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Comparative Analysis of Signal Intensity and Apparent Diffusion Coefficient at Varying b-values in the Brain : Diffusion Weighted-Echo Planar Image ($T_2^*$ and FLAIR) Sequence (뇌의 확산강조 영상에서 b-value의 변화에 따른 신호강도, 현성확산계수에 관한 비교 분석 : 확산강조 에코평면영상($T_2^*$ 및 FLAIR)기법 중심으로)

  • Oh, Jong-Kap;Im, Jung-Yeol
    • Journal of radiological science and technology
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    • v.32 no.3
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    • pp.313-323
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    • 2009
  • Diffusion-weighted imaging (DWI) has been demonstrated to be a practical method for the diagnosis of various brain diseases such as acute infarction, brain tumor, and white matter disease. In this study, we used two techniques to examine the average signal intensity (SI) and apparent diffusion coefficient (ADC) of the brains of patients who ranged in age from 10 to 60 years. Our results indicated that the average SI was the highest in amygdala (as derived from DWI), whereas that in the cerebrospinal fluid was the lowest. The average ADC was the highest in the cerebrospinal fluid, whereas the lowest measurement was derived from the pons. The average SI and ADC were higher in $T_2^*$-DW-EPI than in FLAIR-DW-EPI. The higher the b-value, the smaller the average difference in both imaging techniques; the lower the b-value, the greater the average difference. Also, comparative analysis of the brains of patients who had experienced cerebral infarction showed no distinct lesion in the general MR image over time. However, there was a high SI in apparent weighted images. Analysis of other brain diseases (e.g., bleeding, acute, subacute, chronic infarction) indicated SI variance in accordance with characteristics of the two techniques. The higher the SI, the lower the ADC. Taken together, the value of SI and ADC in accordance with frequently occurring areas and various brain disease varies based on the b-value and imaging technique. Because they provide additional useful information in the diagnosis and treatment of patients with various brain diseases through signal recognition, the proper imaging technique and b-value are important for the detection and interpretation of subacute stroke and other brain diseases.

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Composite valve graft Replacement of the Aortic Root (Composite valve graft를 이용한 대동맥근부 치환술)

  • 백만종;나찬영;김웅한;오삼세;김수철
    • Journal of Chest Surgery
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    • v.35 no.2
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    • pp.102-112
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    • 2002
  • This study was undertaken to analyze the outcome of composite valve graftreplacement(CVGR) for the treatment of aneurysms of the ascending aorta involving the aortic root. Material and Method: Between April 1995 and June 2001, 56 patients had replacement of the ascending aorta and aortic root with a composite graft valve and were reviewed retrospectively. Aortic regurgitation was present in 50 patients(89%), Marfan's syndrome in 18 patients(32%), and bicuspid aortic valve in 7(12.5%). The indications for operation were annuloaortic ectasia(AAE) in 30 patients(53.6%), aortic dissection in 13(23.2%), aneurysms of the ascending aorta involving aortic root in 11(19.6%), and aortitis in 2(3.6%). Cardiogenic shock due to the aortic rupture was present in 2 patients. Nine patients(16%) had previous operations on the ascending aorta or open heart surgery. The operative techniques used for CVGR were the aortic button technique in 51 patients(91%), the modified Cabrol technique in 4, and the classic Bentall technique in 1. The concomitant procedures were aortic arch replacement in 24 patients(43%), coronary artery bypass graft in 8(14.3%), mitral valve repair in 2, redo mitral valve replacement in 1, and the others in 7 The mean time of circulatory arrest, total bypass, and aortic crossclamp were 21$\pm$14 minutes, 186$\pm$68 minutes, and 132$\pm$42 minutes, respectively. Result: Early mortality was 1.8%(1/56). The postoperative complications were left ventricular dysfunction in 16 patients(28.6%), reoperation for bleeding in 7(12.5%), pericardial effusion in 2, and the others in 7. Fifty-three patients out of 55 hospital survivors were followed up for a mean of 23.2 $\pm$ 18.7 months(1-75 months). There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage, and CVGR-related late mortality was 1.9%. The 1- and 6-year actuarial survival was 98.1$\pm$1.9% and 93.2$\pm$5.1%, respectively. Two patients required reoperation for complication of CYGR(3.8%) and two other patients required subsequent operations for dissection of the remaining thoracoabdominal aorta. The 1- and 6-year actuarial freedom from reoperation was 97.8$\pm$2.0% and 65.3$\pm$26.7%, respectively.

The Effects of Chest Injury in the Early Deaths of Trauma Patients (외상에 의한 초기 사망에서 흉부손상에 대한 고찰)

  • Lee Dong Hoon;Cho Dai Yun;Kim Chan Woong;Sohn Dong Suep
    • Journal of Chest Surgery
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    • v.39 no.2 s.259
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    • pp.127-133
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    • 2006
  • Background: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. Material and Method: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. Result: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86$\pm$4.15 for the early deaths and 8.24$\pm$5.02 for the late deaths (p < 0.05). The AIS of thorax were 2.66$\pm$1.87 for the early deaths and 1.55$\pm$1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). Conclusion: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.

A Study on Pulmonary Toxic Effect of High-Dose Cisplatin Administered by Isolated Lung Perfusion in Dogs (잡견에서 분리폐관류 방법으로 투여된 고농도 cisplatin의 페독성에 관한 연구)

  • 김관민;한정호;김주현
    • Journal of Chest Surgery
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    • v.33 no.9
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    • pp.697-706
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    • 2000
  • Background: Isolated lung perfusion(ILP) was developed as a new treatment approach to non-resectable primary or metastatic lung cancer, because of its ability to reduce systemic toxicity while delivering high-dose chemotherapeutic agents to the target organs. This research was planned to evaluate the direct toxic effect of high-dose cisplatin to the lung tissue during isolated lung perfusion. Material and Method: Fifteen mongrel dogs were divided in the perfusate for 40 minutes. The second group was composed of 5 mongrel dogs which underwent ILP with cisplatin 2.5 mg/Kg added to the perfusate for 30 minutes and 10 minutes with washing solution without cisplatin. The third group underwent the same procedure as the second group except cisplatin 5.0 mg/Kg in the perfusate. Activities of serum angiotensin converting enzyme(ACE), tumor necrosis factor-$\alpha$(TNF-$\alpha$), and concentration of serum lactate dehydrogenase(LDH) and blood urea nitrogen/creatinine (BUN/Cr) were analyzed in each groups at the time of pre-perfusion, 1 hour, 1 day, 1 week, and 2 weeks after ILP. Result: Serum ACE activities before and 1 hour, 1 day, 1 week, and 2 weeks after ILP in control group were 45.1$\pm$6.3, 44.6$\pm$9.3, 46.7$\pm$9.5, 50.8$\pm$9.1, 46.1$\pm$4.3 U/L. Those in cisplatin 2.5 and 5.0 mg/Kg groups were 49.4$\pm$12.6, 39.0$\pm$8.6, 42.3$\pm$15.9, 50.0$\pm$2.6, 53.8$\pm$8.3 and 55.5$\pm$12.3, 47.0$\pm$6.3, 45.1$\pm$6.9, 74.8$\pm$19.5, 60.2$\pm$12.0 U/L, respectively. Serum TNF-$\alpha$ activities in each group before and after ILP were 5.0$\pm$1.5 / 7.7$\pm$2.2 / 6.6$\pm$2.5 / 4.3$\pm$1.3 / 5.2$\pm$1.1(control), 8.7$\pm$1.6 / 9.9$\pm$2.2 / 7.9$\pm$1.5 / 6.3$\pm$2.2 / 7.4$\pm$2.4 (cisplatin 2.5 mg/Kg), and 6.9$\pm$0.7 / 8.9$\pm$3.4 / 7.9$\pm$4.0 / 3.3$\pm$0.9 / 5.8$\pm$1.3 pg/ml(cisplatin 5.0 mg/Kg). Mean LDH levels of each group were 225.7 / 271.3 / 328.9 / 350.8 / 255.7(control), 235.7 / 265.7 / 336.0 / 379.5 / 299.2 (cisplatin 2.5 mg/Kg), and 259.6 / 285.2 / 340.6 / 433.4 / 292.4 IU/L(cisplatin 5.0 mg/Kg). So there was no significant difference in serum ACE, TNF-$\alpha$, and LDH activity changes after ILP between the 3 groups. And, there was no significant changes in BUN/Cr in each groups, which was independent of ILP and perfused concentration of cisplatin. In addition, all dogs survived the ILP and there was no significant evidence of pulmonary vascular injury after 2 weeks of ILP with cisplatin. Conclusion: There was no harmful effect of cisplatin to the lund tissue of the mongrel dog up to 5.0 mg/Kg in perfusate. Therefore, it is perceived to be safe and effective to deliver high-dose cisplatin to the lung without pulmonary toxicity and renal damage with ILP.

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Controlled Release of 2,4-D(2,4-Dichlorophenoxy Acetic Acid ) from the Complex of Rice Husk Lignin and 2,4-D-IV. Variation of Herbicidal Activity by Soil Environmental Factors (조곡(組穀) Lignin과 2,4-D (2,4-Dichlorophenoxy Acetic Acid) 결합체(結合體)의 방출제어(放出制御) 연구(硏究)- IV. 토양환경요인(土壤環境要因)에 따른 제초활성(除草活性)의 변이(變異))

  • Guh, J.O.;Lee, D.J.;Lim, K.P.;Kwon, S.L.
    • Korean Journal of Weed Science
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    • v.10 no.2
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    • pp.114-121
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    • 1990
  • Inactivation in soil absorption, translocation of 2, 4-D by plants vary depending upon soil environments and herbicide formulations. Experiment was conducted in a glasshouse using rectangular pots($1350cm^2$) to evaluate the growth responses of barnyardgrass (Echinochloa crus-galli) and Indian jointvetch (Aesehyrcomene indica) to two formulations of 2, 4-D. The formulations used were 40% 2, 4-D amin salt (2, 4-D/AS) and 19.7% complex of rice husk lignin and 2, 4-D (2, 4-D/LG) which were applied at 200g ai/ha. Soil environments included fertilizer levels, soil pH, organic matter contents, and soil textures, Each treatment was replicated three times. The herbicidal activity of 2.4-D increased and lasted with increased levels of fertilizer. The activity also increased and lasted with low soil pH and decreased content of organic matter. Generally 2, 4-D/LG showed higher and longer herbicidal activity than 2. 4-D/AS for both test plants under all conditions applied. However, the herbicidal activity was influenced by the formulations more than by soil textures. It was thought that 2, 4-D/AS was released in a short time and inactivated readily while 2, 4-D/LG was slowly released and gave an opportunity of absorption by plants for a long period.

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Expression of Sodium/iodide Symporter Transgene in Neural Stem Cells (신경줄기세포(HB1.F3)에서 나트륨옥소 공동수송체 도입유전자 발현)

  • Kim, Yun-Hui;Lee, Dong-Soo;Kang, Joo-Hyun;Lee, Yong-Jin;Chung, June-Key;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.1
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    • pp.99-108
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    • 2004
  • Purpose: The ability to noninvasively track the migration of neural progenitor cells would have significant clinical and research implications. We generated stably transfected F3 human neural progenitor cells with human sodium/iodide symporter (hNIS) for noninvasively tracking F3. In this study, the expression patterns of hNIS gene in F3-NIS were examined according to the cultured time and the epigenetic modulation. Materials and Methods: F3 human neural stem cells had been obtained from Dr. Seung U. Kim (Ajou University, Suwon, Korea). hNIS and hygromycin resistance gene were linked with IRES (Internal Ribosome Entry Site) under control of CMV promoter. This construct was transfected to F3 with Liposome. To investigate the restoration of hNIS gene expression in F3-NIS, cells were treated with demethylating agent (5-Azacytidine) and Histone deacetylase inhibitor (Trichostatin A: TSA). The expression of hNIS was measured by I-125 uptake assay and RT-PCR analysis. Results: The iodide uptake of the F3-NIS was higher 12.86 times than F3 cell line. According to the cell passage number, hNIS expression in F3-NIS gradually diminished. After treatment of 5-Azacytidine and TSA with serial doses (up to $20{\mu}M$, up to 62.5nM, respectively) for 24 hours, I-125 uptake and mRNA of hNIS in F3-NIS were increased. Conclusion: These results suggest that hNIS transfected F3 might undergo a change in its biological characters by cell passage. Therefore, the gene ex[ressopm of exogenous gene transferred human stem cell might be affected to the epigenetic modulation such as promoter methylation and Histone deacetylation and to the cell culture conditions.

Effect of Seeding Date and Varieties of Italian Ryegrass on Forage Yield and Quality of Early Spring-seeded at Paddy Field in Southern Region (남부지역 논에서 봄파종시 이탈리안 라이그라스 품종 및 파종시기가 수량과 사료가치에 미치는 영향)

  • Kim, Ki Soo;Lee, Suk Kyung;Choi, Young Sun;Park, Do Hwan;Ji, Hee Jung;Jung, Jong Seong;Choi, Ki Choon;Kim, Won Ho
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.35 no.1
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    • pp.50-56
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    • 2015
  • Italian ryegrass is generally cultivated by a winter forage in a paddy field, the harvest season overlaps with rice transplantion in some cases. In addition, farmers can miss the optimal seedtime for Italian ryegrass because of the rainy season. Therefore, this research was conducted between October 2012 and June 2013 in Kwangjin, Korea to examine the effect of spring-seeding on the yields and quality of Italian ryegrass for the determination of an alternative if the optimal seedtime is missed. This trial consists of four different seeding dates (15 February, 25 February, 5 March, and 15 March) and three varieties (Kowinmaster, Kowinearly, and Green farm). The Italian ryegrass varieties "Kowinmaster," "Kowinearly," and "Green farm" were sown on February 15. The heading date of each variety showed from May 12 to May 9 and interval time of five days but the Treatment of March 15 planting date showed three days interval. The Kowinmaster variety, planted on February 15, was 93.0 cm taller on March 15 with a height of 105.7 cm. The Kowinearly and Green farm varieties planted on February 15 were of a similar height on February 25 and received a poor lodging score when planted quickly. The dry matter (DM) yield of the Kowinearly planted on February 15 was high but that of Green farm was low at 6,609 kg/ha and a difference was not shown between the varieties. The DM yield was different for those varieties planted on February 15 and March 15 (P<0.05). The crude protein content (CPC) of those varieties planted on February 15 showed an average of 8.8%, while those that were planted on March 15 showed an average that was about 2.3% higher at 11.1%; furthermore, the latter also showed lower acid detergent fiber (ADF) and total digestible nutrient (TDN) contents, by 2.1% and 1.5%, respectively. The relative feed value was about 5.9% higher, depending on the seeding date, as well as being slower and showing less difference between the varieties. According to this study, Italian ryegrass planted in a paddy field of the southern region of Korea on February 25 will produce a high-quantity yield with nutritive value.

Study on Manufacture of Square Baled Corn Silage Using Square Silage Wrapping Compressor (소형 사각 곤포기를 이용한 옥수수 사각 압축곤포 사일리지 조제에 관한 연구)

  • Choi, Ki-Choon;Cho, Nam-Chul;Jung, Min-Woong;Kim, Jong-Geun;Shin, Jae-Soon;Lee, Kyung-Dong;Lim, Young-Chul;Kim, Won-Ho;Oh, Young-Keun;Kim, Cheon-Man;Kim, Hyuk-Gi;Han, Dong-Bae
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.31 no.1
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    • pp.75-84
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    • 2011
  • This study was conducted to investigate the effect of harvest stage of corn on the quality of square baled corn silage manufactured with corn grown in paddy land of Department of Animal Resources Development, National Institute of Animal Science, RDA from 2009 to 2010. Corn "Kwangpyungok" was harvested at three different growth stages (milk, yellow ripen and ripen stage) and ensiled at each harvest time. Square baled corn silage was manufactured by use of square silage wrapping compressor. Each treatment was replicated three times. The content of crude protein (CP) of corn in square baled corn silage decreased with delayed maturity, but the content of ADF (acid detergent fiber), NDF (neutral detergent fiber), TDN (total digestible nutrient) and in vitro dry matter digestibility (IVDMD) were not changed. The content of moisture, pH and the nutritive values at three different harvest stages were not influenced by the method of silage manufacture and inoculant. The content of lactate of square baled corn silage harvested in milk stage of corn was significantly increased, as compared with that of round baled corn silage (P<0.05), but in stage of yellow ripen was significantly decreased (P<0.05). The content of acetate in square baled corn silage significantly decreased with delayed harvest maturity, as compared with that of round baled corn silage (P<0.05). Flieg's score of square baled corn silage harvested in milk stage of corn was slightly higher than that of round baled corn silage, but Flieg's scores in yellow ripen stage and ripen stage were not influenced by the method of silage manufacture. Flieg's score with delayed maturity was not influenced by the method of silage manufacture and inoculant. The manufacture of square baled corn silage was proved to be suitable for the fermentation of corn silage. Therefore, this study suggest that square baled corn silage can be a way of new silage manufacture technique.

Anti-inflammatory Effect of Oxya chinensis sinuosa Ethanol Extract in LPS-induced RAW 264.7 Cells (LPS로 유도된 RAW 264.7세포에 대한 벼메뚜기(Oxya chinensis sinuosa) 에탄올 추출물의 항염증 효과)

  • Yoon, Young-Il;Chung, Mi Yeon;Hwang, Jae-Sam;Goo, Tae-Won;Ahn, Mi-Young;Lee, Young-Bo;Han, Myung-Sea;Yun, Eun-Young
    • Journal of Life Science
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    • v.24 no.4
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    • pp.370-376
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    • 2014
  • Although the grasshopper Oxya chinensis sinuosa has long been used as food in Korea, there is little data on its functional effects. In this study, we investigated the anti-inflammatory effect of O. c. sinuosa ethanol extract (OCE) in RAW 264.7 mouse macrophage cells treated with lipopolysaccharide (LPS) for induction of inflammation. First, we determined that there is no cytotoxicity at $2,000{\mu}g/ml$ or less of OCE in RAW 264.7 cells. To evaluate the anti-inflammatory effects of OCE, we investigated expression levels of pro-inflammatory cytokines such as tumor necrosis factor (TNF)-${\alpha}$ and interleukin (IL)-6, and pro-inflammatory enzymes such as inducible nitric oxide synthase (iNOS) and cyclo-oxygenase-2 (COX-2) in LPS-induced RAW 264.7 cells. In addition, we examined whether OCE could inhibit translocation of NF-${\kappa}B$ p65 into the nucleus in LPS induced RAW 264.7 cells. As a result, we found that the mRNA and protein levels of TNF-${\alpha}$ and IL-6 decreased in LPS-induced RAW 264.7 cells after treatment with OCE in a dose-dependent manner. In addition, we confirmed a $2,000{\mu}g/ml$ concentration of OCE inhibited translocation of NF-${\kappa}B$ p65 by immunnostaining and Western blot analysis, and a decrease in the protein expression levels of iNOS and COX-2. Accordingly, we suppose that OCE has an anti-inflammatory effect through down-regulation of TNF-${\alpha}$, IL-6, iNOS, and COX-2 related to ${\kappa}B$ p65 inflammatory signaling pathways.

Effect of Panax ginseng on the Graft-versus-Host Reaction, Production of Leucocyte Migration Inhibitory Factor and Expulsion of Adult Trichinella spiralis in Mice (인삼이 이식편대숙주반응, 대식세포유주저지반응 및 Trichinella spiralis의 expulsion에 미치는 영향)

  • Ha, Tai-You;Lee, Jeong-Ho;Kim, Sang-Hyung
    • The Journal of the Korean Society for Microbiology
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    • v.21 no.1
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    • pp.133-144
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    • 1986
  • This study was undertaken to assess the effect of ginseng administration on T lymphocyte induced local xenogenic graft-versus-host(GVM) reactions which were induced with thymocyte, spleen cell and lymph node cell of ICR mice. Mice received daily 10mg of 70% alcohol ginseng extract oral1y for 100days and control mice remained untreated for the same period of time. The cells from donor mice were injected intradermally into the closely shaven abdominal skin of Sprague-Dawley rats for GVH tests. The thymocyte from control(ginseng-untreated) mice showed a negative local GVH reaction, whereas thymocyte from experimental(ginseng-treated) mice showed a positive reaction with the rate of 17.4%. When spleen cells were injected, the incidence of positive local GVH reaction was 66.7% among ginseng-treated mice, as opposed to incidence of 45.5% of positive local GVH reaction among control mice. The incidence of positive local GVH reaction of the lymph node cells when injected into a recipient was 71.4% among ginseng-treated mice as compared with that of 18.9% among control mice. The relationship between spleen cell inoculum and intensity of the local GVH reaction was assessed in ginseng-untreated mice. The intensity of GVH reaction clearly appears to be dose related. In ginseng-treated mice, a minimum of $1{\times}10^7$ spleen cell was required for production of positive local GVH reaction with almost linear relationship up to an inoculum of $5{\times}10^8$ cells. In control mice, however, a minimum of $1{\times}10^8$ spleen cells was required for positive GVH reaction. These results strongly suggest that the ginseng administration augments significantly the local xenogenic GVH reaction which was used to assess T lymphocyte function and immunocompetence of mice and in addition to this, these results appear to support previous suggestions that the local GVH reaction consitutes a qualitative test of the functional activity of T lymphocytes. These results may be the first to induce local GVH reaction, employing rats as recipient and mice as donor. This study was also desingned to investigate some of the effects of ginseng extract on lymphocyte-macrophage interactions. This was accomplished by in vitro quantification of 1) migratory inhibitory factor(MIF) synthetic capacity of splenic lymphocytes in mice previously primed with ginseng 2) MIF responsiveness of mouse peritoneal macrophages or chicken peripheral leucocytes under the presence of ginseng extract 3) migration ability of chicken peripheral leucocytes by direct stimulation of ginseng extract or ginseng saponin and 4) immunosuppressive effects of immunosuppressants such as cyclophosphamide, cyclosporin A or dexamethasone. Mice divided equally into the ginseng and the saline groups, which received intraperitoneally daily 0.2ml of ginseng absolute alcohol-extract(5mg/ml) and same amount of saline for 15 days, respectively. The cellular immune responsiveness of these mice was assayed 15 days after ginseng pretreatment. Splenic lymphocytes of mice treated with ginseng, when stimulated with sensitized specific-antigen such as sheep red blood cells or toxoplasmin, or with polyclonal activator concanavalin A, produced significantly more MIF than those of control saline group. MIF responsiveness of normal mouse macrophages was significantly augmented when assayed under the presence of ginseng extract (1mg/ml). The migratory ability of normal chicken leucocytes in the absence of MIF was significantly decreased by the stimulation of ginseng extract alone. MIF response was significantly decreased by immunosuppressants and this impaired response was not restored by ginseng pretreatment. This study was additionally performed to evaluate the effect of ginseng on the expulsion of adult Trichinella spiralis in mice. ICR mice were infected experimentally by esophageal incubation of 300 T. spiralis infective muscle larvae prepared by acid-pepsin digestion of infected mice. and received oral administration of 70% alcohol ginseng extract(10mg/mouse/day) for the indicated days plus 4 days before infection. At various times after infection, the number of adult T. spiralis worms in small intestines was determined. Interestingly, ginseng-treatment was accompanied by accelerated expulson of T. spiralis. These results led to the conclusion that Panax ginseng caused some enhancing effect on GVH reaction, macrophage migration inhibition reaction and expulsion of T. spiralis. In addition these results suggested that the mechanisms responsible for this enhancement of ginseng may be chiefly or partially due to nonspecific stimulation of cell-mediated immune response.

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