Stress is known to modulate learning and memory.

with mostly enhancing effects on memory consolidation. However, whether such a consolidation-enhancing effect of acute stress Ispinesib research buy can also be found for extinction memory has not yet been examined in humans. In this study, we investigated the effect of stress after extinction learning on the retrieval of extinction memory in a predictive learning renewal paradigm. Participants took the part of being the doctor of a fictitious patient and learned to predict whether certain food stimuli were associated with “”stomach trouble”" in two different restaurants (contexts). On the first day, critical stimuli were associated with stomach trouble in context a (acquisition phase). On the second day, these associations were extinguished in context B. Directly after extinction, participants were either exposed to a stressor (socially evaluated cold pressor test; n = 22 or a control condition (n = 24). ON the third day,

we tested retrieval of critical associations in contexts A and B. Participants exposed to stress after extinction exhibited a reduced recovery of responding at test in context B, suggesting that stress may context-dependently enhance the consolidation of extinction memory. Furthermore, the increase in cortisol in response to the stressor was negatively correlated with the recovery of responding in context A. Our findings suggest that in parallel to the known effects Adavosertib clinical trial of stress on the consolidation of episodic memory, stress also enhances the consolidation of extinction memory, which might be relevant for potential applications in extinction-based psychotherapy”
“SETTING: An urban primary health care facility in Khayelitsha, South Africa.

OBJECTIVES: To determine the difference in total tuberculosis (TB) treatment delay in patients who initially seek care at National TB Control Programme (NTP) facilities after the onset of TB-related symptoms, compared to patients who initially seek care from non-NTP health care practitioners

(HCPs); and to describe the relative THZ1 purchase contributions of diagnostic, treatment initiation, patient and health system (HS) delay.

DESIGN: A cross-sectional study of adult TB patients treated by the NTP.

RESULTS: A total of 210 patients (median age 31 years) were enrolled from May to December 2009: 46% were male, and 58% were human immunodeficiency virus (HIV) infected. The median duration of total delay was 31 days, diagnostic delay 26, treatment initiation delay 0, patient delay 8 and HS delay 17 days. Initial visit to a non-NTP HCP was independently associated with total (P = 0.007), HS (P = 0.014) and diagnostic delays (P = 0.012). HIV infection was an independent risk factor for total (P = 0.047) and HS delay (P = 0.021); 27% of patients reported first going to a non-NTP HCP.

(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e68-e72)”
“Introduction: Many foreign patients

5-Fluoracil price attending our pain clinic are unable to understand one of the four Swiss national languages and are also unable to speak English. Therefore, communication with these patients can be very difficult or even impossible. Consequently, diagnosis and treatment may also prove difficult. Recognizing that language barriers can have deleterious effects, the use of an interpreter is at times the only way to communicate, however, the financial responsibility becomes that of the health care provider.

Methods: The aim of this paper was to study the aspects of communication with immigrants and to discuss the buy Z-IETD-FMK effect of language difficulties on the organizational structure of a pain clinic. In our analysis, we prospectively included all patients attending our pain clinic between January 1st

and December 31st, 2006 and 2008. The mother tongue, rather than the nationality, of the patients and their ability to communicate was registered.

Results: In 2006, the communication of 92% of the patients was “”good”" or “”very good”". Communication was extremely difficult or impossible in 6% to 7%. No statistically significant difference was found between the number of consultations per patient per mother tongue, irrespective of the patient’s ability to communicate. Additionally, the consultation times were significantly shorter in patients with a poor ability to communicate.

Discussion: In 6% to 7% of our pain patients, communication was impossible or extremely difficult. Language barriers can be problematic in all cultures and consultation situations.

The average consultation EPZ004777 chemical structure length may be associated with better outcomes in chronic pain patients.”
“The photocurrent (PC) variation in photoconductive CuGaSe(2) (CGS) layers had been investigated as a function of temperature. Three peaks A, B, and C of the PC spectra were associated with the band-to-band transitions. Thus, the parameters of the crystal-field splitting (Delta(cr)) and spin-orbit splitting (Delta(so)) were directly acquired through the PC measurement. The Delta(cr) and Delta(so) were 0.0903 eV and 0.2130 eV at 10 K, respectively. From the relations of peak position and temperature, the temperature dependence of the band-gap energy is well described by E(g)(T) = E(g)(0)-(8.63 x 10(-4))T(2)/(336+T). Also, the E(g)(0) is estimated to be 1.7952, 1.8855, and 2.0985 eV at the valence-band states of Gamma(7)(A), Gamma(6)(B), and Gamma(7)(C), respectively. However, the behavior of the PC was different from that generally observed in other semiconductors, the PC intensities decreased with decreasing temperature.

We retrospectively investigated 643 patients who were admitted within 2 days of acute

ischemic stroke between April 2007 and March 2010. Neurologic deterioration was defined as an increase of 4 points or more in the National Institutes of Health Stroke Scale (NIHSS) score within 1 week of admission. We retrieved data on demographic and clinical characteristics, medications, and stroke subtypes. Out of 537 patients, deterioration was noted in 64 patients (11.9%; deterioration group). Multivariate analysis identified history of myocardial infarction (P < .001), NIHSS score >= 8 at onset (P < .001), high leukocyte count (P = .035), see more low-density lipoprotein cholesterol >= 140 mg/dL (P = .002), and hemoglobin A1c >= 7% (P = .006) as significant factors associated with deterioration. Branch atheromatous disease was more frequent in the deterioration

group, and >90% of patients with deterioration either were discharged to nursing home care or died. Multivariate analysis of magnetic resonance imaging findings identified internal carotid/middle cerebral artery occlusion (each P < .001), striate capsular infarction (P = .030), pontine infarction (P = .047), and lesion size of 15-30 mm (P = .011) as independent factors associated with deterioration. Stroke patients with a high low-density lipoprotein level, high hemoglobin A1c level on admission, a history of myocardial infarction, and high NIHSS score are at high risk for neurologic deterioration. Patients with multiple risk factors for deterioration can benefit most from intensive monitoring.”
“The aim of this study is to describe the radiological changes https://www.selleckchem.com/products/oicr-9429.html in rib-vertebral angles (RVAs), rib-vertebral angle differences (RVADs), and rib-vertebral angle ratios (RVARas) in patients with

untreated right thoracic adolescent idiopathic scoliosis and to compare with the normal subjects. The concave and convex RVA from T1 to T12, the RVADs and the RVARas were measured on AP digital radiographs of 44 female patients with right convex idiopathic scoliosis and 14 normal females. Patients were divided into three groups: normal subjects (group 1), scoliotic patients with Cobb’s angle equal or < 30A degrees (group 2) and scoliotic patients with Cobb’s angle over 30A degrees SBI-0206965 (group 3). Overall values (mean +/- A SD) of the RVAs on the concave side were 90.5A degrees A A +/- A 17A degrees in group 1, 90.3A degrees A A +/- A 15.8A degrees in group 2 and 88.8A degrees A A +/- A 15.4A degrees in group 3. On the convex side, values were 90.0A degrees A A +/- A 17.3A degrees in group 1, 86.3A degrees A A +/- A 13.7A degrees in group 2 and 80.7A degrees A A +/- A 14.4A degrees in group 3. Overall values (mean +/- A SD) of the RVADs at all levels were 0.5A degrees A A +/- A 0.7A degrees in group 1, 4.0A degrees A A +/- A 4.8A degrees in group 2 and 8.0A degrees A A +/- A 4.0A degrees in group 3.

“
“HIV-1 escape from the cytotoxic T-lymphocyte (CTL) response leads to a weakening of viral control and is likely to be detrimental to the patient. To date, the impact of escape on viral load and CD4(+) T cell count has not been quantified, primarily because of sparse longitudinal data and the difficulty of separating cause and effect in cross-sectional studies. We use two independent methods to quantify the impact of HIV-1 escape from CTLs in chronic infection: mathematical modelling of escape and statistical analysis of a cross-sectional cohort. Mathematical modelling revealed a modest increase

in log viral load of 0.051 copies ml(-1) per escape event. Analysis of the cross-sectional cohort revealed a significant positive association between viral load and the CP-868596 number of “”escape events”", after correcting for length of infection and rate of replication. We estimate that a single CTL escape event leads to a viral load increase of 0.11 log copies ml(-1) (95% confidence DAPT purchase interval: 0.040-0.18), consistent with the predictions from the mathematical modelling. Overall,

the number of escape events could only account for approximately 6% of the viral load variation in the cohort. Our findings indicate that although the loss of the CTL response for a single epitope results in a highly statistically significant increase in viral load, the biological impact is modest. We suggest that this small increase in viral load is explained by the small growth advantage

of the variant relative to the wildtype virus. Escape from CTLs had a measurable, but unexpectedly low, impact on viral load in chronic infection.”
“Dynamic circadian rhythms contribute to memory formation, and the hormonal and neurochemical changes that follow circadian patterns are frequently dysregulated with aging. The effect of aging on circadian rhythms is a double-edged sword; on one hand, poor sleep quality compromises neuronal structure and function in regions that support cognition, and on the other hand, perturbation of central and peripheral oscillators changes the hormonal milieu, with consequences for neuroplasticity. ON-01910 nmr In the current review, recent developments surrounding the circadian regulation of memory formation are described, with reference to how mechanisms that support temporal coding might change with advancing age. The cognitive consequences of changes in sleep patterns are also discussed. New roles for the circadian clock genes period-1, period-2, and bmal1 in memory formation are discussed in the context of age-related cognitive decline. The potential for chronobiological approaches to the treatment and prevention of Alzheimer’s disease merits further exploration from a pharmacotherapeutic perspective, as the timing of drug delivery could potentiate or diminish treatment efficacy.

As all patients with TB do not present with this peculiar clinical feature, a genetic susceptibility

is suspected.

OBJECTIVE: To determine the major histocompatibility complex (MHC) class I and II alleles in Mexican mestizo patients with Poncet’s disease.

DESIGN: In this case-control study of 16 Mexican mestizo patients diagnosed with Poncet’s disease and 99 ethnically matched healthy controls, high resolution human leukocyte antigen (HLA) typing was performed for HLA-A, B, DR and DQ by polymerase chain reaction. HLA-DRB1 and HLA-DQB1 subtypes were performed by sequence-specific oligonucleotide probe hybridization.

RESULTS: A significantly increased frequency of HLA-B27 (corrected P = 0.01) and DQB1*0301 (corrected P = 0.0009) alleles and decreased frequency of HLA-DQB1* 0302 (corrected AZD1480 P = 0.00001) were identified in patients compared to healthy controls.

CONCLUSION: These data suggest that genes located within the MHC may play a role in the susceptibility to Poncet’s disease in patients diagnosed with TB.”
“Implicit in the growing interest in patient-centered outcomes research is a growing need for better evidence regarding

how responses to a given intervention or treatment may vary across patients, referred to as heterogeneity of treatment effect (HTE). A variety of methods are available for exploring HTE, each associated with unique strengths and limitations. This paper reviews a selected set of methodological approaches to understanding HTE,

focusing largely but not Selleckchem Pexidartinib exclusively on their uses with randomized trial data. It is oriented for the “”intermediate”" outcomes researcher, who may already be familiar with some methods, but would value a systematic overview of both more and less familiar methods with attention to when and why they may be used. Drawing from the biomedical, statistical, epidemiological and econometrics literature, we describe the steps involved in choosing an HTE approach, focusing on whether the intent of the analysis is for exploratory, initial testing, or confirmatory testing purposes. We also map HTE methodological approaches to data considerations as well as the strengths and limitations of each approach. Methods reviewed include formal subgroup analysis, meta-analysis and meta-regression, Selleck BAY 73-4506 various types of predictive risk modeling including classification and regression tree analysis, series of n-of-1 trials, latent growth and growth mixture models, quantile regression, and selected non-parametric methods. In addition to an overview of each HTE method, examples and references are provided for further reading.

By guiding the selection of the methods and analysis, this review is meant to better enable outcomes researchers to understand and explore aspects of HTE in the context of patient-centered outcomes research.

Ontario HIV Treatment Network Cohort Study (OCS) participants who completed an annual interviewer-administered questionnaire on up to three occasions were included. Generalized estimating equations (GEE) were used to assess the impact of HBV and HCV co-infection on physical and mental HRQOL component summary scores (range 0-100) as measured by the Medical Outcomes SF-36 health survey.

As of March 2010, 1,223 participants Pevonedistat ic50 had completed the questionnaire; 964 were HIV mono-infected, 128 were HIV-HBV co-infected, 112

were HIV-HCV co-infected, and 19 were HIV-HBV-HCV tri-infected. Eighty percent were male, median age 46 (IQR 40-53) years, 61 % Caucasian, median CD4 count 464 (IQR 319-636) cells/mm(3), and 74 % had undetectable HIV viremia. Physical HRQOL was lower in HIV-HBV and HIV-HCV co-infected individuals (49.4 (IQR 42.0-53.9) and 48.1 (IQR 36.9-52.8) vs. 51.5 (IQR 45.0-55.4); p = 0.01 and < 0.0001) compared to mono-infected individuals. In the multivariable GEE model, the negative impact

of HCV remained significant (-2.18; PCI-32765 research buy p = 0.01) after adjusting for drug use, smoking, age, and gender. Unadjusted mental HRQOL was lower in HIV-HCV co-infected individuals (44.6 (IQR 34.6-54.0) vs. 48.9 (IQR 36.8-55.9); p = 0.03) compared to mono-infected individuals but no association of mental HRQOL with either co-infection was observed in multivariable GEE models.

HCV appears to negatively impact physical HRQOL suggesting a greater health burden for co-infected individuals. HBV and HCV co-infections were not related to lower mental HRQOL among people living with HIV/AIDS.”
“In this article, a novel two step synthesis of soy oil based isothiocyanate is described. Allylicaly brominated soybean oil (ABSO) was reacted Small molecule library cell assay first with ammonium thiocyanate in tetrahydro furan to form allylic thiocyanates.

These compounds were then converted to isothiocyanated soybean oil (ITSO) by a thermal rearrangement. Conversion was found to be 70%. The structure of the ITSO was characterized by IR and (1)H-NMR techniques. Then ITSO was reacted with ethylene glycol, glycerol, and castor oil to produce polythiourethanes and ethylene diamine and triethylene tetra amine to produce polythioureas. Thermal properties of the products were determined by DSC and TGA techniques. DSC traces showed 7(g)’s for ethylene glycol polythiourethane at -39 and 58 degrees C, for glycerol polythiourethane at -39 and 126 degrees C, for castor oil polythiourethane at -38 degrees C and -17 degrees C, for ethylene diamine polythiourea at -45 degrees C, and for triethylene tetra amine poly thiourea at -39 degrees C. Additionally, DSC analysis of polythioureas showed an endotherm at around 100 degrees C. All of the polymers started to decompose around 200 degrees C. Tensile properties of the polymers were determined. Polythiourethanes showed higher tensile strength and lower elongation when compared with their urea analogs.

“
“Cholinesterase (ChE) and ethoxyresorufin-O-deethylase (EROD) were of special interest to this study as these biochemical tools have been widely used for the determination of exposure to pollutants. In this study, the freshwater oligochaete Limnodrilus profundicola was tested for its potential as a bioindicator of freshwater Prexasertib solubility dmso pollution. For this purpose, the ChE and

EROD activities of L. profundicola and the level of polycyclic aromatic hydrocarbons (PAH) of water samples collected from different sites along the Curuksu stream on the Menderes River (the ancient Meander) running through south-western Turkey were studied. First, these activities were characterized using, as model substrates, acetylthiocholine (ATC), propionylthiocholine (PTC), and butyrylthiocholine (BTC). Then, the in vivo effects of insecticides and pollutants on these activities were investigated. L. profundicola were exposed to various doses of methyl-parathion,

methomyl, and deltamethrin. Although significant inhibition of ChE was detected with each of the insecticides, the highest level of inhibition was observed with methyl-parathion. In addition to the inhibition of ChE, the activity of EROD MI-503 was induced by exposure to oil-contaminated sediments. Thus, although L. profundicola has a reputation for being very resistant to pollution (although it is not insensitive to it), we demonstrated that it may potentially be used as a bioindicator species for contaminant exposure when ChE and EROD are used as biomarkers. (C) 2010 Wiley Periodicals, Inc. Environ Toxicol 26:37-44, 2011.”
“Pulmonary valve replacement (PVR) for pulmonary valve insufficiency (PVI) currently represents the most frequent reoperation performed for adults with congenital heart disease. A variety of pulmonary Galunisertib concentration valve substitutes have been used, but none has proved to be ideal. This report reviews the authors’ experience using a porcine prosthetic valve in the pulmonary position. Between January 2001 and December 2011, 76 patients (mean age, 36 years; range, 18-64

years) underwent PVR for chronic PVI using a porcine bioprosthesis. All the patients had previously undergone surgery: 65 for repair of tetralogy of Fallot and 11 for pulmonary surgical valvotomy. Magnetic resonance imaging (MRI) evaluations before surgery and at the 1-year postoperative follow-up evaluation were compared. Aside from the PVR, 59 patients (59/65, 78 %) received 94 associated cardiac surgical procedures. Two hospital deaths occurred. The mean hospital stay was 13 days (range, 7-48 days). At the 1-year control MRI, pulmonary regurgitation fraction, right ventricular end diastolic volume (RVEDV), and RV/LV EDV had improved significantly. During a mean follow-up period of 52 months (range, 6-132 months), one patient died. All the patients were categorized as New York heart association (NYHA) functional class 1.

Also, [(3)H]taurine

uptake was decreased by cytochalasin B, which is known Rabusertib to glucose transport inhibitor. In conclusion, taurine transport in TR-iBRB cells is regulated diversely at extracellular Ca(2+), oxidative stress and hyperglycemic condition. It suggested that taurine would play a role as a retinal protector in diverse disease states.”
“Present study is the first report on production and purification of beta-keratinase enzyme from a bacterium belongs to the genus Brevibacillus. The response surface optimized alkaline beta-keratinase production by this strain was achieved as 923.0 x 10(3) Ul(-1) post 48 h of incubation. An alkaline beta-keratinase (Brevicarnase) MI-503 purchase having molecular mass of 83.2 kDa purified from this strain showed optimum activity at 45 degrees C and pH 12.5,

respectively. The K(m) and V(max) values of beta-keratinase towards keratin were determined as 0.3 mg ml(-1) and 4.5 mu mol min(-1) mg(-1), respectively. The Brevicarnase demonstrated appreciable thermostability and stability in the presence of anionic and non-ionic surfactants, oxidizing and bleaching agents, EDTA, and compatibility with the tested commercial laundry detergents at a concentration of 0.1%. The purified beta-keratinase did not show collagen-degrading activity however, demonstrated dehairing property when tested on goat skin. These properties reinforce the feasibility of inclusion of Brevicarnase in laundry detergent formulations and WH-4-023 in leather-industry. (C) 2011 Elsevier B.V. All rights reserved.”
“Interferon (IFN) interacts with endothelial cells and modulates the functions of these cells. In our study, we aimed to determine the effects of treatment with pegylated IFN-alpha (peg-IFN-alpha) on fibrinolytic parameters in patients with chronic hepatitis C. Fifteen patients with chronic hepatitis C were treated with

peg-IFN-a once per week plus daily oral ribavirin. Euglobulin lysis time (ELT), plasma levels of D-dimer, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI) were determined before treatment, 2 weeks, 1 month, and 3 months after the initiation of the treatment. Plasma levels of t-PA increased significantly 1 month and 3 months after the treatment (P < .05). The PAI-1 and TAFI levels in 2 weeks, 1 month and 3 months after treatment were not statistically different as compared with pretreatment levels (P > .05) No significant difference in plasma D-dimer levels was observed during peg-IFN-alpha treatment (P > .05). There was a significant decrease in ELT 1 month and 3 months after the treatment (P < .05).

This study evaluates BNP as a marker of LV diastolic dysfunction in a cohort of patients with preserved LV ejection fraction who underwent AVR for pure aortic stenosis and the relationship between BNP values and the grade of LV diastolic dysfunction.

A total of 113 patients were included in the study. Echocardiographic evaluation was performed preoperatively,

5 days postoperatively and at 12-month follow-up, to assess LV dimensional and functional parameters. Diastolic function was labelled as normal, mild, moderate or severe dysfunction. Concomitantly, BNP levels were evaluated.

Mild to severe diastolic dysfunction occurred preoperatively in all patients. At 12-month follow-up, 65 (62.5%) patients had mild and 25 (24.1%) moderate to severe diastolic dysfunction. BNP values, categorized for quartile distribution, correlated with diastolic dysfunction grade (P < 0.001 for each comparison). buy CX-6258 At receiver operating characteristic analysis, the BNP level of 120 pg/ml was 91% sensitive and 85% specific for diastolic disease, while 300 pg/ml was 80% sensitive and 91% specific for moderate or severe diastolic dysfunction. Twelve months after AVR, BNP values MLN8237 research buy were strongly correlated with the significant echocardiographic parameters suggestive of diastolic dysfunction (P < 0.006 in all cases).

The BNP level following AVR is related to diastolic

disease severity and may complement echocardiographic evaluation when symptoms are unclear and LV function is difficult to interpret.”
“Hypothesis: Performance in tone

perception and production are correlated in prelingually deafened pediatric cochlear implant (CI) users across individuals. Demographic variables, such as age at I-BET-762 datasheet implantation, contribute to the performance variability.

Background: Poor representation of pitch information in CI devices hinders pitch perception and affects perception of lexical tones in cochlear implant users who speak tonal languages.

Methods: One hundred ten Mandarin-speaking, prelingually deafened CI subjects and 125 typically developing, normal-hearing subjects were recruited from Beijing, China. Lexical tone perception was measured using a computerized tone contrast test. Tone production was judged by native Mandarin-speaking adult listeners as well as analyzed acoustically and with an artificial neural network. A general linear model analysis was performed to determine factors that accounted for performance variability.

Results: CI subjects scored similar to 67% correct on the lexical tone perception task. The degree of differentiation of tones produced by the CI group was significantly lower than the control group as revealed by acoustic analysis. Tone production performance assessed by the neural network was highly correlated with that evaluated by human listeners.

5) > Palm oil (62.5) > Castor oil (41.6). The immobilized lipase on PSHzGlu suffered only a 12.5% deterioration for olive oil after five cycles. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci, 2012″
“Background:

People with GSK461364 research buy schizophrenia are frequent and heavy smokers.

Methods: The objective of this study was to measure serum nicotine levels and ad libitum smoking behavior for 24+2h using the CReSS micro topography device in 75 smokers with schizophrenia (SCZ) and compare these to 86 control smokers (CON) without mental illness. Mean values of repeatedly measured topography variables were compared using three-level nested linear models to adjust for between subject differences and the double nested data.

Results: Smokers with SCZ smoked more cigarettes in the 24 h period and took an average of 2.8 more puffs per cigarette than CON (p < 0.001). The time between puffs, or interpuff interval (IPI), was shorter in SCZ by an average of 6.5 s (p < 0.001). The peak flow rate was higher in SCZ by an average of 4.9 ml/s (p < 0.05). Smokers with SCZ spent an average of 1.0 min less time smoking a single cigarette vs. selleck screening library CON (p < 0.001). Smokers with SCZ also had shorter IPI and more puffs per cigarette in an analysis of first cigarette of the day. For all subjects, a decrease in IPI by 1 s was associated with an increase

in serum nicotine of 0.19 ng/ml and in cotinine of 5.01 ng/ml (both p < 0.05). After controlling for diagnosis group, higher craving scores on QSU Factor 2 (urgent desire to smoke) were associated with shorter IPI.

Discussion: Smokers with schizophrenia demonstrate more intense cigarette puffing that is associated with greater nicotine intake. This pattern may provide insight into other heavily dependent smokers. Thiazovivin order (C) 2011 Elsevier Ireland Ltd. All rights reserved.”
“Background:

Thiamine, riboflavin, niacin, vitamin B-6, folate, and vitamin B-12 are required to synthesize neurotransmitters that are potentially involved in the pathophysiology of premenstrual syndrome (PMS).

Objective: The objective was to evaluate whether B vitamin intake from food sources and supplements is associated with the initial development of PMS.

Design: We conducted a case-control study nested within the Nurses’ Health Study II cohort. Participants were free of PMS at baseline (1991). After 10 y of follow up, 1057 women were confirmed as cases and 1968 were confirmed as controls. Dietary information was collected in 1991, 1995, and 1999 by using food-frequency questionnaires.

Results: Intakes of thiamine and riboflavin from food sources were each inversely associated with incident PMS. For example, women in the highest quintile of riboflavin intake 2-4 y before the diagnosis year had a 35% lower risk of developing PMS than did those in the lowest quintile (relative risk: 0.65; 95% CI: 0.45, 0.92; P for trend = 0.02).