Since signal intensity of electron spin resonance (ESR) at g=1.95 also decreased with increasing amount of SnO, it is suggested that bismuth radical-like species exist in the glass and that SnO reacts with the bismuth species. Concentration dependence of SnO in the XPS and in the ESR spectra shows that we can assign the observed signal to bismuth radical species in the glass. We, therefore, conclude that there is qualitative correlation between

the optical absorption in the visible region and bismuth radical selleck chemical species in the CaBBAT glass.”
“A new minor quassinoid named bruceine M (1), together with 12 known quassinoids (2-13), was isolated from the fruits of Brucea javanica (Simaroubaceae). Their structures were determined by interpretation of NMR and HR-ESI-MS data. The structures of the known compounds were confirmed by comparison of their spectral data with those reported in the literatures. In vitro cytotoxicity of the isolated compounds against cancer cell lines Bel-7404, BAY 57-1293 nmr MCF-7 and A549 was evaluated. Compounds 4, 6 and 9 exhibited significant growth inhibitory activity against three cancer cell lines.”
“Purpose: To review out-of-pocket costs related to cancer that are borne by patients and their families.

Methods: A literature search using key terms relating to out-of-pocket costs incurred by cancer patients and their families was undertaken to

generate a comprehensive narrative synthesis of the information available.

Results: Four themes were identified: measuring costs; sources of costs; the impact of costs and reducing costs. The wide variety of measures for ascertaining hidden costs makes comparison of findings difficult; some articles cover a very narrow range of costs. Qualitative research is useful for elucidating a wide range of costs. Costs pertaining to hospital visits, nutrition and clothing are widely mentioned. Low additional

expenditure may indicate that needs/wants are going unmet. Financial capacity to cope and subjective perception of impact are important. Low income, younger age, chemotherapy and living rurally are associated CA3 order with greater impact. Extra expense can exert long-term effects on family finances. Primary care follow-up, telemedicine and treatments that entail fewer visits may serve to reduce patient costs.

Conclusions: The key question is how to organise/deliver cancer care in order to reduce additional expenses to patients and families. Future research could identify critical time-points and demographic groups susceptible to significant additional costs, in order to target support at those most in need. (C) 2010 Elsevier Ltd. All rights reserved.”
“We have synthesized and studied a series of composite silver-polymer photonic metamaterials with composition-tunable electric response.

If the foreign body was still noted to be distal to the tracheotomy, postural percussion was performed to dislodge the foreign body into the trachea. Once the foreign body was identified at the tracheotomy, it was removed.

Results: All seven patients presented in respiratory distress and were emergently managed in the operating room. The average age was 2.8 years (6 months-8 years of age). The foreign bodies were successfully removed in all patients. There were

no mortalities and all patients were successfully discharged from the hospital.

Conclusions: Pediatric AZD2171 research buy airway foreign body aspiration is a life-threatening clinical entity in any setting, but it presents unique challenges in resource-limited settings where rigid bronchoscopy is not available. Buparlisib This report presents one such treatment modality and utilizes a combination of

flexible fiberoptic bronchoscopy and tracheotomy to treat such patients. (C) 2012 Elsevier Ireland Ltd. All rights reserved.”
“Objective: Microtia is a complicated congenital anomaly with a genetic and environmental predisposition, and the molecular events underlying this disease are not fully understood. MicroRNAs (miRNAs) are a class of 20-22 nucleotide non-coding RNAs that function to control post-transcriptional gene expression. We want to find the miRNA expression profiling of microtia by using Affymetrix GeneChip (R) miRNA 2.0 Arrays.

Methods: We selected 9 microtia cartilages and 3 normal controls for GeneChip miRNA 2.0 Arrays analysis. The altered miRNA were analyzed by poly (A) RT-PCR from 58 microtia samples and 16 normal controls. We predicted the target genes of miRNAs by bioinformatics and RT-PCT was used to confirm the target genes.

Results: We found 11 miRNAs with significantly altered expression in the microtic group compared to the normal controls, which included 6 up-regulated

miRNAs and 5 down-regulated miRNAs. These miRNAs were further examined using poly (A) RT-PCR analysis, we found that miR-451 and miR-486-5p were significantly up-regulated and miR-200c was significantly P5091 molecular weight down-regulated in the microtic group compared to the normal controls (p < 0.05). Several complementary target messenger RNAs (mRNAs) had been predicted. OSR1, the target gene of miR-451 and miR-200c, was significantly up-regulated (p < 0.01); TRPS1, the target gene of miR-200c, was significantly down-regulated in the microtic group compared to the controls (p < 0.0001).

Conclusion: The reduction in miR-200c expression and the accretion of miR-451 and miR-486-5p expression in microtic samples could be possible causes of the abnormal development of the external ear. OSR1 and TRPS1, as the complementary target mRNAs, may play important roles during the development of the external ear. Further studies are still needed to identify the miRNA target genes and to determine their function in the pathogenesis of microtia.

“
“Fragile X-associated tremor ataxia syndrome

(FXTAS) is a relatively recently described condition that is frequently misdiagnosed as essential tremor and then occasionally treated as such with deep brain stimulation (DBS) to the nucleus ventralis intermedius of the thalamus (Vim). Reports of ataxia worsening after bilateral Vim DBS in FXTAS patients are conflicting, and only five FXTAS patients treated with Vim DBS for intractable tremor have been reported in the literature, three of whom having undergone a bilateral procedure. We report a patient who underwent a staged Vim DBS procedure, with excellent contralateral hand tremor control and no worsening of ataxia after the first procedure, but immediate worsening of his ataxia after the second one, arguing in favor of a unilateral surgical CT99021 PI3K/Akt/mTOR inhibitor approach for intractable tremor in FXTAS.”
“Introduction.

Prescription opioid abuse is a major public health problem in the United States. Physicians who prescribe opioid analgesics are

sometimes confronted with patients who request early refills, claiming that they have been “”shorted”" by their pharmacy. While a substantial differential diagnosis exists for apparent opioid overuse, the underfilling of opioid prescriptions at the level of retail pharmacies has not yet been systematically investigated.

Objective.

The goals of the present study were to: 1) determine the incidence and magnitude JQ-EZ-05 mw of opioid prescription underfilling among retail pharmacies SYN-117 in Northeast Florida and 2) to compare the rates of under- and overfilling with noncontrolled substance prescription controls.

Design.

Patients receiving opioid prescriptions were recruited for this study during routine primary care office visits. These patients, blinded to

the study goals, filled their prescriptions, and returned to the clinic with unopened medication bag(s) for dosage unit counts.

Results.

One hundred and twenty-one patients filled 134 opioid prescriptions from 103 unique pharmacies. Dosage unit counts revealed three slight opioid prescription underfills (1-3 dosage units) and three slight opioid prescription overfills (1-3 dosage units). We found no statistically significant differences between opioids and noncontrolled substance controls with regard to prescription underfills.

Conclusions.

There was no evidence supporting patients’ claims of significant opioid analgesic underfilling by retail pharmacies. Patients who repeatedly report medication shortages should be evaluated for opioid use disorders.”
“Increased antagonist muscle co-activation, seen in motor-impaired individuals, is an attempt by the neuromuscular system to provide mechanical stability by stiffening joints.

Median operative time was 155 minutes (range 100-210min), and median estimated blood loss was 100mL (50-500mL). There were no positive margins, and two postoperative complications (urine leak and clot retention) were encountered. No recurrences were noted with short-term follow-up.

Conclusion: Clampless RFC LPN can be performed safely in carefully selected patients with

favorably positioned tumors. In this initial experience, we observed excellent perioperative and short-term oncologic outcomes. Future comparative studies will dictate the role of RFC-assisted S63845 manufacturer LPN in the armamentarium of kidney surgeons.”
“Hypothesis: Arachnoid granulations (AG) are more prevalent along the middle fossa surface of the temporal bone, where they produce larger bony defects than those occurring on the posterior surface.

Background: Dural and bony defects formed by AGs are proposed to lead to spontaneous meningoencephaloceles and cerebrospinal fluid otorrhea. They most commonly occur at the tegmen and in individuals older than 40 years.

Methods: Vertically sectioned temporal bones were evaluated using light microscopy to determine AG histology, distribution, and morphometry and to determine the prevalence

AC220 purchase of AG penetration in the donor population.

Results: AGs were observed to penetrate the dura mater and make direct contact with cortical surfaces in 12.7% of donors in the Johns Hopkins Temporal Bone Collection. AGs occurred at middle fossa sites 13% more frequently than at posterior fossa sites. At middle fossa sites AGs produced significantly larger bony openings and were more likely to be associated with herniating brain tissue. Donors with AGs were significantly older, and all were in the late 30s or older.

Conclusion: Erosion of the temporal bone by AGs is not a rare occurrence in the population and becomes increasingly prevalent with age. It is estimated that 14 in 1,000 donors were at greatest risk of eventual cerebrospinal fluid leakage at the tegmen.

PND-1186 cost The age and anatomic distribution described in this study strengthens the notion that AG penetration plays a role in the pathophysiology of spontaneous cerebrospinal fluid leaks and meningoencephaloceles of the temporal bone.”
“This study aimed to study differences in lung function after surgical and percutaneous atrial septal defect (ASD) closure. Several studies have demonstrated abnormalities of pulmonary function in adults and children with ASD. These abnormalities persist even a few years after correction. This study compared pulmonary function between patients who underwent ASD closure by surgery and those who had closure by device. This is the ideal pediatric population for studying changes in lung function caused by cardiopulmonary bypass or sternotomy. The 46 patients in this study were treated by percutaneous closure (group 1) or surgical closure (group 2) of ASD and then scheduled for pulmonary function testing an average of 5.

We sought to determine if MH could be identified from BP taken during a single bout of low-intensity exercise. Methods. BP was recorded at rest and during brief low-level cycling exercise (60-70% of age-predicted maximal heart rate) in 75 untreated subjects with a hypertensive response to exercise (aged 54 +/- 9 years). All subjects underwent 24-h ambulatory BP monitoring (ABPM) and MH was defined as clinic BP < 140/90 mmHg and ABPM BP >= 130/80 mmHg. Results. There were 42 (56%) patients with MH, and at rest systolic (SBP) was higher in subjects selleckchem with MH compared with those without MH (127 +/- 9 vs 120 +/- 9 mmHg; p < 0.05). During exercise, MH subjects had significantly higher SBP (188 +/- 22 vs 168 +/- 15

mmHg; p < 0.05), with a greater change from baseline (61 +/- 21 vs 48 +/- 15 mmHg; p < 0.05). Low-level exercise SBP was independently associated with MH, and if >= 175 mmHg, identified MH with 74% sensitivity and 67% specificity (p < 0.001). Conclusion. MH can be identified in untreated individuals from low-intensity exercise SBP. Further research on the diagnostic value of BP during early phases of exercise stress testing is needed.”
“Before a protein

vaccine is introduced into a country, it is essential to evaluate its potential impact and estimate its benefits and costs. The aim of this study was to determine the genetic characteristics of Neisseria meningitidis B (NmB) in the pharyngeal secretions of 1375 healthy adolescents aged 13-19 y living in Milan, Italy, in September 2012, and the possible protection offered by the two currently available NmB protein vaccines. Ninety-one NU7026 supplier subjects were Nm carriers (6.6%), 29 (31.9%) of whom carried the NmB capsular gene. The 29 identified strains belonged to eight clonal complexes (CCs), the majority of which were in the ST-41/44/Lin.3 CC (n = 11; 37.9%). All of the identified strains harboured fHbp alleles representing a total of 15 sub-variants: the gene for NHBA

protein was found in all but three of the studied strains (10.3%) with 13 identified sub-variants. There were 15 porA sub-types, seven of which were identified in just one CC. The findings of this study seem to suggest that both of the protein vaccines proposed for the prevention Compound C datasheet of invasive disease due to NmB (the 4-protein and the 2-protein products) have a composition that can evoke a theoretically effective antibody response against the meningococcal strains currently carried by adolescents living in Northern Italy. The genetic characteristics of NmB strains can be easily evaluated by means of molecular methods, the results of which can provide an albeit approximate estimate of the degree of protection theoretically provided by the available vaccines, and the possible future need to change their composition.”
“Objective: Proteolytic degradation of aggrecan in articular cartilage is a hallmark feature of osteoarthritis (OA).

The formulations were evaluated for patch thickness, tensile strength,

moisture content, water absorption capacity and drug content. In vitro drug release and permeation of the patches were determined using a Franz diffusion cell.

Results: the tensile strength of all the formulations was in the range from 6.09 to 9.85 Mpa indicating Ricolinostat that the [patches were strong. Maximum drug release in 8 h for dibutyl phthalate DBP and dibutyl sebacate DBS patches was 38.9 (DB6) and 53.4 % (DS3), respectively, which are significantly (p < 0.01) higher than the lowest values of 17.8 (for DB1) and 35.0 % for (DS5), respectively. Drug release rate was 1.89 and 3.93 mu g/h/cm(2), respectively with DS2 and DB2 showing the highest permeation rate of 5.39 mu g/h/cm(2). Patches containing DBP followed Higuchi release model while patches formulated with DBS followed first order release kinetics.

Conclusion: Ondansetron matrix-type transdermal patches formulated with suitable amounts of chemical enhancers for better patient compliance are feasible.”
“Fusionless growth modulation is an attractive

alternative to conventional treatments of idiopathic scoliosis. To date, fusionless devices achieve unilateral growth modulation by compressing the intervertebral disc. This study explores a device to control spinal alignment and vertebral morphology BMN 673 DNA Damage inhibitor via growth modulation while excluding the disc in a porcine model.

A device that locally encloses the Navitoclax vertebral growth plate exclusive of the disc was introduced anteriorly over T5-T8 in four immature pigs (experimental) while three underwent surgery without instrumentation (sham) and two were selected as controls. Bi-weekly coronal and lateral radiographs were taken over the 12-week follow-up to document vertebral morphology and spinal alignment modifications via an inverse approach (creation

of deformity).

All animals completed the experiment with no postoperative complications. Control and sham groups showed no significant changes in spinal alignment. Experimental group achieved a final coronal Cobb angle of 6.5A degrees A A +/- A 3.5A degrees (constrained to the four instrumented levels) and no alteration to the sagittal profile was observed. Solely the experimental group ended with consistent vertebral wedging of 4.1A degrees A A +/- A 3.6A degrees amounting to a cumulative wedging of up to 25A degrees and a concurring difference in left/right vertebral height of 1.24 +/- A 1.86 mm in the coronal plane.

The proposed intravertebral epiphyseal device, for the early treatment of progressive idiopathic scoliosis, demonstrated its feasibility by manipulating spinal alignment through the realization of local growth modulation exclusive of the intervertebral disc.”
“The improvement of sample-preparation and extraction techniques for determinations of natural bioactive compounds is very important.

(C) 2010 Wiley Periodicals, Inc. J Appl Polym Sci 120: 1216-1224, 2011″
“Purpose: To compare the diagnostic performance of rapid whole-body anatomic magnetic resonance

(MR) staging of pediatric and adolescent lymphoma to an enhanced positron emission tomographic (PET)/computed tomographic (CT) reference standard.

Materials and Methods: Ethical permission was given by the University College London Hospital Small molecule library ethics committee, and informed written consent was obtained from all participants and/or parents or guardians. Thirty-one subjects (age range, 7.3-18.0 years; 18 male, 11 female) with histologically proved lymphoma were prospectively recruited. Pretreatment staging was performed with whole-body short inversion time inversion-recovery (STIR) half-Fourier rapid acquisition with relaxation enhancement (RARE) MR imaging, fluorine 18 fluorodeoxyglucose PET/CT, and contrast agent-enhanced chest CT. Twenty-six subjects had posttreatment PET/CT and compromised our final cohort. Eleven nodal and 11 extranodal sites per patient were assessed 11-deoxojervine on MR imaging by two radiologists in consensus, with a nodal short-axis threshold of. 1 cm and predefined extranodal positivity criteria. The same sites were independantly evaluated by two nuclear medicine physicians on PET/CT images. Disease positivity was defined as a maximum standardized uptake value >2.5 or nodal size >1 cm. An unblinded expert panel reevaluated

the imaging findings, removing perceptual errors, and derived an enhanced PET/CT reference

standard (taking into account chest CT and 3-month follow-up imaging) against which the reported and intrinsic performance of MR imaging was assessed by using the kappa statistic.

Results: There was very good agreement between MR imaging and the enhanced PET/CT reference standard for nodal and extranodal staging (kappa = 0.96 and 0.86, respectively) which improved GSK2879552 following elimination of perceptual errors (k = 0.97 and 0.91, respectively). The sensitivity and specificity of MR imaging (following removal of perceptual error) were 98% and 99%, respectively, for nodal disease and 91% and 99%, respectively, for extranodal disease.

Conclusion: Whole-body STIR half-Fourier RARE MR imaging of pediatric and adolescent lymphoma can accurately depict nodal and extranodal disease and may provide an alternative nonionizing imaging method for anatomic disease assessment at initial staging. (C) RSNA, 2010″
“We report on low temperature conductance measurements of gold nanogaps fabricated by controlled electromigration. Fluctuations of the conductance due to quantum interferences and depending both on bias voltage and magnetic field are observed. By analyzing the voltage and magnetoconductance correlation functions, we determine the type of electron trajectories generating the observed quantum interferences and the effective characteristic time of phase coherence in our device. (C) 2011 American Institute of Physics. [doi:10.1063/1.

53 and 0.54 for PSI and CRB-65. By fitting a multivariable logistic regression model, a significantly different trend in mortality was found between the CAP/Ca(-) and CAP/Ca(+) groups AZD1480 cell line for both scoring systems.

CONCLUSION: Clinical judgment will continue to be the physicians’ primary tool in defining

the site of care for cancer patients with CAP.”
“Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard in bariatric surgery. A long-term complication can be marginal ulceration (MU) at the gastrojejunostomy. The mechanism of development is unclear and symptoms vary. Management and prevention is a continuous subject of debate. The aim was to assess the incidence, mechanism, symptoms, and management of MU after LRYGB by means of a systematic

review. Forty-one studies with a total of 16,987 patients were included, 787 (4.6 %) developed MU. The incidence of MU varied between 0.6 and 25 %. The position and size of the pouch, smoking, and nonsteroidal inflammatory drugs usage are associated with the formation of MU. In most cases, MU is adequately treated with proton pump inhibitors, sometimes reoperation is required. Laparoscopic approach is safe and effective.”
“Background: Cutaneous arteriovenous malformations click here (AVMs) of stage I may mimic port-wine stains (PWSs) clinicopathologically; therefore, it may be misdiagnosed and mistreated as being PWS.

Objective: To suggest the clinicopathological differential clues between early AVMs and PWSs.

Methods: A set of 10 radiologically proven AVMs of stage I was selected in conjunction with a set of 10 age-/sex-matched PWSs as a control. Their clinical features, hematoxylin and eosin, CD31, and smooth muscle actin immunohistochemistry

were then compared.

Results: Four pathological BAY 63-2521 mw clues for differential diagnosis with statistical significance (P < 0.05) were found: the vessel density (CD31), presence of vascular luminal red blood cells, elongation and haphazard branching of vessels, and thickened vessel walls highlighted by smooth muscle actin.

Conclusion: Therefore, 4 differential clues with respect to stage I AVM and PWS in their earlier developmental stages have been proposed.”
“A cross-sectional cell-to-cell survey was conducted in 18 of 22 prisons in Malawi to determine the period prevalence of smear-positive pulmonary tuberculosis (PTB). In each prison, prisoners were interviewed using a structured questionnaire. Prisoners with cough of >1 week’s duration were investigated by sputum smear examination. Of 7661 prisoners, 3837 had cough of >= 1 week, of whom 3794 submitted three sputum specimens: 54 (0.7%) had smear-positive PTB. The prevalence of PTB was higher in large urban prisons (1.1%) than in district prisons (0.3%, P < 0.001). More needs to be done to improve TB control in urban prisons.

A step-up method of frontal chromatography was used when several inlet concentration steps were made in the range of 0-20 g dm(-3). The obtained experimental data were fitted simultaneously using the general rate model with two estimated parameters. which were the distribution coefficient of linear adsorption isotherm and solid-phase diffusion coefficient. The contribution of individual transport Prexasertib supplier phenomena to dispersion of adsorption fronts was discussed. (C) 2009 Elsevier B.V. All rights reserved.”
“Gallic

acid is widely distributed in plants, fruits and foods with a range of biological activities. In the present study the possible mechanisms of gallic acid anticancer properties were explored in A549, a human lung adenocarcinoma cell line. Our study shows that it inhibited the A549 cell growth and decreased cell viability monitored at 24 h. It also inhibited cell proliferation in dose- and time-dependent manner as measured by 3-[4,5-methylthiazol-2-yl]2,5-diphenyl-tetrazolium bromide assay at 24 and 48 h. Morphological examination of the cells after gallic acid treatment showed the typical feature of cell death such as cell shrinkage

and rounding up of the cells. Clonogenic assay indicated that gallic acid treatments inhibited the colony formation. DNA fragmentation assay indicated the disappearance of the genomic DNA in dose-dependent manner. To find out possible mechanisms, mitochondrial potential and intracellular reactive oxygen species were measured. It was Evofosfamide molecular weight observed that gallic acid treatment decreased mitochondrial membrane potential and increased intracellular reactive oxygen species. Further caspases check details activity was measured and it was found

that gallic acid activated the caspase-3 but not caspase-8 indicating the involvement of intrinsic pathway of cell apoptosis.”
“A novel charring agent, poly(p-propane terephthalamide) (PPTA), was synthesized with terephthaloyl chloride and 1,2-propanediamine through solution poly-condensation at a low temperature. PPTA was used together with ammonium polyphosphate (APP) to prepare a novel intumescent flame retardant (IFR) for an acrylonitrile butadiene styrene (ABS) resin. The flammability and thermal stability of the IFR ABS composites were investigated with limiting oxygen index, UL 94 vertical burning, and thermogravimetric analysis tests. The results showed that the IFR system had excellent flame retardancy and antidripping properties for ABS. The thermogravimetric curves suggested that there was a distinct synergistic effect of PPTA and APP, and this effect greatly promoted the char formation of the IFR ABS composites and hence improved the flame retardancy. Additionally, the structure and morphology of char residues were studied with Fourier transform infrared and scanning electron microscopy. (C) 2010 Wiley Periodicals, Inc. J Appl Polym Sci 120: 968-973, 2011″
“Cytochrome c (Cyt c) is a hemoprotein involved in shuttling electrons in the mitochondrial electron transport chain.

Activity type recognition has great potential to improve the assessment of physical activity-related health outcomes. So far, there is little evidence that adding other physiological measures such as heart rate significantly improves

the estimation of energy expenditure.”
“Objective: To evaluate which of two invitation methods, e-mail or post, was most effective at recruiting general practitioners (GPs) to an online trial.

Study Design and Setting: Randomized controlled trial. Participants were GPs in Scotland, United Kingdom.

Results: Two hundred and seventy GPs were recruited. Using e-mail did not improve recruitment (risk difference = 0.7% [95% confidence interval -2.7% to 4.1%]). E-mail was, however, simpler to use and cheaper, costing 3.20 pound per recruit compared with 15.69 pound for postal invitations. Reminders increased recruitment by around 4% for each reminder MI-503 supplier sent for both invitation methods.

Conclusions: In the Scottish context, inviting GPs to take part in an online trial by e-mail does not adversely affect recruitment and is logistically easier and cheaper than using postal invitations. (C) 2012 Elsevier Inc. All rights reserved.”
“Video capsule endoscopy (VCE) is a noninvasive method for examining the

gastrointestinal tract which has been successful in small intestine studies. Recently, VCE has been attempted in the colon. However, the capsule often tumbles in the wider colonic lumen, resulting in missed regions. Self-stabilizing VCE is a novel method to visualize the colon without tumbling. The aim of the present study was to comparatively LXH254 nmr quantify the effect of stabilization of a commercially available nonmodified capsule endoscope (CE) MiroCam and its modified self-stabilizing Galardin price version in acute canine experiments. Two customized MiroCam CEs were reduced in volume at the nonimaging back-end to allow the attachment of a self-expanding, biocompatible stabilizing device. Four mongrel dogs underwent

laparotomy and exteriorization of a 15-cm segment of the proximal descending colon. A single CE, either self-stabilizing or nonmodified was inserted through an incision into the lumen of the colon followed by pharmacologically induced colonic peristalsis. The inserted capsule was propelled distally through the colon and expelled naturally through the anus. Novel signal processing method was developed to quantify the video stabilization based on camera tracking a predetermined target point (locale). The average locale trajectory, the average radius movement of the locale, and the maximum rate of change of the locale for sequential images were significantly lower for the stabilized capsules compared to the nonstabilized ones (p < 0.05). The feasibility of self-stabilized capsule endoscopy has been demonstrated in acute canine experiments.”
“Branchial anomalies are a consequence of abnormal development of the branchial apparatus during embryogenesis.