7, 8 More importantly, DNROL and DOXOL have also been reported to

7, 8 More importantly, DNROL and DOXOL have also been reported to be responsible for the cardiotoxicity of DNR and DOX, respectively.9, Lapatinib 10 In humans, the conversion of DNR and DOX to DNROL and DOXOL is mainly catalyzed by carbonyl reductase 1 (CBR1).11 CBR1 belongs to the short-chain dehydrogenase/reductase (SDR) family and is ubiquitously expressed in human tissues with particularly high levels in the liver.12 CBR1 is believed to contribute

significantly to the development of resistance toward DNR and DOX. This is supported by the finding that CBR1 overexpression results in DNR resistance in tumor cells.13, 14 DNR resistance in human stomach carcinoma cells has also been shown to result mainly from an induction of CBR1.15 Furthermore, the role of CBR1 in the severe cardiotoxicity associated with anthracycline treatment has been documented. Mice heterozygous for the null allele of CBR1 have shown reduced sensitivity to anthracycline-induced cardiotoxicity because reduced CBR1 expression produces lower levels of DOXOL.16 Because of CBR1′s role in the resistance to and toxicity of anthracyclines,

it has been speculated that the inhibition of CBR1 to prevent carbonyl reduction may be an effective approach to enhancing the efficiency and reducing the toxicity of anthracyclines.17 NVP-BEZ235 In the SDR family, several enzymes are sensitive to inhibition by flavonoids, a group of natural products of plant origin. Flavonoids were first identified as lens aldose CBR inhibitors

in the 1970s.18, 19 More recently, hydroxy-PP has also been reported Epothilone B (EPO906, Patupilone) to inhibit CBR1 and increase the sensitivity of cancer cell lines to DNR treatment (Fig. 1A).20 Flavonoids with different chemical structures are widely distributed in plants, vegetables, fruits, and beverages, particularly in tea and red wine. The major flavonoids of green tea extracts are catechins. Among them, (−)-epigallocatechin gallate (EGCG) is most abundant. EGCG has been shown to possess a wide range of pharmacological properties, including chemopreventive, anticarcinogenic, and antioxidant activity.21, 22 We have noticed a structural similarity between catechins and known inhibitors of CBR1, such as quercetin and quercitrin (Fig. 1A). In this report, evidence is presented that EGCG has a previously unknown inhibitory effect on CBR1 and CBR1-mediated tumor resistance to DNR, and this makes EGCG a potential chemotherapeutic agent for HCC.

Here, we examined whether ants induce dispersal behaviour in spid

Here, we examined whether ants induce dispersal behaviour in spiders. We tested the effect of chemical cues of two ant species (Lasius niger, Formica clara) on the walking activity and the propensity for silk-based dispersal of spiders. Silk-based dispersal of the web-builder

Phylloneta impressa www.selleckchem.com/products/SP600125.html increased by 80% with exposure to Lasius cues, whereas dispersal of the hunting spider Xysticus more than doubled when confronted with cues of both Lasius and Formica. In addition, Xysticus individuals showed a marked increase in walking activity when exposed to Formica but not Lasius cues. Our results show for the first time that perceived predation risk influences spider dispersal. The strong effect of ant chemical cues on spider dispersal demonstrates that TMEs contribute to the impact of selleck chemicals llc ants on arthropod communities. “
“Using plant–herbivore–decomposer

trophic chains as an example, we have tried to clarify the key roles of multitrophic interactions in species diversity. The interactions included two-link (herbivore–decomposer and decomposer–plant) and three-link (decomposer–herbivore–plant) chains within a community. Specifically, we investigated how sika deer abundance impacted dung beetle populations via dung supply and vegetation changes by surveying deer and beetle abundance and community composition monthly in Japan. The forest sites were similar in canopy cover, but differed in the presence (sites A and B) or absence (sites C) of an understory and in the abundance of deer (rare at site A, moderate at sites B and C, and common at site D). Site D was patchy grassland. Beetle species fell into two groups based on whether they were more abundant at sites with more dung or at sites with an understory. We suspect that the type of dung usage and/or beetle RVX-208 body size affected this finding. First, one beetle group was more strongly affected by vegetation cover than dung

supply, and they were mostly dwellers. The other group was affected by dung supply more than vegetation cover and comprised mostly tunnelers. Dwellers may be strongly negatively affected by decreased understory vegetation because of dung drying. Second, large beetle species were positively affected by decreasing vegetation cover and increasing dung supply; understory vegetation may negatively affect mobility in larger species. Our results suggested that increased deer abundance had both positive and negative as well as direct and indirect effects on the dung beetle community by increasing the dung supply and changing the vegetation structure, respectively. Moreover, dung beetle species responded differently depending on their ecological requirements and body sizes. “
“Most studies on excavation behaviour of Amphisbaenia have been based on descriptive analysis through visual observation or external body motion records.

In contrast with other studies on brown algae, inclusive of C im

In contrast with other studies on brown algae, inclusive of C. implexa (e.g., Larned 1998, Schaffelke and Klumpp 1998a,b, Schaffelke 1999), nutrient enrichment appeared to play no role in the elevated growth rates. This disparity may be due to the different experimental designs used: in previous studies nutrients were added as pulses and the experimental period was considerably shorter, whereas learn more in the present study, press nutrient treatments were

applied over 1 month. The mean growth rates of C. implexa under enriched November-PI scenarios over nonenriched treatments are slightly but not significantly elevated. This difference in growth rate between enriched- and ambient-PI scenarios is surpassed by the stimulation of growth observed in November-PI scenarios compared with all other scenarios. Potentially, PI3K Inhibitor Library it is the interaction between light, temperature and SW pCO2 that is driving the response, with light levels 20% greater in November than those observed in August, but the photosynthetic apparatus seemingly only able to

take advantage of the greater light availability when temperature and pCO2 are both relatively low. At present, C. implexa cover at the study site is highest in the month of December (Rogers 1997), but the present data also suggest that the late spring period is not necessarily also the period of greater growth under present-day conditions. The importance of the timing of the experiment as well as the applied scenario conditions is reflected in all productivity measurements (dark-adapted Fv/Fm, Pnmax and Rdark). The dark-adapted Fv/Fm showed a similar trend as the growth data, due to its tendency to be elevated in the November-PI scenario and relatively low in the August-A1FI scenario. The opposing patterns observed for dark-adapted Fv/Fm and O2 flux (Pnmax and Pgross, Pgross

not shown) are unexpected. In the short term, dark-adapted Fv/Fm is typically reduced following closure of reaction centers Adenosine triphosphate (RC) and under conditions that lead to an imbalance between light harvested and photochemical quenching capability (Genty et al. 1989). Frequently, the response to such conditions is to increase nonphotochemical quenching (NPQ); rerouting captured light energy to heat prior to its activation of the RC and hence O2 evolution (Müller et al. 2001). Both the closure of RCs and the activation of NPQ should reduce O2 evolution, that is, Fv/Fm and O2 evolution should work in concert. Decoupling of dark-adapted Fv/Fm and O2 flux responses has previously been observed for Palmaria palmata, in this case constant O2 flux gave way to decreased O2 flux only when Fv was reduced by 40% (Hanelt and Nultsch 1995).

39 The central role of CYP7A1 inhibition in hepatic dyslipidemia

39 The central role of CYP7A1 inhibition in hepatic dyslipidemia becomes evident from studies in mice with transgenic expression of Cyp7A1 in the liver, which

prevents high-fat diet-induced obesity and insulin resistance.40 The same group observed a glucose-mediated epigenetic modification of the CYP7A1 promoter region, leading to CYP7A1 induction, independent of FXR activation, linking glucose metabolism to BA synthesis.41 In a recent study the hepatic response to FGF19 was impaired in 20 NAFLD patients with insulin resistance compared to 15 healthy controls, while plasma FGF19 levels appeared not significantly different between these groups.42 In our cohort, we observed a modest increase in plasma FGF19 levels in NAFL compared to the NASH subgroup. This finding Abiraterone might be in accordance with blunted repression of CYP7A1 and an increased cholestenone production and may also play a functional role in the natural course of the disease. Toxic effects of BAs are not solely the result of detergent effects, but derive from activation of cell death pathways.43, 44 It is well known that BAs exhibit proapoptotic effects in a Fas- and tumor necrosis factor (TNF)-related apoptosis-inducing ligand dependent way in vitro45, 46 as well as by way of mitochondrial pathways, while the mechanism seems to be caspase-dependent.47

High intracellular BA levels promote hepatocyte apoptosis, markers of which we found both at the transcriptional selleck chemicals level within the liver (NOXA, CD95/Fas, FasL) and in the systemic circulation (M30). Interestingly,

in a recent study van der Poorten et al.20 identified increased BA levels in NASH as responsible for the activation of adipocytes to produce adiponectin, which supports the importance of a crosstalk between adipose tissue and the liver in NAFLD. In our cohort, adiponectin was inversely NADPH-cytochrome-c2 reductase correlated with NAFLD disease progression and serum BA levels. We have previously shown that adiponectin prevents CD95/Fas up-regulation and that ApoR2 is associated with steatosis in HCV.3 Adiponectin and other adipokines in the pathogenesis of NASH have recently been widely studied and adiponectin has been evaluated as a prognostic marker for NASH.48 Kaser et al.49 also found decreased expression levels of hepatic adiponectin in patients with NASH as opposed to simple steatosis in obese individuals. In that study, patients with a similar BMI as in our study were investigated and hepatic adiponectin as well as ApoR2 expression were decreased in individuals with NASH. While we observed a similar pattern for adiponectin, hepatic ApoR2 expression in our cohort was lower in obese patients compared to lean patients, but in NASH ApoR2 expression was again increased compared to those patients with an NAS <5. While Kaser et al.

The 48 metallic cylinders were divided into four groups (n = 12),

The 48 metallic cylinders were divided into four groups (n = 12), according to the veneering ceramic (StarLight Ceram and Duceram Kiss) and surface treatments: air-particle abrasion with Al2O3 or tungsten drill (W). Gr1: StarLight + Al2O3; Gr2: StarLight + W; Gr3: Duceram + Al2O3; and Gr4: Duceram + W. The specimens were aged using thermal cycling (3000×, 5 to 55°C, dwell time: 30 seconds, transfer time: 2 seconds). The shear test was performed with a universal testing machine, using a load cell of 100 kg (speed: 0.5 mm/min)

and a specific device. The bond strength data were analyzed using ANOVA and Tukey’s test (5%), and the failure modes were analyzed using an optical microscope (30×). Results: The means and standard deviations of the shear bond strengths were (MPa): G1 (57.97 ± 11.34); G2 (40.62 ± 12.96); G3 selleck chemicals (47.09 ± 13.19); AUY-922 solubility dmso and G4 (36.80 ± 8.86). Ceramic (p= 0.03252) and surface treatment (p= 0.0002)

significantly affected the mean bond strength values. Conclusions: Air-particle abrasion with Al2O3 improved the shear bond strength between metal and ceramics used. “
“Purpose: This study was designed to evaluate three veneering materials for an all-ceramic alumina system in terms of bond strength, microhardness, and core/veneer interface quality. Materials and Methods: Fifteen In-Ceram cores were constructed for this study, forming three groups of five specimens each divided by the DNA ligase veneering ceramic disc fired on the occlusal surface of the alumina core: Vitadur N, Vitadur Alpha, or VM7. The specimens underwent shear bond and microhardness

testing. Gross examination of debonded discs by SEM and EDAX analysis was conducted. Data for shear bond strength (SBS) and microhardness were presented as means and standard deviation (SD) values. One-way ANOVA and Duncan’s post hoc test were used for pairwise comparison between the means when ANOVA test was significant. Results: VM7 showed the highest shear bond value and lowest microhardness values of the three tested veneering materials. No statistically significant difference was evident between the SBSs of Vitadur N and Vitadur Alpha to the alumina cores. Vitadur Alpha showed statistically the highest mean VHN, followed by Vitadur N, while VM7 showed statistically the lowest mean values of VHN. Conclusions: In-Ceram core/Vitadur N disc debondings appeared to be interfacial by complete delaminations, leaving a shiny visible and quite distinct area, whereas there appeared to be perfect adhesion between the core and VM7 veneering material. VM7 appeared to possess ultra-fine texture with intimate contact to the core, forming what seemed like a transition zone where the ceramic and core appeared to blend for a distance. VM7′s finer particle size has improved the core/veneer bond strength and decreased micohardness values. This new veneering material will probably enhance the performance and esthetics of the In-Ceram system.

The 48 metallic cylinders were divided into four groups (n = 12),

The 48 metallic cylinders were divided into four groups (n = 12), according to the veneering ceramic (StarLight Ceram and Duceram Kiss) and surface treatments: air-particle abrasion with Al2O3 or tungsten drill (W). Gr1: StarLight + Al2O3; Gr2: StarLight + W; Gr3: Duceram + Al2O3; and Gr4: Duceram + W. The specimens were aged using thermal cycling (3000×, 5 to 55°C, dwell time: 30 seconds, transfer time: 2 seconds). The shear test was performed with a universal testing machine, using a load cell of 100 kg (speed: 0.5 mm/min)

and a specific device. The bond strength data were analyzed using ANOVA and Tukey’s test (5%), and the failure modes were analyzed using an optical microscope (30×). Results: The means and standard deviations of the shear bond strengths were (MPa): G1 (57.97 ± 11.34); G2 (40.62 ± 12.96); G3 selleck (47.09 ± 13.19); Selleck BAY 73-4506 and G4 (36.80 ± 8.86). Ceramic (p= 0.03252) and surface treatment (p= 0.0002)

significantly affected the mean bond strength values. Conclusions: Air-particle abrasion with Al2O3 improved the shear bond strength between metal and ceramics used. “
“Purpose: This study was designed to evaluate three veneering materials for an all-ceramic alumina system in terms of bond strength, microhardness, and core/veneer interface quality. Materials and Methods: Fifteen In-Ceram cores were constructed for this study, forming three groups of five specimens each divided by the Endonuclease veneering ceramic disc fired on the occlusal surface of the alumina core: Vitadur N, Vitadur Alpha, or VM7. The specimens underwent shear bond and microhardness

testing. Gross examination of debonded discs by SEM and EDAX analysis was conducted. Data for shear bond strength (SBS) and microhardness were presented as means and standard deviation (SD) values. One-way ANOVA and Duncan’s post hoc test were used for pairwise comparison between the means when ANOVA test was significant. Results: VM7 showed the highest shear bond value and lowest microhardness values of the three tested veneering materials. No statistically significant difference was evident between the SBSs of Vitadur N and Vitadur Alpha to the alumina cores. Vitadur Alpha showed statistically the highest mean VHN, followed by Vitadur N, while VM7 showed statistically the lowest mean values of VHN. Conclusions: In-Ceram core/Vitadur N disc debondings appeared to be interfacial by complete delaminations, leaving a shiny visible and quite distinct area, whereas there appeared to be perfect adhesion between the core and VM7 veneering material. VM7 appeared to possess ultra-fine texture with intimate contact to the core, forming what seemed like a transition zone where the ceramic and core appeared to blend for a distance. VM7′s finer particle size has improved the core/veneer bond strength and decreased micohardness values. This new veneering material will probably enhance the performance and esthetics of the In-Ceram system.

RNA extraction was performed using TRI-reagent (Molecular Researc

RNA extraction was performed using TRI-reagent (Molecular Research Center Inc.) using standard protocols. For first-strand synthesis, 0.5 μg of RNA was taken for each sample using iScript kit (Roche). For polymerase chain reaction (PCR), 2 μL of the reverse-transcription product was PLX-4720 clinical trial taken and together with specific primers was amplified in PCR. See Supporting Information for list of primer sequences. Real-time PCR was performed by using the LightCycler 480 (Roche, Gipf-Oberfrick, Switzerland). Results were normalized to glyceraldehyde 3-phosphate dehydrogenase (GAPDH) messenger

RNA levels. Chromatin immunoprecipitation (ChIP) was performed as described.11 Western blotting (protein immunoblotting) was performed as previously described.11, 13 Proteins were detected with the following antibodies: goat anti-R2 (N-18: SC-10844; Santa Cruz Biotechnology, Santa Cruz, CA), mouse antibody to hepatitis B core antigen (anti-HBcAg),13 and rabbit anti-Rfx1 polyclonal antibodies.11 The blots were then reacted with horseradish peroxidase–conjugated secondary antibody (Jackson), and enhanced chemiluminescence (ECL) detection was performed using EZ-ECL (Biological Industries). Isolation of primary mouse hepatocytes was

done according Adriamycin nmr to the method of Moldeus et al.14 The method is based on collagenase digestion and separation of liver parenchymal cells. Hydrodynamic injection was performed as described.15 In brief, 7-week-old female BALB/C mice were injected with 1.5 mL of normal saline (0.9% NaCl) by using the high-pressure hydrodynamic method

containing either a 1.3 HBV wild-type plasmid or a control plasmid. Mice were sacrificed, and livers were harvested after 2 days. As described,16 cells were collected and analyzed by FACSort (Becton Dickinson) fluorescence-activated cell sorting (FACS). Bromodeoxyuridine (BrdU) incorporation was performed as described in Beisker et al.17 HEK293T cells were seeded in 9-cm dishes and transfected with the three Thalidomide constructs of the lenti-system: 10 μg lenti expression vector, 7.5 μg packaging vector (cytomegalovirus delta-R8.9), and 2.5 μg envelope vector (VSV-G [vesicular stomatitis virus glycoprotein]).18 Medium was replaced 7-8 hours after transfection, using 4.5 mL to get a high viral concentration. For viral production HepG2 2.2.15 cells were grown with 2.5% DMSO for 1 week, the medium then was changed to medium containing 2.5% DMSO and 1% serum, with or without 1 mM HU. After a week the medium was collected, and centrifuged in a Sorvall SS34 rotor, at 34,633g RPM, for 30 minutes at 4°C. The cleared supernatant was ultracentrifuged at 140,000g, 16 hours at 4°C to concentrate the virions. The pellet containing virions was resuspended in 100 μL PBS (×300 concentration-fold).

In addition, 43 snap-frozen human HCC specimens were available fr

In addition, 43 snap-frozen human HCC specimens were available from cohort 2 for real-time polymerase chain reaction (PCR) analysis. The fresh frozen specimens were obtained from the Liver Cancer Specimen Bank (part of the National Research Bank Program, Korea Science and Engineering Foundation, Ministry of Science and Technology). Histopathologic analysis was performed for

both cohorts on whole tissue sections, and the variables recorded for each case included tumor size, differentiation according to Edmondson-Steiner grade, presence of multiple tumors, fibrous stroma, tumor capsules, microvascular and major vessel invasion, and background of cirrhosis. Tumor-capsule formation was defined as the presence of a fibrous capsule occupying >50% of the tumor Hydroxychloroquine cell line circumference, and fibrous stroma was defined as the presence of fibrosis occupying 5%-30% of the tumor area. HCCs with fibrous stroma occupying >30% of the entire tumor area were excluded from this study to avoid confusion with “scirrhous HCC.”14, 15 Core

tissue biopsies were taken from individual paraffin-embedded HCC donor blocks EPZ-6438 in vivo and arranged in recipient tissue-array blocks using a trephine apparatus (Superbiochips Laboratories, Seoul, Korea). At least 2 cores were sampled from each tumor, with the number of cores depending on the degree of heterogeneity present on histologic examination. Information on antibodies used and antigen-retrieval conditions are summarized in Supporting Table 1. Immunohistochemical stains were performed as previously described.11 Brown membranous and/or cytoplasmic staining was counted as positive for K19, EpCAM, c-kit, CD133, vimentin, E-cadherin, MMP2, uPAR, and ezrin, and nuclear and/or cytoplasmic staining for snail and S100A4 was counted as positive. For all antibodies studied, GPX6 except E-cadherin, the immunohistochemical stain results of cohort 1 were interpreted in a semiquantitative manner and given a score, from 0 to 3, as follows: 0: staining in <1% of tumor cells; 1: weak staining in ≥1%; 2: moderate staining in ≥1%; and 3: strong staining in ≥1% of tumor cells. Positive staining was defined

as staining scores of 2 and 3, whereas 0 and 1 were regarded as negative. For E-cadherin, immunohistochemical scoring was performed as follows: 0: intact membranous positivity; 1: partial loss of membranous stain; and 2: complete loss of membranous E-cadherin expression. For cohort 2, K19 positivity was defined as membranous and/or cytoplasmic expression in ≥5% of tumor cells with moderate or strong intensity. Total RNA was extracted from 43 snap-frozen human HCC tissues and subjected to complementary DNA (cDNA) synthesis and real-time quantitative reverse-transcriptase PCR, as described previously.4 Supporting Table 2 shows the primer and probe sequences (Roche Molecular Biochemicals, Indianapolis, IN) for K19, uPAR, VIL2, Snail, Slug, and Twist.

The immortalized mouse hepatocyte cell line, AML-12, was purchase

The immortalized mouse hepatocyte cell line, AML-12, was purchased from EX 527 research buy the

American Type Culture Collection (Manassas, VA). Various in vitro assays, using AML-12 cells exposed to ethanol or other reagents, were performed as described in the Supporting Materials. Male C57BL/6J mice (6-8 weeks old) were purchased from Jackson Laboratory (Bar Harbor, ME). Mice were fed a modified Lieber-DeCarli ethanol-containing diet or a pair-fed control diet, as described in the Supporting Materials. Data are presented as means ± standard deviation (SD). All data were analyzed by two-way analysis of variance, followed by Tukey’s multiple comparison procedure, with P < 0.05 being considered significant. Additional materials and methods are described in the Supporting Materials. Mouse AML-12 hepatocytes express sufficient levels of class I (low Km) alcohol

dehydrogenase (ADH) Staurosporine mw and aldehyde dehydrogenase 2 (ALDH2) proteins and efficiently metabolize ethanol (data not shown). However, AML-12 cells lack detectable immunoreactive protein cytochrome P450 2E1 (CYP2E1) (Supporting Fig. 1A). AML-12 cells were transfected with a reporter gene (mouse Lpin1-luciferase)

and an internal control plasmid (β-galactosidase) and exposed to various concentrations of ethanol (20-100 mM), then harvested for assay of reporter enzymes. The Lpin1 reporter activity was significantly increased in a concentration-dependent until manner by incubation with ethanol in AML-12 hepatocytes (Fig. 1A). We determined whether ethanol metabolism was required for ethanol-induced Lpin1 promoter activity by use of inhibitors of ethanol metabolism. We used the ADH inhibitor, 4-methylpyrazole (4-MP), and the ALDH2 inhibitor, cyanamide (Cya). Treatment with each of these inhibitors alone had no effect on baseline Lpin1-luciferase levels; however, when cells were exposed to ethanol, the inhibitors virtually abolished the ethanol-dependent induction of Lpin1-luciferase (Fig. 1B). Moreover, acetate (10 mM), one of ethanol’s major metabolites, shared its ability to increase Lpin1 promoter activity in AML-12 cells (Fig. 1C).

We conducted a systematic literature search with a predetermined

We conducted a systematic literature search with a predetermined protocol that was in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE),21 which studied the quality of reporting.21 We searched MEDLINE (1950 to June 2010) and Embase (1980 to June 2010) for studies

investigating the incidence of PSC. The search strategy is outlined in detail in Appendix I. The search was not limited by language or to human subjects. The reference lists selleck products of relevant articles were also reviewed. Two reviewers (N.A.M. and H.K.) identified articles eligible for further review by performing an initial screening of identified abstracts and titles. Abstracts were eliminated if they were not observational and did not investigate the epidemiology of PSC. Studies that did not report original data (e.g., review articles) were also excluded. The full text of the remaining articles was retrieved and systematically reviewed according to the inclusion and exclusion criteria. Articles were included if they reported an incidence rate (IR) of PSC or enough information to calculate the IR. Disagreements between reviewers were resolved by consensus with third-party experts (R.P.M. and G.G.K.). Two reviewers independently CHIR-99021 supplier extracted data for each study. The variable of interest was the incidence of PSC. The IR per 100,000 person-years with 95% confidence intervals (CIs)

was documented for the overall study period and for individual years when they were reported. Secondary variables extracted from the articles included the following: the method of case ascertainment (i.e., a patient registry or administrative database), the country of origin, the study time period, the median age and range, the male/female incidence

rate ratio (IRR), the incidence of small-duct and large-duct PSC, the percentage of PSC cases with IBD, and information on key indicators of study quality from MOOSE.21 The incidence of PSC was summarized with an IR, which was defined as the number of cases in a population per 100,000 person-years at risk in the population. IRs adjusted Rebamipide for confounding factors were selected over unadjusted IRs. The standard errors (SEs) and 95% CIs for the IRs were estimated under the assumption of a Poisson distribution. The ratio of males to females was summarized with an IRR, which was defined as the IR of PSC in males over the IR of PSC in females. When the IRR was not reported but the number of male and female incident PSC cases and the total study population were included, the IRR was calculated under the assumption that the background population was 50% male. Heterogeneity was assessed with the Q statistic (5% level), and meta-analyses were performed with random-effects models because of the presence of heterogeneity between studies. Stratified analyses and meta-regression were performed according to the methods of case ascertainment (i.e.