miR-4645-3p attenuates podocyte injury and mitochondrial dysfunction in diabetic kidney disease by targeting Cdk5.

Podocyte injury plays a critical role in the progression of diabetic kidney disease (DKD), but the underlying cellular and molecular mechanisms remain poorly understanding. MicroRNAs (miRNAs) can disrupt gene expression by inducing translation inhibition and mRNA degradation, and recent evidence has shown that miRNAs may play a key role in many kidney diseases. In this study, we identified miR-4645-3p by global transcriptome expression profiling as one of the major downregulated miRNAs in high glucose-cultured podocytes. Moreover, whether DKD patients or STZ-induced diabetic mice, expression of miR-4645-3p was also significantly decreased in kidney. In the podocytes cultured by normal glucose, inhibition of miR-4645-3p expression promoted mitochondrial damage and podocyte apoptosis. In the podocytes cultured by high glucose (30 mM glucose), overexpression of miR-4645-3p significantly attenuated mitochondrial dysfunction and podocyte apoptosis induced by high glucose. Furthermore, we found that miR-4645-3p exerted protective roles by targeting Cdk5 inhibition. In vitro, miR-4645-3p obviously antagonized podocyte injury by inhibiting overexpression of Cdk5. In vivo of diabetic mice, podocyte injury, proteinuria, and impaired renal function were all effectively ameliorated by treatment with exogenous miR-4645-3p. Collectively, these findings demonstrate that miR-4645-3p can attenuate podocyte injury and mitochondrial dysfunction in DKD by targeting Cdk5. Sustaining the expression of miR-4645-3p in podocytes may be a novel strategy to treat DKD.

Tangshen formula targets the gut microbiota to treat non-alcoholic fatty liver disease in HFD mice: A 16S rRNA and non-targeted metabolomics analyses.

BACKGROUND: Tangshen formula (TSF) has an ameliorative effect on hepatic lipid metabolism in non-alcoholic fatty liver disease (NAFLD), but the role played by the gut microbiota in this process is unknown. METHOD: We conducted three batches of experiments to explore the role played by the gut microbiota: TSF administration, antibiotic treatment, and fecal microbial transplantation. NAFLD mice were induced with a high-fat diet to investigate the ameliorative effects of TSF on NAFLD features and intestinal barrier function. 16S rRNA sequencing and serum untargeted metabolomics were performed to further investigate the modulatory effects of TSF on the gut microbiota and metabolic dysregulation in the body. RESULTS: TSF ameliorated insulin resistance, hypercholesterolemia, lipid metabolism disorders, inflammation, and impairment of intestinal barrier function. 16S rRNA sequencing analysis revealed that TSF regulated the composition of the gut microbiota and increased the abundance of beneficial bacteria. Antibiotic treatment and fecal microbiota transplantation confirmed the importance of the gut microbiota in the treatment of NAFLD with TSF. Subsequently, untargeted metabolomics identified 172 differential metabolites due to the treatment of TSF. Functional predictions suggest that metabolisms of choline, glycerophospholipid, linoleic acid, alpha-linolenic acid, and arachidonic acid are the key metabolic pathways by which TSF ameliorates NAFLD and this may be influenced by the gut microbiota. CONCLUSION: TSF treats the NAFLD phenotype by remodeling the gut microbiota and improving metabolic profile, suggesting that TSF is a functional gut microbial and metabolic modulator for the treatment of NAFLD.

High-expressed PTPN1 promotes tumor proliferation signature in human hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a highly prevalent malignant tumor that is associated with substantial morbidity and mortality rates. Despite the progress made in diagnostic technology, the survival rate of HCC patients remains unsatisfactory due to the complex nature and extensive metastasis of the disease. Consequently, the discovery of new molecular targets is of great practical significance for the diagnosis and treatment of HCC. Protein tyrosine phosphatases (PTPs) play a crucial role in cell signal transduction by catalyzing the dephosphorylation of tyrosine residues in proteins. The present study has revealed that the upregulation of protein tyrosine phosphatase non-receptor type 1 (PTPN1) is a characteristic feature of HCC and is associated with a poor prognosis. Additionally, our investigation into the functional roles of PTPN1-regulated genes in HCC has demonstrated that alterations in PTPN1 expression disrupt normal cell cycle progression metabolism. Additionally, the capacity for proliferation and migration of HCC cells was notably diminished subsequent to PTPN1 silencing, resulting in the prevention of cell entry into the S phase from the G1 phase. Our investigation indicates that PTPN1 may facilitate the onset and progression of HCC by disrupting the cell cycle, thereby presenting a promising molecular target for the diagnosis and treatment of liver cancer.

High-sulfated derivative of polysaccharide from Ulva pertusa improves Adriamycin-induced nephrotic syndrome by suppressing oxidative stress.

Nephrotic syndrome (NS) is characterized by proteinuria, hyperlipidemia, and hypoalbuminemia. Ulva pertusa, a green seaweed, is a nutritional supplement. In this study, the high-sulfated derivative of Ulva pertusa polysaccharide (HU) was prepared by combining U pertusa polysaccharide with chlorosulfonic acid. The NS rat model was established by tail vein single injection of Adriamycin (6.0 mg kg-1). Normal rats were used as the control group. NS rat models were treated with HU or U (173 mg kg-1 day-1). After treatment for 6 weeks, we assessed urine protein, renal function, and blood lipids, and observed morphology and histologic injury of the kidney and glomerular microstructure. Furthermore, we detected antioxidant enzyme activity and expression level of the Keap1/Nrf2 signaling pathway to explore the potential mechanism of HU. Results showed that HU not only alleviated hyperlipidemia and hypoalbuminemia, but also reduced urine protein by inhibiting podocyte detachment, thickening of the glomerular basement membrane, and expression of kidney fibrosis markers (collagens I and IV). In addition, HU enhanced antioxidant enzyme activity (GSH-Px, CAT, SOD) in both serum and the kidney, which may be due to upregulating the expression of Nrf2 and downregulating the expression of Keap1. In conclusion, HU appears to be effective in attenuating NS in rats through suppressing oxidative stress by regulating the Keap1/Nrf2 signaling pathway.

Thermally Insulating SiO2/PSA Composite Aerogels with Heat Resistance and Mechanical Properties via the Thiol-Yne Click Reaction.

Polymer-reinforced silica aerogels are thermally insulating materials employed to enhance mechanical properties; however, they exhibit low heat stability and require a complex production process. The main body of this work concerns the synthesis of silicon-containing polyarylacetylene (PSA) resin, which has exceptional thermal properties and is used to strengthen the gel skeleton and significantly improve the heat resistance of the polymer reinforcement phase. The honeycomb-like porous SiO2/PSA aerogels derived from directional freezing were obtained via click reaction, gel aging, freeze-drying, and curing without the requirement for time-consuming solvent replacement. The prepared SiO2/PSA aerogel is low density (∼0.3 g/cm3) and high porosity (∼80%), which provides the material with low levels of thermal conductivity (∼0.06 W/m·K) and excellent thermal insulation performance. When compared to the majority of polymer aerogels and aerogel-like materials, the prepared SiO2/PSA aerogels have high Td5 (∼460 °C) and Yr800 (∼80%) and compressive strength (compression strength > 1.5 MPa). SiO2/PSA composite aerogel has numerous functions in areas where materials must withstand extremely elevated temperatures, such as the aerospace industry.

High Wear Resistance of POSS Grafted-Polyimide/Silica Composites under Atomic Oxygen Conditions.

Polyimide-bearing retainer has been successfully used in space environment. However, the structural damage of polyimide induced by space irradiation limits its wide use. In order to further improve the atomic oxygen resistance of polyimide and comprehensively investigate the tribological mechanism of polyimide composites exposed in simulate space environment, 3-amino-polyhedral oligomeric silsesquioxane (NH2-POSS) was incorporated into a polyimide molecular chain and silica (SiO2) nanoparticles were in situ added into polyimide matrix and the combined effect of vacuum environment, and atomic oxygen (AO) on the tribological performance of polyimide was studied using bearing steel as the counterpart by a ball on disk tribometer. XPS analysis demonstrated the formation of protective layer induced by AO. The wear resistance of polyimide after modification was enhanced under AO attack. FIB-TEM confirmed that the inert protective layer of Si was formed on the counterpart during the sliding process. Mechanisms behind this are discussed based on the systematic characterization of worn surfaces of the samples and the tribofilms formed on the counterbody.

Potential use of seaweed polysaccharides as prebiotics for management of metabolic syndrome: a review.

Seaweed polysaccharides (SPs) obtained from seaweeds are a class of functional prebiotics. SPs can regulate glucose and lipid anomalies, affect appetite, reduce inflammation and oxidative stress, and therefore have great potential for managing metabolic syndrome (MetS). SPs are poorly digested by the human gastrointestinal tract but are available to the gut microbiota to produce metabolites and exert a series of positive effects, which may be the mechanism by which SPs render their anti-MetS effects. This article reviews the potential of SPs as prebiotics in the management of MetS-related metabolic disturbances. The structure of SPs and studies related to the process of their degradation by gut bacteria and their therapeutic effects on MetS are highlighted. In summary, this review provides new perspectives on SPs as prebiotics to prevent and treat MetS.

Human placental extract regulates polarization of macrophages via IRGM/NLRP3 in allergic rhinitis.

Allergic rhinitis (AR) is globally prevalent and its pathogenesis remains unclear. Alternative activation of macrophages is suggested in AR and thought to be involved in natural immunoregulatory processes in AR. Aberrant activation of Nod-like receptor protein 3 (NLRP3) inflammasome is linked with AR. Human placenta extract (HPE) is widely used in clinics due to its multiple therapeutic potential carried by diverse bioactive molecules in it. We aim to investigate the effect of HPE on AR and the possible underlying mechanism. Ovalbumin (OVA)-induced AR rat model was set up and treated by HPE or cetirizine. General manifestation of AR was evaluated along with the histological and biochemical analysis performed on rat nasal mucosa. A proteomic analysis was performed on AR rat mucosa. Mouse alveolar macrophages (MH-S cells) were cultured under OVA stimulation to investigate the regulation of macrophages polarization. The morphological changes and the expression of NLRP3 inflammasome and immunity-related GTPase M (IRGM) in nasal mucosa as well as in MH-S cells were evaluated respectively. The results of our study showed the general manifestation of AR along with the histological changes in nasal mucosa of AR rats were improved by HPE. HPE suppresses NLRP3 inflammasome and the decline of IRGM in AR rats and MH-S cells. HPE regulates macrophage polarization through IRGM/NLRP3. We demonstrated that HPE had protection for AR and the protection is achieved partly through suppressing M1 while promoting M2, the process which is mediated by IRGM via inhibiting NLRP3 inflammasome in AR.

Function of TRPC1 in modulating hepatocellular carcinoma progression.

The liver is the main organ of metabolism in the human body, and it is easy to suffer from hepatitis, cirrhosis, liver cancer, and other diseases, the most serious of which is liver cancer. Worldwide, liver cancer is the most common and deadly malignant tumor, the third leading cause of cancer death in the world. Based on TCGA and ICGC databases, our research discovered the important role of TRPC1 in liver cancer through bioinformatics. The results showed that TRPC1 was over-expressed in hepatocellular carcinoma, and the higher the expression level of TRPC1, the worse the OS and the lower the survival rate. TRPC1 was a risk factor affecting the overall survival probability of hepatocellular carcinoma patients. By analyzing the function of the TRP family in liver cancer, TRPC1 might promote the occurrence of liver cancer by up-regulating common signal pathways in tumors such as tumor proliferation signature, and down-regulating important metabolic reactions such as retinol metabolism. In addition, TRPC1 could promote the development of liver cancer by up-regulating the expression of ABI2, MAPRE1, YEATS2, MTA3, TMEM237, MTMR2, CCDC6, AC069544.2, and NCBP2 genes. These results illustrate that TRPC1 is very valuable in the study of liver cancer.

Fabrication of SiCN(O) Aerogel Composites with Low Thermal Conductivity by Wrapping Mesoporous Aerogel Structures over Mullite Fibers.

Silicon-based ceramic aerogels obtained by the polymer pyrolysis route possess excellent thermophysical properties, but their poor mechanical properties limit their broader applicability in thermal insulation materials. Herein, SiCN(O) ceramic aerogels were prepared under the toughening effect of a crosslinker (hexamethylene diisocyanate, HDI), which maintains the structural integrity of the aerogel during the wet gel-to-aerogel conversion. The aerogel maintained a high surface area (88.6 m2 g-1) and large pore volume (0.21 cm3 g-1) after pyrolysis. Based on this, mullite-fiber-reinforced SiCN(O) aerogels composites with outstanding thermal insulation properties and better mechanical performance were synthesized via ambient pressure impregnation. Furthermore, the effect of the impregnation concentration on the mechanical and insulation properties of the composites was investigated. The results revealed that the composite prepared with a solution ratio of 95 wt.% exhibited a low density (0.11 g cm-3) and a low thermal conductivity (0.035 W m-1 K-1), indicating an ~30% enhancement in its thermal insulation performance compared to the mullite fiber; the mesoporous aerogel structures wrapped on the mullite fibers inhibited the gas thermal conduction inside the composites.

PLPP2: Potential therapeutic target of breast cancer in PLPP family.

PLPPs (Phospholipid phosphatases) are widely expressed in different human tissues, regulate cell signal transduction, and are overexpressed in cancers such as gliomas, pancreatic adenocarcinoma, lung adenocarcinoma, and so on. As a member of the PLPP family, PLPP2 (phospholipid phosphatase 2) plays a vital role in the occurrence and development of breast cancer, but its mechanism is still unclear. Our research found that PLPP2 was overexpressed in breast cancer, and the higher expression level of PLPP2 showed a worse prognosis for breast cancer patients. Further analysis showed that overexpression of PLPP2 affected the expression of CDC34 (cell-division cycle 34), LSM7 (Like-Smith 7), and SGTA (small glutamine-rich tetratricopeptide repeat-containing protein alpha) through EMT (epigenetic-mesenchymal transition) related pathways to promote the occurrence and development of breast cancer. In vitro, silencing PLPP2 significantly reduced the proliferation, invasion, and migration abilities of human breast cancer cells MDA-MB-231. ER+ is a common subtype of breast cancer. Furthermore, we found that the overexpression of PLPP2 was significantly related to the poor prognosis of ER+ breast cancer. These results indicate that PLPP2 has value as a potential therapeutic target for breast cancer, especially for ER+ breast cancer.

PKS5 Confers Cold Tolerance by Controlling Stomatal Movement and Regulating Cold-Responsive Genes in Arabidopsis.

Cold stress limits plant growth and development; however, the precise mechanisms underpinning plant acclimation to cold stress remain largely unknown. In this study, the Ser/Thr protein kinase SOS2-LIKE PROTEIN KINASE5 (PKS5) was shown to play a positive role in plant responses to cold stress. A PKS5 loss-of-function mutant (pks5-1) exhibited elevated sensitivity to cold stress, as well as a lower survival rate and increased ion leakage. Conversely, PKS5 gain-of-function mutants (pks5-3, pks5-4) were more tolerant to cold stress and exhibited higher survival rates and decreased ion leakage. Stomatal aperture analysis revealed that stomatal closure was slower during the first 25 min after cold exposure in pks5-1 compared to wild-type, whereas pks5-3 and pks5-4 displayed accelerated stomatal closure over the same time period. Further stomatal aperture analysis under an abscisic acid (ABA) treatment showed slower closure in pks5-1 and more rapid closure in pks5-3 and pks5-4. Finally, expression levels of cold-responsive genes were regulated by PKS5 under cold stress conditions, while cold stress and ABA treatment can regulate PKS5 expression. Taken together, these results suggest that PKS5 plays a positive role in short-term plant acclimation to cold stress by regulating stomatal aperture, possibly via ABA pathways, and in long-term acclimation by regulating cold-responsive genes.

ADAMDEC1 accelerates GBM progression via activation of the MMP2-related pathway.

The ADAM (a disintegrin and metalloprotease) gene-related family including ADAM, ADAMTS, and ADAM-like decysin-1 has been reported to play an important role in the pathogenesis of multiple diseases, including cancers (lung cancer, gliomas, colorectal cancer, and gastrointestinal cancer). However, its biological role in gliomas remains largely unknown. Here, we aimed to investigate the biological functions and potential mechanism of ADAMDEC1 in gliomas. The mRNA and protein expression levels of ADAMDEC1 were upregulated in glioma tissues and cell lines. ADAMDEC1 showed a phenomenon of "abundance and disappear" expression in gliomas and normal tissues in that the higher the expression of ADAMDEC1 presented, the higher the malignancy of gliomas and the worse the prognosis. High expression of ADAMDEC1 was associated with immune response. Knockdown of ADAMDEC1 could decrease the proliferation and colony-forming ability of LN229 cells, whereas ADAMDEC1 overexpression has opposite effects in LN229 cells in vitro. Furthermore, we identified that ADAMDEC1 accelerates GBM progression via the activation of the MMP2 pathway. In the present study, we found that the expression levels of ADAMDEC1 were significantly elevated compared with other ADAMs by analyzing the expression levels of ADAM family proteins in gliomas. This suggests that ADAMDEC1 has potential as a glioma clinical marker and immunotherapy target.

Hormone supply to the pituitary gland: A comprehensive investigation of female­related tumors (Review).

The hypothalamus acts on the pituitary gland after signal integration, thus regulating various physiological functions of the body. The pituitary gland includes the adenohypophysis and neurohypophysis, which differ in structure and function. The hypothalamus­hypophysis axis controls the secretion of adenohypophyseal hormones through the pituitary portal vein system. Thyroid­stimulating hormone, adrenocorticotropic hormone, gonadotropin, growth hormone (GH), and prolactin (PRL) are secreted by the adenohypophysis and regulate the functions of the body in physiological and pathological conditions. The aim of this review was to summarize the functions of female­associated hormones (GH, PRL, luteinizing hormone, and follicle­stimulating hormone) in tumors. Their pathophysiology was described and the mechanisms underlying female hormone­related diseases were investigated.

Structural Characterization and Anti-Nonalcoholic Fatty Liver Effect of High-Sulfated Ulva pertusa Polysaccharide.

The high-sulfated derivative of Ulva pertusa polysaccharide (HU), with unclear structure, has better anti-hyperlipidmia activity than U pertusa polysaccharide ulvan (U). In this study, we explore the main structure of HU and its therapeutic effect against nonalcoholic fatty liver disease (NAFLD). The main structure of HU was elucidated using FT-IR and NMR (13C, 1H, COSY, HSQC, HMBC). The anti-NAFLD activity of HU was explored using the high-fat diet mouse model to detect indicators of blood lipid and liver function and observe the pathologic changes in epididymal fat and the liver. Results showed that HU had these main structural fragments: →4)-ß-D-Glcp(1→4)-α-L-Rhap2,3S(1→; →4)-α-L-Rhap3S(1→4)-ß-D-Xylp2,3S(1→; →4)-α-L-Rhap3S(1→4)-ß-D-Xylp(1→; →4)-α-L-IdopA3S(1→4)-α-L-Rhap3S(1→; →4)-ß-D-GlcpA(1→3)-α-L-Rhap(1→; →4)-α-L-IdopA3S(1→4)-ß-D-Glcp3Me(1→; →4)-ß-D-Xylp2,3S(1→4)-α-L-IdopA3S(1→; and →4)-ß-D-Xylp(1→4)-α-L-IdopA3S(1→. Treatment results indicated that HU markedly decreased levels of TC, LDL-C, TG, and AST. Furthermore, lipid droplets in the liver were reduced, and the abnormal enlargement of epididymal fat cells was suppressed. Thus, HU appears to have a protective effect on the development of NAFLD.

Phospholipid Phosphatase 4 as a Driver of Malignant Glioma and Pancreatic Adenocarcinoma.

Glioma and pancreatic cancer are tumors with a high degree of malignancy, morbidity, and mortality. The present study explored possible molecular mechanisms and potential diagnostic and prognostic biomarker-PLPP4 of glioma and PAAD. PLPP4 is differentially elevated in glioma and PAAD tissues. Statistical analysis from TCGA demonstrated that high expression of PLPP4 significantly and positively correlated with clinicopathological features, including pathological grade and poor overall survival in glioma and PAAD patients. Following this, the methylation levels of PLPP4 also affected overall survival in clinical tissue samples. Silencing PLPP4 inhibited proliferation, invasion, and migration in LN229 cells and PANC-1 cells. Moreover, the combination of multiple proteins for the prognosis prediction of glioma and PAAD was evaluated. These results were conducted to elaborate on the potential roles of the biomarker-PLPP4 in clonability and invasion of glioma and PAAD cells.

Spiral- and meridian-patterned spheres self-assembled from block copolymer/homopolymer binary systems.

Spiral nanostructures, mainly in the 2D form, have been observed in polymer self-assembly, while well-defined 3D spirals are rarely reported. Here we report that a binary system containing polypeptide-based block copolymers and homopolymers can self-assemble into well-defined spiral spheres (3D spirals), in which the homopolymers form the core and the copolymers form the spirals. Upon increasing the preparation temperature, meridian spheres were obtained. Mixing polypeptide block copolymers with opposite backbone chirality also leads to the formation of meridian spheres. In the meridian patterns, a tighter packing manner of the phenyl groups appended to the polypeptide blocks was observed, which is responsible for the spiral-to-meridian transitions. This work enriches the research of spiral assemblies and provides a facile route to switch chiral/achiral nanostructures by regulating the packing manner of the pendant groups.

Developing Highly Tough, Heat-Resistant Blend Thermosets Based on Silicon-Containing Arylacetylene: A Material Genome Approach.

Silicon-containing arylacetylene (PSA) resins exhibit excellent heat resistance, yet their brittleness limits the applications. We proposed using acetylene-terminated polyimides (ATPI) as an additive to enhance the toughness of the PSA resins and maintain excellent heat resistance. A material genome approach (MGA) was first established for designing and screening the acetylene-terminated polyimides, and a polyimide named ATPI was filtered out by using this MGA. The ATPI was synthesized and blended with PSA resins to improve the toughness of the thermosets. Influences of the added ATPI contents and prepolymerization temperature on the properties were examined. The result shows that the blend resin can resist high temperature and bear excellent mechanical properties. The molecular dynamics simulations were carried out to understand the mechanism behind the improvement of toughness. The present work provides a method for the rapid design and screening of high-performance polymeric materials.

Construction of activated carbon-supported B3N3 doped carbon as metal-free catalyst for dehydrochlorination of 1,2-dichloroethane to produce vinyl chloride.

Dehydrochlorination of 1,2-dichloroethane (1,2-DCE) is an important oil-based way for the industrial production of vinyl chloride monomer (VCM), but has proved to be plagued by a high operating temperature and low efficiency. Therefore, environmentally friendly and metal-free catalysts are in high demand for green chemical processes. In view of the stronger electronegativity of borazine (B3N3) and convenience of constructing a two-dimensional structure because of the coplanarity of B3N3, the acetenyl group, and the benzene ring, herein, we report a novel controllable B3N3 doped activated carbon (B,N-ACs) synthesized using B3N3-containing arylacetylene resin for dehydrochlorination of 1,2-DCE. The result is activated carbon loaded with B3N3-doped carbon nanosheets on the surface due to the B3N3-containing arylacetylene resin grown on the surface of activated carbons. The B,N-ACs deliver excellent catalytic performance, with a 1,2-DCE conversion of ∼92.0% and VCM selectivity over 99.9% at 250 °C, significantly higher than that of the current catalysts in the industry. The results further verified that pyridinic-N and the internal B3N3 play significant roles in this catalysis. The new green, metal-free B,N-ACs with excellent catalytic efficiency make it a promising catalyst for dehydrochlorination of 1,2-DCE to produce VCM.

Antioxidant and antihyperlipidemic activities of high sulfate content purified polysaccharide from Ulva pertusa.

In this study, purification of polysaccharide ulvan by anion exchange chromatography was prepared, and the major polysaccharide fraction (FU) was collected at 1.0 M NaCl elute by anion exchange chromatography, then high sulfate content purified ulvan (HFU) was prepared with sulfur trioxide/N,N-dimethylformamide (SO3-DMF) in formamide. The antioxidant activity and the antihyperlipidemic activity of HFU in mice were determined. The results showed that treatment with HFU could improve the antioxidant and antihyperlipidemic activity. Compared with the hyperlipidemic group, the antihyperlipidemic activity of HFU (125 mg/kg) was the strongest, TC concentrations were significantly decreased by 26.7% (P < .01), significantly reduced LDL-C (32.6%, P < .01), significantly increased HDL-C (19.6%, P < .01), and HFU-treated group (250 mg/kg) exhibited optimal effects on TG (29.0%, P < .01); the HFU groups at the doses of 125 mg/kg could significantly decrease the MDA (29.9%, P < .01); the HFU groups at the doses of 500 mg/kg could increase the activities of GSH-Px obviously (19.9%, P < .01).