Methods: We performed a retrospective analysis of 71 cases

\n\nMethods: We performed a retrospective analysis of 71 cases

with coccidioidomycosis involving the CNS seen from 1996 to 2007 at a referral medical center in southern Arizona.\n\nResults: The only presenting symptom found β-Nicotinamide datasheet in the majority of patients was headache. Those who were immunocompromised (most commonly HIV/AIDS and chronic steroid therapy) were at increased risk, but diabetics were not at increased risk. There was a preponderance of males (2:1) and people of Hispanic, African, and Asian (especially Pacific Isles) background. CSF anticoccidioidal antibody and culture were frequently negative on presentation, but in these cases, the serum antibody test was usually positive. Imaging studies were helpful in two thirds of cases, most commonly demonstrating basilar meningitis or hydrocephalus, which frequently required ventriculoperitoneal shunting. Most were treated with fluconazole, GDC-0994 chemical structure and prognosis was good for most of those who remained on treatment.\n\nConclusions: Coccidioidal meningitis remains a diagnostic challenge, but the diagnosis can usually be made successfully when coccidioidal serum and CSF antibodies and cultures are combined with appropriate imaging studies. Neurology (R) 2009; 73: 1780-1786″
“Under physiological

conditions, angiogenesis is regulated by the local balance between endogenous stimulators and inhibitors of this process. In pathological states such as chronic inflammation and tumor growth, there is an imbalance between endogenous stimulator and inhibitor levels, leading to an “angiogenic switch”. Various inhibitors of angiogenesis, including angiostatin, endostatin and thrombospondins,

are Staurosporine mw found in the body. It is uncertain why the body possesses so many inhibitors, and also how these inhibitors interact to overcome the effects of angiogenesis stimulators. This review summarizes the present knowledge about endogenous inhibitors of angiogenesis. (C) 2008 Elsevier Ltd. All rights reserved.”
“Fuelled by the generalized degradation of freshwater ecosystems, the development of tools to assess their ecological status has been the focus of intensive research in the last decades. Although fish are one of the key biological quality elements used to describe the ecological status of rivers, fish metrics that accurately respond to disturbances in Mediterranean trout type streams are still lacking. In these systems, multimetric indices are not optimal indicators because of their low species richness and abundances, thus alternative approaches are needed. Since carrying capacity defines the potential maximum abundance of fish that can be sustained by a river, its relationship with actual density (D/K ratio) could be an accurate indicator of population conservation status and consequently of the ecological status of the river.

DESIGN: Cohort study of smear-negative TB suspects at a South

\n\nDESIGN: Cohort study of smear-negative TB suspects at a South African primary care clinic. Participants provided one sputum sample for fluorescent smear microscopy and culture and an additional sample for Xpert. Outcomes of interest were TB diagnosis, linkage to care, patient and provider costs.\n\nRESULTS: Among 199 smear-negative TB suspects, 16 were positive by Xpert, 15 by culture and 7 by microscopy. All cases identified by Xpert began anti-tuberculosis treatment the same or next day; only one of five Xpert-negative culture-positive cases started treatment after SUMMARY 34 days. Xpert at point

of care offered similar diagnostic yield but a faster turnaround time than smear and culture performed at a centralized laboratory. Compared to smear plus culture, Xpert (at US$9.98 per cartridge) was US$3 less expensive DNA Damage inhibitor Cytoskeletal Signaling inhibitor per valid result (US$21 vs. US$24) and only US$6 more costly per case identified (US$266 vs. US$260).\n\nCONCLUSION: Xpert is an effective method of diagnosing smear-negative TB. It is cost saving for patients, especially if performed

at point of care, but it is costly for health care providers. Data-driven studies are needed to determine its cost-effectiveness in resource-poor settings with diverse diagnostic practices.”
“Surgical eradication of minimal and mild endometriosis has been shown to increase the birth rate both spontaneously and after intrauterine insemination. This study from a reproductive medicine unit at a referral university hospital examined whether surgical eradication of minimal and mild endometriosis prior to IVF improved the treatment outcome. Records of infertile patients with minimal and mild endometriosis (American Society for Reproductive Medicine stages I and II) with no prior IVF/intracytoplasmic sperm injection (ICSI) treatments

were analysed. During the first treatment cycle, women who had undergone complete removal (n = 399) of endometriotic selleck kinase inhibitor lesions experienced, compared with women with diagnostic laparoscopy only (n = 262), a significantly improved implantation rate (30.9% versus 23.9%, P = 0.02), pregnancy rate (40.1% versus 29.4%, P = 0.004) and live-birth rate per ovum retrieval (27.7% versus 20.6%, P = 0.04). Surgical removal of minimal and mild endometriotic lesions also gave shorter time to first pregnancy and a higher cumulative pregnancy rate. The study shows that women with stages I and II endometriosis undergoing IVF/ICSI have significantly shorter time to pregnancy and higher live-birth rate if all visible endometriosis is completely eliminated at the time of diagnostic surgery. (C) 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.”
“Objective: Chronic physical comorbidity is common in dementia. However, there is an absence of evidence to support good practice guidelines for attention to these problems.

pallidum from MSM (prevalence ratio, 3 5; 95% confidence interval

pallidum from MSM (prevalence ratio, 3.5; 95% confidence interval, 1.9Y6.5). However, among T. pallidum from MSM, the A2058G mutation was not associated with the 14d9 subtype.\n\nConclusions: The A2058G mutation and 14d9 subtype of T. pallidum were present

throughout the United States. Both were more commonly found in T. pallidum from MSM compared with women or other men but were not associated with each other. Treating syphilis PX-478 nmr with azithromycin should be done cautiously and only when treatment with penicillin or doxycycline is not feasible.”
“Mathematical modeling of hepatitis C viral (HCV) kinetics is widely used for understanding viral pathogenesis and predicting treatment outcome. The standard model is based on a system of five non-linear ordinary differential equations (ODE) that describe both viral kinetics GDC-0994 purchase and changes in drug concentration after treatment initiation. In such complex models parameter estimation is challenging and requires frequent sampling measurements on each individual. By borrowing information between study subjects, non-linear mixed effect models can deal with sparser sampling from each individual. However, the search for optimal designs in this context has been limited by the numerical difficulty

of evaluating the Fisher information matrix (FIM). Using the software PFIM, we show that a linearization of the statistical model avoids most of the computational burden, while providing a good approximation to the FIM. We then compare the precision of the parameters that can be expected using five study designs from the literature. We illustrate the usefulness of rationalizing data sampling by showing that, for a given level of precision, optimal design could reduce the total number of measurements by up 50 per cent. Our approach can be used by a statistician or

a clinician aiming at designing an HCV viral kinetics study. Copyright (C) 2011 John Wiley & Sons, Ltd.”
“In this paper, we design, fabricate, and test a singleheater microinjector, whose ejected-droplet volume is adjusted by a digital combination of multiple current paths connected to a single microheater. The novel aspect of the present method includes using the single microheater having multiple Quisinostat ic50 current paths to achieve multilevel droplet volume adjustment. In the design process, we design four pairs of current I/O interconnection lines connected to the microheater. We numerically estimate the actually heated area whenever we vary the combination of 4-b current path through the single microheater. On the basis of the numerical and theoretical estimation results, we design the droplet-volume-adjustable microinjector having a rectangular (R)- and a circular (C)-shape single microheater. In the experimental study, we measure the sizes of the generated bubbles, as well as the volumes and velocities of the ejected droplets, according to the digital current-path combination.

As indicated by Fourier Transform Infrared Spectroscopy, the conc

As indicated by Fourier Transform Infrared Spectroscopy, the concentration of tetrahedral and octahedral sites within the Al2O3 layer changes PI3K inhibitor during temperature treatments and correlates with the amount of negative fixed charges at the Si/Al2O3 interface, which was detected by Corona Oxide Characterization of Semiconductors. Furthermore, during a temperature treatment at 820 degrees C for 30 min, the initial amorphous

Al2O3 layer crystallize into the c-Al2O3 structure and was enhanced by additional oxygen as was proven by x-ray diffraction measurements and underlined by Density Functional Theory simulations. The crystallization correlates with the increase of the optical density up to 20% while

the final Al2O3 layer thickness decreases learn more at the same time up to 26%. All observations described above were detected to be Al2O3 layer thickness dependent. These observations reveal novel aspects to explain the temperature induced passivation and degradation mechanisms of Al2O3 layers at a molecular level like the origin of the negative fixe charges at the Si/SiOx/Al2O3 interface or the phenomena of blistering. Moreover, the crystal phase of Al2O3 does not deliver good surface passivation due to a high concentration of octahedral sites leading to a lower concentration of negative fixed charges at the interface. (C) 2014 AIP Publishing LLC.”
“Epileptic Encephalopathy (EE) is a heterogeneous condition in which cognitive, sensory and/or motor functions deteriorate as a consequence of epileptic activity, which consists of frequent seizures and/or major interictal paroxysmal activity. There are various causes of EE and they may occur at any age in early childhood. Genetic mutations have been identified to contribute to an increasing

number of children with early onset EE which had been previously check details considered as cryptogenic. We identified 26 patients with Infantile Epileptic Encephalopathy (IEE) of unknown etiology despite extensive workup and without any specific epilepsy syndromic phenotypes. We performed genetic analysis on a panel of 7 genes (ARX, CDKL5, KCNQ2, PCDH19, SCN1A, SCN2A, STXBP1) and identified 10 point mutations [ARX (1), CDKL5 (3), KCNQ2 (2), PCDH19 (1), SCN1A (1), STXBP1 (2)] as well as one microdeletion involving both SCN1A and SCN2A. The high rate (42%) of mutations suggested that genetic testing of this IEE panel of genes is recommended for cryptogenic IEE with no etiology identified. These 7 genes are associated with channelopathies or synaptic transmission and we recommend early genetic testing if possible to guide the treatment strategy.

The number of subjects remained alcohol free for the entire study

The number of subjects remained alcohol free for the entire study period (16 weeks) and the number of subjects relapsed were not significantly different in the two groups. The survival function showed that patients treated with aripiprazole remained abstinent from any alcohol amount for a longer time with respect to those treated with naltrexone.

As for craving scores, patients treated with naltrexone showed a better outcome. Results from this study globally place aripiprazole at the same range of efficacy of naltrexone, Bcl-2 lymphoma one of the approved drugs used in alcohol relapse prevention. If it could be demonstrated in placebo-controlled trials that aripiprazole is efficacious in decreasing alcohol use, lessening craving, and attenuating psychopathological symptom severity, we will have gained a powerful agent for the treatment of alcohol-dependent subjects.”
“Purpose. To evaluate the clinical significance of a reduction in

serum carcinoembryonic antigen (s-CEA) concentration ratio from before to after preoperative chemoradiotherapy (CRT) in terms of recurrence and prognostic factors in rectal cancer patients.\n\nMethods. We retrospectively evaluated 333 rectal cancer patients who received preoperative CRT followed by surgery with curative intent between January 2000 and December 2006. Patients were divided into GDC-0994 clinical trial three groups: those with pre-CRT s-CEA a parts per thousand currency sign 6 ng/mL (group 1), those click here with pre-CRT s-CEA > 6 mg/mL and post-CRT s-CEA a parts per thousand yen 70% lower than pre-CRT s-CEA (group 2), and those with pre-CRT s-CEA > 6 mg/mL and post-CRT s-CEA < 70% lower or higher than pre-CRT s-CEA (group 3).\n\nResults. The 5-year disease-free survival rate was similar in group 1 (76.0%) and group 2 (66.0%), but significantly lower

in group 3 (39.5%) (p < 0.001). Multivariate analysis showed that CEA group 3, ypT stage, ypN stage, and type of surgery were independent prognostic factors for disease-free survival.\n\nConclusions. The reduction ratio of pre- to post-CRT s-CEA concentration may be an independent prognostic factor for disease-free survival following preoperative CRT and surgery in rectal cancer patients with initial s-CEA > 6 ng/mL.”
“Density functional theory was used to model glycinate enolate binding and enantiomeric allylation transition states mediated by the cinchonidinium phase-transfer catalyst 2. Transition states show oxy-anion-ammonium interactions in contrast to pi-face interactions in the ground states. The details of stereoselectivity are described within the quaternary ammonium-tetrahedron face model.”
“Real time Wide-Angle X-ray Scattering (WAXS) measurements during cyclic tensile tests at high strain rates (from 8 s(-1)-280 s(-1)) and at room temperature on crosslinked Natural Rubber (NR) are performed thanks to a specific homemade device.


“Patients with diseases characterized by chronic inflammat


“Patients with diseases characterized by chronic inflammation, caused by infection or cancer, have T cells and NK cells with impaired function. The CBL0137 Apoptosis inhibitor underlying molecular mechanisms are diverse, but one of the major mediators in this immune suppression is oxidative stress caused by activated monocytes, granulocytes, or myeloid-derived suppressor cells. Reactive oxygen species can seriously

hamper the efficacy of active immunotherapy and adoptive transfer of T and NK cells into patients. In this study, we have evaluated whether enhanced expression of the antioxidant enzyme catalase in human T cells can protect them against reactive oxygen species. Human CD4(+) and CD8(+) T cells retrovirally transduced with the catalase gene had increased intracellular expression and activity of Sirtuin inhibitor catalase. Catalase transduction made CD4(+) T cells less sensitive to H(2)O(2)-induced loss-of-function, measured

by their cytokine production and ability to expand in vitro following anti-CD3 stimulation. It also enhanced the resistance to oxidative stress-induced cell death after coculture with activated granulocytes, exposure to the oxidized lipid 4-hydroxynonenal, or H(2)O(2). Expression of catalase by CMV-specific CD8(+) T cells saved cells from cell death and improved their capacity to recognize CMV peptide-loaded target cells when exposed to H(2)O(2). These findings indicate that catalase-transduced T cells potentially are more efficacious for the immunotherapy of patients with advanced cancer or chronic viral infections. The Journal of Immunology, 2008, 181: 8382-8390.”
“Nucleoside diphosphate kinases (NDPKs) are enzymes required to

preserve the intracellular nucleoside phosphate equilibrium. Trypanosoma cruzi has four putative nucleoside diphosphate kinases with unidentified biological roles and subcellular localization. TcNDPK2 has an N-terminal domain (DM10) with unknown function, which defines a subgroup of NDPKs distributed in a wide variety of organisms. Digitonin extraction demonstrated that this isoform is distributed find more in detergent soluble and insoluble fractions. Fluorescence microscopy showed that TcNDPK2 alone or fused to GFP was localized in cytoskeleton and flagella. TcNDPK2 was also detected by Western blot in purified polymerized tubulin and flagellar samples. In parasites expressing DM10 fused with GFP, the fluorescence was localized in cytoskeleton and flagellum with an identical pattern to TcNDPK2. This constitutes the first report that could give insights on the role of DM10 domains in NDPKs and also the identification of the first T. cruzi peptide that contains a microtubule association domain. (C) 2011 Elsevier B.V. All rights reserved.

In addition, functionality

In addition, functionality

this website of the NS3/4A-specific T cells was analyzed by a standard cytotoxicity assay. First, we identified a new unique murine H-2(d)-restricted NS3/4A cytotoxic T lymphocyte (CTL) epitope, which enabled us to study the epitope-specific immune responses. Our results show that the coNS3/4A vaccine was highly immunogenic by determination of interferon-gamma/tumor necrosis factor-a production and lytic cytotoxic T cells, which could efficiently inhibit in vivo tumor growth. Importantly, we showed that one to four monthly immunizations protected mice from tumor development when challenged up to 16 months after the last immunization. When determining the functionality of NS3/4A-specific T cells in vitro, we showed detectable lytic activity up to 12 months after the last immunization. Thus, NS3/4A-based DNA vaccines activate potent cellular immune responses that are present and function in both BALB/c and C57BL/6J mice up to 12-16 months after the last immunization. The induction of long-term click here immunity after NS3/4A DNA immunization has not been shown previously and supports the use of NS3/4A in hepatitis C virus vaccine compositions.”
“The amygdala is related with the recognition of the emotional meaning of stimuli, long-term memory,

the orientation of social stimuli and the perception of gaze orientation. It plays a fundamental role in the recognition of faces, especially those expressing fear, and makes it possible to comprehend different emotional

states, which will facilitate an appropriate social cognition. Dysfunctions of the amygdala have been associated to a number of different neurodevelopmental disorders as well as neurocognitive and behavioural disorders in specific neurogenetic entities. A number of studies focused on the amygdalic complex have allowed researchers to understand many pathophysiological aspects and to formulate new hypotheses regarding their origins. Given that the disorders or conditions in which the role of the amygdala has been evoked are becoming increasingly more extensive, this article refers the reader to those that have aroused the most interest in recent years. NSC23766 research buy Thus, they can be divided into two groups: developmental and behavioural disorders (autism, anxiety disorders, bipolar disorder, alexithymia and anorexia nervosa) and specific neurogenetic entities (fragile X, Rett, Prader-Willi and Williams syndromes), in which structural or dysfunctional alterations have been observed that may be related with their neurocognitive and behavioural symptoms. It is important to remember that the amygdala is a highly connected structure that forms truly functional networks and has been associated to different disorders with varied explanations and includes several different pathophysiological phenomena. Its role must not, therefore, be simplified in a reductionistic manner, but also placed upon a hierarchy of dysfunctions in other areas that interact with it.


“Accurate prediction of protein-DNA complexes could provid


“Accurate prediction of protein-DNA complexes could provide an important

stepping stone towards a thorough comprehension of vital intracellular processes. Few attempts were made to tackle this issue, focusing on binding patch prediction, protein function classification and distance constraints-based docking. We introduce ParaDock: a novel ab initio protein-DNA docking algorithm. ParaDock combines short DNA fragments, which have been rigidly docked to the protein based on geometric complementarity, to create bent planar DNA molecules of arbitrary sequence. Our algorithm was tested on the bound and unbound targets of a protein-DNA benchmark comprised of 47 complexes. With neither addressing protein flexibility, nor applying any refinement procedure, CAPRI acceptable solutions were obtained among the 10 top ranked hypotheses in 83% of the bound BKM120 order complexes, and 70% of the unbound. Without requiring prior knowledge of DNA length and sequence, and within < 2 h per target on a standard 2.0 GHz single processor CPU, ParaDock offers a fast ab initio docking solution.”
“Large-scale (similar to 36,000 atoms) long-time (30 ns each) molecular dynamics (MD) simulations on the complex of imatinib and 16 common mutants of the ABL tyrosine kinase domain have been performed to study the imatinib resistance mechanisms at the atomic level. MD simulations show that long

time computational simulations could offer insight information that static find protocol models, simple homology modeling methods, or short-time check details simulations cannot provide for the BCR-ABL imatinib resistance

problem. Three possible types of mutational effects from those mutants are found: the direct effect on the contact interaction with imatinib (e. g. some P-loop mutations), the effect on the conformation of a remote region contacting with imatinib (e. g. T315I), and the effect on interaction between two regions within the BCR-ABL domain (e. g. H396P). Insights of possible imatinib resistance mechanisms, not consistent with current consensus, are revealed from various analyses and our findings suggest that drugs with different binding modes may be necessary to overcome the drug resistance due to T315I and other mutations. The relevant patents are discussed.”
“Flax phloem fibers achieve their length by intrusive-diffusive growth, which requires them to penetrate the extracellular matrix of adjacent cells. Fiber elongation therefore involves extensive remodelling of cell walls and middle lamellae, including modifying the degree and pattern of methylesterification of galacturonic acid (GalA) residues of pectin. Pectin methylesterases (PME) are important enzymes for fiber elongation as they mediate the demethylesterification of GalA in muro, in either a block-wise fashion or in a random fashion. Our objective was to identify PMEs and PMEIs that mediate phloem fiber elongation in flax.

The administration of P-naphthoflavone (BNF), an agonist for aryl

The administration of P-naphthoflavone (BNF), an agonist for aryl hydrocarbon receptor (AhR), induced CYP1A1 gene expression in the cornea, lens and Androgen Receptor assay liver of the rats, although the levels of induction were greatest in the liver. An AhR-sensitive UDP-glucuronosyl transferase (UGT) 1A6 gene was also induced in the cornea and the lens by BNF. Phenobarbital (PB) is a known inducer of the CYP2B genes, the expression of which is mediated by constitutive activated receptor (CAR), but did not induce CYP2B1 in the cornea or lens. This insensitivity to PB may be due to the lack of CAR expression in the ocular tissues as revealed in our present

study. Pregnenolone-16 alpha-carbonitrile (PCN) is known to induce CYP3A gene expression in the liver via the activation of pregnane X receptor (PXR). However, although PCN was found to induce the CYP3A1

gene in the rat cornea and liver, it failed to do so in the lens. In addition, another of the PXR-mediated genes, multidrug resistance-associated protein 3 (Mrp3), was not induced by PCN in either ocular region. Since the expression of the PXR gene was not detected in the rat ocular tissues, an unknown mechanism for the inducible regulation of CYP3A1 ON-01910 purchase gene expression by PCN in the cornea is suggested.”
“Study Objectives: Suicide in the adolescent population is a tragic and preventable cause of death. Previous studies have confirmed both long and short total sleep times (TSTs) are associated with suicidal ideation in the adult population.

We hypothesized that both long and short TSTs are risk factors for serious suicide attempt in the adolescent population as well.\n\nMethods: Ilomastat in vivo We tested this hypothesis using the Youth Risk Behavior Surveys from 2007 and 2009, which consist of school-based, nationally representative samples (N = 12,154 for 2007, N = 14,782 for 2009). Logistic regression models were used to assess the relationship between suicidality and sleep after adjusting for confounders including age, sex, race/ethnicity, feelings of sadness, and substance abuse.\n\nResults: Of the total sample, roughly 15% reported suicidal ideation, 10% planned suicide, 5% attempted and 2% reported an attempt requiring treatment. Teens who reported sleeping <= 5 or >= 10 h had a significantly higher risk for suicidality compared to those with a TST of 8 h. The largest odds ratios were found among the most severe forms of suicidality (attempt requiring treatment) with an odds ratio of 5.9 for a TST <= 4 h and 4.7 for a TST >= 10 h.\n\nConclusion: Both short and long TSTs are risk factors for suicidality among teens and extremes in TST may indicate more serious suicidality. Self-reported sleep duration may be a useful screening question for suicide risk. Future studies should examine whether sleep duration is a causal and/or modifiable risk factor for suicidality in teens.

Since ANO1 modulators are developed for the purpose of treating c

Since ANO1 modulators are developed for the purpose of treating chronic diseases such as cystic fibrosis, this finding is likely to predict unwanted effects and provide a guide for better developmental strategy.”
“G protein-coupled receptor 119 (GPCR 119 (GPR119)) agonists have received considerable attention as a promising therapeutic option for treatment of type 2 diabetes mellitus. GPR119 is one of

the GPCRs expressed in pancreatic islet p-cells and its activation enhances stimulation BMS-777607 of insulin secretion in a glucose-dependent manner. We have recently described a series of 6-amino-1H-indan-1-ones as potent, selective, and orally bioavailable GPR119 agonists with an amino group that plays important roles not only in their drug-like properties, such as high aqueous solubility, but also in their potent agonistic activity. However, many of these compounds

check details displayed strong to moderate inhibition of human ether-a-go-go related gene channel. Attenuation of the basicity of the amino group by replacing the adjacent benzene ring with electron-deficient heteroaromatic rings provided several heterocyclic cores among which 6-aminofuro[3,2-c] pyridin-3(2H)-one was selected as a promising scaffold. Further optimization around the side chain moiety led to the discovery of 17i, which showed not only strong human GPR119 agonistic activity (EC50 = 14 nM), but also beneficial effects on gastric emptying and plasma total glucagon-like peptide-1 levels in mice.”
“Background/Aim\n\nDigital www.selleckchem.com/products/cobimetinib-gdc-0973-rg7420.html photography can be used to measure skin color colorimetrically when combined with proper techniques. To better understand the settings of digital photography for the evaluation and measurement of skin colors, we used a tungsten lamp with filters and the custom white balance (WB) function of a digital camera.\n\nMaterials and methods\n\nAll colored squares on a color chart were photographed

with each original and filtered light, analyzed into CIELAB coordinates to produce the calibration method for each given light setting, and compared statistically with reference coordinates obtained using a reflectance spectrophotometer. They were summarized as to the typical color groups, such as skin colors. We compared these results according to the fixed vs. custom WB of a digital camera.\n\nResults\n\nThe accuracy of color measurement was improved when using light with a proper color temperature conversion filter. The skin colors from color charts could be measured more accurately using a fixed WB. In vivo measurement of skin color was easy and possible with our method and settings.\n\nConclusion\n\nThe color temperature conversion filter that produced daylight-like light from the tungsten lamp was the best choice when combined with fixed WB for the measurement of colors and acceptable photographs.”
“Background Warfarin reduces thromboembolic risks in atrial fibrillation (AF), but therapeutic durability remains a concern.