Orthotopic neobladders were used to divert the urine

At

Orthotopic neobladders were used to divert the urine.

At the time of last follow-up, patients were interviewed in a standard fashion to evaluate urinary, bowel and sexually related symptoms. Results. During the follow-up period (mean 72 months, range 33-129) five patients developed metastases and died of bladder cancer. Four men were diagnosed with concomitant prostate cancer. Complete day-time continence was reported in 17/20 (85%) patients. Complete nocturnal continence was seen in 10/20 (50%) men. A total of 20/21 (95%) were sexually active following prostate-sparing cystectomy. Conclusion. Prostatic capsule- and seminal-sparing cystectomy appears to combine acceptable eFT-508 inhibitor oncological outcome with satisfactory function of the lower urinary tract; however, standard

radical cystectomy still represents the gold standard.”
“Objective: Changes in T1 rho and T2 magnetic resonance relaxation times have been associated with articular cartilage degeneration, but similar relationships for meniscal tissue have not been extensively investigated. This work examined relationships between T1 rho and T2 measurements and biochemical and mechanical properties across regions of degenerate human menisci.

Design: Average T1 rho and T2 relaxation times were determined for nine regions each of seven medial and 13 lateral menisci from 14 total knee replacement patients. Sulfated glycosaminoglycan (sGAG), collagen and water this website Kinase inhibitor Library contents were measured for each region. Biomechanical measurements of equilibrium compressive, dynamic compressive and dynamic shear moduli were made for anterior, central and posterior regions.

Results: T1 rho and T2 times showed similar regional patterns, with longer relaxation times in the (radially) middle region compared to the inner and

outer regions. Pooled over all regions, T1 rho and T2 times showed strong correlations both with one another and with water content. Correlations with biochemical content varied depending on normalization to wet or dry mass, and both imaging parameters showed stronger correlations with collagen compared to sGAG content. Mechanical properties displayed moderate inverse correlations with increasing T1 rho and T2 times and water content.

Conclusion: Both T1 rho and T2 relaxation times correlated strongly with water content and moderately with mechanical properties in osteoarthritic menisci, but not as strongly with sGAG or collagen contents alone. While the ability of magnetic resonance imaging (MRI) to detect early osteoarthritic changes remains the subject of investigation, these results suggest that T1 rho and T2 relaxation times have limited ability to detect compositional variations in degenerate menisci. (C) 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

L3-L4 had significantly greater motion than L2-L3 with left-right

L3-L4 had significantly greater motion than L2-L3 with left-right bending and left-right twisting movements (p < 0.05). The least motion occurred at L5-S1 for all movements; the motion at this level was significantly smaller than that at L3-L4 (p < 0.05). Range of motion during left-right bending and left-right twisting at L3-L4 was significantly larger in the degenerative disc disease group than in the Q-VD-Oph order normal group. The range of motion at L4-L5 was

significantly larger in the degenerative group than in the normal group during flexion; however, the ranges of motion in both groups were similar during left-to-right bending and left-to-right twisting.

Conclusions: The greatest range of motion in patients with discogenic back pain was observed at L3-L4; this motion was greater than that in normal subjects, suggesting that superior

adjacent levels developed segmental hypermobility prior to undergoing fusion. L5-S1 had the least motion, suggesting that segmental hypomobility ensues at this level in patients with discogenic low back pain.

Clinical Relevance: These data may be used to study find more the effects of spinal arthrodesis and to further define the mechanical component of adjacent-segment degeneration.”
“Phyllodes tumor (PT) is a rare fibroepithelial tumor of the breast, and these tumors are subdivided into benign, borderline, and malignant tumors. The criteria for their histologic diagnosis have been relatively well-described. However, the cytologic diagnosis presents more difficulties and only a few cytologic studies concerned with their subclassification have been published. The objective of the current study is to describe the cytologic features of benign, borderline and malignant PTs in an attempt to distinguish one from the others. Cytohistologic correlation for 11 benign, 3 borderline and 3 malignant PTs was performed. For all these cases, the preoperative fine needle aspiration (FNA) findings

were available for learn more review. The features we examined were a necrotic background, cellularity, stromal tissue fragments, stromal pleomorphism and atypism, dissociated stromal cells and mitosis. The overall diagnostic accuracy of FNA for the PT grading was 88.2% (15/17). Two benign PTs were cytologically misinterpreted as “”atypical epithelial and stromal cells”" and “”highly suspicious for ductal carcinoma”". Nevertheless, the cytologic diagnosis and the grading of PTs on FNA were relatively reliable. Semiquantitative analysis for the cellular stromal tissue fragments, stromal pleomorphism and atypism, dissociated stromal cells and mitosis might be helpful for subclassifing PTs on FNA. In the case of encountering a markedly necrotic background, special concern about degenerative change such as infarction is needed.

(c) 2011 American Institute of Physics [doi: 10 1063/1 3532033]“

(c) 2011 American Institute of Physics. [doi: 10.1063/1.3532033]“
“Background: An increase in the proportion of vegetables at meals could help achieve recommended vegetable intakes and facilitate

weight management.

Objective: We investigated the effects on food and energy intakes of varying the portion size and energy density of a vegetable that was added to a meal or substituted for other foods.

Design: In 2 experiments with crossover designs, PS-341 Proteases inhibitor men and women were served a meal of a vegetable, grain, and meat. Across the meals, the vegetable was served in 3 portion sizes (180, 270, or 360 g) and 2 energy densities (0.8 or 0.4 kcal/g) by altering the type and amount of added fat. In the addition study (n = 49), as the vegetable portion was increased, amounts of the grain and meat were unchanged, whereas in the substitution study (n = 48), amounts of the grain and meat decreased equally.

Results: An increase in the vegetable portion size resulted in greater vegetable consumption in both studies (mean +/- SE: 60 +/- 5 g; P, 0.0001). The addition of more of the vegetable did not significantly affect meal energy intake, whereas substitution of the vegetable for the grain and meat decreased meal energy intake (40 +/-

10 kcal; P < 0.0001). A reduction in vegetable energy density decreased meal energy intake independent www.selleckchem.com/products/BafilomycinA1.html EPZ5676 of portion size (55 +/- 9 kcal; P < 0.0001). By combining

substitution with a reduction in energy density, meal energy intake decreased by 14 +/- 3%.

Conclusions: Serving more vegetables, either by adding more or substituting them for other foods, is an effective strategy to increase vegetable intake at a meal. However, to moderate meal energy intake, vegetables should be low in energy density; furthermore, the substitution of vegetables for more energy-dense foods is more effective than simply adding extra vegetables. Am J Clin Nutr 2010; 91: 913-22.”
“Analysis and modeling of impedance spectroscopy data of ferroelectric BaTi2O5 single crystal has been carried out at temperatures both below and above the ferroelectric Curie temperature, T-C. The most appropriate equivalent circuit is found to consist of a parallel combination of a resistor (R), capacitor (C), and constant phase element (CPE). Below TC, the resistance R is too large to measure and the circuit simplifies to C-CPE. Above T-C, R shows Arrhenius behavior with low values of conductivity, eg similar to 4 X 10(-7) S cm(-1) at 800 K and high activation energy, 1.13(2) eV, and represents a thermally activated dc hopping process associated with leakage transport of either electrons or holes through the crystal lattice.

Results Mean fibrinogen concentration was 3 0 + 0 7 g/L (range,

Results. Mean fibrinogen concentration was 3.0 + 0.7 g/L (range, 1.3- 4.9). Mean total perioperative bleeding volume was 1552 +/- 1019 mL (range, 100-5800 mL). Total bleeding volume correlated significantly with preoperative fibrinogen concentration (r = -0.31, P = 0.005) but neither with platelet count, aPTT, nor PT (P = 0.61, 0.46, and 0.57, respectively). Bleeders had significantly lower preoperative fibrinogen plasma concentration (2.6 perpendicular to 0.6 vs. 3.1 perpendicular to 0.6 g/L, P = 0.002). Of total, 16% (13/82) of the patients were

transfused with > 2 U of packed red GW120918 cells. Patients with extensive transfusions had significantly lower preoperative fibrinogen plasma concentration (2.5 +/- 0.7 vs. 3.1 +/- 0.6 g/L, P = 0.002), while preoperative platelet count, aPTT, and PT did not differ.

Conclusion. The results indicate that preoperative fibrinogen concentration is a limiting factor for postoperative hemostasis during and after scoliosis surgery. Preoperative measurement of fibrinogen concentration provides more information about bleeding volume and transfusion requirements than standard screening tests.”
“Nifedipine is a calcium channel blocker which is used in the treatment of hypertension angina pectoris. The aim of this study was to formulate and optimize

nifedipine containing microspheres in an attempt to prepare a suitable sustained Saracatinib cost release delivery system using factorial design. Drug loaded microspheres were prepared using Eudragit RL100, through solvent evaporation technique. In the next step, the effect of different formulation variables, including the amount of polymer (1 – 2 g), stabilizer (0.1 – 0.5 g) and drug/polymer ratio (0.05:1 – 0.1:1) on the appearance, physical properties of particles, and the amount of loaded drug was investigated. Based https://www.selleckchem.com/products/ldn193189.html on the type and the variables studied, 8 formulations were designed using factorial design method, and were then prepared and their drug contents were determined. In order

to detect the precise effect of the formulation variables and their interactions, design expert software was used. Data analysis showed that microspheres with optimum drug loading could be prepared using 1 g polyvinylalcohol, 1 – 2 g polymer and 0.07:1 drug/polymer ratio. Among the formulations suggested and based on the predicted responses and their desirability indices, 6 formulations were selected as the optimum formulations. Finally, selected microspheres were evaluated from the view points of morphology and release pattern. Results revealed that microspheres obtained from the formulations S(19), S(20) and S(24) could be selected as the best and optimized formulations due to their high drug contents, appropriate invitro drug release after 12 h and desired morphology.”
“The risk of developing colorectal cancer (CRC) depends on both genetic factors and lifestyle-related factors.

The current review highlights the effect of sublethal physical tr

The current review highlights the effect of sublethal physical treatments such as ultrasound, electroporation and UV radiation on the viability of cells, their potential bioprocess applications, and the possibility of mutations.”
“Aim: In order to reveal the differences between oral contraceptives (OC) perceptions and actual needs, we performed a web-based study in the USA, France, and Japan.

Materials and Methods: The study was carried out using

a web-based questionnaire in May 2009. Two hundred women each from the three countries who were in their 20s, 30s, or 40s were randomly selected and asked about contraception.

Results: The most frequently used contraceptive method was OC in the USA and France and condoms LY2090314 cost in Japan. The most commonly used OC information source was doctors CA-4948 mw in the USA and France, but the media in Japan. The main reason for taking OC was ‘contraception’ in the USA and France, but it was relief from menstruation-related problems in Japan. Partner agreement was highest in France, and partner disagreement was highest in the USA. The most common reason for discontinuing OC use was ‘contraception became unnecessary’ in all three countries. The second most common reason was ‘troublesome to take everyday’ in the USA and France but ‘troublesome to get a doctor’s prescription’ in Japan. The most common reason for never taking OC was also ‘troublesome to get a doctor’s prescription’

in Japan. As a non-contraceptive benefit, ‘relief of dysmenorrhea’ was well known in all three countries; however, other non-contraceptive benefits were little known among Japanese.

Conclusions: There are several differences in the patterns of OC use in the three countries studied. Providers should know more about current OC usage patterns in order to improve the quality of care.”
“Background: To investigate the clinical features of cardiac involvement in polymyositis (PM) or dermatomyositis

(DM).

Hypothesis: More attention will be focused on the heart in PM/DM as we would have wished, which contribute to improve the prognosis.

Methods: All articles published in English were retrieved by searching MEDLINE via PubMed (19752011). this website After selecting eligible articles according to the predefined inclusion and exclusion criteria, a systemic review was carried out.

Results: A total of 26 articles were included in this study, which included 1530 patients. The incidence of cardiac involvement was 9% to 72%. Heart failure was the most frequent (32% to 77%) clinical symptom. Among the abnormal electrocardiogram and ultrasonic cardiogram, the incidence of conduction abnormalities, left ventricular diastolic dysfunction, and hyperkinetic left ventricular contraction were 25% to 38.5%, 42%, and 6% to 12%, respectively. The pathologic findings revealed myocardial inflammation, degenerative changes and necrosis similar to that in skeletal muscles.

(C) 2011 American Institute of Physics [doi:10 1063/1 3536796]“<

(C) 2011 American Institute of Physics. [doi:10.1063/1.3536796]“
“Purpose: To evaluate the effectiveness, cost, and cost-effectiveness of using renal mass biopsy to guide treatment decisions for small incidentally detected renal tumors.

Materials and Methods: A decision-analytic Markov model was developed to estimate LEE011 research buy life expectancy and lifetime costs for patients with small (<= 4-cm) renal tumors. Two strategies were compared: renal mass biopsy to triage patients to surgery or imaging surveillance and empiric nephron-sparing surgery. The model incorporated biopsy performance, the probability of track

seeding with malignant cells, the prevalence and growth of benign and malignant tumors, treatment effectiveness and costs, and patient outcomes. An incremental cost-effectiveness

analysis was performed to identify strategy preference under a willingness-to-pay threshold of $75 000 per quality-adjusted life-year (QALY). Effects of changes in key parameters on strategy preference were evaluated in sensitivity analysis.

Results: Under base-case assumptions, the biopsy strategy yielded a minimally greater quality-adjusted life expectancy (4 days) than did empiric surgery at a lower lifetime cost ($3466), dominating surgery from a cost-effectiveness perspective. Over the majority of parameter ranges tested in one-way sensitivity RGFP966 manufacturer analysis, the 3-MA in vitro biopsy strategy dominated surgery or was cost-effective relative to surgery based on a $75 000-per-QALY willingness-to-pay threshold. In two-way sensitivity analysis, surgery yielded greater life expectancy when the prevalence of malignancy and propensity for biopsy-negative cancers to metastasize were both higher than expected or when the sensitivity and specificity of biopsy were both lower than expected.

Conclusion: The use of biopsy to guide treatment

decisions for small incidentally detected renal tumors is cost-effective and can prevent unnecessary surgery in many cases. (C) RSNA, 2010″
“G protein-coupled receptor 119 (GPR119) is predominantly expressed in beta cells and intestinal L cells. In this study, we investigated whether oleoylethanolamide (OEA), a GPR119 endogenous ligand, and PSN632408, a GPR119 synthetic agonist, can stimulate beta-cell replication in vitro and in vivo and improve islet graft function in diabetic mice. We found that OEA and PSN632408 significantly increased numbers of insulin(+)/5-bromo-2′-deoxyuridine (BrdU)(+) beta cells in cultured mouse islets in a dose-dependent manner. All diabetic recipient mice, given marginal syngeneic islet transplants with OEA or PSN632408 or vehicle, achieved normoglycemia at 4 weeks after transplantation. However, normoglycemia was achieved significantly faster in OEA- or PSN632408-treated diabetic mice than in vehicle-treated diabetic mice (P < 0.05).

The mean follow-up period was 20 4 months (range 6 months-5 years

The mean follow-up period was 20.4 months (range 6 months-5 years). As a result, 19 patients were https://www.selleckchem.com/products/repsox.html ablated with a single dose of I-131 (2-4 GBq). A total of 6 patients took a second dose of radioiodine treatment for lymph node or distant metastases. One of these

patients was 6 years old and had recently received ablation. He had diffuse lung metastasis, which was detected on the 6th day post ablation with whole body scintigraphy, and he is now under follow-up. Successful surgery and an effective radioiodine ablation have a crucial role in good outcomes of childhood DTCs.”
“Purpose: To investigate factors influencing the quality of ultrasonographic (US) elastography in FRAX597 solubility dmso the evaluation of suspicious breast masses.

Materials and Methods: This prospective study was conducted with institutional review board approval; written informed consent was obtained. Between January 2009 and February 2009, real-time US elastography of 312 breast masses (245 benign, 67 malignant) was performed in 268 consecutive patients (mean age, 45.7 years +/- 10.2 [standard deviation]) prior to US-guided core biopsy. Five breast radiologists who had performed the examinations assessed the quality of elasticity images as inadequate, low, or high without histologic information. Age, body mass index

(BMI), mammographic density, lesion size, lesion depth, and breast thickness at US were analyzed for their association with image quality by using the chi(2) test, Student t test, and multivariate analysis. Sensitivities and specificities for the differentiation of benign from malignant masses on the basis of elastography were calculated and compared between groups of quality scores by using the logistic buy 3-MA regression method.

Results: The quality of elasticity images was assessed as inadequate in 21 (6.7%) cases, low in 134 (42.9%), and high in 157 (50.3%). According to univariate analysis, smaller lesion size (P = .001), shallower lesion depth (P = .005), less breast thickness

where the lesion was located (P < .0001), and benign pathologic finding (P = .004) were significantly associated with higher image quality. There was no correlation of image quality with age (P = .213), BMI (P = .191), mammographic density (P = .091), or distance from the nipple (P = .100). Multivariable analysis showed that breast thickness at the location of target lesions was the most important factor influencing elasticity image quality (P = .001). There were significant differences in sensitivity between higher-quality and lower-quality images (87.0% vs 56.8%, respectively; P = .015) in the differentiation of benign from malignant masses.

Conclusion: Breast thickness at the location of the lesion was the most important factor influencing image quality at US elastography.

Elucidating the misfolding of a XN1 monomer can help determine th

Elucidating the misfolding of a XN1 monomer can help determine the molecular mechanism of XN1 aggregation and potentially help develop strategies to inhibit XN1 aggregation. The flanking sequences surrounding the polyQ region can play a critical role in determining Selonsertib solubility dmso the structural rearrangement and aggregation mechanism of XN1. Few experiments have studied XN1 in its entirety, with all flanking regions. To obtain structural insights into the misfolding of XN1 toward amyloid aggregation, we perform molecular dynamics simulations on monomeric

XN1 with full flanking regions, a variant missing the polyproline regions, which are hypothesized to prevent aggregation, and an isolated polyQ peptide (Q(n)). For each of these three constructs, we study glutamine repeat lengths of 23, 36, 40 and 47. We find that polyQ peptides have a positive correlation between their probability to form a beta-rich misfolded CP673451 state and their expansion length. We also find that the flanking regions of XN1 affect its probability to form a beta-rich state compared to the isolated polyQ. Particularly, the polyproline regions form polyproline type II helices and decrease the probability of

the polyQ region to form a beta-rich state. Additionally, by lengthening polyQ, the first N-terminal 17 residues are more likely to adopt a beta-sheet conformation rather than an alpha-helix conformation. Therefore, our molecular dynamics study provides a structural insight of XN1 misfolding and elucidates the possible role of the flanking sequences in XN1 aggregation.”
“P>Optimal donor selection is one of the key factors to enhance the success rate of allogeneic hematopoietic

stem cell transplantation (HSCT). The effect of sex mismatch, especially the effect of Y chromosome mismatch in graft-versus-host disease (GVHD) direction (female donors to male recipients: denoted as FtoM mismatch) on overall survival (OS) has been controversial and S3I-201 cell line not examined out of the patient population in Western countries. We retrospectively analyzed 225 cases of allogeneic HSCT and showed that FtoM mismatch confers a highly significant impact on OS (P < 0.005) in Japanese population. We demonstrated that this effect depends on the disease risk; for standard risk cases, this effect was significantly associated with poor outcome (for OS, P = 0.021), while for high risk cases, it had no effect on the results (for OS, P = 0.26). We further showed that FtoM mismatch was associated with nonrelapse mortality (P = 0.019) and most of them were GVHD-related in standard risk cases. In conclusion, FtoM mismatch has a significant impact on transplant outcome, especially in standard risk cases.”
“We discuss two points related to the simultaneous existence of phononic and photonic band gaps in a two-dimensional crystal constituted by a square array of holes drilled in a matrix.

In the postcentral gyrus, only the shoulder revealed a significan

In the postcentral gyrus, only the shoulder revealed a significant difference (P < .05). Concurrence ratios (activation volume overlap of two tasks/ combined activation area of both tasks) ranged from 0.44 to 0.57. Proportional ratios (activation volume overlap of passive task with active task/total activation volume of passive task) ranged from 0.64 to 0.82.

Conclusion: LCZ696 ic50 Passive

movement paradigms may be an alternative to or complement to active movement tasks in patient populations.”
“P>Arabidopsis TRANSPARENT TESTA19 (TT19) encodes a glutathione-S-transferase (GST)-like protein that is involved in the accumulation of proanthocyanidins (PAs) in the seed coat. PA accumulation sites in tt19 immature seeds were observed as small vacuolar-like structures, whereas those in tt12, a mutant of the tonoplast-bound transporter of PAs, and tt12 tt19 were observed at peripheral regions of small vacuoles. We found that tt19 immature seeds had small selleck chemicals llc spherical structures showing unique thick morphology by differential interference contrast microscopy. The distribution pattern of the thick structures overlapped the location of PA accumulation sites, and the thick structures were outlined with GFP-TT12 proteins in tt19. PA analysis showed higher (eightfold) levels of solvent-insoluble

PAs in tt19 immature seeds compared with the wild type. Metabolic profiling of the solvent-soluble fraction by LC-MS demonstrated that PA derivatives such as epicatechins and epicatechin oligomers, although highly accumulated in the wild type, were absent

Ferrostatin-1 in tt19. We also revealed that tt12 specifically accumulated glycosylated epicatechins, the putative transport substrates for TT12. tt12 tt19 showed a similar metabolic profile to tt19. Given the cytosolic localization of functional GFP-TT19 proteins, our results suggest that TT19, which acts prior to TT12, functions in the cytosol to maintain the regular accumulation of PA precursors, such as epicatechin and glycosylated epicatechin, in the vacuole. The PA pathway in the Arabidopsis seed coat is discussed in relation to the subcellular localization of PA metabolites.”
“Background and Objectives: Although cardiovascular disease (CVD) is an important cause of morbidity and mortality in patients with end-stage renal disease, non-CVD causes account for more than 50% of total deaths. We previously showed that, compared with men, women starting dialysis-both hemodialysis and peritoneal dialysis (PD)-have higher non-CVD mortality rates. Here, we evaluate sex-specific outcomes in a large cohort of incident PD patients.

Methods: Incident de novo PD patients from the Andalusian SICATA Registry for 1999 – 2010, with follow-up until 31 December 2010 or up to 5 years, were investigated for fatal outcomes. Causes of death were extracted from medical records.


“Dopamine agonists disrupt prepulse inhibition (PPI) of st


“Dopamine agonists disrupt prepulse inhibition (PPI) of startle in male rodents. In humans, this is observed only in some studies. We reported that PPI was disrupted by d-amphetamine in men, but only among those with high basal PPI

levels. Here, amphetamine effects on PPI were tested in normal women and female rats.

Acoustic startle and PPI were tested in normal women after placebo or 20 mg amphetamine, in a double-blind, crossover design, and in female rats after vehicle or 4.5 mg/kg amphetamine. Rats were from Sprague-Dawley check details (SD) and Long Evans (LE) strains that differ significantly in gene expression in PPI-regulatory circuitry, including levels of nucleus accumbens PD173074 (NAC) catechol-O-methyl transferase (COMT) mRNA.

Amphetamine was bioactive in humans based on quantitative autonomic and self-rating measures, but did not significantly change startle magnitude or PPI across all subjects. Amphetamine’s effects on PPI in women correlated significantly (p < 0.0008) with placebo PPI levels (reducing PPI only in women

whose basal PPI levels exceeded the sample median) and with measures of novelty and sensation seeking. Amphetamine decreased PPI in SD rats that have relatively low NAC COMT gene expression and increased PPI in LE rats that have relatively high NAC COMT gene expression.

The dopaminergic regulation of PPI in humans is related to basal levels of sensorimotor gating and to specific personality traits in normal men and women. In rats, the effects of amphetamine on PPI differ significantly in strains with low vs. high NAC COMT expression.”
“In this Opinion we discuss the development of artificial spores and their maturation

as an independent field of research. The robust cell-in-shell structures have displayed unprecedented characteristics, which include the retardation of cell division and extensive cytoprotective capabilities that encompass exposure to osmotic pressure, shear force, heat, UV radiation, and lytic enzymes. Additionally, the nanothin shells act as highly versatile scaffolds for chemical functionalization to equip cells for implementation in tissue engineering, biosensors, cell therapy, or other biotechnological applications. Selleck AZD8186 We also explore the future direction of this emerging field and dictate that the next phase of research should focus on attaining more intricate engineering to achieve stimulus-responsive shell-degradation, multilayer casings with orthogonal functions, and the encapsulation of multiple cells for multicellular artificial spores.”
“Background/Aims: Fructose causes a sodium-sensitive hypertension and acutely reduces the urinary Na+ excretion, suggesting that it may regulate the activity of renal tubular sodium transporters. NHE3 is highly expressed in proximal tubule (PT), along with proteins that mediate fructose transport and metabolism.