Despite maintained carcinogen exposure, tumors from smokers showed a relative decrease in
smoking-related mutations over time, accompanied by an increase in APOBEC-associated mutations. In tumors from former smokers, PF-6463922 cell line genome-doubling occurred within a smoking-signature context before subclonal diversification, which suggested that a long period of tumor latency had preceded clinical detection. The regionally separated driver mutations, coupled with the relentless and heterogeneous nature of the genome instability processes, are likely to confound treatment success in NSCLC.”
“IMPORTANCE Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited. OBJECTIVE To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from nonrural counties who experienced out-of-hospital cardiac arrest between January 1, 2009, and October 2, 2011, and for whom ALS Selleck GSK1120212 or BLS ambulance services were billed to Medicare (31 292 ALS cases and 1643 BLS cases). Propensity score
methods were used to compare the effects of ALS and BLS on patient survival, neurological performance, and medical spending after cardiac arrest. MAIN OUTCOMES AND MEASURES Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year. RESULTS Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3-5.7] percentage
point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2-4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6-27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year this website for BLS relative to ALS was $ 154 333. CONCLUSIONS AND RELEVANCE Patients with out-of-hospital cardiac arrest who received BLS had higher survival at hospital discharge and at 90 days compared with those who received ALS and were less likely to experience poor neurological functioning.”
“It has long been speculated that cellular microdomains are important for many cellular processes, especially those involving Ca2+ signalling. Measurements of cytosolic Ca2+ report maximum concentrations of less than few micromolar, yet several cytosolic enzymes require concentrations of more than 20 mu M Ca2+ to be activated.
Research over the last decade has found a variety of abnormalities in the processing of motion information in schizophrenia. The abnormalities span from discrimination of basic motion features (such as speed)
to integration of spatially distributed JNK inhibitor concentration motion signals (such as coherent motion). Motion processing involves visual signals across space and time and thus presents a special opportunity to examine how spatial and temporal information is integrated in the visual system. This article surveys the behavioral and neuroimaging studies that probe into the spatial integration of motion information in schizophrenia. An emerging theme from these studies points to an imbalanced regulation of spatial interaction processes as a potential mechanism mediating different levels of abnormal motion processing in schizophrenia. The synthesis of these mechanism-driven studies suggests that further investigation of the neural basis and functional consequences of
this abnormal motion processing are needed in order to render a basic biomarker for assessment and intervention of cognitive dysfunction in this selleck mental disorder.”
“Objectives/Hypothesis To evaluate the feasibility and efficacy of transtympanic L-N-Acetylcysteine (L-NAC) administration in patients receiving cisplatin chemotherapy for head and neck cancer.\n\nStudy DesignProspective randomized nonblinded open-label clinical trial.\n\nMethodsTranstympanic 2% L-NAC was administered to one randomly selected ear with the other ear as control in each patient. Primary outcome parameter was the difference in the loss of pure
tone averages (PTA) at 2, 4, and 8 kHz between the L-NAC and control ear at 1 to 2 months following chemotherapy.\n\nResultsEleven patients completed the study, with FDA-approved Drug Library two patients demonstrating significantly better hearing in the L-NAC treated ear (18.2%). However, for the overall group, the difference in hearing preservation did not reach significance. Two percent L-NAC administration was well tolerated in this patient population. There were no adverse effects associated with L-NAC.\n\nConclusion Although the study did not demonstrate a significant benefit overall, transtympanic L-NAC was associated with significantly better hearing in two patients. Better delivery methods may improve the efficacy of this treatment. L-NAC remains a promising drug in preventing cisplatin-induced 123 ototoxicity.”
“Steroid sex hormones play critical roles in the development of brain regions used for vocal learning. It has been suggested that puberty-induced increases in circulating testosterone (T) levels crystallize a bird’s repertoire and inhibit future song learning. Previous studies show that early administration of T crystallizes song repertoires but have not addressed whether new songs can be learned after this premature crystallization.
(C) 2010 Wiley-Liss, Inc.”
“Background and Purpose-Increased total homocysteine Ilomastat mw (tHcy) is a risk factor for stroke. This study examines whether the efficacy of B-vitamins in reducing tHcy is modified by ethnicity in a Singaporean ischemic stroke population.\n\nMethods-505 patients (419 Chinese, 41 Malays and 45 Indians) with ischemic stroke were randomized to receive placebo or B-vitamins. Fasting blood samples collected at baseline and 1 year were assayed for tHcy. MTHFR polymorphisms were
genotyped.\n\nResults-Ethnicity did not independently determine tHcy at baseline. The magnitude of tHcy reduction by B-vitamin treatment was consistent across ethnic groups (Chinese -3.8 +/- 4.5, Malay -4.9 +/- 4.2, and Indian -3.3 +/- 3.6 mu mol/L) despite ethnic differences in MTHFR genotype and baseline folic acid (FA) and vitamin B(12) (vitB(12)) concentrations.\n\nConclusions-Ethnicity does not appear to affect the tHcy-lowering effect
of B-vitamins, despite differences in dietary intake and prevalence of MTHFR polymorphisms. This suggests that the effect of B-vitamins in lowering tHcy is generalizable across Asian populations. However, due to relatively small numbers of non-Chinese studied, confirmation in other populations is required. (Stroke. 2009; 40: 2209-2211.)”
“The microRNA-183/96/182 cluster is Wnt inhibitor review highly expressed in the retina and other sensory organs. To uncover its in vivo functions in the retina, we generated a knockout mouse model, designated “miR-183C(GT/GT),” using a gene-trap embryonic stem cell clone. We provide evidence that inactivation of the cluster results in early-onset and progressive synaptic defects of the photoreceptors, leading to abnormalities of scotopic and photopic electroretinograms with decreased b-wave amplitude as the primary defect and progressive retinal degeneration. In addition, inactivation of the miR-183/96/182 cluster resulted in global selleckchem changes in retinal gene expression,
with enrichment of genes important for synaptogenesis, synaptic transmission, photoreceptor morphogenesis, and phototransduction, suggesting that the miR-183/96/182 cluster plays important roles in postnatal functional differentiation and synaptic connectivity of photoreceptors.”
“Cancer patients undergoing treatment may find it difficult to maintain proper caloric intake. This survey sought to characterize food/beverage preferences and services related to nutritional needs for oncology outpatients. A total of 222 adult oncology patients completed surveys while in an oncology clinic for treatment or for a medical appointment. Data were collected on demographic characteristics, cancer diagnosis/treatment, general health behaviours, preferences for various foods and beverages that could feasibly be offered in the clinic setting and interest in nutrition-related services.
of this study was to use oscillatory changes in the electroencephalogram (EEG) related to informative cue processing, motor preparation, and top-down control to investigate neurophysiological differences between typically developing (TD) adolescents, and those diagnosed with predominantly inattentive (IA) or combined (CB) (associated with symptoms of inattention as well as impulsivity/hyperactivity) subtypes of ADHD. Methods: The EEG was recorded from 57 rigorously screened adolescents (12 to17 years of age; 23 TD, Ricolinostat 17 IA, and 17 CB), while they performed a cued flanker task. We examined the oscillatory changes in theta (3-5 Hz), alpha (8-12 Hz), and beta (22-25 Hz) EEG bands after cues that informed participants with which hand they would subsequently be required to respond. Results: Relative to TD adolescents, the IA group showed significantly less postcue alpha suppression, suggesting diminished processing of the cue in the visual 432 cortex, whereas the CB
group showed significantly less beta suppression at the electrode contralateral to the cued response hand, suggesting poor motor planning. Finally, both ADHD subtypes showed weak functional connectivity between frontal theta and posterior alpha, suggesting common top-down control impairment. Conclusions: We found both distinct and common task-related neurophysiological impairments in ADHD subtypes. Our results suggest that task-induced changes in EEG oscillations provide an objective measure, ALK inhibitor which in conjunction with other sources of information might help distinguish between ADHD subtypes and therefore aid in diagnoses Sotrastaurin chemical structure and evaluation of treatment.”
“Stem cells are a powerful resource for cell-based transplantation therapies, but understanding of stem cell differentiation at the molecular level is not clear yet. We hypothesized that the Wnt pathway controls stem cell maintenance and neural differentiation. We have characterized the transcriptional expression
of Wnt during the neural differentiation of hADSCs. After neural induction, the expressions of Wnt2, Wnt4, and Wnt11 were decreased, but the expression of Wnt5a was increased compared with primary hADSCs in RT-PCR analysis. In addition, the expression levels of most Fzds and LRP5/6 ligand were decreased, but not Fzd3 and Fzd5. Furthermore, Dvl1 and RYK expression levels were downregulated in NI-hADSCs. There were no changes in the expression of beta-catenin and GSK3 beta. Interestingly, Wnt5a expression was highly increased in NI-hADSCs by real time RT-PCR analysis and western blot. Wnt5a level was upregulated after neural differentiation and Wnt3, Dvl2, and Naked1 levels were downregulated. Finally, we found that the JNK expression was increased after neural induction and ERK level was decreased.
“In cementless total hip arthroplasty, osteoporosis Navitoclax may jeopardize the achievement of immediate stability and lead to migration of anatomically shaped femoral stems. Poor quality of proximal cancellous bone per se may also affect the rate of osseointegration. In a selected group of female total hip arthroplasty patients (mean age 64 years) with unremarkable medical history, 4 intertrochanteric cancellous bone biopsy was taken from the site of
stem implantation. Local bone quality, determined by structural mu CT imaging and destructive compression testing of the biopsy tissue, was used as the predictor of three-dimensional stem migration determined by radiostereometric analysis (RSA) up to 24 months. The patients exhibited major differences in mechanical properties of the intertrochanteric cancellous bone, which were closely related HDAC cancer to the structural parameters calculated from mu CT data. Unexpectedly, the major differences observed in the quality of trochanteric cancellous bone had
only minor reflections in the RSA migration of the femoral stems. In statistical analysis, the mu CT-based bone mineral density quartile (low, middle, high) was the only significant predictor for stem translation at 24 months (p = 0.022) but only a small portion (R(2)=0.16) of the difference in translation could be explained by changes in bone mineral density quartile. None of the other parameters investigated predicted stem migration in translation or rotation. In conclusion, poor quality of
intertrochanteric cancellous bone seems to contribute to the risk of implant migration less than expected. Probably also the importance of surgical preservation of intertrochanteric cancellous bone has been over-emphasized for osseointegration of cementless stem. (C) 2010 Elsevier Ltd. All rights reserved.”
“Bingeing on sugar may activate neural pathways in a manner similar to taking drugs of abuse, resulting in related signs of dependence. The present experiments test whether rats that have been bingeing on sucrose and then fasted demonstrate signs of opiate-like withdrawal. Rats were maintained on 12-h deprivation followed by 12-h access to a 10% sucrose solution and chow for 28 days, then fasted for 36 h. These animals spent less selleck inhibitor time on the exposed arm of an elevated plus-maze compared with a similarly deprived ad libitum chow group, suggesting anxiety. Microdialysis revealed a concomitant increase in extracellular acetylcholine and decrease in dopamine release in the nucleus accumbens shell. These results did not appear to be due to hypoglycemia. The findings suggest that a diet of bingeing on sucrose and chow followed by fasting creates a state that involves anxiety and altered accumbens dopamine and acetylcholine balance. This is similar to the effects of naloxone, suggesting opiate-like withdrawal. This may be a factor in some eating disorders. (C) 2008 Elsevier Inc. All rights reserved.
To better define the physiological properties of NG2(+) cells, we used transgenic mice that allowed an unbiased sampling of this population and unambiguous identification of cells in discrete states of differentiation. Using acute brain slices prepared from developing and mature mice, we found that NG2(+) cells in diverse brain regions share a core set of physiological properties, including expression of voltage-gated Na(+) (NaV) channels and ionotropic glutamate receptors, and formation of synapses with glutamatergic neurons. Although small amplitude Na(+) spikes could be elicited in some NG2(+) cells during the first postnatal week, they were not capable of generating action potentials. Transition of these
progenitors to the premyelinating stage was accompanied by Bafilomycin A1 order C59 Wnt purchase the rapid removal of synaptic input, as well as downregulation of AMPA and NMDA 123 receptors and NaV channels. Thus, prior reports of physiological heterogeneity among NG2(+) cells may reflect analysis of cells in later stages of maturation. These results suggest that NG2(+) cells are uniquely positioned within the oligodendrocyte lineage to monitor the firing patterns of surrounding neurons.”
“Cellulase was immobilized on chitosan by the method of covalent binding. The optimum immobilized conditions were as follow: the pH value was 5.0, the glutaraldehyde concentration was 0.015 (w/v) and the formaldehyde concentration was 0.15 (w/v). Both the free
and immobilized cellulase were characterized by determining the pH, temperature, thermal stability and storage stability. The optimum pH of both the free and immobilized cellulase was found as 4. The immobilized cellulase had optimum temperature of 50 degrees C as compared to 40 degrees C in case of free enzyme. The immobilized enzyme showed higher thermal stability than the free cellulase, after 120 min, the Crenolanib datasheet activity of immobilized cellulose and the free enzyme retained 86.5 and 61%
respectively. After 11 cycles, the activity of the immobilize enzyme conserved 80.27%. The immobilized enzyme exhibited slightly better storage stability than the free enzyme. The Km and Vm values for the immobilized and free cellulase were 8.1 and 1.84 mg/L and 0.01 and 0.0036 mg/ml/min respectively. Cellulose hydrolysis by immobilized cellulase in the presence of a 88 ionic liquid (IL), 1,3-dimethylimidazolium dimethylphosphate (MMIM-DMP), was investgated. The result showed that the addition of 20% (v/v) MMIM-DMP gave the highest initial rate, which was 1.3 and 13.9 times higher than the hydrolysis rate in citric acid – sodium hydrogen phosphate buffer and in IL, respectively.”
“Animals are known to exhibit ‘personality’; that is, individual differences in behaviour that are consistent across time and/or situations. One axis of personality of particular importance for behavioural ecology is boldness, which can be defined as the tendency of an individual to take risks.
01) after both
types of exercise. Contrary to our hypothesis, the results demonstrate that ER, performed after E, amplifies the adaptive signaling response of mitochondrial biogenesis compared with single-mode endurance exercise. The mechanism may relate to a cross talk between signaling pathways mediated by mTOR. The results suggest that find more concurrent training may be beneficial for the adaptation of muscle oxidative capacity.”
“Apolipoprotein-E protein is an endogenous immunomodulatory agent that affects both the innate and the adaptive immune responses. Since individuals with the APOE4 gene demonstrate worsened pathology and poorer outcomes in many neurological disorders, we examined isoform-specific differences in the response of microglia, the primary cellular component of the brain’s innate immune response, in detail. Our data demonstrate that microglia derived from APOE4/4 targeted replacement mice demonstrate a pro-inflammatory phenotype that includes altered cell morphology, increased NO production associated
with increased NOS2 mRNA levels, and higher pro-inflammatory cytokine production (TNF alpha, IFL-6, IL12p40) compared to microglia derived from APOE-3/3 targeted replacement mice. The effect is gene dose-dependent and increases with the number of APOE4 gene alleles. The APOE genotype-specific immune profile observed in the microglial TH-302 ic50 immune response is also observed in the cortex of aged APOE3/3 and APOE4/4 mice treated with lipopolysacchride (LPS) Small molecule library and in peripheral (peritoneal)
macrophages. To determine if APOE4′s action resulted from an isoform-specific difference in effective levels of the apolipoproteins, we generated mice expressing only a single allele of APOE3. Immune-stimulated macrophages from APOE3/0 mice demonstrated an increased inflammatory response compared to APOE3/3 mice, but less than in APOE4/4 mice. These data suggest that inhibition of inflammation depends upon the dose of apoE3 protein available and that apoE4 protein may alter inflammation partly by dose effects and partly by being qualitatively 432 different than apoE3. Overall, these data emphasize the important role of apolipoprotein E and of the APOE genotype on the immune responses that are evident in most, if not all, neurological disease. (C) 2007 Elsevier Inc. All rights reserved.”
“ATP-sensitive potassium channels (K(ATP)) play a crucial role in coupling metabolic energy to the membrane potential of cells, thereby functioning as cellular “metabolic sensors.” Recent evidence has showed a connection between the amyloid neurotoxic cascade and metabolic impairment. With regard to their neuroprotection in other neuronal preparations, K(ATP) channels may mediate a potential neuroprotective role in Alzheimer’s disease (AD).
\n\n3. The birds stunned with N-2 displayed the highest initial reduction in muscle pH, but after 4 h post mortem there were no differences in pH values associated with the various CAS methods.\n\n4. The CAS method alone had no statistically significant effect on the quality of turkey breast muscle when the chilling speed was rapid (0 degrees C for 4 h, followed by storage at 4 degrees C). When the chilling rate BMS-754807 in vitro was slowed (20 degrees C for 4 h followed by storage at 4 degrees C), a significant decrease in cooking loss and in Warner-Bratzler shear force was recorded for birds stun-killed with
CO2.\n\n5. This study shows that anoxic stun-killing with N-2 had no adverse effects on meat quality despite the rapid post mortem pH decrease. The CAS with N-2 allows Quisinostat ic50 rapid cooling of carcases without the risk of cold shortening, whereas with CO2-stun-killing of turkeys, the rate of chilling should be slower. Concerning meat quality, all the CAS methods tested were suitable for stunning turkeys.”
“Epicardial adipose tissue is a source of pro-inflammatory
cytokines and has been linked to the development of coronary artery disease. No study has systematically assessed the relationship between local epicardial fat volume (EFV) and myocardial perfusion defects. We analyzed EFV in patients undergoing SPECT myocardial perfusion selleck compound imaging combined with computed tomography (CT) for attenuation correction. Low-dose CT without contrast was performed in 396 consecutive patients undergoing SPECT imaging for evaluation of coronary artery disease. Regional thickness, cross-sectional areas, and total EFV were assessed. 295 patients had normal myocardial perfusion scans and 101 had abnormal perfusion scans. Mean EFVs in normal, ischemic, and infarcted hearts were 99.8 +/- A 82.3 cm(3), 156.4 +/- A 121.9 cm(3), and 96.3 +/- A 102.1 cm(3), respectively (P smaller than 0.001). Reversible perfusion defects were associated with increased local EFV compared to normal
perfusion in the distribution of the right (69.2 +/- A 51.5 vs 46.6 +/- A 32.0 cm(3); P = 0.03) and left anterior descending coronary artery (87.1 +/- A 76.4 vs 46.7 +/- A 40.6 cm(3); P = 0.005). Our results demonstrate increased regional epicardial fat in patients with active myocardial ischemia compared to patients with myocardial scar or normal perfusion on nuclear perfusion scans. Our results suggest a 123 potential role for cardiac CT to improve risk stratification in patients with suspected coronary artery disease.”
“We report a method for detecting DNA single-base polymerization using a complementary metal oxide semiconductor (CMOS) field effect transistor (FET)-based redox potential sensor array.
binding constant (K) value as determined from fluorescence experiments of AZD4547 purchase complexes 5 and 6 were calculated to be 4.09 x 10(4) and 2.51 x 10(4) M-1, respectively revealing that complex 5 has greater binding propensity for DNA. To gain further insight into the molecular recognition at the target site, interaction studies of 5 with 5′-GMP were carried out by employing H-1 and P-31 NMR spectroscopy. Complex 5 exhibited preferential selectively towards the minor groove of pBR322 DNA and efficient cleavage activity via hydrolytic pathway. Furthermore complexes 4-6 exhibited significant antimicrobial activity. (C) 2012 Elsevier B.V. All rights reserved.”
“About 30% of all female ‘groin’ hernias are femoral hernias, although often only diagnosed during surgery. A Lichtenstein repair though, as preferred treatment modality according to guidelines, would not diagnose and treat selleck screening library femoral hernias. Totally extraperitoneal (TEP) hernia repair, however, offers the advantage of being an appropriate modality for the diagnosis
and subsequent treatment of both inguinal and femoral hernias. TEP therefore seems an appealing surgical technique for women with groin hernias.\n\nThis study included all female patients a parts per thousand yen18 years operated for a groin hernia between 2005 and 2009.\n\nA total Emricasan supplier of 183 groin hernias were repaired in 164 women. TEP was performed in 85% of women; the other 24 women underwent an open anterior (mesh) repair. Peroperatively,
femoral hernias were observed in 23% of patients with primary hernias and 35% of patients with recurrent hernias. There were 30 cases (18.3%) of an incorrect preoperative diagnosis. Peroperatively, femoral hernias were observed in 17.3% of women who were diagnosed with an inguinal hernia before surgery. In 3 addition, inguinal hernias were found in 24.0% of women who were diagnosed with a femoral hernia preoperatively. After a follow-up of 25 months, moderate to severe (VAS 4-10) postoperative pain was reported by 8 of 125 patients (6.4%) after TEP and 5 of 23 patients (21.7%) after open hernia repair (P = 0.03). Five patients had a recurrent hernia, two following TEP (1.4%) and three following open anterior repair (12.5%, P = 0.02). Two of these three patients presented with a femoral recurrence after a previous repair of an inguinal hernia.\n\nFemoral hernias are common in women with groin hernias, but not always detected preoperatively; this argues for the use of a preperitoneal approach. TEP hernia repair combines the advantage of a peroperative diagnosis and subsequent appropriate treatment with the known good clinical outcomes.”
“The primary management of lymph nodes involved with metastatic melanoma is regional lymphadenectomy.
Through the meticulous study of the first cases and the telephone calls to those who attended the summer camp, 90% of the cases of the outbreak were detected.\n\nConclusions:
The active search of cases allowed an outbreak of whooping cough with a high attack rate to be studied in children and adolescents with a high vaccination coverage, and the application of control measures that contributed to stop the outbreak. (C) 2010 Elsevier Espana, S.L. All rights reserved.”
“In this work, a study about the separation of antioxidant substances from Siraitia grosvenori’ leaves considered as an selleckchem agricultural waste was undertaken. The leaves of S. grosvenori were extracted with ethanol (phi(B) = 0.95) to obtain a crude extract (SEE). The antioxidant activity of SEE was evaluated and compared with that of butylated hydroxytoluene (BHT) using DPPH free radical, ABTS free radical, total antioxidant activity and reducing power assay. SEE had an antioxidant activity
similar to that of BHT. The total flavonoids content of SEE was found to be catechin equivalent check details of 83.45 g kg(-1) of extract. Higher flavonoids compounds may be major contributors to its high antioxidant activity. Following activity-oriented separation, three flavonoid compounds such as kaempferol-3-O-alpha-L-rhamnopyranosyl-7-O-[beta-D-glucopyranosyl-(1-2)-O-L-rhamnoside] (GR), kaempferol-3-O-beta-D-glucose-7-O-alpha-L-rhamnoside (KG) and quercetin were separated from S. grosvenori’ leaves. All of them expressed good free radical scavenging activities. (C) 2011 Elsevier Ltd. All rights reserved.”
great majority of ovarian clear cell carcinomas have a hepatocyte nuclear factor 1 homeobox B (HNF-1)-positive and oestrogen receptor (ER)-negative immunoprofile. However, the pattern of HNF-1 and ER immunostaining in clear cell carcinomas of the endometrium and find more the usefulness of this panel in distinguishing clear cell carcinoma from other histological types of endometrial carcinoma have yet to be well defined. Methods and resultsWe examined the immunostaining patterns of HNF-1, ER and p53 in 15 morphologically classic pure endometrial clear cell carcinomas, and compared these patterns with 15 endometrioid and 15 serous carcinomas of the endometrium. We observed the presence of diffuse ( bigger than 70%) 3 moderate to strong nuclear HNF-1 staining and negative ER staining in 14 of 15 clear cell carcinomas, with the remaining case showing both diffuse strong nuclear HNF-1 staining and focal ER staining. In comparison, only one of 15 serous carcinomas and none of 15 endometrioid carcinomas showed a combination of diffuse moderate to strong HNF-1 nuclear staining and negative ER staining. Aberrant p53 immunostaining was observed in five of 15 (33%) clear cell carcinomas.