Rees et al. Although the presenting feature of hemoglobin Toms River was neonatal cyanosis, both affected individuals also acquired moderate anemia and reticulocytosis, suggesting that the mutant hemoglobin is also unstable. In both hemoglobin hemoglobin and Bristol-Alesha Toms River, the mutant E11 methionine is gradually changed into aspartic acid post-translationally, probably through oxidative mechanisms .14 Considering these findings, we speculate that the substitution of methionine to get valine at E11 in sufferers with the hemoglobin Toms River mutation mainly causes cyanosis. Subsequent transformation of the mutant methionine to aspartic acid destabilizes the hemoglobin tetramer, leading to anemia and hemolysis without the accumulation of soluble methemoglobin. Differences in phenotypes between sufferers with hemoglobin Bristol-Alesha and hemoglobin Toms River may rely on the relative rates of which the mutant E11 methionine is converted to aspartic acid.Analyses performed with readings at the clinical site didn’t materially differ from those performed with central readings. Statistical Analysis The principal analysis was implemented with an analysis of covariance with changes in the WOMAC physical-function score from baseline to six months as the dependent variable, treatment as the independent variable of interest, and study site as a covariate. The primary evaluation used a altered intention-to-treat approach in which patients who did not withdraw from the analysis were evaluated in the group to that they were randomly assigned. We performed three secondary analyses: an analogous intention-to-treat evaluation of covariance with the use of either the KOOS discomfort rating or the SF-36 physical-activity rating as the dependent variables and a logistic regression, with adjustment for the analysis site, that used the binary result described above.10,22 Extra analyses with adjustment for uncertainty due to missing data are described in the Supplementary Appendix.23 We powered the analysis to detect a 10-point difference in the WOMAC physical-function score between your arthroscopic-partial-meniscectomy and physical-therapy groups.