93, 95% CI 0 86 to 0 99) (Table (Table66) DiscussionWe found that

93, 95% CI 0.86 to 0.99) (Table (Table66).DiscussionWe found that 6.6% of 6,819 kidney transplant recipients from nine transplant centers experienced acute illnesses requiring ICU admission and that the reason for ICU admission was ARF in about one-half of CC 5013 these patients. Data collected 90 days after ICU discharge showed that 22.5% of patients had died, 20% had lost their transplant and returned to dialysis, 20% had experienced deterioration in renal function and only 37.5% had recovered their pre-ICU renal function. Mortality was associated not only with the severity of the respiratory and hemodynamic manifestations but also with the cause of ARF, with bacterial and fungal pneumonia being associated with higher mortality rates. Graft loss was associated with ARF severity, bacterial infection and worse renal function at ICU admission.

Importantly, later ICU admission after hospital admission was associated with a higher risk of returning to dialysis.The ICU admission rate in our patients is in agreement with rates reported in previous studies. In a single-center study, the ICU admission rate was 6.4% [21], and other studies have found rates of up to 25% [34,35] overall and lower rates of admission for ARDS [23]. These differences may be related to differences in ICU admission criteria and in medical complications. ARF was consistently the leading reason for ICU admission in our study. Among our patients with ARF, one-third required noninvasive mechanical ventilation and nearly one-half required endotracheal ventilation.Transplant recipients are at increased risk for infection, drug toxicities and cancer [16,20].

Infection is the leading reason for ICU admission and is significantly associated with death [36]. ARF is probably most likely to occur in kidney transplant recipients with high levels of immunosuppression, as indicated in our study by the high rate of previous acute rejection (21.5%), cytomegalovirus disease (18.5%) and retransplantation (19%). In our patients, ARF was due to infection in two-thirds of cases, and E. coli and S. pneumoniae were the most often recovered bacteria. However, the noticeable rates of resistant pathogens, such as methicillin-resistant S. aureus and Pseudomonas spp., should be borne in mind when choosing the first-line antibiotic regimen.

Factors that increase the risk of resistant organisms include high-level exposure to the healthcare system during dialysis and transplantation-related assessments. Invasive fungal infections were associated with mortality in our study. Candidiasis and aspergillosis are known to be associated with very high mortality rates [24]. P. jirovecii pneumonia was the leading cause of opportunistic infection in our study, despite routine trimethoprim-sulfamethoxazole chemoprophylaxis as recommended [37]. However, P. jirovecii pneumonia occurred late after AV-951 transplantation, at least 6 months after chemoprophylaxis was stopped.

This suggests that our assessment of the impact of acquired-BSI o

This suggests that our assessment of the impact of acquired-BSI on survival should be regarded as an upper-estimate of any effect.Finally, because of the relatively low incidence of ICU-acquired BSI in our population, neither ICU-acquired BSI would account for only 5% of deaths, that is 1% excess mortality in the total population. This observation has several implications for randomized controlled trials of interventions aimed at decreasing mortality by preventing ICU-acquired BSI. For example, a putative untargeted intervention capable of preventing 50% of ICU-acquired BSI would be expected to reduce the overall mortality of ICU patients staying for longer than 72 hours by only 0.5%. Accordingly, even a very effective intervention would have to be administered to 200 patients to save one life.

This effect is impossible to test in any feasibly sized randomized controlled trial (in excess of 100,000 patients would be required for adequate power). Interventions to prevent BSI could have a greater impact on survival by impacting sub-clinical, undiagnosed, or localized infection. However, the strength of such effects would need to be quantified if investigators wish to be assured that interventional studies were adequately sized. Our data do suggest that use of formally diagnosed BSI as a surrogate or secondary endpoint in untargeted interventional studies may not be feasible.Study strengths and weaknessesThis study has several strengths. We used a large sample of patients. Data were collected by dedicated data collectors and electronically stored and were thus not amenable to manipulation or bias.

Similarly, microbiological data were collected as part of patient care. We assessed the independent contribution of BSI to patient outcome, providing useful information for trial design and for the assessment of the relevant interventional literature.On the other hand, our study also has some weaknesses. Its findings may not be directly generalizable to differing microbiological environments worldwide. However, its results are comparable with those in similar studies conducted in the USA and Europe suggesting a degree of external validity. During the 11-year study period changes in case-mix, clinical workload, and clinical practice could have affected incidence and outcome of ICU-acquired BSI. However, no trend was evident on inspection of the yearly data (see Additional file 1).

By examining this time-span we were able to include data from over 6,000 ICU admissions Brefeldin_A making this one of the largest studies of BSI in intensive care.We did not have detailed clinical information including exact trigger for drawing blood cultures, antimicrobial therapy, response to treatment, and cause of death. Nor could we determine whether individual episodes of BSI represented true infections.

The developed analytical method was validated with respect to spe

The developed analytical method was validated with respect to specificity, linearity, precision, accuracy, robustness, selleck compound limit of detection (LOD) and quantification (LOQ). The stability of duloxetine samples was also studied. These studies were performed in accordance with established ICH guidelines. MATERIALS AND METHODS Chemicals and reagents The certified duloxetine hydrochloride, the working standard was supplied by Dr. Reddy’s Laboratories limited, Hyderabad, India. The HPLC grade acetonitrile and analytical grade KH2PO4 and ortho-phosphoric acid were purchased from Merck, Mumbai, India. High purity water was prepared by using Millipore Milli-Q Plus water purification system (Millipore, Milford, MA, USA). Swabs for sampling were purchased from ITW Texwipe (Philippines).

Apparatus The chromatography analysis was performed using a Waters Acquity? UPLC separation module (Waters Corporation, Milford, USA) equipped with a UV/visible detector, binary solvent manager and auto sampler system. The output signal was monitored and processed using Empower 2 software. The pH of the solutions was measured by a pH meter (Mettler-Toledo, Switzerland). In the sample preparation, an ultrasonic instrument was used for sonication. Chromatographic conditions The method was developed using an Acquity UPLC? HSS T3 (100 �� 2.1 mm2) 1.8 ��m column with an isocratic mobile phase containing a mixture of 0.01 M potassium dihydrogen ortho-phosphate, pH adjusted to 3.0 with ortho-phosphoric acid and acetonitrile (60:40 v/v). The mobile phase was filtered through nylon 0.22 ��m membrane filters and degassed.

The flow rate of the mobile phase was 0.4 mL/min. The column temperature was maintained at 40 ��C and the eluted compounds were monitored at the wavelength of 230 nm. The sample injection volume was 5 ��l. Standard solution preparation Milli-Q water and methanol in the ratio of 10:90 v/v was used as diluent. A stock solution containing 0.56 mg/mL duloxetine was prepared by an dissolving appropriate amount of drug in diluent. The final concentration of solution was 0.1 ��g/mL of duloxetine. Appropriate dilutions were made with diluent to obtain solution containing 0.5, 1.0, 5.0, and 50 ��g/mL. Sample preparation (extraction procedure) The selected surfaces (25 �� 25 cm2) of stainless steel, previously cleaned and dried, were sprayed with 1000 ��L of standard solution, for the positive swab control at all concentration levels and the solvent was allowed to evaporate.

The total surface were successively wiped first in horizontal and secondly in a vertical way, starting from outside toward the center, with one or two swabs moistened with extraction solution (water�Cmethanol 10:90, v/v) to remove the residue from the surface. The swabs were placed in the 25 mL screw-cap test tubes containing 10 mL extraction Dacomitinib solution.

Written informed consent was acquired from the patient or his leg

Written informed consent was acquired from the patient or his legal representative.Patients and randomizationAdult critically ill patients with acute renal failure requiring CVVH were eligible for inclusion. Exclusion criteria were (recent) bleeding or a suspicion of bleeding necessitating transfusion, selleck chemicals llc need of therapeutic anticoagulation or (suspected) heparin-induced thrombocytopenia. CVVH was initiated when, after resuscitation of the circulation, oliguria persisted and was accompanied by a steep rise in serum creatinine, or at a non-declining rise in creatinine in non-oliguric patients. Randomization was computer-based. When inclusion and exclusion criteria were checked in the patient data management system (MetaVision?, IMDSoft, Tel Aviv, Israel), the system automatically randomized the patients.

Study protocolPatients were randomized to one of two groups. In group 1, postdilutional CVVH was initiated at a filtrate flow of 4 L/h (blood flow 220 ml/min), which was converted to 2 L/h (blood flow 150 ml/min) after 60 minutes. In group 2, postdilutional CVVH was initiated at a filtrate flow of 2 L/h and converted to 4 L/h after 60 minutes. The cross-over design was chosen to detect differences in plasma and ultrafiltrate anti-Xa activity in case of elimination of anti-Xa activity by filtration. The 4 L/h dose is our default starting dose in the unit, which is normally reduced to 2 L/h if uremic toxins are low and circulation has stabilized.We used a 1.9 m2 cellulose triacetate hollow fiber membrane (UF 205, Nipro, Osaka, Japan), bicarbonate buffered replacement fluids heated to 39��C, and the Aquarius device (Edwards LifeSciences, S.

A., Saint-Prex, Switzerland). Nadroparin (Sanofi-Synthelabo, Maassluis, the Netherlands) was added to the one-liter priming solution (2850 IU). Patients received an intravenous bolus of 2850 IU nadroparin at initiation of CVVH, or 3800 IU when body weight exceeded 100 kg, followed by a continuous infusion in the extracorporeal circuit before the filter of 380 or 456 IU/h, respectively.After baseline sampling of arterial blood, samples of ultrafiltrate, arterial blood and postfilter blood were taken one hour after the start of CVVH, and at 15 minutes, 6 hours, 12 hours and 24 hours after the conversion from 4 to 2 L/h or from 2 to 4 L/h to measure antithrombin (at baseline only), anti-Xa activity, PTT, aPTT, platelet count, ETP, prothrombin fragments 1 and 2 (F1+2), thrombin-antithrombin complexes (TAT) and D-dimers.

Postfilter samples were taken directly after the filter, before infusion of the replacement fluid. Results of postfilter measurements are actual values, not corrected for hemoconcentration, unless indicated differently. Circuits were disconnected Entinostat at high prefilter or transmembrane pressure (both more than 300 mmHg), if vascular access failed, routinely after 72 hours or for clinical reasons (renal recovery, transport).

The limited relationship between

The limited relationship between Gilenya vasoconstrictor infusions and hyperemic responses in our studies suggest that exogenous catecholamines do not play a large role (compared to endogenous factors) in dampening hyperemic responses. Because Ang II was equally elevated in patients who did or did not receive exogenous vasoconstrictors, we are urged to investigate relationships between circulating RAS mediators and microvascular function in sepsis.We considered that RAS activation might simply reflect glomerular hypoperfusion due to hypovolemia, hypotension, or insufficient resuscitation. The clinical use of vasopressors, mechanical ventilation, and fluid resuscitation in our subjects was consistent with aggressive resuscitative efforts during the first day of sepsis, although we did not standardize resuscitation to measures of cardiac output, pulmonary artery occlusion (wedge) pressure, or pulse pressure variation in accord with uncertainties regarding what these goals should be [30-32].

Similarly, preexisting hypertension, diabetes, and coronary disease are associated with increased RAS activity, and no doubt are co-morbid conditions in clinical sepsis. We note that the levels of PRA and Ang II measured in our septic subjects are elevated nearly two-fold compared to outpatients with risk factors for vascular disease [33,34], arguing that the acute septic state contributes to RAS activation.

Although we did identify a relationship between arterial hypotension and circulating Ang II after the first day of severe sepsis, the modest statistical significance and lack of a similar relationship between hypotension and PRA (a biologic precursor to Ang II) temper our enthusiasm to declare arterial pressure a dominant factor leading to persistent RAS activation during sepsis.Our most novel finding is the association of circulating mediators of RAS with impaired hyperemic responses to ischemia during sepsis. This association raises the possibility that sepsis stimulates RAS, which contributes to microvascular perfusion heterogeneity (manifested as impaired response to local ischemia), and that perfusion heterogeneity contributes to organ failure. We cautiously note that our studies do not define a causal role of RAS in the pathogenesis of septic microvascular dysfunction, and RAS activation may be unrelated or even compensatory for microvascular dysfunction.

However, findings of Cilengitide increased small vessel density and decreased heterogeneity following vasodilator administration to septic subjects [35,36] suggest that an enhanced vasoconstrictor tone contributes to perturbations of the microvasculature. Thus our findings suggest that RAS contributes to the enhanced microvascular tone in human sepsis.Ang II inhibits endothelium-dependent relaxation of resistance arteries [37] and thus modulates the response to ischemia.

[18] Literature survey revealed that there are many developed met

[18] Literature survey revealed that there are many developed methods on UV,[19�C23] HPTLC,[24,25] HPLC,[26�C31] for estimation of METO single as well as in combination. However, there have been no reports check this concerning the simultaneous determination of (Figure 1) and (Figure 2) TELMI by absorbance correction method. These method was developed and validated as per International Conference on Harmonization (ICH) guidelines.[32]. Figure 1 Chemical structure of Metoprolol succinate (METO) Figure 2 Chemical Structure of Telmisartan (TELM) MATERIALS AND METHODS Apparatus A shimadzu model 1800 (SHIMADZU CORPORATION, International Marketing Division, Japan) double beam UV/Visible spectrophotometer with spectral width of 2 nm, wavelength accuracy of 0.5 nm and a pair of 10 mm matched quartz cell was used to measure absorbance of all the solutions.

Spectra were automatically obtained by UV-Probe system software (UV Probe version 2.31). Digital balance Acculab (ALC 210.4) and Sonicator Eneritech (Ultra Sonicator) was used in the study. Material Active pharmaceutical ingredient of TELM and METO were supplied by Zydus Cadila Healthcare Ltd., Ahmedabad, Gujarat, India. Marketed formulation TELSAR BETA (UNICHEM LABORATORIES, India) contains TELM IP 40 mg and METO USP 50 mg. Other formulation Telmaxx 50 (GLENMARK pharmaceutical Ltd., Mumbai) was purchased from an open market for this study which contains TELM IP 40 mg and METO USP 50 mg [Table 3]. Table 3 Analysis of TELM and METO by proposed method Reagent and chemical Methanol was used as a solvent which was procured from Finar Chemicals Ltd.

, Ahmedabad, India. Double distilled water was used throughout the analysis. Preparation of standard stock solution An accurately weighed quantity of TELM (10 mg) and METO (10 mg) were transferred to a separate 100 ml volumetric flask and dissolved and diluted to the mark with methanol to obtain standard solution having concentration of TELM (100 ��g/ml) and METO (100 ��g/ml). Absorbance correction method The value of ��max of was determined by scanning the drug solution in the range 200-400nm at 0.5 band width and 600 nm/min scan speed and was found to be at 296 nm and 223 nm, respectively. TELM also showed absorbance at 223 nm, while METO did not show any interference at 296 nm. [Figure 3] To construct Beer’s plot for TELM and METO, stock solutions of both the drugs were prepared in methanol [100 ��g/ml]. Also Beer’s plot was constructed for TELM and METO in solution mixture at different concentration. Both the drugs followed linearity individually in TELM (2, 4, 6, 8, 10, 12, 14, 16 ��g/ml) and METO (3, 6, 9, 12, 15, 18, 21, 24 ��g/ml) and in mixture with the concentration range TELM:METO are (1:1.25, 2:2.5, 3:3.75, 4:5, 5:6.25, GSK-3 6:7.5, 7:8.75 ��g/ml).

Table 1 Patient demographic data, hernia characteristics, and ope

Table 1 Patient demographic data, hernia characteristics, and operative features. The previous techniques used were the TAPP in three patients and TEP in two patients. All the recurrences were on the same side. One nevertheless patient previously had had one open and one laparoscopic hernia repairs due to rerecurrence (case 1). The mean interval between the first laparoscopic and the relaparoscopic repairs was 8 months (range, 1�C13 months). Technical problems such as insufficient mesh size, mesh migration, and insufficient fixation were the main factors contributing to recurrences. During the relaparoscopic repair, placement of a new mesh (with or without removal of the old mesh) and fixation were performed in all the patients.

In two cases with no previous mesh fixation (cases number 4 and 5), the old mesh remained on the peritoneal side during preperitoneal dissection in re-TEP repairs and this greatly facilitated surgical manipulation. The mean operative time was 93min (range, 45�C120min). There were no conversions or intraoperative complications in any of the cases. In order to remove the old mesh in one case with mesh shrinkage (case number 3), the inferior epigastric artery had to be ligated due to tight adhesions between the mesh and the artery. In this case, peritoneal tear also occurred; however, it did not obscure the operative field. All the patients were discharged from hospital on the first postoperative day. Seroma formation occurred in two patients (cases number 1 and 2). The sizes of the seroma, as predicted on physical exam, were approximately 5 �� 3cm and 4 �� 3cm in cases 1 and 2, respectively.

As a conservative management, both seromas were allowed to resolve by itself without necessitating needle aspiration or any other interventional procedures. The mean follow-up period was 17 months (range, 7�C24 months). During followup, no documented case of chronic groin pain, sexual dysfunction, mesh infection, or rerecurrence were encountered. 4. Discussion Today, conventional open inguinal hernia repair is the preferred method by most surgeons for the treatment of recurrences after previous laparoscopic repair and this concept is also supported by European Hernia Society [3]. However, a number of published studies have appeared in the literature addressing the use of relaparoscopic repair (TAPP or TEP) of recurrences after previous laparoscopic repair and their findings indicate that there is a place for relaparoscopic surgery in the treatment of such recurrences [4�C11].

van den Heuvel and Dwars [11] and Knook et al. [5] reported on 49 and 18 TAPP repairs for recurrences after previous TAPP or TEP, respectively, and concluded that the TAPP repair is safe and reliable for recurrences. Also, Ferzli et al. [9] reported on 20 cases and found that TEP repair of recurrent inguinal AV-951 hernia after a primary TEP repair is entirely feasible technically as well as entirely safe.


The Veliparib buy incidence of gliomas is expected to be around 5-6/100000 per year, with their survival rate depending heavily on their WHO grade. Even with today’s high medical standards consisting of surgical removal and postoperative combined radiochemotherapy, median survival shows 18�C21 months at its best for glioblastomas [1]. While it is frequently noted that malignant gliomas cannot be cured by surgical resection, recent studies show an improved life expectancy associated with a more extended tumour resection [1�C3]. Thus, currently, research is focussing on increasing the extent of resection through various additional techniques such as neuronavigation [4] or 5-aminolaevulinic acid (5-ALA) fluorescent marking of tumour cells.

While neuronavigation suggests precise imaging of the tumour, this can be misleading due to brain shift occurring during surgery and therefore tumour borders are not depicted according to reality [5]. For 5-ALA, randomized clinical trials showed a significant reduction of second resection in patients treated with 5-ALA compared to those who had surgery being performed solely under white light [6]. However, not all tumour cells show fluorescent activity; thus, neither the introduction of neuronavigation nor 5-ALA tumour imaging solved the problem of intraoperative precise separation of tumour tissue from adjacent intact brain parenchyma. A new way of optical imaging is confocal laser endomicroscopy (CLE) which has recently been applied to other medical fields such as gastroenterology and pulmonology.

As a patent dating back to 1957, confocal microscopy manages to reduce emitted light by molecules that are not in the desired focus plane. Opposed to conventional fluorescence microscopes where the tissue is widely lit upon, confocal laser microscopy only emits a punctual light beam from a laser source reducing the amount of scattered light that is then emitted by the sample. Because of an interposed pinhole blocking all remaining scattered light, only light emitted by the desired point is detected. The confocal light generates clear focused images without any out of focus signals. This technique has allowed visualizing the underlaying tissue on a microscopic scale with its features notably depending on the device in use. Through this method, however, it has been possible to achieve real-time imaging on a scale that has previously only been possible on histologic slices, making it a powerful diagnostic tool for tissue alterations.

Entinostat In gastroenterology as well as in pulmonology, the technique has been used in a combined method with standard endoscopy, giving the possibility of microscopic evaluation combined with targeted biopsies of altered tissue [7�C9]. With these promising results, CLE was introduced to neurosurgery and is currently being evaluated in different settings.

Let a supine infant be susceptible to SIDS only in that central s

Let a supine infant be susceptible to SIDS only in that central segment. Let the probability of a prone sleeping child = Pp and that of a supine merely sleeping child = Ps. For simplicity we include the side sleeping position with the prone, and we require Pp + Ps = 1. Then the probability of dying of SIDS at age m while prone (Ppsids) is written as, Ppsids=Pp??Pg??Pa??([Pn+Pi]?PnPi). (4) One can then write the probability of supine SIDS (Pssids) as, Pssids=Ps??Pg??Pa??Pn??Pi. (5) Combining (4) and (5) we get the total probability of SIDS (Psids) as Psids=Pp??Pg??Pa??(Pn+Pi)+(Ps?Pp)??Pg??Pa??Pn??Pi. (6) We then note that the sum of Pn + Pi has a similar mathematical form as Pn Pi as follows: Pn+Pi=1(m??+??0.31)+1(41.2?m)=[(41.2?m)+(m+0.31)][(m+0.31)??(41.2?m)], (7a) Pn+Pi=41.5[(m+0.31)(41.

2?m)], (7b) Pn??Pi=1[(m+0.31)(41.2?m)]. (7c) Thus the mathematical form for the age distribution of both supine SIDS and prone SIDS can be represented by the same relationship of C Pa/[(m + 0.31) (41.2 ? m)], where C is a constant, which implies that, in terms of relative probability at different values of m, (7b) and (7c) are the same. This is consistent with the report that there were similar frequencies of pathological findings in both supine and prone SIDS confirming that the mode and cause of SIDS death is apparently the same for both sleep positions [42]. This derivation shows how the Venn Diagram and JohnsonSBage distribution predict that supine and prone SIDS have the same age distribution, with lower rates for the supine SIDS.

This corresponds to the supine requirement to have all 4 risk factors (Pg Pa Pn Pi) as opposed to only 3 risk factors (Pa Pg Pi or Pa Pg Pn) that can allow a prone SIDS to happen more readily. Factors that make the prone sleep position a risk factor for SIDS are rebreathing of exhaled breath with reduced oxygen and increased carbon dioxide [43] and the finding that presence of a fan in the infants sleep environment, that disperses exhaled breath, decreases the SIDS rate [44]. 4. Discussion Other hypotheses than the X-linkage hypothesis of Naeye et al. [7] for the male excess in SIDS and other causes of infant respiratory mortality have appeared in the literature [45�C47]. Finnstr?m [48] reviewed this topic and concluded that ��The mechanism behind the excess perimortality rate in male infants is not known.

A genetic factor leading to reduced tolerance to hypoxia is possible.�� Torday et al. [45] analyzed amniotic fluid and showed the male fetus developed pulmonary surfactants slower than the female fetus and suggested that this deficit at birth may cause the male excess in infant respiratory distress syndrome (RDS) that matches that of SIDS. This is not likely because the measured deficit Carfilzomib should decrease with maturity as the infant ages, but CDC reports that the male fraction of RDS between 28 and 364 days [0.617] is greater than the male fraction [0.

All siRNA pools were purchased from Sigma Pro ligo The siRNA seq

All siRNA pools were purchased from Sigma Pro ligo. The siRNA sequences are listed in Additional file 1. Two siRNA pools for KEAP1 and all three compound library pools for NRF2 were comprised of 10 non redundant siRNAs at low concentration which has been shown to result in superior specificity while retaining potent tar get message knockdown compared to less complex pools at higher concentrations. The final pool for KEAP1 was generated through the esiRNA technique. siRNA transfection and RNA preparation for microarray Briefly, endoribonuclease prepared short interfering RNAs or siRNA pools for NRF2 and KEAP1 were incubated with Hiperfect re agent in basal media with no serum or antibiotics and allowed to complex for 10 min at room temperature.

During this incubation, normal human lung fibroblasts were plated in T25 flasks in media con taining 2% serum and growth factors but no antibiotics. The complex was then added to the cell suspension of each well. Cells were then incubated for 30 hr or 48 hr in a humidified incubator. At the end of the incubation period, the culture medium was removed and the cells were lysed by direct resuspension in Trizol reagent. Crude total RNA was isolated from Trizol dissolved samples and purified using the RNAeasy kit as per the manufacturers instructions. RNA concentration was measured using a NanoDrop ND 1000, and RNA in tegrity was determined with a 2100 Bioanalyzer. Samples displaying a RNA integrity number greater than 8 were used for profiling. Affymetrix GeneChip experiment Samples were amplified and labelled using a custom automated version of the RT IVT protocol and reagents provided by Affymetrix.

Hybridization, labelling and scanning were completed following the manufacturers recommendations. For data analysis, we used the mock transfected sample as the reference to compare with all other time matched samples to obtain the ratio data. Merck Affymetrix human custom arrays monitoring 43,737 individual transcripts were used. Raw intensity was normalized using the RMA algorithm. En richment for biological processes was performed by comparing each gene signature against the public gene collections Gene Ontology, KEGG, Swissprot and Pan ther families. Enrichment P values were corrected for multiple testing by using Bonferroni correction. Pathway analysis was performed using Ingenuity Pathway Analysis.

NRF2 and KEAP1 siRNA transfection for Q PCR and chemokine cytokine mesurements Briefly, siRNA pools for NRF2 and KEAP1 were incu bated with Hiperfect reagent in basal media with no serum or antibiotics and allowed to complex for 10min at room temperature. During this incubation, normal human lung fibroblasts were plated in 24 well or 96 well plates, at 4��104 or 2��104 cells GSK-3 well, respectively, with 2% serum but no antibiotics. The complex was then added to the cell sus pension for each well. Cells were then incubated for 48 hrs in a hu midified incubator.