severe illness in subsequent years is corroborated by the observation that rotavirus infections after the first natural rotavirus infection are significantly less severe than first rotavirus infection [21]. As HRV mimics natural rotavirus infection, theoretically subsequent rotavirus Dinaciclib solubility dmso infection in vaccinees should be less severe.

However, the persistence of protection observed in the HRV_3D group make it unlikely that this is a major reason for the diminished vaccine efficacy over 2 consecutive rotavirus found seasons in the HRV_2D group. These data, together with the exploratory analysis which indicated higher point estimate of sero-conversion rates in the HRV_3D group (66.7%) than HRV_2D group (57.1%), indicate that a 3-dose schedule of Rotarix may have an advantage in providing longer-term protection against severe RVGE and severe all-cause gastroenteritis than a 2-dose schedule. The sero-conversion rates are similar to those observed in an earlier immunogenicity study in South Africa, which also reviewed the 2-dose schedule at 10 and 14 weeks of age and the 3-dose schedule at 6, 10 and 14 weeks of age [18]. Although South Africa has introduced a 2-dose schedule of Rotarix, based on its licensure conditions, the dosing schedule being used includes a dose at 6 and 14 weeks of age, rather than the 10 and 14 weeks of age schedule evaluated in our study. The rationale for this dosing schedule included the aim of conferring protection as early as possible with the first dose of vaccine being at 6 rather than 10 weeks of age and minimizing missing the opportunity of vaccination at the earliest well-baby visit.

In the case of avian influenza viruses of the H7 subtype,

In the case of avian influenza viruses of the H7 subtype,

which tend to present preferential tropism for ocular tissues in humans [22], mechanical and innate defences associated with the human eye likely require invasive insults, such as physical abrasion, to allow avian influenza virus infection of the ocular epithelia. Therefore, the relative limited accessibility of receptors used by avian influenza viruses in human hosts may contribute to the relative rarity of their transmission to humans. Sialic acids with α2,6 linkage to galactose are more abundantly distributed in the upper regions of the respiratory tract [60], [68] and [73] and are the cellular receptors used by human influenza Dolutegravir viruses, adapted to and circulating in the human population [54]. They are expressed abundantly on respiratory epithelial cells of the upper respiratory tract, trachea and bronchi [64], [78] and [79] and likely are more accessible to influenza virus particles than sialic acids with α2,3 linkage to galactose. Preferred affinity for these cellular receptors thus may favour successful cross-species transmission of zoonotic influenza viruses from animal reservoirs to humans. Sialic acids

with α2,6 linkage to galactose are not expressed on respiratory or intestinal epithelial cells of ducks [80], but are expressed on respiratory and intestinal epithelial cells of terrestrial birds, such as chicken and quail [80]. Accordingly, avian influenza selleck kinase inhibitor viruses using these cellular receptors do circulate in these species. It is the case for some strains of LPAIV H9N2 and of LPAIV and HPAIV of the H7 subtype, which have caused human infection [81], [82], [83] and [84]. Recently, LPAIV of the H6 subtype were shown to infect mammalian hosts without prior adaptation and not may have dual

affinity for sialic acids with α2,3 and with α2,6 linkage to galactose [85]. Likewise, respiratory epithelial cells of swine were shown to harbour both types of sialic acids [60] and swine influenza viruses circulating endemically in pig populations typically bind to sialic acids with α2,3 and with α2,6 linkage to galactose [86] and [87]. This may explain the more frequent occurrence of cross-species transmission of swine influenza viruses to humans compared to that of avian influenza viruses. The receptor binding site of influenza virus HA protein is a shallow depression at the top of the protein to which sialic acids bind. Key amino-acids within or close to the receptor binding site and conferring α2,3 or α2,6 receptor binding affinity have been identified in the HA protein of influenza viruses of the H1, H2, H3, H4, H5 and H9 subtypes (Table 2). Portals of entry other than the respiratory epithelium were suggested for HPAIV H5N1, yet the sites of initial virus attachment and infection following non-respiratory routes of entry remain unclear.

6 Percentageinhibition(%)=Control−TreatedControl×100 Group-1: Veh

6 Percentageinhibition(%)=Control−TreatedControl×100 Group-1: Vehicle control received 1% CMC (dose: 10 ml/kg). On the 8th day animals were sacrificed and the cotton pellets were removed surgically, freed from extraneous tissue then the weight of wet cotton pellets weights were noted, thereafter the wet cotton pellets were dried in oven for 24 h at 60 °C. After drying the cotton pellets were weighed again to get the weight of dry cotton pellets. Animals were weighed by using animal weighing balance initially before experimentation and at the end of study. All the data

was expressed as Mean ± S.E.M. Statistical significance between more than two groups was tested using one-way ANOVA Lapatinib followed by the Tukey test using computer based fitting program (Prism graph pad.). Statistical significance was taken as p < 0.05. The effect of methanolic leaf extract of A. vulgaris was studied at the doses of

200 mg/kg & 400 mg/kg per body weight. The results revealed that the methanolic extract of A. vulgaris shows dose dependant inhibition of weight of both wet and dry cotton pellets, The mean number of decrease in weight of both wet and dry cotton pellets for rats, which received 200 mg/kg & 400 mg/kg body weight of the extract was significant check details (p < 0.05) lower than those in the control rats. The extract was found to be most effective at a dose of 400 mg/kg body weight. The extract at the dose of 400 mg/kg had shown 55.3%

inhibition in weight these of wet cotton pellets and 64.06% inhibition in weight of dry cotton pellets, while the extract at the dose of 200 mg/kg had shown 33% inhibition in weight of wet cotton pellets and 20.07% inhibition in weight of dry cotton pellets 50% inhibition of implants when compared to that of control group animals as shown in the following Table 1 and in Figs. 1 and 2. Fig. 3, Fig. 4 and Fig. 5 show the exposed cotton pellets at the end of the study. There was no significant weight variation observed in the body weights of the animals shown in Table 2, which reveals no toxic effect of the extract. In the present study, the anti-inflammatory activity of the methanolic leaf extract of A. vulgaris has been established using cotton pellet granuloma method. Cotton pellet granuloma model is an indication of the proliferative phases of inflammation. Inflammation involved proliferation of macrophages, neutrophils and fibroblast, which are basic sources of granuloma formation.7 The results revealed that the extract at the dose of 400 mg/kg had shown 55.3% inhibition in weight of wet cotton pellets and 64.06% inhibition in weight of dry cotton pellets, while the extract at the dose of 200 mg/kg had shown 33% inhibition in weight of wet cotton pellets and 20.07% inhibition in weight of dry cotton pellets when compared to that of control group animals as shown in the following Table 1 and Figs. 1 and 2.

The statistical analyses were performed using STATISTICA 9 1 soft

The statistical analyses were performed using STATISTICA 9.1 software (Statsoft), using the normalized variables. The effect of each variable was estimated, as was standard error, and was assessed Pifithrin-�� cell line by the t-test, with all results giving p < 0.05 being considered statistically significant. Cell growth was measured by absorbance at 600 nm. This was converted to dry mass of cells using a standard calibration curve. Samples of cells from 1 mL culture were resuspended in a sample buffer (60 mM Tris–HCl, pH 6.8, 10% glycerol, 5% β-mercaptoethanol, 2% SDS, 0.5% Bromophenol Blue) to obtain the total protein extract, at a ratio of 25 μL buffer to each 0.1 Abs600 nm. These samples were added to

12.5% SDS-PAGE [17], stained with Coomassie Blue R-250. The same gel also had 2 μL low molecular weight marker (LMW, Amersham Bioscience) added, with 97 kDa, 66 kDa, 45 kDa, 30 kDa, 20.1 kDa and 14.4 kDa bands and 1340 ng, 1660 ng, 2940 ng, 1660 ng, 1600 ng and 2320 ng protein weight in each band, respectively, for the purpose of comparing with the bands corresponding to ClpP. The amount of protein expressed under each condition was analyzed

by densitometry using a Bio-Rad GS-800 calibrated densitometer and QuantityOne 4.4.1 software. The concentration of expressed protein was obtained using the ratio (mg/L) = (Abs600 nm × band in densitometry)/4, where 4 was the concentration factor used in the preparation FRAX597 in vivo of the total protein extract samples. In order to analyze plasmid segregation, 100 μL samples were taken from each experiment at the end of the 4 h expression period, with analysis done on two aliquots from each experiment. Each aliquot was serially diluted in sterile PBS to 10−6 (Fig. 1). 10 μL samples of each dilution with at least three replications were added to LB Agar plates with kanamycin (50 μg/mL) and without it. Plasmid stability was measured as the fraction of plasmid-bearing cells (Φ) by

calculating the ratio between the number of colony forming units (CFU/mL) on the plate with the antibiotic and on the plate without the antibiotic. A statistical evaluation was made with the aim of checking the reproducibility and variability of the procedures Bumetanide for assessing plasmid stability (serial dilution and colony count). Student’s t-test was used to find out whether the mean values from the colony count were equivalent, while the F-test (Fisher) was used to find out whether the errors made at each stage of the count were equivalent. These tests were done using the values obtained from CFU/mL in the experiments at the center point of the experimental design, comparing different aliquots diluted to the same degree from the same culture, and the same aliquots diluted to different degrees from the same culture, as shown in the diagram in Fig. 1. In order to do the F  -test, F   was calculated using Eq.

However, the lower responses were still within the 2-fold GMC cri

However, the lower responses were still within the 2-fold GMC criterion for noninferiority for all pneumococcal serotypes, with the exception of 19F, which

was just below the noninferiority margin. The lower immune response Capmatinib observed by concomitant administration of these vaccine antigens is not easily understood. Such interactions are thought to be caused by complex, multi-factorial interactions, including antigen competition, and the effects of other vaccine components on the immune response [23]. A possible mechanism could be that vaccine antigens interfere with the MHC class I and II antigen processing and presentation pathways, leading to a uniformly reduced response to PCV13 serotypes [24]. Further research is required to better understand this phenomenon. Local reactions at the PCV13 injection site were comparable. Although systemic events were more common after PCV13 + TIV relative to TIV or PCV13 alone, this is probably because of the additive effects of both TIV and PCV13 systemic events. Overall, fever rates were low, and there were no Baf-A1 chemical structure vaccine-related SAEs during the study. Although immune responses to vaccine antigens were

observed after receipt of both vaccines, the lack of knowledge about the threshold level of antibodies needed to protect against pneumococcal disease in adults is a limitation of the study. The results from the efficacy study of PCV13 being conducted in adults aged ≥65 years in The Netherlands are awaited to help establish an effective antibody level against pneumococcal disease in adults [12].

Overall, the why concomitant administration of PCV13 and TIV was demonstrated to be immunogenic and safe. If PCV13 is determined to add value in a comprehensive immunization strategy against pneumococcal disease, the ability to coadminister PCV13 and TIV would facilitate the immunization of older adults. Financial support. This study was funded by Pfizer Inc. Pfizer was involved in the study design, data collection, data analysis, data interpretation, writing of the manuscript, and the decision to submit the paper for publication. Nancy Price at Excerpta Medica provided assistance in preparing and editing the manuscript, which was funded by Pfizer Inc. All authors had full access to all data. Potential conflicts of interest. T.F.S. has received honoraria from Pfizer, GlaxoSmithKline, and Novartis for conducting clinical trials and lecturing, and has participated as a member of advisory boards. J.F., H.C.R., and J.P. have no conflicts to report. C.J., A.W., D.J., P.G., E.A.E., W.C.G., and B.S-T are current or former employees of Pfizer Inc. Author contributions: C.J., E.A.E, W.C.G., and B.S-T participated in the conception and design, acquisition of data, analysis, and interpretation of the study; the writing of the report; and critically revising it for important intellectual content, and approved the final version to be submitted. T.F.S., J.F., H.C.R., and J.