Most pediatric anesthesiologists (89%) measure the hemoglobin level before PRBC transfusion.

Conclusions:

This survey identifies significant differences in transfusion practice patterns among pediatric anesthesiologists with a median transfusion threshold of 7.6 [6.6-8.6] g center dot dl-1 and a median PRBC volume transfusion of 11.7 [16.8-6.6] ml center dot kg-1.”
“Glanzmann’s thrombasthenia (GT) is an autosomal recessive inherited bleeding disorder due to AZD6244 order a defect in platelet function. The hallmark of this disease is severely reduced/absent platelet aggregation in response to multiple physiological agonists. Bleeding signs in

GT include epistaxis, bruising gingival hemorrhage, gastrointestinal hemorrhage, hematuria, menorrhagia and hemarthrosis.Carrier detection in GT is important to control the disorder in family members. Carrier detection can be done both by protein analysis and direct gene analysis.”
“Aim: A new animal model of immunoglobulin A nephropathy (IgAN) was made by infecting mice with Mycoplasma penetrans (Mpe). To examine the pathogenesis of IgAN induced by Mpe infection, tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and nuclear factor-kB (NF-kB) protein levels were compared among study groups.

Methods:

To make an experimental IgAN animal model, mice were infected with Mpe, SP-4 medium or phosphate-buffered saline (PBS) via the urinary tract. To RepSox compare changes in the classical IgAN model, TNF-alpha and IL-6 RNA expression levels CCI-779 cost were measured using RT-PCR, and NF-kB protein was measured using EMSA.

Results: By producing a urinary tract infection with Mpe,

we developed a new animal model of IgAN with a 100% success rate. There was no difference with the classical animal model. We also observed IgG deposition in 66.67% of the Mpe-infection group. Glomerular cell and mesangial matrix proliferation was greater in the Mpe-infection group than in the control groups (p<0.05). In the Mpe-infection and classical groups, TNF-alpha and IL-6 expression levels were much higher than in the control groups (p<0.01). NF-kB expression was much higher in the Mpe-infection group (p<0.05).

Conclusions: We made a new IgAN animal model that will offer a new direction for IgAN research. The activation of inflammation factors was associated with the Mpe induction of IgAN.”
“P>Background:

Caudal block is a widely used technique for providing perioperative pain management in children. In this randomized double-blinded study, we evaluated the effects of preoperative caudal block on sevoflurane requirements in children with cerebral palsy (CP) undergoing lower limb surgery while bispectral index (BIS) values were maintained between 45 and 55.

“
“PIVET Medical Centre has developed an empirical algorithm for the dose of FSH administration based upon day-2 FSH, antral follicle count, anti-Mullerian hormone, body mass index, age and smoking parameters in an attempt to

reduce the incidence of ovarian hyperstimulation syndrome particularly in at-risk women with elevated antral follicle count and anti-Mullerian hormone. The algorithm utilized the incremental dosage capabilities of the recombinant FSH pens to fine-tune the daily concentration Cyclopamine cell line of FSH. Application of the algorithm aimed to minimize any form of excessive follicle recruitment that necessitated increased clinical awareness. The measure used to assess the impact of the algorithm was the number of women who, after oocyte retrieval, were considered to be potentially at risk of any degree of OHSS and were allocated to increased monitoring. Compared with the previous 20-month period, introduction of the algorithm significantly reduced both the incidence of referral for increased monitoring, treatment for OHSS and the

incidence of freeze-all cycles (all P < 0.05). This was particularly focused on those considered to be at risk without reducing the fresh cycle pregnancy rate. (C) 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.”
“Recent studies in mice and human identified osteocalcin (OCN) as a bone-derived Citarinostat cost hormone that modulates insulin secretion and insulin sensitivity. OCN is synthesized by the bone gamma-carboxyglutamate protein (BGLAP) gene located in the well www.selleckchem.com/products/ly2606368.html replicated

region of type 2 diabetes (T2D) linkage on chromosome 1q22. We resequenced BGLAP gene in 192 individuals with T2D and performed case-control studies in 766 Caucasian (461 T2D and 305 controls) and 563 African American individuals (371 T2D and 192 controls). Metabolic effects of BGLAP variants were examined in 127 nondiabetic members of Caucasian T2D families and in 498 unrelated nondiabetic African American and Caucasian individuals. BGLAP expression was tested in transformed lymphocytes from 60 Caucasian individuals. We identified 17 single nucleotide polymorphisms (SNPs) in African Americans, but observed only the two known SNPs in Caucasians. No SNP was associated with T2D. Promoter SNP rs1800247 was not associated with metabolic traits including insulin sensitivity (S(I)) or fasting glucose in either population, but nonsynonymous SNP rs34702397 (R94Q) was nominally associated with SI (uncorrected p = 0.05) and glucose-mediated glucose disposal (S(G); uncorrected p = 0.03) in African Americans. No SNP altered measures of insulin secretion or obesity, nor was BGLAP expression associated with rs1800247. Our study was sufficiently powered to exclude BGLAP variants as a major risk factor (OR > 1.5) for T2D in Caucasians, but coding variants in exon 4 may alter glucose homeostasis and diabetes risk in African Americans.

An explanation of this has been given in terms Nocodazole mechanism of action of the effect of plasmon

coupling on the anharmonic decay route. This explanation is limited to small wave vectors and is not applicable to the case of phonons in general because their interaction with electrons involves larger wave vectors for which the plasma coupling is Landau damped. Nevertheless, a similar decrease of lifetime with density is observed for hot phonons in the channel of a GaN Heterostructure Field Effect Transistor (HFET). We show that this dependence on electron density can be associated with the interaction with the barrier interface mode and the temperature dependence of the phonon lifetimes. It is pointed out that a complete account of the shortening of phonon lifetime in a working HFET requires an analysis of the specific thermal and electron transport properties of the system. Important differences arise between HFETs grown on sapphire and on SiC. (C) 2011 American Institute of Physics. [doi:10.1063/1.3553439]“
“This work is focused on a facile route

to prepare a new type of nylon 6-based nanocomposites with both high fracture toughness and high strength. A series of nylon 6-matrix blends were prepared via melting extrusion VX-661 supplier by compounding with poly (methyl methacrylate-co-butadiene-co-styrene) (MBS) or poly(methyl methacrylate-co-methylphenyl siloxane-co-styrene) (MSIS) latices as impact modifier and diglycidyl ether of bisphenol-A (DGEBA) as compatibilizer. Layered

organic clay was also incorporated into above nylon 6 blends for the reinforcement of materials. Morphology study suggests that the MBS or MSIS latex particles could achieve a mono-dispersion in nylon 6 matrix with the aid of DGEBA, which improves the compatibilization and an interfacial adhesion between the matrix and the shell of MBS or MSIS. High impact toughness was also obtained but with a corresponding reduction in tensile strength and stiffness. A moderate amount of organic clay as reinforcing agent could gain a desirable balance between the strength, stiffness and toughness of the materials, and tensile strength Rabusertib molecular weight and stiffness could achieve an improvement. This suggests that the combination of organic clay and core-shell latex particles is a useful strategy to optimize and enhance the properties of nylon 6. Morphology observation indicates that the layered organic clay was completely exfoliated within nylon 6 matrix. It is found that the core-shell latex particles and the clay platelets were dispersed individually in nylon 6 matrix, and no clay platelets were present in MBS or MSIS latex particles. So the presence of the clay in nylon 6 matrix does not disturb the latex particles to promote high fracture toughness via particle cavitation and subsequent matrix shear yielding, and therefore, provides maximum reinforcement to the polymer.

A literature search (by Medline and Scopus) was performed. The authors also manually reviewed the references of selected articles for any pertinent material. Beyond the ‘quantity’ of LDL, several buy JPH203 lipid-lowering agents and particularly statins, are only in part beneficial on the ‘quality’of LDL, so that their net effect on small, dense LDL is moderate. Among hypoglycemic agents, insulin and metformin have shown a limited role on small, dense LDL, while pioglitazone is more beneficial. The efficacy of incretin-based

therapies on LDL subclasses remains to be tested by future studies, considering that preliminary studies have reported significant improvements by these agents on triglycerides and HDL-C plasma concentrations. Beyond hypolipidemic drugs, hypoglycemic agents have been found to be significantly effective in modulating levels of small, dense LDL, towards less atherogenic particles in patients with Type 2 diabetes. This may be linked to the reduction in cardiovascular risk obtained by these agents in this category of high-risk subjects.”
“The aim of

this study was to describe the clinical characteristics selleck products of children and young people under 19 with both epilepsy and a psychotic state (schizophrenia-like psychotic episode, organic delusional disorder, or other brief psychotic episode). In total, the clinical case notes for 17 young people with these characteristics were identified retrospectively from three different sources. Compared with a group of young people with psychosis without epilepsy, children with epilepsy and psychosis more frequently had other neuropsychological problems like learning disability and autism. Both groups had a high rate of family histories of mental illness and social disability. Contrary to the findings in adults with psychosis and epilepsy, in this group of young people, psychosis was associated neither selleck screening library with temporal lobe epilepsy nor with mesial temporal sclerosis. The children with psychosis and epilepsy

had a variety of seizure types and structural abnormalities. (C) 2010 Elsevier Inc. All rights reserved.”
“We studied the charge and spin currents in magnetic tunnel junctions in the presence of spin dynamics on the basis of a tight-binding scheme; the spin dynamics is assumed to be present only in one of the two ferromagnetic electrodes. The charge current is pumped by the dynamical spins having the form (m) over dot(1) . m(2), where m alpha(alpha = 1, 2) denotes the direction of magnetization in the electrodes and m(1) represents the dynamic spin. In addition, three types of spin currents are induced by the dynamical spins. One of these spin currents has the form (m) over dot(1) x m(2), whose coefficient is proportional to the product of the spin polarizations of both the electrodes.

an increase in Alx4 in Ambn-deficient calvariae. Analysis of these data indicates that ERP expression follows defined developmental profiles and affects osteoblast differentiation, 3Methyladenine mineralization, and calvarial bone development. We propose that, in parallel to their role in the developing enamel matrix, ERPs have retained an evolutionary conserved function related to the biomineralization of bones.”
“Microfluidic devices as immunosensing platforms have had a great deal of attention in recent years, becoming an emergent technology in biomedical, pharmaceutical, environmental and food

analysis. Combination of the remarkable features of microfluidic platforms with those of immunoassays produces a promising tool for selective, sensitive, automatic and point-of-care testing in real applications.

In this article, we review and discuss different aspects of microfluidic material substrate, fluid handling, multiplexing, and, mainly, surface-modification and immunoreagent-immobilization

strategies since 2005. Although different detection modes can be used in this kind of microfluidic immunosensing Selleck Napabucasin platform, the special features of electrochemistry have greatly expanded this technique, and electrochemical detection is common to the articles that we review. Finally, we comment on the future outlook for microfluidic immunosensing. (C) 2011 Elsevier Ltd. All rights reserved.”
“Objectives: The uncertainty. around number needed to treat (NNT) is often represented through a confidence interval (CI). However, it is not clear how the Cl can help inform treatment decisions. We developed decision-theoretic measures of uncertainty for the NNT.

Study

Design and Setting: We build our argument on the basis that a risk-neutral decision maker should always choose the treatment with the highest expected benefit, regardless RSL3 datasheet of uncertainty. From this perspective, uncertainty can be seen as a source of “”opportunity loss”" owing to its associated chance of choosing the suboptimal treatment. Motivated from the concept of the expected value of perfect information (EVPI) in decision analysis, we quantify such opportunity loss and propose novel measures of uncertainty around the NNT: the Lost NNT and the Lost Opportunity Index (LOI).

Results: The Lost NNT is the quantification of the lost opportunity expressed on the same scale as the NNT. The LOI is a scale-free measure quantifying the loss in terms of the relative efficacy of treatment. We illustrate the method using a sample of published NNT values.

Conclusion: Decision-theoretic concepts have the potential to be applied in this context to provide measures of uncertainty that can have relevant implications. (C) 2012 Elsevier Inc. All rights reserved.”
“In 1998, the first plasmid-mediated gene involved in quinolone resistance (currently named qnrA1) was reported.

By using Curcumin drops, the closured paracentesis

area was observed near to the normal eardrum; and thickness of the TM and sclerosis were less than the control, showing the improved healing at 15th day. The possible mechanisms may be anti-inflammatory BKM120 clinical trial effect, improving collagen deposition, and increasing fibroblast and vascular density in wounds thereby enhancing impaired wound healing. (C) 2013 Elsevier Ireland Ltd. All rights reserved.”
“Introduction: Tubular injury is more important than glomerulopathy for renal prognosis in chronic kidney disease (CKD) patients. Numerous studies have demonstrated the active participation of the renin-angiotensin system (RAS) in CKD. However, whether addition of aliskiren, a direct renin inhibitor, to olmesartan improves renal tubular injury in CKD patients is unknown.

Methods: This study compared the effects of aliskiren (300 mg daily), olmesartan (40 mg daily), and its combination therapy on urinary L-fatty acid binding protein (L-FABP), a marker of tubular injury in stage I or II CKD patients. selleck chemicals It also examined which

clinical variables were independently correlated with tubular damage.

Results: Olmesartan or aliskiren monotherapy for 6 months comparably decreased blood pressure (BP) and proteinuria. BP and proteinuria levels were reduced more by combination therapy than by either monotherapy. Olmesartan or aliskiren decreased urinary L-FABP level, and combination therapy produced more incremental reduction in L-FABP level relative to each monotherapy. Multiple stepwise

regression analysis revealed that BMI, low-density lipoprotein (LDL)-cholesterol and proteinuria were independently related to urinary SB525334 purchase L-FABP level.

Conclusions: The present study demonstrated that addition of aliskiren to olmesartan decreased urinary L-FABP level partly via reduction of proteinuria in stage I or II CKD patients.”
“Objectives: To quantify gynecological cancer survivors’ referral to, awareness of, utilization of and satisfaction with community support services, as well as the factors associated with service use.

Methods: In 2004, 802 gynecological cancer survivors, 3 months-5 years post-diagnosis, completed a postal questionnaire (56% response rate). Descriptive statistics summarized outcome prevalences. Logistic regression models identified correlates of service utilization.

Results: Substantial proportions of women were aware of the main cancer support organization, Cancer Council Queensland (72%), and of information booklets (74%), helplines (66%), support groups (56%) and internet information (50%). Less than half were aware of other services. The most commonly used resources and services were information booklets (37%), the internet (23%), and helplines (20%). More broadly, 43% utilized information/internet support, 30% utilized psychosocial services and 27% utilized functional/practical services. Approximately one-fifth (19%) used more than one support types.

In the three decades since Bohan and Peter published their criteria which have long stood as the gold standard for diagnosis in clinical practice as well as inclusion into clinical trials, more sophisticated understanding of immunopathogenesis,

histology, and specific autoantibody associations has broadened our understanding of these diseases. This editorial review examines the diverse approaches between different subspecialists in deriving appropriate IIM classification utilizing this updated knowledge.

Recent findings

Several investigators PI3K inhibitor have proposed improved IIM classification criteria. More recently, larger scale consensus efforts have been undertaken by various expert groups including the European Neuromuscular Centre (ENMC) and The International Myositis Assessment and Clinical Studies Group (IMACS). The intent is to refine the classification criteria utilizing our enhanced understanding which has matured since the original publication of Bohan and Peter’s proposal in 1975.

Summary

Many diagnostic/classification criteria have been proposed for different forms of IIM over the last three decades.

The majority of these have been based on clinical impressions rather than rigorous data analyses or expert consensus and none has been fully tested for sensitivity buy AG-881 or specificity using appropriately powered studies that take into account relevant disease confounders. Different sets of criteria proposed and adopted by different specialties hamper the ability to compare clinical studies and assess clinical trials’ outcomes. Large, multicentered, multispecialty

studies are required to develop improved IIM criteria.”
“Malaria is one of the most common and serious infectious diseases in the tropics and subtropics. For high-risk travelers to endemic regions, malaria chemoprophylaxis is recommended. Internationally, atovaquone-proguanil (A/P), Fosbretabulin mw mefloquine (MEF), or doxycycline (DOX) are the prescribed malaria chemoprophylactic drugs. However, A/P and DOX are not approved in Japan. Therefore, the data on A/P for malaria chemoprophylaxis in Japanese travelers are not clear. We analyzed questionnaire survey data obtained in Hibiya Clinic to assess the safety and tolerability of A/P and compare them with those of MEF for non-immune Japanese travelers. A/P was given to 278 travelers and MEF to 38 travelers. The mean duration of each prophylaxis is for 20.0 +/- A 9.6 and 59.0 +/- A 15.9 days, respectively. Nine travelers discontinued prophylaxis: 5 in the A/P prescribed group (A/P group) and 4 in the MEF prescribed group (MEF group), and the rate of discontinuation was significantly less in the A/P group. The frequency of adverse events was significantly less in the A/P group than in the MEF group [52 cases (18.8 %) vs. 14 cases (36.8 %), respectively]. In particular, the frequency of psychoneurotic adverse events was significantly less in the A/P group.

Six sows were

fed 3 experimental diets, low fiber (LF; 177 g of dietary fiber and 44 g of soluble fiber/kg of DM), high soluble fiber (HF-S; 429 g of dietary fiber and 111 g of soluble GSK690693 order fiber/kg of DM), and high insoluble fiber (HF-I; 455 g of dietary fiber and 74 g of soluble fiber/kg of DM), in a repeated crossover design. Variations in dietary concentration and solubility of dietary fiber were obtained by substituting starch-rich wheat and barley in the LF diet with dietary fiber-rich co-products (sugar beet pulp, potato pulp, pectin residue, brewers spent grain, pea hulls, and seed residue, which have distinct physicochemical properties). The main carbohydrate component of the LF diet was starch and nonstarch polysaccharides (cellulose and noncellulosic polysaccharides) for the 2 high dietary fiber diets. Consumption of the LF diet resulted in increased and rapid glucose absorption at 0 to 4 h postfeeding. With the HF-I diet, the glucose absorption pattern was similar but

at a decreased rate, whereas it was decreased and delayed with the HF-S diet (diet, P < buy Etomoxir 0.001; time, P < 0.001). These differences were also reflected in the insulin response. The quantitative absorption of SCFA at 0 to 10 h postfeeding was greater when feeding the HF-S diet compared with the LF diet (P < 0.001) and intermediate when feeding the HF-I diet (P < 0.001). The study showed that feeding the high dietary fiber diets resulted in a increased and more uniform uptake of SCFA than when feeding the LF control. Moreover, the HF-S diet reduced diurnal variation in glucose and insulin

concentrations.”
“Purpose: To evaluate the use of contrast material-enhanced magnetic resonance (MR) imaging with conventional T1-weighted gradient-recalled echo (GRE) and inversion-recovery (IR)-prepared GRE methods to quantitatively measure the size of irreversible electroporation (IRE) ablation zones www.selleckchem.com/products/gsk923295.html in the liver in a rat model.

Materials and Methods: All studies were approved by the institutional animal care and use committee and were performed in accordance with institutional guidelines. Seventeen adult male Sprague-Dawley rats were divided into four groups. Rats in groups 1-3 (n = 15 total) underwent IRE performed by using different IRE parameters after gadopentetate dimeglumine administration. Rats in group 4 (n = 2) underwent IRE ablation without prior gadopentetate dimeglumine injection to serve as control animals. MR imaging measurements (with conventional T1-weighted GRE and IR-prepared GRE methods) were performed 2 hours after IRE to predict the IRE ablation zones, which were correlated with pathology-confirmed necrosis areas 24 hours after IRE by using the Spearman correlation coefficient.

Results: The incidence of early-onset sepsis (EOS) differed significantly in neonates born to women with and without HCA, after adjustment for gestational age (11% versus 1%, p = 0.011). The incidence of EOS

in neonates was also significantly different, after adjustment for gestational age, in cases with and without funisitis (18% versus 4%, p = 0.002). The same was also found for retinopathy of prematurity (ROP) cases with and without funisitis (23% versus 4%, p = 0.014), after adjustment for gestational age.

Conclusions: HCA and funisitis increase the risk of adverse perinatal outcome in PPROM pregnancies.”
“Objectives: To assess the prevalence and characteristics of severe pyogenic, nonpyogenic, and opportunistic infections in polymyositis and dermatomyositis (PM/DM) patients Cyclopamine and to evaluate the predictive values for infections on clinical presentation and biochemical findings of PM/DM to detect patients at risk for such infections.

Methods: The medical records of 279 consecutive PM/DM patients in 3 medical centers

were reviewed.

Results: One hundred four severe infections occurred in our patients (37.3%), ie, pyogenic (n = Citarinostat 71) and nonpyogenic/opportunistic infections (n = 33). Pyogenic infections were mainly due to aspiration pneumonia (n = 46) and calcinosis cutis infection. Thirty-three PM/DM patients developed nonpyogenic/opportunistic infections that

were due to the following: Candida albicans, Pneumocystis jiroveci, Aspergillus fumigatus, Geotrichum capitatum, Mycobacterium (avium-intracellulare complex, xenopi, marinum, peregrinum, tuberculosis), Helicobacter heilmanii, cytomegalovirus, herpes simplex and zoster virus, hepatitis B and C, JC virus, Leishmania major, Strongyloides stercoralis. Esophageal dysfunction, ventilatory insufficiency, malignancy, and lymphopenia were significantly Prexasertib more frequent in the group of PM/DM patients with infections.

Conclusion: Our study underscores the high frequency of infections in PM/DM, resulting in an increased mortality rate. Our results suggest that prophylaxis against pyogenic infections should be routinely recommended for patients with PM/DM, including regular physical examination of lungs to depict aspiration pneumonia as well as risk factors of aspiration pneumonia. Finally, because a great variety of micro-organisms may be responsible for opportunistic infections, it seems difficult to initiate primary prophylaxis in PM/DM patients exhibiting risk factors for opportunistic infections. (C) 2011 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 41:48-60″
“Background: The impact of an unrepaired fracture of the ulnar styloid base on recovery after internal fixation of a fracture of the distal part of the radius is uncertain.

With x-ray computed tomography, we examine settling of the particulate phase in both flowing and quiescent curing systems and compare the experimental results to the model predictions. The model is also validated with temperature measurements. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci 122: 1587-1598, 2011″
“We report a rare case of a woman with bilateral papillary cystadenomata of the broad ligament with von Hippel-Lindau disease (VHL) (other manifestations: capillary hemangioblastomas of the spinal cord). Patient Doramapimod surveillance

is important, because in the course of VHL-associated tumors malignant lesions may arise that are relevant for the prognosis.”
“Dysprosium-added sintered magnets were prepared from blends of Nd-15.5(Fe,Co,Ga)(78.2)B-6.3 and Dy2S3 powders;

their microstructure and magnetic properties were compared to those of the magnets made with Dy2O3 additions or from single (Nd,Dy)-(Fe,Co,Ga)-B alloys. The addition of Dy2S3 leads to replacement of the neodymium oxide phases in the sintered magnets by the Nd2O2S find more and NdS phases. The magnets prepared with both the Dy2S3 and Dy2O3 powders exhibited inhomogeneous distribution of Dy within the (Nd,Dy)(2)Fe14B grains with Dy-rich outer grain regions. However, in a marked difference from the Dy2O3-added and single-alloy magnets, where the grain-boundary oxide phases were Dy-rich, the magnets prepared with Dy2S3 had their sulfur-containing grain-boundary phases depleted of Dy. With the

larger fraction of Dy atoms available for alloying the main (Nd,Dy)(2)Fe14B phase, the magnets prepared with Dy2S3 showed the largest coercivity gain per 1 at.% of the added Dy. (C) 2011 American Institute of Physics. [doi:10.1063/1.3574444]“
“The ring-opening polymerization of L- or D-lactide was realized in the presence of dihydroxyl or monomethoxy poly(ethylene glycol) (PEG) AZD1390 molecular weight with a number-average molecular weight of 2000. The resulting low-molar-mass poly(L-lactide) (PLLA)/PEG and poly(D-lactide) (PDLA)/PEG triblock and diblock copolymers were characterized with nuclear magnetic resonance (NMR), differential scanning calorimetry, size-exclusion chromatography, and X-ray diffractometric analysis. Bioresorbable hydrogels were successfully prepared from aqueous solutions containing both copolymers because of interactions and stereocomplexation between the PLLA and PDLA blocks. Gelation was evaluated with the tube inverting method and rheological measurements. A phase diagram was realized with gel-sol transitions as a function of concentration. The rheological properties of the hydrogels were investigated under various conditions through changes in the copolymer concentration, temperature, time, and frequency. It was concluded that the hydrogels constituted a dynamic and evolutive system because of the continuous formation/destruction of cross-links and degradation.