SETTING: Doheny Eye Institute, Los Angeles, California, USA.

DESIGN: Cross-sectional study.

METHODS: A Fourier-domain OCT system (RTVue) was used to scan normal eyes, eyes after myopic laser in situ keratomileusis (LASIK), and keratoconic eyes. After the corneal surfaces were delineated, the system calculated anterior and posterior corneal powers by curve fitting over the central 3.0 mm diameter area. Net corneal

power was calculated using a thick-lens formula. The repeatability of the calculations was evaluated by the pooled standard deviation of 3 measurements from the same visit. The net corneal power values were compared with standard automated keratometry measurements (IOLMaster).

RESULTS: The repeatability this website of Fourier-domain OCT net www.selleckchem.com/products/Rapamycin.html corneal power was 0.19 diopters (D), 0.26 D, and 0.30 D in the normal, post-LASIK, and keratoconus groups, respectively. The Fourier-domain OCT net corneal power was significantly lower than keratometry by a mean of -1.21 D, -2.89 D, and -3.07 D, respectively (P<.001). The anterior posterior curvature ratio was lower in post-LASIK and keratoconic eyes than in normal eyes (P<.001).

CONCLUSIONS:

Corneal power measured by Fourier-domain OCT achieved good repeatability in all 3 groups. The repeatability was better than slower time-domain OCT systems. Because Fourier-domain OCT directly measures both anterior and posterior corneal surfaces, it may produce more consistent results than standard keratometry in post-LASIK and keratoconic eyes in which the anterior posterior corneal curvature ratios are altered by surgery or disease.”
“Background: PI3K inhibitor Personality characteristics have been associated with cocaine use. However, little is known about the mechanisms through which personality

could impact drug use. The present study investigated the cross-sectional and prospective relationships between personality dimensions (i.e., impulsivity, neuroticism) and problematic cocaine use. Reactivity to a pharmacological stressor as a potential mediator of the relationship between neuroticism and future cocaine use was also examined.

Methods: Participants were 53 cocaine-dependent individuals and 47 non-dependent controls. Subjects completed the Eysenck Personality Questionnaire (EPQ) at baseline and were administered i.v. corticotrophin releasing hormone (CRH; 1 mu g/kg). Cocaine use in the 30 days following CRH administration was measured.

Results: Cocaine-dependent individuals had higher scores on the psychoticism (i.e., impulsivity, aggression; p = 0.02) and neuroticism (p < 0.01) scales of the EPQ than non-dependent controls. Cocaine-dependent individuals also had a greater subjective stress response to CRH than controls (p < 0.01). Cocaine-dependent individuals with elevated psychoticism used significantly more cocaine over the follow-up period (p < 0.

In contrast, in the abscission zone, accumulation of MiETR1 transcript remained unchanged; a temporal increase in MiETR1 transcript level was observed

in the fruitlet mesocarp, whereas in the seed, MiETR1 expression had already dropped by 24 h. Expression profiles of MiERS1 and MiETR1 were then studied during fruit ripening. In agreement with a previous study and coinciding with the climacteric rise in ethylene production, RNA blot analysis revealed that during fruit ripening, MiETR1 mRNA level increases in both mesocarp and seed tissues. Unexpectedly, however, in those same tissues. MiERS1 transcript accumulation was barely detected. Collectively, our data highlight MiERS1′s possible specific function

in regulating fruitier abscission GDC-0941 concentration rather than fruit ripening. (C) 2011 Elsevier Masson SAS. All rights reserved.”
“To evaluate the predisposing factors, diagnosis and surgical treatment options of patients with intra-abdominal, mislocated intrauterine devices (IUDs).

The diagnosis and management of 18 patients with intra-abdominal, AMN-107 datasheet mislocated IUDs were analyzed in this retrospective study.

Trained midwives inserted ten (55%) of the IUDs, while six (33%) were inserted by general practitioners and two (11%) by specialist gynecologists. Ten (55.5%) of the patients were diagnosed Adriamycin supplier by gynecological examination and ultrasonography (USG); abdominal X-ray, in addition, was required in the other eight (44.4%). Eleven patients (61%) were managed by laparoscopy, whereas laparotomy was required in seven (39%). For all patients, laparoscopy was performed initially. No complication was encountered in any of the patients.

Persons who insert IUDs should receive adequate training before certification, because inadequate pelvic examination before insertion and inexperience of the inserting person might be predisposing factors for uterine perforation. If IUD strings

are not visible during gynecologic examination, USG should be tried to locate the IUD and pelvic X-ray used only when USG fails to locate the IUD. Laparoscopy can be the first choice for removal.”
“Both experiments with deeply penetrating femtosecond laser pulses and theoretical analysis demonstrate that at low laser fluences on (111) and ((1) over bar(1) over bar(1) over bar) surfaces of n-doped GaAs semiconductors the hypersound generation mechanism is the inverse piezoelectric effect. The transient electric field causing the inverse piezoelectric effect is due to the spatial separation in the built-in near-surface electric field of the electrons and holes photoexcited directly in the depletion region and also of those photoexcited outside the depletion region and diffusing toward it.

A total of 88 non-duplicate Salmonella from 66 (22.0%) retail meat and 22 (7.5%) street food samples were recovered and 11 serovars were identified. Among the 88 Salmonella isolates, the highest resistance was to tetracycline (73.8%), followed by sulfonamide (63.6%), streptomycin (57.9%), nalidixic acid (44.3%), trimethoprim-sulfamethoxazole (19.3%), ampicillin (17.0%), chloramphenicol (10.2%), cephalotin (8.0%), kanamycin (6.8%), ciprofloxacin (2.2%) gentamycin (2.2%), cefoxitin (2.2%), amoxicillin-clavulanate (1.0%) and amikacin (1.0%). Sixty-seven percent p38 MAPK apoptosis of the isolates (59/88) were multidrug

resistant (MDR). Ten out of 17 resistance genes (bla(TEM-1), strA, strB, aadA, sull, sulll, tetA, tetB, floR, cmlA) were detected. Twelve of the 59 MDR Salmonella isolates from serovars Typhimurium (6), Newport (3), Agona (1), Albany (1) and Weltevreden (1) had class 1 integrons. The gene cassettes identified were dfrA1, dfrV, dfrA12, aadA2, sul1 genes and an open reading frame orfC of unknown function. Four integron-positive isolates could transfer resistance phenotypes to the recipient strain, E. coli J53 via conjugation. These data revealed that the Salmonella isolates recovered from the retail meats and cooked street foods were resistant to multiple

antimicrobials, which can be transmitted to humans through food products. The occurrence of mobile genetic elements such as integrons reiterates the roles of food of animal origins as a reservoir of MDR Salmonella. (C) 2011 MEK inhibitor Elsevier Ltd. All rights reserved.”
“Eczema herpeticum can clinically resemble smallpox. On the basis of the algorithm for rapid evaluation of patients with an acute generalized vesiculopustular rash illness, a patient met criteria for high risk for smallpox. The Tzanck preparation was critical for rapid diagnosis of herpetic infection and exclusion of smallpox.”
“Genital prolapse is one of the most common indications for gynaecological surgery. Surgery is performed traditionally via abdominal, vaginal and laparoscopic approaches.

A MEDLINE computer search was performed to explore the recent evidence behind laparoscopic

surgery for female pelvic organ prolapse.

Advances in minimal access surgery have led to an increase selleck chemicals in adoption of laparoscopic techniques. Current evidence supports the use of laparoscopy for sacrocolpopexy and colposuspension as an alternative to open surgery. However, the introduction of less invasive midurethral sling procedures for stress incontinence has reserved laparoscopic colposuspension for special indications. The scientific evidence regarding uterosacral suspension procedures and paravaginal and vaginal prolapse repairs are sparse.

The current evidence supports the outcome of laparoscopic sacrocolpopexy as an alternative to open surgery. Further studies are required on the long-term efficiency in laparoscopic paravaginal repair and vaginal wall prolapse.

Predicted values were compared

with respective experimental results. In all cases, a fair agreement between experimental findings and theoretical predictions was found. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci 124: 67-76,2012″
“The irreversible transformation of androgens into oestrogens is catalysed by ecytochrome P450 aromatase. In the present study, we explored the contribution of the (TTTA)(n) polymorphism in the aromatase gene (CYP19) to sperm concentration and motility. Ninety normozoospermic and 60 oligospermic men were examined during infertility examinations. DNA was extracted from spermatozoa, and the CYP19 (TTTA)(n) polymorphism Selleckchem VX 770 was genotyped by PCR. Genotype analysis revealed six CYP19(TTTA)(n) alleles with 7-12 repeats. The allelic distribution of the CYP19 (TTTA)(n) polymorphism differed between normozoospermic and oligospermic men (P < 0.01). Oligospermic men less frequently had long CYP19 alleles than did normozoospermic men (25 and 37.8%, respectively; P, 0.02). The higher frequency of short CYP19 alleles in oligospermic men compared to normozoospermic men (43.3

and 28.3%, respectively; P < 0.01) was primarily due to the distribution of the CYP19 (TTTA)(7) allele. The CYP19 (TTTA)(7) allele was associated with lower sperm concentration in normozoospermic men (P < Selleckchem PP2 0.01) and in the total study population (P < 0.01); it was also associated with lower sperm motility in normozoospermic men (P < 0.05) and in the total study population (P < 0.01). In conclusion, the CYP19 (TTTA)(7) allele probably impairs aromatase activity, which in turn alters aromatase and oestrogen levels in the testis, leading to

decreased sperm concentration and motility. These findings support the significance of cytochrome P450 aromatase in human spermatogenesis and consequently in semen quality. Asian Journal of Andrology (2011) 13, 292-297; doi:10.1038/aja.2010.144; published online 10 January 2011″
“The piezoelectric and ferroelectric properties of microscopically poled poly(vinylidene fluoride trifluoroethylene) [P(VDF-TrFE)] copolymer films have been examined at different temperatures approaching this website Curie point using piezoresponse force microscopy in combination with dual frequency resonance tracking technique, with the amplitude, phase, quality factor, and resonance frequency of the piezoresponse simultaneously quantitatively determined. It is observed that the piezoresponse remains relatively stable up to 110 degrees C, and then drops rapidly to zero. The variations of the quality factor and resonance frequency with respect to the temperature change are also observed, which is consistent with thermal induced softening in films.

We present a discussion of the most relevant recent publications click here on pain rehabilitation in chronic headache disorders. This article describes pain rehabilitation,

reviews outcome data for chronic pain patients treated in this setting, and describes the unique applicability of this treatment approach for patients with chronic headache. Particular attention is directed to the rationale for and the results of the withdrawal, in a pain rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a pain rehabilitation program in the treatment of a patient with intractable headache.”
“Epilepsy is the most prevalent disabling neurological disorder across the life span, and is not controlled by medications in

more than one-third of patients. Epilepsy surgery is an accepted treatment, with guidelines supporting utilization in patients with recurrent temporal lobe seizures after two or more trials of antiepileptic medications. Unfortunately, the average delay in presurgical evaluation of appropriate candidates is more than 20 years, and this delay has not improved in recent decades. This offers the international neurological community the opportunity to improve disability, mortality, JQEZ5 molecular weight and quality of life by more effective application of epilepsy surgery and earlier identification of potential candidates. Optimal use of MRI and video/EEG

monitoring should allow cost-effective screening of persons with recurrent seizures prior to more detailed presurgical evaluation when indicated. (C) 2010 Elsevier Inc. All rights reserved.”
“Study Design. A biomechanical study using human cadaveric lumbar spinal motion segments and three different posterior stabilization devices.

Objective. To compare the range of motion, disc height, and foraminal area of a spinal motion segment intact, injured, and fixed with each of three posterior lumbar motion preservation devices.

Summary of Background Data. Motion-sparing check details lumbar posterior dynamic stabilization devices are gaining increasing popularity, particularly for the treatment of degenerative disc disease.

Methods. The PercuDyn, the X-S top, and the Isobar posterior stabilization devices were compared using an in vitro cadaveric model. First, pure moments of +/- 8 Nm were applied in all three planes, then a follower load of 700 N was applied, and finally, sagittal bending tests were repeated. All tests were conducted using an 8-df servohydraulic load frame. Experiments were performed intact, with a simulated injury, and then with each of the three devices for a total of four specimens per device. Foraminal area and disc height (posterolateral and anterior surface) were measured under neutral and peak torques in all three planes and range of motion was recorded for all experimental conditions.

Results.

The mineralization of the organic Cl was equal to about 97%. The prolonged TeCA biodegradation determined a progressive selection of the bacterial strains more effective in TeCA degradation and less affected by degradation product toxicity. The tested Michaelis-Menten-based kinetic model proved an see more effective tool to interpret the experimental data of TeCA aerobic cometabolism. (C) 2010 Elsevier B.V. All

rights reserved.”
“Study Design. A register study with 2 years of follow up.

Objective. To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD).

Summary of Background Data. There is sparse information about vocational prognosis among Mtor inhibitor HLD patients diagnosed at hospital.

Methods. We followed all in-and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfer Payments (n = 2039). Clinical data were obtained from the Danish National Patient Register. The outcome measure was unfavorable vocational prognosis defined as less than 40 weeks of employment within the second year after hospital contact. Cox proportional hazards models were used.

Results. Altogether 41.8% had

an unfavorable vocational prognosis. The outcome was associated with unskilled work Hazard Ratio (HR) 2.1 (95% confidence interval [CI] = 1.5-2.8), skilled work HR 1.9 (CI = 1.3-2.7), and semi academic work HR 1.5 (CI = 1.1-2.0) as compared

with academic work and less than 40 weeks of employment within year two before hospital find more contact HR 2.1 (CI = 1.9-2.5). Further negative prognostic factors were lumbar fusion alone HR 1.4 (CI = 1.1-1.8) and in combination with discectomy HR 1.6 (CI = 1.2-2.2) as compared with nonsurgical treatment, ethnicity other than Danish HR 1.55 (CI = 1.2-1.8), and female gender HR 1.2 (CI = 1.1-1.4). Discectomy, age, and year of inclusion were not associated with the outcome.

Conclusion. The risk of an unfavorable vocational prognosis after hospital contact for HLD was substantial. Nonacademic work and less than 40 weeks of employment within year two before hospital contact were the strongest prognostic factors, but also lumbar fusion alone and in combination with discectomy, ethnicity, and gender had a negative influence. There seems to be a need for actions addressing these patient categories to avoid long-term sick leave and premature withdrawal from the labor market.”
“. Treatment for hepatitis C virus is often complicated by anaemia from ribavirin-related haemolysis and bone marrow suppression because of peginterferon alfa. An extensive literature search revealed no reports of drug interactions between ribavirin and oseltamivir. We report the case of a patient with chronic hepatitis C infection who developed severe anaemia during antiviral treatment with peginterferon alfa/ribavirin when oseltamivir was added to treat influenza.

09), and a 30% increase in the overall death rate in patients undergoing limited resection (P=0.08). Age, tumour size and specific type of limited resection were also factors influencing the survival rates. Four studies, including the RCT, found increased locoregional recurrence rates with limited resection. There is also evidence that wedge resections, compared with segmentectomies, lead to lower survival and higher recurrence rates. In conclusion, lobectomy is still recommended for younger patients with adequate cardiopulmonary function. Although limited resection carries a decreased rate of complications and BI-D1870 purchase shorter

hospital stays, it may also carry a higher rate of loco-regional recurrences. However, limited resection may be comparable for patients >71 years of age, selleck screening library and those with small peripheral tumours.”
“Pseudomeningocele is a cerebrospinal fluid collection in an extradural area after meningeal tear. The etiology of pseudomeningocele development is iatrogenic or traumatic in most cases. In this study, we report a case of the postsurgical pseudomeningocele presenting as a cystic mass in the external auditory canal and complete sensorineural hearing loss with a review

of the relevant literature.”
“Metachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal storage disorder caused by a deficiency of arylsulfatase A enzyme. This deficiency leads to accumulation of sulfatides in the central nervous system and other organs, such as the gallbladder. Here the authors discuss a 9-year-old Middle Eastern patient with late-infantile-type MLD who presented with symptoms of cholecystitis. Radiographic studies revealed an enlarged gallbladder with a thickened wall and a pericholecystic fluid collection with peripheral calcifications.

Gross examination of the gallbladder showed multiple small to medium-sized papillary projections involving the entire mucosal surface. Sections through the gallbladder wall revealed multilocular dilated mucin-producing cystic spaces. Microscopically, the mucosa showed numerous papillary projections with complex folds lined by mucin-producing cuboidal to tall columnar cells. The cystic spaces were composed of numerous markedly distended Rokitansky-Aschoff sinuses filled with mucin. Ultrastructurally, the epithelial cells and macrophages showed frequent secondary Bucladesine purchase lysosomes containing closely packed lamellar amorphous to prismatic material with alternating leaflets and tubules, imparting a “”herringbone”" or “”tuffstone”" pattern. This case illustrates the features of gallbladder involvement in MLD and the potential role of ultrastructural examination in diagnosis of MLD.”
“A best evidence topic was written according to a structured protocol. The question addressed was: In [patients undergoing oesophagectomy for oesophageal cancer] is a [cervical anastomosis or intrathoracic anastomosis] superior in terms of [post-operative outcomes].

(c) 2013 Elsevier Editora Ltda. All rights reserved.”
“Nadolol and propranolol are beta-blockers used to prevent the onset of migraines. Two simple and rapid High Performance Liquid Chromatographic (HPLC) methods with ultraviolet detection were evaluated in order to establish their efficacy for detecting nadolol and propranolol hydrochloride in samples obtained from in vitro transdermal absorption

studies. Both methods were validated for specificity, linearity, precision, accuracy, limit of detection, limit of quantification and robustness. Moreover, the stability of both drugs in a buffered solution was assessed. Separation was carried out on a 250 mm Kromasil(R) C(18) column at room temperature. When nadolol was analysed, the detector response at 269 nm was found to be linear in a concentration range of

0.17 to 167 click here mu M. In the case of propranolol hydrochloride, a fixed wavelength of 291 nm for quantification corresponded with calibration lines in the range of 0.11 to 113 mu M. The limits of detection (LOD) and quantification (LOQ) were 0.058 and 0.038 M and 0.171 and 0.115 mu M for nadolol and propranolol hydrochloride, respectively. The maximum relative error and relative standard deviation detected were 5.19% and 6.08% respectively for nadolol and 3.57% and 6.44% respectively for propranolol hydrochloride. The results of robustness were highly satisfactory.”
“Structural, magnetic, and electrical properties of Bi1-xPbxFeO3 (x=0, 0.1, 0.2, and 0.3) polycrystalline prepared by solid solution route were studied. The crystal structure data obtained from x-ray diffraction indicate see more that the solid solution Bi1-xPbxFeO3 successively transforms selleck chemicals llc from rhombohedral to pseudocubic symmetry with an increase in the Pb concentration. The observed weak ferromagnetism and

ferroelectricity at room temperature indicated the multiferroic nature of Pb-doped BiFeO3 compounds. The magnetoelectric coupling was estimated by the changes in the dielectric constant with an external magnetic field. It was found that the value of magnetodielectric effect have a maximum of 0.4% for Bi0.7Pb0.3FeO3 ceramic under a magnetic field of 12 kOe at room temperature. (C) 2009 American Institute of Physics. [DOI: 10.1063/1.3079770]“
“Biofilms formed by Candida albicans, a human pathogen, are known to be resistant to different antifungal agents. Novel strategies to combat the biofilm associated Candida infections like multiple drug therapy are being explored. In this study, potential of chloroquine to be a partner drug in combination with four antifungal agents, namely fluconazole, voriconazole, amphotericin B, and caspofungin, was explored against biofilms of C. albicans. Activity of various concentrations of chloroquine in combination with a particular antifungal drug was analyzed in a checkerboard format.

Clinical Relevance-Because the normal DD is rarely visualized during abdominal ultrasonography in dogs, identification of a tubular, fluid-filled structure dorsal to the bladder may indicate an abnormal DD. Transitional cell carcinoma of the DD should be included in the differential diagnoses of affected patients examined for clinical signs involving the urinary tract.

(J Am Vet Med Assoc 2012;240:446-449)”
“We demonstrate a novel application of light-induced transient grating technique for discrimination of deep trap contribution to carrier recombination in compensated semiconductors. This application is based on photoexcitation of deep impurity levels by light interference pattern and subsequent optical monitoring of the recharged state dynamics. The spatially modulated

deep trap occupation leads to changes in a probe beam absorption and formation of a transient diffraction grating. Employment of light diffraction on a short-period MK-2206 mouse reflection grating allowed to realize conditions when the absorption modulation in deep traps dominates over the coexisting refractive index modulation. Selectivity of a transient reflection grating configuration solely to processes in deep traps was proven experimentally and confirmed by numerical modeling. In this way, we discriminated the deep vanadium impurity governed carrier recombination rate from the other coexisting recombination channels in as-grown and annealed semi-insulating CdTe:V crystals.”
“Patients with Medtronic Sprint Fidelis (Medtronic Inc., Minneapolis, MN, USA) lead failures present with oversensing, resulting in pacing LY2835219 manufacturer inhibition and inappropriate shocks. We present

KPT-8602 purchase a case of lead noise from the right ventricular (RV) ring conductor, resulting in multiple inappropriate shocks with subsequent pacing inhibition and syncope. RV pacing lead impedance at no point exceeded 1,000 ohms. We found that increased noise and oversensing was more likely to be induced when pacing at higher pulse widths. RV pacing outputs at lower pulse widths may decrease susceptibility to noise generation and prove an effective temporizing measure in pacing-dependent patients. (PACE 2009; 32: 547-549)”
“Case Description-A 7-month-old male Siberian Husky affected by lower motor neuron tetraparesis was anesthetized for electrodiagnostic testing and collection of muscle and nerve biopsy specimens.

Clinical Findings-Preanesthetic physical examination revealed a high rectal temperature, and serum biochemical analysis revealed high muscle and liver enzyme activities. The dog was anesthetized twice. The dog was anesthetized with isoflurane and developed moderate hypercarbia and mild hyperthermia. Injectable anesthetic agents were used to anesthetize the dog the second time, during which the dog developed severe malignant hyperthermia. A genetic test performed after anesthesia did not reveal a mutation of the RYR1 gene, the gene that mediates calcium-release channels in skeletal muscle.

9%), stenosis (3.6%) and ureteral reflux with recurrent

graft pyelonephritis (1.1%). Thirty-five patients underwent native ureteropyelostomy, and 14 patients had redo-ureterocystostomy. All patients treated for recurrent graft pyelonephritis had no CAL-101 clinical trial further episodes. Overall, the rate of ureteral stenosis was significantly higher after secondary surgery, compared to the primary anastomosis (10% vs. 3.6%, p = 0.039). A significantly lower incidence of graft pyelonephritis was observed in patients after native ureteropyelostomy compared to patients treated with redo-ureterocystostomy (p = 0.019). In conclusion, reflux and recurrent graft pyelonephritis can be treated effectively by secondary surgery. The use of native ureteropyelostomy may offer protection from graft pyelonephritis after secondary surgery.”
“Complete Cu(In, Ga)Se-2 (CIGS) solar cells in which the collecting heterojunctions were formed by chemical bath deposition of CdS were analyzed by transmission

electron microscopy and energy dispersive spectroscopy. The CIGS was produced at 400 or 580 degrees C as either single layers or in a two-step bilayer process. The compositions of grain boundaries were found to be the VX-680 chemical structure same as the grains before CdS deposition except in the low temperature-deposited bilayer but after CdS was formed the grain boundaries were found to be anion deficient with some evidence of Cu loss from the CIGS and residual Cu found in the CdS in most cases. The results are consistent with n-type doping of the surface of the CIGS and wrapping of the junction around the grains. In bilayer films the grain

boundaries were found to be more open containing many voids and this facilitated penetration of the CdS into the boundaries. (C) 2010 American Institute of Physics. [doi: 10.1063/1.3512966]“
“Phenotypic plasticity in general and polyphenic development in particular are thought to play important roles in organismal diversification and evolutionary Citarinostat innovation. Focusing on the evolutionary developmental biology of insects, and specifically that of horned beetles, I explore the avenues by which phenotypic plasticity and polyphenic development have mediated the origins of novelty and diversity. Specifically, I argue that phenotypic plasticity generates novel targets for evolutionary processes to act on, as well as brings about trade-offs during development and evolution, thereby diversifying evolutionary trajectories available to natural populations. Lastly, I examine the notion that in those cases in which phenotypic plasticity is underlain by modularity in gene expression, it results in a fundamental trade-off between degree of plasticity and mutation accumulation. On one hand, this trade-off limits the extent of plasticity that can be accommodated by modularity of gene expression.