tbuckley/cabot-search huggingface dataset:
Abstract P272: Baseline Diet and Long-term Efficacy of a Multivitamin Supplement on Cardiovascular Disease in The Physicians’ Health Study Ii - A Randomized Controlled Trial
Authors: Susanne Rautiainen, J. Michael Gaziano, William G Christen, Robert J Glynn, JoAnn E Manson, Julie E Buring, Howard D Sesso
Journal: Circulation (2016)

Background: Many in the US population take a multivitamin supplement to improve or maintain health however, evidence for long-term health benefits remains scarce. The Physicians’ Health Study II (PHS II) is the only randomized trial investigating the effect from a common multivitamin in men, for which no effect was seen on cardiovascular disease (CVD). An important consideration is the modifying role of baseline nutritional status, as a multivitamin may be more or less efficacious to those with extreme nutritional intake. Hypothesis: Baseline nutritional status modifies the effect of a multivitamin on the risk of CVD. Methods: The PHS II is a randomized, double-blind, placebo-controlled trial evaluating the effects of a multivitamin (Centrum Silver or placebo daily) including 14,641 men aged ≥50 years. Baseline diet was assessed through a 116-item food frequency questionnaire among 13,316 men (91%). We tested the interaction between the randomized multivitamin and tertiles of each dietary factor (Alternate Healthy Eating Index, Alternate Mediterranean Diet score, vitamin B6, B12, folate, vitamin C, calcium, and magnesium) as well as the trend in HRs across tertiles. Results: During an average 11.2 years of follow-up, there were 1487 cases of CVD, 586 cases of myocardial infarction (MI), 559 cases of total stroke, 626 CVD death, and 2086 total deaths. There was no consistent evidence for effect modification by dietary factors. Vitamin B6 modified the effect of multivitamin use on MI (P, interaction=0.01) with an increased risk among men in lowest tertile and decreased risk in highest tertile. The effect on CVD death was modified by vitamin B12 intake with a nonsignificant decreased risk only among men in the lowest tertile, with similar effects noted for total mortality (P, interaction=0.04). Conclusion: For the majority of dietary factors, there was no evidence that the effect of multivitamin use on major CVD and associated endpoints is modified by individual baseline dietary factors in middle-aged and older male physicians.
Should All Patients with Acute Myelogenous Leukemia (AML) Other Than Good Risk Cytogenetics Receive Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in First Remission?
Authors: Onder Alpdogan, Raymond Lenox, Amy Barile, Francine Foss, Warren Shlomchik, Christy Reuben, Dennis Cooper, Stuart Seropian
Journal: Blood (2008)
Late-Relapse Diffuse Large B-Cell Lymphoma Frequently Represents Recurrence of the Original Disease, and Demonstrates Evidence of Superimposed Clonal Heterogeneity and Clonal Evolution
Authors: Rena R. Xian, Genevieve M. Crane, Lisa M. Haley, Christopher D. Gocke, Ming-Tseh Lin, Aparna Pallavajjalla, Michael J. Borowitz, Lode J. Swinnen, Amy S. Duffield
Journal: Blood (2014)
Cytokine Treatment of CD34+ Cord Blood Cells with G-CSF, GM-CSF, or SCF During 48 Hours of Ex Vivo Culture Alters CD26/DPPIV Peptidase Activity and Subsequent Engraftment Into NSG Immunodeficient Mice.
Authors: Laura A Paganessi, Lydia Luy Tan, Sucheta Jagan, Robin Frank, Antonio M. Jimenez, Elizabeth Shima Rich, Sunita Nathan, John Maciejewski, Henry C. Fung, Kent W. Christopherson
Journal: Blood (2010)
Early effects of tissue-type plasminogen activator added to conventional therapy on the culprit coronary lesion in patients presenting with ischemic cardiac pain at rest. Results of the Thrombolysis in Myocardial Ischemia (TIMI IIIA) Trial.
Journal: Circulation (1993)

BACKGROUND The early effects of tissue-type plasminogen activator (t-PA) on the "culprit" coronary lesion in patients presenting with unstable angina or non-Q wave myocardial infarction were determined by quantitative arteriography. METHODS AND RESULTS Of 391 such patients, 306 satisfied clinical and arteriographic requirements for eligibility and received a 90-minute front-loaded infusion of t-PA (0.8 mg/kg i.v.; maximum, 80 mg) or placebo plus conventional antianginal therapy. All patients received full heparinization and a follow-up arteriogram 18-48 hours after treatment. A non-Q wave myocardial infarction (MI) was diagnosed in 97 patients (32%) after entry. In the entire patient population, among t-PA- and placebo-treated patients, respectively, 25% versus 19% (p = 0.25) of all culprit lesions achieved the primary study end point, measurable improvement (by &gt; or = 10% reduction of stenosis or two Thrombolysis in Myocardial Infarction [TIMI] flow grades) at follow-up. Substantial improvement (by &gt; or = 20% reduction of stenosis or two TIMI grades) was seen with t-PA in 15% of all culprit lesions versus 5% with placebo (p &lt; 0.003). Arteriographically apparent thrombus was present at baseline in the culprit lesion of 107 patients (35%). Substantial improvement was more frequent with t-PA among lesions containing apparent thrombus (in 36% with t-PA versus 15% with placebo; p &lt; 0.01), as it was among patients evolving a non-Q wave MI (33% versus 8%; p &lt; 0.005). By multivariate analysis, the significant, independent predictors of substantial improvement include apparent thrombus (p = 0.0001), non-Q wave MI (p = 0.003), and t-PA use (p = 0.01). Both non-Q wave MI status and thrombus had been specified a priori as important variables. CONCLUSIONS Arteriographically apparent intraluminal thrombus and improvement of the culprit lesion with either of these regimens were only moderately frequent in patients with unstable angina or non-Q wave MI. Substantial improvement of culprit lesions was more frequent with t-PA than with placebo overall and in two prospectively defined subgroups. The clinical relevance of these observations is being tested in the larger, ongoing clinical TIMI IIIB study.
Long-Term Dosing of AMG 531 in Thrombocytopenic Patients with Immune Thrombocytopenic Purpura: 48-Week Update.
Authors: David Kuter, James Bussel, James George, Louis Aledort, Alan Lichtin, Roger Lyons, Jorge Nieva, Jeffrey Wasser, Emanuelle Bourgeois, Mies Kappers-Klunne, Francois Lefrere, Martin Schipperus, Reggie Kelly, Jenny Christal, Matthew Guo, Janet Nichol
Journal: Blood (2006)
Constitutive NOTCH3 Signaling Promotes the Growth of Basal Breast Cancers
Authors: Lisa Choy, Thijs J. Hagenbeek, Margaret Solon, Dorothy French, David Finkle, Amy Shelton, Rayna Venook, Matthew J. Brauer, Christian W. Siebel
Journal: Cancer Research (2017)

Notch ligands signal through one of four receptors on neighboring cells to mediate cell-cell communication and control cell fate, proliferation, and survival. Although aberrant Notch activation has been implicated in numerous malignancies, including breast cancer, the importance of individual receptors in distinct breast cancer subtypes and the mechanisms of receptor activation remain unclear. Using a novel antibody to detect active NOTCH3, we report here that NOTCH3 signals constitutively in a panel of basal breast cancer cell lines and in more than one third of basal tumors. Selective inhibition of individual ligands revealed that this signal does not require canonical ligand induction. A NOTCH3 antagonist antibody inhibited growth of basal lines, whereas a NOTCH3 agonist antibody enhanced the transformed phenotype in vitro and in tumor xenografts. Transcriptomic analyses generated a Notch gene signature that included Notch pathway components, the oncogene c-Myc, and the mammary stem cell regulator Id4 This signature drove clustering of breast cancer cell lines and tumors into the common subtypes and correlated with the basal classification. Our results highlight an unexpected ligand-independent induction mechanism and suggest that constitutive NOTCH3 signaling can drive an oncogenic program in a subset of basal breast cancers. Cancer Res; 77(6); 1439-52. ©2017 AACR.
Is moderate alcohol use in nonalcoholic fatty liver disease good or bad? A critical review
Authors: Veeral H. Ajmera, Norah A. Terrault, Stephen A. Harrison
Journal: Hepatology (2017)

Moderate alcohol consumption in patients with nonalcoholic fatty liver disease (NAFLD) is common, yet the effects on cardiovascular and liver health are unclear. Moderate alcohol use is associated with improved insulin sensitivity and decreased cardiovascular mortality in the general population, but whether similar benefits would be observed in persons with NAFLD remains largely unstudied. There is significant overlap in the pathogenesis of alcoholic liver disease (ALD) and NAFLD, although studies of ALD have focused on pathological alcohol intake and few mechanistic studies of moderate alcohol use in NAFLD exist. We undertook a critical review of the effect of moderate alcohol use on cardiovascular and liver disease in patients with NAFLD. A total of seven observational studies met the criteria for inclusion (one for cardiovascular endpoints and six for liver endpoints). Insufficient studies have assessed the association of moderate alcohol use with cardiovascular outcomes. There was a positive association between moderate alcohol use and decreased NASH and fibrosis; however, heavy episodic drinking may accelerate fibrosis progression and moderate alcohol use may increase the risk of hepatocellular carcinoma in patients with advanced fibrosis. Significant methodological limitations were present, including incomplete adjustment for confounding factors and failure to measure lifetime use or the pattern of alcohol intake. Thus, a strong recommendation of benefit of moderate alcohol use in NAFLD cannot be made. There remains a need for additional high-quality longitudinal studies that evaluate both cardiovascular and liver outcomes among NAFLD patients with moderate or lesser degrees of alcohol use. (Hepatology 2017;65:2090-2099).
Differentiation between Radiation Necrosis and Tumor Progression Using Chemical Exchange Saturation Transfer
Authors: Hatef Mehrabian, Kimberly L. Desmond, Hany Soliman, Arjun Sahgal, Greg J. Stanisz
Journal: Clinical Cancer Research (2017)

Purpose: Stereotactic radiosurgery (SRS) is a common treatment used in patients with brain metastases and is associated with high rates of local control, however, at the risk of radiation necrosis. It is difficult to differentiate radiation necrosis from tumor progression using conventional MRI, making it a major diagnostic dilemma for practitioners. This prospective study investigated whether chemical exchange saturation transfer (CEST) was able to differentiate these two conditions.Experimental Design: Sixteen patients with brain metastases who had been previously treated with SRS were included. Average time between SRS and evaluation was 12.6 months. Lesion type was determined by pathology in 9 patients and the other 7 were clinically followed. CEST imaging was performed on a 3T Philips scanner and the following CEST metrics were measured: amide proton transfer (APT), magnetization transfer (MT), magnetization transfer ratio (MTR), and area under the curve for CEST peaks corresponding to amide and nuclear Overhauser effect (NOE).Results: Five lesions were classified as progressing tumor and 11 were classified as radiation necrosis (using histopathologic confirmation and radiographic follow-up). The best separation was obtained by NOEMTR (NOEMTR,necrosis = 8.9 ± 0.9%, NOEMTR,progression = 12.6 ± 1.6%, P < 0.0001) and AmideMTR (AmideMTR,necrosis = 8.2 ± 1.0%, AmideMTR,progression = 12.0 ± 1.9%, P < 0.0001). MT (MTnecrosis = 4.7 ± 1.0%, MTprogression = 6.7 ± 1.7%, P = 0.009) and NOEAUC (NOEAUC,necrosis = 4.3 ± 2.0% Hz, NOEAUC,progression = 7.2 ± 1.9% Hz, P = 0.019) provided statistically significant separation but with higher P values.Conclusions: CEST was capable of differentiating radiation necrosis from tumor progression in brain metastases. Both NOEMTR and AmideMTR provided statistically significant separation of the two cohorts. However, APT was unable to differentiate the two groups. Clin Cancer Res; 23(14); 3667-75. ©2017 AACR.
Incidence of Clostridium Difficile-Induced Diarrhea in Patients Treated with High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation for Lymphoma and Multiple Myeloma.
Authors: Jorge I. Arango, Cesar O. Freytes, Deanna L. Schneider, Alejandro Restrepo, Marcos I. Restrepo, Patrick Bradshaw, Natalie Callander, Leonel Ochoa
Journal: Blood (2004)
Powerful Ideas for Global Access to Medicines
Authors: Suerie Moon
Journal: New England Journal of Medicine (2017)

Interview with Dr. Suerie Moon on recommendations from the United Nations Secretary General’s High-Level Panel on Access to Medicines. (17:53)Download The UN High-Level Panel on Access to Medicines has reframed the access challenge not only as involving prices in lower-income countries, but also as requiring systemic changes to the prevailing research-and-development business model for the sake of all countries.
Retrospective Analysis to Correlate Impact of Symptom Burden and Quality of Life to Treatment Outcome with Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia Chronic Phase
Authors: Binsah George, Williams Lori, Quiling Shi, Talha Badar, Susan O'Brien, Elias Jabbour, Guillermo Garcia-Manero, Nitin Jain, Farhad Ravandi, Gautam Borthakur, William Wierda, Charles S. Cleeland, Hagop M. Kantarjian, Jorge E. Cortes
Journal: Blood (2014)
Clinical Impact of Bone Marrow Morphology for the Diagnosis of Essential Thrombocythemia: Comparison Between the British Standards (BCSH) and the WHO Criteria
Authors: Georg Jeryczynski, Juergen Thiele, Bettina Gisslinger, Maria Theresa Krauth, Martin Schalling, Ana-Iris Schiefer, Ingrid Simonitsch-Klupp, Leonhard Muellauer, Heinz Gisslinger
Journal: Blood (2015)
Efficacy and Mechanisms of Apoptosis Induction by Simultaneous Inhibition of PI3K with GDC-0941 and Blockade of Bcl-2 (ABT-737) or FLT3 (Sorafenib) In AML Cells In the Hypoxic Bone Marrow Microenvironment
Authors: Linhua Jin, Yoko Tabe, Yixin Zhou, Takashi Miida, Michael Andreeff, Marina Konopleva
Journal: Blood (2010)
SATB1 Expression Marks Lymphoid-Lineage-Biased Hematopoietic Stem Cells in Mouse Bone Marrow
Authors: Yukiko Doi, Takafumi Yokota, Tomohiko Ishibashi, Yusuke Satoh, Michiko Ichii, Akira Tanimura, Sachiko Ezoe, Hirohiko Shibayama, Kenji Oritani, Yuzuru Kanakura
Journal: Blood (2015)
Phase 3 Trial of <sup>177</sup>Lu-Dotatate for Midgut Neuroendocrine Tumors
Authors: Jonathan Strosberg, Ghassan El-Haddad, Edward Wolin, Andrew Hendifar, James Yao, Beth Chasen, Erik Mittra, Pamela L. Kunz, Matthew H. Kulke, Heather Jacene, David Bushnell, Thomas M. O’Dorisio, Richard P. Baum, Harshad R. Kulkarni, Martyn Caplin, Rachida Lebtahi, Timothy Hobday, Ebrahim Delpassand, Eric Van Cutsem, Al Benson, Rajaventhan Srirajaskanthan, Marianne Pavel, Jaime Mora, Jordan Berlin, Enrique Grande, Nicholas Reed, Ettore Seregni, Kjell Öberg, Maribel Lopera Sierra, Paola Santoro, Thomas Thevenet, Jack L. Erion, Philippe Ruszniewski, Dik Kwekkeboom, Eric Krenning
Journal: New England Journal of Medicine (2017)

Patients with advanced midgut neuroendocrine tumors who have had disease progression during first-line somatostatin analogue therapy have limited therapeutic options. This randomized, controlled trial evaluated the efficacy and safety of lutetium-177 (177Lu)–Dotatate in patients with advanced, progressive, somatostatin-receptor–positive midgut neuroendocrine tumors.
Overall Survival (OS) of Acute Myeloid Leukemia (AML) Treated at Academic Center (AC) Versus Non-Academic Center (NAC)
Authors: Smith Giri, Valerie Shostrom, Krishna Gundabolu, KM Monirul Islam, Ranjan Pathak, Lori J. Maness, Vijaya R. Bhatt
Journal: Blood (2015)
Impact of echinocandin on prognosis of proven invasive candidiasis in ICU: A post-hoc causal inference model using the AmarCAND2 study
Authors: Sébastien Bailly, Olivier Leroy, Elie Azoulay, Philippe Montravers, Jean-Michel Constantin, Hervé Dupont, Didier Guillemot, Olivier Lortholary, Jean-Paul Mira, Pierre-François Perrigault, Jean-Pierre Gangneux, Jean-François Timsit, Hssain Aait, None Adda, None Allaouchiche, None Ammenouche, None Angel, None Argaud, None Badetti, None Baldesi, None Barthet, None Bastien, None Baudin, None Bellec, None Blasco, None Bollaert, None Bonadona, None Bretonnière, None Brocas, None Brua, None Bruder, None Brunin, None Cabaret, None Carpentier, None Cartier, None Cerf, None Chabanne, None Charles, None Cheval, None Cinotti, None Cohen, None Constantin, None Cousson, None Delpierre, None Demory, None Diconne, None Du Cheyron, None Dubost, None Dumenil, None Durand, None Duroy, None Forel, None Foucher-Lezla, None Fratea, None Gally, None Gaudard, None Geffe, None Gergaud, None Gette, None Girault, None Goubaux, None Gouin, None Grenot, None Grossmith, None Guelon, None Guerin-Robardey, None Guervilly, None Hayl-Slayman, None Hilbert, None Houissa, None Hraiech, None Ichai, None Jung, None Kaidomar, None Karoubi, None Kherchache, None Lambiotte, None Lamhaut, None Launoy, None Lebreton, None Lefrant, None Lemaire, None Lepape, None Lepoivre, None Leroy, None Lesieur, None Levy, None Luyt, None Mahe, None Mahul, None Mateu, None Megarbane, None Merle, None Mira, None Montcriol, None Mootien, None Navellou, None Ouattara, None Page, None Perrigault, None Petitpas, None Plantefeve, None Quinart, None Quintard, None Ragonnet, None Roquilly, None Ruiz, None Saliba, None Samba, None Schmitt, None Seguin, None Sejourne, None Tellier, None Thevenot, None Tonnelier, None Van Grunderbeek, None Vincent, None Wiramus, None Zogheib
Journal: Journal of Infection (2017)
Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis
Authors: Philippa J A Nicolson, Kim L Bennell, Fiona L Dobson, Ans Van Ginckel, Melanie A Holden, Rana S Hinman
Journal: British Journal of Sports Medicine (2017)

To evaluate whether interventions aimed at increasing adherence to therapeutic exercise increase adherence greater than a contextually equivalent control among older adults with chronic low back pain and/or hip/knee osteoarthritis.A systematic review and meta-analysis.Five databases (MEDLINE (PubMed), CINAHL, SportDISCUS (EBSCO), Embase (Ovid) and Cochrane Library) were searched until 1 August 2016.Randomised controlled trials that isolated the effects of interventions aiming to improve adherence to therapeutic exercise among adults ≥45 years of age with chronic low back pain and/or hip/knee osteoarthritis were included.Of 3899 studies identified, nine studies (1045 participants) were eligible. Four studies, evaluating strategies that aimed to increase motivation or using behavioural graded exercise, reported significantly better exercise adherence (d=0.26-1.23). In contrast, behavioural counselling, action coping plans and/or audio/video exercise cues did not improve adherence significantly. Meta-analysis using a random effects model with the two studies evaluating booster sessions with a physiotherapist for people with osteoarthritis revealed a small to medium significant pooled effect in favour of booster sessions (standardised mean difference (SMD) 0.39, 95% CI 0.05 to 0.72, z=2.26, p=0.02, I2=35%).Meta-analysis provides moderate-quality evidence that booster sessions with a physiotherapist assisted people with hip/knee osteoarthritis to better adhere to therapeutic exercise. Individual high-quality trials supported the use of motivational strategies in people with chronic low back pain and behavioural graded exercise in people with osteoarthritis to improve adherence to exercise.
The RNA Binding Protein Musashi 2 Is up-Regulated in the Proliferative B-Cell Fraction of Chronic Lymphocytic Leukemia Clones
Authors: Florencia Palacios, Xiao-Jie Yan, Jaqueline C. Barrientos, Jonathan E. Kolitz, Steven L. Allen, Kanti R. Rai, Nicholas Chiorazzi
Journal: Blood (2015)
SNP-A Based Karyotyping Facilitates Improved Mapping of Deletions and Uniparental Disomy within the Long Arm of Chromosome 5 in Myeloid Disorders.
Authors: Lukasz P. Gondek, Andrew Dunbar, Christine O’Keefe, Michael A. McDevitt, Denise Batista, Karl Theil, Jaroslaw P. Maciejewski
Journal: Blood (2007)
Serum Platelet Factor 4 Is a Promising Therapeutic Response and Prognostic Marker in Patients with Newly Diagnosed Multiple Myeloma
Authors: Ju Bai, Aili He, Wanggang Zhang, Yun Yang, Jianli Wang, Pengyu Zhang, Yang Zhang, Lei Zhang, Liufang Gu, Jin Wang, Rui Shi, Xin Meng, Wei Tian, Xiaman Wang, Xiaoru Lei
Journal: Blood (2014)
A Dynamic Prognostic Model to Predict Survival in Primary Myelofibrosis: a Study of the International Working Group for Myeloproliferative Neoplasm Research and Treatment (IWG-MRT).
Authors: Francesco Passamonti, Francisco Cervantes, Alessandro Vannucchi, Enrica Morra, Elisa Rumi, Arturo Pereira, Paola Guglielmelli, Ester Pungolino, Marianna Caramella, Cristiana Pascutto, Mario Lazzarino, Mario Cazzola, Ayalew Tefferi
Journal: Blood (2009)
Prognostic Impact of Comorbidities In A Cohort of 788 MDS Patients Based On A CIRS-G Derived Score. A MDS Piedmont Registry Prospective Study
Authors: Emanuela Messa, Daniela Gioia, Claudia Bertassello, Gianni Ciccone, Bernardino Allione, Daniela Cilloni, Flavia Salvi, Gianni Cametti, Monia Lunghi, Dario Ferrero, Roberto Freilone, Margherita Bonferroni, Giuseppe Saglio, Alessandro Levis
Journal: Blood (2011)
Absence of High-Dose Consolidation Courses and Low Numbers of Allogeneic HSCTs Did Not Affect Overall Optimistic Results in B-Cell Precursor Ph-Negative Adult ALL Patients Treated By Non-Intensive but Non-Interruptive ALL-2009 Protocol: Data of the Russian ALL Study Group
Authors: Elena N. Parovichnikova, Vera V. Troitskaya, Andrey Sokolov, Galina Kliasova, Larisa A. Kuzmina, Sergey Kravchenko, Elena Gribanova, Segey Bondarenko, Olga Baranova, Tatyana Kaporskaya, Tatyana Ryltzova, Nina Minaeva, Tatiana Zinina, Olga Samoilova, Alfiya Nizamutdinova, Alexandra Klimovich, Elena Karyakina, Alexandra Eluferieva, Lyubov Gavrilova, Tatyana Konstantinova, Natalya Vopilina, Kamil Kaplanov, Valery A. Lapin, Alexander Pristupa, Tatyana Tikunova, Zalina Akhmerzaeva, Tatiana N. Obukhova, Mikhail Rusinov, Sergei M Kulikov, Valeri G. Savchenko
Journal: Blood (2015)
Development of left ventricular muscle in tetralogy of Fallot.
Authors: Jun-Ichi Fukuda, Tohru Izumi, Tetsunosuke Matsukawa, Shoji Eguchi
Journal: Circulation (1984)

Age-related changes of the muscle fiber diameter of the left ventricle were studied in 20 autopsied specimens of tetralogy of Fallot (TOF) and in 34 normal autopsied hears. According to the amount of pulmonary blood flow, two groups were defined: In Group 1, TOF with a markedly decreased pulmonary blood flow. In Group 2, TOF with a moderately decreased pulmonary blood flow. In Group 1, the muscle fiber diameter was nearly normal at birth, but increased slightly and remained constant after one year, so that it was significantly less than normal. Moreover, histological observation revealed underdevelopment of the left ventricular muscle fibers in this group. In Group 2, the diameter increased with age in a manner similar to normal and, histologically, the muscle fibers were not different from normal ones except for those in one heart with left ventricular hypertrophy. The growth of muscle fibers in the left ventricle seems to depend on the volume of pulmonary blood flow, or the left ventricular inflow volume. If the left ventricular functional capacity correlates with the growth of muscle fibers, left ventricular functional capacity correlates with the growth of muscle fibers, left ventricular dysfunction after the corrective operation may originate in the underdevelopment of muscle fibers. Surgical intervention is advisable before the retardation of muscle fiber growth has become apparent.