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At least 1,207 records · Page 67Linked to original sources

PubMed1998

[Prognostic value of myocardial 123I-BMIPP imaging in patients with congestive heart failure without coronary artery disease].

We performed 123I-BMIPP (BMIPP) imaging in order to clarify the characteristics of fatty acid metabolism and its effect on prognosis in patients with congestive heart failure (CHF) without coronary artery disease. We studied 15 normal subjects and 42 patients with CHF (idiopathic dilated cardiomyopathy; 24, hypertensive heart disease; 12, valvular heart disease; 6). We obtained cardiac imaging with BMIPP and 201Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (%Uptake). We calculated the cardiac uptake ratio of BMIPP (%Uptake of BMIPP divided by %Uptake of 201Tl), percent washout of BMIPP from the heart over 3 hours and unhomogeneity of myocardial distribution of BMIPP (coefficient of variation of BMIPP, CV) as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of CHF which requiring readmission. Uptake ratio (CHF: 0.91 +/- 0.17, normal; 1.10 +/- 0.09, p = 0.0000) and CV (CHF; 20 +/- 5, normal; 16 +/- 5, p = 0.0385) were different significantly between CHF and normal subjects. During the follow-up period of 27.2 +/- 14.4 months (4.5-53.5 months) cardiac events developed in 15 patients (cardiac death; 8, deterioration of CHF; 7). In univariate analysis, %uptake of 201Tl, uptake ratio, % FS, serum norepinephrine level and serum renin activity were different significantly between event and event-free groups. Cox proportional hazard analysis showed that the uptake ratio (p = 0.0000) and age (p = 0.018) were independent predictors of cardiac events. In patients with uptake ratio less than 0.88, relative risks of cardiac events was 23.7 times greater than in patients with uptake ratio more than 0.89. These data suggested that in patients with CHF fatty acid metabolism was deteriorated and cardiac uptake of BMIPP was a strong and independent predictor of long-term prognosis in patients with heart failure.

Adult↗

PubMed1998

[Evaluation of long-term prognosis in patients with heart failure: is cardiac imaging with iodine-123 metaiodobenzylguanidine useful?].

The effect of cardiac sympathetic activity on long-term prognosis in patients with heart failure was evaluated by cardiac imaging with iodine-123 metaiodobenzylguanidine (123I-MIBG) in 46 patients admitted for the first episode of heart failure (idiopathic dilated cardiomyopathy: 18, ischemic heart disease: 10, hypertensive heart disease: 7, valvular heart disease: 4, others: 7). Cardiac imaging was performed with 123I-MIBG and thallium-201 (201Tl) at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (percentage uptake). The cardiac uptake ratio of 123I-MIBG (percentage uptake of 123I-MIBG divided by percentage uptake of 201Tl) and percentage washout of 123I-MIBG from the heart over 3 hours were calculated as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of heart failure requiring readmission. Scintigraphic parameters, clinical parameters, left ventricular function obtained by echocardiography and neurohumoral parameters were compared between the event group and event-free group. During the follow-up period of 26.9 +/- 13.9 (7.1-53.8 months), cardiac events developed in 14 patients (cardiac death in 10 and deterioration of heart failure in 4; 30%). Univariate analysis showed uptake ratio and washout rate of 123I-MIBG, percentage uptake of 201Tl, New York Heart Association class at discharge, fractional shortening of the left ventricle, serum norepinephrine and atrial natriuretic peptide levels differed significantly between the two groups. Cox proportional-hazard analysis showed that the uptake ratio was an independent predictor of cardiac events (p < 0.0001). When a cut-off point in the uptake ratio equal to or less than 0.50 and age equal to or more than 65 years old were included in the Cox proportional-hazard analysis instead of actual numbers, relative risks of cardiac events by each index were 31.2 (95% confidence interval, 3.9 to 247.6; p = 0.001) and 4.2 (p = 0.025), respectively. These data suggest that cardiac uptake of 123I-MIBG is a strong and independent predictor of long-term prognosis in patients with heart failure.

3-Iodobenzylguanidine↗

PubMed2001

Impact of cytomegalovirus hyperimmune globulin on outcome after cardiothoracic transplantation: a comparative study of combined prophylaxis with CMV hyperimmune globulin plus ganciclovir versus ganciclovir alone.

BACKGROUND: Cytomegalovirus (CMV) disease was previously shown to be unaltered by a 28-day course of ganciclovir compared with placebo in seronegative recipients of hearts from seropositive donors (D+/R-). This study tests the hypothesis that a combination of ganciclovir plus CMV hyperimmune globulin (CMVIG) is more effective than ganciclovir alone for preventing acute CMV illness and its long-term sequelae. METHODS: The study population receiving CMVIG (n=80) included 27 heart transplant recipients (D+/R-) and 53 heart-lung and lung transplant recipients (R+ and/or D+). Each group was matched with historical controls who underwent transplantation within the preceding 2-3 years. Outcome measures compared were as follows: 3-year incidence of CMV disease; fungal infection; acute rejection; survival; rates and severity of transplant coronary artery disease (in heart patients) defined by intimal thickness (ultrasound) and coronary artery stenosis (angiographic); and incidence and death from obliterative bronchiolitis defined by pathological criteria on endobronchial biopsy specimens (in heart-lung/lung patients). RESULTS: Patients treated with CMVIG had a higher disease-free incidence of CMV, lower rejection incidence, and higher survival rate compared with the patients treated with ganciclovir alone. The coronary artery intimal thickness and the prevalence of intimal thickening were lower in the patients receiving CMVIG. Heart-lung and lung transplant patients treated with CMVIG had lower incidences of obliterative bronchiolitis and death from obliterative bronchiolitis and longer survival compared with the patients treated with ganciclovir alone. CONCLUSIONS: CMVIG plus ganciclovir seems to be more effective that ganciclovir alone for preventing the sequelae of CMV infection. A prospective randomized study is required to confirm these observations.

Adult↗

PubMed1996

[Maternal mortality in Nice. Results of a reproductive age mortality survey using death registries in the Nice University Hospital, 1986-1993].

OBJECTIVE: To define the rate of maternal death on the basis of maternal deaths recorded from January 1986 to May 1993. To determine whether the patients had received "standard" quality health care. METHOD: A Reproductive Age Mortality Survey was performed retrospectively on causes of death in women from 14 to 45 years of age; death registries and clinical records at the Nice University Hospital were used. RESULTS: There were 23 cases of pregnancy-associated death. Maternal mortality was 32.9 per 100000 live births. According to the INSERM survey, the "real" national rate would be 18.3 per 100000. This is a classical underestimation. The overmortality in Nice is partially explained by the AIDS epidemic which was the major cause of female deaths between 14 and 45 years (96/322). Nevertheless, there was an unsatisfactorily large number of cases in which standard obstetrical practises were not applied. This was often due to a combination of factors including poor obstetrical surveillance, insufficient attention by physicians, poor organisation of obstetrical care in the emergency room and referrals. Cesarean section was implicated in 7 out of 12 maternal deaths during the third trimester of pregnancy (58%). The cause of certain maternal deaths remained unexplained; amniotic embolus was always suggested. Unfortunately, an autopsy was performed in only 36% of the cases and its quality was insufficient to determine certain diagnosis.

Adolescent↗

PubMed1992

[Mortality due to suicide, accidents and undetermined causes in hospitalized mental patients 1968-1982].

An analysis of the national statistics on mortality in psychiatric hospitals, covering 14 years from 1968 to 1982, provided rates of deaths by suicides, accidents and ill-defined symptoms (chapters 16 and 17 in the ICD). Death rates among psychiatric inpatients are compared to rates in the general population. For suicide, there is an increase of about 45% in patients under 75, which is higher than for the general population. The evolution for accidents is close to that found in the general population. The death rate by ill-defined symptoms is decreasing. The increase in the rates of deaths by suicide found both in France and in several other countries suggests that the major changes (sectorization policy and use of psychotropic drugs), in the care lead to increased risk of suicide for certain patients due to shortened hospital stays and subsequent intermittent institutional care. Specific modes of death can also be described: senility without mention of psychosis, airway obstruction by false passages, notably in subjects under 55, accidental falls, hangings and drownings are particularly important in the observed over-mortality.

Accidents↗

PubMed2006

Does caffeine consumption during pregnancy increase the risk of fetal mortality? A literature review.

The aim of this study was to evaluate the available epidemiological evidence of the effect of caffeine consumption during pregnancy on fetal mortality. A systematic qualitative review of observational studies that referred to any source of exposure to caffeine from food in pregnancy and to fetal mortality as the outcome was conducted in the databases MEDLINE and LILACS. Studies published between January 1966 and September 2004 were searched. The following descriptors were used: "caffeine", "coffee", "tea", "cola", and "cacao" to define the exposure and "fetal death", "stillbirth", "fetal demise", and "fetal loss" to define the outcome. The search strategy retrieved 32 publications, but only six met the inclusion criteria and three were included. One more article was found using "see related articles" feature in PubMed. A total of four publications were included in the review. The small number of publications addressing this subject, methodological limitations, inaccurate exposure assessment in all the studies, overall risks only marginally significant in most cases, and the possibility of publication bias preclude stating with certainty that caffeine consumption is actually associated with fetal death.

Beverages↗

PubMed2004

Chondrocyte viability and metabolic activity after treatment of bovine articular cartilage with bipolar radiofrequency: an in vitro study.

PURPOSE: Some controversy exists regarding the effects of radiofrequency (RF) probes on articular cartilage. To further elucidate these effects, we examined the chondrocyte viability and metabolic activity after treatment of fresh bovine articular cartilage with bipolar RF probes. TYPE OF STUDY: In vitro assessment. METHODS: Three fresh bovine knees served as a baseline control for chondrocyte viability, yielding 6 samples (1 from each medial femoral condyle and 1 from each lateral femoral condyle). After the baseline expected chondrocyte viability was determined, 3 additional bovine knees served as the experimental specimens for the study. Under sterile conditions, 2 different bipolar RF probes were used to treat the articular surface in a light contact mode, moving at a linear rate of 3 to 4 mm/s to provide tissue debridement. Full-thickness articular cartilage was then harvested from each of the treatment areas. Six samples per probe were then assessed for chondrocyte viability using fluorescent double-staining followed by confocal microscopy; 6 samples per probe were assessed for metabolic activity using an 35SO4 incorporation assay; and 12 additional untreated samples were obtained to serve as controls for viability (n = 6) and metabolic activity (n = 6). RESULTS: The depth of chondrocyte death (mean +/- standard deviation) was 109.4 +/- 22.1 microm after treatment with the ACD-50 probe, and was 172.3 +/- 34.3 microm after treatment with the 2.5-mm/90 degrees probe. The 35SO4 uptake (mean +/- standard deviation) was 2584 +/- 1388 cpm/mg dry cartilage for the ACD-50 probe and 1995 +/- 852 cpm/mg of dry cartilage for the 2.5-mm/90 degrees probe. The 35SO4 uptake for the control was 2647 +/- 1380 cpm/mg dry cartilage. CONCLUSIONS: The 2 probes tested created a well-controlled debridement with smooth edges and a defined margin of chondrocyte death that extended approximately 100 to 200 microm deep to the treatment area. There does not appear to be a significant effect on the metabolic activity of the chondrocytes adjacent to the treatment zone, but with the small sample size we lacked sufficient statistical power to definitively determine these effects. CLINICAL RELEVANCE: The 2 bipolar radiofrequency probes tested created a well-controlled debridement in normal articular cartilage with smooth edges and a defined margin of chondrocyte death that extended approximately 100 to 200 microm into the treatment area.

Animals↗

PubMed2004

Penetrating atherosclerotic ulcer of the descending thoracic aorta and arch.

OBJECTIVE: The clinical behavior of penetrating atherosclerotic ulcers of the aorta is controversial. We reviewed our experience with this entity over a 25-year interval. METHODS: Cases were identified using the Department of Radiology database searching for the diagnoses of aortic dissection, intramural hematoma, or penetrating ulcer between 1977 and 2002. Available imaging studies were reviewed by a vascular radiologist to confirm the diagnosis of penetrating ulcer and perform serial measurements. RESULTS: One hundred five patients with penetrating atherosclerotic ulcers of the descending thoracic aorta or arch with (n = 85) or without (n = 20) associated intramural hematoma were confirmed. Two patients with ulcers in the ascending aorta were excluded. There were 73 men and 32 women with a mean age of 72 +/- 9 years. Comorbidities included hypertension in 97 (92%), tobacco use in 81 (77%), and coronary artery disease in 48 (46%). Of nonoperated patients with follow-up studies, the mean thickness of the intramural hematoma decreased at 1 month in 89% and completely resolved at 1 year in 85%. There were 3 deaths (4%) within 30 days among 76 patients treated medically and 6 deaths (21%) among 29 patients treated surgically (P <.05). Failure of medical therapy defined as surgery or death was predicted by rupture at presentation (odds ratio = 20.6) and era of treatment (before 1990, odds ratio 9.9) but not aortic diameter, ulcer size, or extent of hematoma. CONCLUSION: Although careful follow-up is necessary, many penetrating atherosclerotic ulcers of the thoracic aorta can be managed nonoperatively in the acute setting.

Aged↗

PubMed1992

First-time coronary artery bypass grafting: the anaesthetist as a risk factor.

We have investigated the contribution of the anaesthetist and surgeon to outcome after 1301 consecutive coronary artery bypass grafting operations (first operation). The mean + 1 SD aspartate amino transferase concentration on the day after surgery (AST-D1) was 134 u litre-1 (or, after logarithmic transformation, 94 u litre-1). Twenty patients were selected at random from each of three groups having AST-D1 less than 100 u litre-1, 100-134 u litre-1 or greater than 134 u litre-1; positive ECG diagnoses of perioperative myocardial infarction were significantly more frequent with AST-D1 values greater than 100 u litre-1 than with smaller values, but no more frequent with AST-D1 greater than 134 u litre-1. Because several deaths occurred before AST-D1 could be measured, an "adverse outcome" was defined as either hospital death or AST-D1 greater than 100 u litre-1. Univariate analysis implicated both anaesthetist and surgeon as significant predictors of adverse outcome but, after allowing for 12 patient-related factors, only cardiopulmonary bypass time (or ischaemic cross-clamp time) (P less than 0.01) and anaesthetist (P = 0.05) were associated significantly with outcome.

Aged↗

PubMed2003

[Analysis of factors correlated to death and reinfarction in patients with acute myocardial infarction].

OBJECTIVE: To identify the predictors of death and reinfarction in patients with acute myocardial infarction (AMI) treated with urokinase (UK) thrombolysis or percutaneous transluminal coronary angioplasty (PTCA). METHODS: In ambispective cohort study, 97 cases of AMI were treated with UK thrombolytic therapy, while 93 cases of AMI were treated with PTCA. The patients' data about clinical outcome during hospital and follow-up periods were collected. Death and reinfarction were defined as adverse event. To analyze the correlative factors and independent predictors of death and reinfarction, the spearman rank correlation and multivariate logistic regression modeling were performed. RESULTS: During hospital,incidences of adverse event were 15.46 percent and 6.45 percent in UK and PTCA groups respectively. In follow-up period, they were 30.93 percent and 9.68 percent respectively. Age, Q wave leads, Kill ip class, heart failure in hospital, the history of hypertension and myocardial infarction were positive correlation with adverse event, whereas history of smoking, systolic blood pressure and ejection fraction (EF) showed negative correlation with the adverse event. The interventional therapy, associated with lower mortality and reinfarction rate, was the independent predictor for adverse event in UK and PTCA groups during hospital and follow-up periods. Furthermore, it was the only independent predictor for PTCA group. In UK group, the adverse event also was independently predicted by age, heart failure and Q wave leads in hospital and by age, heart failure during follow-up period. There was negative correlation between preinfarction angina and adverse event, and positive correlation between thrombolysis and adverse event inpatients undergone rescue PTCA. CONCLUSION: Interventional therapy is crucial independent predictor for adverse event of patients suffering from AMI. The adverse event is also predicted by age, Q wave leads and heart failure. The history of preinfarction angina is negative correlation with the adverse event in hospital, due to, maybe, myocardium ischemia preconditioning.

Angina, Unstable↗

PubMed1994

[Implantation of an internal defibrillator].

The article, part one of two in this issue, enables the nurse to follow a patient who receives an implantable defibrillator after surviving sudden cardiac death. Sudden cardiac death, which claims approximately 400,000 lives annually in the United States, is defined as natural, unexpected death due to cardiac causes, preceded by abrupt loss of consciousness within one hour of the onset of acute symptoms. It is generally caused by a complex interaction between a functional heart abnormality (such as ischemia) and an anatomic substrate (such as the myocardial scar tissue). Ventricular dysrrhythmias account for the majority of sudden cardiac deaths. This condition is treated with pharmaceutical antiarrhythmic agents or by implanting an internal cardioverter defibrillator. The equipment and surgery using the transvenous approach are described here. Specific nursing care during the postoperative period is also explained. Finally, the authors present several recommendations related to the convalescent period at home.

Defibrillators, Implantable↗

PubMed2002

A novel TPM1 mutation in a family with hypertrophic cardiomyopathy and sudden cardiac death in childhood.

We sought to define the pathogenic mutation in a family with hypertrophic cardiomyopathy (HC) and a markedly arrhythmogenic phenotype. The proband was an 8-year-old female with a sentinel event of sudden death. Screening echocardiograms revealed HC in 2 of her 3 siblings and her father. Her youngest male sibling was diagnosed with HC at age 2 years and died suddenly at age 6 years from ventricular fibrillation despite an implanted cardioverter defibrillator. Using DNA extracted from peripheral lymphocytes, linkage exclusion was performed by haplotype analysis of polymorphic markers for the HC genes. Genes not excluded by linkage were analyzed for mutations using denaturing high-performance liquid chromatography (DHPLC) and direct DNA sequencing. Using this strategy, a 610 T>G nucleotide substitution in the alpha-tropomyosin gene (TPM1) was identified resulting in a novel L185R (Leucine [L] to Arginine [R]) missense mutation. This mutation was a spontaneous germ-line mutation originating in the proband's father. L185R-TPM1 cosegregated with family members having clinical evidence of HC, including the proband as confirmed by molecular autopsy. The mutation was not present in 400 reference alleles. Thus, a novel missense mutation in TPM1 was discovered in a family with HC and sudden death in childhood. Unlike previously defined mutations that may disrupt the interactions between alpha-tropomyosin monomers, the L185R mutation may affect troponin-T binding. Defining the pathogenic mutation enabled definitive molecular diagnosis of 2 surviving children.

Adult↗

PubMed1975

Radioisotopic bolus technique as a test to detect circulatory deficit associated with cerebral death. 142 studies on 80 patients demonstrating the bedside use of an innocuous IV procedure as an adjunct in the diagnosis of cerebral death.

A portable radioisotopic technique was developed to demonstrate cerebral circulatory deficit, as part of a collaborative study to define and diagnose cerebral death simply and rapidly, in comatose, apneic patients with electrocerebral silence. The method involves an intravenous injection of 2mCi of 99mTcO4, and recording time/activity curves over the cranial cavity and a femoral artery simultaneously, using twin probe radioisotope detector equipment. Eight comatose, apneic patients had 142 studies in conjunction with clinical electroencephalographic and other laboratory evaluations. The results indicate that the absence of a bolus tracing from the head, as contrasted to the usual bolus seen is indicative of significant circulatory deficit to the cerebrum. This test may be used as an adjunct in confirming the diagnosis of cerebral death. A normal bolus tracing should be simultaneously observed over a femoral artery and this is used as a control. The method is safe and simple and offers significant information about the irreversibility of cerebral blood flow. Although further studies are indicated, the method appears to be most promising as a fundamental bedside laboratory test in the diagnosis of cerebral death in conjunction with other clinical and laboratory criteria.

Adult↗

PubMed1996

Head turning in brain death.

Criteria for determination of brain death in adults have been defined. Spinal cord reflexes may persist after brain death. We present the case of a brain dead patient who had a complex spinal automatism resulting in head shaking and arm extension. The report reviews guidelines for the diagnosis of brain death and discusses complex spinal cord reflexes in brain dead patients.

Adult↗

PubMed2005

Apoptotic volume decrease and nitric oxide.

Apoptosis is a physiological cell death process whose well-defined characteristics distinguish it from more accidental cell death processes. The loss of cell volume, or cell shrinkage, recently termed apoptotic volume decrease (AVD), is considered a hallmark of the apoptotic process. The activation and/or repression of the AVD process has been shown to be quite complex during apoptosis, with the involvement of multiple ionic transport mechanisms acting in both a cell type and stimulus specific manner. Similarly, the role of nitric oxide (NO) during apoptosis has also been shown to be just as complex, specifically in its ability to either induce and/or prevent apoptosis. This review examines current evidence for a link between AVD and NO and how they may interact during the programmed cell death process.

Actins↗

PubMed2000

Apoptosis and neurologic disease.

Many neurological disorders involve cell death. During development of the nervous system, cell death is a normal feature. Elimination of substantial numbers of initially generated cells enables useful pruning of "mismatched" or excessive cells produced by exuberance during the proliferative and migratory phases of development. Such cell death, occurring by "programmed" pathways, is termed apoptosis. In mature organisms, cells die in two major fashions, either by necrosis or apoptosis. In the adult nervous system, because there is little cell production during adulthood, there is little normal cell death. However, neurological disease is often associated with significant neural cell death. Acute disorders, occurring over minutes to hours, such as brain trauma, infarction, hemorrhage, or infection, prominently involve cell death, much of which is by necrosis. Chronic disorders, with relatively slow central nervous system degeneration, may occur over years or decades, but may involve cell losses. Such disorders include motor neuron diseases such as amyotrophic lateral sclerosis (ALS), cerebral dementing disorders such as Alzheimer's disease and frontotemporal dementia, and a variety of degenerative movement disorders including Parkinson's disease, Huntington's disease, and the inherited ataxias. There is evidence that the mechanism of neuronal cell death in these disorders may involve apoptosis. Direct conclusive evidence of apoptosis is scarce in these chronic disorders, because of the swiftness of cell death in relation to the slowness of the disease. Thus, at any particular time point of assessment, very few cells would be expected to be undergoing death. However, it is clearly of importance to define the type of cell death in these disorders. Of significance is that while treating the underlying causes of these conditions is an admirable goal, it may also be possible to develop productive therapies based on alleviating the process of cell death. This is particularly likely if this cell loss is through apoptosis, a programmed process for which the molecular cascade is increasingly understood. This article reviews our understanding of apoptosis in the nervous system, concentrating on its possible roles in chronic neurodegenerative disorders.

Apoptosis↗

PubMed1998

Sudden unexpected death from cardiac causes in Nigerians: a review of 50 autopsied cases.

Fifty cases of sudden and unexpected death from cardiac causes in individuals between the ages of 28 and 80 years are reviewed; the causes and circumstances of the deaths of these individuals are defined. 70% were males and 44% of the deaths occurred in the 41-50 years age group. Death was due to hypertensive heart disease in 82% of the cases and only 18% were previously diagnosed. Acute left ventricular failure was the commonest (68%) cause of death. Only 4% of the total died of acute myocardial infarction from coronary artery disease. The causes of sudden cardiac death in a developing country such as Nigeria, appears to be different to the pattern in Western countries.

Adult↗

PubMed2002

Expression of CD57 defines replicative senescence and antigen-induced apoptotic death of CD8+ T cells.

Virus-specific CD8(+) T-cell responses play a pivotal role in limiting viral replication. Alterations in these responses, such as decreased cytolytic function, inappropriate maturation, and limited proliferative ability could reduce their ability to control viral replication. Here, we report on the capacity of HIV-specific CD8(+) T cells to secrete cytokines and proliferate in response to HIV antigen stimulation. We find that a large proportion of HIV-specific CD8(+) T cells that produce cytokines in response to cognate antigen are unable to divide and die during a 48-hour in vitro culture. This lack of proliferative ability of HIV-specific CD8(+) T cells is defined by surface expression of CD57 but not by absence of CD28 or CCR7. This inability to proliferate in response to antigen cannot be overcome by exogenous interleukin-2 (IL-2) or IL-15. Furthermore, CD57 expression on CD8(+) T cells, CD4(+) T cells, and NK cells is a general marker of proliferative inability, a history of more cell divisions, and short telomeres. We suggest, therefore, that the increase in CD57(+) HIV-specific CD8(+) T cells results from chronic antigen stimulation that is a hallmark of HIV infection. Thus, our studies define a phenotype associated with replicative senescence in HIV-specific CD8(+) T cells, which may have broad implications to other conditions associated with chronic antigenic stimulation.

Apoptosis↗