We report the first case with operative demonstration of a primary adenocarcinoma arising from an azygos lobe, which was treated with robot-assisted azygos lobectomy.”
“There is lack data concerning ON-01910 anterior cervical spine revision surgeries; even more data are missing concerning posterior cervical revision surgeries, to determine the feasibility, safety, and clinical efficacy of revision surgery for irreducible atlantoaxial dislocation (RS-IAAD). Patients with IAAD-FS underwent one-stage transoral

release and posterior reduction. Their medical history was documented in detail. The JOA score system was used to evaluate each patient’s neurological status pre and postoperatively, and serial MRI and radiographs were used to determine the status of the reduction and the autografts. 16 patients (average age, 36 years old) underwent successful surgery. There was no intraoperative or postoperative neurological deficit except in two cases that suffered transient neurological deficit that alleviated

after conservative treatment. Solid bony union was seen at the end of 3 months after surgery BEZ235 clinical trial in all patients. The mean follow-up period was 28.8 months (range 18-66 months). No pseudarthrosis was noted. Anterior transoral release and posterior instrumented fusion remain significant surgeries with the potential for serious complications, but in the current series there were no major complications.”
“China’s food consumption patterns and eating and cooking behaviours changed dramatically between PF-6463922 cell line 1991 and

2011. Macronutrient composition has shifted towards fats, and protein and sodium intakes remain high and potassium intake low. The rapid decline in intake of coarse grains and, later, of refined grains and increases in intake of edible oils and animal-source foods accompanied by major eating and cooking behaviour shifts are leading to what might be characterized as an unhealthy Western type of diet, often based on traditional recipes with major additions and changes. The most popular animal-source food is pork, and consumption of poultry and eggs is increasing. The changes in cooking and eating styles include a decrease in the proportion of food steamed, baked, or boiled, and an increase in snacking and eating away from home. Prior to the last decade, there was essentially no snacking in China except for hot water or green tea. Most recently, the intake of foods high in added sugar has increased. The dietary shifts are affected greatly by the country’s urbanization. The future, as exemplified by the diet of the three mega cities, promises major growth in consumption of processed foods and beverages.”
“Endothelial dysfunction is a major underlying mechanism for the elevated cardiovascular risk associated with increased body weight. We aimed to assess the impact of weight loss induced by an intensive very-low-calorie diet (VLCD) on arterial wall function in severely obese patients (SOP).

Steps reflect guidelines and, along with novel patient-centered information technologies, may help support individuals and families navigating complex transitions.SummaryIt is time to integrate transition planning into the medical home. Further evidence is needed to identify transition strategies that improve outcomes. Although innovations in care delivery, payment structures, and information technologies may support HCT, pediatricians can and should implement MK-2206 already available and recommended transition steps.”
“Autophagy is an endogenous tightly regulated process responsible for the degradation of damaged and dysfunctional

cellular organelles and protein aggregates. Emerging data indicate a strong and complex interaction among autophagy, apoptosis and necrosis. We studied these interactions in a neonatal model of hypoxia-ischemia (HI). Autophagy was assessed by evaluating the

expression of the two autophagy proteins beclin 1 and LC3, and by “”in vivo”" autophagic vesicles formation and clearance using monodansylcadaverine (MDC). Both autophagy SBE-β-CD manufacturer and apoptosis pathways were increased in the same neurons at short times after HI. Neuroprotective drugs also increased autophagy. Interestingly, pharmacological inhibition of autophagy switched cell death phenotypes from apoptosis to necrosis. Rapamycin, that enhances autophagy by inhibition of mTOR and previously shown to be neuroprotective in our animal model of HI when administered

before the ischemic insult, was used to study the potential interaction between autophagy and survival pathways. Rapamycin, besides inducing autophagy, also increased Akt Selleck SNX-5422 and CREB (cAMP response element-binding protein) phosphorylation in the same cells. The pharmacological inhibition of the phosphatidylinositol 3-kinase (PI3K)/Akt axis reduced the neuroprotective effect of rapamycin without affecting autophagy. Conversely, pharmacological inhibition of autophagy reduced the neuroprotective effect of rapamycin without affecting Akt phosphorylation. Both treatments, however, caused a rapid switch towards necrotic cell death. Thus, autophagy can be part of an integrated pro-survival signalling which includes the PI3K-Akt-mTOR axis and its activation seems be crucial for pharmacological and ischemic preconditioning.”
“Objective: Age greater than 45 years old is a prognostic marker in well-differentiated papillary thyroid cancer (PTC) using the American Joint Cancer Committee/Union Internationale Contre le Cancer Tumor Nodes Metastasis (AJCC/UICC TNM) staging system. Our clinical observation has been that patients aged 45 to 64 years have similar outcomes when compared to patients younger than 45 years, and we questioned the origin and accuracy of this prognostic variable.

The chromosome-4 break points in this translocation are clustered in a 70-kb region centromeric to the FGFR3 gene. We hypothesized that this translocation may impact the mutation rate at the G1138A site. We employed a semi-quantitative polymerase chain reaction-based assay to measure the frequency of this mutation in multiple myeloma cell lines carrying t (4; 14) translocation.

Analysis of these cell lines varied from no change to a 10-fold increase in the mutation frequency compared with normal controls. In general, there was an increase in the G1138A mutational frequency suggesting that chromosomal rearrangement can affect the stability of the CpG hotspots.”
“In situ x-ray diffraction spectra (25-1000 degrees C) have been measured as a function of temperature for proton-conducting Ba(Zr0.8-xCexY0.2)O-2.9 (x=0.0-0.4) ceramics in CO2 atmosphere. Atomic vibrations before Selleck BMS-777607 and after exposure AZD1208 mouse to CO2 were obtained by using the micro-Raman scattering (150-1600 cm(-1)). Ba(Zr0.8Y0.2)O-2.9 and Ba(Zr0.6Ce0.2Y0.2)O-2.9 reveal a promising thermal stability in CO2 without apparent decomposition up to 1000 degrees C. However, Ba(Zr0.5Ce0.3Y0.2)O-2.9 and Ba(Zr0.4Ce0.4Y0.2)O-2.9 exhibit thermally stable below 550 degrees C and then proceed an obvious chemical decomposition of BaCO3 and Zr0.8-xCexY0.2O2 above 550 degrees C, which were clearly evidenced by the Raman vibrations of 1057 and 466 cm(-1), respectively.

A first-order orthorhombic-hexagonal structure transition was confirmed in BaCO3 in the region of 810-850 degrees C upon heating. This study suggests that the Ba(Zr0.8-xCexY0.2)O-2.9 ceramics with x <= 0.2 are promising candidates for proton-conducting applications in CO2-containing environment.”
“Introduction: Postpartum depression (PPD) FG-4592 in vitro is one of the major psychological disorders worldwide that affects both mother and child. The aim of this study was to correlate the risk of PPD with obstetric and demographic variables in Saudi females.

Materials and methods: Data were collected by interviewing females 8-12 weeks postpartum. PPD symptoms were defined as present

when subjects had an Edinburgh Postnatal Depression Scale score of 10 or higher. Variables included in this study were age, education, occupation, parity, baby’s sex, pregnancy period, delivery type, hemoglobin level, anemia, and iron pills taken during pregnancy.

Results: Of the 352 postpartum females, the prevalence of PPD symptom risk was 117 (33.2%). Among the PPD symptomatic females, 66 (39.8%) had low hemoglobin levels, and 45 (40.5%) females were anemic during pregnancy (P <= 0.05). These results suggest that early postpartum anemia, indicated by low hemoglobin level, is a significant risk factor for PPD (adjusted odds ratio 1.70, 95% confidence interval 1.05-2.74; P=0.03). Other variables, including age, parity, education, occupation, and delivery type, were not significantly correlated (P=0.15-0.

Methods. A FE model of intact C2-C7 segments was developed and validated. Fixed-core (Prodisc-C, Synthes) and mobile-core (Mobi-C, LDR Spine) artificial disc prostheses were integrated at the C5-C6 segment into the validated FE model. All models were subjected to a follower load of 50 N and a moment of 1 Nm in flexion-extension, lateral bending, and axial torsion. The range

of segmental motion (ROM), facet joint force, tension on major ligaments, and stress on the polyethylene (PE) cores were analyzed.

Results. The ROM in the intact segments after ADR was not significantly different from those of the normal cervical spine model. The ROM in the implanted segment (C5-C6) increased during flexion (19% for fixed and 33% for mobile core), extension (48% for fixed and 56% for mobile core), lateral bending (28% for fixed and 35% for mobile core) and axial torsion (45% for fixed and 105% for mobile core). The facet joint force increased see more by 210% in both fixed and mobile core models during extension and the tension increased (range, 66%-166%) in all ligaments during flexion. The peak stress on a PE core was greater than the yield stress (51 MPa for fixed and 36 MPa for mobile core).

Conclusion. The results

of our study presented an increase in ROM, facet joint force, and ligament tension at the ADR segments. The mobile-core model showed a higher increase Selleckchem Cl-amidine in segmental motion, facet force, and ligament tension, but lower stress on the PE core than the fixed-core model.”
“Point mutations resulting in the substitution of a single amino acid can

cause severe functional consequences, but can also be completely harmless. Understanding what determines the phenotypical this website impact is important both for planning targeted mutation experiments in the laboratory and for analyzing naturally occurring mutations found in patients. Common wisdom suggests using the extent of evolutionary conservation of a residue or a sequence motif as an indicator of its functional importance and thus vulnerability in case of mutation. In this work, we put forward the hypothesis that in addition to conservation, co-evolution of residues in a protein influences the likelihood of a residue to be functionally important and thus associated with disease. While the basic idea of a relation between co-evolution and functional sites has been explored before, we have conducted the first systematic and comprehensive analysis of point mutations causing disease in humans with respect to correlated mutations. We included 14,211 distinct positions with known disease-causing point mutations in 1,153 human proteins in our analysis. Our data show that (1) correlated positions are significantly more likely to be disease-associated than expected by chance, and that (2) this signal cannot be explained by conservation patterns of individual sequence positions.

We identified 55 existing headache quality indicators of which 37 evaluated processes of headache care. Most were relevant only to specific populations of patients and to care delivered in high-resource settings. Indicators had been used to describe ARO 002 overall quality of headache care at a national level, but not systematically applied to the evaluation

and improvement of headache services in other settings. Some studies had evaluated the use of existing disability and quality of life instruments, but their findings had not been incorporated into quality indicators. Existing headache care quality indicators are incomplete and inadequate for purpose. They emphasize processes of care rather than structure or outcomes, and are not widely applicable to different levels and locations of headache care. Furthermore, they do not fully incorporate accepted evidence regarding AZD4547 order optimal methods of care. There is a clear need for consensus-based indicators that fully reflect patients’ and public-health priorities. Ideally, these will be valid across cultures and health-care settings.”
“Background: Patterns of symptom frequency and distress have not been examined long-term after heart transplantation, nor have predictors of long-term symptom frequency and distress. This report identified the most commonly reported and distressful symptoms long-term after transplantation, described patterns of symptom frequency and distress

over time, and examined predictors of symptom frequency and distress at 5 and 10 years after heart transplantation.

Methods: The sample included 555 participants from a prospective, multisite, longitudinal study of quality of life outcomes. Patients were 78% male, 88% white, 79% married, and mean age of 54 years at time of heart transplantation. Data were collected using patient self-report and medical records review. Statistical analyses included descriptive statistics, Pearson correlations, t-tests, and generalized linear models.

Results: Significant predictors of lower symptom frequency after heart transplantation were not having psychological problems and AZD6094 in vivo not having cardiac allograft vasculopathy at 5 years, and not having psychological problems

and not having infection at 10 years. Significant predictors of less symptom distress were having more than a high school education, having no psychological problems, and having gout at 5 years, and being married at 10 years.

Conclusions: Symptom frequency is low and symptom distress is moderate long-term after heart transplantation. Significant relationships exist between both demographic and clinical variables and symptom frequency and distress. Identification of the most common and bothersome symptoms after heart transplantation provides clinicians with important information from which to develop a plan of care. J Heart Lung Transplant 2009;28:759-68. Copyright (C) 2009 by the International Society for Heart and Lung Transplantation.”
“Epitaxial Sr1.8Ca0.

4 kOe, and then decreases. Further SEM observation indicates that the microstructure of the optimal ribbons was composed of fine and uniform crystal grains, which was responsible for the ultrahigh intrinsic coercivity of the ribbons. (C) 2011 American Institute of Physics. [doi:10.1063/1.3567144]“
“Globozoospermia is a human infertility syndrome caused by spermatogenesis defects (OMIM 102530). Acrosome plays an important role at the site of sperm-zonapellucida binding during the fertilization process. Thus, malformation of the acrosome buy VX-680 is the most prominent feature seen in globozoospermia. Disruption of several mouse genes, including Gopc (Golgi-associated PDZ and coiled-coil

motif containing protein), Hrb (HIV-1 Rev binding protein), Csnk2a2 (casein

kinase 2, alpha prime polypeptide) and Pick1 (protein interacting with C kinase 1), results in a phenotype similar to globozoospermia in humans, which suggests their potential role in the disease. However, no mutations with a clear link to globozoospermia have been identified in these genes in humans. In this study, we screened the candidate genes mentioned above in three globozoospermia type I patients and discovered a homozygous missense mutation (G198A) in exon 13 of the PICK1 gene in a Chinese family. The family member affected by this homozygous missense mutation showed a complete lack of acrosome. Using the candidate gene screening strategy, CAL-101 manufacturer our study is the first to identify an autosomal recessive genetic mutation in PICK1 that was responsible for globozoospermia in humans.”
“Panic disorder has an elevated prevalence in Parkinson’s disease (PD). To explore the basis for this co-occurrence, the familial aggregation of panic disorder was examined in patients with PD. Probands and relatives of patients with PD and panic disorder (PD-PANIC; CYT387 supplier N=20, N=115) and control probands with PD and no active psychiatric

illness (PD-NA; N=17, N=108) were interviewed by phone, using a structured interview to determine panic status. Lifetime prevalence of panic and “”panic-like”" disorders was higher in PD-PANIC than in PD-NA relatives. Panic and “”panic-like”" disorders are familial disorders in PD. (The Journal of Neuropsychiatry and Clinical Neurosciences 2011; 23:417-424)”
“The effect of the atomic disorder-order transformation on the interaction mechanisms in isotropic PtCo alloys has been studied by isothermal annealing at 953 K, well below the transformation temperature, for 5-30 min after quenching from 1273 K. The transmission electron microscopy (TEM) testing showed that the ordered regions grew with prolonging heat treatment time. Investigation of the interaction mechanisms in PtCo alloys has been made using analysis of the delta M(H) plot. The results of the delta M(H) plot and TEM indicate that the interaction mechanisms are changed by the size of the magnetically soft and hard phases.

“
“Objective To assess sedative and cardiopulmonary effects of premedication with a medetomidine-buprenorphine or acepromazine-buprenorphine combination in dogs anesthetized with propofol and isoflurane.

Design Randomized controlled clinical trial.

Animals-90 dogs undergoing routine surgical and diagnostic procedures.

Procedures Dogs were randomly assigned to 1 of 3 premedication groups: group 1 (acepromazine, 0.03 mg/kg [0.014 mg/lb], IM; buprenorphine,

0.02 mg/kg [0.009 mg/lb[, IM), 2 (medetomidine, 5 mu g/kg [2.3 mu g/lb], IM; buprenorphine, 0.02 mg/kg, IM), or 3 (medetomidine, 10 mu g/kg [4.5 mu g/lb], IM; buprenorphine, 0.02 mg/kg, IM). Anesthesia was induced with propofol and maintained with isoflurane in oxygen. Simple descriptive scores for sedation were assigned 15 minutes BTSA1 Selleckchem Navitoclax (groups 2 and 31 and 30 minutes (group 1) after premedication administration. Basic cardiopulmonary data were recorded throughout the anesthetic period. Times to recovery from anesthesia were recorded.

Results Sedation scores did not differ significantly among groups. Mean and diastolic blood pressures were significantly lower and heart rate was significantly higher in group 1 than in the other

groups. Mean end-tidal partial pressure of CO2 was significantly lower and respiratory rate was significantly higher in group 1 than in the other groups. There were no significant differences in anesthetic recovery times between groups.

Conclusions and Clinical Relevance Results suggested that either acepromazine or medetomidine could be used in combination

with buprenorphine for premedication of dogs anesthetized with propofol and isoflurane for routine surgical and diagnostic procedures. Arterial blood pressure was better maintained with the medetomidine-buprenorphine combinations, but tissue perfusion was not investigated. (J Am Vet Med Assoc 2010;237:1431-1437)”
“The objective of the present study was to prepare ceramic nanoparticles of a poorly aqueous soluble drug (piroxicam) to explore the relationship between particle size and dissolution profile. Ceramic nanoparticles were prepared by self-assembling of hydroxyapatite using colloidal SHP099 Others inhibitor precipitation technique, with the aid of refluxing. Then the nanoparticles were coated with trehalose (polyhydroxyl oligomer) and subsequently piroxicam was allowed to adsorb. These ceramic nanoparticles were characterized for the shape, size, size distribution, yield, drug loading and release profile. The SEM analysis indicated spherical particles with a particle size median of 238 nm. The percent yield of ceramic nanoparticles was 66.7 %. The dissolution profile of piroxicam aquasomes was obtained in 0.1 mol/L hydrochloric acid solution.

Postoperative pain and hospital stay were significantly increased following sternotomy; patient’s subjective cosmetic satisfaction was significantly higher after video-assisted and conventional cervicotornic approaches.

Conclusions Conventional cervicotomic parathyroidectomy may achieve satisfactory results, especially for upper mediastinal glands. Sternotomic approaches are effective, but should be limited

because of invasiveness and increased morbidity. In case of deep and lower hyperfunctioning mediastinal parathyroids, video-assisted approaches represent a less invasive, effective, and safe alternative and might be the technique of choice.”
“BACKGROUND: Elevated levels of high-sensitivity C-reactive protein (hsCRP) correlate with an increased selleck inhibitor risk for cardiovascular events. Combination therapy with a statin and a fibrate may be more effective than statin monotherapy

for reducing hsCRP, especially in patients with mixed dyslipidemia.

OBJECTIVE: To characterize the treatment effects of rosuvastatin and fenofibric acid combination therapy compared with individual monotherapies in mixed dyslipidemic patients with baseline hsCRP >= 2 mg/L versus <2 mg/L and to determine the effects of long-term treatment with rosuvastatin and fenofibric acid combination therapy on hsCRP and other lipids for patients with AZD8186 ic50 hsCRP >= 2 mg/L after treatment with rosuvastatin monotherapy.

METHODS: Data for the post hoc analysis were derived from two 12-week controlled studies and a 52-week extension AZD6738 cell line study. Patients were treated with fenofibric acid 135 mg; rosuvastatin 5, 10, 20, or 40 mg; or rosuvastatin 5, 10, or 20 mg and fenofibric acid 135 mg in the controlled studies; and with rosuvastatin 20 mg and fenofibric acid 135 mg in the extension study.

RESULTS: In this analysis, 65% (1416/2182) of patients

had pretreatment baseline hsCRP >= 2 mg/L. Among all treatment groups, larger decreases in hsCRP were observed in patients with greater baseline hsCRP; however, improvements in other lipids/apolipoprotein were comparable between the baseline hsCRP categories. Among patients with high hsCRP (>= 2 mg/L) remaining after 12 weeks of rosuvastatin 10, 20, or 40 mg monotherapy, hsCRP was reduced by similar to 36% after switching to rosuvastatin 20 mg and fenofibric acid 135 mg for up to 52 weeks, and similar to 36% of patients shifted from hsCRP >= 2 mg/L to <2 mg/L.

CONCLUSIONS: Combination therapy with rosuvastatin and fenofibric acid may be effective for improving the inflammatory biomarker, hsCRP as well as other lipid abnormalities in patients with mixed dyslipidemia and high hsCRP. (C) 2011 National Lipid Association. All rights reserved.”
“Micro-computed tomography (micro-CT) is an important tool in biomedical research and preclinical applications that can provide visual inspection of and quantitative information about imaged small animals and biological samples such as vasculature specimens.

“
“Objective: The Afirma Gene Expression Classifier (GEC) molecular marker assay was developed for the purpose of improving surgical decision-making with indeterminate Kinase Inhibitor Library fine-needle aspiration (FNA) biopsies of thyroid nodules. In this paper, we analyze the performance of the GEC over 27 months in a community hospital-based thyroid surgery practice.

Methods: We began using GEC and Thyroid Cytopathology Partners (TCP) exclusively for thyroid FNA analysis in January 2011, shortly after the Afirma GEC became commercially available. In this paper, we focus on patients with indeterminate FNA results and the outcomes of GEC analysis, with particular attention paid to the calculation of the negative predictive value

(NPV) of the Afirma test.

Results: We performed 645 FNAs in 519 patients over 27 months. Overall, 58 FNAs (9%) were read as indeterminate, with 36 of these classified as suspicious by GEC (62%), 20 characterized as GEC benign (34%), and 2 determined to be inadequate due to low mRNA content. Of the 36 suspicious GEC patients, 30 underwent thyroidectomy, and 21 of the 30 had malignant final pathology. Of the 20 benign GEC patients, 5 underwent thyroid surgery, and 2 were discovered to have malignancies. The NPV for the Afirma GEC in our practice environment was 89.6%.

Conclusion: In a practice with a high incidence of thyroid cancer in patients with indeterminate FNAs (33% for our practice),

the NPV of the Afirma GEC test may not be as robust as suggested

in the existing literature.”
“Background: Sample size planning for clinical trials is usually based on detecting a target effect size of an intervention or treatment. Explicit incorporation of costs Y-27632 purchase into such planning is considered in this article in the situation where effects of an intervention or treatment may depend on (interact with) baseline severity of the targeted symptom or disease. Because much larger sample sizes are usually learn more required to establish such an interaction effect, investigators frequently conduct studies to establish a marginal effect of the intervention for individuals with a certain level of baseline severity.

Methods: We conduct a rigorous investigation on how to determine optimum baseline symptom or disease severity inclusion criteria so that the most cost-efficient design can be used. By using a regression model with an interaction term of treatment by symptom severity, power functions were derived for various levels of baseline symptom severity. Computer algorithms and mathematical optimization were used to determine the most cost-efficient research designs assuming either single-or dual-stage screening procedures.

Results: In the scenarios we considered, impressive cost savings can be achieved by informed selection of baseline symptom severity via the inclusion criteria. Further cost-savings can be achieved if a two stage screening procedure is used and there are some known, relatively inexpensively collected, pre-screening information.

The patients were divided into two groups according to blood platelet count: platelet count < 50,000 mm(3) formed Group I and platelet count 50,000-100,000 mm(3) formed Group

BEZ235 clinical trial II. Clinical findings and laboratory characteristics, maternal complications, perinatal outcomes and comparison of maternal and fetal morbidity according to platelet counts were analyzed.

During the period of 12 years, 44 (0.54%) of 8,132 deliveries had HELLP syndrome. Among 44 patients, the most common complications were disseminated intravascular coagulopathy (18.2%), acute renal failure (15.9%), abruptio placentae (11.4%), and cerebral hemorrhage/infarction (11.4%). Maternal and perinatal mortality rates in HELLP syndrome were 9.1 and 40.9%, respectively. Aspartate aminotransferase

levels were found to be statistically significantly higher in Group I (p = 0.04). While disseminated intravascular coagulopathy and acute renal failure were statistically significantly higher in Group I (p = 0.01; p = 0.03 respectively), fetal growth restriction was statistically significantly higher in Group II (p = 0.04).

HELLP syndrome is associated with high incidences of maternal selleckchem and fetal morbidity and mortality and patients with low platelet counts might have a much increased risk.”
“The search for therapeutic anticancer agents from plant-based foods became the work of numerous researchers when epidemiological studies showed

a relationship between the low incidence of cancer and the intake of plant-based foods. These researchers SNS-032 price were especially interested in plant-based foods with high antioxidant capacities because of the important role antioxidants have been postulated to play in the prevention and treatment of certain cancers. However, at present there is no conclusive proof that high antioxidant activity is a good indicator of high anticancer activity. This poses a challenge for researchers to directly test this hypothesis and resolve the debate. This review summarized the data on both sides of the debate. Crown Copyright (C) 2011 Published by Elsevier Ltd. All rights reserved.”
“We investigated the molecular epidemiology of foot- and-mouth disease virus (FMDV) serotype Asia 1, which caused outbreaks of disease in Asia during 2003-2007. Since 2004, the region affected by outbreaks of this serotype has increased from disease-endemic countries in southern Asia (Afghanistan, India, Iran, Nepal, Pakistan) northward to encompass Kyrgyzstan, Tajikistan, Uzbekistan, several regions of the People’s Republic of China, Mongolia, Eastern Russia, and North Korea. Phylogenetic analysis of complete virus capsid protein 1 (VP1) gene sequences demonstrated that the FMDV isolates responsible for these outbreaks belonged to 6 groups within the Asia 1 serotype.