Clinical Findings-Urinalysis revealed pyuria and fungal hyphae. Fungal culture of a urine sample grew a sterile mold that was identified as Westerdykella

spp via FOR assay.

Treatment Z-VAD-FMK mechanism of action and Outcome-The dog was treated empirically with itraconazole orally and amphotericin B IV for 5 weeks. Because of progressive azotemia, treatment was modified to oral administration of posaconazole. The dog improved but then developed progressive azotemia, hyperphosphatemia, and suspected diskospondylitis. Treatment was again modified to oral administration of terbinafine on the basis of results of antifungal susceptibility testing. The dog was euthanized after 5 months of antifungal treatment because of a deteriorating clinical condition and progressive azotemia.

Clinical Relevance-Westerdykella spp are filamentous hyphal organisms from the family Sporomiaceae and had not previously been reported to cause infections in dogs. selleck Fungal FOR assay and antifungal susceptibility testing may be useful for a patient with a suspected

fungal infection that does not respond to empirical treatment or when traditional culture methods for fungal identification are unsuccessful. Westerdykella spp should be considered as a possible etiologic agent when systemic mycosis is diagnosed. (J Am Vet Med Assoc 2013;242:381-387)”
“Leaf development involves many complex genetic interactions, signals between adjacent cells or between more distant tissues and consequent changes in cell fate. This review describes three stages in leaf development where regulation by small RNAs have been

used to modulate gene expression patterns.”
“Increased cytoplasmic lipid droplets (also known as lipid bodies or adiposomes) in nonadipocytic cells are commonly observed pathological features of a number of infectious diseases. Although the understanding of the functional significance of lipid droplets to host-pathogen interactions and microbial pathogenesis is still very limited, great advances in this growing field have been made in the past few years. Here, we review the recent findings that are starting to uncover the molecular mechanisms that regulate lipid accumulation into lipid droplets and the functions that this organelle may play this website during infection, with an emphasis on the potential implications of lipid droplets on human infectious diseases.”
“Objective To assess effects of camera angle and distance on measurement and reproducibility of thermographically determined temperatures of the distolateral aspect of the forelimbs in horses.

Design-Evaluation study.

Animals-10 adult horses.

Procedures-Thermographic images of both forelimbs were obtained at 3 times during the day (replicates 1, 2, and 3); maximum surface temperature over 1 region (distolateral aspect of the third metacarpal bone and metacarpophalangeal joint) was measured.

J Appl Polym Sci, 2012″
“Infectious CA4P nmr dermatological diseases are a common occurrence in southern Africa. Plants showing dermatological properties are highly sought after due to their ability to stop bleeding,

speed up wound healing and to soothe skin exposed to burns (Lewis and Elvin-Lewis, 1977). An attempt was made to validate the use of Haworthia limifolia and Aloe excelsa against microbial properties from extracts of leaves against five Gram positive, four Gram negative bacteria and six species of fungi. All Gram positive bacteria were inhibited by both the ethyl acetate and acetone extracts for leaves of H. limifolia. However, only one strain of Gram negative bacteria was inhibited by the same extracts. Ethyl acetate extract of A. excelsa was only effective against three Gram positive bacteria whilst acetone extracts were effective against all bacteria except for Shigella sonnei and

Enterobacter aerogene. Both ethanol and aqueous extracts of H. limifolia and A. excelsa showed antifungal activity. H. limifolia extracts showed greater antibacterial activity than A. excelsa MDV3100 mouse whilst A. excelsa showed greater antifungal activity than H. limifolia. Use of either species as traditional medicine will therefore depend on the type of infection or condition presented by the patient.”
“Potato peel, a waste generated from potato processing, is a disposal problem. But, potato peel is a good source of functional ingredients such as phenolic compounds. This study investigated the extraction of eight phenolic compounds (Gallic acid, GAC; Chlorogenic acid, CGA; Caffeic acid, CFA; Protocatechuic acid, PCA; Syringic acid, SGA; p-hydroxyl benzoic acid, PBA; Ferulic acid, FRA and Coumaric acid, CMA) from potato peel using subcritical water. Experiments were performed in a batch stainless steel reactor at 6 MPa, 2 mL/min and temperatures ranging from 100 to 240 degrees learn more C at residence time of 30 to 120 min. High recoveries of phenolic compounds (81.83 mg/100 g; wet basis wb) were obtained at 180 degrees C and extraction time of 30 min compared to 3 h extraction with methanol (46.59 mg/100 g wb). CGA

(14.59 mg/100 g wb) and GAC (29.56 mg/100 g wb) were the main phenolic compounds obtained from potato peel at 180 degrees C . Subcritical water at 160 to 180 degrees C, 6 MPa and 60 min might be a good substitute to organic solvents such as methanol and ethanol to obtain phenolic compounds from potato peel. (C) 2011 Elsevier Ltd. All rights reserved.”
“A novel poly(imide siloxane)/titania (PIS/TiO2) hybrid film was fabricated by sol-gel process via in situ formation of TiO2 within PIS matrix. Poly(amic acid siloxane) (PAAS) was prepared from 4,4′-oxydiphthalic anhydride, 2,2-bis [4-(4-aminophenoxy) phenyl] propane, and alpha,omega-bis(3-aminopropyl)polydimethylsiloxane (APPS). Chelating agent, acetylacetone, and catalyst-free polymerization were used to reduce the rate of hydrolysis of titanium alkoxide in the PAAS.

The same type of stent and filter EPD was used. Filters were collected and, after macroscopic evaluation, they were examined using the Thin-Prep (R) liquid-based cytology (LBC) technique.

Results: Technical success was 100%. Thirty-day stroke and death rates were 1.8% (1/53) and 0%, respectively. Visible debris was detected in

eight (15%) filters, whereas LBC revealed the presence of embolic material particles in 30 filters (56.6%). The presence of embolic material into the filter MRT67307 EPD was 2.38-fold increased for every category change from type IV to type I carotid plaques (OR = 2.38, 95% CI = 1.15-4.93). This association remained robust even after adjustment for age, gender and known atherosclerotic disease risk factors (OR = 2.26, 95%CI = 1.02-5.02). In multivariate analysis LY2090314 in vitro for risk factors, hypertension was associated with increased presence of embolic material detection in filter EPD (OR = 20.4, 95%CI = 1.28-326.1). The time distance from symptom to CAS was inversely correlated with debris quantity in EPD (Spearman rho 0.716; p = 0.02).

Conclusions: Echolucent plaques, smaller time frame from last symptom and hypertension

were associated with increased presence of embolic material. (C) 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.”
“Purpose of review

The present review provides an update on the recent literature regarding disease-specific issues in lung transplantation. Some of the published data will help refine previously Published candidate selection criteria and

provide evidence-based data for choice of procedures.

Recent findings

Recent studies on lung transplant outcomes in older patients underline that satisfactory MK-2206 research buy results can be obtained in patients older than 60 years but not in patients older than 70 years. Data from two large registry-based studies indicate that bilateral lung transplantation in patients with chronic obstructive pulmonary disease confers significantly longer survival than single lung transplantation, especially in patients younger than 60 years. Mathematical models to estimate survival benefit in chronic obstructive pulmonary disease lung transplant candidates have been developed and are being validated. The impact of Bee colonization in cystic fibrosis patients on outcome has been nuanced; thus, cystic fibrosis lung transplant candidates colonized by particular Bcc strains may be transplanted with good outcomes. Novel surgical approaches to peculiar situations in end-stage cystic fibrosis have been described. Candidate selection criteria for retransplantation procedures have further been clarified.

Summary

This article attempts to provide an overview of some of the currently important topics for clinicians involved in referring and evaluating patients with end-stage lung disease for lung transplantation in 2009.

0) Supplemented LY3023414 order with maltose (10%, w/w) and sodium nitrate (1.25%, w/w) as best co-carbon and co-nitrogen sources, respectively resulted in 5-fold increase of beta-keratinase production post-72 h of incubation at 50 degrees

C compared to beta-keratinase production under un-optimized condition. The purified beta-keratinase was a 20.1 kDa molecular weight serine protease requiring Fe(2+) for enzyme activity, showed restricted substrate specificity for beta-keratin, and exhibited a significant stability and compatibility with surfactants, and most of the tested commercial laundry detergents, thus demonstrating its feasibility for inclusion in laundry detergents formulations. (C) 2009 Elsevier B.V. All rights reserved.”
“Background:

Lung transplant (LTx) recipients’ adherence to regular self-monitoring of lung function (SMLF) is important in maintaining health. This study investigated patients’ behavior based on electronic monitoring

(EM) and compared these findings with self-reported data.

Methods:

This single-center study included 269 patients following LTx. Patients reported on adherence regarding SMLF, and data were compared to electronically stored measurements for the last three months prior to self-reporting.

Results:

Non-adherence was 59.4% based on EM for a total of 22 052 measurements performed. Main reported reasons for non-adherence were forgetfulness (22%), lack of time (19%), and good self-perception Geneticin solubility dmso of health status (19%). Determinants for non-adherence were patients constraining beliefs (p < 0.0001), low perceived support from the transplant center (p Blebbistatin solubility dmso < 0.008), a history of infections (p < 0.014) and rejections (p < 0.043), and bronchiolitis obliterans (p < 0.006). Multiple logistic regression revealed low-perceived support from the transplant center (OR 3.22; 95% CI 1.32-7.83; p < 0.01), and lack of support from patient organizations (OR 2.19; 95% CI 1.02-4.72; p < 0.04) as independent predictors for non-adherence.

Conclusions:

LTx recipients had some difficulties maintaining SMLF on a daily basis. Non-adherence

regarding lung function monitoring may provide a clinically relevant estimate of suspect cases for critical events impacting outcomes after LTx.”
“We have studied the temperature dependence of electroluminescence in superluminescent light emitting diode InGaN structures emitting light at 405 nm. Devices were fabricated in the “”tilted ridge”" geometry. We measured the superluminescence emission as a function of temperature from 263 to 295 K and observed a very pronounced power sensitivity with temperature. Simple modeling of the optical intensity reveals that the main temperature dependence is related to the spontaneous emission factor in the amplified spontaneous emission and the temperature dependence of gain is of secondary importance.

First, in 2004 we showed that only six of 13 radio-collared ferrets resident near four observation stations approached to within 8 m of two stations, and only three of the six entered over 8 days of observation. Five of the 15 ferrets available on the 6000 ha study area eluded recapture, although all remained present. Second, in 2006 we monitored the survival of 23 radio-collared ferrets before, throughout and after a 5-week field experiment, using toxic bait deployed in 20 automated bait dispensers distributed over 2554ha. Eight ferrets

entered find more a bait dispenser: four entered but did not take the bait; two did not visit but were killed by secondary poisoning; and nine never entered a bait dispenser. After the experiment, intensive live trapping guided by repeated radio-location surveys retrieved only two of 13 collared ferrets that were definitely still alive on the study area. Inefficiency of trapping wide-ranging

mustelids such as ferrets, stoats (Mustela erminea) and mink (Neovison bison) is probably commonplace, due to lack of opportunity (if animals take longer https://www.selleckchem.com/products/LY294002.html to find or enter a trap than it remains available) and/or to active avoidance (refusal to enter traps or to take bait). Our results provide confirmed examples of both, and help explain why short-term or seasonal control of invasive mustelids is often very inefficient, and eradication unlikely. (C) 2008 Elsevier Ltd. All rights reserved.”
“Carbon fibers must be protected from a high-temperature oxidizing environment because, at approximately 500 degrees C and above, the fibers exhibit reduced mass and strength

stability. The fibers can be protected by the application of thermal coatings, which simultaneously improve the adhesive properties of the carbon fibers in the composite materials. Polysilazanes are a new family of heat-resistant polymer coatings that are converted into silicone carbide or silicone nitride ceramic structures at high temperatures. The converted ceramics are resistant to the effects of high temperatures. In this research work, polysilazane-based coatings were applied to carbon filament (CF) rovings with the dip-coating method. Tensile testing at room selleck kinase inhibitor temperature and under thermal stress was carried out to assess the mechanical and thermomechanical properties of both coated and uncoated rovings. Scanning electron microscopy and energy-dispersive X-ray analysis were performed to evaluate the surface topographical properties of the coated and uncoated rovings. Thermogravimetric analysis was executed to determine the thermal stability of the polymer coatings. The coating performance on the CF rovings was determined by assessment of the test results obtained. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci, 2012″
“Since the first publication describing the identification of prostate-specific antigen (PSA) in the 1960s, much progress has been made.

Progressive disease was deemed the least desirable outcome and was associated with a substantial decline in utility (-0.473).

Findings suggest advanced STS are associated with significant burden for individuals. Treatment-related adverse events were seen as debilitating, however, progression represents an enormous challenge to QoL. This illustrates the significant value to buy Nutlin-3 individuals of extending the progression free survival period.”
“Background: Metabolic changes in the host in response

to Plasmodium infection play a crucial role in the pathogenesis of malaria. Alterations in metabolism of male and female mice infected with Plasmodium berghei ANKA are reported here.

Methods: H-1 NMR spectra of urine, sera and brain extracts of these mice were analysed over disease progression using Principle Component Analysis and Orthogonal Partial Least Square Discriminant MK-2206 in vivo Analysis.

Results: Analyses of overall changes in urinary profiles during disease progression demonstrate that females show a significant early post-infection shift in metabolism as compared to males. In contrast, serum profiles of female mice remain unaltered in the early infection stages; whereas that of the male mice changed. Brain metabolite profiles do not show global changes in the early stages of infection in either sex. By the late stages urine, serum and brain profiles of both sexes are severely affected. Analyses

of individual metabolites show significant increase in lactate, alanine and lysine, kynurenic Nocodazole order acid and quinolinic acid

in sera of both males and females at this stage. Early changes in female urine are marked by an increase of ureidopropionate, lowering of carnitine and transient enhancement of asparagine and dimethylglycine. Several metabolites when analysed individually in sera and brain reveal significant changes in their levels in the early phase of infection mainly in female mice. Asparagine and dimethylglycine levels decrease and quinolinic acid increases early in sera of infected females. In brain extracts of females, an early rise in levels is also observed for lactate, alanine and glycerol, kynurenic acid, ureidopropionate and 2-hydroxy-2-methylbutyrate.

Conclusions: These results suggest that P. berghei infection leads to impairment of glycolysis, lipid metabolism, metabolism of tryptophan and degradation of uracil. Characterization of early changes along these pathways may be crucial for prognosis and better disease management. Additionally, the distinct sexual dimorphism exhibited in these responses has a bearing on the understanding of the pathophysiology of malaria.”
“Silver-nanoparticle-doped poly(9-vinylcarbazole) (PVK) nanocomposites were prepared via the reduction of Ag(+) ions and the self-assembly of PVK on AgNO(3) aqueous solution surfaces. The formed composite nanostructures depended strongly on the experimental temperature.

The interpretation of fetal heart rate tracings was longer using ACOG criteria. The intraobserver agreement was significant. The interobserver agreement was better using NICE guidelines. The same trend MLN4924 mouse showed for the

concordance between investigators’ grading and actual outcomes There was more discordance in worse outcomes. Both guidelines are interesting and useful, but NICE seems easier to handle than ACOG.”
“Hypothesis. The following studies were designed to test the hypothesis that simultaneous administration of either Ang(1-7) or its antagonist A-779 would affect the chronic hypertensive effects of angiotensin II (Ang II).

Introduction. Despite the well-described actions of Ang(1-7) and its role possessing opposite actions to Ang II, there have been few studies examining the role

of Ang(1-7) in a chronic setting. It is well established that Ang(1-7) plays a protective role in preventing deleterious effects of Ang II in the heart, but little is known of its role in modulating VX-680 purchase the chronic hypertensive effects of Ang II.

Materials and methods. Rats were instrumented with venous catheters and telemetric pressure transducers. Arterial pressure responses were measured in rats treated with Ang II (10 ng/kg/min) (n=9) and compared with those treated with Ang II and Ang(1-7) (24 mu g/kg/h) (n=8), or the Ang(1-7) antagonist A-779 (24 mu g/kg/h) (n=7) for 8 days.

Results. Mean arterial pressure rose significantly and similarly in all three groups of rats, such that by day 8 of Ang II infusion, pressures had risen 25-30 mmHg in all rats.

Conclusions.

These results do not support the hypothesis that the chronic hypertensive effects of Ang II in normal rats are altered by co-administration of either Ang(1-7) or A-779.”
“Introduction: Citarinostat purchase The aim of this study was to establish an optimized fast and safe protocol for the pharmacological screening of AT(1) antagonists.

Materials and methods: The pharmaceutical prototype AT(1) antagonist losartan, its active metabolite EXP3174 and the synthetic compound MMK1 were analysed in order to validate the protocol. Ang II was continuously infused while the animals received the drugs in two procedures.

Results: In the post-treatment procedure drugs were administered either in a single bolus dose or in a sequential manner. When losartan was administered in a single bolus dose, efficacy was evident until the 7th min (p=0.012) whilst EXP3174 infusion extended the efficiency up to the end of the study (p=0.006). In addition, the sequential injections of losartan prolonged the inhibitory time interval until the end of the study (p=0.045). In the pre-treatment procedure, results suggested a dose-dependent inhibitory effect for both antagonists. The pressor response to Ang II was unchanged after MMK1 administration either in the post-or in the pre-treatment mode.

Results: Median

age was 12.6 years (range, 6.3-20.3 years), median forced expiratory volume in 1 second was 100% (range, 46%-127%) of the predicted value, and median forced vital capacity Stem Cells & Wnt inhibitor was 99% ( range, 61%-123%) of the predicted value. Very good agreement was observed between end-inspiratory and end-expiratory CT scores for Brody-II total score (ICC = 0.96), bronchiectasis (ICC = 0.98), airway wall thickening ( ICC = 0.94), mucus plugging (ICC = 0.96), and opacities (ICC = 0.90). Intra- and interobserver agreement were good to very good (ICC range, 0.70 – 0.98). Bland-Altman plots showed that differences in scores were independent of score magnitude.

Conclusion: In this pilot study, CT scores from end-expiratory and end-inspiratory CT match closely, suggesting that ultra-low-dose end-expiratory CT alone may be sufficient for monitoring CF-related lung disease. This would help reduce radiation dose for a single investigation by up to 75%. (C) RSNA, 2009″
“ac susceptibility measurement of magnetic markers in solution was performed for the liquid phase

detection of biological targets. First, the properties of the magnetic markers were clarified, such as size distribution, frequency dependence of susceptibility, and field dependence of magnetization. Next, we demonstrated a detection method in which we used large polymer beads to immobilize and prolong the Brownian relaxation time of the bound markers. In https://www.selleckchem.com/products/ferrostatin-1-fer-1.html this method, we could detect the bound markers by the decrease in the susceptibility that they displayed. Using this method, we detected biotin-conjugated polymer beads with avidin-coated Fe(3)O(4) markers. Changes in susceptibility caused by the binding reaction between them were measured with a magnetoresistive sensor. see more A strong relationship was observed between the decrease in susceptibility and the number of polymer beads, which indicates that the bound markers were detected correctly

without the use of the washing process called bound/free separation. The sensitivity of the system was estimated to be as high as 1.3 x 10(-16) mol/ml in terms of the molecular-number concentration of the markers. The binding process was also discussed from the dependence of the signal on the incubation time. (C) 2010 American Institute of Physics. [doi: 10.1063/1.3457233]“
“Theoretical background: Mental disorders emerge in childhood and adolescence and are important risk factors for mental disorders in adolescence and adulthood. Since paediatricians are typically the first to see children with psychological problems, the aim of this study was to obtain a survey of mental disorders of children in paediatric settings.

Nucleosome depletion and H3 acetylation are tissue-specifically regulated at the B-I hepta-repeat and associated with enhancement of b1 expression. H3K9 and H3K27 methylation are tissue-specifically localized at the B’ hepta-repeat and reinforce

the silenced B’ chromatin state. The B’ coding region is H3K27 dimethylated in all tissues analyzed, indicating a role in the maintenance of the silenced B’ state. Taken together, these findings provide insight into the mechanisms underlying paramutation and tissue-specific regulation of b1 at the level of chromatin structure.”
“Evaluation of: Buchwald H, Rudser KD, Williams SE, Michalek VN, Vagasky J, Connett JE: Overall mortality, incremental life expectancy and cause of death in the Program on the Volasertib Surgical Control of the Hyperlipidemia. Annul. Surg. 241, 1034-1040 (2010). The Program on the Surgical Control of the Hyperlipidemia (POSCH) trial was designed aiming to evaluate the effect of cholesterol reduction by ileal bypass on mortality in patients with previous myocardial infarction. The surgical procedure increases 4SC-202 inhibitor fecal loss of bile acids, promoting hepatocellular cholesterol deprivation and, as a result, induces an average 38% reduction of LDL-C and 4% increase in HDL-C, which

held constant throughout the follow-up. In the last report, an analysis of the study after 25 years of follow-up demonstrated the persistence of the reduction of total and cardiovascular mortality in the surgical group, which were 18 and 8% lower, respectively, compared

with the control group. Furthermore, cancer mortality was not different between groups, opposing the hypothesis of a causal association between cholesterol lowering and increases in the incidence of cancer. In this article, we discuss Smoothened Agonist the rationale and findings of the POSCH trial over the past 25 years and their clinical and mechanistic implications.”
“We sought to determine whether recipients of islet transplants have defective proinsulin processing. Individuals who had islet allo- or autotransplantation were compared to healthy nondiabetic subjects. Insulin (I), total proinsulin (TP), intact proinsulin and C-peptide (CP) were measured in samples of fasting serum by immunoassay, and the ratios of TP/TP+I and TP/CP were calculated. Islet allotransplant recipients had elevated TP levels relative to nondiabetic controls (16.8 [5.5-28.8] vs. 8.4 [4.0-21.8] pmol/L; p < 0.05) and autologous transplant recipients (7.3 [0.3-82.3] pmol/L; p < 0.05). Islet autotransplant recipients had significantly higher TP/TP+I ratios relative to nondiabetic controls (35.9 +/- 6.4 vs. 13.9 +/- 1.4%; p < 0.001). Islet allotransplant recipients, some of whom were on insulin, tended to have higher TP/TP+I ratios. The TP/CP ratio was significantly higher in both islet autotransplant (8.9 [0.6-105.2]; p < 0.05) and allotransplant recipients (2.4 [0.8-8.8]; p < 0.001) relative to nondiabetic controls (1.4 [0.5-2.6] %).

4, 95% CI = 2.9-45.3, P = 0.0005) and a 9-fold chance for uninterrupted 5YTR off medications (OR = 9.0, 95% CI = 1.171.9, P = 0.0383) compared find more with those who did not enter 1YR within the first 5 years of treatment. Three additional independent prognostic factors for predicting terminal 5YTR were confirmed: etiology, seizure frequency prior to treatment, and seizure frequency during treatment. We conclude that delayed efficacy after starting drug treatment gradually diminishes chances for long-term seizure remission, whether on medication or not.

Not entering remission within 5 years of starting treatment predicts failure to achieve long-term seizure freedom in the future for the vast majority of patients. (C) 2009 Elsevier Inc. All rights

reserved.”
“Histoplasmosis is a deep mycosis caused Selleck Small molecule library by Histoplasma capsulatum, which is endemic in many areas of the world but is relatively rare in China. Although the majority of cases present as a mild to moderate flu-like disease requiring only supportive therapy, approximately 1% of patients experience more serious pulmonary and extrapulmonary disease, which can be life-threatening if diagnosis is delayed or the treatment is not initiated rapidly. Definitive diagnosis is usually made by a combination of culture, detection of the organism in tissues, measurement of antibodies, and detection of antigen. We present the case of a 51-year-old patient who presented with histoplasmosis only, with several ulcerated lesions in the oral cavity and without HIV infection, who did not show any detectable signs and symptoms of systemic disease or extra-oral manifestations. Histopathological analysis indicated a chronic inflammatory process with granulomas with yeast-like organisms. Isolation of H. capsulatum and molecular identification provided the definitive diagnosis. Treatment with oral itraconazole led to remission of the oral

lesions. This is the first Chinese case report of localized histoplasmosis with lesions restricted to the mouth in an HIV-negative click here patient. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.”
“Cranial nerve involvement in multiple myeloma and solitary plasmacytoma is rare. We report on two patients who developed cranial nerve palsy due to skull base plasmacytoma. Patient 1, a 55-year old man with multiple myeloma, developed right sixth cranial nerve palsy during a phase of chemotherapy. He had an intracranial plasmacytoma in the clival region and was treated with 30 Gy whole brain radiotherapy. Patient 2, a 40-year old man, presented with right third cranial nerve palsy and was detected to have a solitary skull base plasmacytoma. He was treated with radiotherapy followed by thalidomide plus dexamethasone.