scholarly journals Hyperarousal Symptoms in Survivors of Cardiac Arrest Are Associated With 13 Month Risk of Major Adverse Cardiovascular Events and All-Cause Mortality

2020 ◽  
Vol 54 (6) ◽  
pp. 413-422
Author(s):  
Alex Presciutti ◽  
Jonathan Shaffer ◽  
Jennifer A Sumner ◽  
Mitchell S V Elkind ◽  
David J Roh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiovascular Events ◽  
Coronary Revascularization ◽  
Cox Proportional Hazards ◽  
Survival Models ◽  
Major Adverse Cardiovascular Events ◽  
Ptsd Symptoms ◽  
Standard Deviation Increase ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Key dimensions of cardiac arrest-induced posttraumatic stress disorder (PTSD) symptoms include reexperiencing, avoidance, numbing, and hyperarousal. It remains unknown which dimensions are most predictive of outcome. Purpose To determine which dimensions of cardiac arrest-induced PTSD are predictive of clinical outcome within 13 months posthospital discharge. Methods PTSD symptoms were assessed in survivors of cardiac arrest who were able to complete psychological screening measures at hospital discharge via the PTSD Checklist-Specific scale, which queries for 17 symptoms using five levels of severity. Responses on items for each symptom dimension of the four-factor numbing model (reexperiencing, avoidance, numbing, and hyperarousal) were converted to Z-scores and treated as continuous predictors. The combined primary endpoint was all-cause mortality (ACM) or major adverse cardiovascular events (MACE; hospitalization for myocardial infarction, unstable angina, heart failure, emergency coronary revascularization, or urgent defibrillator/pacemaker placements) within 13 months postdischarge. Four bivariate Cox proportional hazards survival models evaluated associations between individual symptom dimensions and ACM/MACE. A multivariable model then evaluated whether significant bivariate predictors remained independent predictors of the primary outcome after adjusting for age, sex, comorbidities, premorbid psychiatric diagnoses, and initial cardiac rhythm. Results A total of 114 patients (59.6% men, 52.6% white, mean age: 54.6 ± 13 years) were included. In bivariate analyses, only hyperarousal was significantly associated with ACM/MACE. In a fully adjusted model, 1 standard deviation increase in hyperarousal symptoms corresponded to a two-times increased risk of experiencing ACM/MACE. Conclusions Greater level of hyperarousal symptoms was associated with a higher risk of ACM/MACE within 13 months postcardiac arrest. This initial evidence should be further investigated in a larger sample.

scholarly journals Association Between Circulating Proprotein Convertase Subtilisin/Kexin Type 9 and Major Adverse Cardiovascular Events, Stroke, and All-Cause Mortality: Systemic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yimo Zhou ◽  
Weiqi Chen ◽  
Meng Lu ◽  
Yongjun Wang
Keyword(s):  
Dose Response ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Systemic Review ◽  
Cochrane Library ◽  
Major Adverse Cardiovascular Events ◽  
Proprotein Convertase ◽  
Standard Deviation Increase ◽  
Increased Risk ◽  
All Cause Mortality

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9), a pivotal protein in low-density lipoprotein cholesterol metabolism, has been validated to be an established target for cardiovascular (CV) risk reduction. Nevertheless, prospective studies concerning the associations between circulating PCSK9 and the risk of CV events and mortality have yielded, so far, inconsistent results. Herein, we conducted a meta-analysis to evaluate the association systemically.Methods: Pertinent studies were identified from PubMed, EMBASE, and Cochrane Library database through July 2020. Longitudinal studies investigating the value of circulating PCSK9 for predicting major adverse cardiovascular events (MACEs) or stroke or all-cause mortally with risk estimates and 95% confidence intervals (CI) were included in the analyses. Dose-response meta-analysis was also applied to evaluate circulating PCSK9 and risk of MACEs in this study.Results: A total of 22 eligible cohorts comprising 28,319 participants from 20 eligible articles were finally included in the study. The pooled relative risk (RR) of MACEs for one standard deviation increase in baseline PCSK9 was 1.120 (95% CI, 1.056–1.189). When categorizing subjects into tertiles, the pooled RR for the highest tertile of baseline PCSK9 was 1.252 (95% CI, 1.104–1.420) compared with the lowest category. This positive association between PCSK9 level and risk of MACEs persisted in sensitivity and most of the subgroup analyses. Twelve studies were included in dose-response meta-analysis, and a linear association between PCSK9 concentration and risk of MACEs was observed (x2 test for non-linearity = 0.31, P non-linearity = 0.575). No significant correlation was found either on stroke or all-cause mortality.Conclusion: This meta-analysis added further evidence that high circulating PCSK9 concentration significantly associated with increased risk of MACEs, and a linear dose-response association was observed. However, available data did not suggest significant association either on stroke or all-cause mortality. Additional well-designed studies are warranted to further investigate the correlations between PCSK9 concentration and stroke and mortality.

Plasma Trimethylamine N-Oxide and Risk of Cardiovascular Events in Patients With Type 2 Diabetes

2020 ◽  
Vol 105 (7) ◽  
pp. 2371-2380 ◽  
Author(s):  
Mikael Croyal ◽  
Pierre-Jean Saulnier ◽  
Audrey Aguesse ◽  
Elise Gand ◽  
Stéphanie Ragot ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Tumor Necrosis Factor Receptor ◽  
Density Lipoprotein ◽  
Major Adverse Cardiovascular Events ◽  
Cox Models ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Design And Methods

Abstract Objective Even though trimethylamine N-oxide (TMAO) has been demonstrated to interfere with atherosclerosis and diabetes pathophysiology, the association between TMAO and major adverse cardiovascular events (MACE) has not been specifically established in type 2 diabetes (T2D). Research Design and Methods We examined the association of plasma TMAO concentrations with MACE and all-cause mortality in a single-center prospective cohort of consecutively recruited patients with T2D. Results The study population consisted in 1463 SURDIENE participants (58% men), aged 65 ± 10 years. TMAO concentrations were significantly associated with diabetes duration, renal function, high-density lipoprotein cholesterol, soluble tumor necrosis factor receptor 1 (sTNFR1) concentrations (R2 = 0.27) and were significantly higher in patients on metformin, even after adjustment for estimated glomerular filtration rate (eGFR): 6.7 (8.5) vs 8.5 (13.6) µmol/L, respectively (PeGFR-adjusted = 0.0207). During follow-up (median duration [interquartile range], 85 [75] months), 403 MACE and 538 deaths were registered. MACE-free survival and all-cause mortality were significantly associated with the quartile distribution of TMAO concentrations, patients with the highest TMAO levels displaying the greatest risk of outcomes (P < 0.0001). In multivariate Cox models, compared with patients from the first 3 quartiles, those from the fourth quartile of TMAO concentration had an independently increased risk for MACE: adjusted hazard ratio (adjHR) 1.32 (1.02-1.70); P = 0.0325. Similarly, TMAO was significantly associated with mortality in multivariate analysis: adjHR 1.75 (1.17-2.09); P = 0.0124, but not when sTNFR1 and angiopoietin like 2 were considered: adjHR 1.16 (0.95-1.42); P = 0.1514. Conclusions We revealed an association between higher TMAO concentrations and increased risk of MACE and all-cause mortality, thereby opening some avenues on the role of dysbiosis in cardiovascular risk, in T2D patients.

scholarly journals Severe varicose veins and the risk of mortality: a nationwide population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034245
Author(s):  
Nan-Chun Wu ◽  
Zhih-Cherng Chen ◽  
I-Jung Feng ◽  
Chung-Han Ho ◽  
Chun-Yen Chiang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Events ◽  
Proportional Hazards ◽  
Varicose Veins ◽  
Systemic Disease ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Risk Of Mortality ◽  
Increased Risk

ObjectiveVaricose veins (VVs) are common and although considered benign may cause morbidity. However, the association between VV severity and cardiovascular and mortality risks remains unknown. The aim of this study was to investigate the factors associated with overall mortality in patients with VV.MethodsA total of 4644 patients with newly diagnosed VV between 1999 and 2013 were identified from Taiwan’s National Health Insurance Database. VV severity was classified from grade 1 to 3 according to the presentation of ulcers or inflammation. Moreover, 9497, 2541 and 5722 age-matched, sex-matched and chronic cardiovascular risk factor-matched controls, as assessed based on propensity score, were separately selected for three grading VV groups. Enrolled patients were analysed using conditional Cox proportional hazards regression analysis to estimate risk of mortality and major adverse cardiovascular events (MACEs) in the VV and control groups.ResultsMost patients with VV were free from systemic disease. However, compared with matched controls, patients with VV showed a 1.37 times increased risk of mortality (95% CI 1.19 to 1.57; p<0.0001). Compared with matched controls, older (age ≧65 years) (adjusted HR: 1.38; 95% CI 1.17 to 1.62; p=0.0001) and male patients with VV (adjusted HR 1.41; 95% CI 1.18 to 1.68; p=0.0001) showed increased risk of mortality. Furthermore, compared with controls, patients with VV showed 2.05 times greater risk of MACE. Compared with matched controls, population at grade 3 increased 1.83 times risk of mortality and 2.04 to 38.42 times risk of heart failure, acute coronary syndrome, ischaemic stroke and venous thromboembolism.ConclusionsThis nationwide cohort study demonstrated that patients with VV are at a risk of cardiovascular events and mortality. Our findings suggest that presence of VV warrants close attention in terms of prognosis and treatment.

scholarly journals Syncope and Collapse Are Associated with an Increased Risk of Cardiovascular Disease and Mortality in Patients Undergoing Dialysis

2018 ◽  
Vol 15 (10) ◽  
pp. 2082
Author(s):  
Shih-Ting Huang ◽  
Tung-Min Yu ◽  
Tai-Yuan Ke ◽  
Ming-Ju Wu ◽  
Ya-Wen Chuang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiovascular Events ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Study Cohort ◽  
Coronary Syndrome ◽  
Cardiovascular Comorbidities ◽  
Increased Risk ◽  
The Impact ◽  
Overall Mortality

Objective: This study explored the impact of syncope and collapse (SC) on cardiovascular events and mortality in patients undergoing dialysis. Methods: Patients undergoing dialysis with SC (n = 3876) were selected as the study cohort and those without SC who were propensity score-matched at a 1:1 ratio were included as controls. Major adverse cardiovascular events (MACEs), including acute coronary syndrome (ACS), arrhythmia or cardiac arrest, stroke, and overall mortality, were evaluated and compared in both cohorts. Results: The mean follow-up periods until the occurrence of ACS, arrhythmia or cardiac arrest, stroke, and overall mortality in the SC cohort were 3.51 ± 2.90, 3.43 ± 2.93, 3.74 ± 2.97, and 3.76 ± 2.98 years, respectively. Compared with the patients without SC, those with SC had higher incidence rates of ACS (30.1 vs. 24.7 events/1000 people/year), arrhythmia or cardiac arrest (6.75 vs. 3.51 events/1000 people/year), and stroke (51.6 vs. 35.7 events/1000 people/year), with higher overall mortality (127.7 vs. 77.9 deaths/1000 people/year). The SC cohort also had higher risks for ACS, arrhythmia or cardiac arrest, stroke, and overall mortality (adjusted hazard ratios: 1.28 (95% confidence interval (CI) = 1.11–1.46), 2.05 (95% CI = 1.50–2.82), 1.48 (95% CI = 1.33–1.66), and 1.79 (95% CI = 1.67–1.92), respectively) than did the non-SC cohort. Conclusion: SC was significantly associated with cardiovascular events and overall mortality in the patients on dialysis. SC may serve as a prodrome for cardiovascular comorbidities, thereby assisting clinicians in identifying high-risk patients.

scholarly journals Evaluating the cardiovascular safety of sclerostin inhibition using evidence from meta-analysis of clinical trials and human genetics

2020 ◽  
Vol 12 (549) ◽  
pp. eaay6570 ◽  
Author(s):  
Jonas Bovijn ◽  
Kristi Krebs ◽  
Chia-Yen Chen ◽  
Ruth Boxall ◽  
Jenny C. Censin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Genetic Variants ◽  
Cardiovascular Events ◽  
Coronary Revascularization ◽  
Meta Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Cardiovascular Safety ◽  
Mineral Density ◽  
Increased Risk ◽  
Cardiovascular Outcome Trial

Inhibition of sclerostin is a therapeutic approach to lowering fracture risk in patients with osteoporosis. However, data from phase 3 randomized controlled trials (RCTs) of romosozumab, a first-in-class monoclonal antibody that inhibits sclerostin, suggest an imbalance of serious cardiovascular events, and regulatory agencies have issued marketing authorizations with warnings of cardiovascular disease. Here, we meta-analyze published and unpublished cardiovascular outcome trial data of romosozumab and investigate whether genetic variants that mimic therapeutic inhibition of sclerostin are associated with higher risk of cardiovascular disease. Meta-analysis of up to three RCTs indicated a probable higher risk of cardiovascular events with romosozumab. Scaled to the equivalent dose of romosozumab (210 milligrams per month; 0.09 grams per square centimeter of higher bone mineral density), the SOST genetic variants were associated with lower risk of fracture and osteoporosis (commensurate with the therapeutic effect of romosozumab) and with a higher risk of myocardial infarction and/or coronary revascularization and major adverse cardiovascular events. The same variants were also associated with increased risk of type 2 diabetes mellitus and higher systolic blood pressure and central adiposity. Together, our findings indicate that inhibition of sclerostin may elevate cardiovascular risk, warranting a rigorous evaluation of the cardiovascular safety of romosozumab and other sclerostin inhibitors.

scholarly journals Serum Biomarkers of Iron Stores Are Associated with Increased Risk of All-Cause Mortality and Cardiovascular Events in Nondialysis CKD Patients, with or without Anemia

2021 ◽  
pp. ASN.2020101531
Author(s):  
Murilo Guedes ◽  
Daniel G. Muenz ◽  
Jarcy Zee ◽  
Brian Bieber ◽  
Benedicte Stengel ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Cardiovascular Events ◽  
Transferrin Saturation ◽  
The United States ◽  
Serum Biomarkers ◽  
Major Adverse Cardiovascular Events ◽  
Content Type ◽  
Iron Stores ◽  
Increased Risk ◽  
All Cause Mortality

BackgroundApproximately 30%–45% of patients with nondialysis CKD have iron deficiency. Iron therapy in CKD has focused primarily on supporting erythropoiesis. In patients with or without anemia, there has not been a comprehensive approach to estimating the association between serum biomarkers of iron stores, and mortality and cardiovascular event risks.MethodsThe study included 5145 patients from Brazil, France, the United States, and Germany enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study, with first available transferrin saturation (TSAT) and ferritin levels as exposure variables. We used Cox models to estimate hazard ratios (HRs) for all-cause mortality and major adverse cardiovascular events (MACE), with progressive adjustment for potentially confounding variables. We also used linear spline models to further evaluate functional forms of the exposure-outcome associations.ResultsCompared with patients with a TSAT of 26%–35%, those with a TSAT ≤15% had the highest adjusted risks for all-cause mortality and MACE. Spline analysis found the lowest risk at TSAT 40% for all-cause mortality and MACE. Risk of all-cause mortality, but not MACE, was also elevated at TSAT ≥46%. Effect estimates were similar after adjustment for hemoglobin. For ferritin, no directional associations were apparent, except for elevated all-cause mortality at ferritin ≥300 ng/ml.ConclusionsIron deficiency, as captured by TSAT, is associated with higher risk of all-cause mortality and MACE in patients with nondialysis CKD, with or without anemia. Interventional studies evaluating the effect on clinical outcomes of iron supplementation and therapies for alternative targets are needed to better inform strategies for administering exogenous iron.

scholarly journals Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery

2013 ◽  
Vol 118 (4) ◽  
pp. 809-824 ◽  
Author(s):  
John F. Mooney ◽  
Isuru Ranasinghe ◽  
Clara K. Chow ◽  
Vlado Perkovic ◽  
Federica Barzi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Events ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Major Adverse Cardiovascular Events ◽  
Increased Risk ◽  
All Cause Mortality ◽  
The Relationship

Abstract Background: Kidney dysfunction is a strong determinant of prognosis in many settings. Methods: A systematic review and meta-analysis was undertaken to explore the relationship between estimated glomerular filtration rate (eGFR) and adverse outcomes after surgery. Cohort studies reporting the relationship between eGFR and major outcomes, including all-cause mortality, major adverse cardiovascular events, and acute kidney injury after cardiac or noncardiac surgery, were included. Results: Forty-six studies were included, of which 44 focused exclusively on cardiac and vascular surgery. Within 30 days of surgery, eGFR less than 60 ml·min·1.73 m−2 was associated with a threefold increased risk of death (multivariable adjusted relative risk [RR] 2.98; 95% confidence interval [CI] 1.95–4.96) and acute kidney injury (adjusted RR 3.13; 95% CI 2.22–4.41). An eGFR less than 60 ml·min·1.73 m−2 was associated with an increased risk of all-cause mortality (adjusted RR 1.61; 95% CI 1.38–1.87) and major adverse cardiovascular events (adjusted RR 1.49; 95% CI 1.32–1.67) during long-term follow-up. There was a nonlinear association between eGFR and the risk of early mortality such that, compared with patients having an eGFR more than 90 ml·min·1.73 m−2 the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml·min·1.73 m−2 was 1.62 (95% CI 1.43–1.80), rising to 2.85 (95% CI 2.49–3.27) in patients with an eGFR less than 30 ml·min·1.73 m−2 and 3.75 (95% CI 3.44–4.08) in those with an eGFR less than 15 ml·min·1.73 m−2. Conclusion: There is a powerful relationship between eGFR, and both short- and long-term prognosis after, predominantly cardiac and vascular, surgery.

Abstract 13: Cardiac Arrest-Induced Posttraumatic Stress Increases 1-Year Risk of Major Adverse Cardiovascular Events and All-Cause Mortality

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Sachin Agarwal ◽  
Alex Presciutti ◽  
Talea Cornelius ◽  
Jeffrey L Birk ◽  
David J Roh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Posttraumatic Stress ◽  
Hospital Discharge ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Tertiary Care ◽  
Self Report ◽  
Ptsd Symptoms ◽  
Risk Of Death ◽  
All Cause Mortality

Importance: Many cardiac arrest (CA) survivors develop posttraumatic stress disorder (PTSD) symptoms (i.e., CA-induced PTSD). The association of CA-induced PTSD with secondary mortality and cardiovascular risk is unknown. Methods: A prospective, observational, cohort study of adults with return of spontaneous circulation after in-hospital or out-of-hospital CA at a tertiary-care center between September 2015 and September 2017. A consecutive sample of survivors with sufficient mental status to self-report CA-induced PTSD symptoms at hospital discharge were included. The combined primary end point was all-cause mortality (ACM) or a major adverse cardiovascular event (MACE)—hospitalization for nonfatal MI, unstable angina, congestive heart failure (CHF), urgent/emergency coronary revascularization procedures, or urgent implantable defibrillators/pacemaker (ICDs/PPM) placements within 12 months of discharge. In-person assessments for CA-induced PTSD were performed within 24 hours of hospital discharge. PTSD symptomatology was assessed via the PTSD Checklist - Specific (PCL-S) scale; a suggested diagnostic cut-off of 36 for specialized medical settings was adopted. Outcomes for patients meeting (vs. not meeting) this cutoff were compared using Cox regression with adjustment for demographic and clinical covariates. Results: Of 114 included patients, 36 (31.6%) screened positive for CA-induced PTSD at discharge (median 21 days post-CA; interquartile range 11-36). During the follow-up period (median = 12.4 months, range 10.2-13.5), 10 (8.8%) died and 29 (25.4%) experienced a recurrent MACE: rehospitalizations due to MI (n=4, 13.8%), UA (n=8, 27.6%), CHF exacerbations (n=4, 13.8%), emergency revascularizations (n=5, 17.2%), and ICDs/PPM placements (n=8, 27.6%). CA-induced PTSD was associated with ACM/MACE in univariate (Hazard Ratio [HR] =3.19; 95% confidence interval [CI], 1.7-6.0) and in models adjusted for age, sex, charlson comorbidity index and nonshockable initial rhythms (HR=3.2; CI, 1.7-6.1). Conclusions: PTSD is common after CA, and survivors with CA-induced PTSD had significantly higher risk of death and cardiovascular events. Further inquiry into underlying mechanisms is warranted.

scholarly journals Safety of add-on sulfonylurea therapy in patients with type 2 diabetes using metformin: a population-based real-world study

2021 ◽  
Vol 9 (2) ◽  
pp. e002352
Author(s):  
Ingrid Hougen ◽  
Reid H Whitlock ◽  
Paul Komenda ◽  
Claudio Rigatto ◽  
Kristin K Clemens ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Cardiovascular Events ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Dipeptidyl Peptidase 4 ◽  
Increased Risk ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
All Cause Mortality

IntroductionMetformin is the initial oral antihyperglycemic agent (OHA) of choice for most patients with type 2 diabetes (T2D). However, more than one agent is often required for optimal glucose control. As the choice of preferred second OHAs is less well defined, we sought to compare the real-world safety of sulfonylureas to other OHAs as add-on therapy to metformin in patients with T2D.Research design and methodsThis retrospective cohort study included adults in Manitoba, Canada with T2D from 2006 to 2017. Using a new-user design, we divided patients who started on metformin into two groups: add-on therapy with a sulfonylurea and add-on therapy with a different OHA. Outcomes included all-cause mortality, cardiovascular events, and major hypoglycemic episodes. We calculated propensity scores and applied inverse probability of treatment weights to each individual. We compared groups using Cox proportional hazards regression and explored differences in HRs between pre-2008 (acarbose, meglitinides, and thiazolidinediones) and post-2008 (dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose linked transporter-2 inhibitors) OHAs.ResultsOur cohort included 32 576 individuals (28 077 metformin plus sulfonylurea and 4499 metformin plus ‘other’). Patients newly prescribed a sulfonylurea in the setting of metformin had a higher risk of all-cause mortality (HR 1.44, 95% CI 1.12 to 1.84, p=0.005) and major hypoglycemic episodes (HR 2.78, 95% CI 1.66 to 4.66, p<0.001) than those prescribed an ‘other’ OHA. No differences in cardiovascular events were observed (HR 0.99, 95% CI 0.81 to 1.22, p=0.92). In subgroup analyses, mortality and cardiovascular event risk was higher in patients prescribed sulfonylureas versus post-2008 OHAs.ConclusionsSulfonylureas as add-on therapy to metformin are associated with increased risk of all-cause mortality and major hypoglycemic episodes compared with ‘other’ OHAs. Post hoc analysis suggests newer OHAs may be preferred to sulfonylureas as second-line therapy for glycemic control.

Sign in / Sign up

Export Citation Format

Share Document